Jinyoung Hwang

A Comparison of Midazolam with Remifentanil for the Prevention of Myoclonic Movements following Etomidate Injection

Etomidate is a popular anaesthetic induction agent, but it frequently causes myoclonic movements. Although both benzodiazepines and opioids reduce myoclonus, there has been no comparative study between these agents. Thus, we conducted a prospective, randomized study to compare midazolam and remifentanil as pre-treatment agents for reducing etomidate-induced myoclonus in 90 adults undergoing surgery. Patients were pre-treated before the etomidate injection, either with saline (Group C), midazolam 0.5 mg/kg (Group M) or remifentanil 1 μg/kg (Group R). Both Groups M and R showed a significantly lower incidence of myoclonus compared with Group C (17%, 17% and 77%, respectively). The incidence of myoclonus was not significantly different between Groups M and R, but 10% (n = 10) of the patients in Group R experienced remifentanil-related side-effects. We conclude that midazolam is probably a better choice than remifentanil for reducing etomidate-induced myoclonus during anaesthesia induction.

Evaluation of first year outcomes of Lee Jong-Wook Seoul Project using Kirkpatrick's four-level evaluation approach

PURPOSEnThe Lee Jong-Wook Seoul Project, which began in 2011, is a training program that aims to educate faculty members of Lao University of Health Sciences in medical knowledge and skills. The project has tremendous significance, attempting to apply the Korean health care developmental model to developing countries. Precise evaluation of the project outcome must be performed to enhance the effectiveness, improve the shortcomings, and adjust the future direction of the program.nnnMETHODSnTrainers and exchange professors were asked to fill out questionnaires in the middle and at the end of the program. Eight months after its completion, an evaluation team visited Lao and interviewed each exchange professor individually. Also, 360-degree feedback was obtained from their colleagues. We analyzed the answers to the questionnaires, based on Kirkpatricks 4-level model.nnnRESULTSnThe trainers and exchange professors had positive reactions to the program. All participants felt that their knowledge and skills improved (in their respective fields), although the actual improvement was not extensive, according to their trainers assessments. The 360-degree feedback demonstrated that the participants actively passed on their experience, knowledge, and skills to their colleagues on returning to work.nnnCONCLUSIONnAlthough a 4-level evaluation was not conducted and despite the limitations in examining academic achievement, interviewing Lao professors, and acquiring quantitative data at Lao University of Health Sciences, this project has demonstrated its value in the development of individual professors and their colleagues.

How different are premedical freshmen who enter after introducing a multiple mini-interview in a medical school?

PURPOSEnSeoul National University College of Medicine (SNUMC) introduced a multiple mini-interview (MMI) to assess the noncognitive ability of applicants in 2013. This study aims to examine whether students differ with regard to their personal career values and academic achievements by admission type.nnnMETHODSnWe administered a survey about career values and self-perception of competencies. We then compared the survey results and academic achievements by admission type. Finally, the correlation coefficient between MMI score and academic achievement was calculated in the MMI group. The data were analyzed by t-test and correlation analysis.nnnRESULTSnThere was no statistically significant difference in career values between groups. For self-perception of competency, only the interact in heterogeneous groups domain was higher for those who entered through the MMI. The MMI group had a higher and broader level of academic achievement. Within the MMI group, there was a significant correlation between grade point average and MMI station scores.nnnCONCLUSIONnThe characteristics of students who entered through the MMI were more in accordance with the goals of SNUMC and the competency of future doctors. Considering the unique feature of premedical academic achievement, this result implies that such students have superior noncognitive abilities, such as self-development and internal motivation. How these differences change subsequently remains to be seen.

Analysis of medical students' needs for development of a career guidance program

PURPOSEnThe purpose of this study is to provide basic data for the development of a career guidance program through a demand survey. For this purpose, three study topics were examined: Is there a difference between the satisfaction and importance of a career program? Is there a difference between the satisfaction and importance of a career program by gender, grade level? and What type of mentor and the mentoring way of medical students demanded?nnnMETHODSnThe subjects were 380 students at Seoul National University College of Medicine. The data were analyzed by frequency analysis, paired t-test, and Borichs formula.nnnRESULTSnBy t-test with matched samples for satisfaction-importance, We noted statistically significant differences in all domains. In particular, the difference was greater in the second year. According to the needs analysis, the most urgent program is meeting with seniors in various career areas. Also, medical students hope for mentor from clinical professors of the university and successful medical practitioners, and personal counseling.nnnCONCLUSIONnThese results show that medical students need a career guidance program. The findings of the study can be used to guide the development of career education programs and curriculum for medicine students.

What is the current orientation of undergraduate medical education in Korea

PURPOSEnThe educational purpose of a medical school is important, because it guides educational decisions in an individual organization and projects the image of the doctors that we are generating. By analyzing the educational goals of entire medical schools, this study aimed to examine the current orientation and future direction of undergraduate medical education in Korea.nnnMETHODSnEducational goals were collected from the website of each medical school and subjected to inductive content analysis. After identifying categories and themes, we examined the differences between medical school subgroups and compared the categories with competencies that have been suggested by the Korean Doctors Role.nnnRESULTSnThirteen themes were identified: medical expertise, professionalism, contribution to various levels of society, self-management and development, basic educational ideology, research ability, cooperation, leadership, dealing with future change, respect for life, creativity, problem-solving ability, and ability to educate. There was a significant difference in educational goals between medical schools when grouped by geographic location and affiliation of research-driven hospitals. Of the 16 competencies that are suggested by the Korean Doctors Role, 12 had one or more corresponding categories.nnnCONCLUSIONnPer their current educational purposes, Korean medical schools pursue a broad variety of competencies that need cultivating during the course of undergraduate medical education. Further research is needed to determine how best to apply these educational purposes in actual institutions and ultimately lead them to become part of the competency of a graduate.

Evaluation of an international faculty development program for developing countries in Asia: the Seoul Intensive Course for Medical Educators

BackgroundThe issue of collaboration in medical education is becoming prominent. Some faculty development programs have suggested an approach for promoting collaboration on a global level. However, non-English-speaking developing countries in Asia, especially in Southeast Asia, do not take advantage of them due to their unique context, such as language and culture. To address these issues, Seoul National University College of Medicine initiated a 6-week international faculty development program called the “Seoul Intensive Course for Medical Educators” for 16 fellows from five Asian countries (Cambodia, Laos, Mongolia, Myanmar, and Vietnam). The aim of this study is to report the evaluation results of the outcome of the program and discuss better ways of collaborating with developing countries.MethodsThree levels of collaboration—intraorganizational, intranational, and international—were central initiatives of the program. Prior to setting up the program details, we first established four design principles, following which the contents, materials, and facilitators were determined to maintain consistency with the design principles. The evaluation of the program was done with Kirkpatrick’s four-level model. Most of the evaluation data for level 1 were collected by two questionnaires, the post-module survey and the post-program survey. Portfolios and progress reports were mainly used to collect outcome data for levels 2 and 3, respectively.ResultsThe reaction was generally positive throughout the program and there was a significant correlation between satisfaction and relevance to one’s job or needs. Despite the fellows’ propensity for overestimating themselves, both the evaluators and fellows reported that there was significant improvement in learning. Opinions on the impact or urgency of the topics were slightly different from country to country; however, the answers regarding feasibility were fairly similar. Moreover, we could observe from the post-program progress reports that the transfer of learning was actively in progress, mainly for topics that were highly feasible.ConclusionsThese results show that the program was successful in terms of its effectiveness. Consistent and timely support is essential for the sustainable development of the medical education systems in these countries. Further understanding of the underlying factors on transfer (level 3) could improve the effectiveness of faculty development programs for developing countries.

Research and development of evaluation criteria for premedical curriculum

PURPOSEnThe purpose of this study was to develop criteria to evaluate a premedical curriculum to ultimately improve the quality of premedical education.nnnMETHODSnThe first draft of the evaluation criteria was developed through a literature review and expert consultation. The Delphi survey was conducted to ensure the validity of the draft.nnnRESULTSnThe final premedical curriculum criteria consisted of three evaluation areas (curriculum development, curriculum implementation, and curriculum outcome), five evaluation items (educational objective, organization of curriculum, instructional method, class management,and educational outcome), and 18 evaluation indicators.nnnCONCLUSIONnThere should be further discussion on the evaluation questionnaire and the content for each evaluation indicator with regard to its practical application. Also, a concrete evaluation system, including evaluation standards and rating scales, should be developed.

A study on premedical curriculum reform of one medical school.

PURPOSEnThe aim of this study was to examine the background and improvement of the reformed premedical curriculum in Seoul National University and to analyze in which it corresponds with its intentions. It gives implications to premedical curriculum through its development model.nnnMETHODSnThe background and improvement of the reformed premedical curriculum was analyzed through several reports from those of associated committees. The development model of the reformed curriculum was made in order to examine correspondence with the intentions of its reformation.nnnRESULTSnThe graduate credit increased while compulsory credit was in decrease which leads to the elimination of standardized education based on the natural sciences. The requirements in compulsory liberal arts and elective major subjects were suggested in order to develop students perspectives in humanities.nnnCONCLUSIONnAs premed is a preliminary course before studying medicine, premedical curriculum should reflect the needs of those parties concerned-society, professors, students, etc.- and be based on core values and educational philosophy of the school in order to derive its competences.

The Effect of Formative Program Evaluation on Continuous Program Improvement: A Case Study of a Clinical Training Program in Lao PDR

This study aimed to evaluate the effect of the formative program evaluation on the continuous improvement of a clinical training program for Lao health professionals. The training program was conducted 4 times consecutively for total 48 health professionals, and the formative program evaluation was carried out during the whole process. To evaluate the satisfaction and the transfer of the trainees, the questionnaire survey, the focus group interview, and the trainees medical records were used. After the end of each batch of the program, the evaluation data were analyzed, and its results were shared with the training management committee and the trainers, who, based on the results, reached a consensus on how to improve the program. The evaluation results and the comparison of them among the four batches of the program showed that there was a continuous increase of the satisfaction and the transfer of the trainees, especially in the early period of the program. The formative program evaluation which was conducted during the whole process of the clinical training program had a positive effect on the improvement of the program, especially in the early phase, by increasing the satisfaction and transfer of the trainees.

The attenuation of neurological injury from the use of simvastatin after spinal cord ischemia-reperfusion injury in rats

BackgroundSpinal cord ischemic injury remains a serious complication of open surgical and endovascular aortic procedures. Simvastatin has been reported to be associated with neuroprotective effect after spinal cord ischemia-reperfusion (IR) injury. The aim of this study was to determine the therapeutic efficacy of starting simvastatin after spinal cord IR injury in a rat model.MethodsIn adult Sprague-Dawley rats, spinal cord ischemia was induced using a balloon-tipped catheter placed in the descending thoracic aorta. The animals were then randomly divided into 4 groups: group A (control); group B (0.5xa0mg/kg simvastatin); group C (1xa0mg/kg simvastatin); and group D (10xa0mg/kg simvastatin). Simvastatin was administered orally upon reperfusion for 5xa0days. Neurological function of the hind limbs was evaluated for 7xa0days after reperfusion and recorded using a motor deficit score (MDS) (0: normal, 5: complete paraplegia). The number of normal motor neurons within the anterior horns of the spinal cord was counted after final MDS evaluation. Then, the spinal cord was harvested for histopathological examination.ResultsGroup D showed a significantly lower MDS than the other groups at post-reperfusion day 1 and this trend was sustained throughout the study period. Additionally, a greater number of normal motor neurons was observed in group D than in other groups (group D 21.2 [3.2] vs. group A: 15.8 [4.2]; group B 15.4 [3.4]; and group C 15.5 [3.7]; Pu2009=u20090.002).ConclusionsThe results of the current study suggest that 10xa0mg/kg can significantly improve neurologic outcome by attenuating neurologic injury and restoring normal motor neurons after spinal cord IR injury.