The Instructional-design According to Different Types of Tasks / 한국의학교육

No abstract available.

Assessing the Effectiveness of Medical Ethics Education / 한국의학교육

PURPOSE: The purpose of this study is to evaluate the effectiveness of a medical ethics course taught in medical school by examining the students' abilities to identify medical ethics issues, the applicability of a medical ethics course, and self-efficacy. METHODS: 366 subjects were recruited from three different groups (medical students, interns, and residents) who had completed a medical ethics course. Data were collected using a 20-item questionnaire. Analysis was done with a SPSS statistics program. RESULTS: Of the three groups, the students scored the highest in identifying medical ethics issues. When asked how often they see medical ethics issues in real medical situations (students were asked how often they would expect to see these ethical issues in medical settings), the students responded with the highest number, followed by the interns. The residents responded with the lowest number. Regarding the applicability of the medical ethics course, while students believed the course was highly useful and applicable to real medical settings, interns and residents did not agree. The participants' self-efficacy and satisfaction were generally low. The majority of all three groups thought that medical ethics education should be more practical and that it should be taught during internship as well as during residency. CONCLUSION: Our findings suggest two important directions for medical ethics education. First, the current medical ethics curriculum should be offered during both internship and residency. Second, the content should focus more on actual clinical scenarios ('clinical ethics') than theoretical principles.

Do Personal Characteristics Related to Breaking Bad News Influence Students' Communication Skills? / 한국의학교육

PURPOSE: Delivering bad news is a task that occurs in most medical practices, rendering communication skills essential to competent patient care. The purpose of this study was to identify factors that are associated with scores on an assessment of medical students' communication skills in delivering bad news to help develop more effective curricula to enhance these essential skills. METHODS: One hundred fifty-four fourth-year medical students at Pusan National University were included. Skills for delivering bad news were assessed using the SPIKES protocol in the CPX. The students were categorized into three main groups according to total scores: 'Exceeds expectations (E)', 'Meets expectations (M)', and 'Needs development (N)'. Personal experiences with misfortune and attitudes toward breaking bad news were surveyed, and school records were collected. The differences between the E and N groups were analyzed based on performance test and survey. RESULTS: Compared with students in the N group, E group students acquired significantlyhigher scores on the items of Perception, Invitation, a division of Knowledge, Empathy and Strategy, and Summary but not on Setting and a part of Knowledge. E group students had better records in classes and clerkships. There were no differences in personal experiences and attitudes toward breaking bad news between the groups. CONCLUSION: Personal experience with delivering bad news does not guarantee better communication, and attitudes toward this task do not influence student performance. We expect that deliberate educational programs will have a positive impact on improving communication skills for delivering bad news.

The Effect of Direct Feedback in Teaching Endotracheal Intubation / 한국의학교육

PURPOSE: This study was conducted to investigate the effect of direct verbal feedback from an expert during endotracheal intubation skills training using a mannequin compared to practice alone without feedback. METHODS: 154 fourth-year medical students at the Pusan National University were divided into control or feedback groups. Both groups were taught by experts using a mannequin at a clinical skills learning center. The feedback group (n=66) received verbal feedback from the expert throughout training. Skills acquisition was tested during a Clinical Performance Examination. RESULTS: There were no differences between the control and feedback groups in terms of prior experiences with endotracheal intubation, confidence level to perform the skill, and grades received from previous clinical clerkships. The average score of the feedback group was significantly higher than that of the control group (14.06 versus 11.98, p<0.05). When the students were divided into 'exceeds expectations', 'meets expectations' and 'needs development' groups according to a global rating, more students from the feedback group were in the 'exceeds expectations' group and less were in the 'needs development' group compared to the control group (p<0.05). The results showed no significant relation with training date. CONCLUSION: This study demonstrated that direct verbal feedback from an expert during training significantly improves the performance of endotracheal intubation skill. Feedback acts as an essential component of clinical education; and its effect is prominent, especially in students who require further development.

Students' Opinions on the Experience of Objective Structured Clinical Examination at Pusan National University School of Medicine / 한국의학교육

PURPOSE: The purpose of this study is to report the opinions of the students on the OSCE and how to improve this exam. METHODS: 135 students at Pusan National University School of Medicine were asked to perform the OSCE. Data were collected through a questionnaire (Cronbach's alpha = .965). Analysis was done using SPSS statistics program. RESULTS: In summary, the students thought the content of the OSCE was all very important but practically, it was difficult to perform due to a lack of practice. Through this exam, thestudents said that they realized their insufficiencies, and they felt more motivated to learn. The BLS station scored very high in the 'validity of contents', 'validity of difficulty', 'validity of time limit', and 'fostering learning motivation'. The opinions of the students on the areas requiring improvement were: the control of information exchange among them, the connection with training, the establishment of a permanent training space, and increasing exposure to the exam. CONCLUSION: The OSCE, now more than ever, definitely has an educating role in preparing physicians for clinical practice.

Epidemiology for Korean Knee Osteoarthritis: Results From the Health and Nutritional Survey in Kuri city

OBJECTIVE: Osteoarthritis is one of the most common joint disorder in the world. But unfortunately there is no fundamental data as to its prevalence and risk factors in Korean population. We performed this study to understand the prevalence and risk factors related to knee osteoarthritis in Koreans. MATERIALS AND METHODS: A total 867 persons aged 20-69 years were selected from the general population in Kuri city and underwent a structured interview, clinical examination of knee joint, and radiologic study. The diagnostic criteria of knee osteoarthritis which we used was composed of clinical and radio- logical criteria reported by Altman et al. General characteristics of prevalence of knee osteoarthritis in relation to age, sex, education, job were evaluated. Risk factors such as obesity, menopause, physical activity, smoking, drinking, osteoporosis, diabetes mellitus, hypertension were evaluated by chi-squre test and logistic regression. RESULTS: This study revealed that prevalence of knee osteoarthritis in Korea is 10.2%, increasing with age. High level of physical activity in men and age, postmenopause and obesity in women can be risk factors.

Revisional Reconstruction of Anterior Cruciate Ligament using Modified One Incision Technique with Autogenous Hamstring Tendon Composite Graft / 대한정형외과학회잡지

PURPOSE: Evaluation of anterior cruciate ligament (ACL) reconstruction using autogenous hamstring tendon composite grafts and the modified one incision technique for the revisional ACL reconstruction. MATERIALS AND METHODS: Eight cases that had undertaken revisional ACL reconstruction were evaluated. Follow-up period was 17.5 months on the average (12-41) . All cases were evaluated using the Lysholm knee score, KT-2000 arthrometer (Medmetrics) and one leg hop test. RESULTS: Lysholm knee score increased from 67.8 to 80.6 by an average of 13 points. When comparing with normal side, the average differences of anterior translation was 2 mm and the average functional activity was 77.1% of the healthy side. All cases returned to the normal activities of daily living. CONCLUSION: New femoral and tibial tunnel can be made regardless of pre-existing tunnels with modified one incision technique and hamstring tendon composite graft. Allogeneous bone grafts were used to fill the enlarged tunnels caused by overlapping with pre-constructed tunnels.

Vascular Leiomyoma of the Median Nerve: A Case Report / 대한정형외과학회잡지

Vascular leiomyoma or angioleiomyoma is a uncommon benign solitary tumor that arises from the tunica muscularis of blood vessels. It is usually located in the wall of the uterus. It may present with a confusing picture of hand pain and paresthesia or be asymptomatic. We describe a 49-year-old man who presented with a slowly growing mass in the volar region of wrist which, on histological examination, was shown to be a vascular leiomyoma. It is not usually included in the differential diagnosis of anterior wrist mass or median nerve tumors.

Optimal Orientation of the Femoral Tunnel in Reconstruction of Posterior Cruciate Ligament / 대한정형외과연구학회지

PURPOSE: We investigated the optimal orientation of femoral tunnel in PCL reconstruction. MATERIALS AND METHODS: Five cadaver knees were used for this study. We made the tibial tunnel at the center of foot-print of posterior cruciate ligament, at an angle of 45o to the long axis of the tibia using the Kirschner wire. The femoral tunnel was made 11mm posterior to the articular cartilage margin of medial femoral condyle. The orientation of the femoral tunnel was made on the expolated line between two points, namely the placement of the femoral tunnel on lateral wall of medial femoral condyle and the opening of the tibial tunnel in full extension of knee. We measured the angles between the tunnel and wire on roentgenogram which passed through the femoral and tibial tunnel. RESULT: On the anteroposterior view, the angle of the graft to the long axis of the femur became acute during flexion. The angle of the graft to the long axis of the femur on the coronal plane changed from 12.6o to 154.9o with flexion from 0o to 105o. The angle of the graft to the long axis of the femur on sagittal plane changed from 137.0o to 45.1o with flexion from 0o to 105o. These results suggest that optimal graft-tunnel divergence (GTD) is obtained when the angle of graft to the long axis of the femur are 83.8o on the coronal plane and about 91o on the sagittal plane. CONCLUSION: To obtain optimal orientation of the femoral tunnel, the opening of the femoral tunnel should be located as near as possible to the margin of the articular cartilage of the medial femoral condyle.

Morphologic Study of the Facet Joint in Spondylolysis and Isthmic Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: Radiological investigation to study the morphologic difference of posterior facet joint in spondylolysis and isthmic spondylolisthesis. OBJECTIVES: To study the correlation of the clinical differences between the one with spondylolysis and another with isthmic spondylolisthesis with morphological analysis of posterior facets of lumbar spine in low back pain, anterior displacement and segmental instability. SUMMARY OF LITERATURE REVEIW: There are many studies for the lumbar facet in back pain, disc degeneration, degenerative spondylolisthesis. However, little is known about the correlation of facet joint between the spondylolysis and isthmic spondylolisthesis. METHODS: This study is done with 27 specimens which contain posterior facet and lamina from 25 patients due to spondylolysis or isthmic spondylolisthesis. We took the computed tomograms in each specimen and obtained the areas and angles of posterior facets of lumbar spine. RESULTS: The group with spondylolysis has mean area(Rt/Lt) of 158.4/159.3mnfand angle(Rt/Lt) of 49.8u/54.0u. The group with isthmic spondylolisthesis has mean area(Rt/Lt) of 172.3/189.6mnfand angle(Rt/Lt) of 44.3u/44.8u. The group with segmental instability has mean(Rt/Lt) area of 155.9/161.8mnfand angle of 48.1u/50.4u. The group without instability has mean area(Rt/Lt) of 173.4/185.2mnfand angle(Rt/Lt) of 46.2u/48.5u. CONCLUSION: There are no significant differences between the morphologic difference of facets with back pain and without back pain. The group with isthmic spondylolisthesis has greater mean area and less mean angle of facet than the group with spondylolysis, but, there are no statistical significant differences(p>0.05). There are no significant morphologic differences of facet between the group with segmental instability and without segmental instability.

Intraosseous Epidermoid Cyst of Distal Phalanx: A case report / 대한정형외과학회잡지

Epidermoid cyst is a common skin lesion. However, in areas where the skin is tightly adherent to the bone, a portion of the epidermis may be implanted into the bone traumatically or a subcutaneous epidermoid cyst may penetrate the bone cortex. Intraosseous epidermoid cyst is rare, and arises almost exclusively in the skull and phalanges of the hand. In the hands, terminal phalanx is involved in almost all cases. Differential diagnosis includes glomus tumor with bone erosion, enchondroma, osteomyelitis, aneurysmal bone cyst and metastatic tumors. We experienced a case of intraosseous epidermoid cyst in the distal phalanx of a 28-year-old woman, who had injured her finger about 20 years ago. We report the clinical, radiographic and pathological findings in detail.

The Study for the Neovascularization and Basic Fibroblast Growth Factor(bFGF) Expression in the Intervertebral Disc Tissue Associated with Aging and Disc Degeneration / 대한척추외과학회지

Numerous studies have shown neovascularization and basic fibroblast growth factor(bFGF) expression in herniated nucleus pulposus. It is not clear whether the neovascularization and bFGF expression are due to herniated nucleus pulposus with secondary reaction phenomenon or due to disc aging and degeneration. The purpose of this study is to investigate neovascularization and bFGF expression in both nucleus pulposus and anulus fibrosus tissues from aging and degenerated discs and compare it to neonate intervertebral disc. Thirty disc blocks obtained during anterior interbody fusion of the lumbar spine with degenerative spine disease were studied by immunochemical stains to observe neovascularization with vascular endothelial cell growth factor(VEGF) and bFGF expression. There were 8 disc blocks from the patients with degenerative disc disease, 15 with spondylolytic spondylolisthesis, and 7 with spinal stenosis with instability. For the control group, 12 neonate disc blocks obtained at autopsy. The neovascularization and bFGF expression were observed in the outer one half layer of the anulus fibrosus in the disease group but not in the nucleus pulposus. The neovascularization and bFGF expression were not observed in the control group. There was a statistical significant difference of neovascularization and bFGF expression between the control and disease group(p0.05). The results of this study suggest that neovascularization and bFGF expression are inherently related to aging and degeneration of the intervertebral disc.

Angiogenesis and the Expression of bFGF in Protruded Disc Herniation / 대한척추외과학회지

There has been suggested to contain neovascularization reported mainly in the extruded and sequestrated disc herniations. This study is the observation of neovascularization of the blood vessels and cells in the protruded disc herniations. The first objective is the observation of the angiogenesis and the bFGF expression in the protruded disc herniations. The second objective is to study the correlation between the age distribution, sex and bFGF expression in the protruded disc herniations. Fourty-eight patients with protruded disc herniation underwent the posterior disectomy at the Ajou university Hospital from Jun. 1994 to Jun 1996. The mean period of postoperative follow-up was 24.5 months. We used the Hematoxylin-eosin stain to confirm the blood vessel formation and a fibroblast growth factor(bFGF) to observe the immunoexpression of the blood vessels and cells in the protruded disc herniation. For the control group, 12 disc specimens were obtained from patients who underwent the anterior interbody fusion for the lumbar burst fracture. The results of staining for the blood vessels or cells were 32 cases in HE stain, and 26 with bFGF. Out of 48 cases, the bFGF expression revealed in 26 cases(54.2%). Neither the correlation between sex and bFGF expression nor age-dependency and bFGF expression was statistically significant(both: chi-square test: p>0.05). The twelve control disc tissues showed the there was no blood vessels in the disc tissues.

Modified ACL Reconstruction Technique: Femoral Tunnel Preparation through the Anteromedial Portal / 대한정형외과학회잡지

Recent development and advances in arthroscopic surgical techniques for Anterior Cruciate Ligament(ACL) reconstruction have led to the single-incision techniques. Several potential pitfalls in the classic single-incision techniques were found and it has become necessary to develop a new, simpler method to overcome these problems. Seventy-five cases of arthroscope-assisted ACL reconstruction were prospectively studied. The radiologic results were compared between the group in which femoral tunnel preparation was performed by the tibia tunnel(classic technique, 35 cases) and the group in which the anteromedial portal was employed(modified technique, 40 cases). Significantly better results were obtained at the angle formed by the bone graft and the interference screw, the angle between the femoral tunnel axis and the anatomic axis of the femur, and the angle between the femoral tunnel axis and tibial tunnel axis in the modified technique(P<0.05). This study presents a modified arthroscope-assisted ACL reconstruction technique that uses the anteromedial portal for femoral tunnel preparation and insertion of interference screw. In the modified ACL reconstruction technique, the femoral tunnel preparation and femoral graft fixation were accomplished in the same direction and the femoral tunnel preparation was performed regardless of the tibial tunnel preparation, this allows the surgeon to handle the arthroscope freely and advance more posteriorly to get a better view of the posterior cortex.

Treatment of Distal Femoral Fractures with a Retrograde Supracondylar Intramedullary Nail assisted with Arthroscopy / 대한정형외과학회잡지

Since Green et al has introduced a new technique of retrograde intramedullary nail, the use of retrograde interlocking intramedullary nails has been recommended as one of the treatment options for the distal femoral fracture. However there are some disadvantages that an arthrotomy is required for insertion and the knee joint could often be violated. Authors present a simple, arthroscopically assisted method using the retrograde intramedullary nailing for distal femoral fractures with minimal invasiveness to the knee. From March 1995 to March 1997, the retrograde intramedullary nail was used to treat 9 distal femoral fractures. Five of 9 patients were fractured at the distal shaft of the femur and others were fractured at the supracondylar region of the femur. Only one of the fractures was open injury(Gustilo-Anderson grade II). Significant concomitant knee joint injuries were revealed through the arthroscopy in 3 patients. Eight of 9 fractures healed by 5 months, but one fracture was not healed and required bone grafting. Average knee range of motion was 130. Complications included 1 nonunion and 1 hardware failure. There were no patellofemoral problems and no posttraumatic arthritis of the knee joint. This arthroscope-assisted method have some potential benefits that include decreased risk of damage to the knee joint, early evaluation and treatment of the associated knee joint injuries, and accurate placement of the nail.

Double Incision Technique for Carpal Tunnel Release / 대한정형외과학회잡지

A preliminary study was conducted to evaluate the immediate postoperative recovery and socioeconomic efficacy with the surgical release of Carpal tunnel syndrome by double incision technique. Sixty cases of carpal tunnel syndrome were operated by one surgeon between 1993 and 1995 and 44 cases in 39 patients were available for this study. Surgery was done under axillary block and patients were evaiuated preoperatively, 3 weeks and 6 weeks each postoperatively. The evaluation was focused on the immediate recovery in terms of subjective symptoms of pain and paresthesia, local tenderness, strength of grip power and pinch power and postoperative disability. 1l was noted that surgical release of carpal tunnel syndrome utilizing double incision technique was as effective as seen in the endoscopic release in terms of quicker recovery of pain, local tenderness and strength. It was also noted that this double incision technique was as safe and economically beneficial as observed in the conventional open procedure.

Arthroscope - Assisted Modified Weaver and Dunn Operation for Acromioclavicular Dislocation / 대한정형외과학회잡지

There is still discussion concerning the methods for treating Tossy type 3 dislocations of the acromioclavicular joint. Since 1995, the authors have treated 10 patients of type 3 dislocations by arthroscope-assisted modified Weaver and Dunn operation with favorable results. The operation consisted of diagnostic shoulder arthroscopy, arthroscopic resection of acromial end of coracoacromial ligament with bone block, excision of distal end of clavicle, bone block transfer of coracoacromial ligament into the medullary canal of clavicle, and augmentation between coracoid process and resected distal end of clavicle with the Mersilene tape. The advantages of this arthroscope-assisted modified Weaver and Dunn operation are as follows: (1) Using the shoulder arthroscope, associated patholgy in the shoulder joint can be found and treated appropriately. (2) Arthroscopic resection of the acromial end of coracoacromial ligament can give the small incision and least damage to the deltoid muscle so that immediate post-operative range of motion exercise can be possible. (3) Bone block transfer of coracoacromial ligament and augmentation between coracoid process and resected clavicular end can prevent displacement of the resected clavicular end.

Midcarpal Fusion with Excision of Scaphoid for Scapholunate Advanced Collapse ( SLAC ) / 대한정형외과학회잡지

Scapholunate advanced collapse (SLAC) deformity most often occurs with chronic rotary scaphoid instability from scaphoiunate ligament tear and scaphoid fracture. Prior to 1984 when Watson HK reported his concept on SLAC wrist deformity, the most popular procedure for this pathology was scaphoid implant arthroplasty with or without midcarpal fusion. We have reviewed 15 cases of SLAC deformity treated with scaphoid excision and midcarpal fusion from 1984 to 1993. Among them, scaphoid implants made of silicone were inserted in 4 cases. Scaphoid implant arthroplsty without carpal fusion has been excluded. The mean period of follow-up was 8.8 years and the mean age of patients was 47.5 years. Males and right wrists were predominant. Wrist motion was 56% and grip power was 71% of the normal opposite side. On the average overall, 8 patients had no pain and 7 patients had mild pain. The grade of pain was minimal, 0.5 in grade (Rating system: no pain-0, mild- 1, moderate-2, severe-3). However, all of the 4 cases of limited carpal fusion with a scaphoid implant developed silicone particulate induced synovitis and pain. The procedure appears to be effective in maintaining function of the hand with minimal pain up to 5.8 years. However, silicone scaphoid implant appears not to be necessary and is not recommended with a limited carpal fusion for this pathology.

Dedifferentiation of Human Chondrocyte in Monolayer Culture and its Reversibility in Pellet Culture / 대한정형외과연구학회지

Articular cartilage is a unique tissue devoid of blood and nerve tissue and so its regeneration is very limited. Recently a clinical trial on transplantation using autologous chondrocyte with periosteal flap has drawn a great deal of attention. Chondrocytes cultured in a plastic flask in monolayer can rapidly dedifferentiate appearing fibroblastic, and exhibit a change in matrix gene expression characterized by a decrease in type II collagen synthesis. It is uncertain whether phenotypic change of dedifferentiated chondrocytes in vitro can be reversible to their original status alter long term culture. It is important to verify tile maintenance of the phenotype and determine the optimum period for culturing chondrocytes to be used in autologous chondrocyte transplantation. This study will be set up to confirm the reversibility of once-dedifferentiated chondrocytes with matrix-producing capability. The phenotype of cultured human chondrocyte is analysed by Northern blot and Western blot analysis for collagen type I and II. Chondrocytes appeared fibroblast right after adhering to the flask buttom at first week of culture. The proliferating rates of chondrocyte in a monolayer culture were maximum at 3rd and 4th week of culture. And thereafter, proliferation rate flowed down or stops as confluence rose. On Northern and Western blot analysis, collagen type II was well expressed by 3th to 4th week culture, thereafter progressively decreased its density with time. On the other hand, collagen type I m-RNA has not expressed until 3rd week of the culture, showing progressive increment of density thereafter. On Northern blot analysis in pellet culture, type II collagen m-RNA is apparantly reexpressed. This study indicates chat in the monolayor culture, the chondrocytic phenotype was lost with regards to morphology and mRNA expression and cartilage specific protein. However, these cells seemed to haute the potential to redifferentiate to well-differentiated chondrocytes in densely packed culture, such as pellet.