Deep End Placements and Social Empathy: Single Centered Before–After Study in Japan

Makoto Kaneko,1– 4 Osamu Nomura,5 Rei Kansaku,4,6,7 Masahiro Yao,8 Yuki Arakawa,9 Hironori Yamada,4 Yusuke Kanakubo,10 Aya Yumino,4,11 Shohei Matsubara,12,13 Hirotaka Onishi111Department of General Medicine, School of Medicine, Kitasato University, Sagamihara-shi, Kanagawa, Japan; 2Department of Health Data Science, Yokohama City University, Yokohama-shi, Kanagawa, Japan; 3Sagamihara Endowed Chair in Comprehensive Community Medicine, School of Medicine, Kitasato University, Sagamihara-shi, Kanagawa, Japan; 4Yokohama Kotobuki-Cho Health and Welfare Exchange Center Clinic, Yokohama-shi, Kanagawa, Japan; 5Division of Educational Development, Medical Education Development Center, Gifu University, Gifu-shi, Japan; 6Department of Public Health, Juntendo University, Bunkyo-ku, Tokyo, Japan; 7Institute for Multicultural Health, Suginami-ku, Tokyo, Japan; 8Department of Family and Community Medicine, Yokohama Hodogaya Central Hospital, Japan Community Healthcare Organization, Yokohama-shi, Kanagawa, Japan; 9Department of Public Health, School of Medicine, Yokohama City University, Yokohama-shi, Kanagawa, Japan; 10Center for Medical Education, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan; 11Department of International Cooperation for Medical Education, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; 12Tama Family Clinic, Kawasaki-shi, Kanagawa, Japan; 13Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Kochi-shi, Kochi, JapanCorrespondence: Makoto Kaneko, Department of General Medicine, School of Medicine, Kitasato University, 1-15-1 Kitazato Minami-ku, Sagamihara-shi, Kanagawa, 252-0373, Japan, Email kaneko.makoto@kitasato-u.ac.jpPurpose: Medical education in socioeconomically deprived areas may help prepare future physicians to better understand the needs of these communities. However, educational outcomes associated with programmes delivered in such settings remain insufficiently studied. The aim of this study was to describe the educational programme within the deprived area in Japan and assess short-term changes in social empathy.Methods: This single-site, uncontrolled before–after study targeted all individuals who participated in clinical placements at single clinic over a 1-year period in the Japanese deprived area, Kotobuki district, Yokohama. The programme offered structured exposure to the social context of health by combining community-based activities, clinical experience, and reflective practice. Pre- and post-placement changes were evaluated using the Social Empathy Index (SEI) immediately after placement.Results: At 1 year, 49 individuals underwent clinical placement, and 43 consented to participate (median age, 26.0 years; female participants, 58.1%). Medical students and interns (postgraduate physicians at 1 or 2 years) constituted 55.8% of the participants (46.5% and 9.3%, respectively). The median clinical placement duration was 1 day (maximum: 20 days). The mean SEI score was 167.2 (standard deviation [SD]: 20.3) before placement, which increased to 175.1 (SD: 22.2) after placement. Sensitivity analysis restricted to participants with 1-day placement revealed similar trends.Conclusion: This study reports a clinical placement programme in a Japanese socially deprived setting and shows that participation was associated with improvements in learners’ social empathy.Keywords: deep end, social deprivation, primary care, general practice