ABSTRACT
Purpose@#South Korea ranked 18th out of the 162 participating countries in the 2019 report on sustainable development goals (SDGs). Among the 17 specified goals, it has the most difficulty in achieving gender equality (SDG 5). This shortcoming is manifested in the lack of studies on gender-sensitive indicators. The study aims to establish the significance of the development of a comprehensive health matrix to concretize the concept of gender-sensitivity which is often considered as abstract. @*Methods@#An integrated analysis of health determinants was conducted through a convergence study involving medical, social and natural sciences. This analysis was based on both literature reviews and focusgroup discussions. The 6 following focal points were chosen based on the SDGs: gender equality, medicine, education, economy, nutrition, and environment. Objective quantitative indicators were then designated to each of the 6 areas and comparatively analyzed for South Korea, North Korea, and the other SDGs countries. Four areas on sexual and reproductive health were also selected. @*Results@#The results indicated that South Korea scored much lower than North Korea and the other SDGs countries in terms of gender equality. It was also behind North Korea in education, although North Korea had a comparatively lower ranking in the rest of the areas. On the other hand, it fared better than the aforementioned countries with respect to environment, nutrition, medicine, and economy. @*Conclusion@#A comprehensive gender-sensitive health matrix was developed to refine the abstract concept of gender-sensitivity through objective quantitative indicators that assess the health status of a country by means of a scoring system. Gender equality was also confirmed as a common and significant component in the disciplines of sexual and reproductive health and comprehensive health.
ABSTRACT
Purpose@#South Korea ranked 18th out of the 162 participating countries in the 2019 report on sustainable development goals (SDGs). Among the 17 specified goals, it has the most difficulty in achieving gender equality (SDG 5). This shortcoming is manifested in the lack of studies on gender-sensitive indicators. The study aims to establish the significance of the development of a comprehensive health matrix to concretize the concept of gender-sensitivity which is often considered as abstract. @*Methods@#An integrated analysis of health determinants was conducted through a convergence study involving medical, social and natural sciences. This analysis was based on both literature reviews and focusgroup discussions. The 6 following focal points were chosen based on the SDGs: gender equality, medicine, education, economy, nutrition, and environment. Objective quantitative indicators were then designated to each of the 6 areas and comparatively analyzed for South Korea, North Korea, and the other SDGs countries. Four areas on sexual and reproductive health were also selected. @*Results@#The results indicated that South Korea scored much lower than North Korea and the other SDGs countries in terms of gender equality. It was also behind North Korea in education, although North Korea had a comparatively lower ranking in the rest of the areas. On the other hand, it fared better than the aforementioned countries with respect to environment, nutrition, medicine, and economy. @*Conclusion@#A comprehensive gender-sensitive health matrix was developed to refine the abstract concept of gender-sensitivity through objective quantitative indicators that assess the health status of a country by means of a scoring system. Gender equality was also confirmed as a common and significant component in the disciplines of sexual and reproductive health and comprehensive health.
ABSTRACT
The aim of this study is to determine whether the 65 competencies, defined in “the role of Korean doctor, 2014”, are suitable for basic medical education phase in Korea. It seeks to analyze the gap among the educational reality and expectation, assessment situation of the competencies above. We also try to define issues of the development, application and assessment phases of competency-based medical education (CBME) at individual medical schools. We designed survey tools based on the Miller's assessment pyramid (knowledge, explanation, demonstration, and performance) for each of the 65 competencies. The survey distributed to 41 medical schools in April 2015 and 38 replies were received (92.7%). Competencies that matched both the educational reality and expectation were numbers 1 (patient care), 33 (social accountability), and 49 (professionalism). However, all the other competencies ranked lower in current status than that of desirable level. 54 out of 65 competencies (83.07%) remained at the knowledge and explanation level when each competence were assessed. In the development, application, and assessment phases of CBME, common issues that medical schools commonly noted were difficulty linking competencies to curriculum preparation and student assessment, the lack of faculty's understanding, difficulty to reach consensus among faculties, and absence of teaching and learning methods and assessment tools that fits CBME. For the successful settle down of CBME, there is a need for efforts to develop the model of graduate outcomes, to share information and experience, and to operate faculty development program by the medical education communities.
Subject(s)
Humans , Consensus , Curriculum , Education, Medical , Korea , Learning , Mental Competency , Needs Assessment , Schools, MedicalABSTRACT
Observation of the current Korean medical education and training system shows that certain negative traits of unchangeable solidification engraft themselves so deeply into the overarching system that they are now hampering the state of the national health welfare. Focusing only on undergraduate medical education, we can point out some glaring side-effects that should be of concern to any stakeholder. For instance, a graduate can legally begin his career as an independent practitioner immediately after passing the licensing exam and return to the old stuck school-year system of 2-year-premedical and 4-year-medical programs where outcome-based and integrated curricula are incomplete and unsatisfactory. In terms of learning opportunities, the balance between patient care and public health, as well as that between in-hospital highly specialized practice and community-based general practice, has worsened. Every stakeholder should be aware of these considerations in order to obtain the insight to forge a new direction. Moreover, our medical schools must prepare our students to take on the global roles of patient care within the Fourth Industrial Revolution, health advocacy for the imminent super-aged society, and education and research in the bio-health industry, by building and applying the concept of academic medicine. We will need to invest more resources, including educational specialists, into the current undergraduate medical education system in order to produce proper outcomes, smart curriculum, innovative methods of teaching and learning, and valid and reliable monitoring and evaluation. The improved quality of undergraduate medical education is the starting point for the success of the national system for public health and medical care as a whole, and therefore its urgency and significance should be emphasized to the public. The medical society should go beyond fixing what is broken and usher in a new era of cooperation and collaboration that invites other health professionals, governmental partners, law-makers, opinion leaders, and the general public in its steps toward the future.
Subject(s)
Humans , Cooperative Behavior , Curriculum , Education , Education, Medical , Education, Medical, Undergraduate , General Practice , Glare , Health Occupations , Learning , Licensure , Patient Care , Public Health , Schools, Medical , Societies, Medical , SpecializationABSTRACT
The Korean Association of Medical Colleges (KAMC) developed graduate outcomes based on “The role of Korean doctor, 2014” to serve as guidelines regarding outcome-based education in Korea. The working group in this study analyzed 65 competencies proposed in “The role of Korean doctor, 2014” according to the developmental principle that certain outcomes should be demonstrated at the point of entry into the graduate medical education. We established 34 competencies as “preliminary graduate outcomes” (PGOs). The advisory committee consisted of 11 professors, who reviewed the validity of PGOs. Ultimately, a total of 19 “revised graduate outcomes” (RGOs) were selected. We modified the RGOs based on opinions from medical schools and a public hearing. In November 2017, the KAMC announced the “graduate outcomes for basic medical education,” which serves as a guide for basic medical education for the 40 medical schools throughout Korea. Medical schools can expand the graduate outcomes according to their educational goals and modify them according to their own context. We believe that graduate outcomes can be a starting point for connecting basic medical education to graduate medical education.
Subject(s)
Advisory Committees , Competency-Based Education , Education , Education, Medical , Education, Medical, Graduate , Education, Medical, Undergraduate , Hearing , Korea , Physician's Role , Republic of Korea , Schools, MedicalABSTRACT
OBJECTIVES: This paper aims to describe an outcome-based curriculum development process at a medical school that has difficulty in advancement from the higher stage outcomes to the individual lesson outcomes, and to propose a way to implement it practically. METHODS: We reviewed the objectives, strategies and previous products of the school's taskforce activities and suggested the principle of bidirectional approaches of outcome based curriculum development. RESULTS: The developing strategy identified such as firstly, the evaluation of present curriculum and then, the review of the outcomes developed previously with considering the nation-wide environmental change in medical education. Then, we selected one example course which was focused the resources of the school to, and finally the product of the example course was propagated to the other courses with central monitoring. CONCLUSION: Bidirectional model of ‘Top-down’ plus ‘Bottom-up’ approaches could be an efficient way to develop the outcome-based curriculum in a medical school, which has difficulties to advance the developing process due to various reasons including limited resources.
Subject(s)
Humans , Curriculum , Education , Education, Medical , Schools, MedicalABSTRACT
PURPOSE: The purpose of this study was to examine students' perception of the educational environment of medical schools in Korea. METHODS: A total of 9,096 of 12,035 students (75.6%) responded to our questionnaire. This study was conducted at the end of the 2013 academic year using the Dundee Ready Education Environment Measure (DREEM) at 40 medical schools in Korea. DREEM comprises five domains: students' perceptions of learning (SPL); students' perceptions of teachers (SPT); students' academic self-perceptions; students' perceptions of atmosphere; and students' social self-perception. The data were analyzed using descriptive statistics, independent t-test, and one-way analysis of variance. RESULTS: The overall mean DREEM score was 113.97 (of 200), and the scores for the 40 medical schools ranged from 100.24 to 134.32. The overall mean and domains scores of the DREEM differed significantly between educational systems, grades, genders, and academic achievement levels. Graduate-level medical students had higher scores for the DREEM and its five domains than undergraduate medical students. The scores were lowest in second-year students (mean, 111.80). Male students' perceptions were significantly higher than those of female students except for SPL and SPT. High academic achievers' perceptions were also greater versus low academic achievers. CONCLUSION: Students' perceptions of their educational environment are positive in Korea. The learning environment should be evaluated by curriculum planners and administrators of medical schools to improve its quality.
Subject(s)
Female , Humans , Male , Achievement , Attitude , Education, Medical, Undergraduate , Perception , Republic of Korea , Schools, Medical , Students, Medical , Surveys and QuestionnairesABSTRACT
PURPOSE: This study examined the use of the Tucker linear equating method in producing an individual student's score in 3 groups with bridging stations over 3 consecutive days of the clinical performance examination (CPX) and compared the differences in scoring patterns by bridging number. METHODS: Data were drawn from 88 examinees from 3 different CPX groups-DAY1, DAY2, and DAY3-each of which comprised of 6 stations. Each group had 3 common stations, and each group had 2 or 3 stations that differed from other groups. DAY1 and DAY3 were equated to DAY2. Equated mean scores and standard deviations were compared with the originals. DAY1 and DAY3 were equated again, and the differences in scores (equated score-raw score) were compared between the 3 sets of equated scores. RESULTS: By equating to DAY2, DAY1 decreased in mean score from 58.188 to 56.549 and in standard deviation from 4.991 to 5.046, and DAY3 fell in mean score from 58.351 to 58.057 and in standard deviation from 5.546 to 5.856, which demonstrates that the scores of examinees in DAY1 and DAY2 were accentuated after use of the equation. The patterns in score differences between the equated sets to DAY1, DAY2, and DAY3 yielded information on the soundness of the equating results from individual and overall comparisons. CONCLUSION: To generate equated scores between 3 groups on 3 consecutive days of the CPX, we applied the Tucker linear equating method. We also present a method of equating reciprocal days to the anchoring day as much as bridging stations.
Subject(s)
Clinical Competence , Educational MeasurementABSTRACT
Since mid-20th century, many environmental changes in medicine have challenged the traditional role of doctors and the movement to outcome-based education (OBE) has progressed gradually but significantly. Over decades bilateral progression of defining the global doctor's role and developing OBE with implementation to medical schools has been spread world-widely. In this paper, we explored the history and contents of the doctor's role and OBE at various levels-international, national, institutional and medical schools. We conclude that the global doctor's role is composed of patient care, communication and professionals added by others related to their peculiar situation and should be linked to the outcomes of undergraduate, postgraduate and continuous medical education which are developed and implemented to the curriculum and program at any country in order to cope with the global challenges of the future.
Subject(s)
Competency-Based Education , Curriculum , Education, Medical , Patient Care , Phosphatidylethanolamines , Physician's Role , Schools, MedicalABSTRACT
Patient consumerism, government regulations, health financial imperatives, litigation, the explosion of medical knowledge, and rapid technical advancements are among the challenges threatening the environment of clinical education. Moreover, in Korea, there has been an uncontrolled trend toward every doctor being a specialist, which causes not only the medical service system to be highly consuming but also the effective clinical education for primary care competency to become compromised. The competency-based clinical curriculum of the undergraduate urgently needs refinement and it must be connected to the post-graduate medical education and continuous professional development programs. The essential competencies should encompass communication, collaboration, management, social accountability, professionalism, and education, as well as patient care. We should apply the adult-learning pedagogy to the clinical teaching and assessment in terms of requiring minimal outcomes for primary care physicians, self-study using mobile information applications, portfolios with reflection, one-on-one preceptors with microteaching skills, inter- and multi- professional education, performance assessment, simulation-based education, workplace-based evaluation, and so on. Coming to a national consensus of supporting and advancing clinical education is critical for the purpose of meeting the medico-health welfare challenges of the super-aged society coming in the near future.
Subject(s)
Humans , Clinical Competence , Consensus , Cooperative Behavior , Curriculum , Education, Medical , Education, Professional , Explosions , Government Regulation , Jurisprudence , Korea , Patient Care , Physicians, Primary Care , Primary Health Care , Social Responsibility , Specialization , TeachingABSTRACT
PURPOSE: This study aims at to make intermediate-term evaluations of a curriculum by investigating its development, operation and outcomes 2 years after its revision. METHODS: A survey using 5-point-Lickert scale questionnaires was given to the group of directors who developed the curriculum, instructors who only used it in their classes, and a student group from the first and second grades. Focus group interviews were performed in the professor groups. RESULTS: Curricular reform was evaluated as being systematic, democratic, and positive in general. Both groups answered questions positively about the relevance of the integrated curriculum and introduction of clinical medicine (ICM), graded as 3.4 (professor) and 3.5 (student). As for problem-based learning (PBL) and the patient-doctor-society (PDS), the professor group responded more positively than students. The 'web-based learning center' was recognized positively by many more students (4.01) than professors (2.75). With regard to the education outcome, professors gave 3.3 points and students 3.5 to an item that asked 'whether students attained the learning goal or not?' Professors, through interviews, showed their satisfaction with the attempt to reform the curriculum, but they pointed out that long-term evaluations should be performed. CONCLUSION: The interim evaluation of the revised curriculum, from its planning to its effects, affirmed by several suggestions to be successful in the long run through 1) enhancement of systematic participation and communication, 2) further integration, 3) steady evaluation, 4) greater effort on professional development, and 5) active interaction between professors and students.
Subject(s)
Humans , Clinical Medicine , Curriculum , Evaluation Studies as Topic , Focus Groups , Learning , Problem-Based Learning , Schools, Medical , Surveys and QuestionnairesABSTRACT
PURPOSE: This research investigated the psychometric properties of the patient-physician interaction (PPI) domain in the clinical performance examination (CPX). This research aimed to understand the PPI domain in the CPX through a psychometric and relationship analysis between the domains. METHODS: Data were drawn from 1,302 examinees on a set of 6 common CPX cases and 1,066 on a 'bad news delivery' case. All cases included 7 PPI items, among which we calculated internal consistency reliability. Correlations were made between PPI and the other domains. Analyses using the structural equation model (SEM) were conducted to assess the relationships between latent factors and controlled measurement errors. To calculate the disparity between colleges, we performed a multi-level analysis. Also, we conducted t-tests to investigate the consistency of the PPI and information sharing (IS) scores in the 'bad news delivery' case. RESULTS: Correlation between the mean PPI score and the total CPX score was high (0.707). The correlations between PPI and other domains were; 0.904 for the patient's overall satisfaction, 0.41 for history taking, and 0.327 for patient education. In SEM, these correlations between latent variables increased. The proportion of level-2 (between-school component) variance in PPI was 4.1%. For 'bad news delivery', the group that checked 'yes' on the IS items had higher PPI scores (mostly p<0.01). CONCLUSION: PPI is an influential domain of the CPX and is highly related with the patient's overall satisfaction, clinical courtesy, and history taking. Disparities between schools in PPI are relatively small, such that the PPI could be due to individual factors rather than the school.
Subject(s)
Humans , Clinical Competence , Comprehension , Education, Medical, Undergraduate , Educational Measurement , Information Dissemination , Patient Education as Topic , PsychometricsABSTRACT
PURPOSE: To examine the effect of bosentan, a dual endothelin receptor (ER) antagonist, on the development of monocrotaline (MCT)-induced pulmonary hypertension in rats by especially focusing on the pulmonary vascular morphology changes. METHODS: Sprague-Dawley rats were treated as follows: controls received a subcutaneous saline injection, MCT-treated rats received a subcutaneous MCT injection, and bosentan-treated rats received a MCT injection followed by treatment with bosentan (20 mg/kg/day). To assess the effects of ER blockade on the time course, the animals were exsanguinated, and their hearts and lungs were dissected after 7, 14, or 28 days. RESULTS: The mean body weights of the MCT- and bosentan-treated rats were significantly lower than that of the control rats on days 7, 14, and 28. Bosentan administration significantly inhibited the progression of right ventricular hypertrophy on day 28 (right ventricle/[left ventricle+septum]: 0.71+/-0.10 in MCT-treated rats vs. 0.49+/-0.09 in bosentan-treated rats; P<0.05). Quantitative analysis of peripheral pulmonary arteries revealed that the increase in medial wall thickness after MCT injection was significantly attenuated in the bosentan-treated rats on day 28 (49.96+/-10.06% in MCT-treated rats vs. 47.09+/-10.48% in bosentan-treated rats; P<0.05). In addition, the increase in the number of intra-acinar muscular arteries after MCT injection was reduced by bosentan on days 14 and 28. CONCLUSION: Bosentan administration in intermediate doses exerts inhibitory effects on lung vascular hypertrophy and right ventricular hypertrophy during the development of MCT-induced pulmonary hypertension in rats.
Subject(s)
Animals , Rats , Arteries , Body Weight , Endothelins , Heart , Hypertension, Pulmonary , Hypertrophy , Hypertrophy, Right Ventricular , Lung , Monocrotaline , Pulmonary Artery , Rats, Sprague-Dawley , Receptors, Endothelin , SulfonamidesABSTRACT
PURPOSE: We did this study to find out the current teaching status of the medical humanities and social sciences curriculum in Korean medical schools. Further, we discuss the tasks at hand to improve the curriculum in medical education. METHODS: The curricula of 41 medical schools and the syllabi of 10 schools were examined. We analyzed the tables of course organization and contents of integrated medical humanities. After analysis of the contents, they were grouped into 6 categories of medical humanities and social sciences domain. RESULTS: Our results are as follow: 1) there are 3 types of medical humanities and social sciences subject forms: inter-disciplinary (integrated, for example, PDS), multi-disciplinary (separated subject form), and mixed (integrated+separated); 2) most schools offer medical humanities and social sciences in a required class; 3) medical humanities and social sciences are taught through all school years and all 8 graduate medical schools offer a medical humanities and social sciences course from year 1; and 4) the average academic credits for medical humanities are 10 or 11. With respect to the curriculum content, there is some commonality in 10 schools: disease prevention, health improvement, medical ethics, medical regulation, professionalism, and community medicine. Differences were seen in content selection and organization. CONCLUSION: After brief reviews of the medical humanities and social science curriculums, we discovered that all Korean medical schools meet the need of medical humanities and social sciences education. However, curriculum implementation differed in various ways. We suggest the following tasks: 1) clarification of educational goals in order to develop a core curriculum of medical humanities and social sciences in Korea; 2) sharing experiences of developing a well-designed curriculum with other medical schools for effective teaching of this subject area.
Subject(s)
Humans , Community Medicine , Curriculum , Education, Medical , Ethics, Medical , Hand , Humanities , Learning , Schools, Medical , Social SciencesABSTRACT
PURPOSE: Information about students is important not only in developing curriculum and teaching strategies, but also in providing support to them. We surveyed students in 2004 (Medical collage) and 2007 (Graduate Medical School) to change our educational system to the GMS. By comparing the characteristics of these students, we expected the new curriculum to be more appropriate for the GMS students. METHODS: Our survey tool was a modified version of the matriculating student questionnaires used by the American Association of Medical Colleges. 60 (80.2%) matriculating students in 2004 (MC), and 71 (93.4%) in 2007 (GMS) responded to the survey. A total of 101 items were asked in 5 areas- 1) Demographic Data, 2) Pre-medical school experience, 3) Medical school application, 4) Career plans and interests, and 5) Perceptions of Medicine and Medical Service. RESULTS: Graduate Medical School matriculates have more diverse backgrounds and experiences before entrance than MC matriculates. GMS students are more sensitive to social issues and accountabilities of medicine and have a higher interest in working with other professionals. Both groups of students were similar in ranking medical professionalism higher than occupational stability or social economic compensation. CONCLUSION: We can use this information about students for curriculum development and, in particular, the differences seen between MC and GMS students could be helpful in improving medical education. If the survey were collected longitudinally and nation-wide, the results could be valuable for policy making not only in medical education but also in medical care and health of the nation.
Subject(s)
Humans , Compensation and Redress , Curriculum , Education, Medical , Policy Making , Schools, Medical , Surveys and QuestionnairesABSTRACT
PURPOSE: Clinical performance examination(CPX) using standardized patients(SPs) is an acceptable method of testing medical professionals, but there has been some concerns about security. The objective of this work is to examine whether the day of the examination influences the scores of examinees of different medical schools at different times throughout the examination period. METHODS: Six medical schools, which had participated in the Seoul-Gyeonggi CPX Consortium 2005, were enrolled. Each station, controlled by the same regulations, included 12 minutes of SP encounter and 5 minutes of writing a short essay. We compared the mean scores using ANOVA and linear trends with multiple regression analyses and SPSS version 11.0. RESULTS: The mean score of examinees from all 6 medical schools was 63.2+/-.9. There was no difference in total mean scores among the medical schools according to the period when CPX was conducted. Classified by their examination day, there was no difference among the mean scores of the 1st, 2nd, and 3rd day, but in one school where the examination was performed for 5days, the mean scores of the 4th day was higher than the others(p<0.05). There were trends of linear increases over the five days for the 'physical examination'question, but not for 'physician-patient interaction'and 'patient education'. CONCLUSION: The changes in scores according to the examination day in this study did not show consistent results. However, the variable results seen according to school, test question, and examination day need further analysis for test security issues.
Subject(s)
Humans , Clinical Competence , Schools, Medical , Social Control, Formal , WritingABSTRACT
PURPOSE: With the changes to the medical environment and to the educational system, we aim to evaluate the current mission statement of the College of Medicine, Ewha Womans University, and revise it. METHODS: To establish the new mission statement, a special committee, the School Mission Revision Committee(SMRC) and an advisory group were organized in 2003. The SMRC functioned through 4 stages of action composed of: investigation, draft development, surveillance of various opinions, and announcement. RESULTS: The revised, final mission statement was: "To contribute to Korea and to the international society by producing excellent woman-leaders in healthcare, who have professional medical knowledge and are humanitarians based on Christian principles." Three key words helped in the realization of this mission: compassion, professionalism, and service. Compassion: a noble physician who practices compassion toward mankind, caring for patients with compassion and the right attitude, and contributing to health promotion. Professionalism: a responsible physician who embodies professionalism, learning the necessary knowledge and skills, having the ability for self-development, and leading in various fields of medicine. Service: a respected physician who serves society, devoting to the community with excellent woman leadership skills and an open mind, and serving Korea and the international society. CONCLUSION: We expect that this new school mission will be helpful in clarifying the whole educational process and will resolve conflicts resulting from the change to the school system within a rapidly changing educational environment.
Subject(s)
Female , Humans , Delivery of Health Care , Empathy , Health Promotion , Korea , Leadership , Learning , Religious Missions , Schools, MedicalABSTRACT
PURPOSE: To compare the evaluation results of faculties to those of Standardized Patients (SP) participating in a Clinical Performance Examination (CPX) administered at Ewha Womans University College of Medicine. METHODS: The CPX was taken by 77 fourth year medical students. Cases and checklist were developed by the medical school consortium in capital area. Six cases were used and 24 SPs participated and evaluated the students' performances. The whole session was recorded on videotapes so that 6 medical school faculties could analyze and evaluate the students' performances as well. The results were compared and analyzed by SPSS package. RESULTS: The agreement between the faculties and the SPs was relatively good (r=0.79), but not good enough. In every case, SPs gave higher marks than did the faculties. Clear disease entity cases like "hepatitis" and "anemia" showed better agreement than obscure clinical contexts such as "bad news delivery". Better agreement was seen in the items of physical exam category (r=0.91), but the agreement was very poor in the items of doctor-patient (Dr-Pt) relationship category (r=0.54). The construction of checklist and the character of each evaluation item should influence the differences. CONCLUSION: More detailed guidelines and clear/specific evaluating items are necessary to improve the agreement rate. In certain categories like physical exam and brief history taking, the SP' s evaluation can replace the faculties', but for complex contexts like Dr-Pt relationship.
Subject(s)
Female , Humans , Checklist , Schools, Medical , Students, Medical , Videotape RecordingABSTRACT
BACKGROUND: It is very important for hemodialysis in patients with end stage renal disease to obtain vascular access that resists repeated punctures and maintains adequate blood flow. This study was designed to indentify factors that may influence early patency rate of autogenous arteriovenous fistula. MATERIAL AND METHOD: 49 cases in 47 patients who underwent radiocephalic fistula formation in our hospital from June 2002 through May 2003 were reviewed and analyzed. RESULT: The early patency rate was 79.6%. Age, sex, hypertension, and diabetes mellitus were not significant factors for patency. Body mass index and duration of hypertension and diabetes did not influence the early results either. Cephalic vein diameter measured preoperatively and blood flow at radiocephalic fistula were significantly positive correlative factors. Groups with the vein diameter less than 2.7 mm, or with the blood flow less than 100 mL/min had significantly lower early patency rate than the other groups. CONCLUSION: To improve early patency rate of radiocephalic fistula, large sized cephalic vein should be selected and if the intraoperative flow at radiocephalic fistula is less than 100 mL/min, another arteriovenous fistula formation should be considered.
Subject(s)
Humans , Arteriovenous Fistula , Body Mass Index , Diabetes Mellitus , Fistula , Hypertension , Kidney Failure, Chronic , Punctures , Renal Dialysis , VeinsABSTRACT
PURPOSE: To report the experience of OSCE performed as a summative assessment of the medical students in year 4 at Ewha Womans University. METHODS: Ninety-eight students took the twenty stations including 3 pairs of linked stations. We conducted duplicated OSCEs and each station runs 4 minutes 30 seconds. We analyzed the validity of stations, the reliability of duplicated OSCEs and the difference of scores according to the OSCE tools and categories. RESULTS: Mean OSCE score was 64.45+/-5.49 and Cronbach-alpha of total stations was 0.74. The scores between duplicated examinee groups and between duplicated evaluator groups were not different: the score of preceding examinee group was 63.3 and the later 65.7 (p=0.13), and the score of the first evaluator group was 64.6 and the second was 63.6 (p=0.16). However according to the individual analysis, 9 stations showed statistically discrepancies (p< 0.05) between duplicated evaluator groups. Regarding OSCE tools and categories, physical examination and skill categories did not show statistically significant differences between duplicated evaluator groups. OSCE scores showed moderate correlation with the cummulative performance grade in general (r=0.53, p< 0.01). CONCLUSIONs: OSCE could be regarded as a reasonable evaluating tool for the summative assessment after two years of clinical clerkship of the fourth year medical students. Analysis of the OSCE stations which was done individually and according to OSCE tools/categories helps to improve the OSCE more complete and the duplicated stations more coincident.