Residency Program Directors’ Perspectives on Overtime Duty Hours and Professional Development Time in Japan

Kiyoshi Shikino,1,2,* Yuji Nishizaki,3,* Kazuya Nagasaki,4 Hiroyuki Kobayashi,4 Koshi Kataoka,3 Taro Shimizu,5 Yasuharu Tokuda6,7 1Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan; 2Department of General Medicine, Chiba University Hospital, Chiba, Japan; 3Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan; 4Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan; 5Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan; 6Muribushi Okinawa for Teaching Hospitals, Okinawa, Japan; 7Tokyo Foundation for Policy Research, Tokyo, Japan*These authors contributed equally to this workCorrespondence: Kiyoshi Shikino, Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chu-pu-ku, Chiba, Japan, Tel +81-43-222-7171, Email [email protected]: This study aimed to explore the perspectives of residency program directors in Japan regarding overtime duty hours and the balance between clinical training and self-improvement activities. This study explores the impact of work-hour regulations on resident well-being and training quality, contributing to global discourse on medical education reform.Participants and Methods: A cross-sectional survey was distributed to 701 residency training hospitals across Japan to investigate their readiness for new duty-hour limits under the Medical Care Act, which categorizes working hours into Level A (960 hours/year), Level B (1440 hours/year), and Level C-1 (1920 hours/year). The survey, conducted from October 18 to December 15, 2023, achieved a 36.2% response rate (n=254). Key questions included: “Considering the balance between clinical skills development and mental well-being, what do you think is the optimal number of overtime duty hours per month for resident physicians?” Statistical analysis included descriptive statistics and Chi-square tests to compare responses across hospital types.Results: Most directors favored a conservative overtime limit of 40 hours per month (mean ± standard deviation: 40 ± 21 h), with 24.0% expressing this preference. These findings reveal a significant evidence-practice gap, suggesting that current practices often exceed recommended limits, highlighting a need for alignment between policy and implementation.Conclusion: This study provides insights into the complex interplay between resident training demands and well-being under Japan’s new duty-hour reforms. It offers valuable insights for policymakers and educators aiming to optimize training environments and enhance resident well-being globally.Keywords: duty hours, program director, professional development, residency, work style reform, fatigue management