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Initiatives and achievements of the Japanese Society of Obstetrics and Gynecology, Obstetrics and Gynecology MIRAI Committee 2020

Abstract Backgrounds In 2013, the total number of obstetrician‐gynecologists decreased. The Japanese Society of Obstetrics and Gynecology established the Obstetrics and Gynecology MIRAI Committee in 2015. Within the MIRAI Committee, Japanese Trainees in Obstetrics and Gynecology (JTOG) was established; it was comprised of 20 promising young obstetrician‐gynecologists recommended from regions across Japan. The office term is 2 years. Objective The purpose of this report is to learn and inform about the results of MIRAI's activities. Methods We surveyed the trends in new obstetrician‐gynecologists and also matched each seminar participant with them. Result The number of new memberships has been increasing since the nadir in 2016. In particular, there are over 100 more new physicians specializing in the field in 2020 than there were at the nadir in 2016. It was revealed that approximately 50% of the participants in the summer school specialized in obstetrics and gynecology. Furthermore, approximately 70% of POP2 participants specialized in obstetrics and gynecology, which shows that these two recruitment seminars are extraordinarily effective events that result in an increase in the number of new obstetricians and gynecologists. Conclusion We conclude that the activities of this MIRAI Committee and JTOG have been effective. With the spread of COVID‐19 and the inability of obstetrician‐gynecologists and students/clinical trainees to perform social distancing, it is currently difficult to hold hands‐on seminars. However, we hope that new JTOG members will be able to create a new seminar format.


Introduction
In 2004, a postgraduate clinical training system was established in Japan. Under this system, physicians who have passed the national examination after completing 6 years of education are obliged to undergo training in multiple clinical departments for 2 years as clinical trainees. This system was created as a countermeasure against the reduced ability of university hospitals to dispatch physicians and the concentration of physicians in urban areas and to correct the uneven regional distribution of physicians. Until 2009, training in obstetrics and gynecology was mandatory, and all clinical trainees had the opportunity to learn how to handle childbirth and medical care related to gynecological diseases. In 2009, the clinical training system was revised, and obstetrics and gynecology education became elective. In 2016, the total number of obstetrician-gynecologists decreased. This decrease in obstetrician-gynecologists was because the number of obstetricians and gynecologists has been decreasing each year since 2012. Given that it was reported that perinatal care could not be maintained in Japan without approximately 500 new obstetricians and gynecologists each year, Dr. Tomoyuki Fujii (Professor of Obstetrics and Gynecology, University of Tokyo), who was the chairman of the Japanese Society of Obstetrics and Gynecology (JSOG) at the time, thought that a novel plan for attracting young obstetrician-gynecologists would be indispensable to solve this decrease in the number of obstetrician-gynecologists. Herein we describe the measures we took to ensure an increase in the number of qualified obstetrician-gynecologists in Japan.

Composition of the Members of the Japanese Trainees in Obstetrics and Gynecology
In 2015, the JSOG established the Obstetrics and Gynecology MIRAI Committee as a committee within the board of directors. Within the MIRAI Committee, Japanese Trainees in Obstetrics and Gynecology (JTOG) was established; it was comprised of 20 young obstetrician-gynecologists recommended from regions across Japan. Obstetrician-gynecologists are selected on recommendation, around the 10th year after graduation, from various regions across Japan. The office term is 2 years. Ten persons are changed every year; the selection is made by evaluating the achievements and motivation during recruiting activities, considering the local region. As of September 2020, a total of 60 young JTOG members have been involved in activities. We also asked the trends of new members of Taiwan Association of Obstetrics and Gynecology and Korean Society of Obstetrics and Gynecology.

Summer school
The summer school is intended for fifth and sixth year medical students and those in their first year of clinical training.
In addition to hands-on seminars using medical equipment and simulators for ultrasonography, childbirth, and laparoscopic surgery training, seminars are designed to convey the appeal of obstetrics and gynecology to participants by dispelling any anxiety about working in the field of obstetrics and gynecology, providing information concerning the working styles of female physicians, and sharing future visions with the participants. A tutor is assigned to each group of four to five persons. The tutors are obstetrician-gynecologists who have acquired the obstetrician-gynecologist specialization approximately 6 years after graduation; their role is to guide the members of the group and facilitate deep mutual communication for 2 days. Approximately 250 participants and 70 executive committee members participate each year. This school is held in a retreat fashion. It was in Nagano Prefecture until the 10th year; however, from the 11th year, the venue was changed to Chiba Prefecture.

Plus One Project 2
The first Plus One Project 2 (POP2) was held in 2018 and has been held three times to date. The name "Plus One" indicates the desire to increase the number of obstetricians and gynecologists, one at a time. The number "2" indicates the second year of clinical training. Like the summer school, POP2 is a 2-day seminar; however, a non-retreat format has been adopted for it. While the summer school consists of a basic course, POP2 has a more advanced content. A tutor system has not been adopted, and in addition to the activities conducted at the summer school, hands-on training using micro insemination and cesarean section models is also included; the satisfaction of the participants is extremely high. The instructors are physicians who are in their 10th year after graduation, and compared with the instructors of the summer school, persons with extensive clinical and general experience. Since the event is held just before the decision is made to specialize in obstetrics and gynecology, it is a recruitment project that has a great influence as a final push for persons who are seriously thinking of specializing in obstetrics and gynecology.

Spring Forum
While the Spring Forum was intended to provide a training that would allow young physicians to develop lateral connections across universities, it is now a strategy that aims to keep obstetrician-gynecologists from quitting. In particular, it is provided as a place for learning about the working styles of female physicians and for enhancing self-motivation. The participants consist of obstetrician-gynecologists 10 to 20 years after graduation, and approximately 70 to 80 persons participate each year. Based on the information obtained at this Spring Forum, the aim is to disseminate information at the instructor training sessions and Committee events at the JSOG Academic Lectures and to ensure that results are achieved.

Revision of the website
We regard it as an important recruitment activity to promote the rewards and appeal of the field of obstetrics and gynecology through our website. The site also contains information on why the MIRAI Committee members working nationwide decided to specialize in obstetrics and gynecology, how they feel, and how they are currently working as obstetriciangynecologists and visions for the future. Furthermore, in order to reduce the anxiety of students and residents to work as obstetrician-gynecologists, a slide presentation has been created to present the current state of the field of obstetrics and gynecology, litigation issues, gender equality, etc. This information has been made available for download.

Accomplishment of Recruitment Activities
Changes regarding obstetrician-gynecologists The changes regarding obstetrician-gynecologists after the formation of the MIRAI Committee and JTOG are shown in Figure 1. The number has been increasing since the nadir in 2016. In particular, there are over 100 more new physicians specializing in the field in 2020 than there were at the nadir in 2016. In fact, there has been an increase in the number of physicians generally, therefore, a certain increase may have occurred naturally. However, when calculating the percentage of obstetriciangynecologists among those who passed the national examination for physicians, the percentage of obstetriciangynecologists was also increasing annually from the lowest point in 2016. Therefore, we conclude that the activities of this MIRAI Committee and JTOG have been effective to recruit new obstetrician-gynecologists.

Trends in summer school and POP2 participants
We conducted a yearly survey to discover how many of the summer school and POP2 participants became obstetrician-gynecologists; the results are shown in Figure 2. Although the results included students whose specialization was undecided, it was revealed that approximately 50% of the participants in the summer school specialized in obstetrics and gynecology. Figure 1 The changes regarding obstetrician-gynecologists. There are over 100 more new physicians specializing in the field in 2020 than there were at the lowest point in 2016 Furthermore, approximately 70% of POP2 participants specialized in obstetrics and gynecology, which clearly demonstrates that these two recruitment seminars are extraordinarily effective events that result in an increase in the number of new obstetricians and gynecologists.

New Memberships and Activities at Taiwan Association of Obstetrics and Gynecology and Korean Society of Obstetrics and Gynecology
Because we assume that other Obstetrics and Gynecology societies in Asia also have been facing the difficulty for recruitment of new obstetricians and gynecologists, we asked the Taiwan Association of Obstetrics and Gynecology (TAOG) and Korean Society of Obstetrics and Gynecology (KSOG) offices about the number of new members over the past 5 years (Figure 3). Although the number of TAOG members has increased year after year, the number of KSOG has declined, which seems a serious problem. We also asked what activities they were doing to promote the appeal of obstetrics and gynecology. TAOG and KSOG responded that they were holding the following events for residents. TAOG: • Tour to TAOG Museum and Welcome Dinner Party in their first year. • Yearly training course for all physicians (R1-R4) at the Annual Meeting of TAOG. KSOG: • Spring meeting: Workshop for first year residents including lectures and hands-on program. • Annual Congress: Educational lectures for residents.

• Winter meetings: Lectures using images and videos
for fourth year residents.
We understand that neighboring countries in Asia are also working with a sense of urgency to acquire obstetricians and gynecologists, and the activity we have been doing may be useful to them as well.

Discussion
JSOG faces several limitations. The number of physicians specializing in the field has been increasing as recruitment activities have continued; however, the participants of these recruitment events consist of persons who are already interested in obstetrics and gynecology, and therefore, the figures do not reflect the results from all students and clinical trainees.
However, it appears that interest in the field of obstetrics and gynecology is growing as students can experience the enjoyment and fulfillment of obstetrics and gynecology through practical training. However, if student education and clinical training education become mixed with recruitment, students and clinical trainees who are uninterested may not be able to receive sufficient guidance; since education is to focus on only the educational aspects, it is desirable that recruitment occurs to produce a fulfilling education. Furthermore because it was not possible to note the participants who have changed their surnames after marriage (it is common to change their surnames Figure 2 Trends in summer school and Plus One Project 2 (POP2) participants. Approximately 50% and 70% of the participants in the summer school and POP2, respectively, specialized in obstetrics and gynecology. This shows that the two recruitment seminars are extraordinarily effective events that lead to the creation of new obstetricians and gynecologists among women' doctors in Japan), we speculate that the real number of students specializing in obstetrics and gynecology is actually higher.

Challenges and Future Outlook
With the spread of COVID-19 and the inability of obstetrician-gynecologists and students/clinical trainees to perform social distancing, it is currently difficult to hold hands-on seminars. Since face-to-face lectures and conversations are not possible, it is necessary to utilize conferencing tools such as on-line meeting application and hold recruitment events in a different format than in the past. In the future, it will be necessary to prepare an environment in which obstetriciangynecologists can work as physicians while flexibly responding to changes in the society such as reforms in work style, decreasing birthrate, and increase in the aging population. We hope that new JTOG members will be able to create a new seminar format.