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

Introduction: Postgraduate clinical training is crucial for developing professional competence, communication skills, and effective teamwork. Although resident physician selection is crucial, little is known about how Japanese residency programs select residents and whether selection practices are associated with difficulties during training. Methods: We conducted a nationwide cross-sectional survey of residency programs participating in Japan's 2023 General Medicine In-Training Examination (GM-ITE). Program directors completed a questionnaire assessing selection methods, interview content, quality-assurance measures, and resident difficulties, defined as at least one postgraduate year 1 or 2 resident physician receiving disciplinary action or a severe warning. Free-text responses were coded using the Situation, Task, Action, and Result framework. Associations between selection methods and resident difficulties were examined using adjusted logistic regression models controlling for hospital type and number of GM-ITE examinees. Results: Of 151 participating physician-selection programs, 150 provided valid responses. Interviews were used by 90.1% of programs and were identified as the most important selection component by 87.3%. Thirty-five programs (23.3%) reported difficulties with resident physicians, involving professionalism and workplace conduct including rule, ethics, or boundary violations, work avoidance or unavailability, and inappropriate communication. Use of applicants' pre-clinical-clerkship computer-based test scores as a selection criterion was associated with resident difficulties (adjusted OR, 4.60; 95% CI, 1.50-14.11; P = 0.008; FDR-adjusted P = 0.048). No significant associations were observed for essays, academic tests, medical school grades, or personality assessment. Program-level GM-ITE total and domain scores did not differ significantly between programs with and without reported resident physician difficulties. Discussion: Resident physician selection in Japan is highly interview-centered; reported difficulties were more often related to professionalism and workplace conduct than to knowledge deficits. Although these exploratory findings are program-level, they highlight the importance of strengthening the quality assurance processes in resident selection systems, particularly for assessing professionalism-related attributes in applicants.