title: Challenging cases of professionalism in Japan: improvement in understanding of professional behaviors among Japanese residents between 2005 and 2013.
abstract: BACKGROUND
  Professionalism is deemed as the basis of physicians' contract with society in Japan. Our study in 2005, using a questionnaire with scenarios to professionalism, suggested that many physicians at various levels of training in Japan encounter challenges when responding to these common scenarios related to professionalism. It is unclear how medical professionalism has changed among Japanese residents in over time.
  
  
  METHODS
  We conducted a follow-up survey about challenges to professionalism for Japanese residents using the same Barry Questionnaire after a seven-year interval from the prior survey. The survey uses six clinical scenarios with multiple choice responses. The six cases include the following challenges: acceptance of gifts; conflict of interest; confidentiality; physician impairment; sexual harassment; and honesty in documentation. Each scenario is followed by 4 or 5 possible responses, including the "best" and the "second best" responses. The survey was conducted as a part of nationwide general medicine in-training examination.
  
  
  RESULTS
  We collected data from 1,049 participants (290 women, 28%; 431 PGY-1 and 618 PGY-2 residents). Overall, the current residents performed better than their colleagues in the earlier survey for five scenarios (gifts, conflict of interest, confidentiality, impairment, and honesty) but not for the harassment scenario. PGY-2 residents were more likely to select either the best or 2nd best choices to gifts (p = 0.002) and harassment (p = 0.031) scenarios than PGY-1 residents. Residents in the current study chose either the best or 2nd best choices to the gifts (p < 0.001) and honesty (p < 0.001) scenarios than those of the previous study conducted seven years ago, but not for the harassment scenario (p = 0.004).
  
  
  CONCLUSIONS
  Our study suggests that there is improvement of medical professionalism with respect to some ethical challenges among the Japanese residents in the current study compared to those in our previous study.
authors.affiliation: Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Mito City, Ibaraki, Japan. kensuke.kinoshita@nifty.ne.jp.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kinoshita
authors.affiliation: Harvard Interfaculty Initiative in Health Policy, Cambridge, MA, USA. tsugawa@fas.harvard.edu.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tsugawa
authors.affiliation: Office of Medical Education, University of Nevada School of Medicine, 1664N Virginia St, Reno, NV 89557, USA. pbarnettmd@gmail.com.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Barnett
authors.affiliation: Japan Community Healthcare Organization, Tokyo, Japan. yasuharu.tokuda@gmail.com.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D032882:Comprehension; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D007564:Japan; D008297:Male; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000941:ethics*; D011361:Professional Competence; D058996:Quality Improvement; D012189:Retrospective Studies; D011795:Surveys and Questionnaires