Exploring factors linked with patient care ownership by stratified analysis: a nationwide cross-sectional study

Purpose: Patient care ownership (PCO) has attracted interest as a critical element of professionalism. However, the optimal approach to tailoring strategies for fostering PCO to the characteristics of individual medical residents remains unclear. To address this gap, we explored factors linked with PCO by stratifying residents based on their level of PCO. Methods: We performed an anonymous, online, self-administered survey across Japan from January to February, 2025. The participants were examinees of the General Medicine In-Training Examination, which is currently taken by over half of all medical residents in Japan. The outcome variable was the Japanese version of the PCO Scale score. We included a variety of factors as explanatory variables, including postgraduate years, sex, academic performance, the number of assigned inpatients in charge, average working hours per week, experience with general medicine department rotation, experience with community medicine rotation, average self-study time per day, hospital location, and hospital type. Subsequent to the stratification of participants into two groups (high and low PCO groups), multivariable linear regression analysis was conducted to examine whether they were associated with PCO. Results : The 2811 residents in the final analysis were divided into high (³ 4.32) and low (< 4.32) PCO groups. In the high PCO group, residents responsible for 10–14 inpatients reported greater PCO than those responsible for 5–9 (adjusted mean difference: 0.20, 95% confidence interval: 0.09 to 0.32). There were negative associations between PCO, female, and university hospital. In the low PCO group, caring for 0–4 inpatients had a negative association with PCO, compared to caring for 5–9 inpatients (adjusted mean difference: -0.12, 95% confidence interval: -0.19 to -0.05). Conclusions : We found that the optimal number of assigned inpatients may vary depending on the level of PCO of residents, and that sex and hospital type may act as suppressive factors for nurturing PCO. These findings suggest the importance of tailoring clinical responsibilities and autonomy support according to individual PCO level, as opposed to a “one-size-fits all approach,” and are insightful for clinical educators and medical education researchers. Stratified approaches to the understanding and fostering PCO would be beneficial.