A Decentralized, Academically Integrated Training Model for Rural General Practice in Japan: A Descriptive Program Evaluation.

Sakaguchi, Kota; Endo, Takeshi; Shiraishi, Yoshihiko; Kaneko, Makoto; Watari, Takashi · J Gen Intern Med · 2026

other · Level V

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Abstract

Rural physician shortages persist globally, with professional isolation a major barrier. Traditional incentives have limited effects on long-term retention. To describe the decentralized, academically integrated training model at Shimane University General Medicine Center (SGMC) and evaluate recruitment and retention outcomes. Shimane Prefecture, a rural, aging region in Japan. Forty-two General Practice residents (2018-2025). 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. 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. 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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