Shikino Kiyoshi, Nishizaki Yuji, Kataoka Koshi, Nagasaki Kazuya, Kobayashi Hiroyuki, Shimizu Taro, Tokuda Yasuharu
Department of Community-oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of General Medicine, Chiba University Hospital, Chiba, Japan.
Adv Med Educ Pract. 2025 Aug 20;16:1461-1468. doi: 10.2147/AMEP.S540698. eCollection 2025.
The recently instituted Japan 2024 physician workstyle reform imposed upper limits on monthly overtime hours. However, the interpretation of these limits by different training hospitals for postgraduate medical trainees (PGY1-2) and their supervisors remains unclear. This study aimed to quantify program directors' perceptions of the "optimal" monthly overtime hours for: (1) achieving educational milestones (Q1), (2) maintaining trainees' well-being (Q2), and (3) complying with trainees' limits through supervisors' workload (Q3), and to compare urban and rural hospitals.
We conducted a cross-sectional, web-based survey of all accredited postgraduate training programs (N = 644) between March 1 and April 30, 2024. Program directors responded to three single-choice questions, selecting a monthly overtime band (none, 10, 20, …100 h/month). Hospitals were classified as urban or rural based on the Ministry of Health, Labor, and Welfare criteria. Linear trends across categories were tested using the Cochran-Armitage trend test.
A total of 151 directors responded (response rate: 23%). Across Q1-Q3, 40 h/month was the most frequently selected time (21-23%). However, the proportion endorsing ≥ 60 h/month was significantly higher in urban than in rural hospitals (Q1: 43% vs 23%, = 0.0347; Q2: 34% vs 23%, = 0.0419; Q3: 40% vs 27%, = 0.0405). Notably, urban programs were twice as likely to consider ≥ 80 h/month appropriate for both trainees' well-being (21% vs 6%, = 0.0066) and supervisors (21% vs 7%, = 0.0137).
Although 40 h/month is the most frequent response by program directors, those from urban hospitals more commonly viewed extended hours acceptable, even exceeding the "A tier" limit of 45 h. Policy initiatives should tailor workload mitigation and task-shifting strategies to urban hospitals to safeguard the well-being of trainees and supervisors.
最近实施的日本2024年医师工作方式改革对每月加班时长设定了上限。然而，不同培训医院对研究生医学实习生（PGY1 - 2）及其导师如何解读这些限制仍不明确。本研究旨在量化项目主任对于以下方面“最佳”每月加班时长的看法：（1）实现教育里程碑（问题1），（2）维护实习生的福祉（问题2），以及（3）通过导师的工作量来遵守实习生的时长限制（问题3），并比较城市和农村医院的情况。
我们在2024年3月1日至4月30日期间对所有获得认可的研究生培训项目（N = 644）进行了一项基于网络的横断面调查。项目主任回答了三个单项选择题，选择一个每月加班时长范围（无、10、20……100小时/月）。根据厚生劳动省的标准，医院被分为城市或农村医院。使用 Cochr an - Armitage趋势检验来检验各分类之间的线性趋势。
共有151名主任回复（回复率：23%）。在问题1 - 3中，每月40小时是最常被选择的时长（21% - 23%）。然而，城市医院中认可每月≥60小时的比例显著高于农村医院（问题1：43%对23%，P = 0.0347；问题2：34%对23%，P = 0.0419；问题3：40%对27%，P = 0.0405）。值得注意的是，城市项目认为每月≥80小时对实习生福祉（21%对6%，P = 0.0066）和导师（21%对7%，P = 0.0137）都合适的可能性是农村项目的两倍。
尽管项目主任最常给出的回复是每月40小时，但城市医院的主任更普遍地认为延长工作时长是可以接受的，甚至超过了“A级”45小时的限制。政策举措应针对城市医院量身定制减轻工作量和任务转移策略，以保障实习生和导师的福祉。
