The effects of self-video feedback on the eyedrop instillation techniques of glaucoma patients: a prospective randomized controlled trial.

BACKGROUND: To evaluate the effectiveness of instillation technique education using self-video feedback in glaucoma patients. METHODS: Sixty-two patients who self-instilled glaucoma eyedrops were randomly assigned to the self-video feedback and control groups according to the block randomization. Each group of the patient was asked to instill eyedrops, and videos were recorded. For the control group, only an educational video was provided. In the self-video feedback group, the patients provided educational video and feedback using a recorded video of their own instillation. After 1 month of education, the patient's instillation techniques were video-recorded again. We divided the steps of instilling eyedrops into ten steps and evaluated whether each step was properly performed using the recorded images from each patient. The main outcome was the proportion of patients who properly instilled their eyedrops in each step. RESULTS: Before education, there was no significant difference in the proportion of patients who were properly instilled between the two groups. In the group that received video feedback, the proportion of patients who instilled the eyedrops correctly after education in some items was significantly higher than that of the control group, and in particular, the educational effect of 'avoids touching dropper to eyelid or eyelash' was superior. CONCLUSIONS: In patients with glaucoma, education on the method of instillation was effective in improving the techniques of instillation. In the items that required accurate actions, the video feedback that allowed the patient to observe themselves had a better improvement effect compared to the traditional education method. TRIAL REGISTRATION NUMBER: KCT0008090 (09/01/2023, retrospectively registered).

Appropriateness of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans to measure preoperative anxiety and the effect of preoperative anxiety on postoperative quality of recovery.

BACKGROUND: The reliability and validity of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans (K-HADS-A) has not been studied in Korean surgical patients. This study aimed to validate the usefulness of K-HADS-A for measuring preoperative anxiety in Korean surgical patients. Additionally, the effect of preoperative anxiety on postoperative quality of recovery was evaluated. METHODS: Preoperative anxiety in 126 inpatients with planned elective surgery was measured using the K-HADS-A. The postoperative quality of recovery was measured using the Korean version of the Quality of Recovery-15. The validity and reliability of the K-HADS-A were evaluated. The differences in quality of recovery on the first and seventh day postoperatively were then compared between the anxious and non-anxious groups. RESULTS: There was a statistical correlation between the K-HADS-A and Anxiety Likert Scale. The goodness-of-fit indices of the structural equation model showed how well the data from the K-HADS-A match their concept. The Kaiser-Meyer-Olkin value was 0.848, and the P value of Bartlett's test of sphericity was < 0.001. Cronbach's alpha was high at 0.872. The K-HADS-A had an acceptable level of validity and reliability. Postoperative quality of recovery was significantly lower in the anxious group (postoperative day 1: t = 2.058, P = 0.042; postoperative day 7: t = 3.430, P = 0.002). CONCLUSIONS: The K-HADS-A is an acceptable tool for appropriately assessing preoperative anxiety in Korean surgical patients. Assessing preoperative anxiety is valuable, because preoperative anxiety affects the postoperative quality of mental and physical recovery.

Facial tinea incognito: a clinical, dermoscopic and mycological study of 38 cases.

BACKGROUND: Tinea incognito (TI) is a dermatophytic infection of the skin that is modified by steroid use. As a result, it shows atypical clinical presentations that can lead to misdiagnosis. TI occurring on the face is most frequently misdiagnosed as cutaneous fungal infection, however, very limited information is available on facial TI. OBJECTIVES: This study aimed to characterize the clinical, dermoscopic and mycological features of facial TI. MATERIALS & METHODS: We retrospectively evaluated 38 patients with mycologically proven facial TI at a single institution in Korea between July, 2014 and July, 2021. RESULTS: The patients had a mean age of 59.6 ± 20.4 years and showed a slight female predominance (male-to-female ratio of 1:1.38). The most common clinical presentation was an eczema-like pattern (47.4%), followed by rosacea-like (15.8%), psoriasis-like (10.5%), lupus erythematosus-like (10.5%), cellulitis-like (7.9%), and folliculitis-like (7.9%) patterns. The mean duration from disease onset to diagnostic confirmation was 3.4 months. Overall, 78.9% of the patients had accompanying chronic systemic diseases, and 57.9% had concurrent tinea infections at other skin sites, mainly the feet and toenails. On dermoscopy, scales and dilated vascular patterns (arborizing vessels and telangiectasia) were commonly observed on glabrous skin, with follicular patterns, such as black dots, broken hairs, and empty follicles. The characteristic trichoscopic features were comma, corkscrew, Morse code-like, and translucent hairs. CONCLUSION: The clinical characteristics and distinct dermoscopic features described in this article may aid in the differential diagnosis of facial TI while reducing diagnostic delays and unnecessary treatments.

Exploration of the changes in the perceptions of medical students about cadaver dissections using metaphors.

OBJECTIVE: This study examines the changes in metaphors used by medical students before and after the dissection of a cadaver. This will help qualitatively understand the meaning of cadaver dissections. METHODS: The metaphorical expressions about the practice of dissection that were used before and after the dissection exercises were collected from 147 Korean medical students. The collected qualitative data were categorised through a repeated comparative analysis. RESULTS: The results of the analysis identified seven types of metaphors that were used before the dissection practice: 'rite of passage', 'first step', 'precious opportunity', 'fog', 'hell', 'thrill', and 'double-edged sword'. After the cadaver dissection, nine types of metaphors were used: 'introspection', 'hell', 'precious opportunity', 'treasure hunt', 'turning point', 'debt', 'mist', 'bittersweet candy', and 'buzzer beater'. In general, before a cadaver dissection, students recognised the importance of the practice of cadaver dissection as being a 'gateway' or a 'growing pain'. Metaphors such as 'introspection' and 'mirror' were used with an improved attitude. However, some students continued to use negative metaphors, such as 'hell', before and after the cadaver dissection and maintained negative feelings about it. CONCLUSIONS: The results of our study suggest that, for many medical students, cadaver dissection is a crucial stage of self-reflection and for the formation of their identities as doctors. The consideration of students' perceptions during all cadaver dissections is therefore essential.

Heart Rate Variability-Measured Stress and Academic Achievement in Medical Students.

OBJECTIVES: Stress can affect learning and memory in students. Previous studies on stress in students were conducted mainly through surveys. We investigated how heart rate variability (HRV)-measured stress is related to academic achievement in medical students during clerkship. SUBJECTS AND METHODS: A cross-sectional study was conducted. HRV measurements were performed in 97 third-year medical students during their family medicine clerkship course. Data on written and skilled examination scores of the end of the school year were also collected. We assessed the association between HRV-measured stress and written/skilled examination scores. RESULTS: Written examination scores showed a positive correlation with standard deviation of the normal-to-normal intervals (SDNNs) (r = 0.245, p = -0.016), sympathetic nervous system/parasympathetic nervous system (SNS/PNS) balance (r = 0.218, p = 0.033), and stress index (r = 0.381, p = 0.004). Students with an unhealthy SDNN, a dominant SNS, and a high stress index had higher scores in written examinations than students with a healthy SDNN, a balanced SNS/PNS, and a normal stress index, respectively (p = 0.004, 0.018, and 0.012, respectively). Moreover, skilled examination scores were negatively correlated with BMI (r = -0.249, p = 0.014) and were higher in female students (r = 0.240, p = 0.018). Students with an abnormal autonomic balance diagram (ABD) had a higher score than students with a normal ABD (p = 0.03). CONCLUSIONS: This study shows that medical students with higher stress measured by HRV have higher academic achievement, especially in written examinations. Further studies are needed to confirm the results of this study and to assess the long-term effects of HRV-measured stress on medical students.

Patterns of Alcohol Consumption and Drinking Motives Among Korean Medical Students.

BACKGROUND Physicians who have healthy lifestyles can provide quality healthcare to their patients and keep themselves healthy. There is little data on the prevalence of drinking behaviors and problems among East Asian medical students. Here, we explored alcohol use and drinking motives among medical students in Korea. MATERIAL AND METHODS A questionnaire-based, multicenter, cross-sectional study was carried out in 323 students from 5 medical colleges in Korea between July and October 2016. We used the Korean version of the Alcohol Use Disorders Identification Test (AUDIT) and an anonymous, self-administered questionnaire that included demographic characteristics, smoking status, consumption of alcohol, and drinking motives. RESULTS The mean AUDIT score was 9.8±7.5 for males and 6.3±5.4 for females. Heavy drinking (75.9%) and binge drinking (56.0%) were very high among Korean medical students. Female medical students drank as much as male students, and much more than other women. The probability that a student would be a binge drinker was 2.72 times higher for a smoker than a non-smoker. The scores for drinking frequency, alcohol intake at one time, heavy drinking, binge drinking, and alcohol dependence symptoms were highest in the group who had "enhancement drinking motives". CONCLUSIONS Heavy drinking and binge drinking are common among both male and female medical students in Korea and this behavior is associated with smoking and enhancement drinking motives. Medical schools should consider implementing effective interventions to prevent and reduce problem drinking among medical students.

Change of accreditation standards of medical schools by the Korean Institute of Medical Education and Evaluation from 2000 to 2019.

It aimed to provide the change of accreditation standards of medical schools in Korea by the Korean Institute of Medical Education and Evaluation (KIMEE) from 2000 to 2019. Specifically, the following was explained: the development process, setting principle and direction, items of evaluation, characteristics of the standards, and validity test of 4 cycles. The first cycle of accreditation (2000-2005) was a process to secure the minimum requirement of the educational environment. The evaluation criteria emphasized the evaluation of the core elements of medical education, including facilities and human resources. The second cycle of accreditation (2007-2010) was a process in which the university emphasized its commitment to social accountability and the pursuit of excellence in medical education. It raised the importance of the qualitative standard for judging the contents and fidelity of education. In the post-2nd cycle of accreditation (2012-2018), the certification criteria were developed to standardize the educational environment and educational programs and to use them in the development of curriculum, to continually improve the quality of basic medical education. The ASK2019 accreditation aimed at qualitative evaluation following the World Federation of Medical Education's accreditation criteria to reach the international level of basic medical education, which stresses the student-centered curriculum, communication with the society, and evaluation through whole basic medical education course. KIMEE has developed the basic medical education evaluation and certification system step by step as above. Understanding the previous process will help to develop the accreditation criteria of medical school in Korea.

Effects of medical communication curriculum on perceptions of Korean medical school students.

PURPOSE: The study examines changes in students' self-assessment of their general communication (GC) and medical communication (MC) competencies, as well as perceptions of MC concepts. METHODS: Participants included 108 second year medical students enrolled at a Korean medical school studying an MC curriculum. It was divided into three sections, and participants responded to questionnaires before and after completing each section. To assess perceived GC and MC competency, items based on a 7-point Likert scale were employed; a single open-ended item was used to examine students' perceptions of MC. Statistical analysis was conducted to gauge GC and MC competency, whereas semantic network analysis was used to investigate students' perceptions of MC. RESULTS: Students perceived their GC competency to be higher than MC. Perceived MC competency differed significantly across the three sections, whereas no differences were found for GC. There were no statistically significant differences after completing the curriculum's second and third sections; however, the vocabulary students used to describe MC concepts became more scholarly and professional. In the semantic networks, the link structure between MC-related words decreased in linearity and looseness, becoming more complex and clustered. The words 'information' and 'transfer' proved integral to students' perceptions; likewise, 'empathy' and 'communication' became closely connected in a single community from two independent communities. CONCLUSION: This study differed from prior research by conducting an in-depth analysis of changes in students' perceptions of MC, and its findings can be used to guide curriculum development.

[Trends of research articles in the Korean Journal of Medical Education by social network analysis].

PURPOSE: This aim of this study is to examine trends in medical education research in the Korean Journal of Medical Education(KJME) and suggest improvements for medical education research. METHODS: The main variables were keywords from research papers that were published in KJME. Abstracts of papers (n=499) that were published from 1991 through 2015 were analyzed by social network analysis (NetMiner 4.0) a common research methodfor trends in academic subjects. RESULTS: The most central keywords were "medical education," "clinical competence," "medical student," and "curriculum." After introduction into graduate medical school, newly appearing keywords were "professional behavior," "medical humanities," "communication,"and "physician-patient relation." Based on these results, we generated a schematic of the network, in which the five groups before introduction to graduate medical school expanded to nine groups after introduction. CONCLUSION: Medical education research has been improving qualitatively and quantitatively, and research subjects have been expanded, subdivided, and specific. While KJME has encompassed medical education studies comprehensively, studies on medical students have risen in number. Thus, the studies that are published in KJME were consistent with the direction of journal and a new study on the changes in medical education is being conducted.

[Perceptual comparison of the "good doctor" image between faculty and students in medical school].

PURPOSE: The purpose of this study is to analyze the differences in the perception of the "good doctor" image between faculty and students, based on the competencies of the "Korean doctor's role." METHODS: The study sample comprised 418 students and 49 faculty members in medical school. They were asked to draw images of a "good doctor," and the competencies were then analyzed using the Draw-A-Scientist test and the social network program Netminer 4.0. RESULTS: Of the competency areas, "communication and collaboration with patient" and "medical knowledge and clinical skills" were the most frequently expressed, and "education and research," "professionalism," and "social accountability" were less commonly expressed. Images of a good doctor by the faculty focused on competencies that were directly related to current clinical doctors. Conversely, those by the students expressed various competencies equally. CONCLUSION: We have provided basic data for faculties and schools to plan various education strategies to help students establish the image of a good doctor and develop the necessary competencies as physicians.

[Relationships among emotional intelligence, ego-resilience, coping efficacy, and academic stress in medical students].

PURPOSE: The purpose of this study was to identify the causal relationship between emotional intelligence, ego-resilience, coping efficacy, and academic stress. METHODS: Participants were 424 medical students from four medical schools in Korea. We examined their emotional intelligence, ego-resilience, coping efficacy, and academic stress using a t-test, an analysis of variance, correlational analysis, and path analysis. RESULTS: First- and second-year students scored higher on academic stress than did those from third- and fourth-year students. Further, coping efficacy mediated the relationships between emotional intelligence, ego-resilience, and academic stress. Academic stress was directly influenced by coping efficacy, and indirectly by emotional intelligence and ego-resilience. This showed that coping efficacy play an important role in academic stress. CONCLUSION: Our findings may help medical schools design educational programs to improve coping efficacy in students, and to reduce their academic stress.

[The differences in self-efficacy in clinical performance between medical students and residents].

PURPOSE: The purpose of this study was to compare the differences in self-efficacy in clinical performance (SECP) between medical students and residents. METHODS: A total of 267 medical students and 110 residents participated in a survey on SECP with regard to seven factors: knowledge acquisition and application, clinical reasoning, clinical skills, communication with patients, relationships with other health professionals, medical ethics, and self-development. The data were examined by multivariate analysis of variance. RESULTS: Residents had higher scores for clinical skills than students (F[1, 372]=8.919, p<0.01), whereas students scored significantly higher for communication with patients (F[1, 372]=26.779, p<0.001), relationships with other health professionals (F[1, 372]=12.807, p<0.001), medical ethics (F[1, 372]=40.136, p<0.001), and self-development (F[1, 372]=32.380, p<0.001). There were no differences between genders or specialties of residents. CONCLUSION: There are differences in SECP between students and residents. These results can guide the design of self-efficacy improvement programs.

[Basic research to guide alterations in an outcome-based curriculum].

PURPOSE: The purpose of this study is to provide basic information that can be used to guide alterations in an outcome-based curriculum by analyzing the current curriculum. METHODS: A survey was administered to 103 juniors, 90 seniors, and 97 professors in Chonbuk National University Medical School on the importance of subgraduate and graduate outcomes, the appropriate curriculum to graduate, operational satisfaction, and self-judged achievement. RESULTS: There were significantly meaningful gaps in the importance of graduate and subgraduate outcomes. However, students considered other competencies, except for medical research, more important. The survey data on the appropriate curriculum for graduation and on the operational satisfaction with the curriculum show that overall reorganization of the curriculum is needed. Students felt that they achieved 50 to 60 of 100 with regard to graduate outcomes. Further, students recognize that there are no differences in achievement level between genders. But, they believe that seniors achieve more than juniors. CONCLUSION: A multilateral basic analysis can be useful to guide the improvement of an outcome-based curriculum to help graduates acquire the ability to provide basic medical treatment.

[Medical student perception of physician values in practice by individual characteristics and preferred medical specialty field].

PURPOSE: Medical students' values figure prominently in their choice of medical specialty; yet, little research has been performed on this topic. The purpose of this study was to analyze the differences in values according to medical students' individual characteristics (medical educational system, gender, and grade) and preferred medical specialty. METHODS: A total of 905 medical students participated in the study; 426 were graduate-entry medical students (GEMS), and 479 were undergraduate medical students (UMS). Further, 561 were male and 316 were female; 356 were in year 1, 219 were in year 2, 230 were in year 3, and 100 were in year 4. Students completed the Physician Values in Practice Scale (PVIPS). The PVIPS comprises six dimensions: autonomy, management, prestige, service, lifestyle, and scholarly pursuits. The data were analyzed by t-test and analysis of variance. RESULTS: GEMS had higher scores for service, management, and scholarly pursuits than UMS. Males had higher scores for prestige, lifestyle, and management, whereas female scored higher on service and scholarly pursuits. Higher grade was associated with increased scores for prestige, lifestyle, and management. The differences in lifestyle and scholarly pursuits were significant between preferred specialties. Students in support specialties scored significantly higher on lifestyle. With regard to scholarly pursuits, basic science specialties scored significantly higher than other specialties. CONCLUSION: There were significant differences in PVIPS according to individual characteristics and preferred medical specialty. This result could be useful in developing a medical specialty choice program for medical students.

The development and effects of a medical communication skills program for medical school students.

PURPOSE: The purpose of the study is to develop education programs for improving medical school students' medical communication ability, and to provide basic information to help develop and operate medical communication education programs by analyzing the education programs and students satisfaction from the education effects. METHODS: The method was to survey 116 sophomores in C medical school in 2014 in order to research students' demands for the medical communication education, level differences of communication between before and after of the education, and students' satisfaction from the education program. Analysis of frequency, paired samples t-test, descriptive statistic analysis were used for the research. RESULTS: There were not only many students who did not get general communication educations before admission, but also many students who said they need medical communication education. On the whole, students' abilities of communication were improved. Building relationship, information gathering, sharing information, understanding one's perspectives factors was improved meaningfully in the statistics. However opening relationship, reach agreement, and providing closure were not improved meaningfully in the statistics. On the whole, the students were satisfied from the education programs. CONCLUSION: To develop education programs for medical communication ability, we need to construct the objectives of education and contents by researching students' demands and level of learning in communication area. Moreover we have to design curriculum to maintain the education effects consistently.

Development and validation of the medical student stress scale in Korea.

PURPOSE: Medical students experience various stresses that arise in a special environment. However, there is no specific stress scale for medical students with regard to their environment in Korea. Therefore, in this study, we developed and confirmed the validity of a stress scale for medical students in Korea. METHODS: A draft version of the scale was developed on the basis of open-ended questionnaires from 97 medical students. The validity of the content of this scale was evaluated by three medical educationists. The scale was administered to 435 third and fourth grade medical students as the main survey. For our data, we performed an exploratory factor analysis and confirmatory factor analysis. We used Cronbach α index to determine internal consistency. RESULTS: Six factors with 40 items were extracted through the exploratory factor analysis: academic stress (9 items); clerkship stress (11 items); interpersonal stress (7 items); career stress (8 items); health-related stress (3 items); and financial stress (2 items). These factors showed a statistically significant correlation. The confirmatory factor analysis demonstrated a favorable RMSEA (0.053) and reasonable fit (CFI=0.847, TLI=0.833). Cronbach α values of the six factors ranged from 0.63 to 0.85. CONCLUSION: The medical student stress scale had a good model fit. It is a valid and reliable instrument in identifying stress in medical students and can be used in future studies. Also, the scale is expected to provide individual stress profiles for students to help them manage stress more effectively.

Analysis of the Relationship between Students' Seating Preferences and Academic Achievement in Medical School.

PURPOSE: This study aimed to explore the relationship between students' seating preferences and academic achievement in medical school. METHODS: The subjects of this study were 109 second-year students in C medical school. The pattern of seat selection of 109 students was surveyed by participant observation for 48 days, and a questionnaire was administered to determine the factors that were considered by students. Using SPSS version 12.0, we analyzed the factors that students considered with regard to seat selection and seat preference and the frequency of seat movements between areas. We performed one-way ANOVA to analyze the differences in academic achievement between students who moved seats versus those who did not. RESULTS: The most common reasons for seat selection were to focus better on the lecture (60 students), to focus better on lecture, and to feel familiar with the same seat (60 students). Students' preferred seats were in rows A4, A7, A5, and A3 (in descending order), which are primarily the central sections, and columns B15, B1, B14, B19 (in descending order), which are primarily both ends of the division. The difference in academic achievement between students who moved seats and those who did not was not significant (p>0.05). Among students who did not move seats, the difference in academic achievement between 9 seating areas was not significant in 6 subjects (p>0.05). CONCLUSION: The results of this study suggest that we should reconsider a professor's general perception regarding academic achievement according to seat location.