Perspectives on expert generalist practice among japanese family doctor educators: A qualitative study

Background: Expert generalist practice (EGP) is increasingly being viewed as the defining expertise of generalist care. In Japan, several prominent family doctors consider it important and relevant in the Japanese context. However, no study has examined Japanese family doctor educators’ perceptions of EGP. Aim: To explore Japanese family doctor educators’ perceptions of EGP. Design & setting: A qualitative study among family doctor educators in Japan. Method: Focus group interviews were conducted using a semi-structured interview guide following a short lecture on EGP. A qualitative description method was adopted and the framework method was used to conduct thematic analysis. Results: Participants were 18 family medicine doctor educators, including 11 directors and six associate directors of family medicine training programmes. The results suggested that the concept of EGP was important and applicable to primary care in Japan. Participants’ perceptions on EGP pertained to the following four areas: impact of EGP, triggers for EGP, enablers for EGP, and educational strategies for EGP. Conclusion: The concept of EGP may be useful in clinical practice in Japan, especially in complex patient care. A clearer framework for or description of EGP, and of non-traditional methods, such as ascetic practice and awareness of the self, were proposed as possible educational strategies

Effect of multimorbidity patterns on the decline in health-related quality of life: a nationwide prospective cohort study in Japan

Objectives Longitudinal studies, which consider multimorbidity patterns, are useful for better clarifying the effect of multimorbidity on health-related quality of life (HRQoL) and for identifying the target population with poorer clinical outcomes among patients with multimorbidity. This study aimed to examine the effects of different multimorbidity patterns on the decline in HRQoL.Design Nationwide prospective cohort study.Setting Japanese adult residents.Participants Residents aged ≥50 years selected by the quota sampling method.Primary outcome measure Clinically relevant decline in HRQoL was defined as a 0.50 SD (5-point) decrease in the 36-Item Short Form Health Survey (SF-36) component summary scores for 1 year.Results In total, 1211 participants completed the follow-up survey. Among the multimorbidity patterns identified using confirmatory factor analysis, multivariable logistic regression analyses revealed that high cardiovascular/renal/metabolic and malignant/digestive/urologic pattern scores were significantly associated with the clinically relevant decline in SF-36 physical component summary score (adjusted OR (aOR)=1.25, 95% CI: 1.08 to 1.44 and aOR=1.28, 95% CI: 1.04 to 1.58, respectively). High cardiovascular/renal/metabolic pattern score was also significantly associated with the clinically relevant decline in SF-36 role/social component summary score (aOR=1.23, 95% CI: 1.06 to 1.42).Conclusions Our study revealed that multimorbidity patterns have different effects on the clinically relevant decline in HRQoL for 1 year. These findings can be useful in identifying populations at high risk and with poor clinical outcomes among patients with chronic diseases and multimorbidity for efficient resource allocation

Use of a 2-year continuing professional development programme to change Japanese physicians’ attitudes to learning primary care: a qualitative study

Objective To evaluate changes in the learning attitudes of primary care physicians.Design Qualitative study through one focus group interview with the programme’s participants. Analysis of the focus group content using the Steps for Coding and Theorization method.Setting Japan.Participants Eight primary care physicians who completed a 2-year continuing professional development (CPD) programme using a problem-based learning (PBL) approach, focused on acquiring the skills needed to practise as primary care physicians in the community.Results Participants described positive changes in their attitudes and behaviours as a result of the training programme. These changes were grouped into three main themes: ‘changes in learning methods regarding medical practice’, ‘encounters with diverse perspectives and values, and confidence gained from those encounters’, and ‘showing one’s attitude towards learning and its influence on others’. The experienced practitioners participating in this study reported that the programme helped them apply their skills more broadly; for example, searching the literature for psychosocial aspects of practice and engaging more comfortably with diverse perspectives. They reported the positive impact of their learning on their coworkers.Conclusion A 2-year CPD programme using PBL can influence primary care physicians’ attitudes and learning-related behaviours. Further research is needed to determine which specific aspects of the programme are the most effective and whether the changes in attitudes and behaviours described affect patient care