The new Japanese postgraduate medical education and quality of emergency medical care

Abstract

Background: The new postgraduate medical education (PGME) was recently introduced to improve quality of emergency care in Japan.

Objectives: To compare the quality of care and confidence in provision of emergency medicine between physicians who completed the old and new PGME programs.

Methods: A cross-sectional survey was sent to 279 physicians of postgraduate years 4-9, and 208 responses (75%) were received. Quality of care in emergency medicine was measured using 26 questions on treatment choices for various clinical conditions. Each question had six responses, including a single correct choice. Effect size was obtained by dividing the total difference in score by the standard deviation of the score distribution. Confidence in emergency medicine was rated using four self-reported items on the level of confidence in treating acute illnesses in various emergency medicine settings.

Results: The mean score for quality of care was significantly higher in the new PGME group (15.3) compared to the old PGME group (12.8). The difference in scores was 2.5 (p < 0.01) and the effect size (0.47) indicated a moderate difference. Linear regression of total scores adjusted for physician covariates produced similar results of an adjusted score difference of 2.5 (p < 0.01) and an adjusted effect size of 0.47. The new PGME group also had significantly greater confidence in provision of emergency medicine based on significant differences between the groups for all four self-reported items (all p < 0.05).

Conclusions: Japanese physicians who complete the new PGME program are likely to provide higher quality of care and have greater confidence in emergency medicine compared to those who completed the old PGME program.