Resident Physician Selection Practices and Professionalism-Related Difficulties in Japan: A Nationwide Cross-sectional Survey

This study surveyed residency programs participating in Japan's 2023 General Medicine In-Training Examination (GM-ITE) to describe selection practices and examine associations with resident difficulties, defined as at least one PGY-1 or PGY-2 receiving disciplinary action or a severe warning. Of 151 programs, 150 provided valid responses. Interviews were used by 90.1% of programs and were considered the most important selection component by 87.3%. Thirty-five programs (23.3%) reported difficulties, primarily involving professionalism and workplace conduct, including rule/ethics/boundary violations, work avoidance, and inappropriate communication. After adjusting for hospital type and number of examinees, the use of pre-clinical-clerkship computer-based test (CBT) scores as a selection criterion was significantly associated with resident difficulties (adjusted OR 4.60; 95% CI 1.50-14.11; P = 0.008; FDR-adjusted P = 0.048). No other selection criteria—essays, academic tests, medical school grades, or personality assessments—showed significant associations, and program-level GM-ITE scores did not differ between programs with and without difficulties. The authors note that the findings are exploratory and program-level, but they underscore the need to strengthen quality-assurance processes in resident selection, particularly for assessing professionalism-related attributes.