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.

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.

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.

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.