Introduction: The aim of this study was to clarify the process by which family physicians succeed their parents in their family's clinic and issues that successors experience during this process.Methods: Subjects were certified family physicians in Japan who either succeeded their parents in their clinics or were working regularly at their family's clinic and were planning to succeed their parents. Participants were recruited through a certified family physician mailing list or privately contacted, and participated in a semi-structured individual interview. The text of the interviews was thematically analyzed.Results: Twelve participants were interviewed. All were male. Seven participants succeeded their parents. Family physicians succeeding their parents in their clinics felt implicit expectations towards succession from their family members and communities, which made them think that succession was the goal. They realized that they had no ability to decide on the timing of succession, clinics have customs and continuity, predecessors have different ideas about professionalism, and family businesses are complex. They felt conflict, especially about predecessors, in their emotions towards family members and ideas based on professionalism.Conclusion: We clarified the process of succession by family physicians in their family's clinic, and the issues and conflicts they face during this process.

Background: Activity in international conferences is essential for the academic progress of primary care in Japan. We aimed to clarify the obstacles Japanese university-based primary care physicians face in attending and presenting at international conferences.
Methods: We conducted a questionnaire of 10 residents and 22 physicians in the Department of General Medicine and Primary Care at the University of Tsukuba.
Results: The primary obstacle preventing conference attendance was English language skills. A secondary obstacle was insufficient time off work.
Conclusions: Additional support in English language skills and time off work is necessary to promote attendance at international conferences.

The realist approach aims to evaluate the process of complex interventions and educational programs that are required in primary care. This is one research method focusing on the clarification of "how and why it works", which has been unclear thus far, and to make it possible to reflect on interventions and processes based on reality. In the realist approach, with realism as a paradigm, researchers collect quantitative and qualitative data, and create an integrated series of context, mechanism and outcome based on the concept of constructive alignment. In this report, the authors introduce an outline of the realist approach using an inter-professional shadowing program evaluation conducted for medical students at a community hospital as an example. It is the authors' goal that scientific evaluation applying realist principles be employed in the field of primary care.

Introduction: The aim of this study was to investigate the current status of patient safety management systems in primary care clinics in Japan.Methods: An online survey on patient safety management systems was conducted among primary care physicians certified by the Japan Primary Care Association who serve as clinic managers.Results: A total of 183 physicians participated in the survey. We found that 53.0%, 73.2%, 38.8%, and 32.8% had developed medical safety guidelines, nosocomial infection control guidelines, drug safety guidelines, and medical device safety guidelines, respectively. Furthermore, 64.5% had fewer than 10 incident/accident reports in the past year, the most common of which were prescription errors, vaccine errors, falls, and needle sticks.Conclusion: The issues identified in this study serve as a basis for promoting the development of educational programs and the creation of evaluation and improvement tools aimed at enhancing patient safety in clinics.

Introduction : To reveal patients' impressions of physicians working short-term in community clinics, and to explore methods for physicians to work short-term in community clinics.
Methods : We conducted a qualitative analysis of recordings of individual interviews performed on patients in community clinics using a partially revised SCAT (Steps for Coding and Theorization) method.
Results : Patients indicated that they felt reassured by the constant presence of a chief physician at community clinics. They expected care within the scope of primary care, but were not expecting every element within this scope to be met. Patients had the attitude of accepting the current situation and were selecting how to receive medical care from the available options based on their personal priorities.
Conclusion : Physicians working short-term in community clinics were satisfying a portion of the patients' needs. Providing care within the scope of primary care and taking the initiative in getting to know patients are essential elements for physicians working short-term in community clinics.

Introduction: This study compared perceptions of interprofessional collaboration and recognition of work between clinic/small hospital staff and those at regional core hospitals.Methods: An anonymous, self-administered questionnaire was administered to the staff at 4 clinics/small hospital and those at 3 regional core hospitals responsible for regional medical care. The following items were compared between the 2 groups: Assessment of Interprofessional Team Collaboration (AITCS) Japanese version, Readiness for Interprofessional Learning Scale (RIPLS) Japanese version, workplace satisfaction, and relationship with neighboring facilities.Results: The subjects were 74 staff members at clinics and small hospital and 576 staff members at regional core hospitals; their average ages were 41.9 years and 40.6 years, respectively. Compared to staff at regional core hospitals, those at the clinics and small hospitals had significantly higher AITCS scores, RIPLS scores, and workplace satisfaction, and they also considered their institutions to have better relationship with neighboring facilities.Conclusion: The staff of clinics and small hospital were more aware of interprofessional collaboration than hospital staff, and were more satisfied with their workplaces. Understanding the underlying organizational differences may facilitate vertical integration in community-based integrated care systems.

Introduction: The University of Tsukuba has a one-week in-home care course combining a problem-based learning style tutorial and lectures in the comprehensive community-based learning curriculum for 2^nd year students. This study aimed to investigate what medical students are learning concretely from this course.

Methods: We performed a qualitative date analysis of the contents of all 111 student course reports written in the free description using a modified Steps Coding and Theorization method employing the framework of patient-centered clinical method (PCCM).

Results: Medical students learned with keen interest based on their experiences and in the framework of PCCM such as 'Exploring health, disease and the illness experience', 'Understanding the whole person'. These processes led to the awareness of responsibility as a physician.

Conclusion: The in-home care course in the classroom may provide medical students with an opportunity to become aware of their responsibility as a physician.

The University of Tsukuba School of Medicine introduced an education program on the social determinants of health (SDH). It consists of lectures during the 3rd year and a 4-week family practice and community medicine clerkship between 5th and 6th years. In the clinical clerkship, students receive lectures on the first day, are instructed to consider the SDH in a patient they met during the course, give group presentations and hand in written reports on the last day. Most students were able to analyze patients beyond the biomedical model, but only a few students were able to consider the social background and timeline of each patient. Our future challenge is to enhance students' understanding of SDH through educational programs for faculty members.