A Preliminary Study to Improve Death Education for the Public and Medical Students after the Enforcement of the Life-Sustaining Treatment Decision Act / 의학교육논단

Considering the recent medicalization of death, the importance of preparing both laypersons and medical students to have meaningful end-of-life conversations, which is among the objectives of death education, will grow. The Act of Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life provided a new source of momentum to death education for both laypersons and medical professionals, as the importance of education on death is widely recognized. However, problems remain regarding how to prepare people for productive conversations at the end-of-life and how to secure the continuity of care. Different focuses and deficiencies are observed in death education programs for each category of learner. In education for laypeople, tangible information on how to actualize one’s existential and personal understanding of death through real-life options is lacking, except for presenting the “protocol” of the Act. Conversely, basic medical education lacks an understanding of or confrontation with death on the existential and personal levels. Death education should aim to build a shared understanding that can facilitate communication between the two groups. The scant overlap between layperson education and basic medical education even after the Act’s enactment is worrisome. Further fundamental changes in death education are required regarding its content. Topics that patients and doctors can share and discuss regarding death and end-of-life care should be discovered and provided as educational content both to laypeople and future medical professionals.

Recent Decrease in Organ Donation from Brain-Dead Potential Organ Donors in Korea and Possible Causes

Background@#In 1999, the Organ Transplantation Act legalized organ donation from brain-dead patients. As a result of the government's continued efforts, the number of brain-dead donors steadily increased from 2002 through 2016. However, the number has declined since 2017. This paper examined the possible reasons behind the decline in brain-dead organ donation. @*Methods@#This investigation was an analysis of published data from the Korea Organ Donation Agency annual reports from 2013 to 2018. @*Results@#The number of brain-dead organ donors in Korea rose steadily until 2016, declined in 2017 for the first time since 2002, and then dropped sharply in 2018. Although the number of brain-dead potential organ donors increased between 2017 and 2018, the number of eligible donors decreased, suggesting that patient families rejected the brain-death determination process and brain-dead organ donation. Statistics gathered during identification of brain-dead potential donors and actual donations confirm that rejection or withdrawal of consent by the family has increased. During the same period when donation from brain- dead patients decreased, five events occurred: 1) compensation for donor families was abolished; 2) an incident of mistreatment of a brain-dead donor's remains occurred; 3) the Life-Sustaining Treatment Act was enacted, providing a legal procedure whereby families of brain-dead patients could forgo life-sustaining treatment; 4) residents' work week was limited to 80 hours; and 5) the Labor Standards Law was amended. @*Conclusion@#Fewer eligible donors in spite of an increase in brain-dead potential organ donors suggests that reduction in these donations resulted mainly from factors associated with family consent. Among such factors, implementation of the Life-sustaining Treatment Act appears to be most important. Abolition of family compensation and the incident in which a brain-dead donor's remains were mistreated may also have influenced family consent.

Recent Decrease in Organ Donation from Brain-Dead Potential Organ Donors in Korea and Possible Causes

Background@#In 1999, the Organ Transplantation Act legalized organ donation from brain-dead patients. As a result of the government's continued efforts, the number of brain-dead donors steadily increased from 2002 through 2016. However, the number has declined since 2017. This paper examined the possible reasons behind the decline in brain-dead organ donation. @*Methods@#This investigation was an analysis of published data from the Korea Organ Donation Agency annual reports from 2013 to 2018. @*Results@#The number of brain-dead organ donors in Korea rose steadily until 2016, declined in 2017 for the first time since 2002, and then dropped sharply in 2018. Although the number of brain-dead potential organ donors increased between 2017 and 2018, the number of eligible donors decreased, suggesting that patient families rejected the brain-death determination process and brain-dead organ donation. Statistics gathered during identification of brain-dead potential donors and actual donations confirm that rejection or withdrawal of consent by the family has increased. During the same period when donation from brain- dead patients decreased, five events occurred: 1) compensation for donor families was abolished; 2) an incident of mistreatment of a brain-dead donor's remains occurred; 3) the Life-Sustaining Treatment Act was enacted, providing a legal procedure whereby families of brain-dead patients could forgo life-sustaining treatment; 4) residents' work week was limited to 80 hours; and 5) the Labor Standards Law was amended. @*Conclusion@#Fewer eligible donors in spite of an increase in brain-dead potential organ donors suggests that reduction in these donations resulted mainly from factors associated with family consent. Among such factors, implementation of the Life-sustaining Treatment Act appears to be most important. Abolition of family compensation and the incident in which a brain-dead donor's remains were mistreated may also have influenced family consent.

A Qualitative Study of Students' Perception on Premedical Curriculum / 이화의대지

OBJECTIVES: A Womans University College of Medicine faces curriculum reform in 2020. To determine what reforms are needed in the premedical curriculum, a needs assessment was conducted.METHODS: This study utilizes qualitative study method. A focus group interview was conducted with four students who completed premedical courses from November to December 2018. Interviews were conducted in two groups by grade level, and each interview was recorded. After transcribing the recorded contents, four researchers analyzed the data using conventional content analysis.RESULTS: Students chose A Womans University College of Medicine considering their future careers as female medical professionals and other considerations such as scholarships. The students expected diverse experiences, exchanges with students in different departments, and fusion of medicine with other fields during their premedical years. Overall, these expectations were met during the course, but individual needs for customized education, such as liberal arts, were unmet. In general, students' attitudes toward premedical courses were very motivated and they actively used resources provided by the university.CONCLUSION: Qualitative research can provide a better understanding of quantitative data, such as a student survey performed to prepare for curriculum reform. Based on this understanding, the curriculum will be reformed to reflect the educational needs of students, to motivate students and to provide satisfactory education.

In order to be medically correct, we must be politically correct in class / 한국의학교육

No abstract available.

Implementation of Outcome-Based Medical Education Theory into the Pre-existing Curriculum / 이화의대지

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.

The Effects of Peer Assessment and Peer Feedback in Writing Education for Premedical Students / 이화의대지

OBJECTIVES: There are several problems which hamper the successful teaching of writing in medical education. To deal with these problems, teachers should be conscious of two general questions; what to teach in writing class for premedical students; and how to utilize the writing class time. This paper examines the value of peer assessment and peer feedback in dealing with those questions. METHODS: This paper reviews a subject in premedical education, Logical Thinking and Writing, from the perspective of peer assessment and peer feedback. RESULTS: Students accomplished the learning objectives and they recognized the value of peer assessment and feedback. CONCLUSION: Peer assessment and peer feedback foster students' participation in class and accelerate the learning process. This strategy reminds students of the fact that they are writing an essay for an audience.

Current status and plans for development of medical self-regulation in Korea

Following several medical scandals, the issue of medical regulation has come under the spotlight in the Republic of Korea. In this article, the authors examine the administrative measures newly required of doctors in the past five years in order to illustrate the current state of medical regulation and demonstrate the urgent need for self-regulation. The history of the General Medical Council in the United Kingdom and its newly launched system of "revalidation" can provide an instructive example of a self-regulation system, and it suggests several principles for self-regulation in Korea. The recent disarray can be viewed as an opportunity to introduce a new system of self-regulation. The authors present three principles-professionalism, transparency, and fairness-for a successful system of medical regulation.

Korean doctors' perception on doctor's social competency: based on a survey on doctors

Medicine is the practice that occurs in the context of the society. It requires interaction with individual patients, fellow doctors and other health care professionals, health care officials, public, institution, and the society as a whole. To date, medical practice in Korea has largely been concentrated on applying biomedical knowledge and skill to a patient. We defines 'social competency' as 'competency for medicine as a social institution.' This survey aims to grasp the current situation of Korean doctors' perception on social competency, in terms of necessity, satisfaction, learning experience, and possible intervention. Respondents generally recognized the necessity of social competencies but were not satisfied with their demonstration of those competencies. Competencies for 'understanding on law and institution' and 'communication' were perceived highly necessary. General satisfaction and each satisfaction rate on individual competencies were all below 'neutral,' showing their dissatisfaction. Especially, doctors assess their fellow doctors' competencies for 'understanding on law and institution' and 'understanding on human being and society' at the lowest level. The mismatch between perceived necessity and satisfaction shows the legitimate ground for educational intervention. The proportions of respondents who have learned on each domain of social competency were all below 70%. Learning experience on self-management and leadership was the least. Among possible remedy for low social competency, respondents perceived 'improvement on national health insurance' and 'improvement on resident training program' as the most urgently needed. The data from this preliminary survey can be utilized for educational and institutional intervention in the future.