Education policies to increase rural physicians in Japan: a nationwide cohort study

Background Japan has established comprehensive education-scholarship programs to supply physicians in rural areas. Their entrants now comprise 16% of all medical students, and graduates must work in rural areas for a designated number of years. These programs are now being adopted outside Japan, but their medium-term outcomes and inter-program differences are unknown. Methods A nationwide prospective cohort study of newly licensed physicians 2014–2018 (n = 2454) of the four major types of the programs—Jichi Medical University (Jichi); regional quota with scholarship; non-quota with scholarship (scholarship alone); and quota without scholarship (quota alone)—and all Japanese physicians in the same postgraduate year (n = 40,293) was conducted with follow-up workplace information from the Physician Census 2018, Ministry of Health, Labour and Welfare. In addition, annual cross-sectional survey for prefectural governments and medical schools 2014–2019 was conducted to obtain information on the results of National Physician License Examination and retention status for contractual workforce. Results Passing rate of the National Physician License Examination was highest in Jichi, followed in descending order by quota with scholarship, the other two programs, and all medical graduates. The retention rate for contractual rural service of Jichi graduates 5 years after graduation (n = 683; 98%) was higher than that of quota with scholarship (2868; 90%; P < 0.001) and scholarship alone (2220; 81% < 0.001). Relative risks of working in municipalities with the least population density quintile in Jichi, quota with scholarship, scholarship alone, and quota alone in postgraduate year 5 were 4.0 (95% CI 3.7–4.4; P < 0.001), 3.1 (2.6–3.7; < 0.001), 2.5 (2.1–3.0; < 0.001), and 2.5 (1.9–3.3; < 0.001) as compared with all Japanese physicians. There was no significant difference between each program and all physicians in the proportion of those who specialized in internal medicine or general practice in postgraduate years 3 to 5 Conclusions Japan’s education policies to produce rural physicians are effective but the degree of effectiveness varies among the programs. Policymakers and medical educators should plan their future rural workforce policies with reference to the effectiveness and variations of these programs.

Factors influencing the National License Examination step 1 score in preclinical medical students

The National License Examination step 1 (NLE1), which tests basic medical sciences knowledge in Thailand, is considered to be tough and stressful for medical students due to the large amount of content. This study aimed to determine factors influencing the NLE1 score (NLE1S). The NLE1S, academic achievement, and class attendance were obtained officially. Other factors, including study habits, were obtained via a questionnaire, with 81.97% (241/294) being returned. Students were divided into four groups according to the central passing score and Z-score of the NLE1S, including the fail (<52%; n = 13), low-pass (52 to <70%; n = 121), high-pass (70 to <80%; n = 89), and excellent (≥80%; n = 18) groups. Men had higher NLE1S ( P < 0.001) and comprehensive examination scores ( P < 0.001) than women. Students with high motivation to study medicine had higher NLE1S. Daily preparation time (h/day) was lower, but stress was higher, in the fail group. In the excellent group, internet for academic use and achievement of study targets were higher; internet for nonacademic use, instance of absence, and stress were lower; and check-in time was earlier. The NLE1S had strong positive correlations with the comprehensive examination score and academic achievement during preclinical studies. By setting the NLE1S as a dependent variable in multivariate regression analyses, models of significant interactions were observed by setting behavioral factors, the comprehensive examination score, and academic achievement during a regular class as independent variables. Thus exhibiting good study habits and showing good academic performance throughout preclinical studies should be encouraged among students to achieve a good NLE1S.

Standards of an Examination (cut points), Construction of Scenarios, Measurement of lmpacts in the Decision Making Process

The National Board of Medical Examiners (NBME®) applies rigorous examinations to determine the impact on candidates taking the United States Medical License Examination (USMLE®) for the purpose of licensing physicians in the US. UU UU These standards apply to all levels of exam development, administration and qualification. The standards apply to the following processes:• Validity of the inferences of the articles: content: the content tested must be appropriate, asking the correct questions, the format of the element, or the design of the test and the design, or the process by which the test is performed, the documentation• Accuracy of the scores: reliability, focalization, information on the cutting edge, standard errors• Determination and application of cut points: methods, modified Angoff procedure, misclassification error.The main focus is on the last standard, although the first two levels are also briefly discussed. Different methods to establish an approval standard will be discussed and the method used for USMLE will be described. Errors of misclassification are also presented and how to minimize them.

Study of driving skill level discrimination based on human physiological signal characteristics

The study of driving skill level discrimination based on EEG, EOG and ECG characteristics, which uses the driver's license examination “subject two”, is carried out in our current research work.