Introduction: Vaccine policies have changed in recent years in Japan. In the present study, we assessed practices, recommendations, knowledge, and sources of information among primary care physicians (PCPs) regarding vaccinations in Japan. Methods: We conducted a nationwide cross-sectional study targeting PCPs in Japan. We used a web-based self-administered questionnaire targeting physicians that were members of the Japan Primary Care Association in 2019. We analyzed respondent administrations, recommendations, knowledge, and sources of information regarding vaccinations. Results: We received responses from 1,084 PCPs (20.1%) and invited 981 participants for the analysis. The rates at which physicians gave routine and voluntary vaccines in their own practices were 23.3-95.5% and 13.2-94.4%, respectively. The active recommendation rates for routine and voluntary vaccines were 41.6-92.0% and 13.6-75.5%, respectively. Furthermore, among routine vaccines, human papillomavirus vaccine was the least administered and recommended. PCPs working at clinics had the most accurate knowledge about vaccinations, and PCPs utilized academic organizations most readily as an information resource. Conclusion: We clarified practices, recommendations, knowledge, and sources of information regarding vaccinations among PCPs in Japan.

Objective: To clarify the involvement of Japanese family physicians with patients and their families in their daily practice.Methods: Participants were Japanese family physicians with over one year of experience of full-time work in their clinics, and who were able to join the focus group discussions (FGD) and member checks. The study employed a qualitative research design with semi-structured FGD. Two analysts examined video recordings of the FGD, and the results were verified through member checks and external checks.Results: Eight physicians participated at first, but five of them dropped out because of job commitments or death. The involvement by Japanese family physicians consisted of three stages. The first stage was "the approach of repeated hypothesis testing and normalizing" as safety interventions. The second stage was "reevaluation of the family" utilizing family genograms, family conferences, and others. After exhausting all other efforts, they engaged in "accepting the one who comes to them" in collaboration with the patient and families. The outcomes included awareness of patients, their smiles due to feeling accepted, and their expressed emotions. They did not explicitly boast that they were able to engage with family members. In addition, they also needed case studies of instances of "failure." Conclusion: Japanese family physicians engaged in three-stage involvement with families.

Objective: To clarify how and when Japanese family physicians assess families in their daily practice.Methods: Participants were Japanese family physicians with over one year of experience of full-time work in their clinics, and who were able to join the focus group discussions (FGD) and member checking. The study employed a qualitative research design with semi-structured FGD. Two analysts examined video recordings of the FGD, and the results were verified through member checking and the checking by external members.Results: Physicians assessed families naturally while examining patients for common cold, during vaccination, and during registration in the Japanese care insurance system.Additionally, the physicians assessed the families when they observed or suspected something strange regarding the patient and/or the family.Families were assessed based on how they spent their time during special Japanese events that the family members attended together (e.g., Bon festival or Japanese style New Year holidays), the patient's illness behavior in non-reserved outpatient clinics, and their communication patterns. Furthermore, the family photograph technique for family therapy was also used for assessment.Conclusion: Participants utilized skills of family therapy such as communication patterns and family photographs. They also employed unique skills such as assessment of the families' sharing time during traditional events, assessment of the patient's illness behavior, and general assessments regarding the Japanese care insurance system.

Introduction: Consultation simulation with simulated patients has rarely been done as a training program.
Method: Fifth-year medical students in 2 neighboring universities attended the same training program at each site. The students’ performance was evaluated.
Result: Most medical students thought that this training program was valuable and that they require more opportunity to practice. Students evaluated their own performance in both medical procedures and differential diagnosis as being poor. However, about 50% of students felt that they paid careful attention to the simulated patient during physical examination. Students thought that the consultation was extremely realistic and that the series of medical procedures they performed at the first attempt was extremely difficult but increased their motivation. They thought that the feedback they received from simulated patients was beneficial.
Discussion: This education program is highly regarded by students and is suggested to be versatile.

A shortage of physicians in rural areas has become a serious problem of the new residency training program in Japan. To address this problem, we propose a model for attracting physicians to rural areas by improving residency training programs and by evaluating a curriculum introduced at Kainan Hospital, a community hospital. In this first paper, we describe the short-term evaluation of the curriculum.1) We introduced clinical teams in which residents were able to actively participate in clinical practice as team members by being supervised by senior physicians. We also introduced teaching rounds and case conferences for residents.2) Focus-group interviews of residents showed that "giving educational opportunities to residents" and "an explicit policy of the hospital to improve the residency training program" are examples of ways to improve residency programs.3) The number of residents working at Kainan Hospital increased. The residency training program was somewhat improved.4) An effective and easily generalized way to provide residents with more learning opportunities is to involve clinicians in teaching residents in hospitals.

A shortage of physicians in rural areas has become a serious problem of the new residency training program in Japan. To address this problem, we propose a model for attracting physicians to rural areas by improving residency training programs and by evaluating a curriculum introduced to Kainan Hospital, a community hospital. In this second paper, we describe the middle-term curriculum evaluation and present our model.1) Interviews of program directors revealed 8 items necessary to improve residency training programs.2) After the residents finish their training, they remain at the same hospital, and the number of the number of physicians at the hospital increases, if the fellowship programs are well-organized.3) Because universities are interested in hospitals at which many residents and fellows work, attracting attending physicians to these hospitals is easier.4) Although attracting enough physicians by improving residency training programs requires 3 to 5 years, achieving this goal by increasing the larger number of medical students would take even longer.

The role of standardized patients (SPs) has developed rapidly over the last10years because of medical education curriculum reform and the introduction of the objective structured clinical examination (OSCE). As the participation of SPs in medical education has increased, the anxieties and frustrations of SPs have also increased. We believe that an understanding of the attitudes of SPs would improve the quality of their activities. The purpose of this survey was to study the activities and psychological needs of Japanese SPs in the OSCE.
1) The response rate to the nationwide survey was62% (332of532SPs).
2) Role-playing and group discussion were the most common training methods, and the length of training varied from 0 to 40 hours.
3) The factors that SPs felt difficult were judging how much to respond in their performances (73%) and maintaining consistent standards in evaluating examinees (66%).
4) Our results suggest that SPs require more training and that the number of SP educators should be increased.

SPs have made a dramatic development in medical education over 10 years, due to the influence of medical education curriculum reform and the introduction of the Objective Structured Clinical Examination. However the quality of SPs' activities varies. In order to increase the quality it is necessary to analyze the psychological needs of SPs. The purpose of this survey is to explore SPs' personal characteristics and how they feel during their activities.
1) In a nationwide survey of Japanese SPs, 332 SPs (62%) out of 532 responded.
2) Sixty percent of SPs were between the ages of 50 and 69 years and the ratio of male to female SPs was 1: 4. The ratio of workers and non-workers was 1: 2.
3) A qualitative analysis found that SP motivations were derived mainly from making a contribution to society and self-improvement. Ninety six percent of SPs were satisfied with being an SP, especially when they saw improvements in the students.
4) However, 67% of SPs expressed difficulty with the three core skills of feedback, evaluation and performance.

As of April 2005, “Shihango-rinsyoushiken” defined in the GPMSP was renamed “Seizouhanbaigo-rinsyoushiken” in the revised regulations (GPSP). The relevant part of the GCP was also modified at the same time. Strictly speaking, therefore, post-approval clinical trials are not the same as postmarketing clinical trials. This report provides an explanation of post-approval clinical trials and the related regulations. It is generally considered that post-approval clinical trials, which help gather more clinical information, should be actively pursued for the further development of approved drugs in the post-marketing setting. However, the results of the questionnaire show that pharmaceutical companies are not willing to conduct them, mainly due to the high cost. To improve the economic efficiency of post-approval clinical trials, it is necessary to streamline monitoring activities that account for 40% of the cost.