Background In anticipation of Japan’s physician work style reforms scheduled for April 2024, which will restrict physicians’ overtime duty hours to under 960 (Level A) or 1920 (Level C-1) hours per year, this study evaluates the potential impact on clinical resident physicians’ training environments through the lens of residency program directors.

Methods A cross-sectional survey was administered to program directors from 701 facilities associated with the 2023 General Medicine-In Training Examination (GM-ITE), capturing responses regarding their planned level of overtime, perceptions of optimal working hours for training efficacy, and items considered as duty hours.

Results Out of the 701 facilities, 254 responded (36.2% response rate), with a predominant inclination towards adopting Level A (83.5%). A consensus emerged favoring 40 overtime duty hours per month as optimal, significantly lower than previous suggestions of 60–65 hours per week. The study also delineated the classification of activities as duty hours, with patient procedures and mandatory educational sessions identified as such, while self-improvement was largely not considered duty.

Discussion The findings indicate a substantial shift from previously recommended optimal duty hours towards a more conservative approach. This shift may reflect a proactive adaptation to upcoming regulatory changes and raises questions about the potential impact on the quality of clinical training. The distinction between educational activities and duty hours underscores the need for clarity within the impending work style reforms.

KS received an honorarium from JAMEP as speakers of the JAMEP lecture and exam preparers of GM-ITE. YN received an honorarium from JAMEP as a GM-ITE project manager. YT is the JAMEP director, and he received an honorarium from JAMEP as a speaker of the JAMEP lecture. HK received an honorarium from JAMEP as speakers of the JAMEP lecture. TS received an honorarium from JAMEP as exam preparers of GM-ITE.

This study was supported by the Health, Labor, and Welfare Policy Grants of Research on Region Medical (21IA2004) from the Ministry of Health, Labour and Welfare (MHLW).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was approved by the Ethics Review Board of the Japan Institute for Advancement of Medical Education Program (23-25).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data from the GM-ITE can be made available to researchers with ethical permissions to access that data for the specified purposes.