Key factors for high-quality residency training programs: Insights from program directors through thematic analysis

Introduction: Clinical training programs in Japan play a crucial role in shaping future healthcare professionals by providing resident physicians with comprehensive education and hands-on experience. Despite a structured framework, variability in the outcomes of residency programs indicates that certain factors may significantly enhance residents' competencies. This study aims to identify key factors contributing to the success of high-performing residency programs in Japan, as measured by their performance on the General Medicine In-Training Examination (GM-ITE), particularly the Clinical Simulation Video-Innovative Examination (CSV-IE). Methods Semi-structured interviews were conducted with nine program directors from the top 25% ranking residency programs based on the CSV-IE accuracy rates. The interviews explored factors contributing to effective clinical training and were analyzed using thematic analysis. Key themes were identified and consolidated to provide a comprehensive understanding of high-performing programs' characteristics. Results Seven key themes emerged as contributors to the effectiveness of residency programs: (1) Active engagement and autonomy in clinical practice: Residents were given substantial responsibility, fostering confidence and critical decision-making skills. (2) Diverse patient exposure: Broad medical conditions and patient demographics enhanced clinical competence. (3) Enhanced learning resources: Access to clinical decision support tools and customized educational materials facilitated evidence-based learning. (4) Peer-assisted learning: Collaborative learning environments promoted knowledge sharing and mentorship. (5) Supportive educational framework: Structured feedback, balanced with autonomy, created a positive learning atmosphere. (6) Clinical reasoning education: Emphasis on case-based learning and routine exercises developed robust diagnostic skills. (7) Professionalism development: Focus on communication and teamwork prepared residents for real-world clinical interactions. Conclusion High-performing residency programs in Japan integrate diverse clinical experiences, advanced resources, peer learning, and structured feedback to enhance residents' competencies. These findings offer valuable insights into optimizing clinical training programs under resource constraints, potentially leading to improvements in medical education frameworks across Japan.