Characteristics of junior residents within an established emergency medicine rotation choosing aesthetic medicine as the initial specialty without completing a full specialty residency training program

Characteristics of junior residents within an established emergency medicine rotation choosing aesthetic medicine as the initial specialty without completing a full specialty residency training program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Characteristics of junior residents within an established emergency medicine rotation choosing aesthetic medicine as the initial specialty without completing a full specialty residency training program Koshi Ota, Kanna Ota This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8502125/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In Japan, most physicians complete a two-year postgraduate clinical training program and pursue board certification in a specialty. However, a growing number of junior residents are bypassing traditional residency pathways to enter aesthetic medicine. This study investigated the characteristics of these junior residents. Methods This retrospective, longitudinal, observational study assessed postgraduate year 1 (PGY1) residents during emergency medicine (EM) rotations at a university hospital from 2019 to 2023. An attending EM physician used a three-item survey (Clinical Attitude, Knowledge and Skills, Positive Participation) to evaluate 222 PGY1 residents. Data were collected on demographics, academic history, club activities, and parental occupation. Logistic regression analysis was used to identify factors associated with choosing aesthetic medicine as an initial specialty without completing the full residency. Results Four junior residents chose aesthetic medicine as the initial specialty. These individuals demonstrated significantly lower scores on the three-item survey compared to those entering traditional residencies. A history of academic difficulty (repeating at least one year of medical school) was also significantly associated with choosing aesthetic medicine. Multivariate analysis identified low scores on the three-item survey, history of academic difficulty, and graduating from public universities as factors significantly associated with choosing aesthetic medicine. Conclusion This study suggests that junior residents choosing aesthetic medicine as the initial specialty without completing a full residency may exhibit lower clinical performance during the EM rotation and have a history of academic difficulty. This information may be important for medical education and workforce planning. aesthetic medicine specialty Background Physicians in Japan are required to complete two years of accredited postgraduate clinical training, including rotations in major specialties such as emergency medicine (EM), internal medicine, pediatrics, surgery, and community-based practice. The majority of junior residents then pursue board certification in one of 19 medical specialties through a rigorous specialty residency training program. 1 , 2 However, in recent years, concerns have been growing about junior residents bypassing this traditional training pathway to enter the field of aesthetic medicine. 3 – 5 Many Korean medical graduates have been pursuing high-paying aesthetic medicine (e.g., dermatological procedures) without postgraduate training, 6 and this same phenomenon of junior residents bypassing rigorous specialty residency training has been observed in Japan. 4 , 5 Unlike many other countries, Japan does not legally require specific specialty residency training for physicians practicing aesthetic medicine. 4 The Japan Society of Aesthetic Surgery offers certification, but this is not mandatory for performing cosmetic procedures. 4 To better understand this trend, we investigated the characteristics of junior residents who chose aesthetic medicine as their initial specialty, despite completing an EM rotation. The EM rotation provides a unique opportunity to assess clinical skills, decision-making abilities, and adaptability to high-pressure situations in residents. 7 By examining the characteristics of those who chose aesthetic medicine, we aimed to identify factors that may influence this career choice. Methods This retrospective, longitudinal, observational study investigated postgraduate year 1 (PGY1) residents during EM rotations conducted from 1 April 2019 to 31 March 2024 (fiscal years 2019–2023). Each rotation lasted 2 months. This study was conducted at an academic university hospital and received approval from the institutional review board. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines were adhered to in the study design and in reporting the results. 8 Participants Participants were 222 PGY1 residents in the EM rotation at an academic university hospital during the 2019–2023 fiscal years. Table 1 lists the specialties of interest for PGY1 residents at the time of the EM rotation. Table 1 Characteristics of junior residents within an established emergency medicine rotation choosing aesthetic medicine as the initial specialty without completing a full specialty residency training program Junior residents who did not choose aesthetic medicine as initial specialty Junior residents who chose aesthetic medicine as initial specialty P-value Sex 1.000 Male 142 3 Female 76 1 Parents 0.071 Not doctor 67 4 General practitioner (private clinic) 67 0 Hospital doctor 66 0 Dentist 14 0 University 0.275 Private medical university 202 3 Public university 16 1 Repeated at least one year of medical school 23 2 0.064 Retook the entrance exam 17 0 1.000 Specialties of interest for PGY1 residents at time of EM rotation 0.018 Internal Medicine Group 86 0 Surgery Group 59 0 Others Group 73 4 Club activities 0.797 Badminton, basketball, handball, volleyball, ice hockey 31 1 Baseball, futsal, soccer, rugby 27 0 Combat sports (aikido, archery, fencing, judo, and karate) 23 0 Cultural clubs and dance 39 1 Golf 21 1 Mountain and marine 15 1 Swimming and track and field 16 0 Tennis (including soft tennis and table tennis) 28 0 Team manager 6 0 No or missing 12 0 The Internal Medicine Group included cardiology, gastroenterology, respiratory medicine, nephrology, neurology, hematology, and rheumatology. The Surgery Group included cardiovascular surgery, thoracic surgery, gastroenterological surgery, breast and endocrine surgery, orthopedic surgery, neurosurgery, obstetrics and gynecology, urology, and EM. The Others Group included pediatrics, anesthesiology, ophthalmology, otorhinolaryngology, dermatology, plastic surgery, radiology, pathology, and psychiatry. Cultural clubs included art club, camera club, chorus, jazz, life support club, literary club, orchestra, tea ceremony, and volunteer club. Residents were divided into three groups: 1) an Internal Medicine Group; 2) a Surgery Group; and 3) an Others Group. The Internal Medicine Group included cardiology, gastroenterology, respiratory medicine, nephrology, neurology, hematology, and rheumatology. The Surgery Group included cardiovascular surgery, thoracic surgery, gastroenterological surgery, breast and endocrine surgery, orthopedic surgery, neurosurgery, obstetrics and gynecology, urology, and EM. The Others Group included pediatrics, anesthesiology, ophthalmology, otorhinolaryngology, dermatology, plastic surgery, radiology, pathology, and psychiatry. Table 2 shows the final chosen specialties after completing two years of postgraduate training. Table 2 Final specialty chosen by junior residents Specialty n Percentage Anesthesiology 9 4.05 Breast surgery 6 2.7 Cardiovascular medicine 13 5.86 Dermatology 9 4.05 Diabetes, metabolism and endocrinology 10 4.5 Emergency medicine 11 4.95 Gastroenterology 16 7.21 General and gastroenterological surgery 11 4.95 General medicine 3 1.35 Hematology 5 2.25 Nephrology 18 8.11 Neurology 2 0.9 Neuropsychiatry 15 6.76 Neurosurgery 4 1.8 Obstetrics and gynecology 9 4.05 Ophthalmology 14 6.31 Orthopedic surgery 11 4.95 Otorhinolaryngology - head & neck surgery 2 0.9 Pathology 1 0.45 Pediatrics 7 3.15 Plastic surgery 5 2.25 Radiology 5 2.25 Respiratory medicine 10 4.5 Rheumatology 9 4.05 Thoracic surgery 1 0.45 Urology 6 2.7 Non-traditional medical specialty outside of the 19 core specialties 10 4.55 Non-traditional Medical Specialties: Aesthetic Medicine: four individuals chose to pursue a career in aesthetic medicine. Going on a Journey: two individuals decided to take time off from medical training to travel or pursue personal interests. Dropping Out: one individual chose to leave the residency program. Industrial Physician: one individual opted for a career as an industrial physician, focusing on occupational health and safety. Free Psychiatry: one individual chose to practice psychiatry independently, outside of a traditional hospital or clinic setting. Residency Training Abroad: one individual decided to pursue residency training in a foreign country. Assessment At completion of the two-month EM rotation, each PGY1 resident was assessed by an attending physician. This assessment utilized the E-POrtfolio of Clinical training for PostGraduates (PG-EPOC), a national electronic common portfolio equipped with rubrics for detailed items in domains A, B, and C. This portfolio serves to facilitate observational assessments of junior residents. The attending physician further supplemented this evaluation by discussing the performance of each resident with three EM residents (postgraduate year 3–5) using a three-item survey. The survey evaluated PGY1 residents on a 5-point Likert scale (with 5 indicating highest performance) across three key areas: Clinical Attitude; Knowledge and Skills; and Positive Participation in EM practice. Clinical Attitude was assessed based on the level of professionalism, including factors such as respectful patient interaction, appropriate attire, and effective communication. Knowledge and Skills were evaluated based on demonstrated medical knowledge and proficiency in critical skills like venipuncture during cardiac arrest. Positive Participation in EM practice was assessed based on teamwork, willingness to help, effective communication with team members, and proactive approach to patient care. The survey results are presented in Table 3 . Table 3 Evaluation of postgraduate year 1 residents Junior residents who did not choose aesthetic medicine as initial specialty Junior residents who chose aesthetic medicine as initial specialty Mean 95%CI Mean 95%CI P-value Clinical attitude 3.78 3.66 - 3.90 2.25 0.39 - 4.11 0.0045 Knowledge and skill 3.36 3.26 - 3.46 2.08 1.18 - 2.99 0.0003 Positive participation 3.66 3.54 - 3.78 2.25 0.50 - 4.00 0.0124 Total score from three-item survey 3.60 3.49 - 3.70 2.19 0.78 - 3.61 0.0045 CI: confidence interval. Assessment utilized the E-POrtfolio of Clinical training for PostGraduates (PG-EPOC), a public electronic common portfolio equipped with rubrics for detailed items in domains A, B, and C. This portfolio serves to facilitate observational assessments of junior residents. The attending physician further supplemented this evaluation by discussing resident performance with three EM residents (postgraduate years 3–5) using a three-item survey. This survey evaluated PGY1 residents on a 5-point Likert scale (with 5 indicating the highest performance) across three key areas: clinical attitude; knowledge and skill in EM; and positive participation in EM practice. Total score from the three-item survey represents the average of scores for these three key areas. Responses were measured on a scale of 1 to 5, with 5 representing the best score. Statistical analysis The primary outcome of this study was to identify factors associated with junior residents opting for aesthetic medicine as the initial specialty. The subgroup analysis included factors affecting the change in score using simple and multiple linear regression analyses. Values are reported as mean and standard deviation for continuous variables, and as frequencies with percentages for categorical variables. Fisher’s exact test was used for categorical variables. The Mann–Whitney U test was used for the analysis of two groups. Uni- and multivariate logistic regression analyses were performed to examine associations between the final chosen specialties of junior residents (after two years of postgraduate training) and baseline characteristics previously determined to be associated with specialty choice. These baseline characteristics included sex, participation in club activities during medical school, academic difficulty during medical school, a history of retaking the medical school entrance exam, parental occupation, and assessment by an emergency attending physician using a three-item survey based on the PG-EPOC framework. All tests were two-tailed, with P-values < 0.05 considered significant. All analyses were performed using STATA software (version 16.1; Stata Corp., College Station, TX, USA). Results A total of 222 PGY1 residents (145 men, 77 women) were recruited at an academic university hospital over the course of 5 years. Four junior residents decided to choose aesthetic medicine as the initial specialty without completing a full specialty residency training program. Table 1 shows the characteristics of junior residents within an established EM rotation choosing aesthetic medicine as the initial specialty without completing a full specialty residency training program. None of the parents of junior residents who chose aesthetic medicine as their initial specialty were doctors. Two of the four junior residents who chose aesthetic medicine as the initial specialty had repeated at least one year of medical school. All four junior residents who chose aesthetic medicine as the initial specialty had participated in club activities during medical school. Table 2 shows the final chosen specialties after completing two years of postgraduate training. In total, 10 residents chose a non-traditional medical specialty outside of the 19 core specialties. Excluding the four junior residents who decided to choose aesthetic medicine, two junior residents decided to take time off from medical training to travel or pursue personal interests, one junior resident opted for a career as an industrial physician, one junior resident chose to leave their residency program, one junior resident chose to practice psychiatry independently, outside of a traditional hospital or clinic setting, and one junior resident decided to pursue residency training in a foreign country (Supplemental Table 1). The parents of the 10 residents in non-standard training pathways were not general practitioners in private clinics (Supplemental Table 1). Table 3 shows the results of assessment by an attending physician (based on the PG-EPOC) using the three-item survey in three areas: Clinical Attitude, Knowledge and Skills, and Positive Participation in EM practice. Each item was scored on a scale of 1–5, with 5 as the highest score. Junior residents who chose aesthetic medicine (n = 4) performed significantly worse than junior residents who did not chose aesthetic medicine (n = 218) in all three areas (Table 3 ). Similarly, all 10 junior residents who chose a non-traditional medical specialty outside of the 19 core specialties also performed significantly worse in all three areas than junior residents who chose a full specialty residency training program (Supplemental Table 2). Univariate logistic regression analysis revealed that choosing aesthetic medicine as the initial specialty was significantly associated with lower scores in the three areas of Clinical Attitude, Knowledge and Skills, and Positive Participation in EM practice. We defined "history of academic difficulty" as repetition of at least one academic year, which is generally required at Japanese medical schools for students who fail a single required course. A history of academic difficulty was also significantly associated with choosing aesthetic medicine as the initial specialty (Table 4 ). PGY1 residents in non-standard training pathways (n = 10) exhibited some similar tendencies to those choosing aesthetic medicine (n = 4). However, compared to PGY1 residents in standard training pathways (n = 212), the non-standard pathway group demonstrated a significantly higher proportion of graduates from public universities (Supplemental Table 3). The most significant distinctions between public and private medical schools in Japan are their financial cost (private tuition being approximately seven times higher than public tuition), class size (private schools having a typically larger average enrollment, such as 117.7 students vs. 105.0 in 2019), and research focus, where public schools have historically been the dominant recipients of grant funding. 9 Multivariate logistic regression analysis revealed that choosing aesthetic medicine as the initial specialty was significantly associated with low total score from the three-item survey, as well as a history of academic difficulty, and graduating from a public university (Table 5 ). However, for PGY1 residents in non-standard training pathways (n = 10), associations were still seen with low total three-item survey score and graduation from a public university, along with participation in cultural clubs and dance during medical school (Supplemental Table 4). Table 4 Univariate logistic regression analysis of choosing aesthetic medicine as initial specialty Odds ratio 95%CI P-value Male 1.61 0.16 - 15.78 0.685 Clinical attitude 0.24 0.09 - 0.61 0.003 Knowledge and skill 0.14 0.06 - 0.35 < 0.001 Positive participation 0.25 0.09 - 0.68 0.006 Total score from three-item survey 0.18 0.07 - 0.51 0.001 Graduated from a public university 4.21 0.41 - 43.04 0.226 Repeated at least one year of medical school 8.48 1.13 - 63.38 0.037 Retook the entrance exam empty Parents Not doctor Reference General practitioner empty Hospital doctor empty Dentist empty Club activities Badminton, basketball, handball, volleyball, ice hockey Reference Baseball, futsal, soccer, rugby empty Combat sports (aikido, archery, fencing, judo, and karate) empty Cultural clubs and dance 0.79 0.05 - 13.40 0.87 Golf 1.48 0.09 - 25.25 0.79 Mountain and marine 2.07 0.12 - 35.82 0.62 Swimming and track and field empty Tennis (including soft tennis and table tennis) empty Team manager empty No or missing empty CI: confidence interval. Cultural clubs included art club, camera club, chorus, jazz, life support club, literary club, orchestra, tea ceremony, and volunteer club. Assessment utilized the E-POrtfolio of Clinical training for PostGraduates (PG-EPOC), a public electronic common portfolio equipped with rubrics for detailed items in domains A, B, and C. This portfolio serves to facilitate observational assessments of junior residents. The attending physician further supplemented this evaluation by discussing resident performance with three EM residents (postgraduate years 3–5) using a three-item survey. This survey evaluated PGY1 residents on a 5-point Likert scale (with 5 indicating the highest performance) across three key areas: clinical attitude; knowledge and skill in EM; and positive participation in EM practice. Total score from the three-item survey represents the average of scores for these three key areas. Responses were measured on a scale of 1 to 5, with 5 representing the best score. Table 5 Multivariate logistic regression analysis of choosing aesthetic medicine as initial specialty Odds ratio 95%CI P-value Male 0.59 0.02 - 14.20 0.743 Total score from three-item survey 0.01 0.00 - 0.16 0.001 Graduated from a public university 850.33 3.02 - 239,646.00 0.019 Repeated at least one year of medical school 769.22 26.91 - 21,986.30 < 0.001 Retook the entrance exam empty Parents Not doctor Reference General practitioner empty Hospital doctor empty Dentist empty Club activities Badminton, basketball, handball, volleyball, ice hockey Reference Baseball, futsal, soccer, rugby empty Combat sports (aikido, archery, fencing, judo, and karate) empty Cultural clubs and dance 6.00 0.16 - 231.88 0.336 Golf 16.80 0.59 - 480.05 0.099 Mountain and marine 3.90 0.27 - 55.57 0.315 Swimming and track and field empty Tennis (including soft tennis and table tennis) empty Team manager empty No or missing empty CI: confidence interval. Cultural clubs included art club, camera club, chorus, jazz, life support club, literary club, orchestra, tea ceremony, and volunteer club. Assessment utilized the E-POrtfolio of Clinical training for PostGraduates (PG-EPOC), a national electronic common portfolio equipped with rubrics for detailed items in domains A, B, and C. This portfolio serves to facilitate observational assessments of junior residents. The attending physician further supplemented this evaluation by discussing resident performance with three EM residents (postgraduate years 3–5) using a three-item survey. This survey evaluated PGY1 residents on a 5-point Likert scale (with 5 indicating the highest performance) across three key areas: clinical attitude; knowledge and skill in EM; and positive participation in EM practice. Total score from the three-item survey represents the average of scores for these three key areas. Responses were measured on a scale of 1 to 5, with 5 representing the best score. Discussion Characteristics of the four PGY1 residents within an established EM rotation who chose aesthetic medicine as their initial specialty without completing a full specialty residency training program were investigated over five years. We also investigated the characteristics of all 10 PGY1 residents in non-standard training pathways who did not complete a full specialty residency training program. None of these PGY1 residents initially intended to specialize in aesthetic medicine during the EM rotation. None of the parents of the junior residents who chose aesthetic medicine as the initial specialty, nor of the 10 in non-standard training pathways, were general practitioners in private clinics. While clear evidence remains lacking, the children of general practitioners in private clinics seem likely to have witnessed their parents working and they may be better equipped to meet the expectations of residency by receiving advice from their parents on successful study habits or coping strategies. Therefore, they may not directly pursue aesthetic medicine. The choice of medical specialty reportedly often reflects parental influences, particularly when parents are physicians. 10 – 12 Aesthetic medicine offers potential for high earnings, 5,6 but also carries a risk of limited long-term career prospects due to a lack of specialty board certification and lower levels of specialized expertise. 5 Further, the longevity of these high earnings is uncertain. Consequently, physician parents may be unlikely to encourage their children to pursue aesthetic medicine directly without completing a specialty residency training program. PGY1 residents who chose aesthetic medicine in this study demonstrated significantly lower scores on the three-item survey compared with those who selected other specialties. One possible explanation for this finding is that residents pursuing aesthetic medicine may have lacked intrinsic enthusiasm or commitment toward EM practice. Such diminished engagement may have led them to prioritize a non-standard specialty path, resulting in lower observational assessment scores compared to their more engaged peers. Uni- and multivariate logistic regression analyses revealed that a history of academic difficulty, such as repeating at least one year of medical school, was significantly associated with a tendency of PGY1 residents to choose aesthetic medicine as their initial specialty without completing a full specialty residency training program. The small sample size of only four junior residents choosing aesthetic medicine as the initial specialty limits the generalizability of these findings to other institutions. However, this observation raises the possibility that these individuals may have lacked enthusiasm for traditional medical practice even during their time in medical school, prior to beginning junior residency. Univariate logistic regression analysis showed that the 10 residents in the non-standard pathway group demonstrated significantly a higher proportion of public university graduates as well as lower scores on the three-item survey, as assessed by the EM attending physician compared to PGY1 residents who ended up taking standard training pathways. As our institution is a private medical university, a large proportion of our graduates work here, and the representation of graduates from public universities is relatively low (Table 1 ). A higher proportion of the parents of junior residents were physicians compared with the socioeconomic backgrounds reported in other studies. 13 Nevertheless, the medical abilities of PGY1 residents appeared comparable to those of senior residents and attending physicians. 14 , 15 Aesthetic medicine offers a high earning potential, even for those without prior experience. 6 Further, the work schedule typically does not involve any night shifts or on-call duties, and generally provides more time off compared to other medical specialties. 5 This trend is increasingly attracting medical students or junior residents who prioritize cost-effectiveness and time management. 5 Medical students and junior residents consider not only income, work-life balance and workload, but also academic interest and prestige when choosing a specialty. 11 , 16 – 18 Medical students and junior residents with parents who are not physicians may prioritize income, workload, and work-life balance more highly than academic interest, prestige, or patient-centered care when making career decisions, potentially due to various factors, such as a lack of direct exposure to the professional lives of physician parents. This study has several limitations. First, the number of junior residents who chose aesthetic medicine as the initial specialty without completing a full specialty residency training program was small (n = 4). Similarly, only 10 junior residents were in non-standard training pathways without completing a full residency. The small sample sizes involved may have influenced the results and resulted in wide confidence intervals. Second, this study was conducted at a single institution, limiting the generalizability to other institutions. Third, while growing concerns are being voiced regarding junior residents bypassing traditional training pathways to enter aesthetic medicine, this study represents an initial exploration of the characteristics of these junior residents. Future research with larger, multi-institutional samples is needed to confirm these findings and explore the motivations and long-term career trajectories of physicians pursuing non-traditional pathways such as aesthetic medicine. Understanding these factors is important for medical education and workforce planning, ensuring that physicians are adequately trained and prepared to meet the evolving healthcare needs of the population. Further, exploring the potential influences of parental background and exposures to physician role models may provide valuable context for these career decisions. Conclusion This study provides preliminary insights into the characteristics of junior residents who choose aesthetic medicine as their initial specialty without completing a full residency training program. Our findings suggest that these individuals may exhibit lower scores in assessments of clinical attitude, knowledge, and skills during the EM rotation, and are more likely to have a history of academic difficulties in medical school. This study highlights the need for further discussion within the medical community regarding the implications of non-standard training pathways and the potential impacts on both patient care and the medical profession. Declarations Ethical approval and consent to participate The research was approved and consent to participate was obtained by the institutional review board at Osaka Medical and Pharmaceutical University (approval no. 2767). Informed consent Written informed consent was obtained from all subjects before the study. Declaration of conflicting interests The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors received no financial support for the research, authorship, and/or publication of this article. ORCiD ID Koshi Ota https://orcid.org/0000-0002-1461-7031 Data availability statement The data sets used and/or analyzed during this study are available from the corresponding author on reasonable request. Authors' contributions All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work. Concept and design: Koshi Ota, Kanna Ota Acquisition, analysis, or interpretation of data: Koshi Ota, Kanna Ota Drafting of the manuscript: Koshi Ota, Kanna Ota Critical review of the manuscript for important intellectual content: Koshi Ota, Kanna Ota References Onishi H. History of Japanese medical education The introduction of Western-style med- ical education. Korean J Med Educ. 2018;30(4):283–94. 10.3946/kjme.2018.103 . Takeda Y, Morio K, Snell L, Otaki J, Takahashi M, Kai I. 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Sites of blood collection and topical disinfectants associated with contaminated cultures: An ambidirectional cohort study. J Gen Fam Med. 2024;25(1):45–52. 10.1002/jgf2.667 . Yang Y, Li J, Wu X, et al. Factors influencing subspecialty choice among medical students: A systematic review and meta-analysis. BMJ Open BMJ Publishing Group. 2019;9(3). 10.1136/bmjopen-2018-022097 . Spooner S, Pearson E, Gibson J, Checkland K. How do workplaces, working practices and colleagues affect UK doctors’ career decisions? A qualitative study of junior doctors’ career decision making in the UK. BMJ Open. 2017;7(10). 10.1136/bmjopen-2017-018462 . Ní hÉalaithe C, Howard A, Corcoran P, et al. Factors influencing medical students’ decision to pursue a career in obstetrics and gynaecology. PLoS ONE. 2023;18(12 December). 10.1371/journal.pone.0288130 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8502125","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":583309119,"identity":"4ab1a5cd-21b7-43dd-acf2-41156522bb0c","order_by":0,"name":"Koshi Ota","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYBACCQYGNoYEEIu9AS6YQJQWCQaeA6RoAdMS+BUigGR7+7MHDxhs6vhnPj66ubCNQZ6/geHZA3xapHnOmBskMKRJSNxOS7s9s43BcMYBhnQDfFrkJHLYgE46LMFwO8fsNm8bA+MGBqAB+LWkPwNrkb95BqzFnqAWaYkEM7AWgxs8YC2JBLVI9pwBajFIk9x4BuiXGeckkmccJuAXiePtzyR/VNjwyx0/fOx2QZmNbX97T9oDfFogAGoqMziemHnSCOuAAWYIxX6MeC2jYBSMglEwEgAAw0VCBHtsi5oAAAAASUVORK5CYII=","orcid":"","institution":"Osaka Medical and Pharmaceutical University","correspondingAuthor":true,"prefix":"","firstName":"Koshi","middleName":"","lastName":"Ota","suffix":""},{"id":583309120,"identity":"83c8c6a6-7f28-4ea3-b831-bbacb663bcee","order_by":1,"name":"Kanna Ota","email":"","orcid":"","institution":"Osaka healthcare clinic","correspondingAuthor":false,"prefix":"","firstName":"Kanna","middleName":"","lastName":"Ota","suffix":""}],"badges":[],"createdAt":"2026-01-02 16:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8502125/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8502125/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101881273,"identity":"cd07e67a-01a4-42a7-a70d-8e85be08d280","added_by":"auto","created_at":"2026-02-04 15:11:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":997150,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8502125/v1/d99a6a45-b068-40d6-a635-d0895b0b95d1.pdf"},{"id":101697434,"identity":"ec7a33b0-a947-4651-b7c2-d87933d1249a","added_by":"auto","created_at":"2026-02-02 17:14:17","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29946,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8502125/v1/7fbd29da9ebcb3e28da29115.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Characteristics of junior residents within an established emergency medicine rotation choosing aesthetic medicine as the initial specialty without completing a full specialty residency training program","fulltext":[{"header":"Background","content":"\u003cp\u003ePhysicians in Japan are required to complete two years of accredited postgraduate clinical training, including rotations in major specialties such as emergency medicine (EM), internal medicine, pediatrics, surgery, and community-based practice. The majority of junior residents then pursue board certification in one of 19 medical specialties through a rigorous specialty residency training program.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHowever, in recent years, concerns have been growing about junior residents bypassing this traditional training pathway to enter the field of aesthetic medicine.\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Many Korean medical graduates have been pursuing high-paying aesthetic medicine (e.g., dermatological procedures) without postgraduate training,\u003csup\u003e6\u003c/sup\u003e and this same phenomenon of junior residents bypassing rigorous specialty residency training has been observed in Japan.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Unlike many other countries, Japan does not legally require specific specialty residency training for physicians practicing aesthetic medicine.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e The Japan Society of Aesthetic Surgery offers certification, but this is not mandatory for performing cosmetic procedures.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e To better understand this trend, we investigated the characteristics of junior residents who chose aesthetic medicine as their initial specialty, despite completing an EM rotation.\u003c/p\u003e \u003cp\u003eThe EM rotation provides a unique opportunity to assess clinical skills, decision-making abilities, and adaptability to high-pressure situations in residents.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e By examining the characteristics of those who chose aesthetic medicine, we aimed to identify factors that may influence this career choice.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis retrospective, longitudinal, observational study investigated postgraduate year 1 (PGY1) residents during EM rotations conducted from 1 April 2019 to 31 March 2024 (fiscal years 2019\u0026ndash;2023). Each rotation lasted 2 months. This study was conducted at an academic university hospital and received approval from the institutional review board.\u003c/p\u003e \u003cp\u003eStrengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines were adhered to in the study design and in reporting the results.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eParticipants were 222 PGY1 residents in the EM rotation at an academic university hospital during the 2019\u0026ndash;2023 fiscal years. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e lists the specialties of interest for PGY1 residents at the time of the EM rotation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of junior residents within an established emergency medicine rotation choosing aesthetic medicine as the initial specialty without completing a full specialty residency training program\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior residents who did not choose\u003c/p\u003e \u003cp\u003eaesthetic medicine as initial specialty\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJunior residents who chose aesthetic\u003c/p\u003e \u003cp\u003emedicine as initial specialty\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral practitioner (private clinic)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDentist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate medical university\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic university\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepeated at least one year of medical school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetook the entrance exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialties of interest for PGY1 residents at time of EM rotation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal Medicine Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClub activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBadminton, basketball, handball, volleyball, ice hockey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseball, futsal, soccer, rugby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombat sports (aikido, archery, fencing, judo, and karate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCultural clubs and dance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGolf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMountain and marine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwimming and track and field\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTennis (including soft tennis and table tennis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeam manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo or missing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eThe Internal Medicine Group included cardiology, gastroenterology, respiratory medicine, nephrology, neurology, hematology, and rheumatology. The Surgery Group included cardiovascular surgery, thoracic surgery, gastroenterological surgery, breast and endocrine surgery, orthopedic surgery, neurosurgery, obstetrics and gynecology, urology, and EM. The Others Group included pediatrics, anesthesiology, ophthalmology, otorhinolaryngology, dermatology, plastic surgery, radiology, pathology, and psychiatry.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eCultural clubs included art club, camera club, chorus, jazz, life support club, literary club, orchestra, tea ceremony, and volunteer club.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eResidents were divided into three groups: 1) an Internal Medicine Group; 2) a Surgery Group; and 3) an Others Group. The Internal Medicine Group included cardiology, gastroenterology, respiratory medicine, nephrology, neurology, hematology, and rheumatology. The Surgery Group included cardiovascular surgery, thoracic surgery, gastroenterological surgery, breast and endocrine surgery, orthopedic surgery, neurosurgery, obstetrics and gynecology, urology, and EM. The Others Group included pediatrics, anesthesiology, ophthalmology, otorhinolaryngology, dermatology, plastic surgery, radiology, pathology, and psychiatry. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the final chosen specialties after completing two years of postgraduate training.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinal specialty chosen by junior residents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialty\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDermatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, metabolism and endocrinology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastroenterology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral and gastroenterological surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNephrology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeuropsychiatry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurosurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstetrics and gynecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOphthalmology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthopedic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOtorhinolaryngology - head \u0026amp; neck surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlastic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRheumatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThoracic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-traditional medical specialty outside of the 19 core specialties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eNon-traditional Medical Specialties:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eAesthetic Medicine: four individuals chose to pursue a career in aesthetic medicine.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eGoing on a Journey: two individuals decided to take time off from medical training to travel or pursue personal interests.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eDropping Out: one individual chose to leave the residency program.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eIndustrial Physician: one individual opted for a career as an industrial physician, focusing on occupational health and safety.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eFree Psychiatry: one individual chose to practice psychiatry independently, outside of a traditional hospital or clinic setting.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eResidency Training Abroad: one individual decided to pursue residency training in a foreign country.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessment\u003c/h3\u003e\n\u003cp\u003eAt completion of the two-month EM rotation, each PGY1 resident was assessed by an attending physician. This assessment utilized the E-POrtfolio of Clinical training for PostGraduates (PG-EPOC), a national electronic common portfolio equipped with rubrics for detailed items in domains A, B, and C. This portfolio serves to facilitate observational assessments of junior residents. The attending physician further supplemented this evaluation by discussing the performance of each resident with three EM residents (postgraduate year 3\u0026ndash;5) using a three-item survey. The survey evaluated PGY1 residents on a 5-point Likert scale (with 5 indicating highest performance) across three key areas: Clinical Attitude; Knowledge and Skills; and Positive Participation in EM practice. Clinical Attitude was assessed based on the level of professionalism, including factors such as respectful patient interaction, appropriate attire, and effective communication. Knowledge and Skills were evaluated based on demonstrated medical knowledge and proficiency in critical skills like venipuncture during cardiac arrest. Positive Participation in EM practice was assessed based on teamwork, willingness to help, effective communication with team members, and proactive approach to patient care. The survey results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of postgraduate year 1 residents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eJunior residents who did not choose\u003c/p\u003e \u003cp\u003eaesthetic medicine as initial specialty\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eJunior residents who chose aesthetic\u003c/p\u003e \u003cp\u003emedicine as initial specialty\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical attitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.0045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge and skill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.0003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.0124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score from three-item survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.0045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eCI: confidence interval.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eAssessment utilized the E-POrtfolio of Clinical training for PostGraduates (PG-EPOC), a public electronic common portfolio equipped with rubrics for detailed items in domains A, B, and C. This portfolio serves to facilitate observational assessments of junior residents. The attending physician further supplemented this evaluation by discussing resident performance with three EM residents (postgraduate years 3\u0026ndash;5) using a three-item survey. This survey evaluated PGY1 residents on a 5-point Likert scale (with 5 indicating the highest performance) across three key areas: clinical attitude; knowledge and skill in EM; and positive participation in EM practice. Total score from the three-item survey represents the average of scores for these three key areas. Responses were measured on a scale of 1 to 5, with 5 representing the best score.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe primary outcome of this study was to identify factors associated with junior residents opting for aesthetic medicine as the initial specialty. The subgroup analysis included factors affecting the change in score using simple and multiple linear regression analyses.\u003c/p\u003e \u003cp\u003eValues are reported as mean and standard deviation for continuous variables, and as frequencies with percentages for categorical variables. Fisher\u0026rsquo;s exact test was used for categorical variables. The Mann\u0026ndash;Whitney U test was used for the analysis of two groups. Uni- and multivariate logistic regression analyses were performed to examine associations between the final chosen specialties of junior residents (after two years of postgraduate training) and baseline characteristics previously determined to be associated with specialty choice. These baseline characteristics included sex, participation in club activities during medical school, academic difficulty during medical school, a history of retaking the medical school entrance exam, parental occupation, and assessment by an emergency attending physician using a three-item survey based on the PG-EPOC framework. All tests were two-tailed, with P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered significant. All analyses were performed using STATA software (version 16.1; Stata Corp., College Station, TX, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 222 PGY1 residents (145 men, 77 women) were recruited at an academic university hospital over the course of 5 years. Four junior residents decided to choose aesthetic medicine as the initial specialty without completing a full specialty residency training program. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the characteristics of junior residents within an established EM rotation choosing aesthetic medicine as the initial specialty without completing a full specialty residency training program. None of the parents of junior residents who chose aesthetic medicine as their initial specialty were doctors. Two of the four junior residents who chose aesthetic medicine as the initial specialty had repeated at least one year of medical school. All four junior residents who chose aesthetic medicine as the initial specialty had participated in club activities during medical school. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the final chosen specialties after completing two years of postgraduate training. In total, 10 residents chose a non-traditional medical specialty outside of the 19 core specialties. Excluding the four junior residents who decided to choose aesthetic medicine, two junior residents decided to take time off from medical training to travel or pursue personal interests, one junior resident opted for a career as an industrial physician, one junior resident chose to leave their residency program, one junior resident chose to practice psychiatry independently, outside of a traditional hospital or clinic setting, and one junior resident decided to pursue residency training in a foreign country (Supplemental Table\u0026nbsp;1). The parents of the 10 residents in non-standard training pathways were not general practitioners in private clinics (Supplemental Table\u0026nbsp;1). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the results of assessment by an attending physician (based on the PG-EPOC) using the three-item survey in three areas: Clinical Attitude, Knowledge and Skills, and Positive Participation in EM practice. Each item was scored on a scale of 1\u0026ndash;5, with 5 as the highest score. Junior residents who chose aesthetic medicine (n\u0026thinsp;=\u0026thinsp;4) performed significantly worse than junior residents who did not chose aesthetic medicine (n\u0026thinsp;=\u0026thinsp;218) in all three areas (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Similarly, all 10 junior residents who chose a non-traditional medical specialty outside of the 19 core specialties also performed significantly worse in all three areas than junior residents who chose a full specialty residency training program (Supplemental Table\u0026nbsp;2). Univariate logistic regression analysis revealed that choosing aesthetic medicine as the initial specialty was significantly associated with lower scores in the three areas of Clinical Attitude, Knowledge and Skills, and Positive Participation in EM practice. We defined \"history of academic difficulty\" as repetition of at least one academic year, which is generally required at Japanese medical schools for students who fail a single required course. A history of academic difficulty was also significantly associated with choosing aesthetic medicine as the initial specialty (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). PGY1 residents in non-standard training pathways (n\u0026thinsp;=\u0026thinsp;10) exhibited some similar tendencies to those choosing aesthetic medicine (n\u0026thinsp;=\u0026thinsp;4). However, compared to PGY1 residents in standard training pathways (n\u0026thinsp;=\u0026thinsp;212), the non-standard pathway group demonstrated a significantly higher proportion of graduates from public universities (Supplemental Table\u0026nbsp;3). The most significant distinctions between public and private medical schools in Japan are their financial cost (private tuition being approximately seven times higher than public tuition), class size (private schools having a typically larger average enrollment, such as 117.7 students vs. 105.0 in 2019), and research focus, where public schools have historically been the dominant recipients of grant funding.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Multivariate logistic regression analysis revealed that choosing aesthetic medicine as the initial specialty was significantly associated with low total score from the three-item survey, as well as a history of academic difficulty, and graduating from a public university (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). However, for PGY1 residents in non-standard training pathways (n\u0026thinsp;=\u0026thinsp;10), associations were still seen with low total three-item survey score and graduation from a public university, along with participation in cultural clubs and dance during medical school (Supplemental Table\u0026nbsp;4).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate logistic regression analysis of choosing aesthetic medicine as initial specialty\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical attitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge and skill\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score from three-item survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduated from a public university\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepeated at least one year of medical school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetook the entrance exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDentist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClub activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBadminton, basketball, handball, volleyball, ice hockey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseball, futsal, soccer, rugby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombat sports (aikido, archery, fencing, judo, and karate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCultural clubs and dance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGolf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMountain and marine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwimming and track and field\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTennis (including soft tennis and table tennis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeam manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo or missing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCI: confidence interval.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCultural clubs included art club, camera club, chorus, jazz, life support club, literary club, orchestra, tea ceremony, and volunteer club.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAssessment utilized the E-POrtfolio of Clinical training for PostGraduates (PG-EPOC), a public electronic common portfolio equipped with rubrics for detailed items in domains A, B, and C. This portfolio serves to facilitate observational assessments of junior residents. The attending physician further supplemented this evaluation by discussing resident performance with three EM residents (postgraduate years 3\u0026ndash;5) using a three-item survey. This survey evaluated PGY1 residents on a 5-point Likert scale (with 5 indicating the highest performance) across three key areas: clinical attitude; knowledge and skill in EM; and positive participation in EM practice. Total score from the three-item survey represents the average of scores for these three key areas. Responses were measured on a scale of 1 to 5, with 5 representing the best score.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression analysis of choosing aesthetic medicine as initial specialty\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score from three-item survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduated from a public university\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e850.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e239,646.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepeated at least one year of medical school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e769.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21,986.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetook the entrance exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDentist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClub activities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBadminton, basketball, handball, volleyball, ice hockey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseball, futsal, soccer, rugby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombat sports (aikido, archery, fencing, judo, and karate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCultural clubs and dance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e231.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGolf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e480.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMountain and marine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwimming and track and field\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTennis (including soft tennis and table tennis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeam manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo or missing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eempty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCI: confidence interval.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCultural clubs included art club, camera club, chorus, jazz, life support club, literary club, orchestra, tea ceremony, and volunteer club.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAssessment utilized the E-POrtfolio of Clinical training for PostGraduates (PG-EPOC), a national electronic common portfolio equipped with rubrics for detailed items in domains A, B, and C. This portfolio serves to facilitate observational assessments of junior residents. The attending physician further supplemented this evaluation by discussing resident performance with three EM residents (postgraduate years 3\u0026ndash;5) using a three-item survey. This survey evaluated PGY1 residents on a 5-point Likert scale (with 5 indicating the highest performance) across three key areas: clinical attitude; knowledge and skill in EM; and positive participation in EM practice. Total score from the three-item survey represents the average of scores for these three key areas. Responses were measured on a scale of 1 to 5, with 5 representing the best score.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCharacteristics of the four PGY1 residents within an established EM rotation who chose aesthetic medicine as their initial specialty without completing a full specialty residency training program were investigated over five years. We also investigated the characteristics of all 10 PGY1 residents in non-standard training pathways who did not complete a full specialty residency training program. None of these PGY1 residents initially intended to specialize in aesthetic medicine during the EM rotation. None of the parents of the junior residents who chose aesthetic medicine as the initial specialty, nor of the 10 in non-standard training pathways, were general practitioners in private clinics. While clear evidence remains lacking, the children of general practitioners in private clinics seem likely to have witnessed their parents working and they may be better equipped to meet the expectations of residency by receiving advice from their parents on successful study habits or coping strategies. Therefore, they may not directly pursue aesthetic medicine. The choice of medical specialty reportedly often reflects parental influences, particularly when parents are physicians.\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Aesthetic medicine offers potential for high earnings,\u003csup\u003e5,6\u003c/sup\u003e but also carries a risk of limited long-term career prospects due to a lack of specialty board certification and lower levels of specialized expertise.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Further, the longevity of these high earnings is uncertain. Consequently, physician parents may be unlikely to encourage their children to pursue aesthetic medicine directly without completing a specialty residency training program.\u003c/p\u003e \u003cp\u003ePGY1 residents who chose aesthetic medicine in this study demonstrated significantly lower scores on the three-item survey compared with those who selected other specialties. One possible explanation for this finding is that residents pursuing aesthetic medicine may have lacked intrinsic enthusiasm or commitment toward EM practice. Such diminished engagement may have led them to prioritize a non-standard specialty path, resulting in lower observational assessment scores compared to their more engaged peers.\u003c/p\u003e \u003cp\u003eUni- and multivariate logistic regression analyses revealed that a history of academic difficulty, such as repeating at least one year of medical school, was significantly associated with a tendency of PGY1 residents to choose aesthetic medicine as their initial specialty without completing a full specialty residency training program. The small sample size of only four junior residents choosing aesthetic medicine as the initial specialty limits the generalizability of these findings to other institutions. However, this observation raises the possibility that these individuals may have lacked enthusiasm for traditional medical practice even during their time in medical school, prior to beginning junior residency.\u003c/p\u003e \u003cp\u003eUnivariate logistic regression analysis showed that the 10 residents in the non-standard pathway group demonstrated significantly a higher proportion of public university graduates as well as lower scores on the three-item survey, as assessed by the EM attending physician compared to PGY1 residents who ended up taking standard training pathways. As our institution is a private medical university, a large proportion of our graduates work here, and the representation of graduates from public universities is relatively low (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A higher proportion of the parents of junior residents were physicians compared with the socioeconomic backgrounds reported in other studies.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Nevertheless, the medical abilities of PGY1 residents appeared comparable to those of senior residents and attending physicians.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAesthetic medicine offers a high earning potential, even for those without prior experience.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Further, the work schedule typically does not involve any night shifts or on-call duties, and generally provides more time off compared to other medical specialties.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e This trend is increasingly attracting medical students or junior residents who prioritize cost-effectiveness and time management.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Medical students and junior residents consider not only income, work-life balance and workload, but also academic interest and prestige when choosing a specialty.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMedical students and junior residents with parents who are not physicians may prioritize income, workload, and work-life balance more highly than academic interest, prestige, or patient-centered care when making career decisions, potentially due to various factors, such as a lack of direct exposure to the professional lives of physician parents.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the number of junior residents who chose aesthetic medicine as the initial specialty without completing a full specialty residency training program was small (n\u0026thinsp;=\u0026thinsp;4). Similarly, only 10 junior residents were in non-standard training pathways without completing a full residency. The small sample sizes involved may have influenced the results and resulted in wide confidence intervals. Second, this study was conducted at a single institution, limiting the generalizability to other institutions. Third, while growing concerns are being voiced regarding junior residents bypassing traditional training pathways to enter aesthetic medicine, this study represents an initial exploration of the characteristics of these junior residents.\u003c/p\u003e \u003cp\u003eFuture research with larger, multi-institutional samples is needed to confirm these findings and explore the motivations and long-term career trajectories of physicians pursuing non-traditional pathways such as aesthetic medicine. Understanding these factors is important for medical education and workforce planning, ensuring that physicians are adequately trained and prepared to meet the evolving healthcare needs of the population. Further, exploring the potential influences of parental background and exposures to physician role models may provide valuable context for these career decisions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides preliminary insights into the characteristics of junior residents who choose aesthetic medicine as their initial specialty without completing a full residency training program. Our findings suggest that these individuals may exhibit lower scores in assessments of clinical attitude, knowledge, and skills during the EM rotation, and are more likely to have a history of academic difficulties in medical school. This study highlights the need for further discussion within the medical community regarding the implications of non-standard training pathways and the potential impacts on both patient care and the medical profession.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was approved and consent to participate was obtained by the institutional review board at Osaka Medical and Pharmaceutical University (approval no. 2767).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInformed consent\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all subjects before the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDeclaration of conflicting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eORCiD ID\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKoshi Ota https://orcid.org/0000-0002-1461-7031\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData availability statement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets used and/or analyzed during this study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003eConcept and design: Koshi Ota, Kanna Ota\u003c/p\u003e\n\u003cp\u003eAcquisition, analysis, or interpretation of data: Koshi Ota, Kanna Ota\u003c/p\u003e\n\u003cp\u003eDrafting of the manuscript: Koshi Ota, Kanna Ota\u003c/p\u003e\n\u003cp\u003eCritical review of the manuscript for important intellectual content: Koshi Ota, Kanna Ota\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOnishi H. 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PLoS ONE. 2023;18(12 December). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0288130\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0288130\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"aesthetic medicine, specialty","lastPublishedDoi":"10.21203/rs.3.rs-8502125/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8502125/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn Japan, most physicians complete a two-year postgraduate clinical training program and pursue board certification in a specialty. However, a growing number of junior residents are bypassing traditional residency pathways to enter aesthetic medicine. This study investigated the characteristics of these junior residents.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective, longitudinal, observational study assessed postgraduate year 1 (PGY1) residents during emergency medicine (EM) rotations at a university hospital from 2019 to 2023. An attending EM physician used a three-item survey (Clinical Attitude, Knowledge and Skills, Positive Participation) to evaluate 222 PGY1 residents. Data were collected on demographics, academic history, club activities, and parental occupation. Logistic regression analysis was used to identify factors associated with choosing aesthetic medicine as an initial specialty without completing the full residency.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFour junior residents chose aesthetic medicine as the initial specialty. These individuals demonstrated significantly lower scores on the three-item survey compared to those entering traditional residencies. A history of academic difficulty (repeating at least one year of medical school) was also significantly associated with choosing aesthetic medicine. Multivariate analysis identified low scores on the three-item survey, history of academic difficulty, and graduating from public universities as factors significantly associated with choosing aesthetic medicine.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study suggests that junior residents choosing aesthetic medicine as the initial specialty without completing a full residency may exhibit lower clinical performance during the EM rotation and have a history of academic difficulty. This information may be important for medical education and workforce planning.\u003c/p\u003e","manuscriptTitle":"Characteristics of junior residents within an established emergency medicine rotation choosing aesthetic medicine as the initial specialty without completing a full specialty residency training program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-02 17:14:13","doi":"10.21203/rs.3.rs-8502125/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2480d0c5-81f3-4d9b-81dd-8f61903f5605","owner":[],"postedDate":"February 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T13:39:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-02 17:14:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8502125","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8502125","identity":"rs-8502125","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}