This “white paper” on junior residents and physicians-in-training of postgraduate year (PGY)-1 and -2 (“Kenshui” in Japanese) reviews current trends for physicians in Japan and discusses how accreditation is given to “Kenshui” in registered hospitals. In 2004, the new postgraduate medical education (PGME) system was established, along with recommended guidelines, and systematic PGME was introduced in all eligible hospitals. This review also describes how “Kenshui” receive PGME at Kyoto Okamoto Memorial Hospital (KOMH), and shows how “Kenshui” at KOMH are trained in accordance with Japanese government guidelines. The rotation system for each specialty, evaluation, daily life, career and background problems of “Kenshui” are explained in the context of the situation at KOMH in 2024.

Completion of reporting of the results of early morning blood specimens (early morning ward specimens) from inpatients before the start of daytime work is considered to be desirable. Our hospital investigated how to improve the reporting rate to a target of 100% by 8:30 am. The measures included starting this early work 30 minutes earlier, and simplification of collection and verification of early morning ward specimens by clinical technologists, with use of clear targets to compare the efficiency before and after implementation of these measures. The targets were the arrival time of specimens at the inspection room and the percentage report completion (reporting rate) at 8:00 am and 8:30 am for biochemistry data and blood cell counts. The results showed earlier arrival times, with changes from 7:11 am to 6:40 am for Ward A and from 7:18 am to 7:04 am for Ward B. The reporting rates increased for biochemistry data from 39.9% to 86.6% at 8:00 am and from 84.5% to 97.5% at 8:30 am, and for blood counts from 84.8% to 93.5% at 8:00 am and from 96.1% to 98.3% at 8:30 am. The earlier reporting times and more complete reports are likely to lead to prompter treatment and earlier discharge, with a corresponding shortening of the days of hospitalization.

The infection control team in our hospital has reported increased problems with organizing, zoning, and management of treatment supplies on a nursing cart. Thus, we determined the appropriate number of individual treatment supplies required for a well-organized cart with zoning. This was based on interviews with nurses with experience of 5 years or longer who had many opportunities to use such a cart as a leader.

The results permitted clarification of the frequency of use of a cart and the appropriate number of treatment supplies on the cart. Zoning of these supplies on the cart allowed easy use and a tidy cart, and this also permitted effective supplementation after use. A table of the appropriate number of supplies for a well-organized cart was prepared.

Zoning of the supplies was performed because treatment rooms in which carts are placed might be an infection source. Securing a working space in the treatment room allows the infection route to be broken. By determining the required number of individual goods and tools on a cart, overloading was prevented and efficiency of management was improved.

The revision of medical fees in fiscal year 2020 newly established an “additional fee for urination independence support” and urination care teams were launched in Hospital A. Knowledge dissemination in mixed wards and evaluation of learning were performed as an intervention to improve team activities. Based on data from self-administered anonymous surveys and interviews before the intervention, study sessions to address the shortage of knowledge and instructional sessions using actual cases were held. A similar survey six months after the intervention showed an overall improvement in knowledge. The number of consultations with the urination care team also increased. We believe that design of the intervention based on a preliminary understanding of the situation prior to the intervention led to this improvement in knowledge. However, a follow-up survey at one year after the intervention showed deterioration of the overall results. This suggests that the learning effects were temporary and that continued intervention is desirable in the future.

Collection of inpatient data is important to support hospitalization and discharge. However, in the intensive care unit (ICU), most patients are admitted as emergency cases, and many nurses have difficulty supporting hospitalization and discharge of these patients. Thus, we have introduced use of pamphlets with key points for collection of inpatient data with the goal of improving this support. The effectiveness of this intervention was evaluated using a self-administered anonymous questionnaire that was completed by 35 ICU nurses in hospital. In general, use of the pamphlet improved the ability of nurses to collect inpatient data and complete evaluation sheets. Improvement depends on the generation of nurses, and it was particularly good for nurses with 0–5 years of experience, since these nurses reported that frequent collection of inpatient information and utilization of the pamphlet led to this improvement. Pamphlets should be brushed up in their contents with much wider circulation.

Occupational therapists (OTs) in our rehabilitation department annually evaluate about 100 cases targeting resumption of automobile driving among patients and outside applicants after cerebral stroke (with exclusion of those with dementia). Comprehensive results from neuropsychological examinations and a driving simulator are reported to physicians. In this study, several activities were introduced in our hospital and a follow-up survey was implemented for 10 subjects under certain conditions after completion of evaluation of their automobile driving. All subjects had resumed driving and their frequency of driving differed according to their occupations and purposes. Some subjects stated that considerations for safe driving and advice for evaluation of driving were effective. Some occupational drivers had phases of fear, suggesting that long working hours with long driving may increase the risk of accidents after resumption of driving after cerebral stroke. Hereafter, we will continue to use follow-up surveys to obtain more accurate evaluations of resumption of automobile driving, including actual vehicle evaluation, and we will collaborate with other occupations and organizations to provide better support.