Passivity, task segmentation, and relational capital: a study of interpersonal relationship formation among freshman medical students in team-based activities / 한국의학교육

Purpose@#Team-based learning in medical education facilitates the formation of interpersonal relationships, enhances academic achievement, and establishes future clinical connections. Despite medical schools’ distinct educational environments and curricula, research investigating students’ learning and behavioral characteristics within this context remains limited. This study aimed to investigate the specific characteristics of interpersonal relationship formation among freshmen medical students in team-based learning activities. @*Methods@#Focus group interviews were conducted with 11 students who participated in a team-based class held during the first semester of the premedical year. @*Results@#Medical students passively expressed their thoughts and feelings, such as active sympathy for the team’s opinions and self-censorship of SNS (social networking service) conversations. When performing team activities, students were excessively conscious of others and focused on evenly dividing their work, minimizing their opinions, and fulfilling their share to prevent potential interpersonal conflicts. Interpersonal activities were only superficial, as students intentionally maintained a certain distance from team members or used team activities as an opportunity to accumulate relational capital. @*Conclusion@#The results of this study are expected to provide a useful basis for designing and conducting team activity classes to enhance interpersonal relationship formation.

Is it possible to introduce an interview to the Korean Medical Licensing Examination to assess professional attributes?: a survey-based observational study / 보건의료교육평가

Purpose@#This study aimsed to gather opinions from medical educators on the possibility of introducing an interview to the Korean Medical Licensing Examination (KMLE) to assess professional attributes. Specifically following topics were dealt with: the appropriate timing and tool to assess unprofessional conduct; ; the possiblity of prevention of unprofessional conduct by introducing an interview to the KMLE; and the possibility of implementation of an interview to the KMLE. @*Methods@#A cross-sectional study approach based on a survey questionnaire was adopted. We analyzed 104 pieces of news about doctors’ unprofessional conduct to determine the deficient professional attributes. We derived 24 items of unprofessional conduct and developed the questionnaire and surveyed 250 members of the Korean Society of Medical Education 2 times. Descriptive statistics, cross-tabulation analysis, and Fisher’s exact test were applied to the responses. The answers to the open-ended questions were analyzed using conventional content analysis. @*Results@#In the survey, 49 members (19.6%) responded. Out of 49, 24 (49.5%) responded in the 2nd survey. To assess unprofessional conduct, there was no dominant timing among basic medical education (BME), KMLE, and continuing professional development (CPD). There was no overwhelming assessment tool among written examination, objective structured clinical examination, practice observation, and interview. Response rates of “impossible” (49.0%) and “possible” (42.9%) suggested an interview of the KMLE prevented unprofessional conduct. In terms of implementation, “impossible” (50.0%) was selected more often than “possible” (33.3%). @*Conclusion@#Professional attributes should be assessed by various tools over the period from BME to CPD. Hence, it may be impossible to introduce an interview to assess professional attributes to the KMLE, and a system is needed such as self-regulation by the professional body rather than licensing examination.

Exploring the preconception of the first year of medical students on medicine before entering medical school / 한국의학교육

Purpose@#First-year students can form a preconception based on life experiences before entering college and identifying learners’ existing characteristics can be useful foundation data for curriculum development. This study examines what preconceptions freshman students had about medicine before entering medical school. @*Methods@#A total of 110 first-year students were asked about what preconceptions they had about “medicine”. A total of 1,124 data were used in the content analysis method. @*Results@#The results were extracted into 5, and 12 twelve categories. On the theme of “scientific discipline”, the knowledge students had about general health was based on scant expertise and little evidence. Students perceived medicine as Western and scientific, considering Korean traditional medicine as unscientific. Students believed that “medical practice” should be a “disease treatment” and “patient-centered” approach rather than a “social responsibility”. In “the role of the doctor”, students were concerned about the doctor's being financially stable on the positive side, and about the high-intensity workload on the negative side. In “medical education”, students believed that studying medicine would be “hard and difficult” because of the “importance of memorizing” and “extensive study load”. In “specialty stereotype”, students had biases that were mostly concentrated on “psychiatry” and “surgery” @*Conclusion@#Perception of “medicine” has been revealed to a varied range of themes, but some have been inaccurate or unrealistic. These prejudices and groundless beliefs have a gap with the learning outcomes that students should achieve in the curriculum, and these preconceptions seem to have been influenced by South Korea’s unique cultural context.

Pre-clerkship students’ perception and learning behavior of online classes during coronavirus disease 2019 pandemic / 한국의학교육

Purpose@#This study aims to analyze pre-clerkship medical students’ learning strategies and perceptions in online classes during the coronavirus disease 2019 pandemic. @*Methods@#To develop the survey items, 20 pre-clerkship students were interviewed about their learning experiences in the first semester of 2020. A total of 425 pre-clerkship students have participated in the survey, which comprised four parts (general experience, learning strategies, important features, and overall satisfaction). @*Results@#Before classes began, students generally had “neutral expectations” about online classes (2.90 out of 5). At the end of the semester, overall satisfaction with the curriculum was moderate (3.04 out of 5). Premedical students reported lower scores in “daily study hours” and “regular lifestyle” and higher scores in “experience of playing recorded lectures solely for an attendance check” (p<0.001). In addition, first-year premedical students not only showed significantly lower utilization of learning strategies compared to other grades (p<0.001). @*Conclusion@#Although pre-clerkship students mostly shared similar perceptions and behaviors in their learning regardless of grade level, some characteristics were either more prominent in premedical students on the whole or limited to first-year premedical students.

A Qualitative Study on the Perceptions and Learning Behavior of Medical Students in Online Classes / 의학교육논단

Since the emergence of coronavirus disease 2019 (COVID-19), medical schools have experienced a sudden, full-scale transition to online classes. As the COVID-19 pandemic continues, it is important to evaluate current educational programs and to assess their implications. This study explored perceptions of online classes and learning behavior among medical students. Twenty preclinical medical students were interviewed in focus groups for 2 months. They generally expressed positive perceptions about online classes, and in particular, positively assessed the ability to lead their individual lifestyles and study in comfortable environments with fewer time and space constraints. Students thought that the online environment provided a fair chance of facilitating positive interactions with the professor and considered communication with the professor to be an important factor only when it was related to the class content or directly helped with their grades and careers. Students also had negative views, such as feeling uncertain when they could not see their peers' learning progress and assess themselves in comparison and feeling social isolation. Learning behaviors have also changed, as students explored their learning styles and adapted to the changed learning environment.Students expanded their learning by using online functions. However, students sometimes abused the online class format by “just playing” the lecture while not paying attention and relying on other students’ lecture transcripts to study. The results of this study are hoped to provide a useful foundation for future research on online class-based teaching and learning.

Changes in academic performance in the online, integrated system-based curriculum implemented due to the COVID-19 pandemic in a medical school in Korea / 보건의료교육평가

Purpose@#This study examined how students’ academic performance changed after undergoing a transition to online learning during the coronavirus disease 2019 (COVID-19) pandemic, based on the test results of 16 integrated courses conducted in 3 semesters at Hanyang University College of Medicine in Korea. @*Methods@#For the 16 required courses that formed an integrated system-based curriculum running for 3 semesters, the major examinations’ raw scores were collected for each student. Percent-correct scores were used in the subsequent analysis. We used the t-test to compare grades between 2019 and 2020, and the Cohen D was calculated as a measure of effect size. The correlation of scores between courses was calculated using Pearson correlation coefficients. @*Results@#There was a significant decrease in scores in 2020 for 10 courses (62.5%). While most of the integrated system-based curriculum test scores showed strong correlations, with coefficients of 0.6 or higher in both 2019 and 2020, the correlation coefficients were generally higher in 2020. When students were divided into low, middle, and high achievement groups, low-achieving students consistently showed declining test scores in all 3 semesters. @*Conclusion@#Our findings suggest that the transition to online classes due to COVID-19 has led to an overall decline in academic performance. This overall decline, which may occur when the curriculum is centered on recorded lectures, needs to be addressed. Further, medical schools need to consider establishing a support system for the academic development of low-achieving students.

Pre-clerkship students’ perception and learning behavior of online classes during coronavirus disease 2019 pandemic / 한국의학교육

Purpose@#This study aims to analyze pre-clerkship medical students’ learning strategies and perceptions in online classes during the coronavirus disease 2019 pandemic. @*Methods@#To develop the survey items, 20 pre-clerkship students were interviewed about their learning experiences in the first semester of 2020. A total of 425 pre-clerkship students have participated in the survey, which comprised four parts (general experience, learning strategies, important features, and overall satisfaction). @*Results@#Before classes began, students generally had “neutral expectations” about online classes (2.90 out of 5). At the end of the semester, overall satisfaction with the curriculum was moderate (3.04 out of 5). Premedical students reported lower scores in “daily study hours” and “regular lifestyle” and higher scores in “experience of playing recorded lectures solely for an attendance check” (p<0.001). In addition, first-year premedical students not only showed significantly lower utilization of learning strategies compared to other grades (p<0.001). @*Conclusion@#Although pre-clerkship students mostly shared similar perceptions and behaviors in their learning regardless of grade level, some characteristics were either more prominent in premedical students on the whole or limited to first-year premedical students.

The pharmacology course for preclinical students using team-based learning / 한국의학교육

Purpose@#A pharmacology course in undergraduate medical education aims to enable students to cultivate the ability of applying drugs in the clinical context using basic scientific knowledge. Although team-based learning could be a useful approach, the literature on pharmacology education using team-based learning is limited. This study aims to evaluate the effectiveness of a pharmacology course using team-based learning. @*Methods@#We developed an “integrated clinical pharmacology” course for first-year medical students. All 49 students enrolled in the course. Individual and group scores were recorded for each session, and a post-course survey was conducted after the course. We compared the performance of the current class to that of a previous class based on scores in a nationwide test conducted at the end of every year. @*Results@#The reactions of the students were generally positive, with the exception of their perception of the preparatory burdens for the individual test. Throughout the team-based learning sessions, the achievement at the group level was significantly higher than at the individual level. In the nationwide test, however, when we divided students into high and low achiever groups, only the low achievers demonstrated significant improvement compared to the cohort from the previous year. @*Conclusion@#The study demonstrates that team-based learning could be an effective way of teaching pharmacology to medical students in the preclinical stage. Although most of the students were actively engaged regardless of their preparedness, low-achieving students in particular seemed to gain more benefits than high achievers regarding the acquisition of knowledge.

Effects of Academic Relationships on Academic Burnout in Health Professions Students / 의학교육논단

There are several dimensions of academic burnout experienced by medical and health science college students. The purpose of this study was to examine the effects of academic relationships on academic burnout. Data was collected from 476 Eulji University students using an online survey over 4 days in April of 2018. Of the 264 respondents, 111 studied medicine (42.0%), 105 studied nursing (39.8%), and 48 studied clinical pathology (18.1%). The questionnaire was composed of the following sections: demographics (four questions), general life characteristics (seven questions), academic enthusiasm (eight questions), academic relationships (15 questions), and academic burnout sub-dimensions (partially revised Maslach Burnout Inventory-Student Survey Scale) (11 questions). T-tests and one-way analysis of variance were performed to illustrate the differences among the three departments. The effects of academic relationships and academic enthusiasm on academic burnout were analyzed using linear regression. Comparing the three departments, academic burnout was not found to be statistically significant (p=0.296). However, medical students' academic enthusiasm was significantly lower (p<0.001) and academic relationships were significantly higher (p<0.001) than nursing and clinical pathology students. The difference in academic burnout among the three departments was not significant. However, medical students have stronger academic relationships, while nursing and clinical pathology students were more focused on academics. Relationships and academic enthusiasm contribute to reducing academic burnout. Therefore, strategies need to be developed to deal with academic burnout considering relationship factors.

Evaluation of critical thinking course for premedical students using literature and film / 한국의학교육

PURPOSE@#Premedical education is one stage in which various educational approaches are used to promote critical thinking. Given that critical thinking ability could be regarded as one of the intended outcomes of social science and humanities education, this study explored the effectiveness of a course to promote critical thinking in a premedical curriculum using both literature and film.@*METHODS@#Fifty-one 2nd year premedical students enrolled in a 'Critical Thinking for Premeds' course. Students were required to read or watch a selected material, submit group discussion agendas, attend five group discussion sessions, and write critical essays. Five tutors facilitated the group discussions, observed and assessed the students' performance and critical essay. Students' critical thinking disposition and opinion on assigned reading materials were examined before and after the course. A program evaluation survey was conducted to investigate the students' reaction after the course.@*RESULTS@#On average, students appreciated 78.6% of the total assigned materials. The students indicated that group discussions and the narrative comments of facilitators contributed the most to develop critical thinking. After the course, the students' tendency preferring cheaper price books, as well as medicine-related books decreased significantly. Students who had critical essay scores greater than or equal to the median demonstrated a significant improvement in critical thinking disposition scores.@*CONCLUSION@#The course was well-accepted by premedical students and had several positive outcomes. A more effective use of the course could be anticipated with a clearer explanation of the purpose, the consideration of previous reading experience, and use of complementary learning activities.

Evaluation of critical thinking course for premedical students using literature and film / 한국의학교육

PURPOSE: Premedical education is one stage in which various educational approaches are used to promote critical thinking. Given that critical thinking ability could be regarded as one of the intended outcomes of social science and humanities education, this study explored the effectiveness of a course to promote critical thinking in a premedical curriculum using both literature and film. METHODS: Fifty-one 2nd year premedical students enrolled in a 'Critical Thinking for Premeds' course. Students were required to read or watch a selected material, submit group discussion agendas, attend five group discussion sessions, and write critical essays. Five tutors facilitated the group discussions, observed and assessed the students' performance and critical essay. Students' critical thinking disposition and opinion on assigned reading materials were examined before and after the course. A program evaluation survey was conducted to investigate the students' reaction after the course. RESULTS: On average, students appreciated 78.6% of the total assigned materials. The students indicated that group discussions and the narrative comments of facilitators contributed the most to develop critical thinking. After the course, the students' tendency preferring cheaper price books, as well as medicine-related books decreased significantly. Students who had critical essay scores greater than or equal to the median demonstrated a significant improvement in critical thinking disposition scores. CONCLUSION: The course was well-accepted by premedical students and had several positive outcomes. A more effective use of the course could be anticipated with a clearer explanation of the purpose, the consideration of previous reading experience, and use of complementary learning activities.

Evaluation of Process and Satisfaction for Selective Courses in a Medical School / 의학교육논단

The necessity of embracing selective courses in medical curriculum is increasing due to the expansion of medical knowledge and changes in the health care environment. In contrast to the abundant evidence regarding elective or selective courses during the clinical phase, articles focusing on the preclinical period are relatively scarce. This study aims to explore the development, implementation, and evaluation of newly-adopted selective courses in the first-year medical curriculum in a medical school which recently underwent a major curricular revision. First of all, the Curriculum Committee established goals and operating principles of the courses, and then the committee encouraged all participating professors to attend a related faculty development workshop after finalizing the list of courses. A survey was conducted at the end of each course for evaluation. Of the 36 courses opened in 2016, the overall satisfaction of students was 4.98±1.06 (out of 6) and showed a strong correlation with students' previous expectations, reasoning- and participation-oriented teaching, and outcome of the courses including increased motivation. In the open-ended responses, students and professors described not only intended outcomes such as acquisition of medical knowledge and increased interest in new topics, but also unintended outcomes including positive impression for selective courses and even high satisfaction and rewarding experiences, especially from the teachers' perspective. Although long-term outcomes remain to be seen, the results of this study show the feasibility and impact of selective courses and will contribute to effective implementation in other medical schools.

Evaluation of an extracurricular program for students interested in rural and public health / 한국의학교육

PURPOSE: The problem regarding the geographic imbalance of the physician workforce has been a long-standing problem in South Korea. Additionally, rural medicine and public health have been marginalized across whole undergraduate curriculums. The aim of this study was to evaluate the effectiveness of an extracurricular program targeting medical students interested in rural and public health. METHODS: A 2-day extracurricular program was held twice in 2015 and 2016. A total of 53 students were selected among eighty students who voluntarily applied to participate in the program. The effectiveness of the program was evaluated by pre- and post-program surveys. RESULTS: The overall satisfaction for the program was 5.35 out of 6. The participants showed a significant improvement in perception of the clerkship experience in a rural and public health care setting as well as the importance of rural medicine and public health in South Korea. CONCLUSION: In conclusion, this study showed the acceptability of a short-term extracurricular program for medical students interested in rural and public health.

Transnational collaboration for faculty development in health professions education in Mongolia / 한국의학교육

PURPOSE: The Mongolian National University of Medical Sciences is the only national university in Mongolia and has produced more than 90% of health professionals in the country. Experts from Mongolia and Korea embarked on a collaborative effort to develop educational programs for faculty development based on the personal and professional needs of faculty members. This study aimed to evaluate the outcomes of those educational programs to determine whether this transnational collaboration was successful. METHODS: A needs assessment survey was conducted among 325 faculty members. Based on the results of this survey, the joint expert team developed educational programs on seven core topics: clinical teaching, curriculum development, e-learning, item writing, medical research, organizational culture, and resident selection. Surveys evaluating the satisfaction and the attitudes of the participants were conducted for each program. RESULTS: Throughout the 17-day program, 16 experts from Korea and 14 faculty members from Mongolia participated as instructors, and a total of 309 participants attended the program. The average satisfaction score was 7.15 out of 8.0, and the attitudes of the participants towards relevant competencies significantly improved after each educational program. CONCLUSION: The faculty development programs that were developed and implemented as part of this transnational collaboration between Mongolia and Korea are expected to contribute to the further improvement of health professions education in Mongolia. Future studies are needed to evaluate the long-term outcomes of these educational programs.

The Effect of Formative Program Evaluation on Continuous Program Improvement: A Case Study of a Clinical Training Program in Lao PDR

This study aimed to evaluate the effect of the formative program evaluation on the continuous improvement of a clinical training program for Lao health professionals. The training program was conducted 4 times consecutively for total 48 health professionals, and the formative program evaluation was carried out during the whole process. To evaluate the satisfaction and the transfer of the trainees, the questionnaire survey, the focus group interview, and the trainees' medical records were used. After the end of each batch of the program, the evaluation data were analyzed, and its results were shared with the training management committee and the trainers, who, based on the results, reached a consensus on how to improve the program. The evaluation results and the comparison of them among the four batches of the program showed that there was a continuous increase of the satisfaction and the transfer of the trainees, especially in the early period of the program. The formative program evaluation which was conducted during the whole process of the clinical training program had a positive effect on the improvement of the program, especially in the early phase, by increasing the satisfaction and transfer of the trainees.

What is the current orientation of undergraduate medical education in Korea? / 한국의학교육

PURPOSE: The educational purpose of a medical school is important, because it guides educational decisions in an individual organization and projects the image of the doctors that we are generating. By analyzing the educational goals of entire medical schools, this study aimed to examine the current orientation and future direction of undergraduate medical education in Korea. METHODS: Educational goals were collected from the website of each medical school and subjected to inductive content analysis. After identifying categories and themes, we examined the differences between medical school subgroups and compared the categories with competencies that have been suggested by the "Korean Doctor's Role." RESULTS: Thirteen themes were identified: medical expertise, professionalism, contribution to various levels of society, self-management and development, basic educational ideology, research ability, cooperation, leadership, dealing with future change, respect for life, creativity, problem-solving ability, and ability to educate. There was a significant difference in educational goals between medical schools when grouped by geographic location and affiliation of research-driven hospitals. Of the 16 competencies that are suggested by the Korean Doctor's Role, 12 had one or more corresponding categories. CONCLUSION: Per their current educational purposes, Korean medical schools pursue a broad variety of competencies that need cultivating during the course of undergraduate medical education. Further research is needed to determine how best to apply these educational purposes in actual institutions and ultimately lead them to become part of the competency of a graduate.

Research and development of evaluation criteria for premedical curriculum / 한국의학교육

PURPOSE: The purpose of this study was to develop criteria to evaluate a premedical curriculum to ultimately improve the quality of premedical education. METHODS: The first draft of the evaluation criteria was developed through a literature review and expert consultation. The Delphi survey was conducted to ensure the validity of the draft. RESULTS: The final premedical curriculum criteria consisted of three evaluation areas (curriculum development, curriculum implementation, and curriculum outcome), five evaluation items (educational objective, organization of curriculum, instructional method, class management, and educational outcome), and 18 evaluation indicators. CONCLUSION: There should be further discussion on the evaluation questionnaire and the content for each evaluation indicator with regard to its practical application. Also, a concrete evaluation system, including evaluation standards and rating scales, should be developed.

BAFF knockout improves systemic inflammation via regulating adipose tissue distribution in high-fat diet-induced obesity

Obesity is recognized as a chronic low-grade inflammatory state due to adipose tissue expansion being accompanied by an increase in the production of proinflammatory adipokines. Our group is the first to report that B-cell-activating factor (BAFF) is produced from adipocytes and functions as a proinflammatory adipokine. Here, we investigated how loss of BAFF influenced diet-induced obesity in mice by challenging BAFF-/- mice with a high-fat diet for 10 weeks. The results demonstrated that weight gain in BAFF-/- mice was >30% than in control mice, with a specific increase in the fat mass of the subcutaneous region rather than the abdominal region. Expression of lipogenic genes was examined by quantitative real-time PCR, and increased lipogenesis was observed in the subcutaneous adipose tissue (SAT), whereas lipogenesis in the epididymal adipose tissue (EAT) was reduced. A significant decrease in EAT mass resulted in the downregulation of inflammatory gene expression in EAT, and more importantly, overall levels of inflammatory cytokines in the circulation were reduced in obese BAFF-/- mice. We also observed that the macrophages recruited in the enlarged SAT were predominantly M2 macrophages. 3T3-L1 adipocytes were cultured with adipose tissue conditioned media (ATCM), demonstrating that EAT ATCM from BAFF-/- mice contains antilipogenic and anti-inflammatory properties. Taken together, BAFF-/- improved systemic inflammation by redistributing adipose tissue into subcutaneous regions. Understanding the mechanisms by which BAFF regulates obesity in a tissue-specific manner would provide therapeutic opportunities to target obesity-related chronic diseases.

Evaluation of first year outcomes of Lee Jong-Wook Seoul Project using Kirkpatrick's four-level evaluation approach / 한국의학교육

PURPOSE: The Lee Jong-Wook Seoul Project, which began in 2011, is a training program that aims to educate faculty members of Lao University of Health Sciences in medical knowledge and skills. The project has tremendous significance, attempting to apply the Korean health care developmental model to developing countries. Precise evaluation of the project outcome must be performed to enhance the effectiveness, improve the shortcomings, and adjust the future direction of the program. METHODS: Trainers and exchange professors were asked to fill out questionnaires in the middle and at the end of the program. Eight months after its completion, an evaluation team visited Lao and interviewed each exchange professor individually. Also, 360-degree feedback was obtained from their colleagues. We analyzed the answers to the questionnaires, based on Kirkpatrick's 4-level model. RESULTS: The trainers and exchange professors had positive reactions to the program. All participants felt that their knowledge and skills improved (in their respective fields), although the actual improvement was not extensive, according to their trainers' assessments. The 360-degree feedback demonstrated that the participants actively passed on their experience, knowledge, and skills to their colleagues on returning to work. CONCLUSION: Although a 4-level evaluation was not conducted and despite the limitations in examining academic achievement, interviewing Lao professors, and acquiring quantitative data at Lao University of Health Sciences, this project has demonstrated its value in the development of individual professors and their colleagues.

How different are premedical freshmen who enter after introducing a multiple mini-interview in a medical school? / 한국의학교육

PURPOSE: Seoul National University College of Medicine (SNUMC) introduced a multiple mini-interview (MMI) to assess the noncognitive ability of applicants in 2013. This study aims to examine whether students differ with regard to their personal career values and academic achievements by admission type. METHODS: We administered a survey about career values and self-perception of competencies. We then compared the survey results and academic achievements by admission type. Finally, the correlation coefficient between MMI score and academic achievement was calculated in the MMI group. The data were analyzed by t-test and correlation analysis. RESULTS: There was no statistically significant difference in career values between groups. For self-perception of competency, only the 'interact in heterogeneous groups' domain was higher for those who entered through the MMI. The MMI group had a higher and broader level of academic achievement. Within the MMI group, there was a significant correlation between grade point average and MMI station scores. CONCLUSION: The characteristics of students who entered through the MMI were more in accordance with the goals of SNUMC and the competency of future doctors. Considering the unique feature of premedical academic achievement, this result implies that such students have superior noncognitive abilities, such as self-development and internal motivation. How these differences change subsequently remains to be seen.