Unconscious bias refers to implicit associations or attitudes we hold that operate beyond our conscious awareness. It can significantly influence our behavior and decision-making. Studies suggest that the lack of advancement into prestigious and leadership positions by women and gender pay gaps are due to the unconscious gender bias against women. In traditionally male-dominant fields, such as medicine, women are evaluated less favorably than their male colleagues. Women physicians are exposed to negative unconscious bias in numerous settings from daily interactions with patients, physician colleagues and co-medical workers to evaluations, access to educational opportunities and promotions. The unconscious bias against women negatively affects not only social interactions and external evaluations of women, but also their performance. To reduce the unconscious bias against women, training for staff and stakeholders, including women themselves, and the construction multi-faceted systematic interventions are needed.

BACKGROUND: Understanding the job satisfaction and dissatisfaction of physicians might help to improve health care in Japan. Nevertheless, no job-satisfaction scale for physicians has been validated in Japanese.
OBJECTIVE: To develop a Japanese version of the Physician Job Satisfaction Scale (JSS), a multi-dimensional questionnaire developed by the Society of General Internal Medicine (SGIM) Career Satisfaction Study Group (CSSG), and to evaluate its reliability and validity.
METHODS: A Japanese version of the JSS was developed according to the standard protocol of scale translation. A focus group of 7 Japanese physicians was established to identify “Japanese-specific” facets of job satisfaction. After revising the scale based on the discussions of the focus group, a cross-sectional sample of 87 Japanese physicians from hospitals in different regions completed the Japanese version of the Physician Job Satisfaction Scale (JSS-J) to assess its reliability and validity.
RESULTS: A focus group identified a Japanese-specific facet, “prestige”. Content validity was also established through the focus group. Internal consistency ranged from 0.53 to 0.83. Test-retest reliability, convergent and discriminant validity were good to excellent.
CONCLUSIONS: Although the overall results suggest that the JSS-J can be applied to assess the job satisfaction of Japanese physicians, further qualitative research is required to refine the JSS-J.

OBJECTIVE: To describe gender differences in job satisfaction, mental health and work conditions of Japanese hospital internists
METHODS: A self-administered, mailed survey was conducted among hospital internists throughout Japan. The survey included questions such as job satisfaction, time allotted for an ambulatory patient, and work environments.
RESULTS: Two hundred thirty-four hospital internists were eligible (59 women). Female internists allotted more time for each patient in an ambulatory care setting than their male colleagues (new patient/consultation: P<0.01, routine follow ups: P=0.046). Female internists worked continuously for as long as their male colleagues when they were on night duty (average: 31.1 hours), but their replies indicated that they were not able to maintain continuous high-quality care for as long as the male internists (-4 hours, P=0.02).
CONCLUSIONS: Female internists allotted more time for each ambulatory patient, and their replies showed that they were able to maintain quality care continuously for less time than were the males.

In light of the implementation of a quota system for electing the Society's Board of Directors, the Diversity Promotion Committee organized a workshop to explore women's leadership, followership, and sponsorship.This initiative identified unique characteristics associated with these roles for women and identified ways to support them in expressing these qualities effectively.The workshop also served as a peer meeting, and both needs and satisfaction levels were high. We aim to extend this workshop to other fields in the future.

In Europe and America, it is reported that residents develops burnout syndrome or depression by their stress, and these are connected with dropouts from their training program and undesirable outcomes of the patients such as unethical practice. Recently, though resident's poor working conditions and death from overwork, etc. become problems also in Japan.But, Japanese resident's stressor is uncertain.
1) Focus group interview was executed for 25 junior residents in 10 facilities, and their stressor were explored.
2) As a result, three cateogories ; physiological stressor as one human being, stressor as a new member of society, and stressor as a trainee doctor and beginner novice doctor was extracted.
3) Three stressors were named the life gap, the society gap, and the profession gap respectively. The stressor of junior resident was described as the product what was born by the gap of medical student and becoming a doctor.
4) Japanese residents have various stressors. Stressor as a trainee doctor was a stressor peculiar to Japanese junior residents.
5) Stress management should be done considering such a stressor in the light of safety and effective clinical training.

In Europe and the United States, residents develop“burnout syndrome”or depression because of stress, and these conditions are associated with withdrawal from training programs and undesirable clinical outcomes, such as unethical practices.How stress affects Japanese medical residents and their practice is uncertain, as are factors that relieve stress.Furthermore, a theoretical model of stress in Japanese medical resident is uncertain.
1) Focus group interviews were performed for 25 junior residents at 10 institutions to explore their stress reactions and stress-relieving factors.A theoretical model of stress was then constructed.
2) Adverse effects in patient care and in training, in addition to events in daily life, were found to occur as stress reactions.
3) Improvements in the support system and positive feedback from patients were found to be stress-relieving factors.
4) A theoretical model of stress for trainee physicians was constructed and was similar to a general occupational stress model.
5) Stressors should be reduced and stress-relieving factors should be improved to improve the working conditions of residents and the quality of medical care.

Postgraduate residents face formidable stress. Unfortunately, many residents withdraw from training programs because of reactions to stress, such as depression. We performed a comprehensive study to examine the working conditions and stress of residents to improve the conditions of resident-training programs and reduce levels of stress.
1) The study examined 548 first-year residents starting postgraduate clinical training at 41 hospitals in Japan. A selfadministered questionnaire, which included questions about working conditions, job stressors, buffer factors, and stress reactions, was answered before and 2 months after the start of training.
2) A total of 318 subjects completed the survey.Of these subjects, 80 (25.2%) had depression after the start of training.
3) Job stress patterns of residents were characterized by high workload and extremely low “reward from work” and “Job control.”
4) Many residents had depression after the start of training.To improve residency programs, program directors should recognize the specific characteristics of residents' job stress and focus on buffer factors.

A new educational program for the medical doctor was introduced at Tokyo Women's Medical College in 1990 with a 4-year tutorial education model as its core. To develop the program for educational training more efficiently, current facilities were reviewed on a large scale, and various types of equipment and supplementary materials were made available. We are now investigating utilization and problems of the current program. Supplies and materials of tutorial rooms and mirror rooms have been used effectively. The library has become increasingly useful as a place for independent study and research. However, audiovisual materials have not yet been made fully available. We suggest that further improvements to the system and fostering an environment of open access to information are necessary to increase the accessibility of the support system for tutorial education.

Tutors must understand their role in advance so that tutorial education can be conducted smoothly and effectively. These abilities and attitudes require training. At our school, tutors serve as faculty for basic courses and clinical courses. We assessed their training conditions and future tasks. Of the 1, 077 faculty members who received tutor training between 1988 and 1997, 935 are current faculty members who have completed in-service training (basic course, 115; clinical course, 820). Before 1989, training was on campus, but since 1990 it has been conducted at Shirakawa Seminar House with a 2-day program. The number of working tutors per year is 192, with a basic course to clinical course ratio of 3: 7. About half of the faculty members in the basic course have had four or more experiences as tutors, whereas most clinical course faculty members have had only one experience. Thus, many tutors have had no experience. In a questionnaire survey after undergoing the training program, most participants felt that they were able to understand the theory of tutorial education and the actual role of the tutor and that they were able to concentrate on off-campus training that was removed from their everyday work. To provide added impetus to tutorial education, we suggest that in the future, in addition to the understanding and mutual cooperation of those involved, it will be necessary to provide an advanced program to train tutors who have appropriate abilities and attitudes.

Tokyo Women's Medical University introduced tutorial education in 1990 for 1st-through 4th-year students. To examine the effectiveness of this system in a basic-medicine course, questionnaires were given to all 2nd-year students. Many students felt that they had become accustomed to performing self-learning tasks through collecting information themselves and discussing their findings in a group; in particular, they found that tutorial education markedly improved their communication skills. A few students thought that this method helped them develop the ability of logical/critical thinking and analytic skills from multiple viewpoints. These findings suggest that an assessment system should be established by which students themselves could recognize the extent to which they have developed their abilities, which was the aim of tutorial education.