Application of Social Constructivism in Medical Education / 의학교육논단

The purpose of this study is to discuss the main principles and concepts of social constructivism, examine the literature on the application of social constructivism in medical education, and explore the meaning and limitations of the utilization of social constructivism with learning theory. A literature search was carried out in two stages, utilizing PubMed, CINAHL and Education Source databases. The primary search included both fields (social constructivism AND medical education), while the secondary search was performed by subject (Vygotsky or ZPD or zone of proximal development or scaffolding AND medical education). A total of 96 papers were found through the primary and secondary searches, and after reviewing the abstracts of all 96 papers, 41 papers were deemed suitable for research purposes. In medical education, social constructivism is applied in areas such as (1) social and cultural behaviors (hidden curriculum), (2) social construct of “meaning” (dialogue and discourse), (3) learner’s identity transformation (expert), and (4) instructional intervention (ZPD and scaffolding). Social constructivism has provided many ideas to explore in terms of the composition of knowledge in the sociocultural context of health care, but it has not demonstrated an explicit instructional method or educational effects.

Research Trends on Doctors’ Competencies in Korea Using Text Network Analysis / 의학교육논단

We use the concept of the “doctor’s role” as a guideline for developing medical education programs for medical students, residents, and doctors. Therefore, we should regularly reflect on the times and social needs to develop a clear sense of that role. The objective of the present study was to understand the knowledge structure related to doctors’ job competencies in Korea. We analyzed research trends related to doctors’ job competencies in Korea Citation Index journals using text network analysis through an integrative approach focusing on identifying social issues. We finally selected 1,354 research papers related to doctors’ job competencies from 2011 to 2020, and we analyzed 2,627 words through data pre-processing with the NetMiner ver. 4.2 program (Cyram Inc., Seongnam, Korea). We conducted keyword centrality analysis, topic modeling, frequency analysis, and linear regression analysis using NetMiner ver. 4.2 (Cyram Inc.) and IBM SPSS ver. 23.0 (IBM Corp., Armonk, NY, USA). As a result of the study, words such as “family,” “revision,” and “rejection” appeared frequently. In topic modeling, we extracted five potential topics: “topic 1: Life and death in medical situations,” “topic 2: Medical practice under the Medical Act,” “topic 3: Medical malpractice and litigation,” “topic 4: Medical professionalism,” and “topic 5: Competency development education for medical students.” Although there were no statistically significant changes in the research trends for each topic over time, it is nonetheless known that social changes could affect the demand for doctors’ job competencies.

The Patient-Centered Doctor’s Competency Framework in Korea / 의학교육논단

With increasing demands for medical care by society, the medical system, and general citizens and rapid changes in doctor’s awareness, the competencies required of doctors are also changing. The goal of this study was to develop a doctor’s competency framework from the patient’s perspective, and to make it the basis for the development of milestones and entrustable professional activities for each period of medical student education and resident training. To this end, a big data analysis using topic modeling was performed on domestic and international research papers (2011–2020), domestic newspaper articles (2016–2020), and domestic social networking service data (2016–2020) related to doctor’s competencies. Delphi surveys were conducted twice with 28 medical education experts. In addition, a survey was conducted on doctor’s competencies among 1,000 citizens, 407 nurses, 237 medical students, 361 majors, and 200 specialists. Through the above process, six core competencies, 16 sub-competencies, and 47 competencies were derived as subject-oriented doctor’s competencies. The core competencies were: (1) competency related to disease and health as an expert; (2) competency related to patients as a communicator; (3) competency related to colleagues as a collaborator; (4) competency related to society as a health care leader (5) competency related to oneself as a professional, and (6) competency related to academics as a scholar who contributes to the development of medicine.

A Delphi Study to Validate the Patient-Centered Doctor’S Competency Framework in Korea / 의학교육논단

Defining a competent doctor is important for educating and training doctors. However, competency frameworks have rarely been validated during the process of their development in Korea. The purpose of this study was to validate the patient-centered doctor’s competency framework, which had been developed by our expert working group (EWG). Two rounds of Delphi questionnaire surveys were conducted among a panel of experts on medicine and medical education. The panel members were provided with six core competencies, 17 sub-competencies, and 53 enabling competencies, and were asked to rate the importance of these competencies on a 5-point Likert scale. Between April and July 2021, a total of 28 experts completed both rounds. The data of the Delphi study were analyzed for the mean, standard deviation, median, inter-rater agreement (IRA), and content validity ratio (CVR). A CVR >0.36 and IRA ≥0.75 were deemed to indicate validity and agreement. This study found that five enabling competencies were not valid, and agreement was not reached for three sub-competencies and two enabling competencies. In consideration of CVR and the individual opinions of panel members at each session, the final competencies were extracted through consensus meetings of the EWG. The competencies were modified into six core competencies, 16 sub-competencies, and 47 enabling competencies. This study is meaningful in that it proposes patient-centered doctor’s competencies enabling the development of residents’ milestone competencies, an assessment system, and educational programs.

Establishment of a Cohort at Chosun University College of Medicine for Social Accountability / 의학교육논단

Cohorts are established and operated at medical schools as part of efforts to improve the quality of education. Chosun University College of Medicine clarified the purpose of establishing three cohorts in light of its core values and developed criteria and indicators for each purpose. An organization focusing on cohort construction and operation was established as the Cohort Committee under the Quality Improvement Committee, and guidelines were proposed. In addition, a database and system were developed to handle primary data efficiently, and tools for measuring psychological variables were created. The data collected by establishing a cohort, regions, and admission types of graduates were first analyzed for the following projects: (1) an analysis of the educational process and quality improvement to educate medical professionals who contribute to the community after graduation, and (2) an analysis of the educational process and quality improvement to secure excellence in the medical field (e.g., knowledge and clinical reasoning), using information on the academic achievements of students and graduates as primary data. Chosun University College of Medicine is conducting cohorts and longitudinal studies gradually, starting with a simple, practically feasible system to solve the difficulties faced in cohort establishment and operation. Medical educators hope that future data collection and analysis will improve the quality of medical school education and have practical implications.

Needs Assessment for the Development of Training Curricula for Internal Medicine Residents

Background@#Patient-centered outcomes can be achieved when common core and specialist competencies are achieved in a balanced manner. This study was conducted to assess the need to fill the gap between the defined competencies and learners’ achievement, in order to improve the internal medicine (IM) training education curriculum for promoting patientcentered outcomes. @*Methods@#A cross-sectional online survey was conducted. The participants were 202 IM specialists who obtained board certification in 2020−2021. We developed a questionnaire to investigate the self-evaluation of common core competencies and achievement level of IM essential competencies. For analysis, frequency tests, paired t-test, Borich priority formula, and χ 2 were performed. @*Results@#In common core competencies, IM specialists recognized that their achievement levels in all competency categories were lower than their importance level (P < 0.001), and the highest educational demands were related to self-management. They assessed their five essential procedure skill levels as novice or advanced beginner status. The achievement level for the essential symptoms and signs that IM specialists should be able to manage was predominantly competent level. However, on average, 34.9% answered that they had never assessed during training for essential skills, and 29.7% answered the same for essential symptoms and signs. @*Conclusion@#We identified the priorities of core competencies, the level of achievement in essential procedures and patient care with essential symptoms and signs for IM training, and the related educational methods and assessment status. This study is expected to be used as basic data for developing and revising IM training educational curriculum.

Beginning of outcome-based medical education: development of medical schools’ mission statements based on stakeholders’ priority / 한국의학교육

Background@#Many studies report the positive effects of outcome-based education in improving medical education quality. An important aspect of outcome-based education is the statement of learning outcomes, which is closely associated with medical schools’ mission, vision, and educational goals. Medical schools’ mission statement not only sets the standards to determine educational goals and outcomes but also provides an indicator to monitor and evaluate medical education quality.Purpose: This study identified a methodology to provide optimal mission statements at medical schools through the framework of suggested decision-making method. @*Methods@#This study analyzed the focus of the mission development suggested by World Federation for Medical Education and Liaison Committee on Medical Education medical education standards and searched for appropriate decision-making methods based on these standards. In addition to validate the suggested framework of mission statement, case analysis of medical schools was conducted. @*Results@#Consequently, a mission development method that applies the mission statement based on stakeholders’ priority (MSSP) was derived. The MSSP involves (1) content analysis, (2) candidate extraction, (3) priority evaluation, and (4) priority validation. The keywords of the mission system derived during this process were categorized and listed in ranks to be suggested as the mission, vision, and core values. The proposed MSSP was applied in two South Korean medical schools and, thereby, the mission, vision, and core values were determined for each medical school. @*Conclusion@#The two schools’ case analysis verified MSSP’s effectiveness as a decision-making methodology to gather and converge diverse opinions from stakeholders for the mission statement at the medical schools.

Beginning of outcome-based medical education: development of medical schools’ mission statements based on stakeholders’ priority / 한국의학교육

Background@#Many studies report the positive effects of outcome-based education in improving medical education quality. An important aspect of outcome-based education is the statement of learning outcomes, which is closely associated with medical schools’ mission, vision, and educational goals. Medical schools’ mission statement not only sets the standards to determine educational goals and outcomes but also provides an indicator to monitor and evaluate medical education quality.Purpose: This study identified a methodology to provide optimal mission statements at medical schools through the framework of suggested decision-making method. @*Methods@#This study analyzed the focus of the mission development suggested by World Federation for Medical Education and Liaison Committee on Medical Education medical education standards and searched for appropriate decision-making methods based on these standards. In addition to validate the suggested framework of mission statement, case analysis of medical schools was conducted. @*Results@#Consequently, a mission development method that applies the mission statement based on stakeholders’ priority (MSSP) was derived. The MSSP involves (1) content analysis, (2) candidate extraction, (3) priority evaluation, and (4) priority validation. The keywords of the mission system derived during this process were categorized and listed in ranks to be suggested as the mission, vision, and core values. The proposed MSSP was applied in two South Korean medical schools and, thereby, the mission, vision, and core values were determined for each medical school. @*Conclusion@#The two schools’ case analysis verified MSSP’s effectiveness as a decision-making methodology to gather and converge diverse opinions from stakeholders for the mission statement at the medical schools.

Applications and Effects of EdTech in Medical Education / 의학교육논단

Rapid developments in technology as part of the Fourth Industrial Revolution have created a demand for educational technology (EdTech) and a gradual transition from traditional teaching and learning to EdTech-assisted learning in medical education. EdTech is a portmanteau (blended word) combining the concepts of education and technology, and it refers to various attempts to solve education-related problems through information and communication technology. The aim of this study was to explore the use of key EdTech applications in medical education programs. A scoping review was conducted by searching three databases (PubMed, CINAHL, and Educational Sources) for articles published from 2000 to June 2021. Twenty-one studies were found that presented relevant descriptions of the effectiveness of EdTech in medical education programs. Studies on the application and effectiveness of EdTech were categorized as follows: (1) artificial intelligence with learner-adaptive evaluation and feedback, (2) augmented/virtual reality for improving learning participation and academic achievement through immersive learning, and (3) social media/social networking services with learner-directed knowledge generation, sharing, and dissemination in medical communities. Although this review reports the effectiveness of EdTech in various medical education programs, the number of studies and the validity of the identified research designs are insufficient to confirm the educational effects of EdTech. Future studies should utilize suitable research designs and examine the instructional objectives achievable by EdTech-based applications to strengthen the evidence base supporting the application of EdTech by medical educators and institutions.

Application of Social Constructivism in Medical Education / 의학교육논단

The purpose of this study is to discuss the main principles and concepts of social constructivism, examine the literature on the application of social constructivism in medical education, and explore the meaning and limitations of the utilization of social constructivism with learning theory. A literature search was carried out in two stages, utilizing PubMed, CINAHL and Education Source databases. The first search included both fields (social constructivism AND medical education), while the second search was performed by subject (Vygotsky or ZPD or zone of proximal development or scaffolding AND medical education). A total of 96 papers were found through the first and second searches, and after reviewing the abstracts of all 96 papers, 41 papers were deemed suitable for research purposes. In medical education, social constructivism is applied in areas such as (1) social and cultural behaviors (hidden curriculum), (2) social construct of “meaning” (dialogue and discourse), (3) learner’s identity transformation (expert), and (4) instructional intervention (ZPD and scaffolding). Social constructivism has provided many ideas to explore in terms of the composition of knowledge in the sociocultural context of health care, but it has not demonstrated an explicit instructional method or educational effects.

The correlation between triglyceride to HDL cholesterol ratio and metabolic syndrome, nutrition intake in Korean adults: Korean National Health and Nutrition Examination Survey 2016 / 한국영양학회지

PURPOSE: Metabolic syndrome causes diabetes and increases the risk of cardiovascular disease. This study examined the correlation between metabolic syndrome, nutrition intake, and triglyceride (TG)/high-density lipoprotein (HDL) cholesterol ratio. METHODS: Using the data from the 7th KNHANES (2016), this study was conducted on healthy adults aged 19 and older. The components and existence of metabolic syndrome and nutrition intake were independent variables and the TG/HDLcholesterol ratio was a dependent variable. A complex sample logistic progress test was used with age, sex, smoking, and drinking frequency corrected. RESULTS: The TG/HDLcholesterol ratio of people with metabolic syndrome was as high as 1.314 on average, compared to people without metabolic syndrome (p < 0.0001). Among each component of metabolic syndrome, the TG/HDL cholesterol ratio had a significant association with fasting blood glucose, TG, HDL cholesterol, and waist circumference (p < 0.05). Only energy and carbohydrate intake were significantly related to the TG/HDLcholesterol ratio (p < 0.05). CONCLUSION: The TG/HDLcholesterol ratio is associated with each component of metabolic syndrome, but in particular, it is positively correlated with the presence of metabolic syndrome. Lower energy intakehad a positive correlation with the TG/HDLcholesterol ratio. These results show that metabolic syndrome can be predicted using the TG/HDLcholesterol ratio, and a diet strategy through nutrition and health education is necessary to prevent metabolic syndrome.

The learning characteristics of primary care physicians / 한국의학교육

PURPOSE: This study analyzed the learning characteristics of primary care physicians that are necessary to develop proper educational support systems in continuing medical education. METHODS: The research participants were 15 physicians with an average of 8 years of experience in primary care clinics. The data were collected through in-person interviews with each participant and analyzed by keyword coding, expert review, and content elaboration. RESULTS: The learning styles of primary care physicians were classified as "reactive," "organized," and "exploratory," according to their problem-solving approaches in clinics. The types of learning interaction were "unilateral acquisition," "mutual exchange," and "organization participation." The primary motives of learning in clinics were the primary care physicians' recognition of accountability and the intrinsic enjoyment of learning itself. CONCLUSION: For continuous professional development-i.e., the self-directed learning of primary care physicians with problemsolving approaches-learning interactions in professional communities should be considered in continuing educational support systems.