Relationship of Peer- and Self Assessments in the Anatomy Laboratory and Academic Performance of Gross Anatomy / 체질인류학회지

Gross anatomy, with cadaver laboratory dissection, is in a unique position to preside over a rich number of activities such as the team work, integrity, active learning, communication in the small group-all aspects of professional conduct. The purposes of this study are to investigate the correlation of professionalism with academic performance and the characteristics of groups of students in the performance variables. First-year Pusan National University School of Medicine students (n=108) from the Class of 2015 taking the gross anatomy course were required to do the self- and peer assessment about the professional behaviors of each of the six members of their dissecting group. The students were classified into one of four subgroups based on their deviation from the self- and peer assessment medians, such as high peer/high self (HP/HS), high peer/low self (HP/LS), low peer/high self (LP/HS), low peer/low self (LP/LS). There were significant higher scores in the high peer groups (HP/HS, HP/LS) in comparison with low peer groups (LP/HS, LP/LS) in the academic performance of end-of-term (F=3.24), credit (F=3.54), pre-Lab (F=3.94), practical examination (F=3.60) scores. Significant correlations among academic performance variables were observed generally. There were some differences in the correlation in the practical examination and other variables. The relatively high correlation between practical examination and other variables is HP/HS, followed by LP/LS, LP/HS and then HP/LS. In conclusion, peer- and self assessment subgroups showed a significant differences in the academic performance. This assignment would be available to evaluate work habits of professionalism in the gross anatomy laboratory. It is suggested that HP/HS group was more adaptable in the contextual leaning the gross anatomy course.

Structured Assessment to Evaluate a Family Medicine Clerkship Program / 의학교육논단

This correction is being published to revise the acknowledgements of the above article.

Structured Assessment to Evaluate a Family Medicine Clerkship Program / 의학교육논단

This study was conducted to analyze the strengths and weaknesses of a 3-week family medicine clerkship program based on the results of an online survey taken by the students (N=127) and a structured interview with a focus group (n=10), aimed to improve the quality of the clerkship program. The online survey contained questions pertaining to goals, schedule, contents, arrangement, atmosphere, environment, evaluation, and satisfaction regarding the clerkship. The focus group interview addressed the schedule and achievements of the program. Scores were reported on a 5-point Likert scale. Most students were highly satisfied with the overall quality of the clerkship. The structured interview results showed that 97.6% of the clerkship program was executed according to the schedule. The focus group reported a perfect score of 5 points on several measures including: accomplishment of the educational goals of the family medicine clerkship, providing many chances to obtain medical histories and perform physical examinations on real patients, experience with various symptoms and diseases, positive attitudes of faculty members when teaching, notification of the guidelines for evaluation beforehand, well-constructed and effective clerkship schedule, and reflection of student feedback. However, the focus group gave low scores on: support for health accidents of students, access to patient information, enough opportunities to practice clinical skills, appropriate rest facilities for students, and fairness of clerkship evaluation process. In conclusion, the structured evaluation performed after the 3-week clerkship program motivated students and helped them ensure an efficient clerkship. This structured evaluation also suggested basic data to make the professor who is subject of the assessment. This study shows that structured assessment is an effective method which can be used to improve the quality of clerkships.

A pilot study on the evaluation of medical student documentation: assessment of SOAP notes / 한국의학교육

PURPOSE: The purpose of this study was evaluation of the current status of medical students' documentation of patient medical records METHODS: We checked the completeness, appropriateness, and accuracy of 95 Subjective-Objective-Assessment-Plan (SOAP) notes documented by third-year medical students who participated in clinical skill tests on December 1, 2014. Students were required to complete the SOAP note within 15 minutes of an standard patient (SP)-encounter with a SP complaining rhinorrhea and warring about meningitis. RESULTS: Of the 95 SOAP notes reviewed, 36.8% were not signed. Only 27.4% documented the patient's symptoms under the Objective component, although all students completed the Subjective notes appropriately. A possible diagnosis was assessed by 94.7% students. Plans were described in 94.7% of the SOAP notes. Over half the students planned workups (56.7%) for diagnosis and treatment (52.6%). Accurate documentation of the symptoms, physical findings, diagnoses, and plans were provided in 78.9%, 9.5%, 62.1%, and 38.0% notes, respectively. CONCLUSION: Our results showed that third-year medical students' SOAP notes were not complete, appropriate, or accurate. The most significant problems with completeness were the omission of students' signatures, and inappropriate documentation of the physical examinations conducted. An education and assessment program for complete and accurate medical recording has to be developed.

Two-and-a-half year follow-up study of strategy factors in successful learning to predict academic achievements in medical education / 한국의학교육

PURPOSE: We performed a two-and-a-half year follow-up study of strategy factors in successful learning to predict academic achievements in medical education. METHODS: Strategy factors in successful learning were identified using a content analysis of open-ended responses from 30 medical students who were ranked in the top 10 of their class. Core words were selected among their responses in each category and the frequency of the words were counted. Then, a factors survey was conducted among year 2 students, before the second semester. Finally, we performed an analysis to assess the association between the factors score and academic achievement for the same students 2.5 years later. RESULTS: The core words were "planning and execution," "daily reviews" in the study schedule category; "focusing in class" and "taking notes" among class-related category; and "lecture notes," "previous exams or papers," and "textbooks" in the primary self-learning resources category. There were associations between the factors scores for study planning and execution, focusing in class, and taking notes and academic achievement, representing the second year second semester credit score, third year written exam scores and fourth year written and skill exam scores. Study planning was only one independent variable to predict fourth year summative written exam scores. CONCLUSION: In a two-and-a-half year follow-up study, associations were founded between academic achievement and the factors scores for study planning and execution, focusing in class, and taking notes. Study planning as only one independent variable is useful for predicting fourth year summative written exam score.

Study of Clinical Medical Teachers' Attitudes to the Knowledge of Gross Anatomy of Medical Students / 체질인류학회지

There is concerns about the perceived decline in the knowledge of gross anatomy of the medical students and postgraduate trainees. It is partly caused by the introduction of integrated medical curriculum and the shortage of basic medical science program and the extension of clinical clerkship consequently. There is widespread variability in the teaching style and anatomical curricular content at the medical school in Korea. Despite these changes in the anatomical education, there have been few attempts to assess the opinions of senior clinical teachers on the state of anatomical knowledge of students and the place of anatomy teaching within the curriculum. We sought the views of the clinical teachers on the adequacy of the anatomical knowledge of current students and recent graduates of 5 medical schools in Pusan and Gyeongsang-Nam do areas. Most of the clinical teachers were of the opinion that current medical students have an insufficient anatomical knowledge. They indicated the causes of decline were the clinical irrelevant anatomical teaching content and weakness of identity of anatomy by the introduction of the integrated medical education program. There was widespread support for both the concepts of spreading anatomy teaching throughout the medical course, and an optional, clinically related final year student project in the anatomy.

Group Counseling for Medical Students with Drop-Out Experiences / 한국의학교육

PURPOSE: The purpose of this research was to describe our group counseling methods for medical students with drop-out experiences. METHODS: Group counseling was offered to 11 medical students with drop-out experiences in their previous second semester. All subjects provided written informed consent before participating and completed a 2-day group counseling program using the Gestalt approach. The self-assertiveness training group counseling program consisted of 6 sessions, each of which lasted 90 minutes. Experience reports by participants after the program and data from semi-structured qualitative interviews were qualitatively analyzed. RESULTS: Program participants reported that they were moderately satisfied with the program regarding its usefulness and helpfulness on self-awareness, understanding, and reminding them of attempts to change behavior. Most students showed heightened levels of sincerity perceptions and positive attitudes in every session. The results demonstrated significant changes in experience in self-esteem, self-recognition, and interpersonal relationships. CONCLUSION: A group counseling program using the Gestalt approach could help medical students with drop-out experiences to adjust with 1 year their juniors, enhance their self-esteem, contribute to their psychological well-being, and prevent student re-failure through effective stress management and improved interpersonal relationships.

Experience of clinical skills assessment in the Busan-Gyeongnam Consortium / 한국의학교육

PURPOSE: The purpose of this study is to judge the quality of clinical skills assessment in Busan-Gyeongnam Consortium. METHODS: Fourth grade medical school students (n=350 in 2012 and n=419 in 2013) in the Busan-Gyeongnam Consortium were included in the study. The examination was consisted of 6 clinical performance examination (CPX) and 6 objective structured clinical examination (OSCE) stations. The students were divided into groups to take the exam in 4 sites during 3 days. The overall reliability was estimated by Cronbach alpha coefficient across the stations and the case reliability was by alpha across checklist items. Analysis of variance and between-group variation were used to evaluate the variation of examinee performance across different days and sites. RESULTS: The mean total CPX/OSCE score was 67.0 points. The overall alpha across-stations was 0.66 in 2012 and 0.61 in 2013. The alpha across-items within a station was 0.54 to 0.86 in CPX, 0.51 to 0.92 in OSCE. There was no significant increase in scores between the different days. The mean scores over sites were different in 30 out of 48 stations but between-group variances were under 30%, except 2 cases. CONCLUSION: The overall reliability was below 0.70 and standardization of exam sites was unclear. To improve the quality of exam, case development, item design, training of standardized patients and assessors, and standardization of sites are necessary. Above of all, we need to develop the well-organized matrix to measure the quality of the exam.

Strategies for Effective Teaching in Clinical Clerkship / 한양의대학술지

Clerkship has a vital role in undergraduated medical education. Despite potential benefits, clinical teaching has been much criticised for its variability due to its complex clinical environment. This article describes several problems and educational theories related to learning in clinical settings. Effective strategies were developed after these problems arised and learning theories were created, in terms of students, clinical teachers and teaching institution: first, the student should prepare medical knowledge and survival skills for self-directed learning in the clinical setting; second, the clinical teachers provide opportunities for active participation-effective feedback-reflection to students; and lastly, the teaching institution has to design a clerkship curriculum effectively. A clinical environment for students allowing them to participate actively is essential.

Instructional Analysis of Lecture Video Recordings and Its Application for Quality Improvement of Medical Lectures / 한국의학교육

PURPOSE: The lecture is a technique for delivering knowledge and information cost-effectively to large medical classes in medical education. The aim of this study was to analyze teaching quality, based on triangle analysis of video recordings of medical lectures, to strengthen teaching competency in medical school. METHODS: The subjects of this study were 13 medical professors who taught 1st- and 2nd-year medical students and agreed to a triangle analysis of video recordings of their lectures. We first performed triangle analysis, which consisted of a professional analysis of video recordings, self-assessment by teaching professors, and feedback from students, and the data were crosschecked by five school consultants for reliability and consistency. RESULTS: Most of the distress that teachers experienced during the lecture occurred in uniform teaching environments, such as larger lecture classes. Larger lectures that primarily used PowerPoint as a medium to deliver information effected poor interaction with students. Other distressing factors in the lecture were personal characteristics and lack of strategic faculty development. CONCLUSION: Triangle analysis of video recordings of medical lectures gives teachers an opportunity and motive to improve teaching quality. Faculty development and various improvement strategies, based on this analysis, are expected to help teachers succeed as effective, efficient, and attractive lecturers while improving the quality of larger lecture classes.

The Impact of Bladder Distension on Blood Pressure in Middle Aged Women / 가정의학회지

BACKGROUND: The purpose of the present study was to investigate the relation between the extent of bladder distention and the rise of blood pressure in middle aged women. METHODS: In a cross-sectional, descriptive observational study, we obtained data from 172 middle aged women at a health promotion center of Pusan National University Hospital. We measured duration of urine-holding as the degree of the extension of bladder distention. Blood pressure was measured twice while holding urine and immediately after urination. Urine holding with full bladder was confirmed by abdominal ultrasound. RESULTS: Difference in systolic blood pressure was 4.2 +/- 10.7 (P < 0.001), and that in diastolic blood pressure was 2.8 +/- 7.7 mm Hg (P < 0.001) between holding urine and immediately after urination. There was no significant correlation between the urine-holding duration and differences in systolic and diastolic blood pressure. CONCLUSION: Our findings suggest that systolic and diastolic blood pressure is increased by urine-holding at least 3 hours after the last urination in middle aged women. Thus in practice, blood pressure should be measured after the bladder is emptied.

Effects of Differences in Problem-Based Learning Course Length on Academic Motivation and Self-Directed Learning Readiness in Medical School Students / 한국의학교육

PURPOSE: Problem-based learning (PBL) is an educational approach in which complex authentic problems serve as the context and stimulus for learning. PBL is designed to encourage active participation during learning. The goal of this study was to study the effects of PBL on academic motivation and self-directed learning readiness in medical school students. METHODS: The subjects of this study were 190 students in the 1st and 2nd grade of medical school. The period of the PBL course was two weeks for Year 1 and five weeks for Year 2 students. Students completed one module over one week. Academic motivation tests and self-directed learning readiness tests were performed before and after the PBL course. The differences between the two groups were analyzed using paired t-test and repeated measures MANCOVA. RESULTS: PBL had positive effects on academic self-efficacy (self-control efficacy, task-level preference) and academic failure tolerance (behavior, task-difficulty preference) as academic motivation. PBL had a mildly positive effect on self-directed learning readiness. In addition, the five-week PBL course had greater positive effects on academic motivation than the two-week course but not with regard to self-directed learning readiness. CONCLUSION: Medical students engage in academic motivation and self-directed learning readiness during PBL, suggesting that the five-week PBL course has greater positive effects than the two-week course. Future studies are needed to confirm the most effective periods of PBL.

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.

A Case of Severe Hemolytic Disease of the Newborn Due to Anti-Di(a) Antibody / 대한진단검사의학회지

Here we report a severe case of hemolytic anemia of the newborn with kernicterus caused by anti-Di(a) antibody. A full term male infant was transferred due to hyperbilirubinemia on the third day of life. Despite single phototherapy, the baby's total bilirubin had elevated to 30.1 mg/dL. After exchange transfusion, total bilirubin decreased to 11.45 mg/dL. The direct antiglobulin test on the infant's red cells was positive. The maternal and infant's sera showed a negative reaction in routine antibody detection tests, but were positive in Di(a) panel cells. The frequency of the Di(a) antigen among the Korean population is estimated to be 6.4-14.5%. Anti-Di(a) antibody could cause a hemolytic reaction against transfusion or hemolytic disease of the newborn. We suggest the need for reagent red blood cell panels to include Di(a) antigen positive cells in antibody identification test for Korean.

A case of hepatopulmonary syndrome in a child with fatty liver disease secondary to hypopituitarism after craniopharyngioma resection / 소아과

Hepatopulmonary syndrome is a triad that includes: hepatic dysfunction, intrapulmonary vascular dilatation and abnormal arterial oxygenation. The incidence of intrapulmonary vascular dilatations, in adults with end-stage liver disease, has been reported to be 13% to 47%, however the incidence in children is unclear and the cases in Korean children have never been reported. The hepatopulmonary syndrome may occur as a result of chronic liver disease following nonalcoholic steatohepatitis in children with hypothalamic or pituitary dysfunction. We report a case of hepatopulmonary syndrome in a 13-year- old child who had rapidly progressive liver dysfunction secondary to panhypopituitarism after craniopharyngioma resection. Careful monitoring and treatment of endocrine abnormalities and metabolic status, as well as liver function, are required in all children undergoing pituitary tumor resection.

Investigation of causes of FUO (fever of unknown origin) in children / 소아과

PURPOSE: The causes of prolonged fever have changed during the years and are influenced by age, geographic location and availability of diagnostic facilities/techniques. The aim of the present study was to determine the causes of prolonged fever, to know the proportion and outcomes of undiagnosed children. METHODS: We reviewed patients with fever persisting for more than 2 weeks in duration, with documented temperatures of 38 degrees on several occasions, or uncertain diagnosis after intensive study of 1 week duration in other hospitals who were admitted to Pusan National University Hospital during the period from July 1999 to June 2004. RESULTS: Fifty-four (59.0 percent) were boys and thirty-seven (41 percent) were girls. Forty-six cases were less than 6 years and 45 cases were more than 6 years; the mean age was 6.48+/-6.56 years. In 62 cases (68.1 percent), the fever had persisted for 2 to 3 weeks before admission and in 26 cases (28.6 percent), had lasted longer than a month. Final diagnosis had been reached in 66 of 91 children (72.5 percent). The most common cause was infection (38/91), followed by collagen vascular disease (12/91), immune deficiency (3/91), neoplasia (2/91), and miscellaneous disease. Tuberculosis was the most common infectious cause. The causes of fever were not revealed in 25 cases. Outcome on discharge were as follows; 77 cases (84.6 percent) were improved, 10 cases (11.0 percent) discharged without improvement and 4 cases (4.4 percent) expired. CONCLUSION: The most common cause of prolonged fever in Korean children remains infection, but the incidence of infection was decreased as compared with previous studies. Tuberculosis is the most common among infectious causes. As Kikuchi disease (subacute necrotizing lymphadenitis) represented a significant cause of prolonged fever, it should be considered if a patient has neutropenia with lymphadenopathy. Undiagnosed patients with prolonged fever (27.5 percent) have increased over previous studies.

Clinical Features of Dietary Protein Induced Proctocolitis / 대한소아소화기영양학회지

PURPOSE: Dietary protein induced proctocolitis (DPIPC) can be considered as a cause of rectal bleeding or blood streaked stool in otherwise healthy-looking infants in the first several months of life. Failure to appreciate this entity may lead to inappropriate diagnostic or therapeutic intervention. This study aimed to ascertain the clinical features, treatment and prognosis of DPIPC. METHODS: We reviewed 13 infants retrospectively, presented with bloody stool in early infancy. They were diagnosed as DPIPC clinically in Pusan National University Hospital from May 2002 to June 2004. RESULTS: Seven males and six females were included. The mean age at onset of bleeding was 96.8+/-58.8 days. The mean frequency of hematochezia was 2.6+/-2.5 times a day. Duration from onset of symptom to diagnosis was 35.5+/-55.0 days and duration from onset of symptom to resolution of bleeding was 58.7+/-67.0 days. Nine (69.2%) were exclusively breast-fed infants and two (15.4%) were formula-fed infants. All but one infant did not have family history of other allergic diseases. A dietary history of ingestion of cow's milk, nut or shellfish was present in three mothers. Peripheral eosinophil count was normal to slightly elevated (total WBC count 10,555+/-3,145/mm3, relative eosinophil count 6.3+/-3.0%, absolute eosinophil count 659.0+/-532.2/mm3). Sigmoidoscopy revealed lymphonodular hyperplasia with surrounding hemorrhagic spots in the rectosigmoid colon in 6 infants. Histopathologic finding of colonic biopsies in 5 infants showed chronic inflammation with lymphoid follicular hyperplasia (5 infants), crypt abscess (3 infants), or mild infiltration of eosinophils (less than 20/high power field) in the lamina propria. Spontaneous resolution of rectal bleeding occurred in all infants without dietary change or medicine. CONCLUSION: Most infants with DPIPC experience a very benign course and have spontaneous resolution of rectal bleeding without changes in the mother's diet. In the case of strong evidence for DPIPC we suggest deferring further invasive investigation and continuing breast feeding.

A Galactosialidosis Mimicking GM1-gangliosidosis Type I

Galactosialidosis is a lysosomal storage disease associated with a combined deficiency of beta-galactosidase and alpha-neuraminidase, secondary to a defect of another lysosomal protective protein. It is a neurodegenerative disorder clinically characterized by psychomotor deterioration, cerebellar ataxia, coarse facies, generalized bony deformity and organomegaly. Three phenotypic subtype are recognized:early infantile, late infantile and juvenile/adult type. We report a 13 months old boy with a late infantile galactosialidosis. He was presented with progressive mental regression and motor disturbance and observed cherry red spot, hearing loss, moderate dysostosis multiplex and vacuolated lymphocytes in peripheral blood. He showed only beta-galactosidase deficiency in the lymphocytes and was diagnosed as GM1-gangliosidosis type 1. However, further studies revealed the possible defect of alpha-neuraminidase suggesting that he was a case of galactosialidosis which was mimicking GM1-gangliosidosis type 1.