Accreditation standards items of post-2nd cycle related to the decision of accreditation of medical schools by the Korean Institute of Medical Education and Evaluation / 한국의학교육

Purpose@#The purpose of this study is to analyze the accreditation standards items related to the decision of accreditation of medical schools by the Korea Institute of Medical Education and Evaluation (KIMEE). @*Methods@#The subjects are medical schools in Korea that have received post-2nd cycle accreditation from the KIMEE between 2012 and 2016. Analyses were conducted for differences in accreditation decisions according to the characteristics of medical schools, sufficient ratios of basic standards items, and correlation between standards items related to accreditation decisions. @*Results@#After examining differences in accreditation decisions by the medical school’s characteristics, there were no significant correlations between accreditation standard items and accreditation decisions. Second, according to the number of schools that sufficiently or insufficiently met each standard item, from the total of 97 standard items, 20 (20.6%) were sufficiently fulfilled by all medical schools. Standard item 2-5-2 demonstrated the highest insufficiency ratio. Third, with respect to the standard item that had an effect on accreditation decisions, standard item 1-5-1 showed the highest correlation with the sufficiency rate. @*Conclusion@#The validity of accreditation standards items was assured as this study evaluated the post-2nd cycle accreditation standards items regardless of each medical school’s characteristics. The accreditation standards items were found to have a meaningful impact on the development of medical schools and qualitative improvement in medical education. The findings are expected to contribute to guaranteeing the validity and reliability of accreditation decisions and raising the quality of accreditation.

The Relationship between Dietary Na/K Ratio and Bone Mineral Density in Korean Middle-Aged Women / 가정의학회지

Background@#Dietary Na+ or Na+/K+ ratio has been reported to be associated with bone mineral density (BMD). However, this remains unclear, and only a few studies have been reported on the Korean population. Therefore, this study aimed to determine the association between dietary Na+, K+, and Na+/K+ ratios and BMD in middle-aged Korean women. @*Methods@#This study used data from the Korea National Health and Nutrition Examination Survey 2008–2011. A total of 3,690 women aged >50 years were included. Study participants were classified into quartiles (lowest quartile Q1–highest quartile Q4) according to dietary Na+, K+, and Na+/K+ ratio, and we examined the association of these parameters with BMD. Total femur and lumbar spine BMD were measured using dual-energy X-ray absorptiometry. Multiple linear regression analyses were performed using IBM SPSS ver. 19.0. @*Results@#The mean age was 62 years, and a significant negative trend in the β-coefficient regarding dietary Na+ was only observed in the total femur BMD. However, the total femur and lumbar spine BMD decreased from Q1 to Q4 regarding the dietary Na+/K+ ratio (P-value for trend: 0.044 for total femur BMD and 0.002 for lumbar spine BMD). @*Conclusion@#A significant negative trend in the β-coefficient for both total femur and lumbar spine BMD was observed regarding the Na+/K+ ratio. Therefore, based on the results of this study, a higher dietary Na+/K+ ratio may be associated with a lower BMD.

Analysis of Social Needs for Doctors and Medicine through a Keyword Analysis of Newspaper Articles (2016–2020) / 의학교육논단

The purpose of this study was to explore, using topic modeling, the social value of doctors and medicine demanded by society as reflected in published newspaper articles in Korea. Ultimately, this study aimed to reflect social needs in the process of developing the Patient-Centered Doctor’s Competency Framework in Korea. For this purpose, a total of 2,068 newspaper articles published from 2016 to 2020 were analyzed.Through topic modeling of these newspaper articles over the past 5 years, 18 topics were derived and divided into four categories. Focusing on the derived topics and keywords, the topics derived in specific years and the proportion of topics by year were analyzed. The results of this study make it possible to grasp the needs of society projected through the press for doctors and medicine. Due to the nature of the press, topics that frequently appeared in newspaper articles were mainly social phenomena related to requirements for doctors, particularly dealing with economic and legal aspects. In particular, it was confirmed that doctors are now required to have a wider range of competencies that go beyond their required medical knowledge and clinical skills. This study helped to establish doctor’s competencies by analyzing social needs for doctors through the latest research methods, and the findings could help to establish and improve doctor’s competencies through ongoing research in the future.

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.

Effectiveness of an interprofessional ethics education for nursing and medical students in South Korea / 의료커뮤니케이션

Background@#: Interprofessional education is a necessary step in preparing healthcare providers. This study was done to develop an interprofessional ethical education for nursing and medical students in South Korea, and examine its effects on their readiness for interprofessional learning and achievement in learning outcomes. @*Methods@#: The study was designed using a one-group pretest-posttest design. The subjects were 34 4th-year nursing students and 39 5th-year medical students who participated in an interprofessional ethical education program. Descriptive statistics, a independent t-test, and a dependent t-test were used for data analysis. @*Results@#: After interprofessional ethical education, students’ readiness for interprofessional learning and achievement in learning outcomes were improved. The improvement of nursing students were higher than that of medical students. @*Conclusion@#: The study results indicate that an interprofessional ethical education for nursing and medical students is effective in increasing their readiness for interprofessional learning and achievement in learning outcomes.

Negative school experiences of Late Millennial Korean medical students: a qualitative study using the critical incident technique / 한국의학교육

Purpose@#Today's students have distinctive generational characteristics and increased psychopathology and generational tension. The authors investigated the negative experiences of Late Millennial students in medical school to draw implications for student support. @*Methods@#The authors explored medical students’ negative experiences using the critical incident technique. The authors conducted semi-structured in-depth interviews with 13 medical students, between February and May 2016. The authors focused on occurrences that significantly influenced medical students’ school lives negatively from the students’ perspective. All interviews were recorded and transcribed. The authors classified incidents into frames of reference for the use of faculty development for student support. @*Results@#The authors extracted 22 themes from a total 334 codes and classified them into eight subcategories. Finally, four categories emerged from frames of reference. Students manipulate relationships and colluding for better specialty choice. They experience uncontrolled rifts in interpersonal relationships between peers including lawsuits, sexual assaults, and social network service conflicts. Today’s students feel resentment towards dependent hierarchical relationships with seniors. They struggle with gender discrimination but perpetuate outdated gender role toward the opposite gender. @*Conclusion@#Faculty members should understand today’s students’ level of career stress and desire for work life balance. They should motivate students’ professional identity, promote assertiveness against unfair authorities, and focus on mental health, teamwork, and relationship building. All generations need to understand other generations and develop appropriate leadership and gender sensitivity.

Diagnosis of Coronavirus Disease 2019 / 계명의대학술지

The first massive outbreak of coronavirus disease 2019 (COVID-19) in Korea was controlled by fast diagnosis, isolation and triage systems. The development of therapeutic agents and vaccinations are going on, but many studies clarified the nature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this review, we will discuss the characteristics and spreading of SARS-CoV-2, and prognostic factors and diagnosis of COVID-19.

Socioeconomic Vulnerability, Mental Health, and Their Combined Effects on All-Cause Mortality in Koreans, over 45 Years: Analysis of Korean Longitudinal Study of Aging from 2006 to 2014 / 가정의학회지

BACKGROUND: We evaluated the effects of socioeconomic factors and psychosocial factors, both individually and combined, on all-cause mortality risk (mortality risk). METHODS: We conducted an 8-year (2006–2014) longitudinal analysis of 10,247 individuals who took part in the Korean Longitudinal Study of Aging, a nationwide survey of people aged 45–79 years. Socioeconomic vulnerability (SEV) was assessed with factors such as education, household income, commercial health insurance, and residential area. Mental health (MH) was assessed with factors such as depression, social engagement, and life satisfaction. The covariates were age, gender, marital status, cohabiting, number of chronic diseases, and health behaviors such as regular exercise, smoking, and alcohol intake. We used a Cox proportional hazard analysis to investigate the effects of SEV and MH on mortality risk and also to analyze the superimposed effects of SEV-MH on mortality risk. RESULTS: After the controlling for the covariates, high SEV and negative MH were found to be strong predictors of all-cause mortality. The highest quartile of SEV (vs. lowest) had a 1.70 times greater mortality risk (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.24–2.33) and the highest quartile of MH (vs. lowest) had a 2.13 times greater mortality risk (HR, 2.13; 95% CI, 1.72–2.64). Being in the highest quartile for both SEV and MH (vs. lowest) increased mortality risk more than 3 times (HR, 3.11; 95% CI, 2.20–4.40). CONCLUSION: High SEV and negative MH were independently associated with increased mortality risk, and their superimposed effects were associated with an increased risk of mortality.

Influence of National Health Screening Program on All-Cause Mortality in Korea Analysis of the Korean Longitudinal Study of Aging, 2006–2014

BACKGROUND: To investigate the impact of national health screening on all-cause mortality risk, aged over 45.METHODS: Data from Korean Longitudinal Study of Aging 2006–2014 were assessed. A total of 10,254 participants were included at baseline, and survival rate was assessed biennially. Using cox proportional hazards model, the effect of health screening on mortality risk was investigated. Covariates were gender, depression, education, marital status, co-habitants, house income, social engagement, economic satisfaction, private health insurance, residence location, chronic diseases, and health behaviors (smoking, alcohol intake, regular exercise).RESULTS: At baseline 2006, 54.4% of participants didn't undergo health screening. A hazard ratio (HR) for mortality risk of non-participants were 1.36 (95% confidence interval [CI], 1.21–1.53) after adjusting age and gender. Adding marital status and co-habitants to model 1 as covariates, HR was 1.34 (95% CI, 1.18–1.50) (model 2). Adding depression scores and socioeconomic vulnerabilities to model 2, HR was 1.29 s (95% CI, 1.14–1.45) (model 3). Adding chronic diseases to model 3, HR was 1.26 (95% CI, 1.14–1.48) (model 4). Finally, health behaviors have been added to model 4, HR was 1.24 (95% CI, 1.10–1.40) (model 5). In addition, the mortality risk increased as the cumulative number of missing health screenig increased accordingly.CONCLUSION: Health screening was an independent factor to reduce mortality risk. Therefore, active encouragement to participate the health screening should be implemented to reduce all-cause mortality.

Research trends in studies of medical students' characteristics: a scoping review / 한국의학교육

The purpose of this study is to investigate domestic and international research trends in studies of medical students' characteristics by using the scoping review methods. This study adopted the scoping review to assess papers on the characteristics of medical students. The procedure of research was carried out according to the five steps of the scoping review. The full texts of 100 papers are obtained and are read closely, after which suitable 88 papers are extracted by us for this research. The review is mapped by the year of the study, source, location, author, research design, research subject, objective, and key results. The frequency is analyzed by using Microsoft Excel and SPSS. We found 70 papers (79.5%) on a single medical school, 15 (17.0%) on multiple medical schools, and three (3.4%) on mixed schools, including medical and nonmedical schools. Sixty-nine (79.5%) were cross-sectional studies and 18 (20.5%) were longitudinal studies. Eighty-two papers (93.2%) adopted questionnaire surveys. We summarized research trends of studies on medical students in Korea and overseas by topic, and mapped them into physical health, mental health, psychological characteristics, cognitive characteristics, social characteristics, and career. This study provides insights into the future directions of research for the characteristics of medical students.

Response: Relation between Body Mass Index, Waist Circumference, and Echocardiographic Index of Left Ventricular Diastolic Function (Korean J Obes 2016;25:84-91)

No abstract available.

Relation between Body Mass Index, Waist Circumference, and Echocardiographic Index of Left Ventricular Diastolic Function

BACKGROUND: Obesity is associated with a variety of diseases and increases cardiovascular morbidity and mortality. The purpose of this study is to examine the relationship between the obesity index and diastolic function parameters of the left ventricle. We use body mass index (BMI) and waist circumference (WC) as the obesity index. METHODS: From January 2010 to December 2012, 390 cases (283 men, 109 women) were enrolled in this study. The blood pressure, height, weight, blood test, personal habits questionnaire, and echocardiographic indices were obtained. We analyzed the echocardiographic indices of left ventricular diastolic function with BMI and WC. RESULTS: The left ventricle (LV) mass index (P=0.007), LV dimension (P<0.01), A (P<0.01), A' (P=0.030), and E/E' (P=0.006) were higher, and E (P=0.003), E' (P<0.01), E/A (P<0.01) were lower in the overweight and obese groups than in the normal group. On multiple linear regression analysis, E/E' correlated positively with age, gender, BMI and systolic blood pressure. In men, E/E' correlated positively with age and BMI or WC. In women, only age had a positive correlation with E/E'. CONCLUSION: In men, increased BMI or waist circumference are associated with an increase in E/E', which surrogates left ventricular diastolic dysfunction. In women, obesity and abdominal obesity have no correlation with E/E'.

The Measurement of Korean Pediatric Subglottic Transverse Diameter Using Computed Tomography Imaging and Validation of the Formulas for the Appropriate Cuffed Endotracheal Tube

PURPOSE: It has been established that the subglottic transverse diameter (SD-T) is the narrowest portion of the pediatric airway. In this study, we aimed to measure SD-T using computed tomography (CT) among Korean pediatrics, and compare and verify the measured SD-T with several formulas for appropriate size of the cuffed endotracheal tube (ETT) in pediatrics. METHODS: This is a retrospective study of 364 children from 0 month to 10 years undergoing facial CT scan. The CT scans were performed in children with spontaneous respiration. We obtained SD-T by these CT scans, and compared them with the Motoyama's formula [internal diameter (ID, mm)=(age/4)+3.5], the formula by Khine et al [ID (mm)= (age/4)+3.0], and the formula by Kim et al [outer diameter (OD, mm)=0.01×age (month)+0.02×height (cm)+3.3]. The obtained ID by these formulas was converted to correspond with OD. RESULTS: SD-T had a strong association with age (Estimate=0.029, R²=0.853, p<0.001), weight (Estimate=0.108, R²=0.698, p<0.001), and height (Estimate=0.048, R²=0.854, p<0.001), according to a linear regression analysis. There was no difference of SD-T between males and females (p=0.636). The intraclass coefficients of OD by the Motoyama's formula and the formula by Khine et al with OD of the cuffed ETT by measured SD-T were high (0.910, p<0.001, 0.897, p<0.001). CONCLUSION: Age based formulas for the appropriate cuffed ETT could be sufficient for emergency endotracheal intubation in Korean pediatrics.

The Association between Metabolic Syndrome and Intraocular Pressure

BACKGROUND: Many studies have reported that high intraocular pressure (IOP), a well-known risk factor for glaucoma and especially primary open angle glaucoma, is associated with age, sex, hypertension, diabetes mellitus and obesity. We investigated the association between IOP and metabolic syndrome (MS). METHODS: We measured IOP and MS components according to the National Cholesterol Education Program Adult Treatment Panel III and the American Heart Association and the National Heart, Lung, and Blood Institute with modified guideline for waist circumference. High IOP was defined as > or =21 mmHg in one or both eyes. RESULTS: Looking at the components of MS in men, those with high blood pressure (BP) had significantly higher IOP. In regression analysis, fasting glucose, triglyceride, systolic BP and diastolic BP were positively, and age was negatively associated with IOP. In women, those with high fasting glucose and BP had significantly higher IOP. In regression analysis, diastolic BP, systolic BP, fasting glucose, body mass index and triglyceride were positively associated with left IOP while diastolic BP, fasting glucose and triglyceride were positively associated with right IOP. There were significantly increasing odds ratios for high IOP according to the number of components of MS. CONCLUSIONS: These findings suggest that MS and its components are significantly associated with IOP.

The Diagnostic Criteria of Metabolic Syndrome and the Risk of Coronary Heart Disease according to Definitions in Men / 가정의학회지

BACKGROUND: Early detection of metabolic syndrome (MS) is important to prevent complications. Yet, there is no internationally agreed definition for MS. This study was performed to compare the diagnostic criteria of MS using various definitions and agreements, and to find better definition for screening high risk group of coronary heart disease. METHODS: The participants were 426 men above forty years old who had visited to have health screening in a general hospital in Daegu from March to December in 2007. The diagnostic criteria of MS and Kappa statistic were calculated according to the following five diagnostic definitions; modified World Health Organization (WHO), National Cholesterol Education Program Third Adult Treatment Panel (NCEP-ATP III), International Diabetes Federation (IDF), American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) and NCEP-ATP III modified waist circumference > or = 90 cm (modified NCEP-ATP III). The sensitivity and specificity of each definition of MS were calculated with respect to high risk group by Framingham risk score (FRS). RESULTS: The diagnostic criteria of MS were 6.6% by IDF, 7.7% by WHO, 10.6% by NCEP-ATP III, 18.1% by modified NCEP-ATP III and 22.3% by AHA/NHLBI. The kappa satistic ranged from 0.30 to 0.87. The sensitivity of each definition with respect to FRS was 8.3% in IDF, 13.4% in WHO, 15.3% in NCEP-ATP III, 27.4% in modified NCEP-ATP III and 32.5% in AHA/NHLBI. CONCLUSION: There was great difference in the diagnostic criteria of MS according to diagnostic definitions. The author suggests that AHA/NHLBI or modified NCEP-ATP III definition may be better for screening high risk group of coronary heart disease than others.

Reference Values for the Augmentation Index and Pulse Pressure in Apparently Healthy Korean Subjects

BACKGROUND AND OBJECTIVES: Arterial stiffness is a precursor to premature cardiovascular disease. The augmentation index (AI) and pulse pressure (PP) are cardiovascular risk factors. The aim of this study was to define the diagnostic values of the AI and PP from the peripheral arterial and central aortic waveforms in healthy subjects. SUBJECTS AND METHODS: We recruited 522 consecutive subjects (mean age 46.3+/-9.6 years, 290 males) who came to our facility for a comprehensive medical testing. We measured the body mass index (BMI), blood pressure, peripheral and central PP, and a pulse wave analysis that included the central and peripheral AI. RESULTS: The peripheral and central AIs in the female subjects were significantly higher than that in the male subjects (p<0.001). The peripheral and central PPs in the subjects with hyperlipidemia were significantly higher than subjects with normal lipid profiles (p<0.001). The peripheral and central PPs and peripheral and central AIs significantly increased with age. CONCLUSION: Pending validation in prospective outcome-based studies, a peripheral PP of 70 mmHg, central PP of 50 mmHg, peripheral AI of 100%, and central AI of 40% may be preliminary values in adult subjects.

The Evaluation of Foreign Graphic Health Warning Labels on Smoking Cessation Effectiveness

BACKGROUND: Many countries have been legally prescribing graphic health warning labels on cigarette package as a part of their national policy of smoking cessation. This study was designed to evaluate the effectiveness and appropriateness of graphic health warning labels of Canada, Singapore and European union, in Korean for smoking cessation. METHODS: From February to July in 2005, we surveyed 110 people who were high school students and college students. After showing them the 64 graphic health warning labels (16 from Canada, 6 from Singapore and 42 from European union), the self recorded questionnaires were collected. RESULTS: The effectiveness for smoking cessation was related to the arousal levels of visual effects and it had the same result for each country in which we researched. The high arousal loss-framed graphic health warning labels were more effective than the gain-framed low arousal ones. CONCLUSION: To quit smoking, it can be reasonably concluded that high and negative images of health that were shown on warning labels of cigarette packages were effective. Hereafter, it is recommended more useful and proper designs of graphic warning labels be developed and applied.

A Case of Cesarean Scar Endometriosis / 대한산부인과학회잡지

Extrapelvic endometriosis is a fairly rare phenomenon. The majority of extrapelvic endometriosis involves scar tissue following obstetric or gynecologic procedures. Abdominal wall endometriosis secondary to cesarean section is a very rare condition, being reported in less than 0.5% of patients undergoing cesarean section. It has a distinct presentation and treatment. An abdominal mass with noncyclical symptoms is a common presentation. Imaging techniques are nonspecific and needle biopsy may confirm the diagnosis. Wide excision is the treatment of choice for abdominal wall endometriosis as well as for recurrent lesions. A patient with a history of cesarean section presented with a painful, enlarging mass. The pain was cyclic and aggravated just prior to menstruation. The patient was treated with surgical scar excision pathologically confirmed as endometriosis. We present this case with a brief review of literature.

A Case of Primary Ovarian Pregnancy / 대한산부인과학회잡지

Although tubal pregnancy is increasing, primary ovarian ectopic pregnancy has remained a rare event. However, recent reports suggest an increasing incidence to both tubal and term pregnancies. Ovarian pregnancy occurs within the ovary and on the corpus luteum. Earlier diagnosis is now possible, owing to the availability of highly specific radioimmunoassay for human chorionic gonadotrophin and the development of transvaginal ultrasonography. Clinical and even intraoperative diagnosis is difficult and confirmation may be made only by microscopic examination of the tissue specimen. Current understanding of the etiological factors, classification, possible pathogenesis, clinical presentation, diagnostic steps, reevaluation of diagnostic criteria, preferred management and future fertility are detailed. The therapy is surgical and currently more conservative than in the past, because of improvement in operative laparoscopy. We report a case of primary ovarian pregnancy treated conservatively under laparoscopic surgery with a brief review of literature.

Clinical study of orthognathic surgery on cleft lip and palate patients

No abstract available.