%0 Journal Article
%T Quality of care associated with number of cases seen and self-reports of clinical competence for Japanese physicians-in-training in internal medicine
%A Yasuaki Hayashino
%A Shunich Fukuhara
%A Kunihiko Matsui
%A Yoshinori Noguchi
%A Taro Minami
%A Dan Bertenthal
%A John W Peabody
%A Yoshitomo Mutoh
%A Yoshihiko Hirao
%A Kazuhiko Kikawa
%A Yohei Fukumoto
%A Junichiro Hayano
%A Teruo Ino
%A Umihiko Sawada
%A Jin Seino
%A Norio Higuma
%A Hiroyasu Ishimaru
%J BMC Medical Education
%D 2006
%I BioMed Central
%R 10.1186/1472-6920-6-33
%X Cross-sectional study using univariate and multivariate linear analyses in 11 teaching hospitals in Japan. Participants were physicians-in-training in internal medicine departments. Main outcome measure was standardized t-scores (quality of care) derived from responses to five clinical vignettes.Of the 375 eligible participants, 263 (70.1%) completed the vignettes. Most were in their first (57.8%) and second year (28.5%) of training; on average, the participants were 1.8 years (range = 1¨C8) after graduation. Two thirds of the participants (68.8%) worked in university-affiliated teaching hospitals. The median number of cases seen was 210 (range = 10¨C11400). Greater exposure to cases (p = 0.0005), higher self-reports of clinical competence (p = 0.0095), and type of institution (p < 0.0001) were significantly associated with higher quality of care, using a multivariate linear model and adjusting for the remaining factors. Quality of care rapidly increased for the first 100 to 200 cases seen and tapered thereafter.The amount of clinical exposure and levels of self-reports of clinical competence, not years after graduation, were positively associated with quality of care, adjusting for the remaining factors. The learning curve tapered after about 200 cases.Healthcare systems throughout the world are searching for better ways of delivering high quality care. Attention to quality of patient care has become an important healthcare issue during the last decade, not only for health authorities, policymakers, and managers, but also for physicians and patients. Improving the quality of healthcare involves a broad range of discrete activities such as rigorous evaluation of conventional treatments, incorporating patients' views in healthcare decisions, and audit and feedback of healthcare practices. Physicians are one of the main healthcare providers and are confronted with increasing pressure to provide and improve care. The skills and knowledge of physicians improve through a c
%U http://www.biomedcentral.com/1472-6920/6/33