History of the medical education accreditation system in Korea: implementation and activities in the early stages / 보건의료교육평가

Following the opening of 12 new medical schools in Korea in the 1980s, standardization and accreditation of medical schools came to the forefront in the early 1990s. To address the medical community’s concerns about the quality of medical education, the Korean Council for University Education and Ministry of Education conducted a compulsory medical school evaluation in 1996 to see whether medical schools were meeting academic standards or not. This evaluation was, however, a norm-referenced assessment, rather than a criterion-referenced assessment. As a result, the Accreditation Board for Medical Education in Korea (ABMEK) was founded in 1998 as a voluntary organization by the medical community. With full support of the Korean medical community, ABMEK completed its 1st cycle of evaluations of all 41 medical schools from 2000 to 2004. In 2004, ABMEK changed its name to the Korean Institute of Medical Education and Evaluation (KIMEE) as a corporate body. After that, the Korean government paid closer attention to its voluntary accreditation activities. In 2014, the Ministry of Education officially recognized the KIMEE as the 1st professional institute for higher education evaluation accreditation. The most important lesson learned from ABMEK/KIMEE is the importance of collaboration among all medical education-related organizations, including the Korean Medical Association.

History of the medical education accreditation system in Korea: implementation and activities in the early stages / 보건의료교육평가

Following the opening of 12 new medical schools in Korea in the 1980s, standardization and accreditation of medical schools came to the forefront in the early 1990s. To address the medical community’s concerns about the quality of medical education, the Korean Council for University Education and Ministry of Education conducted a compulsory medical school evaluation in 1996 to see whether medical schools were meeting academic standards or not. This evaluation was, however, a norm-referenced assessment, rather than a criterion-referenced assessment. As a result, the Accreditation Board for Medical Education in Korea (ABMEK) was founded in 1998 as a voluntary organization by the medical community. With full support of the Korean medical community, ABMEK completed its 1st cycle of evaluations of all 41 medical schools from 2000 to 2004. In 2004, ABMEK changed its name to the Korean Institute of Medical Education and Evaluation (KIMEE) as a corporate body. After that, the Korean government paid closer attention to its voluntary accreditation activities. In 2014, the Ministry of Education officially recognized the KIMEE as the 1st professional institute for higher education evaluation accreditation. The most important lesson learned from ABMEK/KIMEE is the importance of collaboration among all medical education-related organizations, including the Korean Medical Association.

The History and Implications of the Medical Education Accreditation System in Korea: Implementation and Activities in Early Stages / 의학교육논단

Following the opening of eleven medical schools in Korea in the 1980s, the issues of standardization and accreditation of medical education came to the forefront in the early 1990s. To address the medical community’s concern about the quality of medical education, the Korean Council for University Education and Ministry of Education conducted a compulsory medical school evaluation in 1996 to see whether the medical schools were meeting accreditation standards or not. The evaluation was a “relative evaluation” rather than an “absolute evaluation.” The Accreditation Board for Medical Education in Korea (ABMEK), established in 1998, was a mere voluntary organization, but with the full support of the Korean medical community, it successfully completed its first cycle of evaluations on all 41 medical schools from 2000–2004. The history of medical education evaluation activities, including those of ABMEK, was not well recorded. In 2004, ABMEK changed its name to the Korean Institute of Medical Education and Evaluation (KIMEE) as a corporate body and the government paid much attention to its voluntary accreditation activities. In 2014, the Ministry of Education officially recognized the KIMEE as an Institute for Accreditation of Higher Education Evaluation. The most important lesson learned from the history of ABMEK/KIMEE is the importance of cooperation among all medical education-related organizations, including the Korean Medical Association.

A lesson learned from the MERS epidemic in Korea: an essay on MERS / 한국역학회지

No abstract available.

Five suggestions for future medical education in Korea / 한국의학교육

This study is to investigate the historical characteristics of medical education and healthcare environment in Korea and to suggest the desirable direction for future medical education. We draw a consensus through the literature analysis and several debates from the eight experts of medical education. There are several historical characteristics of medical education: medical education as vocational education and training, as a higher education, rapid growth of new medical schools, change to the medical education system, curriculum development, reinforcement of medical humanities, improvement of teaching and evaluation methods, validation of the national health personnel licensing examination, accreditation system for quality assurance, and establishment of specialized medical education division. The changes of health care environment in medical education are development of medical technologies, changes in the structures of the population and diseases, growth of information and communication technology, consumer-centered society, and increased intervention by the third party stakeholder. We propose five suggestions to be made to improve future medical education. They are plan for outcome and competency-based medical education, connection between the undergraduate and graduate medical education, reinforcement of continuous quality improvement of medical education, reorganization of the medical education system and construction of leadership of "academic medicine."

Ethical Issues in Physician-Pharmaceutical Industry Interactions

On April 28, the National Assembly passed 3 bills revising the Medical Act, Pharmaceutical Affairs Act, and Medical Instruments Act which are related to the so-called 'dual punishment system' at its 9th plenary session of the 289th provisional meeting. According to the government timetable, beginning November of this year (2010), doctors will be subject to imprisonment for up to two years or face fines of up to 30 million won when found to have taken financial or non-financial benefits from drug companies. Their license could also be suspended for one year. Interactions between industry and physicians are vital to public health. However, they must be principled partnerships effectively managed to sustain public trust in both partners' commitment to patient welfare and the improvement of health care. Mounting scientific evidence indicates that gifts, favors, and other marketing activities, both explicit and implicit, prejudice independent judgment in unconscious ways. Physicians who receive free gifts from the pharmaceutical industry must consider the ethical dilemmas posed by this practice. These dilemmas are conflict of interest, impairment of objectivity, and the impact of these free gifts on the cost of health care. In order to minimize the likelihood of biased decisions by physicians, pharmaceutical companies should comply with their code of ethics for fair competition, while medical societies should establish an influence-free culture for physicians and optimize the benefits inherent in the principled relationships between medical society and industry.

Teaching Medical Professionalism in Korean Medical Schools: Tasks and Prospect / 한국의학교육

The Medical Student Objectives Project of the American Association of Medical Colleges states that physicians must demonstrate "a commitment to advocate at all times the interests of one's patients over one's own interests," as well as "an understanding of the threats to medical professionalism posed by the conflicts of interest inherent in various financial and organizational arrangements for the practice of medicine." Due to these concerns, for the last some 30 years, there have been many attempts to improve medical professionalism curriculum in medical education such as altruistic attitudes and professional behaviors that those pursuing careers in medicine should possess. However, physicians today are not infrequently confronting conflicts of interest, such as those arising between the health system that employs them and the individual patient seeking care. This paper briefly reviews current status of teaching medical professionalism in Korean medical schools, and discusses tasks to be coped with to further improve the medical professionalism curriculum in Korea including development of effective teaching and evaluation methods. This paper also emphasizes the importance of the role of the medical education systems such as National Licensing Medical Examination and the Medical School Accreditation System in improving the teaching of medical professionalism in Korean medical schools.

Future Prospect of the Silver Industry in Korea and Physicians' Participation

Silver industry or senior friendly industry is an industry that helps the aged people maintain their healthy life and increase their quality of life. It includes various specialized industries such as health care facilities and service industry, senior friendly housing industry, medical and rehabilitation equipments industry, senior friendly leisure industry, health information service industry, and so on. The silver industry is growing and becoming popular in countries where proportion of aged population and their buying power are increasing, and Korea is one of the fastest aging countries in the world and the buying power of the aged is also increasing. This means that the silver industry in Korea is expected to grow rapidly in the near future. In fact, one report foresees that the annual growth rate of silver industry for 10 years from 2010 in Korea is expected to be 12.9% whereas that of overall industry is only 4.7%.It is quite natural that active participation of physicians is desperately needed in the development of silver industry because of the nature of health problems of the aged population, and for effective applications and supplies of the silver industry to the aged. For this, specialized curriculum on geriatric health problems and the characteristics of silver industry should be provided to the medical students in the undergraduate medical education and to the physicians in the postgraduate and continuing medical education programs. Special short-term educational program for the retired physicians to work at the health care facilities with or without being paid are also desirable.

'Informed Consent' in Public Health Activities: Based on the Universal Declaration on Bioethics and Human Rights, UNESCO / 예방의학회지

OBJECTIVES: The objective of this paper is to discuss the importance of obtaining informed consent for conducting epidemiological studies and public health activities, based on the Report of the UNESCO's Working Group on Informed Consent. METHODS: The Report of the UNESCO's Working Group on Informed Consent was reviewed and discussed in connection with the ethical considerations of public health activities and epidemiological research. RESULTS: It was at the Nuremberg Trial for the German war criminals of the Second World War that the principle of 'consent' was first stated as a consequence of the medical abuses carried out during the War. As a result of the Trial, the Nuremberg Code came out in 1947. Since then, various international declarations or ethical principles on 'informed consent' have been developed and published. These ethical principles on 'informed consent' have mostly to do with the clinical research that involves human subjects, and not with epidemiological studies and public health activities. However, UNESCO recently issued a comprehensive Report on Informed Consent based on the Universal Declaration on Bioethics and Human Rights adopted in 2005, and this included detailed guidelines on informed consent in epidemiological studies and public health activities. CONCLUSIONS: Universal Declaration on Bioethics and Human Rights emphasizes the principle of autonomy to protect the human rights of the human subjects involved in any public health activities and epidemiological research. As a practical guideline, obtaining informed consent is strongly recommended.

Teaching Medical Humanities in Korean Medical Schools: Tasks and Prospect / 한국의학교육

Scientific and humanistic aspects are integral to medicine and they must be bounded and integrated, not to suggest that one is more important than the other, or that they operate separately.In fact, the symbol of the physician, 'Caduceus' properly represents the bonding and intertwining between two forces of knowledge and wisdom or science and humanities, and as seen in the Hippocratic Oath, the humanities and the humanistic aspect of medical profession were important parts of practice thousands of years before medicine learned to use science as a new approach to acquire knowledge. However, the advances in science and technology in the early twenty century have fostered an emphasis on knowledge and technical skills in medical education with a neglect of the traditional humane and interpersonal aspects of the practice of medicine. Due to these concerns, for the last some 30years, there have been many attempts to improve general professional education and promote humanities curricula in medical education such as atruistic attitudes and professional behaviors that those pursuing careers in medicine should possess. This paper briefly reviews current status of teaching medical humanities and social sciences in Korean medical schools, and discusses tasks to be coped with to further improve the medical humanities curriculum in Korea including development of effective teaching and evaluation methods. This paper also emphasizes the importance of the role of the medical education systems such as National Licensing Medical Examination and the Medical School Accreditation System in improving the teaching of medical humanities and social sciences in Korean medical schools.

The Relationship between Intake of Vegetables and Fruits and Colorectal Adenoma-Carcinoma Sequence / 대한소화기학회지

BACKGROUND/AIMS: Evidence for the effect of dietary factors on colorectal carcinogenesis is yet inconsistent. Few studies have been conducted to investigate whether dietary factors were associated with the developement of colorectal adenoma-carcinoma sequence in Korea. We evaluated the relationship between the intake of vegetables and fruits and the degree of dysplasia of the colorectal adenoma and cancer. METHODS: For this study, 539 cases with histopathologically confirmed incidental colorectal adenoma, 162 cases with colorectal cancer and 2,576 controls were collected from Our Lady of Mercy Hospital, The Catholic University of Korea during 1994-1999. Informations on demographic characteristics, life style habits and dietary intake were obtained by interviewed questionnaire before the colonoscopy. Adjusted odds ratio (OR) and 95% confidence interval (CI) were estimated by using polytomous logistic regression model. RESULTS: In female, the high intake of raw green and yellow vegetables were found to be negatively associated with the risk of colorectal cancer (adjusted OR: 0.54, 95% CI=0.32-0.93) and the high intake of persimmon, mandarin and strawberry among fruits were negatively associated with the risk of adenoma with mild dysplasia (adjusted OR: 0.43, 95% CI=0.20-0.94). In male, the high intake of banana, pear, apple and watermelon among fruits were negatively associated with the risk of colorectal cancer (adjusted OR: 0.36, 95% CI=0.16-0.84). CONCLUSIONS: These findings suggest that the intake of vegetables and fruits may act differently in developmental steps of colorectal adenoma-carcinoma sequence.

Medical Education Plan for the Twenty-first Century in Korea: Hopes and Challenges / 한국의학교육

No abstract available.

A Case-control Study of the Relationships between Reproductive Factors and Degree of Dysplasia of the Colorectal Adenoma and Cancer / 예방의학회지

OBJECTIVES: Evidence for an effect of reproductive factors on colorectal carcinogenesis is not yet consistent. Little research has been conducted to investigate whether reproductive factors were associated with colorectal adenomas that are the precursors of colorectal cancer. We evaluated the relationships between reproductive factors and the degree of dysplasia of the colorectal adenoma and cancer as colorectal adenoma-carcinoma sequence. METHODS: For this study, 241 adenoma cases with histo-pathologically confirmed incident colorectal adenoma, 76 cancer cases with colorectal cancer and 1677 controls were collected from Our Lady of Mercy Hospital, The Catholic University of Korea, during 1994-1999. Before colonoscopy, information on demographic characteristics, reproductive factors, life style habits and dietary intake were obtained by interviewed questionnaire. Adjusted OR and 95% CI were estimated by using polytomous logistic regression model. Potential confounders that were selected based on the goodness of fit statistics and interaction between risk factors were considered in this adjustment. The Wald statistic was calculated to test the heterogeneity of the odds ratios for each case. RESULTS: Postmenopausal women with natural menopause were found to be positively associated with the risk of mild dysplasia adenoma (multivariate-adjusted OR : 2.59, 95% CI=1.1-6.2). Parity was found to be negatively associated with the risk of colorectal cancer (age-adjusted OR : 0.40, 95% CI=0.2-0.9), but did not significantly decrease the risk of colorectal cancer (multivariate-adjusted OR : 0.95, 95% CI=0.3-2.9). No associations were seen between age at menarche, breast feeding, induced abortion, oral contraceptive use, menopausal types, menopausal age or hormone replacement therapy (HRT) and the degree of dysplasia of the colorectal adenoma and cancer. However, none of these associations differed significantly between the degree of dysplasia of the colorectal adenoma and cancer. CONCLUSIONS: These findings suggest that postmenopausal women with natural menopause may experience increased risk of mild dysplasia adenoma among colorectal adenoma-carcinoma sequence.

Association of Endothelial NO Synthase Gene Glu298Asp Polymorphism with Acute Myocardial Infarction

BACKGROUND AND OBJECT: Several studies suggest that endothelial nitric oxide synthase (eNOS) Glu298Asp polymorphism is associated with coronary heart disease. We evaluated the relation between eNOS Glu298Asp polymorphism and the risk factors for myocardial infarction. MATERIALS AND METHOD: We selected 102 acute myocardial infarction (AMI) male patients younger than 65 years old and 112 healthy men as age matched controls. The eNOS genotypes were determined from blood lymphocyte DNA samples by using PCR-RFLP method. RESULTS: There was no difference in frequency of eNOs Glu298Asp polymorphism between the AMI and control groups. eNOS Glu298Asp polymorphism was not an independent risk factor for AMI. However smoking, smoking amount, hypertension, hypercholesterolemia, high fasting sugar and low HDL-cholesterol were independent risk factors (p<0.01). Among the subjects having the eNOS GG genotype, the smokers had 3 times higher risk of AMI compared with nonsmokers (p=0.0413). Among the subjects having the eNOS TT or GT genotype, the smokers had 15 times higher risk of AMI compared with nonsmokers (p=0.0271). Among the subjects having the eNOS GG genotype, the high risk group had 21.9 times higher risk of AMI compared with the low risk group (p=0.0001). Among the subjects having eNOS TT or GT genotype, the high risk group had 31.9 times higher risk of AMI compared with the low risk group (p=0.0089). CONCLUSION: eNOS TT or GT genotype demonstrated a synergistic effect with smoking and high risk group on the risk of AMI.

The Relationship between Alcohol Use and Job Stress among Firemen / 대한산업의학회지

OBJECTIVES: To establish the relationship between alcohol use and job stress among firemen, and to develop a comprehensive health promotion program including stress management and the prevention of problem drinking. METHODS: Data was collected from July to August, 2000. Study subjects included 97 rescue workers, 97 emergency medical personnel, 179 fire extinguishers, 116 administrators and 49 others. RESULTS: The firemen displayed higher scores of stress due to promotion-related pressures and salary. We found significant differences in job internal factors, job role, interpersonal relationship, organizational norm, work environment and stress outcome among the various jobs. Job internal factors, job stress factors, personal characteristics, coping skills, and stress outcome were higher in heavy drinkers compared with the light and moderate drinkers. Job internal factors and smoking habit showed a positive correlation with the amount of drinking, although coping skill, exercise frequency and monthly income showed a negative relation with the amount consumed. CONCLUSION: This study suggested that alcohol drinking is associated with job stress. This suggests that a comprehensive health promotion program including stress management and problem drinking prevention and control should be developed.

Ethics in Medical Research

All medical researches concentrate primarily on advances of medical knowledge and strategies for prevention, diagnosis and treatment of diseases. However, since most of the medical researches are being carried out on human subjects, they often pose ethical problems. Clinical investigations from which the human subjects involved may not derive any personal benefits include studies of physiological function in health or disease, investigations of new drugs, and the trial of new procedures. This paper discusses the ethical problems associated with medical researches, especially clinical investigations involving human subjects directly or indirectly. One general principle that has been wildly accepted is that patients or volunteers involved in the clinical investigations should be fully informed about the experiment in which they participate. However, ethical problems in those clinical investigations should be evaluated by the three major biomedical ethical principles, or the principle of autonomy, the principle of beneficence, and the principle of justice. This paper also presents the 'Helsinki Declaration' advocated by the World Medical Association in 1964 and revised thereafter several times as a practical guideline for the ethics of medical research.

Background and the Future Direction of the Korean Medical School Accreditation System

No abstract available.

Changes in the Positivities of HBsAg and Anti-HCV Antibody among Army Draftees in Korea / 대한간학회지

BACKGROUND/AIMS: Before the introduction of the HBV vaccination programs, the positivity of HBsAg among the general population was reported to be around 8% in Korea. Although recent reports revealed somewhat decreased values, a wide range of variation exists according to the authors. Major movements to control HBV infection include the programs such as the introduction of HBV vaccination in 1983, mass inoculation of the elementary school children since 1988 and inclusion of type B hepatitis in 1995 in Class III legal epidemics. The purpose of the present study was to examine the changing trend of the positivities of HBsAg, HBeAg and anti-HCV in army draftees in Korea since we believed that they are an ideal study group with a set of fixed variables such as gender and age. METHODS: From January 1, 1993 to December 31, 1999, we evaluated a total of 498,206 male army draftees for serum ALT, HBsAg, HBeAg and anti-HCV antibody. HBsAg (Genedia, Yongin, Korea) and HBeAg (Amrad, Austrailia) were examined by EIA and Immunochromatography, respectively. Anti-HCV antibody was tested by 3rd generation EIA (Genedia, Yongin, Korea). Serum ALT was determined by autoanalyser, Polystat 2000 (Hitachi, Japan). RESULTS: The majority of the draftees were 20 years old (68.8%). The positivity of HBsAg gradually decreased from 5.8% in 1993 to 4.3% in 1999(mean 4.8%). The positivity of HBeAg among the asymptomatic HBsAg carriers ranged from 47.9% to 55.6%(mean 51.8%). The positivity of anti-HCV antibody was seen in the range from 0.09% to 0.29%(mean 0.18%), and 84.5% showed normal ALT. The positivity of HBsAg among the anti-HCV positive subjects was 6.6%. CONCLUSION: The HBsAg positivity has significantly(p=0.001) decreased for the past 7 years. However, the positivity of anti-HCV antibody showed no significant pattern of change during the same period.

The Awareness and Countermeasures against Harmful Effect of Passive Smoking in Korean Adults / 예방의학회지

OBJECTIVES: This study is to evaluate the awareness, attitude, practice and the countermeasures against passive smoking in Korean adults. METHODS: By self-administered questionnaires, we assessed the knowledge, attitude, behavior for passive smoking and the countermeasure for reduction of it's harmful effects in 289 men and 238 women. RESULTS: The subjects that have heard about passive smoking were 96.8% in total and well known were 26.4% of current smoker, 56.6% of ex-smoker, and 14.8% of non-smoker(p=0.001). The irritative symptom from passive smoking was the most frequent in non-smokers and the most common place where exposed to passive smoking was public place. For attitude against passive smoking in 'no smoking allowed area', ex-smokers were the most active to recommend to stop smoking. And for opinion about establishment of 'no smoking allowed area', the restriction by law was the best acceptable method in smokers, exsmokers, and nonsmokers. In marking of 'no smoking allowed area', 69.9% of smokers answered no smoking, but in non-marking area only 6.3% stop smoking. When smokers were recommended to stop smoking, the more subjects stop smoking with good feeling in marking area, but the less in non-marking area. The factor associated the high awareness of passive smoking were aged(OR=1.07, 1.03-1.12), men(OR=4.34, 2.32-8.46). The persons who have known well about passive smoking had good attitude and behavior to prevent of harmful effect of passive smoking. CONCLUSIONS: This study suggested that education program would be necessary to reduce the passive smoking.

On Medical Student Enrollment and the Plan for the Development a Medical Education

No abstract available.