title: Impact of inpatient caseload, emergency department duties, and online learning resource on General Medicine In-Training Examination scores in Japan.
abstract: BACKGROUND
  Both clinical workload and access to learning resource are important components of educational environment and may have effects on clinical knowledge of residents.
  
  
  METHODS
  We conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY)-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE). An individual-level analysis was conducted to examine the impact of the number of assigned patients and emergency department (ED) duty on the residents' GM-ITE scores by fitting a multivariable generalized estimating equations. In hospital-level analysis, we evaluated the relationship between for the number of UpToDate reviews for each hospital and for the hospitals' mean GM-ITE score.
  
  
  RESULTS
  A total of 431 PGY-1 and 618 PGY-2 residents participated. Residents with four or five times per month of the ED duties exhibited the highest mean scores compared to those with greater or fewer ED duties. Those with largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge. Hospitals with the greater UpToDate topic viewing showed significantly greater mean score.
  
  
  CONCLUSIONS
  Appropriate ED workload and inpatient caseload, as well as use of evidence-based electronic resources, were associated with greater clinical knowledge of residents.
authors.affiliation: Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Mito City, Ibaraki, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kinoshita
authors.affiliation: Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tsugawa
authors.affiliation: Tokyo Joto Hospital, Koto-ku, Toky, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Good Medicine Japan, Miyagi, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tanoue
authors.affiliation: Department of General Internal Medicine, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Konishi
authors.affiliation: Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishizaki
authors.affiliation: Department of General Internal Medicine, Asahi General Hospital, Asahi, Chiba, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shiojiri
authors.affiliation: Japan Community Healthcare Organization, Minato-ku, Tokyo, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
keywords: Japan; knowledge; online resource; postgraduate; resident; workload