Faculty perceptions and use of e-learning resources for medical education and future predictions / 한국의학교육

Purpose@#This study aims to investigate medical faculties’ perceptions and current practice of using e-learning resources, needs and suggestions for more effective use of such resources, and future directions of e-learning in medical education. @*Methods@#This descriptive study was conducted on full-time faculty members who were registered users of the e-learning portal of the consortium of Korean medical schools. Participants were invited to an online survey containing 45 items that addressed their perceptions and use of e-learning resources, and their predictions of future use. Descriptive analysis and reliability analysis were conducted as well as a thematic analysis of qualitative data. @*Results@#Ninety faculty members from 31 medical schools returned the questionnaires. Participants positively perceived e-learning resources and that they predicted their use would become increasingly popular. Still, only half of the respondents were using e-learning resources for teaching and agreed that they were willing to share their e-learning resources. Our study illustrates several barriers inhibit faculty use and sharing of e-learning resources, and a need for a more comprehensive, better-organized resource repository. Participants also pointed out the needs for more resources on multimedia assessment items, clinical videos, and virtual patients. @*Conclusion@#Our study sheds light on medical faculty needs for institutional support and faculty development programs on e-learning, and institutional policies that address faculty concerns regarding ownership, intellectual property rights, and so forth on creating and sharing such resources. Collaborations among medical schools are suggested for creating a better organized around learning outcomes and more comprehensive repository of resources.

Current status and development direction of hyperbaric medicine in Korea

The indications of hyperbaric oxygen therapy (HBOT) covered by the health insurance in Korea increased to 16 in 2019, which includes acute central retinal artery obstruction within 24 hours of vision loss; anemia due to excessive bleeding, since blood transfusion is impractical; chronic refractory osteomyelitis (Wagner grade ≥3); and intracranial abscess.Current Concepts: HBOT affects the treatment in the primary and secondary mechanisms. According to the Boyle’s law, the primary mechanism is important in treating decompression sickness and intravascular air embolism by decreasing the volume of air bubbles when pressure increases, whereas the secondary mechanism involves hyperoxygenation of the primary mechanism and various effects, such as vasoconstriction, angiogenesis, immune function enhancement, reperfusion injury prevention, antimicrobial action, and gas washout effect, occur. In the past 5 years, domestic HBOT has made significant progress. However, there are many non-therapeutic lowpressure HBOT facilities that are limited by insurance coverage issues, quality equipment management, and medical personnel in HBOT facilities.Discussion and Conclusion: To solve the problem, the introduction of the definition of therapeutic hyperbaric pressure and certification system of HBOT facilities must be initiated. Moreover, the system should be improved so that insurance can be applied for a more indication of HBOT.

The efficacy of peer assessment in objective structured clinical examinations for formative feedback: a preliminary study / 한국의학교육

Purpose@#We sought to determine the impact of medical students’ prior experience of assessing peers in the objective structured clinical examination (OSCE) on their clinical performance. @*Methods@#Forty-two year 4 medical students participated in an OSCE comprised of three 10-minute stations (syncope, hemoptysis, and back pain). Each student took part in two iterations of the three‐station OSCE as either the examiner or examinee, and student performance was assessed using a checklist by a medical faculty member and a student simultaneously. Students were randomly assigned to two groups and their OSCE scores were compared. Students in the control group were tested at a station first and then participated at the same station as a peer examiner, and those in the intervention group participated as a peer examiner first and then as an examinee. Moreover, student OSCE scores rated by peer examiners were compared with those awarded by faculty to evaluate the accuracy of peer assessment. Following the test, students completed surveys on their perceptions of the usefulness of this formative OSCE. @*Results@#Student overall OSCE scores did not differ between groups. Students in the study group performed better at the hemoptysis station (p<0.001), but poorer at the syncope station (p<0.01). Student performances at the back-pain station were similar in these two groups (p=0.48). OSCE scores rated by faculty and peer examiners were moderately negatively associated at the hemoptysis station (p<0.05), but no such association was observed at the other two stations. This trend was similar in peer examiners who were high-achievers and low-achievers in OSCEs. Students showed positive perceptions of their experience with this OSCE. @*Conclusion@#Student experience as peer assessor offers a feasible means of providing them greater access to OSCEs without consuming more resources, although its impact on enhancing performance in the OSCE is likely to differ across stations.

Development of e-learning in medical education: 10 years’ experience of Korean medical schools / 한국의학교육

PURPOSE@#We aimed to explore medical students’ online learning patterns and needs by analyzing data obtained from an e-learning portal of Korean medical schools.@*METHODS@#Data were obtained from learning resources and registered users of the e-learning portal by the consortium of 36 Korean medical schools, e-MedEdu (

Development of e-learning in medical education: 10 years’ experience of Korean medical schools / 한국의학교육

PURPOSE: We aimed to explore medical students’ online learning patterns and needs by analyzing data obtained from an e-learning portal of Korean medical schools. METHODS: Data were obtained from learning resources and registered users of the e-learning portal by the consortium of 36 Korean medical schools, e-MedEdu (www.mededu.or.kr) over a period of 10 years. Data analytics were performed of its contents and usage patterns using descriptive statistics. RESULTS: The website currently has over 1,600 resources, which have almost tripled over the past decade, and 28,000 registered users. Two hundred and twenty medical faculty have contributed the resources; a majority of them were clinical cases and video clips, which accounted for 30% and 27% of all resources, respectively. The website has received increasing hits over the past decade; annual website hits increased from 80,000 in 2009 to over 300,000 in 2018. The number of hits on resources varied across resource types and subjects; 90% of all website hits were on online videos, and 28% of them originated from mobile devices. Among the online videos, those on procedural skills received more hits than those on patient encounters and video lectures. CONCLUSION: Our findings demonstrate the increasing use of e-learning in medical education in Korea over the past decade. Our study also shows a wide disparity in the frequency of use in learning resources across resource types and subjects, which have implications for improvements in the design and development of learning resources to better meet medical students’ curricular needs and their learning styles.

Effect of typhoons on the Korean national emergency medical service system

OBJECTIVE: While the effect of typhoons on emergency medicine has been evaluated, data are scarce on their effects on the emergency medical service (EMS). This study evaluated the effect of typhoons on EMS patients and performance. METHODS: The study period was January 2010 to December 2012. Meteorological data regarding typhoons were provided by the Korean Meteorological Administration. EMS data were retrieved from the EMS database of the national emergency management agency. The database includes ambulance run sheets, which contain clinical and operational data. In this case-crossover study, the cases and controls were EMS calls on the day of typhoon warnings and calls one week prior to the typhoon warnings, respectively. RESULTS: During the study period, 11 typhoons affected Korea. A total of 14,521 cases were selected for analysis. Overall, there were no obvious differences between the case and control groups. However, there were statistically significant differences in age, place, and time requests. There were fewer patients between 0 and 15 years of age (P=0.01) and more unconscious patients (P=0.01) in the case group. The EMS operational performance, as measured by the times elapsed between call to start, call to field, and call to hospital did not differ significantly. There was also no significant difference in the time from hospital arrival between the cases (28.67, standard deviation 16.37) and controls (28.97, standard deviation 28.91) (P=0.39). CONCLUSION: Typhoons did not significantly affect the EMS system in this study. Further study is necessary to understand the reasons for this finding.

Comparison of internal jugular vein dilation between Valsalva maneuver and proximal internal jugular vein compression

OBJECTIVE: The Valsalva maneuver is recognized as an effective method to dilate the internal jugular vein (IJV). However, this maneuver cannot be performed in many cases, such as children and unconscious patients. The aim of this study was to evaluate the effectiveness of proximal IJV compression, which can easily be performed, regardless of patient cooperation. METHODS: Healthy adult volunteers were recruited from tertiary hospital employees. Basic anatomic and physiologic data were collected. The subjects lay down as if they were undergoing IJV catheter insertion, in the supine position with their necks turned 30 degrees to the left. The main outcome was the cross-sectional area (CSA) of the distal IJV as measured by ultrasound in four stages. The first stage was sham without any maneuver. The second was Valsalva maneuver, the third was digital IJV compression, and the fourth was digital compression accompanied by simultaneous Valsalva maneuver. RESULTS: A total of 41 volunteers were enrolled. Twenty-six (63.41%) were male with an average age of 28.15±2.85 years. Mean height was 170.74±8.66 cm and mean neck circumference was 35.28±3.87 cm. The mean CSA-IJV was 1.06±0.36 cm² without any maneuver. It increased to 1.34±0.45 cm² with Valsalva maneuver (P<0.001), to 1.26±0.41 cm² with digital compression (P<0.001), and to 1.41±0.47 cm² with the two maneuvers combined (P=0.01). CONCLUSION: Digital proximal IJV compression effectively dilates the distal IJV. When performed simultaneously with the Valsalva maneuver, the effect was enhanced.

Outcome and Current Status of Therapeutic Hypothermia Following Out-of-hospital Cardiac Arrest in Korea from the Korea Hypothermia Network Registry

PURPOSE: Therapeutic hypothermia (TH) has become a standard strategy for reducing brain damage in the postresuscitation period. The aim of this study is to investigate the outcomes and current performance of TH with out-of-hospital cardiac arrest (OHCA) survivors through the Korean hypothermia network (KORHN) registry. METHODS: We used the KORHN registry, a web-based, multicenter registry that includes 24 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TH from 2007 to 2012 were included. The primary outcomes were neurologic outcome at hospital discharge and in-hospital mortality. The secondary outcomes were TH performance and adverse events during TH. RESULTS: A total of 930 patients were included; of these, 556 (59.8%) patients survived to discharge and 249 (26.8%) were discharged with good neurologic outcomes. The median time from return of spontaneous circulation (ROSC) to the start of TH was 101 (interquartile range (IQR): 46-200) minutes. The induction, maintenance, and rewarming durations were 150 (IQR: 80-267) minutes, 1440 (IQR: 1290-1440) minutes, and 708 (IQR: 420-900) minutes, respectively. The time from the ROSC to coronary angiography was 1,045 (IQR: 121-12,051) hours. Hyperglycemia (46.3%) was the most frequent adverse event. CONCLUSION: Over one quarter of OHCA survivors (26.8%) were discharged with good neurologic outcome. TH performance was managed appropriately in terms of the factors related to the timing of TH, which were the start time for cooling and the rewarming duration.

Clinical applications and contemporary trends of hyperbaric oxygen therapy in Korea

Hyperbaric oxygen therapy (HBOT) is approved in the United States for 14 accepted indications, which are approved by the HBOT committee of the Undersea and Hyperbaric Medical Society and by the Food and Drug Administration. These indications are also used worldwide. HBOT is a mode of medical treatment in which the patient is situated in an enclosed pressure chamber and breathes 100% oxygen at a pressure greater than 1 atmosphere absolute (ATA), with the usual therapeutic pressure set at greater than 1.4 ATA. In South Korea, an expanded knowledge base and formalized education in HBOT do not exist, and numerous HBOT devices are old and nearing the cessation of operation, although HBOT has undergone refinement, with an increased understanding of mechanisms of action and clinical applications. Furthermore, there is no specific board certification of HBO competence for emergency, critical care, and surgical physicians and technicians in South Korea. We summarize the existing literature on the uses of HBO with the aim of enhancing the understanding of this therapeutic technique.

The Assessment of a Patient's Chief Complaints by Emergency Medical Technicians and Residents of an Emergency Department

PURPOSE: Addressing a patient's chief complaint is the first and key element of treating patients. This study determined the effectiveness of emergency medical technician and residents of an emergency department in addressing a patient's chief complaints. If emergency and hospital personnel misunderstand the chief symptoms of patients it could result in erroneous transport and treatment, thus losing precious time in finding the proper treatment. METHODS: A retrospective chart review study was performed in 1137 patients (at least 18 years of age), who visited one university hospital, for a period of 3 months. Patients who were did not undergo trauma, addiction, and cardiac arrest were included. RESULTS: A total of 150 cases (13.2%) did not match the chief symptoms reported by 119 emergency medical personnel and emergency medicine residents. Systemic symptoms, nervous system symptoms, and psychiatric symptoms were the main categories inconsistently assessed. The rank and certification of emergency medical technicians did not make a difference, but older patients (59 years of age or older) were statistically different. The assessment fo chief symptoms by an emergency medical resident tended to be more accurate than assessment of emergency medical technicians in the final diagnosis. CONCLUSION: Systemic symptoms, nervous symptoms, and psychiatric symptoms, were chief complaines easily misreported for older patients. This likely reflects a difficulty in the evaluation of obscure symptoms in older patients. It will require specific additional training programs to improve the response to these chief complaints.

A Successful Repair of Nail Bed Injury with 2-N-butylcyanoacrylate (Histoacryl(TM)): A Case Report

Injury of the nail bed is commonly encountered in the emergency department. Despite the importance of initial management, difficulties such as long duration of operation and need of skill hinder the practice. Tissue repair with tissue adhesives, like 2-N-butylcyanoacrylate (Histoacryl(TM)), is a common replacement for suture repair. Here we describe a case of nail bed injury, which was repaired with Histoacryl(TM), and the method of repair.

A Comparative Study Between Newly Developed Wave-form and Traditional Straight-form Splints

PURPOSE: Widely used fiberglass splints are made from straight-form material. These prove difficult to mold at joints and form wrinkles, causing complications such as pain, pressure sores, and peripheral nerve palsy. We compared the usefulness of wave-form splints with straight-form splints and the level of satisfaction of these designs from care providers and wearers. METHODS: Eighty-nine (n=89) emergency physicians and orthopedic surgeons participated in this study. The subjects (acting as care providers and mock patients) used wave-form and straight-form material to construct and wear short leg splints, long arm splints, and sugar tong splints. The clinicians were surveyed on their satisfaction as providers and wearers. All questions were measured on scores from 0 and 10(10=maximum score). After splints were removed, subjects were surveyed on the extent of splint wrinkling with scores from 1 to 3(3=maximum wrinkling). RESULTS: Provider satisfaction scores for wave-form splints versus straight-form splints in short leg splint applications were 7.76+/-1.30 vs 6.74+/-1.25 (p=0.000). Provider satisfaction scores for wave-form splints versus straight-form splints in long arm splint applications were 7.73+/-1.33 and 6.73+/-1.59 (p=0.004), respectively. The subjects felt more comfortable wearing wave-form splints, compared to straight-form splints (7.79+/-1.49 vs. 6.79+/-1.58, respectively; p=0.004) and more satisfied (8.03+/-1.35 vs. 7.18+/-1.33, respectively; p=0.003). The frequencies of wrinkle occurrence in wave-form and straight-form splints were 29.7% and 42.2%, respectively (p=0.02). CONCLUSION: Wave-form splints may be more practical for molding and wearing than traditional straight-form splints.