Using Problem-based Learning to Teach Antibiotics use during a Clerkship in Internal Medicine / 한국의학교육

PURPOSE: The purpose of this study is to develop a course to teach through problem-based learning the use of antibiotics during an internal medicine clerkship, and to evaluate the responses of students to it. METHODS: The course was designed to teach third-year medical students how to prescribe antibiotics to be given to real patients. A qualitative evaluation for the modified problem-based learning was performed by tutor's observation and focus group interview, and a quantitative evaluation by questionnaires before and after the course. RESULTS: Seventy-nine students experienced the modified problem-based learning during the infectious disease section of an internal medicine clerkship. Most students participated actively and gave a positive evaluation expressing a need for problem-based learning on prescribing antibiotics. The course significantly increased the students' self-confidence in both approaching patients and prescribing antibiotics. CONCLUSION: Modified problem-based learning is a useful educational tool in clinical clerkship.

The Accuracy of Standardized Patients' Rating according to the Order of Examinees in Clinical Performance Examination / 한국의학교육

PURPOSE: The purpose of this study is to evaluate the accuracy of standardized patients'(SP) rating according to the order of examinees in clinical performance examination. METHODS: In the clinical performance examination which was administered in 2005 at Seoul National University College of Medicine, each SP evaluated 16 students consecutively. For all 16 SPs(2 SPs per station), accuracy of rating was evaluated by comparing the individual records of each SP to the 'recording keys' made by two SPs from reviewing a video recording of performances by examinees. RESULTS: The average number of items incorrectly rated by SP was 3.8(range, 0~12), 2.8 in female SPs and 4.8 in male SPs(p<0.001). No statistical correlation was observed between the number of errors and the order of examinees(p=0.843). Even after stratification by gender or age of the SPs or domains of examination, the number of items incorrectly rated did not differ significantly according to the order of examinees. CONCLUSION: An increase in SP's rating error with time after the start of examinations was not observed within the 16 consecutive encounters in clinical performance examination. The effect of SP's fatigue on the accuracy of simulation as an examination progresses remains to be studied.

Correlation of CPX Scores with the Scores of the Clinical Clerkship Assessments and Written Examinations / 한국의학교육

PURPOSE: Recently, the clinical performance examination (CPX) using standardized patients has been introduced to several Korean medical schools. The purpose of this paper is to evaluate the correlation of CPX scores with the scores of other clinical clerkship assessments and written examinations. METHODS: We evaluated the correlation of the scores of CPX, which was administered to third-year medical students (n=230) at Seoul National University College of Medicine in January 2005, with the scores of a slide examination in internal medicine, an objective structured clinical examination (OSCE) in pediatrics and obstetrics/gynecology, and the written examinations in internal medicine and general surgery. RESULTS: CPX scores showed a mild correlation with the scores of the slide examination in internal medicine and OSCE in pediatrics and obstetrics/gynecology (r=0.19, 0.28, 0.30). CPX scores were also mildly correlated with written examination scores in internal medicine but not associated with those in general surgery. CONCLUSION: Considering the mild correlation of CPX scores with scores of other clinical clerkship assessments and written examinations, CPX should be affirmatively considered as an examination complementary to previous examinations.

Causal Analysis and Improvement Strategies of the Problems in Implementing a PBL Program in Integrated Curriculum / 한국의학교육

PURPOSE: The purpose of this study was to analyze the causes of the problems in Problem Based Learning (PBL) program performed in integrated curriculum of Hematology, Seoul National University College of Medicine, 2002, and to determine the improvement strategies for a successful PBL in integrated curriculum. METHODS: This study was conducted using qualitative methods with participant observations, descriptive participants, in-depth interviews and an open questionnaire, etc. during the three days two weeks. Ten of 17 tutors including 10 faculty and 7 residents took part in the study. Among the 10 tutors, 7 were the faculty tutors, 3 were the residents tutors. The data was analyzed the causal chains which were developed by Colby. RESULTS: The main problems revealed in implementing of PBL program were a large class size, lacks of tutors, time, budget, faculty education and college authorities' interests in undergraduate medical education, etc. The main problem of a PBL program in an integrated curriculum of Hematology was the recruitment of tutors. According to the casual chains analysis, the factors that affected the recruitment of PBL tutors were related to college authorities' lack of interest in undergraduate medical education. CONCLUSION: In order to have successful PBL program in an integrated curriculum, several administrative factors, including extrinsic reward systems such as promotion and tenure decision, and departmental budgetary requirements, should be considered.

A Study on the Use of Reflective Journals in Problem Based Learning / 한국의학교육

PURPOSE: The purpose of this study was to analyze the opinions of students and tutors about the use of reflective journals in Problem Based Learning performed in Seoul National University College of Medicine over a period of 4 weeks, and to determine the possible applications of such journals as an evaluation tool. METHODS & RESULTS: The writing of a reflective journal helps students to achieve some of the important PBL goals, for example, keeping such a journal encourages students to reflect on their learning experiences, and fosters problem solving skills. All students were asked to complete the same questionnaire every weeks for the four week period. Most students thought of a reflective journal as a tool for personal reflection, rather than as a tool for fostering problem solving skills. The questionnaire was rated on 5 point scale: from 'very important' to 'not important at all'. Fifty eight percent of tutors and 20% of students replied that the journal writing was 'very important'. CONCLUSION: We suggest the following items for the future application of the reflective journal as an evaluation tool. First, intimate trust should be developed between students and tutors, as a reflective journal can include private matters. Second, tutors should give feedback for the student's reflective journal. Finally, comprehensive direction should be given to students and tutors to allow them to use their reflective journals effectively.

A Study on the Integrated Medical Teaching Courses Administration at Seoul National University College of Medicine for the Past Thirty Years / 한국의학교육

It was about thirty years ago that integrated teaching courses were first introduced to the undergraduate medical educational curriculum in Korea. Seoul National University College of Medicine, who had totally discipline-based curriculum up to 1971, implemented the new curricular component which was benchmarked from the experiment of Case Western University (USA) in 1950s, and accommodated it to her educational environment fairly delicately at least for the first ten years, and her pioneering experiment played a role-model to many medical colleges in Korea. However, the integrated courses(1/4 of basic medical science learning period) became stereotyped in curricular management, distended in contents, became more and more lecture-dependent, despite basic principles advocated at the implementation stage which emphasized diversification in learning methods, and at last fell to a faulty component in curriculum. And it became a serious handicap hindering the latest endeavor for curricular innovation aiming at a whole, vertical and horizontal curricular integration. From analysis of various numerical data and historical records, we arrived at the following conclusions: integrated curricular component should be supervised and evaluated continuously by a powerful standing committee far more than non-integrated one should be; success in the formation of multi-departmental consensus group which is influenced by cultural or political factor of the country or the medical professional society, is a precondition to run it successfully; an integration of curriculum not only requires deliberate technical manipulation of educational contents and diversification of learning methods but also requires a philosophical or political innovation in medical society to overcome firm and high inherited barrier between departments.

Cloning and Sequence Analysis of the Full-length cDNA of Coxsackievirus B3 Isolated in Korea

We have determined and analyzed the full-length cDNA sequence of a coxsackievirus B3 (CVB3) Korean isolate (CVB3-Korea/97) which has been known as a general human pathogen. The whole genome contains 7,400 nucleotides and has a single large open reading frame with 6,555 nucleotides that encodes a potential polyprotein precursor of 2,185 amino acids. The genome also contains a 5' non-coding region (NCR) of 741 bases and a 3' NCR of 104 bases followed by poly(A) tail. Sequence homologies of nucleotides and deduced amino acids between the CVB3-Korea/97 strain and the prototype (Nancy strain) were 81.7% and 91.5%, respectively. The genes encoding the functional proteins including viral protease and RNA dependent RNA polymerase showed higher homology than those encoding the structural proteins. We have further analyzed the sequences of 5' NCR, VP1 and VP2 of CVB3-Korea/97, which are known as cardiovirulent determining factors at the nucleotide and amino acid levels. Although the CVB 3-Korea/97 strain was isolated from an aseptic meningitis patient without cardiomyopathy, its 234th nucleotide and 165th amino acid were uracil and Asn as same as those of other cardiovirulent strains one. However, the 155th amino acid of VR1, which closely associated with cardiovirulence, was replaced with Arg155 by single nucleoptide substitution from A2916 to T2916. Moreover, additional amino acid substitutions were observed in the flanking region of Asp155. Taken together, aminoacid(s) substitution in VP1 may play a critical role in determining cardiovirulence of the CVB3-Korea/97 strain rather than individual nucleotide replacements in the 5' NCR and/or an amino acid substitution in VP2.

An Epidemiological Study of Enteroviruses as Causative Agents of Aseptic Meningitis between 1993 and 1998 in Korea / 감염

BACKGROUND: To investigate the epidemiology of aseptic meningitis in Korea, we have isolated and characterized enteroviruses isolated from patients with acute meningitis from 1993 to 1998. METHODS: Stool and/or cerebrospinal fluid (CSF) samples from patients with aseptic meningitis were inoculated onto enterovirus-susceptible cell lines. The virus propagation was examined by the presence of cytopathic effects and each viral isolate was further characterized using a neutralization test. RESULTS: Out of 1,127 specimens, 197 enteroviral isolates were obtained mostly from stool samples (82.8 %) of children aged zero to ten years. At least 15 serotypes of enteroviruses, including echoviruses (EV) 3, 6, 7, 9, 25 and 30, coxsackieviruses (CV) B1~B6, and vaccine-derived polioviruses (PV) had circulated during the previous 6 years. The major serotypes that caused outbreaks of aseptic meningitis, were EV30 in 1997 and EV6 in 1998. Although the incidence of virus isolation peaked during summer, we had isolated enteroviruses all the year round in 1998. CONCLUSION: Since 1993, we had confirmed 197 cases of enteroviral meningitis. Outbreaks of aseptic meningitis were mainly caused by EVs, with peaks during the summer months. Our data emphasize that the nationwide surveillance of aseptic meningitis should be expanded and maintained throughout the year.

An Epidemiological Study of Enteroviruses as Causative Agents of Aseptic Meningitis between 1993 and 1998 in Korea / 감염

BACKGROUND: To investigate the epidemiology of aseptic meningitis in Korea, we have isolated and characterized enteroviruses isolated from patients with acute meningitis from 1993 to 1998. METHODS: Stool and/or cerebrospinal fluid (CSF) samples from patients with aseptic meningitis were inoculated onto enterovirus-susceptible cell lines. The virus propagation was examined by the presence of cytopathic effects and each viral isolate was further characterized using a neutralization test. RESULTS: Out of 1,127 specimens, 197 enteroviral isolates were obtained mostly from stool samples (82.8 %) of children aged zero to ten years. At least 15 serotypes of enteroviruses, including echoviruses (EV) 3, 6, 7, 9, 25 and 30, coxsackieviruses (CV) B1~B6, and vaccine-derived polioviruses (PV) had circulated during the previous 6 years. The major serotypes that caused outbreaks of aseptic meningitis, were EV30 in 1997 and EV6 in 1998. Although the incidence of virus isolation peaked during summer, we had isolated enteroviruses all the year round in 1998. CONCLUSION: Since 1993, we had confirmed 197 cases of enteroviral meningitis. Outbreaks of aseptic meningitis were mainly caused by EVs, with peaks during the summer months. Our data emphasize that the nationwide surveillance of aseptic meningitis should be expanded and maintained throughout the year.

The Phylogenetic Analysis of the NS-5 Region Sequence of Hepatitis G Viruses Isolated in Korea

We examined the hepatitis G virus infections among 227 Koreans who were healthy or were suspected of hepatitis and determined the phylogenetic relationship based on a part of the NS-5 region of 5 positive samples. Viral RNA was extracted from sera and cDNA was synthesized and subsequently amplified by RT-PCR (reverse transcription-polymerase chain reaction) or RT-nested PCR using random hexamer and NS-5 specific primers (470-20-1-77F, 470-20-1-211R, HGVNESTFO, HGVNESTRE). Five positives were found to belong to samples of patients showing symptoms of viral hepatitis. Primers used for PCR or nested PCR were derived from the NS-5 region. On the other hand, no amplification was detected using primers derived from the 5'-NCR (G-146F, G-401R). We performed TA cloning and sequencing of 5 amplified fragments, and their sequences were compared with those of foreign isolates of HGV. The phylogenetic analysis using MegAlign programme of DNAstar has shown that the Korean isolates are clustered on the phylogenetic tree. In summary, we confirmed the hepatitis G virus infection in 5 cases out of 12 patients showing the symptoms of viral hepatitis. The phylogenetic analysis of sequences of 5 amplified fragments showed that their relations to each other were closer than those to the foreign HGV isolates reported.

The Current Practice of the Autopsy Services and the Autopsy Records at the Seoul National University Hospital

This study outlines the current status of the autopsy practice and the medical records for autopsies at the Department of Pathology, Seoul National University Hospital. Total number of autopsy cases from 1954 to 1995 was 3,131. Adults aged over 17 were 371 cases and children were 2,515 cases. The demographic data in 245 cases was not available. The number of adult autopsies and its proportion among total number of autopsies during 10-year periods decreased from 144 cases (40%) during the 10-year-period from 1956 to 52 cases (3%) during the 10-year-period from 1986. The number of children cases during the same period groups increased slightly from 210 cases (58%) to 393 cases (25%). But the number of fetal cases increased rapidly from 7 cases (2%) to 1,146 cases (72%). Among fetal autopsies the proportion of fetuses died earlier than 24 weeks of gestation increased and this figure exceeds that of fetuses that died later than 24 weeks of gestation from 1992. Forty percent of the cases were submitted from the clinical departments of the Seoul National University Hospital but the remainders were referred from 73 hospitals. Final autopsy diagnoses were analysed according to the Korean Standard Classification of Disease (KCD)-3 coding system and by searching key words for all cases. Common diagnoses as coded among cases from 1990 were P9, P0, P2, Q2 and Q0. Common diseases by key words for adult cases were liver disease, tuberculosis and pneumonia. Common diseases for children cases were pneumonia, hyaline membrane disease, meningitis and tuberculosis. Through this study we could show the importance of autopsy services for fetuses. We could also establish a regular registration system for autopsies at general hospitals.

Future directions of Medical Education and License Examination / 한국의학교육

No abstract available.

Future directions of Medical Education and License Examination / 한국의학교육

No abstract available.

Acquired immune deficiency syndrome: report of an autopsy case

Authors report the first autopsy case of acquired immune deficiency syndrome in Korea. The patient was a 26 years old Korean male who died of respiratory failure due to mixed pulmonary infections. He had history of homosexual contacts with partners of both domestic and foreign nationalities. Initial presentation was unexplained fever for two months. Serological test and western blot test for anti-HIV were positive and T-cell subset analysis revealed T3/T4/T8 to be 73/8/67%. Pulmonary tuberculosis with mediastinal lymphadenopathy and esophagonadal fistula and oral candidiasis were presented. Respiratory infection progressed gradually and he died seven months after the initial symptom. Autopsy findings were generalized severe lymphoid cell depletion, especially of T-cell population and mixed pulmonary infections with Pneumocystis carinii and cytomegalovirus (CMV). The CMV infection involved lungs and adrenals. Oral candidiasis was also demonstrated.