The shortage of rural physicians remains a public health concern. Placing medical students in rural areas and exposing them to rural physicians as models may enhance physician retention in rural areas. The purpose of this study was to explore the core competencies of medical students for rural practice and develop a framework of such competencies.
A three-stage mixed method was used to develop the core competencies of medical students who will engage in rural practice. In the exploring stage, four physicians completed in-depth interviews; eight students participated in the focus group to identify the core competencies. In the construct stage, two students were interviewed individually and four students as a group to construct the framework. Finally, the competencies were validated by experts in the verification stage. In addition, the analytic hierarchy process was used.
After thematic analysis, three themes—adaptation, befriending, and career—emerged as the ABC model for rural practice. The framework of competencies for rural practice was established with the ABC model and validated by the analytic hierarchy process (AHP).
Although some competencies vary across professional stages, the ABC model—adaptation, befriending, and career—is the competencies essential for medical students preparing to practice in rural areas.
Varicella pneumonia is a rare but severe complication of varicella-zoster infection in adults. We present what is, to our knowledge, the first documented case of a 24-year-old woman with trisomy 21 who developed disseminated varicella and varicella pneumonia, likely exacerbated by the absence of childhood varicella vaccination. Her social background, including single-parent upbringing and childhood relocation, contributed to her incomplete immunization history. This case highlights the convergence of immunological and social vulnerability and underscores the need for comprehensive vaccination assessments in adults with complex medical and social histories to prevent severe infectious diseases.
Polypharmacy has been increasing attention as it is associated with a number of health problems, especially adverse outcomes in older adults. However, there is insufficient evidence regarding the risk of polypharmacy and long-term care.
We analyzed a community-based retrospective cohort of residents of Goto City by combining data from health checkups, prescription information, and long-term care needs certification database. The study sample included residents aged 65–79 years in 2015 who were followed up for 4 years. The number of medications used was categorized as 0, 1–5, 6–9, and ≥10. The outcome was initiation of long-term care. Cox regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for potential confounders.
Among 1083 participants, 58 used long-term care for 4 years. Compared with participants taking no medication, the incidence of long-term care initiation was approximately double in those taking 1–5 medications, four times higher in people taking 6–9 medications, and 13 times higher in people taking ≥10 medications. After adjusting for potential baseline confounders, the number of medications was significantly associated with the initiation of long-term care services (1–5 drugs: adjusted HR 2.38, 95% CI 1.06–5.34; 6–9 drugs: adjusted HR 2.97, 95% CI 1.23–7.15; and ≥10 drugs: adjusted HR 5.54, 95% CI 1.89–16.23).
Among community-dwelling residents aged 65–79 years, the risk of requiring long-term care had a dose–response relationship with the number of prescribed medications.
“What do generalists do in clinical practice?” Students and specialists often ask this question. Although the identity of generalists in Japan is steadily forming, their specific roles in clinical practice remain unclear.
This ambiguity stems largely from the diverse nature of generalist practice in Japan. Generalists engage in a wide range of activities, including clinical practice, medical education, research, and management; in a range of settings including hospitals, clinics, and home care; in both urban and rural areas.1 Although this diversity is a strength, descriptions often emphasize differences rather than commonalities. Consequently, what generalists do in practice remains unclear.
This situation creates two important problems. For students, it can foster uncertainty about choosing a career as a generalist. For specialists, it can lead to confusion about when and how to collaborate with generalists, potentially hindering effective teamwork.
To address these challenges, we developed a model to clarify the common clinical roles of generalists (Figure 1). This editorial introduces the key aspects of the generalist's work in practice, focusing on the two fundamental processes of “problem setting” and “problem-solving”.2
Generalists fundamentally differ from specialists in their initial approach to patient care. Whereas specialists typically begin with a defined problem and apply evidence-based strategies to engage in “problem-solving,” generalists must first engage in “problem setting.” This is a complex process that involves identifying, prioritizing, and framing the patient's problems within their unique context before proceeding with problem-solving. Although specialists may appear to engage in problem setting during diagnosis, their main role is to assess whether managing the problem falls within the scope of their specialty; thus, their first step is problem-solving, not problem setting.
The process of problem setting starts with collecting a range of information extending beyond biomedical data from history taking, physical examination, and diagnostic tests, to include contextual factors such as daily life, the patient's health resources, biographical narratives, preferences, values, and life goals. The generalist then analyzes the interrelationships among these elements and works collaboratively with the patient to develop a shared understanding of the situation as a whole. Based on this holistic understanding, the healthcare team formulates a care strategy focusing on the most important health problem.
Problem-setting skills have become a focus of academic inquiry within the fields of generalism and diagnostic excellence. “Patient-centered medicine” stresses the importance of problem definition and proposes practical clinical methods.3 Furthermore, the “Craft of Generalism” highlights the role of interpretive
The role of pharmacists in community settings is expanding, and understanding patient experience– an essential indicator of person-centered care–is crucial for improving pharmacy service quality. However, the extent to which patient experience has been studied in community pharmacies remains unclear. This scoping review aimed to explore the scope of research on patient experience in community pharmacies.
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive literature search was conducted in October 2024 using PubMed, Web of Science, and Google Scholar with predefined keywords, including “patient-centered,” “experience,” and “community pharmacy.”
Of the 121 records identified, 15 studies, published between 2008 and 2024, met the eligibility criteria. These studies were conducted in Australia (n = 4), the United States (n = 3), and the United Kingdom (n = 3), with six studies published in non-English languages. Study methodologies included qualitative (n = 7), quantitative (n = 5), and mixed (n = 2). Four studies used patient-reported experience measures (PREMs). Terminology for study participants varied, with “patients” (n = 10), “consumers” (n = 3), and “customers” (n = 1). In addition, one study included pharmacists (n = 1) and another included caregivers (n = 1).
This review emphasizes advancing person-centered care in pharmacy practice, with a growing focus on patient experience in community pharmacies. Future studies should develop and implement patient-reported experience measures tailored to different social contexts to enhance care and service evaluation.
The effectiveness of Community-Based Clinical Training (CBCT) in increasing the number of general practice physicians remains uncertain. In Japan, where the population is rapidly aging and shrinking, the demand for general practice physicians has significantly escalated to ensure adequate health care for the public, particularly in rural and underserved areas. General practice physicians are expected to play a vital role in providing comprehensive and continuous care to the aging population. Therefore, finding an effective strategy to secure an adequate number of general practice physicians is a crucial social issue.
CBCT is considered a promising approach to addressing this issue. It provides students and residents opportunities to engage with various aspects of community healthcare, including outpatient care, home visiting care, nurse home care, preventive care, health education, and more, particularly in rural and underserved areas. First introduced in the United States, CBCT has been implemented in numerous countries. It has spread rapidly worldwide since the 1990s, and nearly all medical schools and teaching hospitals in Japan offer this clinical training program.
Several studies have examined the effects of CBCT. Trainees report that their experiences during CBCT profoundly influence their understanding of general practice. They acknowledge the importance of acquiring diverse perspectives, understanding the physician's role, recognizing the significance of community care, respecting individual lifestyles, addressing multimorbidity, navigating various healthcare settings, and collaborating with different professionals.1 This training has a positive short-term impact on attitudes and awareness related to general practice and community healthcare. Participants' ratings of their attitudes and awareness significantly improved after the training, not only in rural areas,1 but also in urban settings.2
However, the effect of CBCT is insufficient regarding career preferences for general practice physicians. The research conducted with graduates from a single medical university suggests that conventional CBCT might not be sufficient in Japan for effectively developing general practice physicians.3 Additionally, a study at one teaching hospital indicated no positive relationship between the amount of compulsory undergraduate education in community-based medicine and the subsequent rise in the number of residents choosing general practice majors in Japan.4
A Longitudinal Integrated Clerkship (LIC) is a novel model of CBCT where students participate in the comprehensive care of patients over time and maintain ongoing learning relationships with both patients and supervising clinicians across multiple disciplines. Although there is no definitive minimum duration for student placements in an LIC program, severa
The involvement of primary care physicians (PCPs) is essential to meet the diverse needs of cancer survivors, yet their engagement remains insufficient. Consequently, identifying the factors associated with PCPs' practices in each component of cancer survivorship care is crucial. However, there is no study on the factors for individual care components. Therefore, we conducted a survey to identify the involvement and factors related to PCPs' practice of each component of cancer survivorship care.
A web-based questionnaire was distributed to 1091 family physicians in Japan. We identified four cancer survivorship care components: surveillance of recurrence, care for late effects, care for psychological problems, and care for social problems. The association between the practice of the components and the presence of knowledge or information resources, access to oncologists, and requests from patients and oncologists was evaluated.
A total of 191 PCPs (response rate: 17.5%) responded, and 180 were included in the analysis. Multivariate logistic regression analyses revealed that knowledge or information resources were associated with care for late effects (odds ratio (OR), 5.09; 95% confidence interval (CI), 1.54–23.1) and psychological problems (OR, 4.77; 95% CI, 1.52–17.8). Access to oncologists was associated with surveillance of recurrence (OR, 2.97; 95% CI, 1.08–8.75). Requests from patients and oncologists were associated with almost all survivorship care components.
Requests from patients and oncologists might be key to PCPs' involvement in cancer survivorship care. PCPs need to be proactive in identifying patient needs and fostering trust from patients and oncologists for better cancer survivorship care.
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