The change of the COVID-19 pandemic on medical education in Korea: a national survey of medical schools / 한국의학교육

Purpose@#This study aims to investigate how medical schools in Korea managed their academic affairs and student support in response to the coronavirus disease 2019 (COVID-19) pandemic and their plans for the post-COVID-19 era. @*Methods@#An online survey was conducted, and a link to a questionnaire was distributed to all the administrators of the 40 medical schools in Korea. The final analysis data involved responses from 33 medical schools and 1,342 students. Frequency analysis, cross-tabulation analysis, Fisher’s exact test, and one-way analysis of variance were applied for statistical analysis. @*Results@#Regarding instruction methods, most medical schools in Korea transitioned from in-person learning to video-on-demand learning (51.5%) and real-time online learning (42.4%). Among the school leaders, 36.4% planned to continue offering online classes combined with in-person classes beyond the end of the pandemic. Among the students, the online class concentration and participation score was 3.0 points or lower, but the class understanding score was 3.6 points, above a moderate level. @*Conclusion@#Students cited the shorter times needed to attend school and being able to take classes repeatedly as advantages of online classes, and over one-third of medical schools intended to continue with a hybrid of in-person and online learning even after the COVID-19 pandemic restrictions end.

The mental health of medical students in Daegu during the 2020 COVID-19 pandemic / 한국의학교육

Purpose@#In February 2020, the first outbreak of coronavirus disease 2019 (COVID-19) occurred in Daegu, South Korea, and confirmed cases increased sharply, sparking intense anxiety among residents. This study analyzed the data of a mental health survey on students enrolled at a medical school located in Daegu in 2020. @*Methods@#An online survey was administered to 654 medical school students (pre-medical course: 220 students, medical course: 434 students) from August to October 2020, with 61.16% (n=400) valid responses. The questionnaire included items about COVID-19-related experiences, stress, stress resilience, anxiety, and depression. @*Results@#Of the survey participants, 15.5% had experienced unbearable stress, with the most significant stress factors (in descending order) being limited leisure activities, unusual experiences related to COVID-19, and limited social activities. Approximately 28.8% reported psychological distress, and their most experienced negative emotions were helplessness, depression, and anxiety (in descending order). The mean Beck Anxiety Inventory and Beck Depression Inventory-II scores were 2.44 and 6.08, respectively, both within normal ranges. Approximately 8.3% had mild or greater anxiety, and 15% had mild or greater depression. For students under psychological distress, the experience of unbearable stress before COVID-19 affected anxiety (odds ratio [OR], 0.198; p<0.05), and having an underlying condition affected depression (OR, 0.190; p<0.05). With respect to their psychological distress during August–October 2020 compared with that during February–March 2020 (2 months from the initial outbreak), anxiety stayed the same while depression increased and resilience decreased at a statistically significant level. @*Conclusion@#It was found that some medical students were suffering from psychological difficulties related to COVID-19, and there were several risk factors for them. This finding suggests that medical schools need to not only develop academic management systems but also provide programs that can help students manage their mental health and emotions in preparation for an infectious disease pandemic.

The Application of Cognitive Teaching and Learning Strategies to Instruction in Medical Education / 의학교육논단

The purpose of this study was to examine teaching strategies from cognitive learning theory applied to medical education and to present specific applications of the strategies and cases. The results of this study yielded (1) seven teaching strategies and specific sample activities that instructors can use based on learning processes in medical schools; (2) nine instructional events to which cognitive learning strategies were applied; (3) principles of curriculum design from a cognitive perspective; and (4) instruction cases employing cognitive teaching strategies. Cognitive learning theory has two implications: first, if instructors in medical schools apply the results of the study to design a class and curriculum, it would be possible for them to minimize cognitive loading of the learners that may stem from ineffective teaching strategies or curricula; second, cognitive teaching strategies that seek improvement in thinking skills could provide useful teaching strategies for medical education, which aims to develop experts with high-level thinking processes. In this sense, cognitive learning theory is

Students' self-assessment of achievement of terminal competency and 4-year trend of student evaluation on outcome-based education / 한국의학교육

PURPOSE: This study was designed to allow a student at School of Medicine, Kyungpook National University (KNUSOM) to self-assess how well they had achieved competency and to analyze the differences and trends of the scores by year. Furthermore, students are asked to evaluate the need for curriculum improvement by competency, the tendency of the score is analyzed by year, and the results are reflected in the improvement of the curriculum. METHODS: We conducted a questionnaire survey for fourth-year students of KNUSOM who took medical education classes from 2015 to 2018. Questionnaire items were evaluated on the basis of their current achievement of 30 subordinate competencies of competency and the degree of necessity with respect to revising the curriculum. One-way analysis of variance was performed for the yearly difference analysis. RESULTS: The students' scores on the graduation competency were 2.03 to 4.06. In the yearly difference analysis, there was no significant difference in the average of 30 total competencies, but 16 of the sub-competencies showed significant year-to-year differences. The scores for the 30 graduation competencies were different for each year, but the competencies showing high scores and low scores were found to be similar each year. CONCLUSION: We found that the achievement level of the students was approximately 60% to 70%. We were able to confirm the contents of the education that the students continuously demand. The curriculum trend graphs for each year showed that the students' scores improved when the curriculum was being revised. We found that it is necessary to accept the students' self-evaluation reliable as the students indicated that the contents of the curriculum should be added to the areas where the contents were lacking in the present curriculum.

An analysis of verbs used in the course outcomes of outcome-based integrated courses at a medical school based on the taxonomy of educational objectives / 한국의학교육

PURPOSE@#The purposes of this study were to analyze the course outcomes of integrated courses of a medical school that introduced an outcome-based curriculum and to suggest ways to improve techniques in the description of outcomes.@*METHODS@#In order to investigate the course outcomes of 39 courses in the first and second grades at Kyungpook National University School of Medicine in Korea, verbs for the course outcome were classified according to Bloom’s taxonomy and frequency analysis was completed. The appropriateness of use of verbs in description of the outcomes was also analyzed.@*RESULTS@#The total number of course outcomes for both grades was 497. The number of course outcomes per credit ranged from a minimum of 0.9 to a maximum of 22.0. Most of the course outcomes were classified as the comprehension domain according to Bloom’s taxonomy. The most frequently used verb was “explain,” accounting for 61.0% (n=303) of the entire course outcome verbs. Some verbs in the outcomes, however, were unmeasurable.@*CONCLUSION@#The major findings of this study include the followings. First, the number of course outcomes varied according to courses. Second, several course outcomes included unmeasurable verbs. Finally, most of the verbs used to describe course outcome belonged to the two lower levels of Bloom’s taxonomy—knowledge and comprehension. In order to improve the description of course outcomes, this study suggests that it is necessary to adjust the number of course outcomes, applicate overt behavior verbs, and elevate the level of course outcomes from the lower memorizing level to the higher application level.

Students' self-assessment of achievement of terminal competency and 4-year trend of student evaluation on outcome-based education / 한국의학교육

PURPOSE@#This study was designed to allow a student at School of Medicine, Kyungpook National University (KNUSOM) to self-assess how well they had achieved competency and to analyze the differences and trends of the scores by year. Furthermore, students are asked to evaluate the need for curriculum improvement by competency, the tendency of the score is analyzed by year, and the results are reflected in the improvement of the curriculum.@*METHODS@#We conducted a questionnaire survey for fourth-year students of KNUSOM who took medical education classes from 2015 to 2018. Questionnaire items were evaluated on the basis of their current achievement of 30 subordinate competencies of competency and the degree of necessity with respect to revising the curriculum. One-way analysis of variance was performed for the yearly difference analysis.@*RESULTS@#The students' scores on the graduation competency were 2.03 to 4.06. In the yearly difference analysis, there was no significant difference in the average of 30 total competencies, but 16 of the sub-competencies showed significant year-to-year differences. The scores for the 30 graduation competencies were different for each year, but the competencies showing high scores and low scores were found to be similar each year.@*CONCLUSION@#We found that the achievement level of the students was approximately 60% to 70%. We were able to confirm the contents of the education that the students continuously demand. The curriculum trend graphs for each year showed that the students' scores improved when the curriculum was being revised. We found that it is necessary to accept the students' self-evaluation reliable as the students indicated that the contents of the curriculum should be added to the areas where the contents were lacking in the present curriculum.

Differences and changes in the empathy of Korean medical students according to gender and vocational aptitude, before and after clerkship / 한국의학교육

PURPOSE@#The purpose of this study is to determine whether there is any change in the empathy scores of third-year medical graduate students after they have taken a clerkship and have begun gaining more opportunities to meet patients through the clerkship.@*METHODS@#The participants were 109 third-year students in 2014 and 110 fourth-year students in 2015 at Kyungpook National University, School of Medicine. The author measured empathy using a modified and expanded version of the Korean version of the Jefferson Scale of Empathy of Physician Empathy-Student version and used the Holland-III aptitude test-S to assess vocational aptitude.@*RESULTS@#As a results, male students in their third year exhibited higher scores, but there was no significant difference in the fourth year. The empathy score increased slightly when third-year students became fourth-year students, but the difference was not statistically significant. There was no statistically significant change in the scores of both male and female students between the 2 years. The results of the vocational aptitude test showed that students who preferred person-oriented specialties had higher empathy scores when they entered their fourth academic year compared to objectively-oriented students.@*CONCLUSION@#In this study, male students showed higher empathy scores than female students, an atypical finding that was inconsistent with the results of previous studies. However, the distribution of scores among male students was wider than that of female students, a finding consistent with previous studies. As such, individual differences need to be considered when developing curriculum in order to improve the empathy of medical students.

Differences and changes in the empathy of Korean medical students according to gender and vocational aptitude, before and after clerkship / 한국의학교육

PURPOSE: The purpose of this study is to determine whether there is any change in the empathy scores of third-year medical graduate students after they have taken a clerkship and have begun gaining more opportunities to meet patients through the clerkship. METHODS: The participants were 109 third-year students in 2014 and 110 fourth-year students in 2015 at Kyungpook National University, School of Medicine. The author measured empathy using a modified and expanded version of the Korean version of the Jefferson Scale of Empathy of Physician Empathy-Student version and used the Holland-III aptitude test-S to assess vocational aptitude. RESULTS: As a results, male students in their third year exhibited higher scores, but there was no significant difference in the fourth year. The empathy score increased slightly when third-year students became fourth-year students, but the difference was not statistically significant. There was no statistically significant change in the scores of both male and female students between the 2 years. The results of the vocational aptitude test showed that students who preferred person-oriented specialties had higher empathy scores when they entered their fourth academic year compared to objectively-oriented students. CONCLUSION: In this study, male students showed higher empathy scores than female students, an atypical finding that was inconsistent with the results of previous studies. However, the distribution of scores among male students was wider than that of female students, a finding consistent with previous studies. As such, individual differences need to be considered when developing curriculum in order to improve the empathy of medical students.

An analysis of verbs used in the course outcomes of outcome-based integrated courses at a medical school based on the taxonomy of educational objectives / 한국의학교육

PURPOSE: The purposes of this study were to analyze the course outcomes of integrated courses of a medical school that introduced an outcome-based curriculum and to suggest ways to improve techniques in the description of outcomes. METHODS: In order to investigate the course outcomes of 39 courses in the first and second grades at Kyungpook National University School of Medicine in Korea, verbs for the course outcome were classified according to Bloom’s taxonomy and frequency analysis was completed. The appropriateness of use of verbs in description of the outcomes was also analyzed. RESULTS: The total number of course outcomes for both grades was 497. The number of course outcomes per credit ranged from a minimum of 0.9 to a maximum of 22.0. Most of the course outcomes were classified as the comprehension domain according to Bloom’s taxonomy. The most frequently used verb was “explain,” accounting for 61.0% (n=303) of the entire course outcome verbs. Some verbs in the outcomes, however, were unmeasurable. CONCLUSION: The major findings of this study include the followings. First, the number of course outcomes varied according to courses. Second, several course outcomes included unmeasurable verbs. Finally, most of the verbs used to describe course outcome belonged to the two lower levels of Bloom’s taxonomy—knowledge and comprehension. In order to improve the description of course outcomes, this study suggests that it is necessary to adjust the number of course outcomes, applicate overt behavior verbs, and elevate the level of course outcomes from the lower memorizing level to the higher application level.

Course quality management based on monitoring by students at a medical school / 한국의학교육

PURPOSE: This study aims to develop a system of course monitoring by students and evaluate the course quality management system (CQMS) implemented as an educational assessment tool. METHODS: This research was conducted in accordance with the ADDIE model which is a well-known instructional design model. The ADDIE process includes needs analysis, design of the course monitoring and course evaluation, development of evaluation forms, implementation of course monitoring, and evaluation of the program. RESULTS: To meet the need for a system that can replace the traditional lecture evaluation approach, this study developed and implemented a new course evaluation system. In comparison with the quantitative evaluation method, course monitoring by students provided more qualitative information on classes and courses from the students' perspective. The students' realistic description helped know how student felt the atmosphere of class and what kinds of teaching style students preferred. However, some view that the evaluation by the four monitoring members was less reliable. CONCLUSION: This study proposed a course quality management based on students' monitoring which emphasized the narrative evaluation to help to identify the strengths and weaknesses of the classes and gather qualitative information from the students' perspective that can be used to improve the courses. It is expected that providing the monitoring members with better orientation could help manage the quality of the courses using the monitoring system.

Development and Operation of Longitudinal Integrated Clerkship Programs in Overseas Medical Schools / 의학교육논단

In recent years, Korean medical schools have shown a growing interest in the longitudinal integrated clerkship (LIC) as a means of improving clinical education. Some overseas medical schools have tried the LIC since the 1970s. In the 1990s, several universities in the United States, Canada, and Australia introduced LICs. A variety of studies have confirmed positive results of the LIC. Traditional block-rotation is a discipline-based, inpatient-centered practice. Instead, under the LIC system, a medical student responsible for a panel of longitudinal patients observes developments of their diseases, serving several departments simultaneously. Overseas medical schools have different LIC models depending on their affiliate hospitals' sizes and characteristics. The purpose of this study is to introduce LIC practices in Harvard Medical School and University of California San Francisco, which could be applied by Korean medical schools. This paper also aims to find out the strategies that have been able to help the two US medical schools implement the LIC successfully.

Implementation of problem-based learning in medical education in Korea / 한국의학교육

PURPOSE: This study aims to identify how problem-based learning (PBL) has been implemented in Korean medical education, and how it is evaluated by each medical school. METHODS: For this study, a total of 40 medical schools in Korea were surveyed via e-mail. The survey tool was a questionnaire consisting of 22 questions which was developed independently by the researchers. RESULTS: Of the 40 medical schools, 35 schools were implementing PBL programs in their medical curriculum, while five were found not currently to be running the program. A large number of the schools which introduced PBL (30 schools, 85.7%) used a hybrid PBL model. In over 70% of the medical schools surveyed, professors evaluated the effects of PBL as positive. Most medical schools (85.7%) stated they would maintain or expand their use of PBL. However, the lack of understanding and skeptical attitude of the faculty on PBL, the lack of self-study time and passive attitude of students, insufficiency of good PBL cases, and the perfunctory PBL introduction for school accreditation interfere with the successful PBL. CONCLUSION: PBL has been incorporated in Korean medical curriculum as hybrid PBL type. It is analyzed that intensive tutor training and good PBL case development are necessary for the success and effective operation of PBL.

Students' perceptions and satisfaction level of hybrid problem-based learning for 16 years in Kyungpook National University School of Medicine, Korea / 한국의학교육

PURPOSE: Kyungpook National University School of Medicine has been implementing hybrid problem-based learning (PBL) since 1999. The aim of this study was to investigate the changes in the students' perceptions and satisfaction levels of hybrid PBL. METHODS: The target period of our study was from 1999 to 2014, and target subjects were second-year medical students in Kyungpook National University School of Medicine. The survey was conducted at the end of semester. We had a focused interview with group leaders and some volunteer students. RESULTS: As for the scores regarding students' overall satisfaction with PBL, there was significant improvement in 2005 compared to 2002, but the scores decreased and no differences between the survey years noted after 2005. The students' preference ratio for the once a week PBL sessions, tutor presence, synchronization of contents, and arrangement of PBL sessions and related lectures was 60%–80%, 50%–90%, 52%–96%, and 78%–93%, respectively. CONCLUSION: In order to increase students' satisfaction with hybrid PBL and to improve the perception of it, firstly, it is necessary to arrange the date and the time of PBL sessions so that students can concentrate on PBL. Secondly, PBL cases should be selected and arranged to be well synchronized with the ongoing lectures. Finally, it is important to create a safe atmosphere so that students can engage actively in PBL sessions.