Published online: 7 May, TAPS 2019, 4(2), 7-13
DOI: https://doi.org/10.29060/TAPS.2019-4-2/OA2079

Yuki Kataoka1,2, Hiraku Tsujimoto2, Yasushi Tsujimoto3, Yuka Urushibara-Miyachi4, Yuda Miyamoto5, Hideto Yasuda6, Hiromitsu Yamashita5, Ryohei Yamamoto6 & Hiroshi Nishigori7

1Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Japan; 2Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Japan; 3Department of Nephrology and Dialysis, Kyoritsu Hospital, Japan; 4Science and Religion, School of Divinity, University of Edinburgh, Scotland; 5Outpatient Facility Kameda Clinic, Japan; 6Department of Intensive Care Unit, Kameda General Hospital, Japan; 7Center for Medical Education, Kyoto University, Japan

Abstract

Background: The representation of Japan in science has been decreasing. No data is available on the current status of medical education research in Japan.

Aim: The present study aims to describe the current status of medical education research in Japan.

Methods: We conducted a meta-epidemiological investigation of the conference abstracts from Japan for the Japan Society for Medical Education (JSME), the Association for Medical Education in Europe (AMEE) Conference, and Asia Pacific Medical Education Conference (APMEC) published between April 2012 and March 2017.

Results: A total of 1399 JSME conference abstracts and 193 AMEE conference and APMEC conference abstracts were published. From a total of 382 abstracts, 37 abstracts (10%) presented at the JSME 2014 conference were published as full papers. From a total of 39 abstracts, four (10%) abstracts presented at the AMEE Conference 2014 and APMEC 2014 from Japan were published, respectively. Exploratory analysis showed that the characteristics of abstracts were not related significantly with subsequent publication. Of the original articles, 0.46% (31/6727) from Japan were presented in 7 international medical education journals.

Conclusion: We found a low subsequent publication rate for Japanese conference abstracts and low representativeness in medical education journals. Further investigation to improve the number of publications is required.

Keywords:            Medical Education Research, Postgraduate Education, Continuous Medical Education

Practice Highlights

  • We described the current status of medical education research in Japan.
  • We found a low subsequent publication proportion for abstracts and low representativeness in journals.
  • The characteristics of conference abstracts were not related to subsequent publication.

I. INTRODUCTION

The need for the best evidence has been indicated in medical education (Harden, Grant, Buckley, & Hart, 1999). Every medical educator is expected to engage in scholarship by contributing new, peer-reviewed resources that advance the field (Norman, 2002; Simpson et al., 2007). The impact factors of medical educational journals, which reflect some aspects of scholarship activity, have been increasing in recent years (Azer, Holen, Wilson, & Skokauskas, 2016). Most medical education studies are conducted in the US or European countries. Studies from Asia are relatively less (Doja, Horsley, & Sampson, 2014).

The Japan Society for Medical Education (JSME) was founded in 1969. JSME is the largest medical education organisation in Japan. More than 2000 members are engaged in educational and research activities (Suzuki, Gibbs, & Fujisaki, 2008). However, no data is currently available on the current status of medical education research in Japan.

II. METHODS

A. Aims and Objectives

Our research objectives are as follows:

  • To describe the characteristics of the conference abstracts of JSME, the Association for Medical Education in Europe (AMEE) Conference, and Asia Pacific Medical Education Conference (APMEC) from Japan.
  • To describe the characteristics of articles published in medical education journals from Japan.
  • To evaluate the relationship between the characteristics of conference abstracts and subsequent publication in peer-review journals.

B. Design

We conducted a meta-epidemiological investigation, which is a variant method of systematic review and usually used to describe the distribution of research evidence in a specific setting (Murad & Wang, 2017). We have developed a protocol a priori.

C. Types of Study

We included research abstracts presented in JSME from April 2013 to March 2017. We also included research abstracts presented by researchers affiliated with Japanese institutions at the AMEE and APMEC conferences from April 2012 to January 2017. We excluded abstracts of invited presentations, symposium, panel discussions, or educational workshops. We included full articles published by researchers affiliated with Japanese institutions in Medical Education, Academic Medicine, Medical Teacher, BMC Medical Education, Advances in Health Science and Education, Perspectives on Medical Education, or Teaching and Learning in Medicine from April 2012 to March 2017. We searched PubMed using the following search formula: “Name of Journal” [journal] AND “Japan” [affiliation] AND “2012/04/01” [PDAT]: “2017/03/31” [PDAT] NOT “Letter” [pt] in September 2017.

D. Definition of Study Characteristics

We evaluated abstracts without presentation data. We classified abstracts as quantitative, qualitative, or mixed method study. We defined text mining, which is an automatic assessment technique for qualitative text data as a qualitative study (Zhang et al., 2012). We defined quantitative evaluation without data, which were abstracts with the interpretation of numerical results without data as a quantitative study. We defined abstracts without evaluation as “without data”. We classified abstracts as “undergraduate”, “postgraduate”, “continuous medical education (CME)”, “interprofessional education”, and “other” according to the study participants.

We classified topics as follows: knowledge/attitude, clinical diagnosis, clinical interventions, teaching and leadership, assessment, other following the previous study (Cook, Bordage, & Schmidt, 2008). We classified purposes of research as follows: description, justification, or clarification following the previous study (Cook et al., 2008). Description means the simple observation undertaken to answer the question: What was done? Justification means comparing one educational intervention with another to answer the question: Did it work? Clarification means updating models or theories to answer the questions: How does it work? Why does it work? (Cook et al., 2008).

E. Data Extraction

We judged the affiliations of the first author and presentation styles using the Microsoft Excel® 2016 search function. The other characteristics were extracted by some of the authors (YK, HT, YT, YU-M, YM, HY, and HY) and confirmed by others (YK and YU-M). We resolved any disagreements through discussions.

F. Outcome Measures

The primary outcome was the publication proportion. The denominator was the number of abstracts included. The numerator was the number of abstracts published in peer-review journals. One author (YK) searched Google Scholar and PubMed using the first authors’ names in both Japanese and English. The search was conducted in September 2017. Published manuscripts were matched with other authors’ names and titles. We included JSME, AMEE Conference, and APMEC in 2014 because one previous study reported that the median publication duration from the conference was 20 months (Walsh, Fung, & Ginsburg, 2013).

G. Statistical Analysis

We summarised data using descriptive statistics. We calculated risk ratios and 95% confidence interval using general linear models. We used STATA® ver. 14.2 (Stata Corp., College Station, TX, USA). P < 0.05 was considered statistically significant.

H. Ethical Considerations

Because all the data were retrieved from public databases, this study did not require institutional review board approval.

III. RESULTS

A total of 1399 JSME conference abstracts, 193 AMEE conference and APMEC abstracts, and 31 original articles were included (Figure 1). The characteristics of the studies are presented in Table 1. During the study period, 6727 original articles were published in seven journals. Original articles from Japan were found to constitute 0.46% (31/6727).

Abstracts presented at the Annual Meeting of the JSME

n (%)

Abstracts presented at the AMEE Conference and APMEC from Japan*

n (%)

Original articles

 n (%)

Year      

2012

2013

2014

2015

2016

 

NA**

231 (17)

382 (27)

342 (24)

444 (32)

 

30 (16)

35 (18)

39 (20)

43 (22)

46 (24)

 

5 (16)

3 (10)

6 (20)

6 (20)

11 (35)

Number of authors**    

1

2-5

6-10

11-

 

115 (10)

543 (46)

400 (34)

111 (10)

12 (6)

111 (58)

70 (36)

 

1 (3)

13 (42)

14 (45)

3 (10)

Affiliations of 1st author

University or Medical college

Other

 

1202 (86)

197 (14)

 

184 (95)

9 (5)

 

24 (77)

7 (23)

Presentation style

Oral

Poster

 

994 (71)

405 (29)

 

42 (22)

151 (78)

 

Conference or journal

 

AMEE 181 (94)

APMEC 12 (6)

Medical Education 1 (3)

Academic Medicine 3 (10)

Medical Teacher 3 (10)

BMC Medical Education 20 (65)

Advances in Health Science and Education 1 (3)

Perspectives on Medical Education 1 (3)

Teaching and Learning in Medicine 2 (6)

Method

Quantitative study

Mixed method study

Qualitative study

Without data

Title only

 

722 (51)

224 (16)

226 (16)

192 (14)

35 (3)

105 (54)

46 (24)

30 (16)

12 (6)

 

23 (74)

6 (19)

2 (6)

 

 

Study participants

Undergraduate

Postgraduate

CME

IPE and other

 

770 (55)

177 (13)

104 (7)

348 (25)

 

98 (51)

19 (10)

15 (8)

61 (32)

 

14 (45)

13 (42)

2 (6)

2 (6)

Topics (with duplication)

Knowledge/attitude

Clinical diagnosis

Clinical interventions

Teaching and leadership

Assessment

Other

 

756 (54)

77 (6)

153 (11)

111 (8)

150 (11)

243 (17)

 

57

27

24

15

30

56

 

5 (16)

6 (19)

1 (3)

1 (3)

8 (26)

10 (32)

Purposes of research

Description

Justification

Clarification

Title only

 

1037 (74)

84 (6)

243 (17)

35 (3)

 

114 (59)

11 (6)

68 (35)

 

 

15 (48)

5 (16)

11 (35)

 

Total 1399 193 31

Note: JSME – Japan Society for Medical Education; AMEE – The Association for Medical Education in Europe;
APMEC – Asia Pacific Medical Education Conference; CME – Continuing Medical Education; IPE – Interprofessional education.
*AMEE Conference from 2012 to 2016 and APMEC from 2012 to 2015.
**NA, not available.
***The number of authors in JSME 2013 is not included.
Table 1. Characteristics of the included abstracts and full articles

Note: JSME – Japan Society for Medical Education; AMEE – The Association for Medical Education in Europe;
APMEC – Asia Pacific Medical Education Conference.
Figure 1. Flow diagram

Abstracts presented at the Annual Meeting of the JSME 2014

Published / subtotal (%)

Risk ratio for publication (95% confidence interval)
Number of authors**

1

2-5

6-10

11-

 

3/24 (13)

19/183 (10)

12/139 (9)

3/36 (8)

 

Reference

0.83 (0.27 to 2.60)

0.69 (0.21 to 2.27)

0.67 (0.15 to 3.03)

Affiliation of 1st author

University or Medical college

Other

 

34/323 (11)

3/59 (5)

 

Reference

0.48 (0.15 to 1.52)

Presentation style

Oral

Poster

 

28/237 (12)

9/145 (6)

 

Reference

0.53 (0.26 to 1.08)

Method

Quantitative study

Mixed method study

Qualitative study

Without data

 

16/189 (8)

10/66 (15)

4/75 (5)

7/52 (13)

 

Reference

1.79 (0.86 to 3.75)

0.63 (0.22 to 1.82)

1.59 (0.69 to 3.66)

Study participants

Undergraduate

Postgraduate

CME

IPE and other

 

20/230 (9)

4/52 (8)

3/32 (9)

10/68 (15)

 

Reference

0.88 (0.32 to 2.48)

1.08 (0.34 to 3.42)

1.69 (0.83 to 3.44)

Topics (with duplication)

Knowledge/attitude

Clinical diagnosis

Clinical interventions

Teaching and leadership

Assessment

Other

 

25/275 (9)

1/10 (10)

2/27 (7)

1/18 (6)

4/28 (14)

7/51 (14)

 

Reference

1.18 (0.18 to 7.89)

0.82 (0.21 to 3.30)

0.55 (0.08 to 3.78)

1.62 (0.61 to 4.27)

1.55 (0.71 to 3.37)

Purposes of research

Description

Justification

Clarification

 

30/293 (10)

1/23 (4)

6/66 (9)

 

Reference

0.42 (0.06 to 2.97)

0.89 (0.39 to 2.04)

Total 37/ 382 (10)

Note: JSME – Japan Society for Medical Education; AMEE – The Association for Medical Education in Europe;
APMEC – Asia Pacific Medical Education Conference; CME – Continuing Medical Education; IPE – Interprofessional education.
Table 2. The relationship between publication and characteristics in JSME 2014 abstracts

From a total of 382 abstracts, 37 abstracts (10%) presented at the JSME 2014 conference were published. From a total of 39 abstracts, four (10%) abstracts presented at AMEE Conference 2014 and APMEC 2014 from Japan were published, respectively. A total of 11 (30%) articles were published in English journal from JSME. Other 26 abstracts (70%) published in 18 Japanese journals with peer review. All four articles were published in English journal from the AMEE and APMEC conferences. Exploratory analysis showed that the number of authors, affiliation of the first author, presentation style, method, topics, and purposes of the research were not statistically significant associated with subsequent publication rate (Table 2).

IV. DISCUSSION

We evaluated the characteristics of abstracts pertaining to medical education from Japan. Walsh et al. (2013) reported that the proportion of quantitative/mixed/qualitative study in medical education conference in America and Canada were 55%, 8% and 15%, respectively. Cook et al. (2008) reported the proportion of published medical education articles categorised as clarification to be 6 to 26%. Our study revealed almost the same proportion (17% to 35%). The characteristics of our study were not significantly differed from previous reports.

The representativeness of Japan in medical education journals was 0.46%. Fukui, Takahashi, and Rahman (2013) reported that the Japanese contribution was 3.6% in basic science journals and 0.74% in general medicine journals during 2001-2010. The current status of medical education research in Japan is almost equivalent to that of general medicine.

The proportion of subsequent publication (10%) was very low. Scherer, Langenberg and von Elm (2007) reported that the full publication rate was 45% in biomedical science conference abstracts. Other previous studies have reported publication rate for medical education conference abstracts to be were 35% to 44% (Sawatsky et al., 2015; Smith et al., 2014; Walsh et al., 2013). Characteristics of abstracts we have investigated were not related to publication (Table 2).

A possible explanation for the lower subsequent publication proportion may be the worse average quality of each abstract (Sawatsky et al., 2015), or inadequate time of researchers (Smith et al., 2014). The acceptance rates for the conference abstracts in JSME is nearly 100% (personal communication). The number is higher than other medical education conferences. For example, the acceptance rate of AMEE 2018 is nearly 45%, which is estimated from the 3766 submissions (Harden, 2018) and the 1658 occurrences of “background” in the abstract book (The Association for Medical Education in Europe, 2018). This difference would be evidence of poor abstract quality. Love et al. (2016) revealed that education for clinicians to gain skills including quantitative and qualitative methods improved the medical education research output. A lack of quantitative research education programs for post-graduates in Japan was identified (Arimura et al., 2010). To provide education programs for medical teachers in Japan is one of the options to promote educational researches. Considering the high burnout rate of doctors including residents (Tateno et al., 2018), the Japan Ministry of Health, Labour and Welfare (2018) is now attempting to reform the work lives of doctors to reduce their burden. It is important to use any gained surplus time for research productivity improvement.

By offering educational programs on medical education research for several physicians who lack knowledge of research (Kurita et al., 2016; Suzuki & Fukushima, 2014), consequently, the number of studies on medical education would increase. The total quality and publication rate may improve (Huang, 2016). In April 2018, the board certification system changed to standardise the certification of fellows in Japan (Hirokuni, 2017). To improve the system, the post-graduate medicine curriculum should be evaluated (Iwata, Mosby, & Sakane, 2017). There are several opportunities to conduct medical educational research.

Our study has several limitations. First, seven individual authors judged the characteristics of abstracts to reduce burden, which may cause misclassifications. To reduce the information bias, another author confirmed the decision, and we followed the pre-defined protocol. Second, we did not search for medical education abstracts in other conferences, such as the Association of American of Medical Colleges (AAMC) or Ottawa Conference. Furthermore, some medical education abstracts have been presented in clinical conferences, such as general internal medicine or paediatrics (Sawatsky et al., 2015; Smith et al., 2014). In general, medical education research is not often pre-registered, so we believe that to focus on medical education conferences was the best way to know the current status but further evaluation is warranted.

V. CONCLUSION

We described the current status of medical education research in Japan. We identified a low subsequent publication rate for conference abstracts and low representativeness in medical education journals. Further investigation is required to improve the number of publications.

Notes on Contributors

Yuki Kataoka, MD, MPH, is a Medical Head at the Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Japan. He contributed to the design of the research, retrieving data, analysing, prepared the draft of the article, and approved the final version of the article.

Hiraku Tsujimoto, MD, is a research fellow at the Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Japan. He contributed to the design of the research, retrieving data, and approved the final version of the article.

Yasushi Tsujimoto, MD, MPH, is an attending staff member at the Department of Nephrology and Dialysis, Kyoritsu Hospital, Japan. He contributed to the design of the research, retrieving data, and approved the final version of the article.

Yuka Urushibara-Miyachi, MD, MHPE, is an MSc Science and Religion student at the School of Divinity, the University of Edinburgh. She contributed to the design of the research, retrieving data, and approved the final version of the article.

Yuda Miyamoto, MD, is a resident at the Outpatient Facility Kameda Clinic, Japan. He contributed to the design of the research, retrieving data, and approved the final version of the article.

Hideto Yasuda, MD, is an attending staff member at the Department of Intensive Care Unit, Kameda General Hospital, Japan. He contributed to the design of the research, retrieving data, and approved the final version of the article.

Hiromitsu Yamashita, MD, is a fellow at the Outpatient Facility Kameda Clinic, Japan. He contributed to the design of the research, retrieving data, and approved the final version of the article.

Ryohei Yamamoto, MD, is a fellow at the Department of Intensive Care Unit, Kameda General Hospital, Japan. He contributed to the design of the research, retrieving data, and approved the final version of the article.

Hiroshi Nishigori, MD, MMEd, PhD, is an Associate Professor at the Center for Medical Education, Kyoto University, Japan. He contributed to the design of the research and approved the final version of the article.

Ethical Approval

As all the data were retrieved from public databases, this study did not require institutional review board approval.

Acknowledgements

This study was conducted as a part of a project by the Japan Society for Medical Education. The Society supported data retrieval but has no role in the conceptualisation, analysis, or preparation of this manuscript.

Funding

This work was supported in part by a grant from the Hyogo Prefectural Amagasaki General Medical Center fiduciary funds (for English editing).

Declaration of Interest

The authors report no conflicts of interest. All the authors are responsible for the content and writing of the article.

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*Yuki Kataoka
Department of Respiratory Medicine
Hyogo Prefectural Amagasaki General Medical Center
Higashi-Naniwa-Cho 2-17-77,
Amagasaki, Hyogo 660-8550, Japan
Email: youkiti@gmail.com