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Reflection in medical education is vital for students’ development as professionals. The lack of medical educators in rural family medicine can impinge on the effective reflection of residents’ learning. Hence, based on qualitative research, we proposed a framework regarding reflection in rural family medicine education, indicating when, where, and how reflection is performed and progresses. The contents of reflection include clinical issues regarding knowledge and skills, professionalism in clinical decisions, and work-life balance. The settings of reflection include conference rooms, clinical wards, residents’ desks, and hospital hallways. The timing of educational reflection includes during and after patient examination and discussion with various professionals, before finishing work, and during “doorknob” times (right before going back home). Rural medical teachers need competence as clinicians and medical educators to promote learning in medical residents and sustain rural medical care. Furthermore, medical teachers must communicate and collaborate with medical residents and nurses for educational reflection to take place in rural family medicine education, especially regarding professionalism. In rural family medicine education, reflection can be performed in various clinical situations through collaboration with learners and various medical professionals, aiding the enrichment of residents’ learning and sustainability of rural medical care.

Bedside teaching is essential in family medicine education so that residents may learn about various clinical conditions and develop professional skills. In particular, bedside teaching is useful in a rural context because rural family medicine deals with a broad scope of biopsychosocial problems among older patients. Accordingly, based on an inductive thematic analysis, we propose a framework for bedside teaching in rural family medicine education, which consists of four themes: accommodation of different learners, near-peer learning, the change in engagement of medical teachers in bedside teaching, and driving interpersonal collaboration. Bedside teaching can promote interactions between different medical learners. Near-peer learning in bedside teaching compensates for the limited availability of educators and improves learners’ motivation for self-directed learning. Through bedside teaching, medical learners can observe each other and provide constructive feedback, thereby improving their relationships and learning. For effective bedside teaching, medical educators should facilitate learners and collaborate with other medical professionals. Additionally, bedside teaching should accommodate a variety of learners, facilitate near-peer and self-directed learning, educators’ involvement based on cognitive apprenticeship, along with interprofessional collaboration with nurses. Interprofessional collaboration between rural family medicine teachers, learners, and nurses may improve the quality of patient care due to the increased understanding between patients and other medical staff in hospitals.

Physician maldistribution remains a global challenge, with Japan's rural regions facing critical health care shortages. Regional quota programs aim to attract medical students to underserved areas; however, their effectiveness in fostering long-term commitment is uncertain. Community-oriented medical education (COME) programs aim to address this issue by developing students' understanding and dedication to rural health care. This study investigated the impact of an enhanced COME program, featuring increased early clinical exposure and faculty development, on first-year regional quota medical students' perception of community health care at Chiba University. We conducted a cross-sectional qualitative study comparing 2 cohorts, 20 students enrolled from the existing COME course (April-December 2021) and 20 from the revised course (April-December 2022). The revised course included an additional day of community-based clinical exposure supervised by COME-trained attending physicians. Students' written reflections were analyzed using qualitative content analysis and categorized according to the Fink Taxonomy of significant learning, comprising 6 domains, including foundational knowledge, application, integration, human dimension, caring, and learning how to learn. Reflections were synthesized into higher-order themes crosswalked to the Fink domains. Demographics were similar between the 2021 and 2022 cohorts. In 2021, 311 learning codes were identified across foundational knowledge (n=128), application (n=91), integration (n=40), human dimension (n=16), caring (n=30), and learning how to learn (n=6). In 2022, codes increased to 385, with notable growth in caring (n=58) and human dimension (n=57), alongside increases in learning how to learn (n=15) and integration (n=45). Theme-based synthesis identified four overarching themes: (1) community health care as an interconnected, resource-constrained system; (2) patient-centered relationships and trust through communication and teamwork; (3) emerging professional identity and responsibility toward community service; and (4) developing a self-directed learning orientation for community practice. Qualitative analysis revealed that students gained a deeper understanding of patient-centered care, interprofessional collaboration, and social challenges in rural health care. The consistency in the foundational knowledge domain underscored a stable conceptual foundation, while the increase in affective and reflective domains reflected greater emphasis on interpersonal, value-oriented, and reflective learning in the revised cohort. Enhancements of the COME program, including additional early clinical exposure and faculty development, were associated with improved students' perceptions of community health care. The increased focus on the caring and human dimension domains underscores the role of practical experiences in fostering collaboration, communication, and patient-centered care. The theme-based synthesis further suggests that the revised program prompted more frequent reflections on professional identity formation and self-directed learning while maintaining a stable foundation of community health care concepts. Mentorship by community hospital attendings, alongside structured clinical exposure, appears crucial in shaping medical students' understanding and commitment to rural medicine. Ongoing longitudinal evaluations are warranted to assess the sustained impact of COME programs on career trajectories in underserved areas.

This article presents preliminary results from a survey commissioned for ICME 13 (2016) focusing on 'Teachers Working and Learning Through Collaboration'. It takes as a starting point a previous survey, commissioned for ICME 10 in 2004 that focused on Mathematics Teacher Education. The current survey focuses centrally on teachers involved in collaborations, sometimes in formal settings of professional development, but also in a more diverse range of collaborative settings including research initiatives. The roles of teachers involved in the collaboration, survey methods, decisions and limitations are described. While some of the findings to date resonate with those of the earlier survey, other findings highlight characteristics and issues relating to the differing ways in which teachers collaborate, either with other teachers or the various 'others', most notably mathematics teacher educator researchers. The roles and relationships that contribute to learning in such collaborations, as well as theories and methodologies found in survey sources, are a focus of the findings presented here. Studies rarely theorised collaboration, and few of those that did so reported explicitly on how their theoretical frame shaped the design of research methodologies/approaches guiding activities with teachers. One significant outcome has been the difficulty of relating teachers' learning to collaboration within a project, although many initiatives report developments in teaching, teacher learning and students' learning. [Author abstract]

Background Community-based medical education (CBME) has been evolving globally. However, the long-term impacts of CBME programs on career intention are ambiguous. Therefore, this study aimed to reveal the long-term impact of community-based clinical training (CBCT) such as CBME programs in Japan on current community healthcare (CH) practice. Methods This cross-sectional study targeted physicians who had graduated from Kobe University School of Medicine between 1998 and 2004 and had over 15 years’ experience after graduation. Self-administered questionnaires were mailed to participants between September and November 2019. Of the 793 potential subjects, 325 questionnaires were undeliverable. A total of 468 questionnaires substantially sent to the subjects. The exposure was the undergraduate CBCT defined as clinical training about CH in a community. The primary outcome was the provision of current CH practice. The secondary outcome was rural retention. The odds ratios (ORs) and confidence intervals (CIs) were calculated, and the confounders (age, gender, and attitude toward CH at admission; primary outcome, and age, gender, attitude toward rural healthcare at admission, own and spouse’s hometown, and emphasis on child education; secondary outcomes) were adjusted using multivariate logistic regression analysis. Results A total of 195 (41.7%) questionnaires were analyzed. The mean (standard deviation [SD]) age of study participants was 43.8 (3.5) years and 76.4% were men. A total of 48 physicians (24.6%) experienced CBCT, of which the mean (SD) training period was 26.3 (27.3) days. As many as 148 (76.3%) physicians provided CH at the time of the study, and 12 (6.5%) worked in rural areas. There was no notable impact of undergraduate CBCT on current CH practice (OR, 1.24; 95% CI, 0.53–3.08; adjusted OR [aOR], 1.00; 95% CI, 0.43–2.30) and rural retention (OR, 0.59; 95% CI, 0.06–2.94; aOR, 0.59; 95% CI, 0.11–3.04). Conclusions It may be insufficient to use conventional CBCT in Japan to develop CH professionals effectively. Japanese CBME programs should be standardized through a review of their content and quality. They should continue to be evaluated for their medium- to long-term effects.

Background The general medicine in-training examination (GM-ITE) is designed to objectively evaluate the postgraduate clinical competencies (PGY) 1 and 2 residents in Japan. Although the total GM-ITE scores tended to be lower in PGY-1 and PGY-2 residents in university hospitals than those in community-based hospitals, the most divergent areas of essential clinical competencies have not yet been revealed. Methods We conducted a nationwide, multicenter, cross-sectional study in Japan, using the GM-ITE to compare university and community-based hospitals in the four areas of basic clinical knowledge“. Specifically, “medical interview and professionalism,” “symptomatology and clinical reasoning,” “physical examination and clinical procedures,” and “disease knowledge” were assessed. Results We found no significant difference in “medical interview and professionalism” scores between the community-based and university hospital residents. However, significant differences were found in the remaining three areas. A 1.28-point difference (95% confidence interval: 0.96–1.59) in “physical examination and clinical procedures” in PGY-1 residents was found; this area alone accounts for approximately half of the difference in total score. Conclusions The standardization of junior residency programs and the general clinical education programs in Japan should be promoted and will improve the overall training that our residents receive. This is especially needed in categories where university hospitals have low scores, such as “physical examination and clinical procedures.”

Background In Japan, postgraduate clinical training encompasses a 2-year residency program, including at least 24 weeks of internal medicine (IM) rotations. However, the fragmented structure of these rotations can compromise the training’s quality and depth. For example, a resident might spend only a few weeks in cardiology before moving to endocrinology, without sufficient time to deepen their understanding or have clinical experience. This study examined current patterns and lengths of IM rotations within the Japanese postgraduate medical system. It scrutinized the piecemeal approach—whereby residents may engage in multiple short-term stints across various subspecialties without an overarching, integrated experience—and explored potential consequences for their clinical education. Methods This nationwide, multicenter, cross-sectional study used data from self-reported questionnaires completed by participants in the 2022 General Medicine In-Training Examination (GM-ITE). Data of 1,393 postgraduate year (PGY) one and two resident physicians who participated in the GM-ITE were included. We examined the IM rotation duration and number of IM subspecialties chosen by resident physicians during a 2-year rotation. Results Approximately half of the participants chose IM rotation periods of 32–40 weeks. A significant proportion of participants rotated in 5–7 internal medicine departments throughout the observation period. Notable variations in the distribution of rotations were observed, characterized by a common pattern where resident physicians typically spend 4 weeks in each department before moving to the next. This 4-week rotation is incrementally repeated across different subspecialties without a longer, continuous period in any single area. Notably, 39.7% of participants did not undertake general internal medicine rotations. These results suggest a narrowed exposure to medical conditions and patient care practices. Conclusions Our study highlights the need to address the fragmented structure of IM rotations in Japan. We suggest that short, specialized learning periods may limit the opportunity to gain broad in-depth knowledge and practical experience. To improve the efficacy of postgraduate clinical education, we recommend fostering more sustained and comprehensive learning experiences.

Health literacy (HL) promotes healthy lifestyle behaviors among older adults, and its relationship with frailty remains unclear. This study examined whether HL is a predictor of frailty progression among community-dwelling older adults. Data from two surveys conducted in 2012 and 2016 involving older residents (mean age, 71.6 ± 4.6 years) of Kashiwa City, Chiba Prefecture, Japan were used. Only healthy individuals without frailty and cognitive impairments participated in the 2012 assessment, where the Kihon Checklist (KCL), HL, and other variables were assessed. Logistic and multiple logistic analyses were used to assess the effects of HL and other factors on frailty between the ‘high HL’ vs. ‘low HL’ groups in 2012 and between the ‘robust’ vs. ‘frailty-progressing’ groups in 2016. Of the 621 robust participants, 154 (25.4%) had progression of frailty in 2016, which was significantly associated with advanced age, higher KCL score, lower HL, poor mental health, and lack of social support. Furthermore, low HL was a predictor of frailty progression. Low HL may be associated with frailty progression. The obtained results suggest that increased health literacy should be effective in preventing frailty for community-dwelling older residents.