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This study aimed to investigate the current status of faculty development (FD) programs operated by medical colleges and institutions in Korea, and to suggest future-oriented directions for FD. A survey was conducted targeting medical colleges and medical education institutions that operate FD programs. We investigated the reasons for selecting topics, program themes, program operation methods, longitudinal program status, program improvement and quality control methods, the evaluation of the program effects, the outcomes and problems of the programs, and opinions on the latest trends. Twenty-nine out of 40 medical colleges and three out of six institutions responded. Topics were selected based on an analysis of medical education trends and the educational environment in both groups. The most common program themes were assessments in medical colleges, and teaching/learning and curriculum themes in institutions. FD was perceived to induce professors’ and administrators’ interest in medical education and improve the quality of medical education. The most common program method was workshops. Three medical colleges and one institution had longitudinal programs. Participant surveys constituted the most common method of evaluating programs’ effects. Difficulties in publicizing programs and inducing voluntary participation were the most common problems in both groups. New attempts for FD were perceived as the role of external institutions. Based on the results, it is necessary to develop a framework and quality improvement indications for FD programs in the future, and FD programs are expected to be developed through new initiatives, such as longitudinal programs and those focusing on the community of practice.

This study explored the public’s response to an incident involving publicity about how physicians broke bad news to a terminal cancer patient by analyzing 1,960 comments from three online news websites that reported on this event using Braun and Clarke’s theme analysis methods. Three themes and 10 subthemes emerged from the public’s responses to the way the physicians broke the bad news. Theme 1 (a physician is a person who tells the facts) contained the following subthemes: physicians are responsible for delivering facts, but it is a matter of consideration for patients to deliver bad news to them, empathy and consolation should be expected from people other than physicians, and physicians who say what patients want to hear are cheaters. Theme 2 (there is a problem with physicians) included the following subthemes: the physicians’ empathy or personality and problems with their communication methods. Theme 3 (there are obstacles to communication with dying patients) had the following subthemes: physicians become emotionally dull and find it very stressful to break bad news, giving hope to dying patients can lead to medical disputes, and empathy and consolation are also costly. When breaking bad news, the physicians delivered factual information, but they did so inappropriately, and emotional support for the patient was insufficient. In medical communication education, it is necessary to emphasize training in emotional support. In the medical field, an environment should be created where physicians can communicate as they have learned.

The purpose of this study was to investigate the current status of interprofessional education (IPE) and the efforts required to promote, popularize, and implement it in Korea. The IPE status of 40 medical colleges was investigated using a survey with questions regarding the details of IPE, the future plans and necessary support required, and the reasons for not implementing IPE. Thirty-two medical colleges responded, of which 10 are implementing or have implemented IPE. Most of these colleges started IPE in 2018, and the duration of IPE was less than 9 hours. All medical colleges held classes with nursing students. As for the type of IPE, there were independent courses for IPE, one-time special lectures, or partial sessions in one course. Lectures, discussions and presentations, role playing, and high-fidelity simulations were mainly used as educational methods. The support and interest of the dean was the most important facilitating factor. No medical colleges were currently preparing to implement IPE, four colleges had planned IPE but failed to implement it, and 16 had no plans for IPE at all. All medical colleges cited scheduling or cooperation with other majors as the most significant barrier. All the colleges listed their requirements for educational materials, cases, guidelines, and teaching and learning methods for IPE from external institutions. To activate IPE, it is necessary to create an appropriate atmosphere and conditions for developing IPE competencies and a model suitable for the domestic situation. External medical education support organizations should distribute IPE development guidelines and educational materials, form a network between medical colleges with IPE experience, and make efforts to promote the importance of IPE.

This study aimed to analyze the subjects, situations, and reflection levels related to role modeling experienced by medical students during their clinical clerkship and their own reflections. This study intends to suggest ways of improving how residents and clinical faculty should treat and teach medical students. Written interviews were conducted regarding senior medical students’ role modeling experiences during their clinical clerkships in 2018 and 2019. Content analysis was conducted for a total of 224 cases from 196 students. Content analysis revealed three types of role modeling content: subjects (faculty, residents, nurses, peer students), situations (clinical competence, personal qualities, teaching skills), and the level of reflection (critical reflection, reflection, thoughtful action, and habitual action) in each case. As role model subjects, faculty were found to be the paramount role model (n=142, 62.83%). Role modeling was the most frequently performed for clinical competence (n=103, 45.98%). Clinical competence was frequently shown in communication and empathic listening during rounds and outpatient relationships between the patient and doctor. Regarding the level of reflection for role modeling, the number of critical reflections was 86 (38.39%) and that of reflections was 80 (35.71%). In particular, negative role modeling showed a high level of critical reflection in relation to faculty (64.44%) and nurses (8.89%). In conclusion, role modeling of medical students participating in clinical clerkships occurs in situations that the role models are not aware of, with positive or negative effects on the formation of professional identity among medical students.

This study analyzed the effect of lower back exercise using Web for each age group to use it as nursing intervention. We conducted a randomized experiment with 54 patients with low back pain, composed of 26 middle-aged and 28 older adult people with low back pain who visited a joint center. The participants were instructed to perform the exercise at least twice a day, four times a week. Pain, muscle strength, disability, and quality of life were measured before the exercise intervention, and data were collected again 8 weeks after. The data were analyzed using independent t tests, χ2test, Fisher's exact tests, repeated measures analysis of variance, and paired t tests. The middle-aged and older groups showed differences in pain, muscle strength, disability, and quality of life before and after exercise. In particular, the older group showed statistically significantly larger differences in quality of life compared with the middle-aged group. The results indicated that the effects of the lower back exercises, performed using the Web-based videos, were the same for both the middle-aged and older groups, whereas quality of life showed better improvement in the latter than in the former group. For elderly patients, exercise intervention is an appropriate nursing care to improve the quality of life.

This study investigated medical students’ perceptions of good jobs. We classified medical students’ perceptions of good jobs and analyzed the characteristics of each type. The Q methodology was used to extract medical students’ subjective thoughts. After extracting statements based on previous studies, 46 Q samples were selected. The P sample consisted of 40 medical students divided evenly by gender and grade. They performed a Q sort of the 46 Q sample questionnaire and the results were analyzed using the QUANL ver. 1.2 program. Very few consensus statements were found in the replies. We divided answers into four types, each of which was clearly distinguished: (1) quality of life-oriented jobs, (2) reward-oriented jobs, (3) service-oriented jobs, and (4) self-realization-oriented jobs. Medical students in type 1 prioritized quality of life equally at work and at home. Medical students in type 2 preferred high-paying jobs. Medical students in type 3 placed importance on serving others. Finally, medical students in type 4 viewed good jobs as involving learning and development. The types of jobs sought were classified according to individual students’ values and subjectivity. Medical schools may use the results of this study as a basis for career guidance.

Due to the short history of dental education in Laos, the educational system is still incomplete, with only a few faculty development (FD) programs. This study aims to identify the needs assessment for FD, in Lao dental education. A survey was conducted, with dentists from the Faculty of Dentistry, in 2022. Data on demographics, perceived importance, and ability, on the 13 roles and competencies of teachers, as well as the 26 FD items’ needs assessment were collected. Data were compared between the two groups (lecturers and assistant teachers), and analyzed to identify different needs. Sixty-seven responses were included, after excluding inappropriate ones. Lecturers and assistant teachers expressed their needs for developing a syllabus, and teaching using simulation. Lecturers revealed the need to improve their roles as resource developers, followed by learning facilitators and lecturer in a classroom setting. Assistant teachers reported their prioritized needs for improving their role as on-the-job role models, followed by lecturer in a classroom setting, and mentor, personal adviser, or tutor. Assistant teachers showed higher educational needs scores than lecturers, in most questionnaire items. Although the needs assessment of FD indicates different needs, based on the differing roles and responsibilities, assistant teachers’ needs scores are generally higher. An FD program could prioritize the most common needs of both groups at an early stage, but the topics most needed by each group should also be considered. This study can inform a future FD program, to improve Lao dental education.

Purpose This study determined the effects of interprofessional education (IPE) on self-efficacy and attitude by comparing an interprofessional (IP) group of medical students (MSs) and nursing students (NSs) and a uniprofessional (UP) group of MSs. Methods An experimental IP group consisting of 49 MSs and 62 NSs was selected, alongside a UP control group of 48 other MSs. The groups participated in a class titled "Team Communication and Interprofessional Collaboration." A sub-analysis of the two groups' professions was also conducted. The groups participated in the same lesson separately, with a week's interval. The Interprofessional Attitudes Scale (IPAS) and the Self-Efficacy Perception for Interprofessional Experiential Learning (SEIEL) scale were used before and after the class to compare changes in reports of self-efficacy and attitudes in both groups. Students' responses to learning experiences and satisfaction were also evaluated. Results IPAS and SEIEL values increased after the class for MSs in both groups; there were no differences between the groups. IPAS and SEIEL values increased after the class in MSs and NSs in the IP group, and the effect size for IPAS was larger for IP-group NSs than for IP-group MSs. Satisfaction scores exceeded 3.70 in both groups. Conclusion The UP group showed similar IPE effects as the IP group, as measured by SEIEL and IPAS, in a single IPE program that used role-play and case-based discussion. However, it would be desirable for the UP group to interact with other professions to improve understanding and experience.

Concern for patient safety underlies the need for interprofessional education (IPE). One way to measure the effectiveness of IPE is by measuring attitude change toward other healthcare professionals; however, there are currently no valid Korean tools to measure such a change in attitudes. Therefore, this study aims to develop and test a Korean version of the Interprofessional Attitudes Scale (IPAS). The original IPAS was translated into Korean according to the World Health Organization’s guidelines after obtaining permission from the article’s corresponding author. A total of 414 questionnaires were collected from third- and fourth-year medical and nursing students at four Korean institutions in December 2018. To analyze the validity of the Korean IPAS, exploratory and confirmatory factor analyses were conducted. Cronbach’s α was used to evaluate reliability. Results from the exploratory factor analysis identified four functions: teamwork, community-centeredness, patient-centeredness, and respect for diversity. Significant cross-correlations were found among the four functions (r=0.438–0.631, p

This study explored emergency physicians' experiences and perspectives related to brain death organ tissue donation (OTD) after the enforcement of the Life-Sustaining Treatment (LST) Decision Act in Korea.Using the Braun and Clarke thematic analysis method, this qualitative study analyzed interview data-comprising experiences and perspectives of brain death OTD since the LST Decision Act-of 10 emergency physicians who specialized in targeted temperature management (TTM) and cared for post-cardiac arrest patients.Data analysis revealed 13 subthemes and 5 themes the LST Decision Act is easier to explain to family members than brain death OTD, but it does not fit well in an emergency medical setting; many family members decide to stop LST even before physicians mention brain death or OTD; family members view stopping LST as being about comforting patients without bothering them, and decision-makers are therefore no longer willing to choose OTD; stopping LST does not always result in brain death, but cases of brain death are preceded by stopping LST; and since the LST Decision Act, the number of TTM cases and potential brain death donors has decreased.Unless a supplementary policy that connects stopping LST to brain death OTD is prepared, the withdrawal of LST in patients resuscitated after cardiac arrest is expected to continue, and brain death OTD is expected to decrease.

Purpose: This study aimsed to gather opinions from medical educators on the possibility of introducing an interview to the Korean Medical Licensing Examination (KMLE) to assess professional attributes. Specifically following topics were dealt with: the appropriate timing and tool to assess unprofessional conduct; ; the possiblity of prevention of unprofessional conduct by introducing an interview to the KMLE; and the possibility of implementation of an interview to the KMLE.Methods: A cross-sectional study approach based on a survey questionnaire was adopted. We analyzed 104 pieces of news about doctors’ unprofessional conduct to determine the deficient professional attributes. We derived 24 items of unprofessional conduct and developed the questionnaire and surveyed 250 members of the Korean Society of Medical Education 2 times. Descriptive statistics, cross-tabulation analysis, and Fisher’s exact test were applied to the responses. The answers to the open-ended questions were analyzed using conventional content analysis.Results: In the survey, 49 members (19.6%) responded. Out of 49, 24 (49.5%) responded in the 2nd survey. To assess unprofessional conduct, there was no dominant timing among basic medical education (BME), KMLE, and continuing professional development (CPD). There was no overwhelming assessment tool among written examination, objective structured clinical examination, practice observation, and interview. Response rates of “impossible” (49.0%) and “possible” (42.9%) suggested an interview of the KMLE prevented unprofessional conduct. In terms of implementation, “impossible” (50.0%) was selected more often than “possible” (33.3%).Conclusion: Professional attributes should be assessed by various tools over the period from BME to CPD. Hence, it may be impossible to introduce an interview to assess professional attributes to the KMLE, and a system is needed such as self-regulation by the professional body rather than licensing examination.

Purpose: We aimed to develop a program for error disclosure for emergency medicine (EM) residents to determine its effects.Methods: Fifteen EM residents participated in 2020. The program included two-error disclosure sessions using standardized patients (SPs), a didactic lecture, and debriefing. The Kirkpatrick model was used to evaluate this program. Satisfaction scores and narrative reactions were collected (level 1). Residents were asked to choose their actions and explain reasons for the representative error cases before and after the program (level 2). After 2 months, they were asked to write their experiences of disclosing errors to real patients (level 3). The differences in the disclosing communication scores allocated by the SPs were compared between the senior and junior residents.Results: The residents’ satisfaction scores were high. Before the program, some residents chose not to disclose errors when there were no harmful sequelae at the time of the incident. After the program, opinions changed, and the residents thought that all errors should be disclosed. Before the program, most residents disclosed the errors to patients first; after the program, they would report to the hospital first to receive guidance. After 2 months, five residents reported disclosing errors to real patients. The senior residents’ total scores and the scores for “prevention of future errors” were higher.Conclusion: The residents showed confidence in error disclosure while maintaining rapport with the real patient, and some were satisfied with their disclosure approach. Our error disclosure program for EM residents had a positive effect on their behavior and attitude toward error disclosure.

Interprofessional education (IPE) can promote high-quality patient care and good medical outcomes through teamwork among health professionals. However, there are no valid measurements to prove the effectiveness of IPE in Korea. This study aimed to develop and test a Korean version of the Self-efficacy for Interprofessional Experimental Learning Scale (SEIEL). The original SEIEL was translated into Korean by two experienced medical professors, and 368 questionnaires were collected from medical and nursing students (third and fourth year). To analyze the validity of the Korean version of the SEIEL, an exploratory and confirmatory factor analysis was conducted. Cronbach’s α was used to evaluate reliability. Results from the exploratory factor analysis identified two functions: “interprofessional collaboration” and “interprofessional team evaluation.” A significant cross-correlation was found between the two functions (r=0.690, p

The aim of this study was to use narrative inquiry to explore the experiences of medical students who faced expulsion, military service, and readmission, and their journeys of identity formation. Three medical students were recruited via snowball sampling, and each participant was interviewed twice. According to the sequence of experiences, their stories were summarized as follows: the process of being expelled, the military service experience and readmission process, and the present. Before all three students were expelled, they lived dissolute lives free of concern from the entrance examination and failed to cope well with dropping out. They felt that military experience had helped them develop interpersonal skills in the clinical setting and the strength to withstand a difficult crisis. Two students were motivated to become doctors after military service, but the other was not. They had reflected deeply over their unique experiences. The scars imprinted from their experiences became a means of stimulation, and they ultimately acquired the resilience and ability to accommodate for and counteract their weaknesses. This appears to have been an important influence on their identity formation. The narrations of their rare experiences can help medical educators more fully understand and support medical students through difficulties, specifically with regard to academic failure or expulsion. These findings may prompt medical professors to think about the kind of guidance or motivation that could help students before expulsion, rather than assuming that they are simply lacking academic ability.

Purpose Brain swelling post-cardiac arrest may affect cerebrospinal fluid volume. We aimed to investigate the prognostic performance of the proportion of cerebrospinal fluid volume (pCSFV) using brain computed tomography (CT) in cardiac arrest survivors. Materials and Methods This retrospective multicentre study included adult comatose cardiac arrest survivors who underwent brain CT scan prior to target temperature management (TTM) from 2015 to 2016. Grey-to-white matter ratio (GWR) and pCSFV values were calculated. pCSFV analysis was performed using automated quantitative analysis programming. The primary outcome was a 6-month neurological outcome. Results Of 251 patients (median age, 57 years), 173 (68.9%) were male, 87 (34.7%) had a shockable rhythm, and 160 (63.7%) had unfavourable neurological outcomes. GWR but not pCSFV was significantly higher in terms of favourable neurological outcomes (p = .015). pCSFV prognostic performances were similar to GWR, and were poor overall, (0.521; 95% confidence interval [CI], 0.446–0.694 vs. 0.515; 95% CI, 0.441–0.589). After adjusting for covariates, pCSFV but not GWR was independently associated with neurological outcome 6 months following cardiac arrest (p = .049). Conclusion pCSFV was independently associated with neurological outcome 6 months following cardiac arrest, however prognostic performance was not good.

Team communication, teamwork, and interprofessional collaboration are critical and the basis for patient safety in a more diverse and complex clinical environment. This study explored the current status of teamwork, team communication, and interprofessionalism in the context of patient safety within undergraduate medical education. A scoping review of the literature published since 2010 was undertaken. Fifteen papers were included for final review. The most commonly used educational methods were off-line lectures and simulations. Standard team communication tools suggested in TeamSTEPPS (team strategies and tools to enhance performance patient safety) were covered in some of the research. Knowledge, skills, and teamwork attitudes, interprofessional collaboration, and/or patient safety were improved in most of the papers. In the previous studies of team communication, the content and method of education, and the change in knowledge and attitudes of the individuals have been widely reported, but more research is needed regarding the method of evaluating the teamwork itself. In addition, education on team communication as well as patient safety and interprofessionalism is lacking. As the importance of team communication in patient safety increases, more attention is needed on this topic in undergraduate medical education.

Background: In Korea, a new law was enacted in January 2016 allowing life-sustaining treatment (LST) of patients in end-of-life to be stopped, popularly known as the LST Decision Act. It came into effect in February 2018. Since then, brain death organ tissue donation affiliated with emergency physicians has decreased. This study aimed to explore emergency physicians’ experiences of and perspectives toward the impact of the LST Decision Act on brain death in Korea. Methods: A qualitative study was conducted using thematic analysis methods. Ten emergency physicians with experience in brain death, organ tissue donation, and LST were interviewed. Data analysis was performed following the six steps proposed by Braun and Clarke. Results: Data analysis revealed 14 subthemes and 5 themes: 1) The LST Decision Act is a legitimate way to stop LST, but it is not enough; 2) Many family members stop LST first, often more quickly and actively than physicians expect them to; 3) Stopping LST makes the patient more comfortable; thus, caregivers do not wish to opt for organ tissue donation, which is seen as distressing; 4) Not all patients experience brain death, and LST is stopped before brain death; and 5) Since the LST Decision Act, brain death organ tissue donation has decreased. Conclusion: Emergency physicians generally welcomed the LST Decision Act. However, family members seemed to perceive stopping LST as the means to making the patients comfortable, resulting in the loss of potential organ tissue donors. There is a need for a supplementary policy that connects stopping LST to brain death organ tissue donation.

The purpose of this study was to develop a Web exercise video for nursing intervention among outpatients with low back pain by applying the analysis-design-development-implementation-evaluation model to promote continuous exercise. During the analysis phase, we assessed the needs for the lower back exercise video as well as details of the current situations of the participants. Additionally, we investigated the intervention methods that the medical practitioners thought would be helpful in promoting lower back exercise. After the design and development phase, a lower back exercise video of 5 minutes 46 seconds was developed. The main contents in the video were the stretching and flexing exercises of the spine and muscles, including "One knee to chest," "Both knees to chest," "Hip bridge," "Prone position to erect spine," "Kneeling back extension," "Kneeling, opposite arm and leg raised," and "Sitting rotation stretch." For the implementation and analysis phase, a pilot test was done. The lower back exercise video was posted on the Web site, and participants watched the video and exercised individually. Participants reported that they were able to use the Web video whenever required, and after following the video a few times, they grew accustomed to the practice and were able to perform it repeatedly to help strengthen the lower back. In the future, experimental research is needed to confirm the effectiveness of exercise using Web video.

Objective. Excessive daytime sleepiness (EDS) in emergency medicine (EM) residents is associated with patient safety. However, studies regarding EDS in EM residents are limited. The objective of this study was to identify the prevalence of EDS and its associated factors among EM residents. Methods. Epworth sleepiness scale scores, working hours per week (WHW), night working days per month, working environment, and depression were analyzed using data from the 2019 Korean Emergency Medicine Resident Survey. Results. The survey response rate was 63.8% (384/601). Among 241 respondents, the prevalence rate of EDS was 32.4%. Multivariable logistic regression analysis demonstrated that WHW (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01–1.06) and depression (OR = 3.64, 95% CI = 1.91–6.96) had increased ORs for EDS. Conclusions. Approximately one-third of EM residents had EDS. Depression and WHW were the associated factors.

On-demand music streaming has grown remarkably driving the growth in digital to compensate for the decline in downloads. Additionally, Technology and innovation has donated immensely to the Internet architecture and applications of audio streaming services. More recently, the rise in paid music streaming service companies such as Apple Music, MelOn, YouTube Music, Spotify, and SoundCloud was responsible for the increase of the on-demand music streaming services revenue. The rapid birth of these new audio streaming services relied on not only the mobile or online applications but also on the market penetration strategy of companies from different industries motivated to take part of the Music Industry. This comparative study of major music streaming services illustrates the significant impact of on-demand music streaming services on the global growth of the Recorded Music Industry. Additionally, the study underlines Internet technology advancement, connectivity including Wireless, and dynamic and diverse markets as the driving forces behind the rapid growth of on-demand music streaming services. From a practical perspective, this research study provides insights on the current state of the Music Industry and its future direction that can be valuable to new entrants, current market players, investors, stakeholders, and R & D.

This study aimed to investigate burnout and resilience among emergency physicians (EPs) at university teaching hospitals during the coronavirus disease (COVID-19) pandemic.In April to May 2021, a survey was administered to 331 and 309 emergency medicine specialists and residents, respectively, from 31 university teaching hospitals in Korea. Data on the respondents' age, sex, designation, working area, experience with treating COVID-19 patients, and personal experience with COVID-19 were collected. Based on the participants' characteristics, quality of life (compassion satisfaction, burnout, and secondary traumatic stress), resilience, emotional content, and self-image were analyzed.A total of 247 responses were analyzed. Compared to specialists, compassion satisfaction and resilience in residents were not good, burnout was severe, and emotional content and self-image were less positive. Experiences with treating COVID-19 patients did not cause any difference in quality of life, resilience, emotional content, and self-image among participant subgroups. Personal COVID-19 experiences were associated with poor compassion satisfaction, resilience, less positive emotional content and self-image, and severe burnout. Compassion satisfaction, secondary traumatic stress, and resilience can definitively affect burnout.The quality of life and resilience of EPs in university teaching hospitals in Korea during the COVID-19 pandemic have been low. Supportive measures to improve resilience can prevent burnout among emergency staff, particularly residents and EPs, with personal experiences related to COVID-19.

Attending the operation room is an essential part of surgical clerkships. Syncope or presyncopal attacks in the operation room may negatively affect students’ learning and career development. This study set out to identify the prevalence of syncope and presyncopal attacks in the operation room during medical students’ surgical clerkships. Data from 420 medical students (303 men and 117 women) in their 3rd year of clerkship were collected between 2014 and 2017. An anonymous questionnaire was distributed to assess the prevalence and degree of syncope and presyncopal symptoms. A total of 27% of the respondents had experienced syncope or presyncopal symptoms, 49.6% of the female students and 18.8% of the male students (p

Purpose: The purpose of this study was to explore the experience of medical teachers in the process of adapting flipped learning method through a phenomenological approach. Methods: Semi-structured interviews with five medical teachers from two medical colleges and one medical school were conducted in December, 2017. Data analysis was done according to Colaizzi’s descriptive phenomenological methodology. Results: A total of 160 unique significant statements were extracted. These statements generated 17 formulated meanings that were categorized into seven theme clusters and four theme categories. Main themes were: (1) teacher with high levels of passion and motivation; (2) hurdles of flipped learning: students were still passive, struggling in preparing for flipped learning; (3) positive changes from flipped learning: changes to classroom environment and teachers’ reflection through experience; and (4) challenges of flipped learning: remaining tasks for teachers, expansion of flipped learning. Conclusion: Through phenomenological approach, researchers were able to elucidate categories about the experience of medical teachers when attempting flipped learning. Although medical teachers did not have the exact same idea on how flipped learning was conducted and implemented, the perception of flipped learning, or difficulties in class activities, they were still wondering how they could teach students well. This study might draw more attention to flipped learning and stimulate educational and institutional supports to improve teaching and learning in medical schools.

The purpose of this study was to investigate grayanotoxin (GTX) levels in the blood of patients with GTX intoxication and in the consumed Rhododendron liqueur, and to determine whether there was an association between blood GTX level and the patient's clinical status.In September 2015, six patients were concurrently presented to the emergency department with various toxicity symptoms, which occurred after the consumption of Rhododendron liqueur at the same toxin concentration. Liquid chromatography-tandem mass spectrometry analysis was conducted on blood samples obtained from six cases of GTX intoxication treated in our emergency department.At the initial evaluation in the emergency department, the mean arterial pressure of the patients ranged from 36.7 to 76.7 mm Hg. The concentrations of GTX-I and GTX-III in Rhododendron liqueur were 1.436 and 16.907 ng/mL, respectively. The initial blood GTX-III and GTX-I levels ranged from 2.9 to 58.0 ng/mL and the lower limit of quantification (LLOQ) to 8.33 ng/mL, respectively. After 20 h, the mean arterial pressure ranged from 76.7 to 93.3 mm Hg, while the blood GTX-III and GTX-I levels ranged from the LLOQ to 17.8 and 2.52 ng/mL, respectively.We estimated that the minimum blood GTX-III and GTX-I levels that caused hypotension were between 17.83 and 27.3 ng/mL, and 2.52 and 4.55 ng/mL, respectively.

The purpose of this study was to develop a Web video designed to promote regular shoulder joint exercise on a continuous basis among patients with shoulder joint disease. This is a methodological research. A shoulder joint exercise video was developed through the five stages of the ADDIE model: analysis, design, development, implementation, and evaluation. The video demonstrates exercises that stretch and strengthen the joints and muscles of the shoulders. Stretching exercises include the pendulum, forward elevation, outer rotation, crossover arm stretch, inner rotation, and the sleeper; strengthening exercises include dumbbell exercises, a chair exercise, wall push-ups, and rowing. This Web exercise video can be used as an educational resource for preventing shoulder joint diseases by middle-aged and elderly people and those seeking to restore shoulder joint function damaged by shoulder joint diseases.

Background No study comparing short message service (SMS) texts and telephone counseling for patients undergoing total knee replacement (TKR) has been reported. Purpose The purpose of the study was to provide postdischarge telephone counseling and SMS texts to TKR patients and to analyze the effects of these services on their knee function (KF), activities of daily living (ADL), and life satisfaction (LS). Methods This study used a randomized clinical trial design. This study was conducted with 40 patients (counseling group: 21; SMS group: 19). In the telephone counseling group and the SMS group, KF, ADL, and LS were assessed before surgery and 1 and 3 months after TKR. Results Telephone counseling and SMS texts have the same effects on KF, ADL, and LS of TKR patients. Conclusion Future research is needed to determine optimal frequency and duration of post-TKR SMS to support patients who have undergone TKR.

Aim The purpose of this study was to analyze the effect of an exercise programme that uses text messages on knee function after arthroscopic knee surgery. Methods This was a quasi-experimental study that used the nonequivalent control group non-synchronized design. A total of 52 adult patients (25 in the experimental group and 24 in the control group). scheduled for arthroscopic knee surgery for meniscal tears were included in the study. The knee injury and osteoarthritis outcome score was used to confirm the effect. The collected data were statistically analyzed using SPSS version 23.0. Repeated-measures analysis of covariance was used to analyze symptoms, activities of daily living (ADL), and knee-related quality of life (QOL). Repeated-measures analysis of variance was used to analyze pain and sports and recreation function. Results Significant differences in symptoms, ADL, sports and recreation function, and knee-related QOL were found according to time and group. Conclusion The use of text messages was effective as a way of promoting exercise after arthroscopic knee surgery.

Purpose High self-awareness can promote communication and empathy. The Enneagram is a well-known personality tool to enhance self-awareness. We evaluated differences in empathy among medical students using the Enneagram typology. Methods This cross-sectional study included first and second grade students at the Inje University College of Medicine. The Jefferson Scale of Empathy was used to measure empathy and the Korean Enneagram Personality Type Indicator was used for examining personality characteristics. Empathy scores were analyzed according to the Triads, Hornevian group, Harmonic group, and each Enneagram type. Results The Instinctive triad, the Withdrawns, and the Positive outlook group were the most common, and the Feeling triad, the Assertives, and the Emotional realness group were the least common. Students in the Feeling triad and the Dutifuls had higher compassionate care (CC) scores as compared to their counterparts. Type 2 and 6 students showed the two highest empathy and CC scores. The empathy score of type 3 students was the lowest. Type 7 had the lowest CC score but the highest perspective taking score. Conclusion These differences in empathy according to Enneagram personality types can be applied to medical education to maintain and improve medical students' empathy.

Autologous fat injection is a common procedure used for skin augmentation. It is known to be safe and simple, but severe complications have been reported at times. The authors observed a patient with acute large cerebral infarction including the territories of the anterior and middle cerebral arteries and optic nerve infarction developing after autologous fat transplantation. A 32-year-old woman was referred to the emergency room of our hospital due to sudden stupor. Thirty minutes earlier, she was undergoing cosmetic autologous fat injection into the glabella area by a plastic surgeon at a private clinic. The cause was confirmed to be anterior and middle cerebral arteries infarction on brain imaging studies. When a patient presents abrupt mental change, hemiplegia, ocular pain, or blindness after autologous fat particle injection, physicians must consider cerebral infarction and combined retinal artery occlusion.

Saccharomyces cerevisiae has a natural ability to produce higher alcohols, making it a promising candidate for production of isobutanol. However, the several pathways competing with isobutanol biosynthesis lead to production of substantial amounts of l -valine and l -isoleucine in mitochondria and isobutyrate, l -leucine, and ethanol in cytosol. To increase flux to isobutanol by removing by-product formation, the genes associated with formation of l -valine (BAT1), l -isoleucine (ILV1), isobutyrate (ALD6), l -leucine (LEU1), and ethanol (ADH1) were disrupted to construct the S. cerevisiae WΔGBIALA1_2vec strain. This strain showed 8.9 and 8.6 folds increases in isobutanol concentration and yield, respectively, relative the corresponding values of the background strain on glucose medium. In a bioreactor fermentation with a gas trapping system, the WΔGBIALA1_2vec strain produced 662 mg/L isobutanol concentration with a yield of 6.71 mgisobutanol/gglucose. With elimination of the competing pathways, the WΔGBIALA1_2vec strain would serve as a platform strain for isobutanol production.

Purpose Organophosphates, commonly used in agricultural pesticides, pose high risks and incidences of poisoning. In the present study, we investigated the relative risk and clinical severity, including laboratory results, of non-oral route poisoning (NORP) patients, compared to oral route poisoning (ORP) patients. Materials and methods A single institutional toxicology database registry was utilized to gain information on clinical laboratory results on organophosphate poisoning patients who visited the emergency department (ED) between January 2000 and October 2016. Clinical outcomes, such as mortality and complication rates, were compared using 1:2 propensity score matching in the total cohort. Results Among a total of 273 patients in our study, 34 experienced NORP. After 1:2 propensity score matching, rates of respiratory complications and mortality were higher in the ORP group than in the NORP group. However, there was no difference in hospitalization time and time spent in the intensive care unit between the two groups. Compared with ORP patients after matching, the relative risk of mortality in NORP patients was 0.34, and the risk of respiratory distress was 0.47. The mean level of pseudocholinesterase was significantly higher in the NORP group than in the ORP group, while recovery rates were similar between the two groups. Conclusion Although the majority of NORP patients were admitted to the ED with unintentional poisoning and the relative risk of NORP was lower than that for ORP, we concluded that NORP is as critical as ORP. Considerable medical observation and intensive therapeutic approaches are also needed for NORP patients.

Objectives To examine the relationship between stress, social support, and empathy among medical students. Methods We evaluated the relationships between stress and empathy, and social support and empathy among medical students. The respondents completed a question-naire including demographic information, the Jefferson Scale of Empathy, the Perceived Stress Scale, and the Multidimensional Scale of Perceived Social Support. Corre-lation and linear regression analyses were conducted, along with sub-analyses according to gender, admission system, and study year. Results In total, 2,692 questionnaires were analysed. Empathy and social support positively correlated, and empathy and stress negatively correlated. Similar correla-tion patterns were detected in the sub-analyses; the correla-tion between empathy and stress among female students was negligible. In the regression model, stress and social support predicted empathy among all the samples. In the sub-analysis, stress was not a significant predictor among female and first-year students. Conclusions Stress and social support were significant predictors of empathy among all the students. Medical educators should provide means to foster resilience against stress or stress alleviation, and to ameliorate social support, so as to increase or maintain empathy in the long term. Furthermore, stress management should be emphasised, particularly among female and first-year students.

The purpose of this study to understand collaborative process and the capabilities of the firm impact on innovation performance in convergence environment. To achieve the purpose, research model was empirically tested with a survey from 162 employees from 4 Korea manufacturing companies and 1 USA company. The data obtained from the survey were analyzed using Partial Least Squares (PLS). As a result, collaboration process, learning capability and operation capability have significant and positive impact on innovation performance. It is a meaningful result that the collaboration process improve the innovation performance of firms through the operation capability and the learning capability.

South Korean Government confirmed the creation of competency-centered society as a key national issue and announced development and utilization plan of NCS(National Competency Standards) On May 21, 2013. As a part of the government's plans, they had been developed NCS about 833 jobs by 2014. But Big Data related job, as an emerging job, cannot be seen as a reliable form of job yet. As, at the major industrialized countries and the domestic, education and job competency models of knowledge and skills to take advantage of various types of Big Data have coming, it is a situation that is certainly not settled and more or less in confusion. In this study, for the purpose to present the Big Data Competency reference model for companies and organizations to effectively leverage Big Data, we have presented this reference model and summarized competency elements units such as 20 knowledges and 15 skills of Big Data competency. Key Words : Big Data Competency, NCS(National Competency Standards), Reference Model, Competency Unit Element, Knowledge and Skill

Purpose Nonverbal communication (NVC) is important in the patient-physician relationship, but the effect of NVC education is not well kown. In this study, we try to identify if students' NVC abilities are improved through communication training. Methods First-year medical students conducted medical interviews, which were performed with standardized patients (SPs) before and after communication skill education, and recorded in video. Fifty-one students were enrolled for this study. Two researchers used the NVC checklist, which consists of 12 nonverbal behaviors, to analyze and compare the students' nonverbal expressions in the interviews recorded before and after the education. Results After the students participated in communication training, open body position and adequate facial expression were increased while unnecessary silence, un-purposive movements, and giggling were decreased. These results can be interpreted as positive effects of the education. However, hand gesture was increased as a negative effect of the education. The total NVC score of the 12 nonverbal behaviors in the NVC checklist improved significantly, rising from 8.56 to 10.03. Conclusion Communication skill education using SPs can improve nonverbal behaviors of medical students, especially facial expression, un-purposive movement, body position, unnecessary silence, and giggle, but not hand gesture. Further research is needed on a variety of teaching methods to improve NVCs.

Whether coronary artery changes are a main mechanism in the development of carbon monoxide (CO)-induced cardiomyopathy remains unknown. We investigated the effects of coronary artery stenosis on the presence or patterns of cardiomyopathy in CO-poisoned patients with myocardial injury defined as elevation of troponin I.This prospective observational study collected data from consecutive patients who were diagnosed with CO poisoning and myocardial injury during the 24-month study period. Transthoracic echocardiography (TTE) and coronary computed tomography angiography (CCTA) were performed to evaluate cardiac function and coronary artery status.TTE and CCTA were performed in 32 consecutive patients. The observed echocardiographic patterns included non-cardiomyopathy (59.4%), left ventricular global dysfunction (25%), Takotsubo cardiomyopathy (6.3%), and cardiomyopathy matching the distribution of the left anterior descending (LAD) artery (9.4%). Four patients had more than moderate stenosis, while stenoses of the LAD, left circumflex, and right coronary arteries were observed in two (6.3%), three (9.4%), and zero patients, respectively. Patients with coronary artery stenosis did not develop cardiomyopathy except for one patient; this patient also did not have regional wall motion abnormalities (RWMA) matched with the stenosis territory.Because there was no difference in coronary artery stenosis according to the presence or patterns of CO-induced cardiomyopathy, coronary artery stenosis is not the main mechanism for the development of CO-induced cardiomyopathy. Thus, the evaluation of coronary arteries is not necessary in all patients with CO-induced cardiomyopathy unless there is RWMA consistent with ischemic changes in electrocardiograms and elevated troponin I levels.

Aim We previously reported that diffusion-weighted magnetic resonance imaging (DW-MRI) could be used to predict neurologic outcomes before targeted temperature management (TTM) after return of spontaneous circulation (ROSC) from cardiac arrest (CA). We compared the efficacy of brain computed tomography (CT) and DW-MRI to predict neurologic outcome before TTM in comatose cardiac arrest survivors. Methods We performed a retrospective study of CA patients treated with TTM. The brain CT and DW-MRI were both obtained before TTM. We analysed the grey matter to white matter ratio (GWR) on the brain CT and the presence of high signal intensity on DW-MRI, alone or in combination, to predict poor neurologic outcome (CPC 3–5). Results Of 47 comatose CA patients treated with TTM, 39 patients with brain CT and DW-MRI data were included. Median time from the ROSC to the brain CT and DW-MRI was 90 min (52–150) and 175 min (118–240), respectively. There was no significant difference in predicting poor neurologic outcome between average GWR (area under the curve [AUC] 0.891, sensitivity/specificity 78.8%/100%) and DW-MRI (AUC 0.894, sensitivity/specificity 75.8%/100%) (p = 0.963). The combination of average GWR and DW-MRI (AUC 0.939, sensitivity/specificity 87.9%/100%) improved the prediction of poor neurologic outcome rather than each one alone and in other combinations. Conclusion Our preliminary finding suggests that DW-MRI is potentially useful for early prediction of neurologic outcome (i.e., before TTM) in CA patients. The combination of GWR on brain CT and that on DW-MRI, rather than on each modality alone, appears to improve the sensitivity for predicting neurologic outcome after ROSC from CA. Large prospective multicenter studies should be conducted to confirm these results.

Purpose A suture line placed with the same direction as the relaxed skin tension line leads to good healing, but a suture line with over 30 degrees of angle from the relaxed skin tension line leads to longer healing time and more prominent scarring. W-plasty is widely used to change the direction of the scar or to divide it into several split scars. In this study, we applied W-plasty to patients with facial lacerations in the emergency department. Methods From June 2012 to December 2014, 35 patients underwent simple repair or W-plasty for facial lacerations. Patients in the simple repair group underwent resection following a thermal margin, and the W-plasty group was resected within a pre-designed margin of W-shaped laceration. We assessed prognosis using the Stony Brook Scar Evaluation Scale (SBSES) after 10 days (short-term) and six months (long-term), respectively, following suture removal. Results Among 35 patients, 15 (42.9%) underwent simple debridement and 20 (57.1%) underwent W-plasty. In the W-plasty group, there was no difference between short-term and long-term follow-up showing high SBSES, but in the simple debridement group, long-term follow-up SBSES significantly decreased. W-plasty SBSES was higher than simple debridement at short-term as well as long-term follow-up. Conclusion We experienced good results of direct W-plasty application at six-month long-term follow-up. Therefore, W-plasty application is more effective in reducing scar appearance than a simple debridement method for facial laceration patients with an angle of 30 degrees or more to the relaxed skin tension line.

Due to recent climate changes that accompany drastic changes in water recycle process, extreme floods and droughts are occurring frequently throughout the world. In response to these events, Smart Water Management that refers to implement intelligent water information systems by IT convergence is considered as a new paradigm. In this study, we seek to explore the Smart Water Management, especially the adoption of Smart Water Grid Technology. We aim to review previous studies to identify factors that influence the adoption of the Smart Water Grid and to analyze the importance and priority of the factors affecting Smart Water Grid adoption, thereby presenting the successful adoption measures for Smart Water Grid in Korea. This study set a research model with the influencing factors in relation to the adoption of new IT technologies that were identified through the literature reviews of previous studies based on the TOE framework. This study also conducted empirical analysis of the findings and found out that the issue of privacy protection and security due to hacker’s attack would be emerged as a significant risk factor.

Benign pulmonary tumors are rare, composing less than 1% of pulmonary tumors; of these, hamartomas are the most common. Endobronchial hamartomas are rarer still, composing 1.4% of all pulmonary hamartomas. As therapeutic bronchoscopy has improved, it has replaced conventional operations for resection of endobronchial benign tumors, although there are limitations to the procedure in the case of large tumors causing complete obstruction. The present report describes a case of a large endobronchial hamartoma inducing total lung atelectasis, which was successfully resected using an electrosurgical snare through flexible bronchoscopy. This could be a useful option in select endobronchial tumors.

This study was conducted in order to identify the characteristics of total knee replacement patients and analyze their knee life satisfaction. It surveyed the characteristics and life satisfaction of 60 patients diagnosed with osteoarthritis and waiting for TKR at the Joint Center of a university hospital during April and May in 2015. Collected data were statistically analyzed using SPSS 23.0. 90.4% were female, and the largest age group consisted of people in their 60s. BMI was over 25.0 in 58.3% of the patients. The mean score of life satisfaction was 1.94 out of 3, and it was significantly different according to age. Intensive care of the knee is required for people in their 60s, women, and those with high BMI.

We aimed to share the experience of educating the clinical performance examination (CPX) using self video monitoring and to investigate the core contents for improvement of clinical performance of medical students. Forty forth-year medical students participated in this study in 2011. This course consisted of simple lecture one CPX practice and self video monitoring. They submitted two reports describing their opinions about this course and analyzing their CPX practice through video monitoring. In addition, their satisfaction score was investigated. Average satisfaction point was over 4.5 on a five-point scale. Common strengths and weaknesses were patient education, eye contact, sympathy expression, and gesture. Suggestion for improvement of this course was repeated CPX practice, and advantage of this course was that they realized their improper nonverbal communication using video monitoring and other students’ CPX. ln conclusion, video monitoring was effective CPX teaching method and patient education, eye contact, sympathy expression, and gesture were the core contents for improvement ofclinical performance of medical students.

PURPOSE Action learning is an educational method, whereby participants study their own actions and experiences to improve performance. We aimed to study the effects and share the experiences with action learning to teach clinical performance examination (CPX). METHODS Twenty-eight fourth-year medical students participated in this study in 2010. This course consisted of three mini-lectures, three CPX practice sessions, and an evaluation. Satisfaction and improved and deficient elements in the CPX practice session were investigated. Internal consistencies of peer evaluation and CPX scores were also investigated using Cronbach's alpha. RESULTS Average satisfaction was 4.5 on a 5-point scale. Low Cronbach's alpha was noted for the consistencies of peer evaluation and patient-physician interaction. The most common improved element was self-confidence, followed by accustoming themselves to conversation with the standard patient. Seven students stated that they were deficient in self-confidence; other deficiencies were sympathy expression, conversation, and physical examination. CONCLUSION CPX education using action learning by peer evaluation, generating CPX cases by themselves, repeated practices, and feedback, effected self-active learning. However, the educator and educatee must invest much time and effort. Allotting specific, scheduled times for this type of education would be more effective.

ing), '공격성/확인'(aggression/checking), '저장'(hoard- ing), '대칭/정리하기'(symmetry/ordering), '성적/종교적 사 고(sexual/religious)'의 적어도 5가지의 대표적 증상 요인 이 있음이 보고되어 왔다. 또한 이러한 다양한 차원의 강박 Objectives:The purpose of this study was to assess the factor structures related to the Maudsley Obsessive-Compulsive In- ventory (MOCI) in middle school students. Methods:A total of 1,175 7th grade students from four middle schools in Paju city completed the MOCI, Center for Epide- miological Studies-Depression scale (CES-D), and Self Esteem Scale (SES). An exploratory factor (maximum likelihood meth- od with oblique rotation) and correlation analyses were subsequently performed. Results:The two main factors related to the MOCI were 'intrusive thought' and 'contamination'. 'Intrusive thought' was posi- tively correlated with the CES-D and negatively associated with the SES. 'Contamination' had a negative correlation with self-es- teem as measured by the SES. Conclusion:The results of this study revealed a two-factor structure of obsessive and compulsive symptoms in middle school

119 rescuer's ability in prehospital emergency medical system is very important for the better outcome of patients. The proper education program is needed to improve the appropriateness of prehospital emergency care by 119 rescue services. To establish the proper education plan, educational needs of 119 rescuers should be assessed first of all.