{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:27:08Z","timestamp":1790342828214,"version":"4.1.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1177","license":[{"start":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T00:00:00Z","timestamp":1689811200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Health, Labor, and Welfare Policy Grants of Research on Region Medical","award":["21IA2004"],"award-info":[{"award-number":["21IA2004"]}]},{"name":"Ministry of Health, Labor, and Welfare"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>A regional quota program (RQP) was introduced in Japan to ameliorate the urban\u2013rural imbalance of physicians. Despite concerns about the low learning abilities of RQP graduates, the relationship between the RQP and practical clinical competency after initiating clinical residency has not been evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a nationwide cross-sectional study to assess the association between the RQP and practical clinical competency based on General Medicine In-Training Examination (GM-ITE) scores. We compared the overall and category GM-ITE results between RQP graduates and other resident physicians. The relationship between the RQP and scores was examined using multilevel linear regression analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 4978 other resident physicians and 1119 RQP graduates out of 6097 participants from 593 training hospitals. Being younger; preferring internal, general, or emergency medicine; managing fewer inpatients; and having fewer ER shifts were all characteristics of RQP graduates. In multilevel multivariable linear regression analysis, there was no significant association between RQP graduates and total GM-ITE scores (coefficient: 0.26; 95% confidence interval: \u22120.09, 0.61; P\u2009=\u2009.15). The associations of RQP graduates with GM-ITE scores in each category and specialty were not clinically relevant. However, in the same multivariable model, the analysis did reveal that total GM-ITE scores demonstrated strong positive associations with younger age and GM preference, both of which were significantly common in RQP graduates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Practical clinical competency evaluated based on the GM-ITE score showed no clinically relevant differences between RQP graduates and other resident physicians.<\/jats:p>\n                  <jats:p>Key messages What is already known on this topic Many countries offer unique admission processes to medical schools and special undergraduate programs to increase the supply of physicians in rural areas. Concerns have been raised about the motivation, learning capabilities, and academic performance of the program graduates. What this study adds This nationwide cross-sectional study in Japan revealed clinical competency based on the scores from the General Medicine In-Training Examination showed no clinically relevant differences between graduates of regional quota programs and other resident physicians. How this study might affect research, practice, or policy The study provides evidence to support the Japanese regional quota program from the perspective of clinical competency after initiating clinical practice.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/postmj\/qgad059","type":"journal-article","created":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T03:09:52Z","timestamp":1689908992000},"page":"1197-1204","source":"Crossref","is-referenced-by-count":10,"title":["Association between regional quota program in medical schools and practical clinical competency based on General Medicine In-Training Examination score: a nationwide cross-sectional study of resident physicians in Japan"],"prefix":"10.1093","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3082-1374","authenticated-orcid":false,"given":"Sho","family":"Fukui","sequence":"first","affiliation":[{"name":"Department of Emergency and General Medicine, Kyorin University , Tokyo, 181-8611 , Japan"},{"name":"Immuno-Rheumatology Center, St. Luke\u2019s International Hospital , Tokyo, 104-8560 , Japan"},{"name":"Division of Rheumatology, Brigham and Women\u2019s Hospital , Boston, MA, 02115 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3721-3443","authenticated-orcid":false,"given":"Kiyoshi","family":"Shikino","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Chiba University Hospital , Chiba, 260-0856 , Japan"},{"name":"Department of Community-Oriented Medical Education, Chiba University School of Medicine , Chiba, 260-0856 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Nishizaki","sequence":"additional","affiliation":[{"name":"Division of Medical Education, Juntendo University School of Medicine , Tokyo, 113-8421 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3788-487X","authenticated-orcid":false,"given":"Taro","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital , Tochigi, 321-0293 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Division of General Medicine , Center for Community Medicine, , Tochigi, 329-0498 , Japan"},{"name":"Jichi Medical University , Center for Community Medicine, , Tochigi, 329-0498 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine , Mito Kyodo General Hospital, , Ibaraki, 310-0015 , Japan"},{"name":"University of Tsukuba , Mito Kyodo General Hospital, , Ibaraki, 310-0015 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuharu","family":"Tokuda","sequence":"additional","affiliation":[{"name":"Muribushi Okinawa Center for Teaching Hospitals , Okinawa, 901-2132 , Japan"},{"name":"Tokyo Foundation for Policy Research , Tokyo, 106-0032 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,20]]},"reference":[{"key":"2023101917081081400_ref1","article-title":"Geographic imbalances in doctor supply and policy responses","volume":"69","author":"Ono","year":"2014","journal-title":"OECD Health Working Papers"},{"key":"2023101917081081400_ref2","volume-title":"Doctors","author":"Organisation for Economic Co-operation and Development (OECD)"},{"key":"2023101917081081400_ref3","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/0140-6736(92)92569-2","article-title":"Geographic distribution of physicians in 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