Designing a Longitudinal Database for Cohort Construction in Medical Education / 의학교육논단

Longitudinal data can provide important evidence with the potential to stimulate innovation and affect policies in medical education and can serve as a driving force for further developments in medical education through evidence-based decisions. Tracking and observing cohorts of students and graduates using longitudinal data can be a way to link the past, present, and future of medical education. This study reviewed practical methods and technical, administrative, and ethical considerations for the establishment and operation of a longitudinal database and presented examples of longitudinal databases. Cohort study design methods and previous examples of research using longitudinal databases to explore major topics in medical education were also reviewed. The implications of this study are as follows: (1) a systematic design process is required to establish longitudinal data, and each university should engage in ongoing deliberation about this issue; (2) efforts are needed to alleviate “survey fatigue” among respondents and reduce the administrative burden of those conducting data collection and analysis; (3) it is necessary to regularly review issues of personal information protection, data security, and ethics regarding the survey respondents; and (4) a system should be established that integrates and manages a longitudinal database of medical education at the national level. The hope is that establishing longitudinal data and cohorts at individual medical schools will not be a temporary phenomenon, but rather that they will be well utilized at the national level to innovate and implement ongoing changes in medical education.

Design of a Model to Structure Longitudinal Data for Medical Education Based on the I-E-O Model / 의학교육논단

The purpose of this study was to establish a model for constructing longitudinal data for medical school, and to structure cohort and longitudinal data using data from Yonsei University College of Medicine (YUCM) according to the established input-environment-output (I-E-O) model. The study was conducted according to the following procedure. First, the data that YUCM has collected was reviewed through data analysis and interviews with the person in charge of each questionnaire. Second, the opinions of experts on the validity of the I-E-O model were collected through the first expert consultation, and as a result, a model was established for each stage of medical education based on the I-E-O model. Finally, in order to further materialize and refine the previously established model for each stage of medical education, secondary expert consultation was conducted. As a result, the survey areas and time period for collecting longitudinal data were organized according to the model for each stage of medical education, and an example of the YUCM cohort constructed according to the established model for each stage of medical education was presented. The results derived from this study constitute a basic step toward building data from universities in longitudinal form, and if longitudinal data are actually constructed through this method, they could be used as an important basis for determining major policies or reorganizing the curricula of universities. These research results have implications in terms of the management and utilization of existing survey data, the composition of cohorts, and longitudinal studies for many medical schools that are conducting surveys in various areas targeting students, such as lecture evaluation and satisfaction surveys.

Medical Educators’ Response to Changes in Medical Education due to COVID‐19 / 의학교육논단

To analyze medical professors’ evaluation of their online education experiences in an attempt to support faculty members and indicate the future direction of medical education. Faculty members who taught online in the first semester of 2020 at Yonsei University College of Medicine in South Korea were surveyed. The results of the survey were analyzed in June 2020. There were 88 respondents (35.1% of 251): 59 professors (67.0%), 16 associate professors (18.2%), and 13 assistant professors (14.8%). Their specialties lay in basic medicine (25.0%), clinical medicine (65.9%), and research and special purposes (9.1%). Sixteen participants (18.2%) had previous experience in online lectures; 23 (26.1%) reported that preparation time for online lectures was the same as before; 65 (73.9%) reported that the preparation time had increased; 38 (43.2%) faced difficulties in preparation and lecturing online, and among them 16 (42.1%) indicated inadequate interaction with students; 11 (28.9%) needed extra preparation time; and 11 (28.9%) attributed their difficulties to technical issues with the online platform. Participants’ satisfaction with online lectures was low (p<0.001). In the free response question on overall experience with online education, 38.3% mentioned the need for an instructional design that allows students to actively participate and interact with professors, 29.5% mentioned the need for the establishment of an information & communications technology system, and 17.0% mentioned the necessity of faculty development. To prepare for the current pandemic and more in the long term, an appropriate educational support system must be constructed, and a learner-centered instructional design that enables wider interactions and active learning is needed.

A Critical Review of Medical Humanities Education Curriculum Development Based on Kern’s Curriculum Development Model / 의학교육논단

Medical humanities education (MHE) is as essential as basic medical sciences and clinical medicine education.Despite the importance of MHE, MHE curriculum development (CD) has proven to be challenging. This critical review examines the MHE CD at one medical school. The critical review methodology was developed based on Kern’s six step CD model to systematically examine the CD of “Doctoring and Medical Humanities (DMH)” at the Yonsei University College of Medicine. Five review questions were developed related to (1) necessity, (2) direction and purpose, (3) design, (4) operation, and (5) evaluation of CD based on Kern’s model. The review showed that the process of DMH CD mapped to components of Kern's model. The DMH curriculum content selected was closely related to medical practice and aimed to combine the acquisition of understanding and skills by designing a student-participatory curriculum based on clinical cases. Assessment methods that emphasized students’ reflections were actively introduced in the evaluation section. Since the regular committee for DMH continued the work of the special ad hoc committees for DMH CD, the CD was effectively completed. However, the planning and evaluation functions and responsibilities of the DMH committee need to be strengthened. Despite the apparent limitations, the fact that students showed a high satisfaction rate and preferred small group discussions based on clinical cases has significant implications in the instructional design of MHE, where changes in self-awareness and attitude are more important than the acquisition of information. It is necessary to systematically review and study students’ reflection results produced by the changed assessment methods and to develop assessment indicators for MHE that reflect the achievements of the MHE competencies of students

Usefulness of neutrophil-lymphocyte ratio in young children with febrile urinary tract infection / 소아과

PURPOSE: Acute pyelonephritis (APN) is a serious bacterial infection that can cause renal scarring in children. Early identification of APN is critical to improve treatment outcomes. The neutrophil-lymphocyte ratio (NLR) is a prognostic marker of many diseases, but it has not yet been established in urinary tract infection (UTI). The aim of this study was to determine whether NLR is a useful marker to predict APN or vesicoureteral reflux (VUR). METHODS: We retrospectively evaluated 298 pediatric patients (age≤36 months) with febrile UTI from January 2010 to December 2014. Conventional infection markers (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and NLR were measured. RESULTS: WBC, CRP, ESR, and NLR were higher in APN than in lower UTI (P<0.001). Multiple logistic regression analyses showed that NLR was a predictive factor for positive dimercaptosuccinic acid (DMSA) defects (P<0.001). The area under the receiver operating characteristic (ROC) curve was high for NLR (P<0.001) as well as CRP (P<0.001) for prediction of DMSA defects. NLR showed the highest area under the ROC curve for diagnosis of VUR (P<0.001). CONCLUSION: NLR can be used as a diagnostic marker of APN with DMSA defect, showing better results than those of conventional markers for VUR prediction.

Usefulness of neutrophil-lymphocyte ratio in young children with febrile urinary tract infection / 소아과

PURPOSE: Acute pyelonephritis (APN) is a serious bacterial infection that can cause renal scarring in children. Early identification of APN is critical to improve treatment outcomes. The neutrophil-lymphocyte ratio (NLR) is a prognostic marker of many diseases, but it has not yet been established in urinary tract infection (UTI). The aim of this study was to determine whether NLR is a useful marker to predict APN or vesicoureteral reflux (VUR). METHODS: We retrospectively evaluated 298 pediatric patients (age≤36 months) with febrile UTI from January 2010 to December 2014. Conventional infection markers (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and NLR were measured. RESULTS: WBC, CRP, ESR, and NLR were higher in APN than in lower UTI (P<0.001). Multiple logistic regression analyses showed that NLR was a predictive factor for positive dimercaptosuccinic acid (DMSA) defects (P<0.001). The area under the receiver operating characteristic (ROC) curve was high for NLR (P<0.001) as well as CRP (P<0.001) for prediction of DMSA defects. NLR showed the highest area under the ROC curve for diagnosis of VUR (P<0.001). CONCLUSION: NLR can be used as a diagnostic marker of APN with DMSA defect, showing better results than those of conventional markers for VUR prediction.

Hyponatremia May Reflect Severe Inflammation in Children with Kawasaki Disease

PURPOSE: The aim of the present study was to investigate the risk factors for the development of coronary artery lesions (CALs) and to determine whether hyponatremia is associated with CALs in children with Kawasaki disease (KD). METHODS: We retrospectively analyzed the data of 105 children with KD who were admitted to Ilsan Hospital between January 2000 and July 2011. RESULTS: Erythrocyte sedimentation rate (P = 0.013), total bilirubin levels (P = 0.017) were higher and serum sodium levels (P = 0.027) were lower in KD children with CALs than those without. White blood cell (WBC) counts (P = 0.006), neutrophil counts (P = 0.003) were higher and albumin levels (P = 0.009) were lower in KD children with hyponatremia than those without. On multiple logistic regression analysis, hyponatremia (P = 0.024) and intravenous immunoglobulin??resistance (P = 0.024) were independent risk factors for CALs in KD. Furthermore, serum sodium levels were correlated negatively with WBC counts (P = 0.004), neutrophil counts (P < 0.001), total bilirubin levels (P = 0.005) and positively with albumin levels (P = 0.009). CONCLUSION: Our study indicates that hyponatremia may reflect severe inflammation in children with KD.