2020 Volume 66 Issue 2 Pages 127-128
In Japan, until 2007 the number of medical school enrollment had decreased from 8,280 to 7,625 due to the prediction of future surplus of medical doctors. However, the decision was reversed and now 9,419 students enter medical school. In order to improve the geographical disparities, a special quota was allocated for applicants who are willing to stay in the prefecture where the school is located; it is called community-quota (chiiki-waku). Chiiki-Waku was started in 2008 and 2,293 students of the quota graduated by 2018 1).
On the other hand, according to a report from Nagasaki 2), 54% of the community-quota students had returned their scholarship and withdrawn (34.6% was still at school). While 30% of the students enrolled as quota expressed their willingness of engaging community medicine but less than 10% of the graduates chose the primary care as their specialty 3). Among 67 colleges which have instituted Chiiki-Waku system, 30 colleges provide lectures about community medicine and 26 send students to community rotation 4).
To explore what affect medical students’ willingness to practice in underserved areas, I conducted a cross-sectional survey involving Chiiki-Waku students from second to final year at Juntendo University. The questionnaire asked students their future career preference including a specialty, area of practice, and types of medical facilities. I analyzed the association with time spent in rural clinics as a student. Response rate was 92.4% (61 of the 66 Chiiki-Waku students). Analysis of covariance was used to test for the differences. The potential confounders (i.e. gender, year in medical school and the types of Chiiki-Waku) were adjusted in the analyses.
This study demonstrated that the Chiiki-Waku students (years 2 to 6) who participated in electives at rural practice expressed more interest in working in a rural area and tended to choose specialties in primary care, such as pediatrics (p<0.05). Moreover, students who experienced rural practice had positive perceptions toward community medicine compared with their retrospective feelings upon first entering medical school.
Further follow-up study is needed to elucidate the causal effects of clinical experience in rural areas on their perception of future career.
