Assessing Interest and Awareness Among Japanese Medical Students in International Standardized Testing: The Introduction of the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE) in Japan

Title:
"Assessing Interest and Awareness Among Japanese Medical Students in International Standardized Testing: The Introduction of the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE) in Japan"

Authors and Affiliations:
Emi Saegusa-Beecroft, M.D., Ph.D.1,2,4
Kentaroh Takagaki, M.D., Ph.D., B.Agr.3
Junji B. Machi, M.D., Ph.D., FACS1,2,4

1. Office of Global Health and International Medicine, John A, Burns School of Medicine, University of Hawai`i at Manoa
2. Department of Surgery, John A, Burns School of Medicine, University of Hawai`i at Manoa
3. Department of Anatomy and Systems Biology, Faculty of Medicine, University of Yamanashi, Japan
4. JrSr Corporation, Japan (A Non-profit Educational Organization)

Introduction:
Since 2016, the University of Hawaii John A. Burns School of Medicine, in partnership with the JrSr Corporation and 14 out of 82 medical schools in Japan, has been offering the Hawaii Medical Education Program (HMEP). This program offers clinical clerkships, workshops, on-demand course materials, and live online classes, all focused on global health and international medical standards. This study's primary goal was to examine the feasibility of rolling out the National Board of Medical Examiners (NBME) Comprehensive Basic Science (CBSE) and Clinical Science Examinations (CCSE) in Tokyo, potentially impacting the U.S. healthcare workforce, highlighted by Non-U.S. International Medical Graduates comprising 27.2 percent of all primary care positions in the 2023 U.S. match [1], with a particular focus on Hawai'i due to its significant Japanese heritage community (16.5%) [2].

Objectives:
1. To assess the level of interest among Japanese medical students in internationally standardized medical testing, specifically the USMLE Step 1 and NBME shelf examinations.
2. To present the implementation of the NBME CBSE and CCSE in Japan, affirming our HMEP program's direct role in this educational advancement.

Methods:
Using Google Forms, an online anonymous survey was conducted across 14 medical schools, with 1900 students on the HMEP mailing list (20% of medical students). Of those, 279 students (15%) were active participants, defined by direct participation in any of the HMEP curriculum. Participation was voluntary, and data were collected and analyzed by two independent researchers.

Results:
Out of 115 survey responses, 101 responses from medical students were retained (36% of active students), and the other responses from residents and faculty were excluded. Among the valid responses (n=99; 79 pre-clinical and 22 clerkship students), 98% expressed interest in participating in a testing-center-based NBME CBSE (n=97), with 23% strongly determined to take the exam (n=23). Only 1 student was not interested in the USMLE Step 1. While 55% (n=54) planned to take the Step 1 exam during medical school, 8% (n=8) intended to do so during post-graduate residency, and one third remained undecided (35%, n=35). Respondents cited various reasons for pursuing clinical training in the U.S., including experiencing advanced medical practice (64%, n=63), a desire to live in the U.S. (35%, n=35), perceived higher physician compensation (26%, n=26), a desire to see the world (83%, n=82), a passion for global healthcare and international medicine (60%, n=59), and the belief in potential career advantages within Japan (22%, n=22). Regarding the USMLE Step 1, 47.5% (n=47) faced challenges in balancing exam preparation with extracurricular activities and their busy Japanese medical curriculum, while 62% (n=61) found gathering information for effective preparation challenging.

Discussion:
Survey results show strong interest for the NBME CBSE and CCSE at testing centers among Japan's medical students. A majority wish to train in the U.S., aiming for the USMLE. Although this study was limited by its voluntary nature, the survey offers insights into the ambitions and barriers of the responders who are highly-motivated students pursuing international medical careers, who may stand to benefit from new center-based exams, particularly for U.S. residencies.

Conclusion:
The introduction of NBME Shelf Examinations in Japan by the HMEP marks a significant milestone in aligning Japanese medical education with international standards. This initiative is a substantial contribution to the modernization of medical education in Japan. It addresses the strong demand from students aiming for international medical careers and enhances proficiency in professional English communication. The successful implementation of these examinations is anticipated to profoundly impact the global healthcare workforce, including in the U.S., by producing a generation of medical professionals equipped with global competencies and perspectives.

Target Audience:
International Medical Students, Medical School Faculty, Medical School Administrators, Medical Education Researchers.

References:
[1]https://www.nrmp.org/wp-content/uploads/2023/05/2023-Main-Match-Results-and-Data-Book-FINAL.pdf
[2] 2020 Unites States Census