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1.
Korean Medical Education Review ; (3): 146-152, 2020.
Article | WPRIM | ID: wpr-836877

ABSTRACT

Hospice and palliative care (HPC) education is an essential component of undergraduate medical education.Since February 4th, 2018, withholding and withdrawing life-sustaining treatment at the end of life (EOL) has been permitted in Korea as put forth by law, the “Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life.” Therefore, Korean medical schools have faced a challenge in providing comprehensive HPC education in order to better prepare medical students to be competent physicians in fulfilling their role in caring for patients at the EOL. There have been considerable variations in the evolution and organization of HPC education across Korean medical schools for the past 20 years. In 2016, all medical schools taught HPC curriculum as a separate course or integrated courses, with the most frequently taught topics including: delivering bad news, pain management, and the concept of palliative medicine. However, the content, time allocation, learning format, and clinical skills practice training of HPC education have been insufficient, inconsistent, and diverse. For this reason, we propose a HPC curriculum containing seven domains with 60 learning objectives in a course duration of over 20 hours based on the Palliative Education Assessment Tool (PEAT) as standard HPC curriculum. Furthermore, we recommend development of a national curriculum for HPC/EOL care education to be organized by the HPC board and managed under the accreditation criteria of the Korea Institute of Medical Education and Evaluation.

2.
Journal of Korean Medical Science ; : e401-2020.
Article in English | WPRIM | ID: wpr-892011

ABSTRACT

Background@#Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses. @*Methods@#We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea. @*Results@#For most illnesses, most physicians (adjusted proportions – end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was “the patient's right to know his/her condition” (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was “psychological burden such as anxiety and depression” (35.8%), while for the physicians it was “disclosure would have no beneficial effect” (42.4%). @*Conclusion@#Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.

3.
Journal of Korean Medical Science ; : e401-2020.
Article in English | WPRIM | ID: wpr-899715

ABSTRACT

Background@#Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses. @*Methods@#We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea. @*Results@#For most illnesses, most physicians (adjusted proportions – end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was “the patient's right to know his/her condition” (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was “psychological burden such as anxiety and depression” (35.8%), while for the physicians it was “disclosure would have no beneficial effect” (42.4%). @*Conclusion@#Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.

4.
Korean Journal of Hospice and Palliative Care ; : 51-57, 2018.
Article in Korean | WPRIM | ID: wpr-715337

ABSTRACT

PURPOSE: End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. METHODS: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. RESULTS: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P < 0.05). CONCLUSION: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and two-thirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage.


Subject(s)
Humans , Advance Care Planning , Cause of Death , Central Nervous System , Critical Care , Decision Making , Medical Records , Resuscitation Orders , Retrospective Studies , Terminal Care , Ventilators, Mechanical
5.
Korean Journal of Hospice and Palliative Care ; : 111-121, 2017.
Article in Korean | WPRIM | ID: wpr-189018

ABSTRACT

PURPOSE: This study was performed to explore the current state of end-of-life (EoL) care education provided to new interns at two university hospitals. METHODS: A questionnaire was given to incoming interns (N=64). The levels of acquired knowledge and experience of clinical observation were measured. Seven areas for self-assessment questions were identified and used to analyze the interns' attitudes towards EoL-related education and practice. RESULTS: On average, participants learned five elements (nine in total) from EoL-related classes and two (seven in total) from clinical observation. The most frequently educated element was how to deliver bad news (96.9%) in the classroom setting and how to control physical symptoms (56.5%) in clinical observation. Less than 20% received training on EoL care communication, including discussion of advanced directives. Compared with participants who had no EoL training, those who had EoL training showed positive attitudes in all seven categories regarding overall satisfaction, interest and preparedness in relation to EoL-care classes and practice. CONCLUSION: Although interns are responsible for caring of dying patients, their EoL training in classroom and clinical settings was very insufficient. Further research should be conducted to establish an education system that provides sufficient knowledge and training on EoL care.


Subject(s)
Humans , Clinical Clerkship , Education , Education, Medical , Hospitals, University , Self-Assessment , Terminal Care
6.
Cancer Research and Treatment ; : 534-538, 2015.
Article in English | WPRIM | ID: wpr-189076

ABSTRACT

We report a case of a 56-year-old woman with breast cancer, ovarian cancer, and diffuse large B-cell lymphoma with a BRCA1 gene mutation. Evidence is mounting that there is a large increase in the risk for hematologic malignancies among patients with genetic changes in the BRCA pathways. The genomic analysis demonstrated a frameshift mutation in the BRCA1 gene: 277_279delinsCC (Phe93fs). It is a novel BRCA1 mutation that has never been reported, and caused malignant lymphoma as well as breast and ovarian cancer.


Subject(s)
Female , Humans , Middle Aged , Breast , Breast Neoplasms , Frameshift Mutation , Genes, BRCA1 , Germ-Line Mutation , Hematologic Neoplasms , Lymphoma , Lymphoma, B-Cell , Ovarian Neoplasms
7.
The Ewha Medical Journal ; : 67-68, 2015.
Article in Korean | WPRIM | ID: wpr-37522

ABSTRACT

No abstract available.


Subject(s)
Female , Humans , Academic Medical Centers
8.
Korean Journal of Radiology ; : 300-304, 2014.
Article in English | WPRIM | ID: wpr-187058

ABSTRACT

Gefitinib is regarded as a relatively safe agent for the treatment of an advanced non-small cell lung cancer (NSCLC). Pulmonary toxicity such as interstitial lung disease associated with gefitinib is uncommon with an estimated all time incidence around 1% worldwide. Moreover, a case of gefitinib associated with pulmonary cystic changes has not been reported yet. In this report we present a case of progressive multiple air cystic changes in both lungs in a patient with NSCLC and intrapulmonary metastases who underwent a gefitinib therapy.


Subject(s)
Female , Humans , Middle Aged , Antineoplastic Agents/adverse effects , Brain Neoplasms/secondary , Carcinoma, Non-Small-Cell Lung/drug therapy , Cysts/chemically induced , Lung/pathology , Lung Diseases/chemically induced , Lung Diseases, Interstitial , Lung Neoplasms/drug therapy , Quinazolines/adverse effects
9.
Korean Journal of Hospice and Palliative Care ; : 30-35, 2012.
Article in Korean | WPRIM | ID: wpr-181899

ABSTRACT

PURPOSE: Most medical schools in Korea do not provide adequate education in end-of-life care. This study was designed to illustrate the need to improve end-of-life care education and to assess the effect of the education on fourth-year medical students' awareness and attitude towards hospice and palliative care for terminally ill patients. METHODS: One hundred sixty six fourth-year medical students were surveyed with questionnaires on end-of-life care before and after they received the education. RESULTS: Before receiving the education, students most frequently answered "at the end of life" (33.6%) was appropriate time to write an advance medical directive. After the education, the most frequent answer was "in healthy status" (58.7%). More students agreed to withholding or withdrawing futile life-sustaining treatment increased after the education (48.1% vs. 92.5% (P<0.001) for cardiopulmonary resuscitation, 38.3% vs. 92.5% (P<0.001) for intubation and mechanical ventilation, 39.1% vs. 85.8% (P<0.001) for inotropics, 60.9% vs. 94.8% (P<0.001) for dialysis and 27.8% vs. 56.0% (P<0.001) for total parenteral nutrition). Significantly more students opposed euthanasia after the education (46.6% vs. 82.1%, P<0.001). All students agreed to the need for education in end-of-life care. CONCLUSION: After reflecting on the meaning of death through the end-of-life care education, most students recognized the need for the education. The education brought remarkable changes in students' awareness and attitude towards patients at the end of life. We suggest end-of-life care education should be included in the regular curriculum of all medical schools in Korea.


Subject(s)
Humans , Cardiopulmonary Resuscitation , Curriculum , Dialysis , Euthanasia , Hospice Care , Hospices , Intubation , Korea , Palliative Care , Respiration, Artificial , Schools, Medical , Students, Medical , Terminal Care , Terminally Ill
10.
Korean Journal of Medicine ; : 238-242, 2011.
Article in Korean | WPRIM | ID: wpr-47586

ABSTRACT

Pancreatic endocrine tumors are low-to-intermediate-grade neoplasms arising from the pancreatic islets that produce various hormones. These tumors account for a minority of pancreatic tumors and are generally considered functional if they are associated with a hormonal syndrome. Adrenocorticotropic hormone-secreting tumors (ACTHomas) are very rare and require special clinical consideration. Patients with ACTH-secreting tumors usually present with Cushing's syndrome, due to ectopic ACTH production. ACTHomas have a poor prognosis because of early metastasis and difficulty controlling corticosteroid production. We report a 62-year-old male with an ACTH-secreting metastatic pancreatic neuroendocrine tumor, who did not respond to somatostatin analogs and died.


Subject(s)
Humans , Male , Middle Aged , Adrenocorticotropic Hormone , Cushing Syndrome , Islets of Langerhans , Neoplasm Metastasis , Neuroendocrine Tumors , Pancreas , Prognosis , Somatostatin
11.
Korean Journal of Hospice and Palliative Care ; : 32-40, 2010.
Article in Korean | WPRIM | ID: wpr-10960

ABSTRACT

PURPOSE: The survey was aimed to provide basic data to develop a certification system for hospice and palliative care professionals. METHODS: National Cancer Center (NCC) and the Korean Society for Hospice & Palliative Care (KSHPC) conducted the survey for hospice and palliative care professionals who worked at 34 Palliative care units designated by the Ministry of Health, Welfare, and Family Affairs (MW) and the members of the KSHPC. The survey was conducted via e-mail from June 17 to 23, 2009. Total 220 professionals were surveyed. RESULTS: Most of the hospice and palliative care professionals reported a great need for certification system: Physician, 90% (n=51) nurse, 84% (n=134) social worker, 89% (n=35). In regard with the requirement for the certification, a majority of physicians (46%) preferreddiploma course, while social workers (46%) preferred training course for medical social workers. Concerning the certification body, physician (45%) preferred the KSHPC and the MW almost equally, while nurses (50%) and social workers (60%) preferred the MW highly. As for the body to develop and accredit advance training course for each professionals, most of the physicians (51%) preferred the KSHPC, whereas nurses and social workers preferred collaboration of the MW (or NCC) with the professional society, such as the KSHPC (23%), the Korean Hospice & Palliative nurses association for nurses (21%), or the Korean association of (medical) social workers (37%). Lastly, all respondents preferred the course format of once a week, full day, and some field study at weekend. CONCLUSION: Korean hospice and palliative care professionals identified the great need for the certification system, therefore, the adequate system development must be followed to reflect their voice.


Subject(s)
Humans , Accreditation , Certification , Cooperative Behavior , Curriculum , Surveys and Questionnaires , Electronic Mail , Hospices , Palliative Care , Program Development , Social Workers , Voice
12.
Korean Journal of Medical Education ; : 57-64, 2010.
Article in Korean | WPRIM | ID: wpr-211343

ABSTRACT

PURPOSE: This study aims at to make intermediate-term evaluations of a curriculum by investigating its development, operation and outcomes 2 years after its revision. METHODS: A survey using 5-point-Lickert scale questionnaires was given to the group of directors who developed the curriculum, instructors who only used it in their classes, and a student group from the first and second grades. Focus group interviews were performed in the professor groups. RESULTS: Curricular reform was evaluated as being systematic, democratic, and positive in general. Both groups answered questions positively about the relevance of the integrated curriculum and introduction of clinical medicine (ICM), graded as 3.4 (professor) and 3.5 (student). As for problem-based learning (PBL) and the patient-doctor-society (PDS), the professor group responded more positively than students. The 'web-based learning center' was recognized positively by many more students (4.01) than professors (2.75). With regard to the education outcome, professors gave 3.3 points and students 3.5 to an item that asked 'whether students attained the learning goal or not?' Professors, through interviews, showed their satisfaction with the attempt to reform the curriculum, but they pointed out that long-term evaluations should be performed. CONCLUSION: The interim evaluation of the revised curriculum, from its planning to its effects, affirmed by several suggestions to be successful in the long run through 1) enhancement of systematic participation and communication, 2) further integration, 3) steady evaluation, 4) greater effort on professional development, and 5) active interaction between professors and students.


Subject(s)
Humans , Clinical Medicine , Curriculum , Evaluation Studies as Topic , Focus Groups , Learning , Problem-Based Learning , Schools, Medical , Surveys and Questionnaires
13.
Cancer Research and Treatment ; : 12-18, 2009.
Article in English | WPRIM | ID: wpr-17150

ABSTRACT

PURPOSE: Heptaplatin (Sunpla) is a cisplatin derivative. A phase IIb trial using heptaplatin resulted in a 34% response rate with mild nephrotoxicity. We conducted a randomized phase III trial of heptaplatin plus 5-FU compared with cisplatin plus 5-FU in patients with advanced gastric cancer. MATERIALS AND METHODS: One hundred seventy-four patients (heptaplatin, n=88; cisplatin, n=86) from 13 centers were enrolled. The eligibility criteria were as follows: patients with pathologically-proven adenocarcinoma, chemonaive patients, or patients who had received only single adjuvant chemotherapy, and who had a measurable or evaluable lesion. On day 1, heptaplatin (400 mg/m2) or cisplatin (60 mg/m2) was given over 1 hour with 5-FU (1 gm/m2) on days 1~5 every 4 weeks. RESULTS: At the time of survival analysis, the median overall survival was 7.3 months in the 5-FU + heptaplatin (FH) arm and 7.9 months in the 5-FU + cisplatin (FP) arm (p=0.24). Of the FH patients, 34.2% (complete response [CR], 1.3%; partial response [PR], 32.9%) experienced a confirmed objective response compared with 35.9% (CR 0%, PR 35.9%) of FP patients (p=0.78). The median-time-to-progression was 2.5 months in the FH arm and 2.3 months in the FP arm. The incidence of neutropenia was higher with FP (28%) than with FH (16%; p=0.06); grade 3~4 nausea and vomiting were more frequent in the FP than in the FH arm (p=0.01 and p=0.05, respectively). The incidence of increased proteinuria and creatininemia was higher with FH than with FP; however, there was no statistical difference. There were no treatment-related deaths. CONCLUSION: Heptaplatin showed similar effects to cisplatin when combined with 5-FU in advanced gastric cancer patients with tolerable toxicities.


Subject(s)
Humans , Adenocarcinoma , Arm , Chemotherapy, Adjuvant , Cisplatin , Drug Therapy, Combination , Fluorouracil , Incidence , Malonates , Nausea , Neutropenia , Organoplatinum Compounds , Proteinuria , Stomach Neoplasms , Vomiting
14.
Cancer Research and Treatment ; : 45-49, 2009.
Article in English | WPRIM | ID: wpr-17145

ABSTRACT

The vast majority of patients with metastatic prostate cancer present with bone metastases and high prostate specific antigen (PSA) level. Rarely, prostate cancer can develop in patients with normal PSA level. Here, we report a patient who presented with a periureteral tumor of unknown primary site that was confirmed as prostate adenocarcinoma after three years with using specific immunohistochemical examination. A 64-year old man was admitted to our hospital with left flank pain associated with masses on the left pelvic cavity with left hydronephrosis. All tumor markers including CEA, CA19-9, and PSA were within the normal range. After an exploratory mass excision and left nephrectomy, the pelvic mass was diagnosed as poorly differentiated carcinoma without specific positive immunohistochemical markers. At that time, we treated him as having a cancer of unknown primary site. After approximately three years later, he revisited the hospital with a complaint of right shoulder pain. A right scapular mass was newly detected with a high serum PSA level (101.7 ng/ml). Tissues from the scapular mass and prostate revealed prostate cancer with positive immunoreactivity for P504S, a new prostate cancer-specific gene. The histological findings were the same as the previous pelvic mass; however, positive staining for PSA was observed only in the prostate mass. This case demonstrates a patient with prostate cancer and negative serological test and tissue staining that turned out to be positive during progression. We suggest the usefulness of newly developed immunohistochemical markers such as P504S to determine the specific primary site of metastatic poorly differentiated adenocarcinoma in men.


Subject(s)
Humans , Male , Adenocarcinoma , Flank Pain , Hydronephrosis , Neoplasm Metastasis , Nephrectomy , Prostate , Prostate-Specific Antigen , Prostatic Neoplasms , Reference Values , Serologic Tests , Shoulder Pain , Biomarkers, Tumor
15.
The Korean Journal of Internal Medicine ; : 156-159, 2009.
Article in English | WPRIM | ID: wpr-111409

ABSTRACT

A 60-year-old man presented with cough, sputum, and dyspnea. He had a history of acute myeloid leukemia and hematopoietic stem cell transplantation with chronic renal failure. Chest CT scans showed miliary nodules and patchy consolidations. Histological examination revealed numerous fibrin balls within the alveoli and thickening of the alveolar septum, both of which are typical pathological features of acute fibrinous and organizing pneumonia (AFOP). We report the first case of AFOP following allogeneic hematopoietic stem cell transplantation.


Subject(s)
Humans , Male , Middle Aged , Acute Disease , Anti-Bacterial Agents/therapeutic use , Biopsy , Cryptogenic Organizing Pneumonia/etiology , Fatal Outcome , Glucocorticoids/administration & dosage , Hematopoietic Stem Cell Transplantation/adverse effects , Hemoptysis/etiology , Leukemia, Myeloid, Acute/surgery , Lung Diseases/etiology , Pleural Effusion/etiology , Pulse Therapy, Drug , Radiography, Thoracic , Respiratory Insufficiency/etiology , Tomography, X-Ray Computed
16.
Journal of Korean Medical Science ; : 747-750, 2009.
Article in English | WPRIM | ID: wpr-71709

ABSTRACT

The pyrimidine antimetabolite 5-fluorouracil (5-FU) is a chemotherapeutic agent used widely for various tumors. Common side effects of 5-FU are related to its effects on the bone marrow and gastrointestinal epithelium. Neurotoxicity caused by 5-FU is uncommon, although acute and delayed forms have been reported. Wernicke's encephalopathy is an acute, neuropsychiatric syndrome resulting from thiamine deficiency, and has significant morbidity and mortality. Central nervous system neurotoxicity such as Wernicke's encephalopathy following chemotherapy with 5-FU has been reported rarely, although it has been suggested that 5-FU can produce adverse neurological effects by causing thiamine deficiency. We report a patient with Wernicke's encephalopathy, reversible with thiamine therapy, associated with 5-FU-based chemotherapy.


Subject(s)
Female , Humans , Middle Aged , Acute Disease , Antimetabolites, Antineoplastic/adverse effects , Fluorouracil/adverse effects , Magnetic Resonance Imaging , Nasopharyngeal Neoplasms/drug therapy , Thiamine/therapeutic use , Thiamine Deficiency/complications , Wernicke Encephalopathy/chemically induced
17.
Korean Journal of Medicine ; : 192-197, 2008.
Article in Korean | WPRIM | ID: wpr-222777

ABSTRACT

The superior vena cava (SVC) syndrome results from the disturbance of blood flow in superior vena cava caused by the obstruction. The most common etiology of this condition is the external compression by a malignant tumor. Other causes include thrombus from a pacemaker, defibrillator or central venous catheters. The conventional treatment is radiation and chemotherapy. Recently stenting has been used as a first-line therapeutic strategy for non-malignant cases with balloon and self-expanding stents. In our report, a 77 year-old woman had the SVC syndrome without identification of an underlying disease. A percutaneous endovascular intervention was performed. The stent was placed successfully but just after the procedure, the venous return immediately increased and acute pulmonary edema developed. The patient improved after intravenous diuretics and oxygen. Here we report our experience and review the medical literatures for the management of the non-malignant SVC syndrome, with percutaneous endovascular intervention and the rare complication of pulmonary edema.


Subject(s)
Female , Humans , Central Venous Catheters , Defibrillators , Diuretics , Oxygen , Pulmonary Edema , Stents , Thrombosis , Vena Cava, Superior
18.
Korean Journal of Medical Education ; : 133-144, 2008.
Article in Korean | WPRIM | ID: wpr-214683

ABSTRACT

PURPOSE: We did this study to find out the current teaching status of the medical humanities and social sciences curriculum in Korean medical schools. Further, we discuss the tasks at hand to improve the curriculum in medical education. METHODS: The curricula of 41 medical schools and the syllabi of 10 schools were examined. We analyzed the tables of course organization and contents of integrated medical humanities. After analysis of the contents, they were grouped into 6 categories of medical humanities and social sciences domain. RESULTS: Our results are as follow: 1) there are 3 types of medical humanities and social sciences subject forms: inter-disciplinary (integrated, for example, PDS), multi-disciplinary (separated subject form), and mixed (integrated+separated); 2) most schools offer medical humanities and social sciences in a required class; 3) medical humanities and social sciences are taught through all school years and all 8 graduate medical schools offer a medical humanities and social sciences course from year 1; and 4) the average academic credits for medical humanities are 10 or 11. With respect to the curriculum content, there is some commonality in 10 schools: disease prevention, health improvement, medical ethics, medical regulation, professionalism, and community medicine. Differences were seen in content selection and organization. CONCLUSION: After brief reviews of the medical humanities and social science curriculums, we discovered that all Korean medical schools meet the need of medical humanities and social sciences education. However, curriculum implementation differed in various ways. We suggest the following tasks: 1) clarification of educational goals in order to develop a core curriculum of medical humanities and social sciences in Korea; 2) sharing experiences of developing a well-designed curriculum with other medical schools for effective teaching of this subject area.


Subject(s)
Humans , Community Medicine , Curriculum , Education, Medical , Ethics, Medical , Hand , Humanities , Learning , Schools, Medical , Social Sciences
19.
Korean Journal of Medical Education ; : 11-21, 2008.
Article in Korean | WPRIM | ID: wpr-89242

ABSTRACT

PURPOSE: Information about students is important not only in developing curriculum and teaching strategies, but also in providing support to them. We surveyed students in 2004 (Medical collage) and 2007 (Graduate Medical School) to change our educational system to the GMS. By comparing the characteristics of these students, we expected the new curriculum to be more appropriate for the GMS students. METHODS: Our survey tool was a modified version of the matriculating student questionnaires used by the American Association of Medical Colleges. 60 (80.2%) matriculating students in 2004 (MC), and 71 (93.4%) in 2007 (GMS) responded to the survey. A total of 101 items were asked in 5 areas- 1) Demographic Data, 2) Pre-medical school experience, 3) Medical school application, 4) Career plans and interests, and 5) Perceptions of Medicine and Medical Service. RESULTS: Graduate Medical School matriculates have more diverse backgrounds and experiences before entrance than MC matriculates. GMS students are more sensitive to social issues and accountabilities of medicine and have a higher interest in working with other professionals. Both groups of students were similar in ranking medical professionalism higher than occupational stability or social economic compensation. CONCLUSION: We can use this information about students for curriculum development and, in particular, the differences seen between MC and GMS students could be helpful in improving medical education. If the survey were collected longitudinally and nation-wide, the results could be valuable for policy making not only in medical education but also in medical care and health of the nation.


Subject(s)
Humans , Compensation and Redress , Curriculum , Education, Medical , Policy Making , Schools, Medical , Surveys and Questionnaires
20.
The Korean Journal of Laboratory Medicine ; : 258-261, 2008.
Article in Korean | WPRIM | ID: wpr-67877

ABSTRACT

Type 2N von Willebrand disease (vWD) can be confused with hemophilia A due to decreased factor VIII levels and a bleeding tendency, and differential diagnosis is of importance for providing the optimal treatment and genetic counseling. For the accurate diagnosis of type 2N vWD, von Willebrand Factor (vWF) function tests, multimer assay and gene mutation analysis are needed. The patient was a 38-yr-old Nepalese woman with a history of bleeding manifestations from childhood, such as hemarthrosis, intramuscular hematoma, and menorrhagia. Family history revealed that her mother and elder brothers also had bleeding manifestations from childhood. When she had a laparotomy in 1991, she was diagnosed as hemophilia A with factor VIII level of 3.6% and was transfused with whole blood, factor VIII and cryoprecipitates. In June 2007, she was admitted to our hospital for further evaluation of bleeding tendency. Blood tests revealed normal CBC; bleeding time, 2 min; PT, 14.9 sec (11-14 sec); aPTT, 51.2 sec (24-38 sec); and factor VIII, 4.9% (50-150%). The prolonged aPTT was corrected by 1:1 mixing test to the levels of 106% and 84%, respectively, before and after 2 hr-incubation at 37degrees C. No abnormalities were found in the vWF antigen level (71.3%), ristocetin cofactor assay (130.4%), and multimer assay. Direct DNA sequencing of the VWF gene revealed homozygous missense mutation located in exon 19, c.2446C>T (p.Arg816Trp), confirming the diagnosis of type 2N vWD.


Subject(s)
Adult , Female , Humans , Amino Acid Substitution , Asian People/genetics , Base Sequence , Genotype , Homozygote , Nepal , von Willebrand Diseases/blood , von Willebrand Factor/analysis
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