Junki Mizumoto

Introduction: Although professional guidance generally discourages physicians from treating their own family members, family physicians often become involved in caring for dying relatives. However, little is known about how they experience caring for dying relatives. This study aims to explore how family physicians made sense of caring for a dying family member while simultaneously inhabiting the roles of physician and family member. Methods: We conducted an interpretative phenomenological analysis (IPA) of family physicians in Japan who had cared for a dying family member as the primary physician. Participants were recruited through purposive sampling. Semi‐structured interviews were conducted and analyzed iteratively according to the methodology of IPA, focusing on how participants made sense of their experiences. Results: Seven family physicians participated. Participants described a dynamic interplay between two identities, physician and family member, throughout the process of providing end‐of‐life care. Four interrelated themes were identified: negotiating for practical family needs, leading decision‐making within the family contexts, redefining the best care, and using the physician role as both protection and connection. Participants fluidly navigated and integrated these identities. Care was guided less by biomedical correctness than by relational considerations, with participants balancing responsibility and emotional burden. Conclusions: Caring for a dying family member involves not only role conflict but also the integration of professional and familial identities. This duality can enable context‐sensitive and meaningful care while introducing ethical and emotional complexity. Rather than focusing solely on prohibiting such involvement, support should help physicians navigate these roles in practice.

Background: Integrating medical students into school cancer education programs as service-learning is a promising strategy. This study assessed the impact of such programs and evaluated their effectiveness in improving students’ teaching self-efficacy and understanding of cancer. Methods: Medical students participated in observations, lectures, preparation, and teaching sessions under the supervision of an experienced oncologist. Effectiveness was measured by comparing the pre- and post-test scores for the Physician Teaching Self-Efficacy Questionnaire (PTSQ) and the Japanese Cancer Intelligence Quotient (JCIQ). Additionally, cancer literacy (JCIQ-Literacy) among pupils was measured before and after the program to compare outcomes in lecturer type: physicians or medical students. An analysis of covariance (ANCOVA) was conducted to adjust for baseline differences in literacy scores. Results: Medical students ( N = 23) showed significant improvements in teaching self-efficacy (self-regulative: pre-score = 2.58, post-score = 3.07, p < 0.01; dyadic-regulation: pre-score = 2.33, post-score = 2.90, p < 0.01) and cancer-related knowledge and literacy (JCIQ-Knowledge: pre-score = 39.9, post-score = 42.9, p < 0.01; JCIQ-Literacy: pre-score = 28.2, post-score = 37.2, p < 0.01). Pupils ( N = 1,210) also improved their cancer-related literacy, with no significant difference between physician- and student-led programs (33.4 vs. 33.1, p = 0.66; ANCOVA: F (1, 1207) = 1.85, p = 0.17, partial η² < 0.01). Conclusions: Participation in school-based cancer education programs was associated with short-term improvements in medical students’ teaching self-efficacy and cancer-related knowledge. These findings suggest that such programs may offer educational value for students and pupils alike, though further research is needed to assess long-term outcomes and broader implementation.

Background: Dual‐location living, in which individuals reside across two geographically distinct regions, is becoming increasingly prevalent in Japan. Consequently, general practitioners and family physicians (GPs/FPs) are more likely to encounter such patients, particularly in clinical settings located in resort areas and other non‐metropolitan communities. Nevertheless, competency frameworks specifically tailored to the care of dual‐location residents remain to be established. Methods: A Delphi method was employed to develop a competency list for GPs/FPs involved in dual‐location resident care. An expert panel of healthcare professionals with relevant clinical or educational experience in providing care for dual‐location residents in Nagano Prefecture was invited to participate in the online Delphi rounds. In Round 1, the panelists responded to an open‐ended questionnaire regarding competencies required for high‐quality dual‐location resident care. Responses were analyzed using qualitative content analysis to generate an initial competency list. In Round 2, the list was refined and confirmed by consensus. Results: A total of 36 participants completed Round 1, of whom 35 also completed Round 2. Through the Delphi process, a competency list comprising 10 items was developed. These competencies were organized into four domains, summarized using the acronym ROAM: Recognition of dual‐location context, Orchestration of dual‐location care, Alignment of care plan, and Multicultural professionalism. Conclusions: This study developed a consensus‐based competency framework for GPs/FPs involved in dual‐location resident care. The ROAM model may serve as a helpful reference for clinical practice, medical education, and future research, while further studies are warranted to examine its applicability across different settings.

Introduction Lack of health insurance is known to delay care-seeking and contribute to preventable morbidity. Although Japan has established a universal health insurance system, more than 10% of households have unpaid insurance premiums, and approximately 2.5% possess insurance certificates with restricted or no validity. Under these circumstances, preventable deaths attributable to delayed medical care for financial reasons have been reported. Individuals facing unstable employment or job loss are particularly vulnerable to premium non-payment, even when willingness to pay exists. The actual scale, characteristics, and clinical outcomes of uninsured patients in Japan remain largely unknown. Materials and methods We conducted a retrospective chart review at a small suburban hospital in Japan. The characteristics of patients without any form of health insurance at the time of the encounter were extracted from medical records from October 2021 to September 2025. Patient consent was obtained on an opt-out basis. Results Over the four-year study period, 20 patients received medical care at the hospital without any form of health insurance. Twelve patients (60%) required hospital admission at their first encounter. Nine patients (45%) were diagnosed with psychological disorders. Severe functional impairment or death occurred in 10 patients (50%), including two cases of death. Prior to hospital presentation, four patients (20%) had attempted to apply for public assistance at a municipal office but were denied. Conclusions Some individuals who remained outside the national insurance system present with severe and preventable illnesses. Although this study cannot establish a causal relationship, lack of insurance coverage may contribute to delayed care and adverse health outcomes. Efforts to remove administrative barriers and strengthen social work support may help reduce preventable harm and promote health equity within Japan's healthcare system.

Medical schools are often characterized by rigid hierarchical structures that may suppress student voices. Student governments provide an avenue for students to represent their peers, influence institutional policies, and foster personal and professional development. This study aims to reveal how participation in self-governance shapes students' attitudes, skills, and orientations toward change within their educational environments. This qualitative study recruited current executive members and recent graduates who had served in the Japan Association for Medical Student Societies (Igakuren), the only nationally elected medical student body in Japan. Participants were identified through email invitations, personal networks, and official meetings. The first author conducted in-depth online interviews, which were audio-recorded, transcribed verbatim, and analyzed via a thematic analysis using a framework approach. A total of 21 medical students and doctors participated in the study. A thematic analysis identified four main themes: learning through everyday negotiations; advocacy and empowerment; cooperation and interaction; and contribution to professional development. Student self-governance cultivates medical students' self-efficacy, leadership, and professional development. Participants acquired key competencies by recognizing systemic issues, collaborating with diverse stakeholders, and leading initiatives for change-demonstrating the principles of Freire's problem-posing education. For health professions education to be genuinely student-centered, faculty and institutional leaders must support and engage in equitable, respectful dialogue with students.

Introduction: Microaggressions are common in medical education but have been studied mainly in Western contexts. This study explored medical students' experiences of microaggressions in Japan to contextualize them within broader sociocultural structures. Methods: Participants were recruited through the Japan Association for Medical Student Societies (Igakuren), the sole nationwide representative body. Eligible individuals were current executive committee members or physicians within six years of graduation who had previously served. Data gained from in-depth online interviews were analyzed using a thematic analysis. Results: Twenty-one participants reported diverse microaggressions during clinical training. To capture these, the conventional microaggression triangle (source, recipient, bystander) was expanded with a fourth element: topic. Three themes emerged: (i) microaggressions about marginalized patients, (ii) hierarchy and dehumanization of students, and (iii) managing microaggressions. These findings highlight how hierarchical norms and structural inequities perpetuate microaggressions in medical education in Japan. Discussion: Microaggressions in Japan reflect structural inequities and entrenched hierarchies, including gender-based discrimination, rather than isolated interpersonal slights. Addressing them requires empowering students, preparing faculty for constructive intervention, and reforming hierarchical norms. This study provides a culturally grounded perspective to advance global discussions on equity in health professions education.

Background: As older adults lose physical function with age, family members often become primary, unpaid caregivers. In Japan, despite having a universal long‐term care (LTC) system, families often still bear the caregiving burden. Limited research exists on who supports older outpatients with daily tasks and healthcare access. This study aimed to identify caregivers' involvement in healthcare access and assistance with household tasks for patients aged 80 years or older. Methods: A descriptive study at a suburban hospital in Japan from April 2023 to March 2024. We developed a self‐administered questionnaire about LTC certification, transportation to the hospital, and daily activities, and distributed it to all outpatients aged 80 and over. Caregivers or staff assisted patients unable to complete it themselves. Results: Among 371 older patients approached, 359 participated (median age 84; 61.8% female). Among 334 respondents, 32.4% relied on family for visiting the hospital, while 29.3% drove themselves. Fewer used LTC (6.4%) or public transport (7.0%). Reliance on family increased with higher care need levels. Among 358 respondents, 53.4% relied on families for shopping and 48.3% for laundry. Approximately one‐third handled these tasks themselves. Use of LTC services was limited (11.7% for shopping, 8.7% for laundry), and reliance on family increased with care needs. Conclusions: In primary care settings, older adults frequently depend on family caregivers for both access to healthcare and the management of daily household tasks. Primary care professionals are well‐positioned to recognize and address these prevalent challenges.