(2023) 24:139
Miyagami et al. BMC Primary Care
https://doi.org/10.1186/s12875-023-02090-w

BMC Primary Care

Open Access

RESEARCH

Roles considered important for hospitalist
and non‑hospitalist generalist practice in Japan:
a survey study
Taiju Miyagami1, Taro Shimizu2*, Shunsuke Kosugi3, Yohei Kanzawa4, Kazuya Nagasaki5, Hiroyuki Nagano6,
Toru Yamada7, Kazutoshi Fujibayashi1, Gautam A. Deshpande1, Flora Kisuule8, Susumu Tazuma9 andToshio Naito1

Abstract
Background An increased focus on quality and patient safety has led to the evolution of hospitalists. The numberof hospitalists covering ward and outpatient care is on the rise in Japan. However, it is unclear what roles hospital
workers themselves consider important in their practice. Therefore, this study investigated what hospitalists and nonhospitalist generalists in Japan consider important for the practice of their specialty.
Methods This was an observational study that included Japanese hospitalists (1) currently working in a general
medicine (GM) or general internal medicine department and (2) working at a hospital. Using originally developed
questionnaire items, we surveyed the items important to hospitalists and non-hospitalist generalists.
Results There were 971 participants (733 hospitalists, 238 non-hospitalist) in the study. The response rate was 26.1%.
Both hospitalists and non-hospitalists ranked evidence-based medicine as the most important for their practice. In
addition, hospitalists ranked diagnostic reasoning and inpatient medical management as the second and third mostimportant roles for their practice, while non-hospitalists ranked inpatient medical management and elderly care as
second and third.
Conclusions This is the first study investigating the roles Japanese hospitalists consider important and comparing
those to that of non-hospitalist generalists. Many of the items that hospitalists considered important were those that
hospitalists in Japan are working on within and outside academic societies. We found that diagnostic medicine andquality and safety are areas that are likely to see further evolution as hospitalists specifically emphasized on them. In
the future, we expect to see suggestions and research for further enhancing the items that hospital workers value andemphasise upon.
Keywords Hospitalist, General medicine, Questionnaire, Non-hospitalist generalist*Correspondence:
Taro Shimizu
shimizutaro7@gmail.com
Full list of author information is available at the end of the article© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to theoriginal author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images orother third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of thislicence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. The Creative Commons Public Domain Dedication waiver (http://​creat​iveco​
mmons.​org/​publi​cdoma​in/​zero/1.​0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Miyagami et al. BMC Primary Care

(2023) 24:139

BackgroundIn the mid-1990s, an increased focus on quality andpatient safety led to the evolution of the hospitalist specialty [1, 2]. Since its inception, the number of hospitalists
has grown, with current estimates of at least 44,000 nonpaediatric hospitalists in the United States of America(USA) [3]. An interesting aspect of the rapid expansion of
hospital medicine is the growth of the field beyond USA,
including Asian Countries [4–6]. While some of the reasons for the development of hospital medicine internationally are the same as in the United States, there aredifferences in training, healthcare systems, regulations,and cultural norms, underscoring the practice of hospital
medicine in different countries. In Japan, the number ofhospitalists is increasing; however, their role and importance is unclear as of 2022. This survey study investigatedwhat hospitalists and non-hospitalist generalists in Japanconsider important for the practice of their specialty.
In Japan, post-graduate year (PGY)1 − 2 residents
spend the first two years rotating through various specialties such as internal medicine, general medicine(similar to family practice in the United States), paediatrics, obstetrics and gynaecology, and emergency medicine after graduation from medical school [7]. In PGY
3 − 5, residents pick an area of specialisation [8]. In 2018,
post-graduate training in Japan was modified to incorporate hospital medicine [8]. There are now two pathways
through which Japanese doctors can become hospitalists.
PGY 3 − 5 residents specialising in either general internal medicine or general medicine can go on to become
hospitalists. Specialists in general internal medicine, general medicine, and hospital medicine are all considered
generalists (Appendix 1). Until recently, the definitionof general medicine in Japan has been ambiguous, andthere has been no clear distinction between the role ofa hospitalist and a non-hospitalist generalist [9, 10]. The
historical lack of role clarity has influenced the practiceof hospitalists in Japan, who, unlike many hospitalists in
the U.S., do not work exclusively in hospitals. Instead,Japanese hospitalists take care of patients in multiple
locations at hospitals (over 20 beds), outpatient clinics,
emergency rooms, and ICUs. Non-hospitalist generalists
are often described as family physicians. They often workin clinics with no beds or fewer than 20 beds. They specialise in treating different patients and problems froma broad perspective, not limited to a specific disease orage group. While emphasising family relationships, theymust be able to comprehensively address health issues
commonly encountered in the community regardless ofage or disease, including preventive care, multimorbidity,
and psychosocial issues [11, 12].
Most of the hospitalist and non-hospitalist generalists in Japan belong to one (or both) of two societies: The

Page 2 of 8

Japan Primary Care Association (JPCA) and the JapaneseSociety of Hospital General Medicine (JSHGM). In 2022,
the JPCA became a professional organisation certifying
family physicians, while JSHGM is the entity for certifying hospitalists [13, 14]. Membership in an academic
society is a prerequisite for both specialties. As a professional and certification organisation for hospitalists,
JSHGM has described the 10 most important roles for
the Japanese hospitalist [15]. These include a generalist
mindset, leadership, management, comprehensive community care, collaboration with multiple professions,medical interviews, physical examinations, diagnostic
Reasoning, and active educational and academic activities [15, 16]. These roles are akin to the 24 “core competencies” for hospitalists in the U.S. defined by the Societyof Hospital Medicine (SHM) [17].
Although these priorities have been defined by theirprofessional organisations in Japan and the U.S., it isunclear what roles hospitalists themselves consider
important in their practice. It is also unknown whether
clinical priorities for hospitalists differ from those of
non-hospitalist generalists. Clarity around practice isimportant in differentiating the professional differences
between hospitalists and non-hospitalist generalists andwill facilitate the continued training and development of
hospitalists in Japan. Therefore, we performed this survey
study to investigate what hospitalists and non-hospitalist
generalists in Japan consider important for the practice of
their specialty.

Methods
Setting and participantsThis study was an observational survey, based with questionnaires sent to all hospitalists and non-hospitalist
generalists listed in the JPCA and JSHGM mailing lists.
For this study, hospitalists were defined as general medicine physicians working in hospital wards or in a clinicalpractice affiliated with a medium to a large hospital. The
response period was from January 28 to March 28, 2020.
Residents were excluded from the study [17, 18]. We used
the Research Electronic Data Capture to store data online[19].
Survey instrument

Subject matter experts (TM, SK, YK, KN, HN, and GD)
met in a series of rapid cycle sessions to generate andrevise questions for the survey. This content expertise
was based on: (1) approximately 10 years of hospitalist
practice in Japan, (2) experience working as a hospitalist
in the United States (GD), and (3) involvement in creating competencies for hospitalists in Japan (TS and TN).
The content experts first determined the possible rolesof Japanese hospitalists based on the 10 items consideredMiyagami et al. BMC Primary Care

(2023) 24:139

Page 3 of 8

important by the JSHGM [15] and the 24 items includedin the core competencies for hospital medicine in healthcare systems for hospitalists in the U.S. as described by
SHM [17]. Twenty-six items were ultimately includedin the survey. Respondents were asked to select thethree items they thought were the most important roles
for hospitalist practice, ranking them first to third.
Responses were scored by applying 3 points to the firstranked item, 2 points to the second, 1 point to the third,
and 0 points for “not applicable.” This scoring method
was created based on the Borda count [19, 20]. The scoresfor each item were then divided by the overall total scoreand expressed as a percentage. The survey also included
demographics questions (age and sex), post-graduateyears at the time of the baseline survey, academic society memberships (JPCA and JSHGM), whether they
belonged to a general medicine department in a schoolof medicine, practice setting (university hospital, community-based hospital, clinic), and hospital size. Institutions with 19 or fewer beds were referred to as clinics,
and institutions with 20 or more beds were referred toas hospitals, according to the standards of the Ministryof Health, Labour and Welfare [19, 21]. A sub-analysis,comparing the scores, was performed for communitybased and university hospitals. For this study, hospitals

with 20 − 199 beds, 200 − 399 beds, and > 400 beds werecategorised as small, medium-sized, and large hospitals,
respectively. Respondents were categorised as residents,
attendings, managers, and “other” (Table 1). Doctors who
attended a specialty program for three years (PGY3 − 5)were called residents. Staff members were called attendings, managers were called managers, and physicians
who did not fit into any preceding category were calledothers. The survey was conducted in Japanese, and theEnglish version of the questionnaire was published as anappendix (Appendix 2).
Data analysis

Results are presented as medians (interquartile range)
for continuous variables or prevalence (%) for categorical variables. All calculations were performed using
JMP PRO software, version 13.0 (SAS Institute, Cary,
NC, USA). Variables were subjected to the chi-square
test, and p values < 0.05 were considered statisticallysignificant.

Results
The number of physicians with known affiliations onthese two mailing lists was 3,466 for JPCA and 1,766
for JSGHM. Several participants were members of both

Table 1 Participant characteristics
Participant characteristics

Hospitalist group
Total N = 733
N (%)

Non-hospitalist group
Total N = 238
N (%)

P valueMale

610 (83.2)

185 (77.8)

0.010

Age, median (range)

46 (37,55)

45 (38,55)

0.899

Post-graduate year, median (range)

20 (11,30)

19 (12,28)

0.943

Belong to ­JPCAa

553 (75.4)

226 (95.0)< 0.0001

Belong to ­JSHGMb

468 (63.9)

34 (14.2)< 0.0001

Belong to JPCA and JSHGM

295 (40.2)

23 (9.7)< 0.0001

520 (70.9)

N/A

196 (26.7)

N/A

Small hospital 20–199

192 (26.2)

N/A

Medium hospital 200–399

201 (27.4)

N/A

Large hospital ≥ 400

323 (45.1)

N/A

Work Environment   Community-based hospital
University hospital
No. beds of primary ­hospitalc

Position
Resident of specialty training program

76 (10.3)

11 (4.6)< 0.0001

Attending392 (53.5)

46 (19.3)< 0.0001

Manager

224 (30.6)

152 (63.9)< 0.0001

Others41 (5.6)

29 (12.1)< 0.0001

Values are presented as medians (interquartile range) or number (%)
a

JPCA Japanese primary care associationb

JSHGM Japanese society of hospital general medicinecSome participants “’” were not aware of the number of their primary hospitals

Miyagami et al. BMC Primary Care

(2023) 24:139

associations but only responded to the questionnaire
once. There were 1,367 unique respondents, and theoverall response rate was 26.1%. Two hundred eightyeight incomplete surveys were excluded from the analysis. Nine respondents did not meet the inclusion criteria(eight were residents, and one was not a physician). A
total of 733 hospitalists and 238 non-hospitalist generalists were included in the study (Fig. 1).
In the hospitalist group, 85.2% were men, and the
median age was 46 years. Further, 41.2% belonged to both
JSHGM and JPCA; 72.6% of the respondents worked
in community-based hospitals, 45.1% worked in large
hospitals, and 53.5% were attendings. There were no
significant differences between the hospitalist and nonhospitalist groups regarding age and post-graduate yearof practice (Table 1).
Both hospitalists and non-hospitalists most frequently
ranked evidence-based medicine among the three mostimportant roles. However, hospitalists ranked diagnostics and inpatient medical management as the second
and third among the three most important roles, while
non-hospitalists ranked inpatient medical management and elderly care as the second and third among
the three most important roles. While there were similarities in what the generalists ranked as important, theroles least often identified as among the most importantdiffered in the two groups (Fig. 2) (Appendix 3). Interestingly, in a comparison of community-based hospitals
and university hospitals, hospitalists at community-based
hospitals placed the highest importance on inpatient

Page 4 of 8

medical management (13.2% (6.2% in the university hospital group)), while hospitalists at university hospitals
placed the highest importance on diagnostic reasoning(15.2% (10.3% in the community-based hospital group))(Appendix 4). Regarding gender comparison, males rendered the most importance to evidence-based medicine(13.0% [11.5% in the female group]), while females gave
the most importance to inpatient medical management(14.8% [10.7% in the male group]) (Appendix 5). According to position, residents and attending respondents gave
the highest importance to evidence-based medicine (resident 17.1%, attending 13.2%), while managers accorded
the highest importance to diagnostic reasoning (11.5%)(Appendix 6). In comparison by academic society, thosebelonging to only JPCA regarded inpatient medical management as the most important (14.1%), while thosebelonging to only JSHGM regarded evidence-based medicine as the most important (15.5%). Those who belonged
to both societies considered diagnostic reasoning themost important (13.0%) (Appendix 7).

Discussion
This study is the first to investigate what roles Japanesehospitalists consider important for their practice. Japanese and non-hospitalist generalists ranked evidencebased medicine, diagnostic reasoning, and inpatient
medical management as the most important roles fortheir practice. The relative importance of evidence-based
medicine, diagnostic reasoning, and inpatient medical
management for both hospitalists and non-hospitalist

Fig. 1 Flow chart of participants in this study. From 1,367 survey respondents, 971 were included in the study. Of these, 733 were in the hospitalist
group and 238 were in the non-hospitalist groupMiyagami et al. BMC Primary Care

(2023) 24:139

Page 5 of 8

Fig. 2 Please choose what is the most important to you as a hospitalist. Respondents were asked to select each of the three items they thought
were most important roles for hospitalist practice, ranking them first to third. Responses were scored by applying 3 points to the first ranked item,
2 points to the second, 1 point to the third, and 0 points for “not applicable.” This scoring method was created based on the Borda count. The mostand least often identified as among the most important of each group are listed

generalists is congruent with clinical practice in Japan.
In addition, in a study of Japanese general medicine doctors, clinical care was the most important among thefour categories of clinical care, education, research, andmanagement [22]. This suggests that both hospitalists
and non-hospitalist generalists may also emphasise on
clinical care. A comparison of community-based hospitals and university hospitals among hospitalists showedthat community-based hospitals placed more importanceon inpatient medical management. In comparison, university hospitals placed more importance on diagnostic
reasoning. This may reflect the large number of hospitalists in this study who belonged to community-based hospitals. This may also be influenced by previous reportsthat university hospitals tend to receive consults for difficult-to-diagnose cases [23]. Moreover, there is a longstanding history of training diagnostic thinking in Japan.
This is accomplished through collective intelligence andnon-profit conferences on diagnostic reasoning frequently held in Japan [24, 25]. In 2019, JSGHM createda working group on diagnostic excellence to evolve thearea of diagnostic medicine in Japan, and this group has
been very active to date [26, 27]. Within JSGHM conferences, the group reports the largest number of cases andconducts workshops on diagnostic medicine. Outside of
the JSGHM, the group has produced the most research inJapan in this field.
Hospitalists prioritise the quality and safety of medicalcare over non-hospitalist generalists. Studies have shownthat the presence of hospitalists in Japan has shortened
hospital stays and reduced costs for common diseases
such as pneumonia and heart failure [28–30]. Similarly, areport summarising the role of hospitalists in four Asian
countries also emphasises the importance of their rolein addressing healthcare quality [5]. The results of theseprevious studies indicate that medical care quality andsafety are core interest for Japanese hospitalists and that
their work improves patient care in this area.
Our study also shows that non-hospitalist generalists inJapan place more importance on elderly care comparedMiyagami et al. BMC Primary Care

(2023) 24:139

to that by hospitalists. When the frequency of inpatient
medical management and the frequency of elderly care
are added together, there may not be a large difference.
Still, the care of the elderly is important to hospitalists.
Japan is an aging society, with 25% of the population
over 65 years old as of 2013, and this figure is expected
to reach 40% by 2060 [31]. Elderly people are more likely
to have multimorbidity, and 62.8% of those aged 65 years
and older present with multiple co-morbidities [32].
Korean hospitalists reportedly contribute to shorter hospital stays for this patient population [33]. In addition, aprevious report recommends that hospitalists in Europe,
where the proportion of elderly patients is smaller than inJapan, need to pay more attention to diseases related tothe elderly [34]. We believe that the care of the elderly is a
crucial area of development for hospitalists in the future.
In order to distinguish between hospitalists and nonhospitalist generalists, JSHGM believes that the original
criteria could be refined to better define the role of thehospitalist [15].
This study has several limitations. First, the response
rate was low at 26.1%. However, our survey was sent to
all non-unique members of JPCA and JSHGM; therefore, our response rate is underestimated. In addition, alarge number of respondents dropped out of the survey,
288, of which 281 were nearly non-responsive, which
is a very large number. This may be because the survey was an online survey that could be answered froma cell phone, and therefore many respondents may havebeen interrupted by other tasks or may have opened thesurvey once and answered later. Moreover, those who
respond to a research-based survey like this may have ahigh affinity for research among general medical doctors.
However, this study did not examine the respondents’backgrounds; thus, further research is needed. Second,
we only surveyed Japanese hospitalists and non-hospitalist generalists who are members of JPCA and JSHGM;
hence, there is a high possibility of response bias. Further,
their perspectives do not necessarily represent those of
the broader population of Japanese generalists. Third,
the evaluation is based on a ranking system. As a result,the interval between the first, second, and third places in
the chosen ranking is not necessarily the same. Fourth,the survey items were slightly skewed, and the fact thatsome items were detailed, and others were not may haveaffected the results of this survey. Fifth, participants inthis study differed by gender, position, and academic affiliation, and this bias may have affected the results. Sixth,
this survey was conducted exactly when the COVID-19
epidemic began to spread in Japan. Perhaps, this timing may have influenced the responses, as the results of
the questionnaire also focused on the increasing intensity of public health messages and the increasing clinicalPage 6 of 8

evidence on COVID-19; however, this is one of the only
viable ways to characterise informants’ perspectives.
Despite these limitations, this study is the first to evaluate what Japanese hospitalists consider important roles intheir practice. This study could be an important contribution highlighting key areas for the professional development of the hospital medicine profession in Japan andglobally.

Conclusion
Japanese hospitalists practice in multiple settings, andthere is some ambiguity around the uniqueness of theirrole compared to non-hospitalist generalists. While
JSHGM has defined some core competencies for theirpractice, it is not yet known what Japanese hospitalists
consider important for their practice. These findings callattention to current gaps in the top three priorities of
hospitalists. They may be useful in investigating whether
and how hospitalist priorities differ from core competencies and other requirements that determine whether
training and practice activities should be renewed. Further research is needed to look at comparisons in practice and attitudinal similarities and differences in what
hospitalists around the world consider important rolesin their practice. Opportunities for enhancing hospitalist practice in the areas identified as important for theirpractice would also be a significant next step. This work
would be crucial in fostering collaboration in training
and practice development to build a strong specialty thatleverages the unique characteristics of the international
hospitalist community.
Abbreviations
JPCA	Japan primary care association
JSHGM	Japanese Society of Hospital General Medicine
SHM	Society of hospital medicine
ICU	Intensive care unit
PGY	Post-graduate year

Supplementary Information
The online version contains supplementary material available at https://​doi.​
org/​10.​1186/​s12875-​023-​02090-w.
Additional file 1.
Additional file 2: Appendix 2. Questionnaire raw data English Ver.
Additional file 3: Appendix 3. Questionnaire resultwhat you consider
important as a hospitalist?
Additional file 4: Appendix 4. Compare community-based hospital with
university hospital.
Additional file 5: Appendix 5. Compare male with female.
Additional file 6: Appendix 6. Compare resident of specialty training
program, attending with manager.
Additional file 7: Appendix 7. Comparison of Academic Affiliations.

Miyagami et al. BMC Primary Care

(2023) 24:139

Acknowledgements
We are very grateful to Rachel Thompson, president of the society of hospital
medicine, for all her advice on the paper.
Authors’ contributions
All authors were involved in study design, data interpretation, and manuscript
preparation. TM and TS are the principal investigators and were responsible forregulatory compliance, participant recruitment, data collection, data analysis,
and manuscript preparation. TS, KN, HN, YK, SK, TY, KF, GAD, FK ST and TN
contributed to the study coordination and data collection, entry, and analysis.
All authors read and approved the final manuscript.

Page 7 of 8

5.
6.
7.

8.

Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

9.

Availability of data and materials
The datasets used and analysed during the current study are available fromthe corresponding author on reasonable request.

10.

Declarations
Ethics approval and consent to participate
The institutional ethics committee of Juntendo University Hospital approved
the research (No. 19T7009). The survey was web-based, and informed consent
was obtained from all participants. There was no patient or public involvement in this study. All methods were carried out according to the relevant
guidelines and regulations.

11.
12.
13.

Consent for publication
Not applicable.

14.

Competing interests
The authors declare no competing interests.

15.

Author details
1
Department of General Medicine, Juntendo University Faculty of Medicine,Tokyo, Japan. 2 Department of Diagnostic and Generalist Medicine, Dokkyo
Medical University Hospital, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi
321‑0293, Japan. 3 Department of General Internal Medicine, Iizuka Hospital,
Iizuka, Fukuoka, Japan. 4 Department of General Internal Medicine, Akashi
Medical Center, Hyogo, Japan. 5 Department of Internal Medicine, Mito Kyodo
General Hospital, University of Tsukuba, Ibaraki, Japan. 6 Department of Healthcare Economics and Quality Management Graduate School of Medicine, Kyoto
University, Kyoto, Japan. 7 Department of General Medicine, Graduate Schoolof Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo,
Japan. 8 Division of Hospital Medicine at Johns Hopkins Bayview Medical
Center, Baltimore, MD, USA. 9 JA Onomichi General Hospital, Hiroshima, Japan.
Received: 14 October 2022 Accepted: 22 June 2023

16.
17.
18.

19.
20.
21.

References
1. Wachter RM, Katz P, Showstack J, Bindman AB, Goldman L. Reorganizing an academic medical service impact on cost, quality, patientsatisfaction, and education. JAMA. 1998;279:1560–5. https://​doi.​org/​10.​
1001/​jama.​279.​19.​1560..
2. Auerbach AD, Wachter RM, Katz P, Showstack J, Baron RB, Goldman
L. Implementation of a voluntary hospitalist service at a Community
Teaching Hospital: cmproved clinical efficiency and patient outcomes.
Ann Intern Med. 2002;137:859–65. https://​doi.​org/​10.​7326/​0003-​4819-​
137-​11-​20021​2030-​00006.
3. Lapps J, Flansbaum B, Leykum LK, Bischoff H, Howell E. Growth trendsof the adult hospitalist workforce between 2012 and 2019. J Hosp Med.
2022;17:888–92. https://​doi.​org/​10.​1002/​jhm.​12954.
4. Wachter RM, Goldman L. Zero to 50,000 - The 20th anniversary of thehospitalist. N Engl J Med. 2016;375:1009–11. https://​doi.​org/​10.​1056/​
NEJMp​16079​58.

22.

23.

24.
25.

Yan Y, Naito T, Hsu NC, Shin DH, Kang HJ, Vidyarthi RR. Adoption of Hospitalist Care in Asia: Experiences from Singapore, Taiwan, Korea, and Japan.
J Hosp Med. 2021;16:443–5. https://​doi.​org/​10.​12788/​jhm.​3621.
Kisuule F, Howell E. Hospital medicine beyond the United States. Int J Gen
Med. 2018;11:65–71. https://​doi.​org/​10.​2147/​IJGM.​S1512​75.
Ministry of Health, Labour and Welfare. [homepage on the Internet]
Meeting of knowledgeable people to prepare for the implementation of
the new clinical training system for medical doctors. Cited: March 9, 2004
https://​www.​mhlw.​go.​jp/​topics/​bukyo​ku/​isei/​rinsyo/​keii/​040310.​html.
Doctor specialist system homepage [homepage on the Internet] Indianapolis: Ministry of Health, Labor and Walfare. updated: April 22, 2013
Cited: April 29, 2020. available from: https://​www.​mhlw.​go.​jp/​stf/​seisa​
kunit​suite/​bunya/​kenkou_​iryou/​iryou/​rinsyo/​index_​00011.​html.
Sasaki Y, Takahiro S, Tadashi M, et al. The actual condition of medical treatment in university hospital general medical department: what is requiredfor general medical department of university hospital. (in Japanese). J
Japan Hosp Gen Med Assoc. 2015;9:1–8.
Yokota Y, Watari T. Various perspectives of “General Medicine” in JapanRespect for and cooperation with each other as the same “General
Medicine Physicians.” J Gen Fam Med. 2021;22:314–5. https://​doi.​org/​10.​
1002/​jgf2.​500.
Japan Primary Care Association. [homepage on the Internet] What is afamily doctor. [cited: 2019] https://​www.​shin-​katei​iryo.​prima​r y-​care.​or.​jp/​kateii 24 Accessed Jan 2023.
Ohta R, Sano C. Family physicians as ystem-specific specialists in Japan’s
aging society. Cureus. 2022;14:e30811. https://​doi.​org/​10.​7759/​cureus.​
30811.
Japanese Society of Hospital General Medicine. [homepage on theInternet] Board of certified physician. Cited: 2019. http://​hgm-​japan.​com/​news/​2018/​ninte​ii/​index.​php. Accessed 5 May 2022.
Japan Primary Care Association. [homepage on the Internet] Hospital
general medicine trial program. [Cited: 2019] https://​www.​prima​r y-​care.​or.​jp/​nintei_​ge/​index.​html. Accessed 3 May 2022.
Japanese Society of Hospital General Medicine. [homepage on theInternet] List of hospital general practice specialist program goals. Cited:2020. http://​hgm-​japan.​com/​progr​am/​progr​am_​manual/. Accessed 3
May 2022.
Tago M, Watari T, Shikino K, Sasaki Y, Takahashi H, Shimizu T. Five tips forbecoming an ideal general hospitalist. Int J Gen Med. 2021;14:10417–21.
https://​doi.​org/​10.​2147/​IJGM.​S3410​50.
Dressler DD, Pistoria MJ, Budnitz TL, McKean SCW, Amin AN. Core competencies in hospital medicine: development and methodology. J Hosp
Med. 2006;1(Suppl 1):48–56. https://​doi.​org/​10.​1002/​jhm.6.
Ministry of Health, Labour and Welfare. [homepage on the Internet].
Changes in junior resident clinical training system; Cited: 2018. https://​www.​mhlw.​go.​jp/​topics/​bukyo​ku/​isei/​rinsyo/​hensen/. Accessed 5 May
2022.
Blumenberg C, Barros AJ. Electronic data collection in epidemiological research. The use of REDCap in the Pelotas birth cohorts. Appl Clin
Inform. 2016;7:672−81.
Black D. Partial justification of the Borda count. Public Choice.
1976;28:1–15.
Ministry of Health, Labour and Welfare. [homepage on the Internet]
Summary of the 2013 medical facilities (Movement) survey and hospital
report; Cited: 2014 (https://​www.​mhlw.​go.​jp/​toukei/​saikin/​hw/​iryosd/​
13/) Accessed 5 May 2022.
Miyagami T, Yamada T, Kanzawa Y, Kosugi S, Nagasaki K, Nagano H, et al.
Large-scale observational study on the current status and challenges ofgeneral medicine in Japan: job description and required skills. Int J Gen
Med. 2022;15:975–84. https://​doi.​org/​10.​2147/​IJGM.​S3368​28.
Yokose M, Harada Y, Hanai S, Tomiyama S, Shimizu T. Outcomes ofgeneral internal medicine consultations for diagnosis from specialists ina tertiary hospital: a retrospective observational otudy. Int J Gen Med.
2022;15:7209–17. https://​doi.​org/​10.​2147/​IJGM.​S3781​46.
Watanuki S, Sada R, Ishikane M, Shimizu T, Kutsuna S. The Tokyo GIM Conference: clinical reasoning conference from real cases. J Gen Fam Med.
2018;19:228. https://​doi.​org/​10.​1002/​jgf2.​209.
Harada T, Shimizu T, Kaji Y, Suyama Y, Matsumoto T, Kosaka C, et al. A Perspective from a case conference on comparing the diagnostic process:human diagnostic thinking vs. artificial intelligence (AI) decision supportMiyagami et al. BMC Primary Care

26.
27.
28.

29.

30.

31.

32.

33.

34.

(2023) 24:139

Page 8 of 8

tools. Int J Environ Res Public Health. 2020;17:6110. https://​doi.​org/​10.​3390/​ijerp​h1717​6110.
Harada T, Miyagami T, Watanuki S, et al. Special contribution: report on
the activities of the working group on diagnostic errors and reflections
on the history and culture of diagnostic errors. JSHGM. 2021;17.
Harada T, Miyagami T, Watari T, et al. Barriers to diagnostic error reductionin Japan. Diagnosis (Berl). 2021. https://​doi.​org/​10.​1515/​dx-​2021-​0055.
Hamada O, Tsutsumi T, Tsunemitsu A, Fukui T, Shimokawa T, Imanaka
Y. Impact of the hospitalist system in Japan on the quality of care andhealthcare economics. Intern Med. 2019;58:3385–91. https://​doi.​org/​10.​
2169/​inter​nalme​dicine.​2872-​19.
Wada M, Nishiyama D, Kawashima A, Fujwara M, Kagawa K. Effects ofestablishing a Department of General Internal Medicine on the length of
hospitalization. Intern Med. 2015;54:2161–5. https://​doi.​org/​10.​2169/​inter​
nalme​dicine.​54.​3900.
Kurihara M, Kamata K, Tokuda Y. Impact of the hospitalist system on inpatient mortality and length of hospital stay in a teaching hospital in Japan:
a retrospective observational study. BMJ Open. 2022;12:e054246. https://​doi.​org/​10.​1136/​bmjop​en-​2021-​054246.
Arai H, Ouchi Y, Toba K, Endo T, Shimokado K, Tsubota K, et al. Japan as
the front-runner of super-aged societies: perspectives from medicine andmedical care in Japan. Geriatr Gerontol Int. 2015;15:673–87. https://​doi.​
org/​10.​1111/​ggi.​12450.
Aoki T, Yamamoto Y, Ikenoue T, Onishi Y, Fukuhara S. Multimorbidity patterns in relation to polypharmacy and dosage frequency: a nationwide,cross-sectional study in a Japanese population. Sci Rep. 2018;8:3806.
https://​doi.​org/​10.​1038/​s41598-​018-​21917-6.
Lee JH, Kim AJ, Kyong TY, Jang JH, Park J, Lee JH, et al. Evaluating theoutcome of multi-morbid patients cared for by hospitalists: a reportof Integrated Medical Model in Korea. J Korean Med Sci. 2019;34:e179.
https://​doi.​org/​10.​3346/​jkms.​2019.​34.​e179.
Bernabeu-Wittel M, Para O, Voicehovska J, Gómez-Huelgas R, Václavík J,
Battegay E, et al. Competences of internal medicine specialists for the
management of patients with multimorbidity. EFIM multimorbidity working group position paper. Eur J Intern Med. 2023;S0953–6205(23)00016-X.
https://​doi.​org/​10.​1016/j.​ejim.​2023.​01.​011.

Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Ready to submit your research ? Choose BMC and benefit from:• fast, convenient online submission• thorough peer review by experienced researchers in your field• rapid publication on acceptance• support for research data, including large and complex data types• gold Open Access which fosters wider collaboration and increased citations• maximum visibility for your research: over 100M website views per year
At BMC, research is always in progress.
Learn more biomedcentral.com/submissions