October 13, 2015

Improving Gender-Specific Health Care Training in Japan Improves Care

The cultural context of teaching and learning sexual health care examinations in Japan: a mixed-methods case study assessing the use of standardized patient instructors among Japanese family physician trainees of the Shizuoka Family Medicine Program

In Japan, deep-rooted taboos surrounding gender-specific health care can deter patients from accessing cancer screening and other important preventive services within the primary care setting.  Less frequent screening is a concern because Japan has higher rates of breast, prostate, uterine, cervical, and ovarian cancer when compared to many other countries. To counter these taboos, researchers at the University of Michigan Department of Family Medicine and Japan’s Shizuoka Family Medicine Program developed a specialized program giving Japanese family medicine residents exposure to world-class training in breast, pelvic, male genital, and prostate examinations. The findings of their evaluation of the program have just been published in the journal, Asia Pacific Family Medicine.

Unique to this training was the use of standardized patient instructors (SPIs), who worked one-on-one with the Japanese family medicine residents during observerships at the University of Michigan. SPIs are not patients, but trained professionals who play the role of patients and provide an opportunity to teach clinical skills. The SPIs provided participating learners individualized feedback about how to conduct these potentially life-saving examinations while also respecting the patient’s modesty.  Attending to modesty is particularly important when working with a Japanese population, as gender-specific health care is perceived by many as intensely embarrassing.  

Michael D. Fetters, M.D., M.P.H., M.A.
Michael D. Fetters, M.D., M.P.H., M.A.

Michael D. Fetters, M.D., M.P.H., M.A., professor of family medicine and director of U-M’s Japanese Family Health Program, directs a clinic serving Japanese patients and training future leaders of family medicine in Japan and was the senior author of the publication.

Dr. Fetters notes, “Providing sexual health care examinations are critical skills for doctors, though systematic training in such skills looms as a huge gap in medical education in Japan.”

Perceptions of the training were universally positive, and the training had a positive effect on residents’ confidence, knowledge, and skill.  Dr. Fetters serves as the lead investigator of the “Shizuoka-University of Michigan Advanced Residency Training Experience and Research in Family Medicine” (SMARTER-FM) project that supported the training. A follow-up evaluation conducted 1 and 2 years after the training in Japan revealed continued benefits, with residents and staff alike describing improved quality in the provision of care.

Despite these positive outcomes, there was general consensus among participants that implementing an SPI training program similar to that offered at the University of Michigan would be difficult within Japan.  In addition to the absence of an institutionalized mechanism to recruit Japanese SPIs, study participants described that SPIs would likely face considerable stigma if their identities were leaked to the community.  This sentiment reflects long-held traditions where discussions about genitalia and sex run counter to social norms.  It was noted that overcoming this barrier would likely require a targeted campaign from credible institutions, such as government and health systems, where a counter message normalizing sex-related and gender-specific health care needs to be assertively communicated.

Dr. Fetters concludes, “This study is an important step showing the feasibility of training sexual health care examinations to Japanese family doctors, and could improve access to sex-related and gender-specific health care in Japan. It shows the primary care setting can be a culturally safe place for gender-specific cancer screening and prevention.”

Eric P. Skye, M.D.
Eric P. Skye, M.D.

Eric P. Skye, M.D., associate professor of family medicine, noted “This study demonstrates the enormous potential of educational collaborations when we combine the resources developed here at the University of Michigan with our international partners.”