The Value of Medical Humanities in Medical Education : Focusing on the History of Medicine / 의사학

The history of medicine has been continuously devaluated in medical education but its importance should not be ignored as for other medical humanities. The educational value of the history of medicine could be summarized as follows ; it allows the students 1) to understand the humane aspect of medicine by telling them how medicine has dealt with human health-disease phenomena in each era of the human history. 2) to improve the professionalism by recognizing that medicine is a profession with a long tradition that dates back to the Hippocratic era 3) to improve current medical practice by understanding the limitations and uncertainties of medicine. 4) to understanding the historical changes of the disease phenomena 5) to develop the basic competence of learned intellectual. 6) to integrate the tradition of their own institutions with themselves.

A Study on the Name of “Po Goo Nyo Goan” and Its Marking / 의사학

This study aims to correct the Chinese characters of 普救女館 (Po Goo Nyo Goan) and its Korean pronunciation by re-examining the circumstances around the establishment of this hospital, and to discover its naming principle which is associated with the Confucian political philosophy of the Joseon Dynasty. Although 普救女館 is the first modern women's hospital in Korea, most historical studies of this institute have been conducted on limited documents and records. Many published studies use the incorrect names in many ways, so the correct name of the hospital is still in confusion.普救女館, however, was named with four or five of the Chinese characters given by the Joseon government (King Gojong (高宗)) at the time of its establishment. The Joseon government gave the name of Seonnyeoboguwon (善女普救院) to the first modern women's hospital established by Mary Scranton, the name of which was changed to 普救女館.Some records left by the female missionary doctors who worked in 普救女館 show the romanization and meaning of the name of the hospital. The romanization of 普救女館 clarified the Korean pronunciation of “女 (nyeo)” at that time. English translation name of the hospital has always shown that the place provided “extensive” medical treatment to women. It proves the fact that the first Chinese character of the name is “普”, not “保” which is expressed in many documents today.The hospital was named according to Confucian ideals just like the other modern hospitals established around the same time, such as Jejungwon (濟衆院), Gwangjewon (廣濟院), Gwanghyeyeowon (廣惠女院). The Joseon government commonly used similar Chinese characters during the naming of these hospitals, characters that imply the ideal of the good Confucian king's favor for many people of Joseon. 普救女館 was unique in having the character “館(gwan)” in its name, not “院(won)” as in other hospitals. It seems to stem from the characteristic of “women's hospital.” Po Gu Nyo Goan, the unprecedented women's hospital, was probably imagined as a hospitable accommodation where women provided kindness to people in need. This may have been the reason why “館”, which has the meaning of accommodation, was chosen instead of “院” that primarily meant medical facilities.Correcting the name of 普救女館 helps to eliminate the confusion in current historiography and to promote the understanding of the historical significance of this hospital.

Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.

Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.

The Necessity for End-of-Life Care Education: A Preliminary Analysis with Interns at Two University Hospitals / 한국호스피스완화의료학회지

PURPOSE: This study was performed to explore the current state of end-of-life (EoL) care education provided to new interns at two university hospitals. METHODS: A questionnaire was given to incoming interns (N=64). The levels of acquired knowledge and experience of clinical observation were measured. Seven areas for self-assessment questions were identified and used to analyze the interns' attitudes towards EoL-related education and practice. RESULTS: On average, participants learned five elements (nine in total) from EoL-related classes and two (seven in total) from clinical observation. The most frequently educated element was how to deliver bad news (96.9%) in the classroom setting and how to control physical symptoms (56.5%) in clinical observation. Less than 20% received training on EoL care communication, including discussion of advanced directives. Compared with participants who had no EoL training, those who had EoL training showed positive attitudes in all seven categories regarding overall satisfaction, interest and preparedness in relation to EoL-care classes and practice. CONCLUSION: Although interns are responsible for caring of dying patients, their EoL training in classroom and clinical settings was very insufficient. Further research should be conducted to establish an education system that provides sufficient knowledge and training on EoL care.

Burden of Disease Study and Priority Setting in Korea: an Ethical Perspective

When thinking about priority setting in access to healthcare resources, decision-making requires that cost-effectiveness is balanced against medical ethics. The burden of disease has emerged as an important approach to the assessment of health needs for political decision-making. However, the disability adjusted life years approach hides conceptual and methodological issues regarding the claims and value of disabled people. In this article, we discuss ethical issues that are raised as a consequence of the introduction of evidence-based health policy, such as economic evidence, in establishing resource allocation priorities. In terms of ethical values in health priority setting in Korea, there is no reliable rationale for the judgment used in decision-making as well as for setting separate and distinct priorities for different government bodies. An important question, therefore, is which ethical values guiding the practice of decision-making should be reconciled with the economic evidence found in Korean healthcare. The health technology assessment core model from the European network for Health Technology Assessment (EUnetHTA) project is a good example of incorporating ethical values into decision-making. We suggest that a fair distribution of scarce healthcare resources in South Korea can be achieved by considering the ethical aspects of healthcare.

Human Research Protection Program in Mokdong Hospital / 이화의대지

Human Research Protection Program (HRPP) is a special program to promote the basic human rights and welfare of the human subjects enrolled in the medical research conducted in Ewha Womans University Mokdong Hospital. The program also plays an important role in protecting the researcher and the hospital from any complaints or blames of the human subjects and in making sure the good quality of the research itself scientifically as well as ethically. For the purpose, HRPP is running a special committee and center-Human Research Protection Center (HRPC). The HRPC provides counseling and consulting for the human subjects and researchers, and educational programs for the researchers are also offered. In addition, the center conducts audit and monitoring of the human research in collaboration with the Institutional Review Board. To conduct an ethically and scientifically sound research, researchers should fully understand the function of HRPP, affirmatively work together with HRPP, readily participate in any educational program required for the human researcher, and keep the rules and guidelines regarding human research well.

Social competencies of Korean doctors

'Social competence' is understood in behavioral science and developmental psychology to be a bundle of diverse social skills that are necessary for appropriate social adaptation. However, a physician's social competence in our healthcare context should be understood as clinically necessary skills that are not directly related to understanding of the natural sciences essential for clinical practice. In Korea, such 'non-science competencies' have long been ignored by both doctors and laypeople in their understanding of medicine as a discipline. However, the clinical practice should embrace the centrality of humane and social elements, without which medicine could not exist. Our research team has proposed 6 competencies in light of the current Korean healthcare context and circumstances: understanding of the related law and healthcare system, professionalism and ethics, leadership, self-management, communication, and understanding of the humanities. These competencies are important to current medical practice in Korea and should be developed and promoted among doctors in the present and future. Of course, these competencies are not absolutely fixed or unchangeable. They should be re-interpreted or modified as time passes and the healthcare context changes. However, for the time being, these competencies will provide some guidance for educating doctors and promoting dialogue among related stakeholders in the healthcare field.

Korean doctors' perception on doctor's social competency: based on a survey on doctors

Medicine is the practice that occurs in the context of the society. It requires interaction with individual patients, fellow doctors and other health care professionals, health care officials, public, institution, and the society as a whole. To date, medical practice in Korea has largely been concentrated on applying biomedical knowledge and skill to a patient. We defines 'social competency' as 'competency for medicine as a social institution.' This survey aims to grasp the current situation of Korean doctors' perception on social competency, in terms of necessity, satisfaction, learning experience, and possible intervention. Respondents generally recognized the necessity of social competencies but were not satisfied with their demonstration of those competencies. Competencies for 'understanding on law and institution' and 'communication' were perceived highly necessary. General satisfaction and each satisfaction rate on individual competencies were all below 'neutral,' showing their dissatisfaction. Especially, doctors assess their fellow doctors' competencies for 'understanding on law and institution' and 'understanding on human being and society' at the lowest level. The mismatch between perceived necessity and satisfaction shows the legitimate ground for educational intervention. The proportions of respondents who have learned on each domain of social competency were all below 70%. Learning experience on self-management and leadership was the least. Among possible remedy for low social competency, respondents perceived 'improvement on national health insurance' and 'improvement on resident training program' as the most urgently needed. The data from this preliminary survey can be utilized for educational and institutional intervention in the future.

Physicians' perspectives on social competency education in academic medicine / 한국의학교육

PURPOSE: This study aims to explore the improvement of medical curriculums by examining the relationship between attributes of the Korean physicians and their needs for specialized departments and professionals for enhancing Korean physicians' social competence. METHODS: The uniqueness of this study is in its conduction a survey about the Korean physicians' needs of specialized departments and professionals for physicians' social competence or not, unlikely that previous studies focused on reviews. Subjects of this study are 288 physicians among the members of the Korean Society of Medical Education and The Korea Intern Resident Association. The hierarchical regression analyses are conducted. RESULTS: The authors present the results. First, the needs of specialized departments decline if physicians have ever majored on basic medical and learned professionalism ethics. Second, the older physicians are, the much more learned professionalism ethics and the needs of leadership competence physicians have, the necessities of specialized professionals are reduced. Finally, the physicians' needs of patient-oriented communication and sympathy of human in society as well as professionalism ethics increase recognitions of the importance of specialized professionals. CONCLUSION: These results show that strengthening systemic and educators' individual capacity for successful social competence curriculums is important.

Koreans' Traditional View on Death / 한국호스피스완화의료학회지

Koreans' traditional view on death has been much influenced by Confucianism, Taoism, Buddhism, and shamanism since ancient times. Confucianism emphasizes the importance of the real life in this world and highly praises doing good deeds for the family and the community. It also praises people who are enlightened by education and self-discipline. Confucian scholars admit that death cannot be understood by rational thinking although it is unavoidable as a cosmic order. Taoism sees life as the same entity as death; Both are two different aspects of the same cosmos or the wholeness. However, the disciples of Taoism became much interested in a long life and well being that may be achieved by harmonizing with the cosmic order. Buddhism thinks that death and life are an "illusion". It says that people can be enlightened by recognizing the fact that "Nothing is born and nothing is dying in this world. Everything is the product of your mind occupied with false belief." However, secular Buddhists believe in the afterlife and metempsychosis of the soul. This belief is sometimes connected with the view of the traditional shamanism. Shamanism dichotomizes the world between "this world" and "that world". After death, the person's soul travels to "that world", where it may influence life of people who reside in "this world". And shamans who are spiritual beings living in "this world" mediate souls and living people. In conclusion, there are various views and beliefs regarding death, which are influenced by a number of religions and philosophies. They should be seriously considered when making a medical decision regarding the end of patients' life.

Medical Ethics as Professional Ethics / 대한소화기학회지

Contemporary medical ethics is far from the traditional concept of "In-Sul (benevolent art)" or "Yul-Li (ethics)", which emphasizes so much the personality or the character of a doctor. Nowadays, medical ethics should be considered as "professional ethics" which regulates the acts and medical practices of ordinary doctors in their daily practice. The key concepts of the professional ethics are "autonomy", "integrity", and "professional standard" established by medical organizations such as medical societies or associations. Most of Korean doctors have not been familiar with the concept of professional ethics or professionalism, which is due to the modern history of Korea. However, the concept of professional ethics is really critical to Korean doctors from the perspective of professional dignity and social respect to this profession. The current healthcare system of Korea is suffering from many problems of both private and public sector. Nonetheless, the professional ethics is urgently demanded for that very reason.

The meaning of medical professionalism for the faculty members of medical school and university hospitals in Korea

The medical professionalism for faculty members of medical schools has some different implication from other medical professions. They have to work as educator, researcher, and manager as well as clinician. The professionalism of each duties has its own uniqueness, which sometimes causes a conflict between them. Therefore, the faculty members of medical schools have to harmonize their different tasks and duties each other, looking after the professional development through the professional life.

Analytical Case Study of Evaluation of Curriculum at a Medical School / 한국의학교육

PURPOSE: This study aims at to make intermediate-term evaluations of a curriculum by investigating its development, operation and outcomes 2 years after its revision. METHODS: A survey using 5-point-Lickert scale questionnaires was given to the group of directors who developed the curriculum, instructors who only used it in their classes, and a student group from the first and second grades. Focus group interviews were performed in the professor groups. RESULTS: Curricular reform was evaluated as being systematic, democratic, and positive in general. Both groups answered questions positively about the relevance of the integrated curriculum and introduction of clinical medicine (ICM), graded as 3.4 (professor) and 3.5 (student). As for problem-based learning (PBL) and the patient-doctor-society (PDS), the professor group responded more positively than students. The 'web-based learning center' was recognized positively by many more students (4.01) than professors (2.75). With regard to the education outcome, professors gave 3.3 points and students 3.5 to an item that asked 'whether students attained the learning goal or not?' Professors, through interviews, showed their satisfaction with the attempt to reform the curriculum, but they pointed out that long-term evaluations should be performed. CONCLUSION: The interim evaluation of the revised curriculum, from its planning to its effects, affirmed by several suggestions to be successful in the long run through 1) enhancement of systematic participation and communication, 2) further integration, 3) steady evaluation, 4) greater effort on professional development, and 5) active interaction between professors and students.

The change of perspective on brain death, euthanasia and withdrawal of the life supporting medical treatments in Korea for pediatric patients / 소아과

A recent High Court's decision regarding the withdrawal of life supporting medical treatment (artificial ventilator) from an elderly female patient in the terminal stage has opened up a new era of the "euthanasia dispute" in Korea. With this decision, the legitimate withdrawal of life supporting treatment became possible under certain conditions and the Korean Medical Association is working toward the establishment of practical guidelines for the terminal-stage patients. However, there are still very few debates on the cases of pediatric patients in the terminal stage or suffering from fatal diseases. For pediatric patients, the core principle of autonomy and following procedure of "advance directives" are hardly kept due to the immaturity of the patients themselves. Decisions for their lives usually are in the hands of the parents, which may often bring out tragic disputes around "child abuse", especially in Korea where parents have exclusive control of the destiny of their children. Some developed countries such as the U.S.A., the U.K. and Canada have already established guidelines or a legal framework for ensuring the rights of the healthcare system regarding children suffering from severe illness, permitting the withdrawal of Life supporting medical treatment (LSMT) in very specific conditions when the quality of life of the children is severely threatened. For the protection of the welfare and interest of the children, we should discuss this issue and develop guidelines for the daily practice of pediatricians.

Study on the Medical Humanities and Social Sciences Curriculum in Korean Medical School: Current Teaching Status and Learning Subjects / 한국의학교육

PURPOSE: We did this study to find out the current teaching status of the medical humanities and social sciences curriculum in Korean medical schools. Further, we discuss the tasks at hand to improve the curriculum in medical education. METHODS: The curricula of 41 medical schools and the syllabi of 10 schools were examined. We analyzed the tables of course organization and contents of integrated medical humanities. After analysis of the contents, they were grouped into 6 categories of medical humanities and social sciences domain. RESULTS: Our results are as follow: 1) there are 3 types of medical humanities and social sciences subject forms: inter-disciplinary (integrated, for example, PDS), multi-disciplinary (separated subject form), and mixed (integrated+separated); 2) most schools offer medical humanities and social sciences in a required class; 3) medical humanities and social sciences are taught through all school years and all 8 graduate medical schools offer a medical humanities and social sciences course from year 1; and 4) the average academic credits for medical humanities are 10 or 11. With respect to the curriculum content, there is some commonality in 10 schools: disease prevention, health improvement, medical ethics, medical regulation, professionalism, and community medicine. Differences were seen in content selection and organization. CONCLUSION: After brief reviews of the medical humanities and social science curriculums, we discovered that all Korean medical schools meet the need of medical humanities and social sciences education. However, curriculum implementation differed in various ways. We suggest the following tasks: 1) clarification of educational goals in order to develop a core curriculum of medical humanities and social sciences in Korea; 2) sharing experiences of developing a well-designed curriculum with other medical schools for effective teaching of this subject area.

The Comparison of Backgrounds and Characteristics of Students in Medical College and Graduate Medical School: A Case Study of One Medical School / 한국의학교육

PURPOSE: Information about students is important not only in developing curriculum and teaching strategies, but also in providing support to them. We surveyed students in 2004 (Medical collage) and 2007 (Graduate Medical School) to change our educational system to the GMS. By comparing the characteristics of these students, we expected the new curriculum to be more appropriate for the GMS students. METHODS: Our survey tool was a modified version of the matriculating student questionnaires used by the American Association of Medical Colleges. 60 (80.2%) matriculating students in 2004 (MC), and 71 (93.4%) in 2007 (GMS) responded to the survey. A total of 101 items were asked in 5 areas- 1) Demographic Data, 2) Pre-medical school experience, 3) Medical school application, 4) Career plans and interests, and 5) Perceptions of Medicine and Medical Service. RESULTS: Graduate Medical School matriculates have more diverse backgrounds and experiences before entrance than MC matriculates. GMS students are more sensitive to social issues and accountabilities of medicine and have a higher interest in working with other professionals. Both groups of students were similar in ranking medical professionalism higher than occupational stability or social economic compensation. CONCLUSION: We can use this information about students for curriculum development and, in particular, the differences seen between MC and GMS students could be helpful in improving medical education. If the survey were collected longitudinally and nation-wide, the results could be valuable for policy making not only in medical education but also in medical care and health of the nation.

The Comparison of Clinical Performance Examination Scores according to the Different Testing Time: Six Medical Schools in Seoul.Gyeonggi CPX Consortium 2005 / 한국의학교육

PURPOSE: Clinical performance examination(CPX) using standardized patients(SPs) is an acceptable method of testing medical professionals, but there has been some concerns about security. The objective of this work is to examine whether the day of the examination influences the scores of examinees of different medical schools at different times throughout the examination period. METHODS: Six medical schools, which had participated in the Seoul-Gyeonggi CPX Consortium 2005, were enrolled. Each station, controlled by the same regulations, included 12 minutes of SP encounter and 5 minutes of writing a short essay. We compared the mean scores using ANOVA and linear trends with multiple regression analyses and SPSS version 11.0. RESULTS: The mean score of examinees from all 6 medical schools was 63.2+/-.9. There was no difference in total mean scores among the medical schools according to the period when CPX was conducted. Classified by their examination day, there was no difference among the mean scores of the 1st, 2nd, and 3rd day, but in one school where the examination was performed for 5days, the mean scores of the 4th day was higher than the others(p<0.05). There were trends of linear increases over the five days for the 'physical examination'question, but not for 'physician-patient interaction'and 'patient education'. CONCLUSION: The changes in scores according to the examination day in this study did not show consistent results. However, the variable results seen according to school, test question, and examination day need further analysis for test security issues.

Revision Process of Mission of Medical School, Ewha Womans University, with the Change of Medical Environment and Educational System / 한국의학교육

PURPOSE: With the changes to the medical environment and to the educational system, we aim to evaluate the current mission statement of the College of Medicine, Ewha Womans University, and revise it. METHODS: To establish the new mission statement, a special committee, the School Mission Revision Committee(SMRC) and an advisory group were organized in 2003. The SMRC functioned through 4 stages of action composed of: investigation, draft development, surveillance of various opinions, and announcement. RESULTS: The revised, final mission statement was: "To contribute to Korea and to the international society by producing excellent woman-leaders in healthcare, who have professional medical knowledge and are humanitarians based on Christian principles." Three key words helped in the realization of this mission: compassion, professionalism, and service. Compassion: a noble physician who practices compassion toward mankind, caring for patients with compassion and the right attitude, and contributing to health promotion. Professionalism: a responsible physician who embodies professionalism, learning the necessary knowledge and skills, having the ability for self-development, and leading in various fields of medicine. Service: a respected physician who serves society, devoting to the community with excellent woman leadership skills and an open mind, and serving Korea and the international society. CONCLUSION: We expect that this new school mission will be helpful in clarifying the whole educational process and will resolve conflicts resulting from the change to the school system within a rapidly changing educational environment.

Comparison of the Evaluation Results of Faculty with Those of Standardized Patients in a Clinical Performance Examination Experience / 한국의학교육

PURPOSE: To compare the evaluation results of faculties to those of Standardized Patients (SP) participating in a Clinical Performance Examination (CPX) administered at Ewha Womans University College of Medicine. METHODS: The CPX was taken by 77 fourth year medical students. Cases and checklist were developed by the medical school consortium in capital area. Six cases were used and 24 SPs participated and evaluated the students' performances. The whole session was recorded on videotapes so that 6 medical school faculties could analyze and evaluate the students' performances as well. The results were compared and analyzed by SPSS package. RESULTS: The agreement between the faculties and the SPs was relatively good (r=0.79), but not good enough. In every case, SPs gave higher marks than did the faculties. Clear disease entity cases like "hepatitis" and "anemia" showed better agreement than obscure clinical contexts such as "bad news delivery". Better agreement was seen in the items of physical exam category (r=0.91), but the agreement was very poor in the items of doctor-patient (Dr-Pt) relationship category (r=0.54). The construction of checklist and the character of each evaluation item should influence the differences. CONCLUSION: More detailed guidelines and clear/specific evaluating items are necessary to improve the agreement rate. In certain categories like physical exam and brief history taking, the SP' s evaluation can replace the faculties', but for complex contexts like Dr-Pt relationship.