Impact of third-party accreditation and General Medicine In-training Examination participation on residency program popularity: A nationwide matching data analysis in Japan

BACKGROUND Third-party accreditation and the visibility of educational outcomes may influence medical students’ choice of training sites; however, national evidence of their effect in Japan is limited. This study examined whether hospital characteristics—especially Japan Council for Evaluation of Postgraduate Clinical Training (JCEP) certification and General Medicine In-Training Examination (GM-ITE®) participation—are associated with residency program choice in Japan’s Physician Clinical Training Matching Program. METHODS We conducted a nationwide cross-sectional study of 1,029 clinical training hospitals participating in the 2023 matching cycle. The outcome was a popularity index defined as the number of first-choice applicants per number of positions available. Predictors included JCEP certification, GM-ITE® participation, location (urban/rural), hospital type (community, university, university branch), and facility/service metrics (number of permitted beds, average daily number of inpatients, annual number of ambulance transports, annual number of outpatients, length of stay (general beds), number of doctors, number of nurses, annual number of computed tomography and magnetic resonance imaging scans). Continuous variables were analyzed using multiple linear regression of natural log-transformed data and exponentiated regression coefficients were reported. RESULTS Of the hospitals, 32.1% were JCEP-certified and 67.1% participated in GM-ITE®. In the multivariable analysis, the popularity index was higher for hospitals with JCEP certification (1.12, p = 0.022) and GM-ITE® participation (1.14, p = 0.011), urban locations (p < 0.001), and higher annual number of ambulance transports (per log-unit, 1.15, p = 0.006), and lower with longer hospital stay (per log-unit, 0.73, p = 0.005) and at university (0.48; p < 0.001) and university branch (0.59; p < 0.001) hospitals than at community hospitals. CONCLUSION Program popularity in Japan is positively associated with JCEP certification, GM-ITE® participation, urban location, and higher emergency caseload, and negatively associated with longer hospital stay and university affiliation. These findings suggest that assurance of educational quality and opportunities for diverse, practical clinical exposure are important drivers of medical students’ program selection.