Ducksun Ahn

Personality, Dopamine Receptor D4 Exon III Polymorphisms, and Academic Achievement in Medical Students

This study investigated the relationships between genetic polymorphisms, personality traits, and academic achievement in medical school students. Study subjects were 220 1st-year medical students at Korea University Medical School during two consecutive academic years (2003–2004). Grade-point averages (GPA) during the second semester of the 1st year of the medical school were obtained as a measure of academic achievement. In addition, all participants completed the Temperament and Character Inventory and questionnaires on depression and anxiety. The polymorphisms in exon III of the dopamine D4 receptor (DRD4) were determined using the polymerase chain reaction. Our results revealed that both male and female subjects with a higher GPA may be characterized as having higher persistence and lower novelty seeking traits. In addition, male subjects with high GPA had higher scores in self directedness and female subjects with a higher GPA may be characterized as having higher scores in harm avoidance. Male students with 4-repeat alleles had a significantly lower GPA than male students without 4-repeat alleles.This relationship also remained after controlling for the personality variables, none of which showed a relationship with the polymorphism after Bonferroni correction. For females, however, no associations could be found between GPA and the polymorphism. Thus, the present study demonstrated for the first time a possible influence of the DRD4 48 bp variable number of tandem repeats polymorphism on academic achievement and proved that this was not mediated by performance-associated personality traits.

Continuous quality improvement in an accreditation system for undergraduate medical education: Benefits and challenges*

Abstract Background: Accreditation reviews of medical schools typically occur at fixed intervals and result in a summative judgment about compliance with predefined process and outcome standards. However, reviews that only occur periodically may not be optimal for ensuring prompt identification of and remediation of problem areas. Aims: To identify the factors that affect the ability to implement a continuous quality improvement (CQI) process for the interval review of accreditation standards. Methods: Case examples from the United States, Canada, the Republic of Korea and Taiwan, were collected and analyzed to determine the strengths and challenges of the CQI processes implemented by a national association of medical schools and several medical school accrediting bodies. The CQI process at a single medical school also was reviewed. Results: A functional CQI process should be focused directly on accreditation standards so as to result in the improvement of educational quality and outcomes, be feasible to implement, avoid duplication of effort and have both commitment and resource support from the sponsoring entity and the individual medical schools. Conclusions: CQI can enhance educational program quality and outcomes, if the process is designed to collect relevant information and the results are used for program improvement.

Beyond accreditation: excellence in medical education.

Medical school accreditation is a relatively new phenomenon in Korea. The development of an accreditation body and standards for a two-tiered “Must” and “Should” system in 1997 eventually led to the implementation of a third “Excellence” level of attainment. These standards were conceived out of a desire to be able to first recognize and promote outstanding performance of medical schools, second to provide role models in medical education, and furthermore to preview the third level as potential components of the pre-existing second level for the next accreditation cycle. It is a quality-assurance mechanism that, while not required for accreditation itself, pushes medical schools to go beyond the traditional requirements of mere pass-or-fail accreditation adequacy, and encourages schools to deliver an unprecedented level of medical education. The Association for Medical Education in Europe developed its own third-tier system of evaluation under the ASPIRE project, with many similar goals. Due to its advanced nature and global scope, the Korean accreditation body has decided to implement the ASPIRE system in Korea as well.

Historical Perception of Korean Medical Education

Received: February 9, 2011 • Revised: February 12, 2011 • Accepted: February 15, 2011 Corresponding Author: Ducksun Ahn Department of Plastic and Reconstructive Surgery, Korea University Medical College, 126-1 Anam-dong 5-ga, Seongbuk-gu,, Seoul 136-705, Korea Tel: +82.2.920.5342 Fax: +82.2.920.6198 email: dsahn@korea.ac.kr Korean J Med Educ 2011 Jun; 23(2): 79-81. doi: 10.3946/kjme.2011.23.2.79. pISSN: 2005-727X eISSN: 2005-7288 C The Korean Society of Medical Education. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. OPINION

Experimental analysis of a dimensionless number in the cathode channels of a polymer electrolyte membrane fuel cell with different head losses

Abstract This study investigates the effects of stoichiometry, humidity, cell temperature, and pressure on the performance and the flooding of the proton exchange membrane fuel cell. Values of stoichiometry are 1.5, 2.0, and 2.5 at cell temperatures of 50, 55, and 60 °C, respectively. This study shows that the dimensionless flooding value (FV) is a function of the stoichiometry, humidity, temperature, and pressure. The FV is calculated by using the measured values of temperature, humidity, pressure, and flowrate of the cathode. The effect of the dimensionless number on the flooding of the cathode in the proton exchange membrane fuel cell is analysed in this study. The effects of air stoichiometry, cell temperature, and air humidity are also discussed in this article.

Perception of interprofessional conflicts and interprofessional education by doctors and nurses

PURPOSE This study aimed to collect information that is needed to develop interprofessional education curricula by examining the current status of interprofessional conflicts and the demand for interprofessional education. METHODS A total of 95 doctors and 92 nurses in three university hospitals in Seoul responded to a survey that comprised questions on past experience with interprofessional conflicts, the causes and solutions of such conflicts, past experience with interprofessional education, and the demand for interprofessional education. RESULTS We found that 86% of doctors and 62.6% of nurses had no interprofessional education experience. Most of them learned about the work of other health professions naturally through work experience, and many had experienced at least one interprofessional conflict. For doctors, the most popular method of resolving interprofessional conflicts was to let the event pass; for nurses, it was to inform the department head. Further, 41.5% of doctors and 56.7% of nurses expressed no knowledge of an official system for resolving interprofessional conflicts within the hospital, and 62.8% of doctors and 78.3% of nurses stated that they would participate in interprofessional education if the opportunity arose. CONCLUSION In Korean hospital organizations, many doctors and nurses have experienced conflicts with other health professionals. By developing an appropriate curriculum and educational training system, the opportunities for health professionals to receive interprofessional education should expand.

Analysis of the Perceived Effectiveness and Learning Experience of Medical Communication Skills Training in Interns

PURPOSE This study aims to explore the perceived effectiveness, benefits, and learning experiences of interns with regard to their participation in a communication skills workshop program, which can have implications for the development and implementation of future communication skills training. METHODS One hundred twenty one interns and 12 senior residents and fellows participated in the workshop program as learners and tutors. The participating interns encountered three difficult communication situations, represented by trained standardized patients. During each encounter, each participant had an individual encounter, group discussion, and feedback on his performance. A self-assessment survey, composed of five itemized questions and seven open-ended questions, was administered after the workshop. A mixed methods approach was used to analyze the quantitative and qualitative data. RESULTS The participants had positive perceptions of the implementation and effects of the workshop, and they responded higher than 4.0 to all itemized questions on their perception of the effectiveness and benefits of the workshop. The analysis of open-ended questions demonstrated specific learning experiences of the participants, such as the hardship of solving ill-structured communication problems and reflection on their current knowledge, skills, attitudes, and practice as physicians. The participants reported that the workshop provided opportunities of improving diverse communication skills and problem-solving skills and identifying further learning needs. CONCLUSION The results suggest that communication skills training for interns facilitates their reflection and development of communication skills, as well as their competency of situated problem solving. Consequently, communication skills development should be regarded as an important subject of continuing medical education. Several implications of this study can contribute to the design and development of communication skills-related programs.

Problem based learning (PBL) case bank.

There are 41 medical schools in Korea and most of them have implemented, at least to some degree, PBL programmes into their respective curricula. However, medical schools that lack experience of PBL among the staff usually have difficulty in developing case problems. The solution to this conundrum is to form a national consortium among the medical schools. In April 2004, under the auspices of the Korean Society of Medical Education, a PBL study group hosted a symposium/ workshop for module development and the members of the study group agreed to create the PBL Case Bank, which would be available to all of the participating medical schools to administer their PBL curricula. Thirty-eight of the 41 medical schools agreed to produce five modules by the end of 2004, and another five by the end of 2006. The annual fees for participating medical schools amounted to US

Introducing a legal mandate for basic medical education accreditation in Korea

500 and one of the medical schools was designated to collect, control, classify and compile all of the case modules. Participating members are allowed to modify any of the pre-existing modules but are required to indicate the module’s origin. This is accomplished by coding systems of modules, and modified problems are reintroduced into the Case Bank for future use and reference. The ability of participating schools to modify the case problems according to their needs was reportedly a great success. Contrary to expectations, examination of the initial 100 modules has shown that there was virtually no overlap in the content of the modules that were produced. And even smaller schools with no prior PBL cases or experience were extremely enthusiastic about creating and submitting their own case problems to the bank. In addition, inter-medical school relations improved significantly as a consequence of implementation of the PBL Case Bank. Future plans include an annual meeting for review and revision of existing PBL modules, to assess their validity, measure their feedback, and subsequently produce more updated and effective PBL modules. Other long-term plans include translation of our modules into English, in an effort to allow medical schools in less developed countries to benefit from our wealth of PBL modules.

Factors Influencing Sleep Quality in Clinical Nurses

South Korea’s medical education history is intertwined with its explosive economic growth. In the 1980s, the Korean government opened the medical education industry to the private sector. The desired results for the schools were twofold: (1) to meet the needs of the healthcare system with a growing economy; and (2) to generate positive economic gain in local communities. These intentions were clear in the government’s instructions: In order to open a medical school, the founding body had to also build a 500-bed teaching hospital in the same region. The government, in return, would provide tax exemptions or deductions to the hospital by categorizing it as an educational facility. With the flourishing economy, many schools and hospitals were established across South Korea over the following two decades. However, the prolific growth came at a price. Preying on the students’ hopes of becoming medical professionals, medical schools began enrolling students, without providing them with the basic facilities. Arguing that the construction of the teaching hospital would be completed by the time students needed clinical education (in 5–6 years); schools lured prospective students to their barely-completed medical schools. This phenomenon was particularly worrisome because medical schools in Korea sit at an intersection of nonprofit and for-profit management practices. While all Korean medical schools must be nonprofit operations by law, private schools often operate as a for-profit organization. With hefty tuition fees being generated through the new student body, the new private schools saw little reason to forego a revenue generating opportunity. In order to regulate and implement quality assurance structures, South Korea introduced accreditation for basic medical education (BME) in 1999. However, neither the government nor the society in general had any experience nor vision of what quality assurance management should entail. Before 1999, no inquiries had been made about the quality of education programs or the competencies of physicians. The medical society felt that graduates from schools with inadequate resources and poor school governance would negatively affect the profession, and ultimately the patients. With the help of other stakeholders, the Korean Medical Association established quality assurance agencies such as The Korean Hospital Association, the Korean Society of Medical Education, and the Korean Association of Medical Colleges. The year 1997 saw the first quality assurance assessment of medical education. Transforming themselves into a committee, this group of assessors actively benchmarked foreign quality assurance systems and adapted them to the Korean environment. After the initial trial in 1999, a full scale accreditation was launched in 2000. Since then, the accreditation process has evolved from an input-oriented system to a process-oriented system, to its current outcome-oriented format. The number of prerequisites prescribed by accreditation standards was increased from the initial 50 to the current 97 items. In the last two decades, 41 medical schools have acquired complete accreditation over the course of three cycles, and have become fully accredited, with the exception of two schools that still have some unsolved issues with the school management. One has nonaccredited status, and the other is on probation. Meanwhile, the accrediting committee became incorporated as the Korean Institute of Medical Education and Evaluation (KIMEE), under the Ministry and Health in 2004. KIMEE was recently certified by the Ministry of Education as an official accreditor for basic medical education in 2014. Parallel to this internal progress, the Korean accreditation process has also undergone internal and external evaluation for quality assurance. Meanwhile, a national, large scale objective structured clinical examination (OSCE) was introduced as part of the licensing examination to improve practical clinical education in the last 2 years of medical curriculum in 2010. This was possible because accreditation standards prescribed the installation of skill labs and OSCE at medical schools. The internal evaluation of the accreditation process provides evidence to show how medical education has improved in South Korea. In the evaluation, the Korean Association of Medical Colleges acknowledges the advantages of providing accreditation to medical schools. However, an internal evaluation alone was deemed insufficient to diagnose where Korean accreditation stood in the global environment. Therefore, a meta-evaluation by an external body was conducted to gain an insight from a global perspective. The goal of accreditation is to improve the quality of education and to institute self-regulation. The meta-evaluation team discovered that accreditation had been carried out fairly well but it did not add value to medical education or raise its standards. While facilities and faculty capacity for education had improved, the stakeholders’ perception of the inherent value of education did not change. Education was perceived as secondary to research or clinical service in all the medical schools. The current accreditation of basic medical education achieved the regulatory aspect of accreditation, but did not generate innovation to the degree that KIMEE desired. However, there are certain limitations related to the appraisal of accreditation in Korea. It has been only 15 years since the KIMEE started providing accreditation to medical colleges. Accreditation, a periodic investigation from an independent external body, only occurs once every 4 to 6 years in a medical school. This gap between each accreditation visit poses some problems. Until 2012, the process did not include any progress checks built in to verify compliance. Additionally, members of the medical school deanery had either changed or did not fully recall the details of the previous visit. The short duration in office of each dean also contributed to this discontinuity. Thus, the current system of external accreditation often undergoes difficulty in coordinating with the internal program evaluation system. The overall result, however, from the meta-evaluation on BME accreditation in 2012 is clear: ongoing internal program evaluations by medical schools for quality improvement are vital for quality assurance. Therefore, continuous quality improvement (CQI) of the BME program should be the center of the accreditation process. CQI is already a prerequisite for medical schools according to new accreditation standards. The most recent version of accreditation standards from the World Federation for Medical Education highlights the importance of CQI. There are three areas of accreditation for CQI: program evaluation, governance and administration, and continuous renewal. These three areas form the basis of CQI. The new standards also require progress reports to be submitted every 2 years between the accreditation visits. However, these changes were only implemented in 2012. So far (2012–2015), the compliance efforts from medical schools for CQI measures vary from nil to a creation of a CQI unit with good standing within the medical school administration. Many schools with some degree of CQI practice has had its CQI capacity transferred from its teaching hospital and the hospital’s accreditation process to an international agency. It is still too early to expect fully functioning CQI units within medical schools. CQI is rather new for most medical schools and educators, even though the concept of CQI has been introduced in the industrial sector since the 1960s. Interestingly, even schools with CQI practice in university hospitals had difficulty transferring the knowledge and capacity from the hospital setting to the school. This shows that there is a significant disconnect between education and practice. Ideally, medical education should be a continuum. Any issues raised from practice should be reflected into improving resident training, and it should also become incorporated in BME. The feedback loop has to be so designed that the practice change can be initiated from the BME level. The ideal end-goal of CQI is perhaps an effective two-way communication cycle between school and hospital, providing feedback and initiating improvements in one other. Currently, neither KIMEE nor the medical schools themselves have enough capacity to execute and evaluate the CQI efforts of medical schools. It is only recently that the importance of CQI has been stressed and implemented in all aspects of medical education. This external perspective on the educational program of the school has yielded precious insights into the areas of improvement. Building a sound CQI practice in a medical school is a daunting task because that requires a change in the organizational culture at the institutional level. New laws for mandatory accreditation across all healthcare practices, including medicine, dentistry, traditional medicine, and nursing, have recently been passed by legislation in Korea. Historically, South Korea is not accustomed to relying on professional-led self-regulation. It is a general perception among Koreans that only the government has the authority to regulate public affairs. In this sense, these new laws will strongly empower current accreditation practices. These unprecedented measures is the levying mandate for health education providers and accreditors to accomplish the goal of educational change not only to safely produce competent graduates from medical school, but also to change current practices for increased safety of patients and the society.