Serum Low-Density Lipoprotein Cholesterol Levels and Depressive Mood in Korean Adults: A Nationwide Population-Based Study / 가정의학회지

Background@#The association between serum cholesterol levels and depression has been studied extensively; however, results are inconsistent. This study aimed to investigate the association between low-density lipoprotein cholesterol (LDL-C) levels and depressive symptoms among Korean adults. @*Methods@#This cross-sectional study used data obtained from the 2007–2015 Korea National Health and Nutrition Examination Survey. In total, 40,904 adults were included in the final analysis. Participants were categorized into five groups according to their LDL-C levels, using the Korean guidelines for dyslipidemia. Symptoms of depression were evaluated using a self-reported questionnaire. Weighted logistic regression was used to examine the relationship between LDL-C levels and self-reported depressive symptoms. @*Results@#Compared with the intermediate category, the lowest (<70 mg/dL) and highest (≥160 mg/dL) LDL-C categories were associated with depressive symptoms, after adjusting for potential confounding factors (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.008–1.409; OR, 1.241; 95% CI, 1.073–1.435, respectively). The highest LDL-C category was positively associated with depressive symptoms in those who were middle-aged, female, had a low body mass index, and taking or not taking dyslipidemia medications. @*Conclusion@#A U-shaped association was identified between LDL-C categories and self-reported depressive symptoms. Our findings suggest that LDL-C levels that are too low or too high are associated with self-reported depressive symptoms. Further prospective studies are needed to determine the causal relationship of this association.

Current Status and Needs Assessment for Obesity Prevention and Management Project at Public Health Centers

Purpose@#The obesity prevention and management program led by public health centers are important in the community.This study aims to identify the current status of obesity prevention and management programs at public health centers and perceptions regarding facilitators and barriers when implementing programs. @*Methods@#This study used a concurrent mixed methods design. A survey was conducted to investigate the current status and infrastructure of the obesity prevention and management program at eighty-three public health centers nationwide. Nine program managers and six local residents with experience in the program were interviewed by using a semi-structured questionnaires. @*Results@#Most of the infrastructure facilities for the program were inadequate, and insufficient budgets and lack of professional staff were identified as barriers. Facilitators included diversification of program delivery methods, operator competence, and visible outcomes and rewards. For the effectiveness of the program, it is vital to have adequate assistants, a sufficient budget, various promotional methods, and connections with various institutions in the community. On this basis, it is acknowledged that the public health center serves as a platform for preventing and managing obesity in the community. Conclusion: It is expected that infrastructure improvements in public health centers and the link with community resources are needed. In addition, there is an urgent need to set standards for obesity prevention and management programs implemented in public health centers to ‘resolve regional disparities’.

Newly appointed medical faculty members’ self-evaluation of their educational roles at the Catholic University of Korea College of Medicine in 2020 and 2021: a cross-sectional survey-based study / 보건의료교육평가

This study aimed to investigate the degree to which newly appointed medical faculty members at the Catholic University of Korea are aware of Harden and Crosby’s 12 educational roles and to identify their preferred educational roles. A 12-item survey questionnaire was distributed to 110 participants, and 100 responses were included in the analysis. The respondents gave the highest score to “clinical or practical teacher” and the lowest score to “curriculum planner” for their current personal competencies. For their preferred personal future competencies, they assigned the highest score to “on the job role model” and the lowest score to “student assessor.” They gave almost equally high values to all 12 roles. However, individual faculty members had different preferences for educational roles. Accordingly, medical schools need to plan and implement customized faculty development programs, and efforts to provide appropriate educational roles according to individual faculty members’ preferences are needed.

Development and validation of a portfolio assessment system for medical schools in Korea / 보건의료교육평가

Purpose@#Consistent evaluation procedures based on objective and rational standards are essential for the sustainability of portfolio-based education, which has been widely introduced in medical education. We aimed to develop and implement a portfolio assessment system, and to assess its validity and reliability. @*Methods@#We developed a portfolio assessment system from March 2019 to August 2019 and confirmed its content validity through expert assessment by an expert group comprising 2 medical education specialists, 2 professors involved in education at medical school, and a professor of basic medical science. Six trained assessors conducted 2 rounds of evaluation of 7 randomly selected portfolios for the “Self-Development and Portfolio II” course from January 2020 to July 2020. These data are used inter-rater reliability was evaluated using intra-class correlation coefficients (ICCs) in September 2020. @*Results@#The portfolio assessment system is based on the following process; assessor selection, training, analytical/comprehensive evaluation, and consensus. Appropriately trained assessors evaluated portfolios based on specific assessment criteria and a rubric for assigning points. In the analysis of inter-rater reliability, the first round of evaluation grades was submitted, and all assessment areas except “goal-setting” showed a high ICC of 0.81 or higher. After the first round of assessment, we attempted to standardize objective assessment procedures. As a result, all components of the assessments showed close correlations, with ICCs of 0.81 or higher. @*Conclusion@#We confirmed that when assessors with an appropriate training conduct portfolio assessment based on specified standards through a systematic procedure, the results are reliable.

Comparison of Health Status in Primary Care Underserved Area Residents and the General Population in Korea / 가정의학회지

Background@#This study compared chronic diseases and health-related quality of life (HRQoL) in between primary care underserved areas residents and the general population. @*Methods@#Underserved areas were identified according to accessibility and the time relevance index for primary care. Overall, 279 participants aged ≥60 years from four counties enrolled voluntarily. A total of 1,873 individuals were assigned in the control group using the Korea National Health and Nutrition Examination Survey database. We assessed the differences in prevalence, awareness, and control of hypertension and diabetes and HRQoL using both subjective health status and the Korean version of the EuroQol-5D (EQ-5D) questionnaire using multivariate logistic regression analysis between the two groups. @*Results@#For hypertension, prevalence did not differ significantly between the two groups, whereas awareness and control were lower in the underserved areas than that in the general population; the adjusted odds ratios (95% confidence interval) were 0.40 (0.25–0.64) and 0.27 (0.18–0.41), respectively. For diabetes, differences in prevalence, awareness, and control were statistically insignificant. The proportion reporting poor subjective health status and problems in four EQ-5D indexes (ability to exercise, daily activities, pain/discomfort, anxiety/depression) was higher in the underserved areas, which also had a lower EQ-5D index, than that in the general population. @*Conclusion@#Primary care underserved area residents were underdiagnosed and under-controlled for hypertension and reported poorer subjective health and HRQoL compared to the general population. Primary care is the attributable factor to awareness and control of chronic diseases and subjective health and QoL in communities.

Development and validation of a portfolio assessment system for medical schools in Korea / 보건의료교육평가

Purpose@#Consistent evaluation procedures based on objective and rational standards are essential for the sustainability of portfolio-based education, which has been widely introduced in medical education. We aimed to develop and implement a portfolio assessment system, and to assess its validity and reliability. @*Methods@#We developed a portfolio assessment system from March 2019 to August 2019 and confirmed its content validity through expert assessment by an expert group comprising 2 medical education specialists, 2 professors involved in education at medical school, and a professor of basic medical science. Six trained assessors conducted 2 rounds of evaluation of 7 randomly selected portfolios for the “Self-Development and Portfolio II” course from January 2020 to July 2020. These data are used inter-rater reliability was evaluated using intra-class correlation coefficients (ICCs) in September 2020. @*Results@#The portfolio assessment system is based on the following process; assessor selection, training, analytical/comprehensive evaluation, and consensus. Appropriately trained assessors evaluated portfolios based on specific assessment criteria and a rubric for assigning points. In the analysis of inter-rater reliability, the first round of evaluation grades was submitted, and all assessment areas except “goal-setting” showed a high ICC of 0.81 or higher. After the first round of assessment, we attempted to standardize objective assessment procedures. As a result, all components of the assessments showed close correlations, with ICCs of 0.81 or higher. @*Conclusion@#We confirmed that when assessors with an appropriate training conduct portfolio assessment based on specified standards through a systematic procedure, the results are reliable.

The Association between Neutrophil to Lymphocyte Ratio and Development of Early Adenomatous Colon Polyps among Middle-Aged and Elderly Individuals in Korea

BACKGROUND: Colon cancer is one of the main causes of mortality. Early adenomatous colon polyp is a precursor of colon cancer through the ‘adenomacarcinoma sequence.’ Epidemiological studies suggest that the neutrophil to lymphocyte ratio can be one of useful inflammatory markers in clinical settings. This study aimed to evaluate the association between neutrophil to lymphocyte ratio and development of early adenomatous colon polyps.METHODS: This cross-sectional study retrospectively examined 960 middle-aged and elderly individuals aged ≥45 years who underwent colonoscopy in a health examination program. Multivariate logistic regression was used to analyze the association between neutrophil to lymphocyte ratio and development of early adenomatous colon polyps.RESULTS: Among the 960 subjects, the prevalence of early adenomatous polyps was 20.7% (n=199). The mean age, body mass index, number of current smokers, white blood cell count, triglyceride level, and number of subjects receiving hypolipidemic drugs were higher in the group with early adenomatous polyps than in the multivariate analysis, the odds ratio (95% confidence interval) for the development of early adenomatous polyps was 1.23 (1.01–1.50) with neutrophil to lymphocyte ratio increment after adjusting the confounding variables (P=0.037).CONCLUSION: We found that the neutrophil to lymphocyte ratio was associated with the development of early adenomatous colon polyps among middle-aged and elderly individuals. Accordingly, this result suggests that regular monitoring of early adenomatous colon polyps may be useful among individuals with a higher neutrophil to lymphocyte ratio.

Satisfaction with and suitability of the problem-based learning program at the Catholic University of Korea College of Medicine / 보건의료교육평가

Purpose@#This study was conducted to identify suggestions for improving the effectiveness and promoting the success of the current problem-based learning (PBL) program at the Catholic University of Korea College of Medicine through a professor and student awareness survey. @*Methods@#A survey was carried out by sending out mobile Naver Form survey pages via text messages 3 times in December 2018, to 44 medical students and 74 professors. In addition, relevant official documents from the school administration were reviewed. The collected data were analyzed to identify the achievement of educational goals, overall satisfaction with, and operational suitability of the PBL program. @*Results@#The overall satisfaction scores for the PBL program were neutral (students, 3.27±0.95 vs. professors, 3.58±1.07; P=0.118). Regarding the achievement of educational goals, the integration of basic and clinical medicine and encouragement of learning motivation were ranked lowest. Many respondents expressed negative opinions about the modules (students, 25.0%; professors, 39.2%) and tutors (students, 54.5%; professors, 24.3%). The students and professors agreed that the offering timing of the program in medical school and the length of each phase were suitable, while opinions expressed in greater detail pointed to issues such as the classes being held too close to exams and their alignment with regular course units. @*Conclusion@#Issues with modules and tutors were the most pressing. Detailed and appropriate modules should be developed on the basis of advice from professors with experience in PBL tutoring. Inconsistencies in tutoring should be reduced by standardization and retraining.

Evaluation of a portfolio-based course on self-development for pre-medical students in Korea / 보건의료교육평가

Purpose@#We have developed and operated a portfolio-based course aimed at strengthening pre-medical students’ capabilities for self-management and self-improvement. In order to determine the effectiveness of the course and to establish future operational strategies, we evaluated the course and the students’ learning experience. @*Methods@#The subjects of this study were 97 students of a pre-medical course “Self-development and portfolio I” in 2019. Their learning experience was evaluated through the professor’s assessment of portfolios they had submitted, and the program was evaluated based on the responses of 68 students who completed a survey. The survey questionnaire included 32 items. Descriptive statistics were reported for quantitative data, including the mean and standard deviation. Opinions collected from the open-ended question were grouped into categories. @*Results@#The evaluation of students’ portfolios showed that only 6.2% of the students’ portfolios were well-organized, with specific goals, strategies, processes, and self-reflections, while most lacked the basic components of a portfolio (46.4%) or contained insufficient content (47.4%). Students’ responses to the survey showed that regular portfolio personality assessments (72.1%), team (64.7%), and individual (60.3%) activities were felt to be more appropriate as educational methods for this course, rather than lectures. Turning to the portfolio creation experience, the forms and components of the portfolios (68.2%) and the materials provided (62.2%) were felt to be appropriate. However, students felt that individual autonomy needed to be reflected more (66.7%) and that this course interfered with other studies (42.5%). @*Conclusion@#The findings of this study suggest that standardized samples, guidelines, and sufficient time for autonomous portfolio creation should be provided. In addition, education on portfolio utilization should be conducted in small groups in the future.

Evaluation of a systematic career coaching program for medical students in Korea using the Career Readiness Inventory / 보건의료교육평가

PURPOSE: The purpose of this study was to implement a systematic career coaching program for medical students and to evaluate its effectiveness. METHODS: First-year medical students of Konyang University College of Medicine took part in the FLEX Mentoring II: Career Coaching Program from September to December in 2016 and 2017. This program included 16 weekly sessions, comprising a total of 32 hours. The students took the Career Readiness Inventory before and after the program, as a pre- and post-test of the program. Data from 100 students were used (46 students in 2016, 54 students in 2017) for the evaluation. RESULTS: Medical students' career readiness pre-test was rated as medium. In particular, many students were at a low level in terms of ‘support from colleagues and peers’ (53.0%), ‘career decision’ (48.0%), and ‘efforts for job preparation’ (60.0%). After 16 sessions of a systematic career coaching program, their career readiness level showed a significant increase except for ‘career decision’ (t=4.242, P=0.001) and ‘independence’ (t=0.731, P=0.466), a sub-factor of ‘career maturity.’ CONCLUSION: The career readiness level of medical students was not sufficiently high. However, a semester of educational training in a systematic career coaching program helped the students to be better prepared for their career. In particular, the significant reduction in the ‘career decision’ variable after the program can be interpreted as indicating that the students changed their behavior to explore and approach their career more seriously and carefully, which also underscores the need for the implementation of career coaching programs in medical schools.

Dental students' learning attitudes and perceptions of YouTube as a lecture video hosting platform in a flipped classroom in Korea / 보건의료교육평가

PURPOSE: The aim of this study was to confirm the applicability of YouTube as a delivery platform of lecture videos for dental students and to assess their learning attitudes towards the flipped classroom model. METHODS: Learning experiences after using the YouTube platform to deliver preliminary video lectures in a flipped classroom were assessed by 69 second-year students (52 males, 17 females) at Dankook University College of Dentistry, Korea, who attended periodontology lectures during 2 consecutive semesters of the 2016 academic year. The instructor uploaded the lecture videos to YouTube before each class. At the end of the second semester, the students were surveyed using a questionnaire devised by the authors. RESULTS: Of the students, 53 (76.8%) always watched the lecture before the class, 48 (69.6%) used their smartphones, and 66 (95.7%) stated that they watched the lectures at home. The majority of the students replied that the video lectures were easier to understand than face to face lectures (82.6%) and that they would like to view the videos again after graduation (73.9%). CONCLUSION: Our results indicate that YouTube is an applicable platform to deliver video lectures and to expose students to increased learning opportunities.

Development of a systematic career coaching program for medical students / 한국의학교육

PURPOSE: This study aimed to develop a systematic career-coaching program (SCCP) that can be used by medical teaching schools to address a growing need for career-coaching. The program objectives were to help students (1) develop a comprehensive self-understanding of their aptitudes, interests, and personality traits; (2) explore possible career choices and decide on a career path; and (3) develop the competencies needed to prepare for their future careers. METHODS: The SCCP was based on the ADDIE (analysis, design, development, implementation, and evaluation) model and decision-making questioning model. Medical professionals, medical education and career counseling experts, and students participated in designing the program. RESULTS: The SCCP describes coaching content, tools, operational methods, and appropriate timing, and identifies the professionals and specialists who can offer their expertise in the different coaching phases. It is designed to allow medical schools to offer the program in segments or in its entirety, depending on the curriculum and environment. CONCLUSION: The SCCP represents a viable career-coaching program for medical students that can be applied in part or in its entirety, depending on a medical school’s curriculum and educational environment.

Exploring the possibility of one-on-one mentoring as an alternative to the current student support system in medical education / 한국의학교육

PURPOSE: Purpose: The purpose of this study was to explore the possibility of mentoring as an alternative to the current student support system based on our experiences of developing, operating, and evaluating a mentoring program. METHODS: In 2014 and 2015, a total of 29 mentoring pairs were selected to be trained as mentors and mentees. The mentoring program was evaluated by the following methods. First, at the end of the one-on-one mentoring program, the mentee made a presentation summarizing their experiences and submitted a portfolio. Second, suggestions from the mentors and mentees were gathered from a survey and from a focus group interview. The quantitative data were analysed using descriptive statistics, frequency, and the Mann-Whitney U-test using SPSS version 21.0. RESULTS: One-on-one mentoring sessions were carried out an average of five times during the semester. The topics of discussion were very diverse, including career coaching, personal counselling, journal club, field trips, leisure activities, and volunteering. Mentors and mentees showed high satisfaction rates regarding the content and administration of the program (mentors: 4.15±0.59, mentees: 4.00±1.58). However, the duration of the mentoring program was given a comparatively low rating (mentors: 3.15±1.09, mentees: 3.24±1.03). CONCLUSION: Overall, the implementation of the mentoring program was successful. Based on the content of the main activities, we can confirm the possibility of implementing an individualized support program for solving the mentoring issues faced by medical students.

Evaluation of a systematic career coaching program for medical students in Korea using the Career Readiness Inventory / 보건의료교육평가

PURPOSE@#The purpose of this study was to implement a systematic career coaching program for medical students and to evaluate its effectiveness.@*METHODS@#First-year medical students of Konyang University College of Medicine took part in the FLEX Mentoring II: Career Coaching Program from September to December in 2016 and 2017. This program included 16 weekly sessions, comprising a total of 32 hours. The students took the Career Readiness Inventory before and after the program, as a pre- and post-test of the program. Data from 100 students were used (46 students in 2016, 54 students in 2017) for the evaluation.@*RESULTS@#Medical students' career readiness pre-test was rated as medium. In particular, many students were at a low level in terms of ‘support from colleagues and peers’ (53.0%), ‘career decision’ (48.0%), and ‘efforts for job preparation’ (60.0%). After 16 sessions of a systematic career coaching program, their career readiness level showed a significant increase except for ‘career decision’ (t=4.242, P=0.001) and ‘independence’ (t=0.731, P=0.466), a sub-factor of ‘career maturity.’@*CONCLUSION@#The career readiness level of medical students was not sufficiently high. However, a semester of educational training in a systematic career coaching program helped the students to be better prepared for their career. In particular, the significant reduction in the ‘career decision’ variable after the program can be interpreted as indicating that the students changed their behavior to explore and approach their career more seriously and carefully, which also underscores the need for the implementation of career coaching programs in medical schools.

Dental students' learning attitudes and perceptions of YouTube as a lecture video hosting platform in a flipped classroom in Korea / 보건의료교육평가

PURPOSE@#The aim of this study was to confirm the applicability of YouTube as a delivery platform of lecture videos for dental students and to assess their learning attitudes towards the flipped classroom model.@*METHODS@#Learning experiences after using the YouTube platform to deliver preliminary video lectures in a flipped classroom were assessed by 69 second-year students (52 males, 17 females) at Dankook University College of Dentistry, Korea, who attended periodontology lectures during 2 consecutive semesters of the 2016 academic year. The instructor uploaded the lecture videos to YouTube before each class. At the end of the second semester, the students were surveyed using a questionnaire devised by the authors.@*RESULTS@#Of the students, 53 (76.8%) always watched the lecture before the class, 48 (69.6%) used their smartphones, and 66 (95.7%) stated that they watched the lectures at home. The majority of the students replied that the video lectures were easier to understand than face to face lectures (82.6%) and that they would like to view the videos again after graduation (73.9%).@*CONCLUSION@#Our results indicate that YouTube is an applicable platform to deliver video lectures and to expose students to increased learning opportunities.

Joint Effect of Cigarette Smoking and Body Mass Index on White Blood Cell Count in Korean Adults / 가정의학회지

BACKGROUND: White blood cell count is an independent risk factor for cardiovascular disease. Several lifestyle and metabolic factors such as cigarette smoking and obesity are known to be associated with an elevated white blood cell count. However, the joint effect of cigarette smoking and obesity on white blood cell count has not yet been fully described. METHODS: We explored the joint effect of cigarette smoking and obesity on white blood cell count using multiple logistic regression analyses after adjusting for confounding variables in a population-based, cross-sectional study of 416,065 Korean adults. RESULTS: Cigarette smoking and body mass index have a dose-response relationship with a higher white blood cell count, but no synergistic interaction is observed between them (men, P for interaction=0.797; women, P for interaction=0.311). Cigarette smoking and body mass index might have an additive combination effect on high white blood cell count. Obese male smokers were 2.36 times more likely and obese female smokers 2.35 times more likely to have a high white blood cell count when compared with normal body mass index non-smokers. CONCLUSION: Cigarette smoking and body mass index are independently associated with an elevated white blood cell count in both men and women.

Medical students' and patients' perceptions of patient-centred attitude / 한국의학교육

PURPOSE: Patient-centred care can increase patient satisfaction and lead to better clinical outcomes for them, such as improved physical status and higher health-related quality of life. However, doctors' and patients' views on patient-centred attitude might differ and could be affected by culture and the community environment. To clarify the differences in primary care patients' and senior medical students' perceptions of medical students' patient-centred attitude. METHODS: A total of 1,025 subjects-827 patients from primary care institutions and 198 fourth-year medical students from a medical college in South Korea-completed the Patient Practitioner Orientation Scale (PPOS). The students completed the self-reported questionnaire at the end of their clinical clerkship. Descriptive statistics, t-tests, and one-way analysis of variances were conducted in SPSS version 21.0. RESULTS: Firstly, sharing subscale scores were higher among patients than among medical students (students, 3.61 vs. patients, 3.76; p<0.001), but secondly, caring subscale scores were higher among medical students (students, 4.18 vs. patients, 3.82; p<0.001). Thirdly, PPOS total scores were higher among medical students (students, 3.90 vs. patients, 3.79; p=0.001). Finally, male students had the lowest sharing scores (F=6.811, p<0.001) and female students showed the highest PPOS total scores (F=5.805, p=0.001). CONCLUSION: Significant differences between medical students' and patients' perceptions of medical students' patient-centred attitudes suggest the necessity of educational efforts to overcome the gap between the groups.

Measuring medical students’ empathy using direct verbal expressions / 한국의학교육

PURPOSE: Empathy is an important trait in physicians and a key element in the physician-patient relationship. Accordingly, one of the goals in medical education is developing empathy in students. We attempted to practically assess medical students’ empathy through their direct verbal expressions. METHODS: The medical students’ empathy was measured using the modified Pencil-and-Paper Empathy Rating Test by Winefield and Chur-Hansen (2001). The students took 15 minutes or so to complete the scale, and it was then scored by one of two trained evaluators (0 to 4 points for each item, for a total score of 40). The subjects were 605 medical students, and the data were analyzed using descriptive analysis, independent t-test, and one-way analysis of variance in SPSS version 21.0. RESULTS: The students’ empathy scores were low (mean, 12.13; standard deviation, 2.55); their most common responses (78.6%) registered as non-empathetic. Differences in empathy were observed by gender (female students>male students; t=-5.068, pmedical college; t=-1.935, p=0.053), and academic level (pre-medical 1 year < other years; t=-4.050, p<0.001). CONCLUSION: Our findings lead us to the significant conclusion that there is the need for empathy enhancement training programs with practical content.

How to provide tailored career coaching for medical students / 한국의학교육

PURPOSE: This study was performed to develop a counseling strategy, based on the profiles of medical students' Strong Interest Inventory (STRONG) and Myer-Briggs Type Indicator (MBTI) results, focusing on the three following questions: Into what distinct levels are students categorized by STRONG and MBTI? and What is the dispersion of the integrated profiles? METHODS: Freshmen students from Konyang University College of Medicine who matriculated between March 2011 and 2013 were administered the MBTI personality type test and the STRONG interest inventory assessment. The integrated profiles were categorized per Kim et al. (2006), and frequency analysis was performed with the collected data, using SPSS version 21.0. RESULTS: Regarding MBTI types, 16.9% of students were categorized as ESTJ, and 12.9% was ISTJ. Further, 62.4% of students were Investigative (I) according to STRONG. The integrated profiles were divided into four types, according to their unclear/clear preference in the STRONG and MBTI results. Most students had 'clear preference and clear interest' (n=144, 80.9%), six students (3.4%) had 'clear interest but unclear preference,' and 28 students (15.7%) showed 'unclear interest but clear preference.' CONCLUSION: Using the combined results of the STRONG interest inventory assessment and MBTI tools, we can purvey more tailored information to students.

Book Review: A practical guide for medical teachers, 4th edition / 한국의학교육

No abstract available.