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A Decentralized, Academically Integrated Training Model for Rural General Practice in Japan: A Descriptive Program
Kota Sakaguchi1, Takeshi Endo2,3, Yoshihiko Shiraishi2,4
1General Medicine Center, Shimane University Hospital, Izumo City, Shimane Prefecture, Japan. bananakuriimu@gmail.com.
Background:
Rural physician shortages persist globally, with professional isolation a major barrier. Traditional incentives have limited effects on long-term retention.
Aim:
To describe the decentralized, academically integrated training model at Shimane University General Medicine Center (SGMC) and evaluate recruitment and retention outcomes.
Setting:
Shimane Prefecture, a rural, aging region in Japan.
Participants:
Forty-two General Practice residents (2018-2025).
Program Description:
SGMC implemented a prefecture-wide "Neural GP Network" community of practice and a "Virtual Office" using Slack and Zoom. Residents completed longitudinal rural placements in local care teams.
Program Evaluation:
Annual recruitment averaged 15.8% of specialty trainees, significantly exceeding the national average (2.6%; P < 0.001). As of January 2026, 88.1% (37/42) remained in the prefectural network, exceeding estimates for rural Japan (~ 50%). The Virtual Office generated 26,787 messages and 6803 files (Feb 2024-Jan 2025). Since 2021, affiliates published 58 English-language papers.
Discussion:
Over 8 years, this hybrid model integrating digital networking with longitudinal training was associated with strong workforce stability, representing a promising approach to strengthen rural primary care.
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