Lessons learned in developing family medicine residency training programs in Japan.
BACKGROUND
While family medicine is not well established as a discipline in Japan, a growing number of Japanese medical schools and training hospitals have recently started sougoushinryoubu (general medicine departments). Some of these departments are incorporating a family medicine approach to residency training. We sought to learn from family medicine pioneers of these programs lessons for developing residency training.


METHODS
This qualitative project utilized a long interview research design. Questions focused on four topics: 1) circumstances when becoming chair/faculty member; 2) approach to starting the program; 3) how Western ideas of family medicine were incorporated; and 4) future directions. We analyzed the data using immersion/crystallization to identify recurring themes. From the transcribed data, we selected representative quotations to illustrate them. We verified the findings by emailing the participants and obtaining feedback.


RESULTS
Participants included: five chairpersons, two program directors, and three faculty members. We identified five lessons: 1) few people understand the basic concepts of family medicine; 2) developing a core curriculum is difficult; 3) start with undergraduates; 4) emphasize clinical skills; and 5) train in the community.


CONCLUSIONS
While organizational change is difficult, the identified lessons suggest issues that merit consideration when developing a family medicine training program. Lessons from complexity science could inform application of these insights in other countries and settings newly developing residency training.
Murai
Mitsuya
M
Kashima Hospital, Kashima City, Japan. ciz70600@ams.odn.ne.jp
Kitamura
Kazuya
K
Fetters
Michael D
MD
D000046:Academic Medical Centers / Q000458:organization & administration*; D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003479:Curriculum; D003659:Decision Making, Organizational; D005180:Faculty, Medical; D005194:Family Practice / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007407:Interviews as Topic; D007564:Japan; D008297:Male; D009936:Organizational Innovation; D008486:Physician Executives; D016730:Program Development; D036301:Qualitative Research; D013663:Teaching / Q000379:methods