A National Sample Survey of Medical Students about Their Perception and Evaluation on Medical Study, Career Plan, and Medical Care System: Part 2. Career Plan after Graduating from Medical School / 한국의학교육

A national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system was conducted in December 1997 through January 1998. About 10% of all the medical students in 32 medical schools that had students from freshman to senior in November 1997 were systematically sampled for a questionnaire survey. Out of 1,386 students, 1,233(89.0%) had responded and 12 of them were excluded from the analysis because of incomplete response. This report is the second part of the study regarding career plan of students after graduating from medical school. Criteria of medical students for choosing specialty of medicine are professional reward and personal interest. Among the respondents, 92.2% plan to choose clinical medicine, 2.5% basic medical sciences, and 4.8% special areas of medicine such as health administration, medical engineering, forensic medicine, medical education, and health economics. If it is guaranteed that they will be a professor after training, 8.8% of them want to study special areas of medicine, and 7.3% basic medical sciences. The students who had admitted to a medical school after obtaining bachelor's degree were more prone to choose clinical medicine than other students. The most common reason for not choosing basic medical sciences was lower income than clinician. Among the students who want to be a clinician, 92.2% want to be a specialist and the preferred specialties were internal medicine 36.0%, orthopedics 9.0%, general surgery 7.7%, psychiatry 7.5%, and pediatrics 5.7%. Comparing with the findings of 1983 study, the proportions of students who want to major internal medicine and minor subjects were markedly increased and that of general surgery increased slightly while that of pediatrics was decreased. The places of work that the students prefer in the future were university hospital 43.2% (10% point increase from the finding in 1983), general hospital 37.1% and private practice 9.4% (10% point decrease from the finding in 1983). It was noticeable that some of the students want to be a medical missionary and health administrator. The students prefer their university hospital most for post-graduate training and the reason is only because it is their alma mater. One can anticipate from these findings that it will be very difficult to get basic medical scientists and primary physicians in the future.

A Case of Heat Stroke in an Aluminium Utensil Plant / 대한산업의학회지

An 18-year-old man suffered heat stroke after continuous working for 26 hours on his first day in an aluminium utensil plant in August 1998. His job was to put a pressed aluminium utensil on the conveyer before the process of spray painting. The ranges of temperature and relative humidity measured at the local weather-station during the patient' s working period were 23.6-30.2 degrees C, 49-87 % respectively. On arrival the patient was comatose and suffered generalized seizure three times. His rectal temperature was 41.2 degrees C . blood pressure was 90/60 mmHg, pulse was 148 beats/minute and respiratory rate was 28 times/minute. The serum level of AST was 421 IU/L. ALT was 205 IU/L, LDH was 1,160 IU/L. myoglobin was higher than 500 ng/mL. OK was higher than 2,000 IU/L. He recovered consciousness 7th day of admission and discharged after 2 months but cerebellar dysarthria was remained. The patient felt himself several prodromal symptoms of heat stroke and he showed awkward behavior considered to be drowsiness, but the patient and his co-workers neglected them. This case report shows that heat stroke can be occurred in a condition that ambient temperature, humidity, and working load are not extreme. A thorough health education and management concerned with guidelines on salt and water intake, detection of early symptoms of heat-related illness, prompt body cooling and rapid transportation to a hospital is necessary.

A National Sample Survey of Medical Students about Their Perception and Evaluation on Medical Study, Career Plan, and Medical Care System: Part 3. Student's View on Merits and Demerits of Being Physician, Patients and Diseases, Medical Practice, and Medic / 한국의학교육

A national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system was conducted in December 1997 through January 1998. About 10% of all the medical students in 32 medical schools that had students from freshman to senior in November 1997 were systematically sampled for a questionnaire survey. Out of 1,386 students, 1,233(89.0%) had responded and 12 of them were excluded from the analysis because of incomplete response. This report is the third part of the study regarding students' view on merits and demerits of being physician, patients and diseases, medical practice, and medical care system. Respondents indicated that the merits of being a physician are humanitarian nature of work(30.0%) and autonomy of work(28.0%) and the demerits are too busy to enjoy peronal life(56.5%) and too much stress from work(41.2%). Social status of physicians was assessed by the students in four dimensions, i.e. social prestige, social influence, power, and income. Students were found to think that the current social status of physicians is lower than it should be ideally in all of four dimensions. Ninety percent of student agreed that physician is a noble occupation that deals with human life but only two-thirds of students agreed that physician is economically secured and socially well recognized occupation. Students regarded the medical insurance system as instigating increase of general hospital and withering of private clinics and hindering medical development by reducing investment capacity. Major problems in medical care system indicated by the students are irrational medical insurance system, concentration of physicians in large cities, and irrational health care delivery system. Medical students regarded the role of nurses as not merely assisting physicians(40.7%) but have to participate more actively in patient care(49.8%). Regarding medical study's effect on views of patients and diseases, 60.4% of them indicated that they became to view patients more as entities of diseases and this was a significant increase from 28.9% in 1983 study. For criteria of death, 73.5% agreed with brain-death. Regarding organ transplantation, 79.2% agreed to encourage it but only 46.9% agreed to encourage artificial fertilization in vitro. In case of accidental death, 73.5% agreed to donate their organs for transplantation. To a statement related with medical malpractice reading "Physicians should be treated generously for their mistakes in medical practice so long as the mistakes are not due to negligence", 71.6% of the students agreed to the statement. To another statement reading "Physicians should be thoroughly investigated and duly penalized for mistakes made by them in their medical practice", only 31.8% agreed to it. These findings suggested that medical students are well aware of the problems in the health care system and social status of physicians. Changes were noticed in the sense of responsibility for medical malpractice and physician's attitude toward patients since 1983 study.

A National Sample Survey of Medical Students about Their Perception and Evaluation on Medical Study, Career Plan, and Medical Care System: Part 3. Student's View on Merits and Demerits of Being Physician, Patients and Diseases, Medical Practice, and Medic / 한국의학교육

A national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system was conducted in December 1997 through January 1998. About 10% of all the medical students in 32 medical schools that had students from freshman to senior in November 1997 were systematically sampled for a questionnaire survey. Out of 1,386 students, 1,233(89.0%) had responded and 12 of them were excluded from the analysis because of incomplete response. This report is the third part of the study regarding students' view on merits and demerits of being physician, patients and diseases, medical practice, and medical care system. Respondents indicated that the merits of being a physician are humanitarian nature of work(30.0%) and autonomy of work(28.0%) and the demerits are too busy to enjoy peronal life(56.5%) and too much stress from work(41.2%). Social status of physicians was assessed by the students in four dimensions, i.e. social prestige, social influence, power, and income. Students were found to think that the current social status of physicians is lower than it should be ideally in all of four dimensions. Ninety percent of student agreed that physician is a noble occupation that deals with human life but only two-thirds of students agreed that physician is economically secured and socially well recognized occupation. Students regarded the medical insurance system as instigating increase of general hospital and withering of private clinics and hindering medical development by reducing investment capacity. Major problems in medical care system indicated by the students are irrational medical insurance system, concentration of physicians in large cities, and irrational health care delivery system. Medical students regarded the role of nurses as not merely assisting physicians(40.7%) but have to participate more actively in patient care(49.8%). Regarding medical study's effect on views of patients and diseases, 60.4% of them indicated that they became to view patients more as entities of diseases and this was a significant increase from 28.9% in 1983 study. For criteria of death, 73.5% agreed with brain-death. Regarding organ transplantation, 79.2% agreed to encourage it but only 46.9% agreed to encourage artificial fertilization in vitro. In case of accidental death, 73.5% agreed to donate their organs for transplantation. To a statement related with medical malpractice reading "Physicians should be treated generously for their mistakes in medical practice so long as the mistakes are not due to negligence", 71.6% of the students agreed to the statement. To another statement reading "Physicians should be thoroughly investigated and duly penalized for mistakes made by them in their medical practice", only 31.8% agreed to it. These findings suggested that medical students are well aware of the problems in the health care system and social status of physicians. Changes were noticed in the sense of responsibility for medical malpractice and physician's attitude toward patients since 1983 study.

A National Sample Survey of Medical Students about Their Perception and Evaluation on Medical Study, Career Plan, and Medical Care System: Part 1. Survey Methods and Characteristics of Sample / 한국의학교육

Since the first survey done in 1983, this is the second national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system. One out of every 10 students plus one in each class were systematically sampled from each grade year of 32 medical schools in Korea that had students from freshman to senior in November 1997. A questionnaire was developed by adding items related with recent changes in medical care environment and with viewpoint on medicine and physician as an occupation to the questionnaire used in 1983. The questionnaire was administered at each school under the supervision of designated collaborator of the same school in December 1997 through January 1998. A total of 1,386 students were sampled from a total of 11,987 medical students and 1,233 students(89.0%) filled out the questionnaire. Twelve students were excluded from the analysis because of incomplete response and the final analysis was done for 1,221 students. A few demographic characteristics of the sample were compared with those of the study population to check the representativeness of the sample and found no skew. The contents of the study were divided into three parts and the first part describes the study methods, demographic and other characteristics of the sample, students' viewpoint on medical education, and students' aptitude for medicine Male students accounted for 75.7% of the sample. The proportion of students who entered medical school right after graduating from a high school was 45.8% in Seoul and 53.4% in other than Seoul area. The students who classified their own political inclination conservative were 43.9% in Seoul and 33.0% in other than Seoul and the percentage of students with progressive inclination was higher in out of Seoul than Seoul area. The proportion of students who have a religion was 57.2%; Christian 31.0%, Catholic 15.2%, and Buddhist 9.5%. The educational level of fathers of students was far higher than the level of general population, e.g. 59.8% had college or higher education. Occupation of fathers was mainly white-collar worker; professional worker 21.2%, company employee 17.2%, government official 13.1%, manager 11.8%, and medical professional 8.7%. In the decision-making process to enter the medical school, 53.7% of the students were influenced by someone else and 62.1% of them were parents. Socio-economic factor was the most common reason for recommending medical school and it accounted 33.5% of the reasons. Medical students enjoy learning life phenomenon(47.2%) and human being(44.3%) in medical study but most disturbing factors are memory work(39.7%) and too much to study(34.1%). If students were given another chance to choose a college as a senior student in high school, 50.3% of them said that they would choose medical school. Only 6% of students have intention to change their major subject of study if they are allowed to change now. The proportion of students who consider their scholastic aptitude is compatible with medical study was 64.9% and such proportion increased with grade. The percentage of students who are going to recommend medical school to their own son in the future was 36.6% for male and 26.7% for female students and to their own daughter 33.6% and 27.7%, respectively.

Decision-making process and satisfaction of pregnant women for delivery method / 예방의학회지

This study was conducted to assess the attitude of pregnant women toward delivery method, understanding of the reason for determining her own delivery method, participation in decision-making process and satisfaction with delivery method after labor. Study subjects were 693 pregnant women who had visited obstetric clinic for prenatal care in the last month of pregnancy in one general hospital and one obstetrics-gynecology specialty hospital in Taegu city from February 1 to March 31 in 1998. A questionnaire was administered before and after labor and a telephone interview was done one month after labor. Proportion of women who had health education and/or counselling about delivery method during prenatal care was 24.0% and this proportion was higher for women who had previous c-section(35.5%) than others. Women thought vaginal delivery is better than c-section for both maternal and baby's health regardless of previous delivery method. About 90% of primipara and multiparous women who had previous vaginal delivery wanted vaginal delivery for the index birth, while 85.6% of multiparous women who had previous c-section wanted repeat c-section. Reasons for choosing c-section in pregnant women who preferred vaginal delivery before labor were recommendation of doctors(81.9%), recommendation of husband(0.8%), agreement between doctor and pregnant woman(4.7%), and mother's demand(12.6%). Reasons for choosing vaginal delivery were mother's demand(30.6%) and no indication for c-section(67.2%). Reasons for choosing c-section in pregnant women who preferred c-section before labor were recommendation of doctors(76.2%), mother's demand(20.0%), recommendation of husband(1.3%), and agreement between doctor and pregnant woman(2.5%). Of the pregnant women who had c-section, by doctor's recommendation, the proportion of women who had heard detailed explanation about reason for c-section by doctor was 55.1%. Mother's statement about the reason for c-section was consistent with the medical record in 75.9%. However, over 5% points disparities were shown between mother's statement and medical record in cases of the repeat c-section and mother's demand. In primipara and multiparous women who had previous vaginal delivery, the delivery method for index birth had statistically significant association with the preference of delivery method before labor(p<0.05). All of the women who had previous c-section had delivered the index baby by c-section. Among mothers who had delivered the index baby vaginally, 84.9% of them were satisfied with their delivery method immediately after labor and 85.1% at 1 month after labor. However, mothers who had c-section stated that they are satisfied with c-section in 44.6% immediately after labor and 42.0% at 1 month after labor. Preferred delivery method for the next birth had statistically significant association with delivery method for the index birth both immediately after labor and in 1 month after labor. The proportion of mothers who prefer vaginal delivery for the next birth increased with the degree of satisfaction with the vaginal delivery for the index birth but the proportion of mothers who prefer c-section for the next birth was high and they did not change significantly with the degree of satisfaction with the c-section for the index birth. These results suggest that the current high technology-based, physician-centered prenatal and partritional cares need to be reoriented to the basic preventive and promotive technology-based, and mother-fetus-centered care. It is also suggested that active involvement of pregnant woman in decision-making process for the delivery method will increase the rate of vaginal birth after c-section and decrease c-section rate and improve the degree of maternal satisfaction after delivery.