Impact of inpatient caseload, emergency department duties, and online learning resource on General Medicine In-Training Examination scores in Japan

Abstract

Background

Both clinical workload and access to learning resource are important components of educational environment and may have effects on clinical knowledge of residents.

Methods

We conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY)-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE). An individual-level analysis was conducted to examine the impact of the number of assigned patients and emergency department (ED) duty on the residents’ GM-ITE scores by fitting a multivariable generalized estimating equations. In hospital-level analysis, we evaluated the relationship between for the number of UpToDate reviews for each hospital and for the hospitals’ mean GM-ITE score.

Results

A total of 431 PGY-1 and 618 PGY-2 residents participated. Residents with four or five times per month of the ED duties exhibited the highest mean scores compared to those with greater or fewer ED duties. Those with largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge. Hospitals with the greater UpToDate topic viewing showed significantly greater mean score.

Conclusion

Appropriate ED workload and inpatient caseload, as well as use of evidence-based electronic resources, were associated with greater clinical knowledge of residents.

Keywords:

• workload
• online resource
• knowledge
• resident
• postgraduate
• Japan

Acknowledgments

The authors thank all executive people for their excellent assistance. The JAMEP funded the study grant and conducted the examination for resident physicians as explained in the text and data collection but had no role in the study design, data interpretation, or preparation of the article. Dr Tsugawa was supported by Honjo International Scholarship Foundation.

Author contributions

K Kinoshita is the guarantor for the integrity of the data and the accuracy of the data analysis. K Kinoshita and Y Tokuda conceived the research idea. K Kinoshita and Y Tsugawa designed the study, conducted statistical analysis, and drafted the manuscript. All authors contributed to the interpretation of data, critically revised the paper for important intellectual content, and agreed to be accountable for all aspects of the work.

Disclosure

Y Tsugawa and Y Tokuda received honorarium from the JAMEP for preparing study questions. The other authors report no other conflicts of interest in this work.