Objective: To clarify the characteristics of medical students' motives for choosing their profession.Methods: A nationwide, cross-sectional, quantitative web survey was conducted using the Profession Choice Motivation Scale for Education Students. Results: Valid responses were obtained from 1,804 medical students, and the applicability of this scale was demonstrated. Medical students considered "contribution to others," "fulfillment in the profession and studying medicine," "financial aspects," and "evaluation by others" to be important, while "mental and physical comfort" was deemed less important. Mean scores for "contribution to others" were significantly higher among female students, public medical school students, students attending their first- or second-choice medical schools, regional quota students, public high school graduates, and first-generation college students. Conversely, students with very low scores for "contribution to others" showed opposite demographic backgrounds. Discussion: The Profession Choice Motivation Scale for Education Students was applicable to the analysis of medical students, and a correlation was observed between demographic backgrounds and profession choice motives.

Background : Health Advocacy (HA) is an important competency for physicians, but education in this area remains underdeveloped in Japan. This study aimed to qualitatively analyze the educational effects of the Child Advocacy Training (CHAT) program designed for pediatric residents in Japan and to derive implications for future educators.　Methods : Semi-structured interviews were conducted with six pediatric residents who participated in all sessions of CHAT after program completion. The obtained transcripts were analyzed using thematic analysis.　Results : Three categories and 12 themes were extracted : “Deepening of Conceptual Understanding,” “Expansion and Quality Improvement of Practice Content,” and “Expansion of Considerations for Practice Environment.” Participants demonstrated long-term understanding of HA concepts, acquired the ability to systematically combine HA methods, and developed changes in their practical environment. Additionally, they gained perspectives on educational recall and educational expansion.　Discussion : Through CHAT learning, participants not only acquired superficial HA knowledge and skills but were also confirmed to engage in self-reflection and form new values or reconstruct existing ones, suggesting the possibility that CHAT promotes the experiential learning cycle.　Conclusion : The CHAT program may promote awareness and behavioral transformation related to the HA role and serve as a foundation for developing practical HA competencies through experiential learning cycles.

Objective: To determine the socio-economic and educational backgrounds of first-generation college students (FGCs) among Japanese medical students, with the aim of contributing to the improvement of medical school admissions.　Methods: A nationwide cross-sectional online questionnaire survey was conducted. A total of 1,849 medical students and 295 nursing students participated.　Results: The proportion of FGCs among medical students was 12.1%, lower than that among nursing students (39.4%). The backgrounds of FGCs were compared with those of non-FGCs (students whose parents were university graduates). FGCs were more likely to come from small cities and from outside the Kanto/Kansai regions. They reported lower annual family incomes and had fewer doctors or dentists among their relatives. FGCs attended cram schools less frequently, were more likely to have graduated from national or public high schools, and had higher academic grades. They applied exclusively to national or public medical schools, were more likely to take regional quota or recommended AO entrance examinations, passed these exams immediately after high school graduation, and were more often enrolled in their first-choice and national or public medical schools. FGCs also expressed a stronger intention to work in less-populated areas in the future.　Discussion: The backgrounds of FGCs differ significantly from those of non-FGCs. Further investigation into the challenges and potential of FGCs in medicine is warranted.

OBJECTIVE: To examine the socioeconomic backgrounds of medical students who intend to practice in less-populated areas.METHODS: A nationwide online questionnaire survey was conducted among 1,822 Japanese medical students (1,024 from public universities and 798 from private universities) across 40 medical schools.RESULTS: Regarding preferred future practice locations, 25.2% of students intended to work in areas with populations over 1,000,000; 36.8% in areas with 200,000-1,000,000; 17.2% in areas with 50,000-200,000; and 4.8% in areas with fewer than 50,000 residents. Students who intended to work in less-populated areas (population >200,000) were more likely to have grown up in such areas, come from families with lower annual incomes, have fewer physician parents, have graduated from public high schools, and be enrolled in regional quota programs. Logistic regression analysis identified having a family background in a less-populated area (OR 9.46) and enrollment in a regional quota program (OR 2.72) as significant predictors of the intention to work in less-populated areas.DISCUSSION: There is a correlation between medical students’ intentions to work in less-populated areas and their socioeconomic backgrounds, which are important factors to consider when addressing the uneven distribution of physicians in Japan.

Objective: Perceptions of citizens and health professions educators towards the socioeconomic backgrounds of medical students were investigated to elucidate the challenges of selecting medical students who will be responsible for the future of healthcare in Japan.Methods: Ten focus groups, comprising 14 citizens and 26 health professions educators, were conducted regarding the presented information on the socioeconomic backgrounds of Japanese medical students. Data were analyzed using an inductive thematic analysis approach.Results: Six themes related to family backgrounds, such as higher economic status, five themes related to social backgrounds, such as social and educational disparity, and four themes related to expectations for medical education, such as selection of medical students with diverse backgrounds were extracted.Discussion: Both citizens and health professions educators were aware of the problem of the skewed socioeconomic backgrounds of medical students and the need to expand diversity. This finding will contribute to the reconsideration of future medical school admission criteria.

Objective: Bevacizumab maintenance therapy following platinum-based combination chemotherapy for metastatic, recurrent, or persistent cervical cancer is not recommended as standard therapy. This pilot study aimed to evaluate the efficacy and safety of bevacizumab maintenance therapy and the contribution of the platinum-free interval to the efficacy of subsequent chemotherapy for advanced cervical cancer. Methods: We retrospectively identified 115 patients with metastatic, recurrent, or persistent cervical cancer treated with platinum-paclitaxel chemotherapy plus bevacizumab at 7 institutions between 2015 and 2020. The primary endpoints were overall survival (OS) and progression-free survival (PFS) in patients who received bevacizumab maintenance therapy and those who did not. We also analyzed the adverse events associated with bevacizumab and survival time from the start of subsequent chemotherapy in both groups. Results: Following platinum-paclitaxel plus bevacizumab chemotherapy, 34 patients received bevacizumab maintenance therapy and 81 patients did not. Of the 115 patients, 56 received chemotherapy for subsequent relapse. Although bevacizumab maintenance therapy prolonged PFS (median of 16.0 months vs. 9.0 months, p=0.041), significant differences were not observed in OS (p=0.374). Furthermore, bevacizumab maintenance therapy did not prolong OS and PFS after the start of subsequent chemotherapy (p=0.663 and p=0.136, respectively). Bevacizumab maintenance therapy significantly increased hypertension (p=0.035) and proteinuria (p=0.005) but did not cause complications leading to death. Conclusion Bevacizumab single-maintenance therapy for advanced cervical cancer can be considered in selected cases, such as those with acceptable bevacizumab-related side effects. The outcomes of our study will likely contribute to decision-making regarding practical treatment strategies.

Context: As a contribution to this special issue of the journal featuring the computerization of the national medical licensing examination (NMLE), this paper seeks to explore the steps to shift the NMLE toward computer-based testing (CBT). Objectives: The purpose of this paper is to explore the movement of the NMLE toward CBT over the last 20 years and the merits and demerits of computerizing the NMLE. Methods: To explore the contents of committees' reports on the improvement of the NMLE, which have been held almost every five years. We also report the results of research we conducted on the computerization of NMLE. The research was supported by a grant from the Ministry of Health, Labor and Welfare (MHLW). Discussion: The former part of this paper explores the reports by the committees to improve the NMLE from 2011 onward. The latter half of this paper focuses on the result of our research from 2018 to 2020, favoring the computerization of NMLE based on the analysis of the merits and demerits of CBT.

Purpose: To investigate the influence of multiple recurrences and repeated surgeries of Hunner lesions on bladder capacity under general anesthesia in patients with interstitial cystitis (IC). Methods: We retrospectively reviewed the clinical records of Hunner-type IC (HIC) patients who underwent transurethral fulguration or resection of Hunner lesions combined with hydrodistension by a single surgeon between 2011 and 2020. Recurrence was defined as reappearance of uncontrolled urinary symptoms in association with new Hunner lesions identified by cystoscopy. Recurrent Hunner lesions were then treated by transurethral surgeries. The recurrence-free rate, potential predictive factors of recurrence, and changes in bladder capacity under anesthesia were examined at each surgical procedure. Results: A total of 92 surgeries were performed in 47 HIC patients, 23 (49%) of whom required multiple procedures (range, 1–5 times). The mean recurrence-free time after the first surgery was 21.7 months. The recurrence-free rate was 53% at 24 months, and decreased to 32% at 48 months. There were no significant differences in age, sex, bladder capacity under anesthesia at the first surgery, duration from symptom onset to the first surgery, O’Leary-Sant questionnaire including symptom and problem indexes, visual analogue scale pain score, and the number of comorbidities between the cases with or without recurrence. Bladder capacity under anesthesia was gradually decreased as the number of surgeries was increased, and bladder capacity at the fourth procedure was significantly decreased to 80% of the capacity at the first surgery. Conclusions These results suggest that multiple recurrences and repeated surgeries of Hunner lesions result in a reduction of bladder capacity under anesthesia in HIC patients although no predictive factors for recurrence of Hunner lesions were detected.

Over the past 20 years, the Center for Medical Education Development Center, Gifu University has been working on training medical educators across the country. The Center offers a wide variety of programs to meet participants’ various needs and levels, targeting medical educators and administrative staff in various fields such as dentistry, pharmacy, nursing, physical therapy, and occupational therapy. This paper introduces the “Medical Education Starter Kit,” “Fellowship Program,” and “Master’s Course of Health Professions Education” among the programs. The objectives, target participants, and features of each program are outlined, including future prospects.