When participating in problem-based learning (PBL), it is important for medical students to generate claims and provide justifications for their claims in small group discussions. This study aimed to investigate the effect of argumentation instruction on medical student learning experiences with PBL. A total of one hundred first-year preclinical students from Inje University College of Medicine, who had attended argumentation instruction, participated in this study. All of the participants completed a 5-point Likert scale questionnaire regarding their learning experiences with PBL, before and after the argumentation instruction. The questionnaire comprised 22 items with eight subcategories: argumentation activity, reflection, integration of basic and clinical science, identification of lack of knowledge, logical thinking, self-directed study, communication, and attitude toward discussion. The collected data were analyzed through a paired-sample t-test. The results of this study found that the argumentation instruction promoted the preclinical students' experiences with argumentation activities, reflection, an integration of basic and clinical science, the identification of their lack of knowledge, logical thinking, and self-directed study, and it increased positive attitudes toward group discussion. The findings suggest argumentation instruction can enhance medical student group discussions and help students achieve the objectives of PBL, including acquisition of basic and clinical science knowledge and development of clinical reasoning and self-directed learning abilities, which can highlight the meaningful learning experiences students have with PBL.
Humans ; Learning ; Logic ; Problem-Based Learning ; Students, Medical ; Thinking

PURPOSE: Hypothetico-deductive reasoning (HDR) is an essential learning activity and a learning outcome in problem-based learning (PBL). It is important for medical students to engage in the HDR process through argumentation during their small group discussions in PBL. This study aimed to analyze the quality of preclinical medical students' argumentation according to each phase of HDR in PBL. METHODS: Participants were 15 first-year preclinical students divided into two small groups. A set of three 2-hour discussion sessions from each of the two groups during a 1-week-long PBL unit on the cardiovascular system was audio-recorded. The arguments constructed by the students were analyzed using a coding scheme, which included four types of argumentation (Type 0: incomplete, Type 1: claim only, Type 2: claim with data, and Type 3: claim with data and warrant). The mean frequency of each type of argumentation according to each HDR phase across the two small groups was calculated. RESULTS: During small group discussions, Type 1 arguments were generated most often (frequency=120.5, 43%), whereas the least common were Type 3 arguments (frequency=24.5, 8.7%) among the four types of arguments. CONCLUSION: The results of this study revealed that the students predominantly made claims without proper justifications; they often omitted data for supporting their claims or did not provide warrants to connect the claims and data. The findings suggest instructional interventions to enhance the quality of medical students' arguments in PBL, including promoting students' comprehension of the structure of argumentation for HDR processes and questioning.
Cardiovascular System ; Clinical Coding ; Comprehension ; Humans ; Learning ; Problem-Based Learning* ; Students, Medical*

PURPOSE: The purpose of the study was to identify factors influencing physical activity among community-dwelling older adults with type 2 diabetes. The study design was based on the Theory of Triadic Influence. METHODS: A total of 242 older adults with type 2 diabetes participated in this study. Six variables related to physical activity in older adults, including self-efficacy, social normative belief, attitudes, intention, experience, and level of physical activity, were measured using reliable instruments. Data were analyzed using descriptive statistics, Pearson's correlation analyses, and a path analysis. RESULTS: The mean physical activity score was 104.2, range from zero to 381.21. The path analysis showed that self-efficacy had the greatest total effect on physical activity. Also, experience had direct and total effects on physical activity as well as mediated the paths of social normative beliefs to attitudes and intention to physical activity. These factors accounted for 10% of the total variance, and the fit indices of the model satisfied the criteria of fitness. CONCLUSION: The findings of the study reveal the important role of self-efficacy and past experience in physical activity in older adults with type 2 diabetes.
Aged ; Aged, 80 and over ; Attitude ; Diabetes Mellitus, Type 2/*physiopathology/psychology ; Female ; Humans ; Male ; Motor Activity/*physiology ; Personal Satisfaction ; Residence Characteristics ; Self Efficacy ; Surveys and Questionnaires

Educational program evaluation can improve the quality of the curriculum, instructional methods, and resources and provide useful data for making educational decisions and policies. Developing and implementing a program evaluation system is essential in competency-based medical education. The purpose of this study was to explore and establish an educational program evaluation system adapting an integrated program evaluation model to promote competency-based medical education. First, an Educational Evaluation Committee was organized, consisting of faculty, staff members, and students. The committee established an integrated program evaluation model, combining Stufflebeam’s Context, Input, Process, and Product (CIPP) model of a process-oriented approach and Kirkpatrick’s four-level model of an outcome-oriented approach. Kirkpatrick’s model was applied to the product evaluation of the CIPP model. The committee then developed evaluation criteria, indicators, and data collection methods according to the components of the CIPP model and the four levels (reaction, learning, behavior, and results) of Kirkpatrick’s model, and collected and analyzed data. Finally, the committee reported the results of evaluation to a Medical Education Quality Improvement Committee, and the results were used to improve the curriculum and student selection. To enhance the quality of education, identifying educational deficiencies and developing various elements of education in a balanced way through educational evaluation will be needed. Furthermore, it will be necessary to listen to opinions of various stakeholders, work with all members involved in education, and communicate with decision-makers in the process of educational evaluation.

Evaluating the effectiveness of educational programs involves measuring learning processes as well as outcomes.It is essential to study cohorts of students and graduates to evaluate the long-term effects of educational programs with data generated both during education and after graduation. The purpose of this study was to establish cohorts of students and graduates to evaluate their performance, thereby providing a basis for evaluating the social accountability of medical education. In this study, student and graduate cohorts were built for both students currently enrolled and graduates at Inje University College of Medicine (IUCM). A model involving the process of cohort establishment and an evaluation indicator framework was developed. In the process of cohort establishment, the following steps were conducted: defining the goals and objectives of the student and graduate cohorts, organizing a cohort committee, developing regulations, registering cohorts, acquiring consent, and building a database. A framework of evaluation indicators according to the graduate roles of IUCM was developed by adapting Kirkpatrick’s evaluation model. Next, items to be collected in student and graduate cohorts were selected, and the current status of existing data was analyzed. Moreover, a preliminary analysis was conducted, including analyses of the evaluation indicators and graduates’ performance. This study suggests that it is necessary to include additional evaluation indicators considering students’ learning environment and well-being in student cohorts and to develop strategies or methods for graduates to continue participating in data collection for a long-term study.

One important purpose of premedical education is to help students attain core competencies during the two-year premedical program. Since premedical curriculum is the foundation of medical education, it is necessary to develop the premedical curriculum in accordance with the overarching curriculum of a medical school. Inje University's College of Medicine (IUCM) has attempted to integrate competency-based medical education into the premedical education curriculum. The revised premedical curriculum aims to develop students' intrinsic competencies during premedical years. In an effort to do so, IUCM defined competencies for premedical education, analyzed and designed premedical courses according to the defined competencies, and suggested learner-centered instructional methods. As a result of implementing the revised premedical curriculum, students have reported both positive experiences and difficulties. Based on the results, it will be necessary to continuously improve the premedical curriculum as well as develop appropriate methods for evaluating student achievement of the defined competencies.
Competency-Based Education ; Curriculum ; Education, Medical ; Education, Premedical ; Humans ; Schools, Medical

This study aimed to identify maternal, infant, and perinatal mortality using the nationalpopulation data of South Korea between 2018 and 2020, and to analyze mortality rates according tocharacteristics such as age, date of death, and cause of death in each group. This study updates themost recent study using 2009 to 2017 data.Methods: Analyses of maternal, infant, and perinatal mortality were done with data identifiedthrough the supplementary investigation system for cases of death from the Census of PopulationDynamics data provided by Statistics Korea from 2018 to 2020.Results: Between 2018 and 2020, a total of 99 maternal deaths, 2,427 infant deaths, and 2,408 perinatal deaths were identified from 901,835 live births. The maternal mortality ratio was 11.3 deathsper 100,000 live births in 2018; it decreased to 9.9 in 2019 but increased again to 11.8 in 2020. Thematernal mortality ratio increased steeply in women over the age of 40 years. An increasing trend inthe maternal mortality ratio was found for complications related to the puerperium and hypertensive disorders. Both infant and perinatal mortality continued to decrease, from 2.8 deaths per 1,000live births in 2018 to 2.5 in 2020 and from 2.8 in 2018 to 2.5 in 2020, respectively.Conclusion: Overall, the maternal, infant, and perinatal mortality statistics showed improvements.However, more attention should be paid to women over 40 years of age and specific causes of maternal deaths, which should be taken into account in Korea’s maternal and child health policies.

Salivary function in mammals may be defective for various reasons, such as aging, Sjogren's syndrome or radiation therapy in head and neck cancer patients. Recently, tissue-specific stem cell therapy has attracted public attention as a next-generation therapeutic reagent. In the present study, we isolated tissue-specific stem cells from the human submandibular salivary gland (hSGSCs). To efficiently isolate and amplify hSGSCs in large amounts, we developed a culture system (lasting 4-5 weeks) without any selection. After five passages, we obtained adherent cells that expressed mesenchymal stem cell surface antigen markers, such as CD44, CD49f, CD90 and CD105, but not the hematopoietic stem cell markers, CD34 and CD45, and that were able to undergo adipogenic, osteogenic and chondrogenic differentiation. In addition, hSGSCs were differentiated into amylase-expressing cells by using a two-step differentiation method. Transplantation of hSGSCs to radiation-damaged rat salivary glands rescued hyposalivation and body weight loss, restored acinar and duct cell structure, and decreased the amount of apoptotic cells. These data suggest that the isolated hSGSCs, which may have characteristics of mesenchymal-like stem cells, could be used as a cell therapy agent for the damaged salivary gland.
Amylases/genetics/metabolism ; Animals ; Antigens, CD/genetics/metabolism ; Apoptosis ; Cell Differentiation ; Humans ; Male ; Mesenchymal Stromal Cells/*cytology/metabolism ; Radiation Injuries, Experimental ; Rats ; Rats, Wistar ; *Regeneration ; Salivary Glands/cytology/injuries/physiology/*surgery ; *Salivation ; *Stem Cell Transplantation

BACKGROUND/OBJECTIVES: Diabetes-specific oral nutritional supplements (ONS) have anti-hyperglycemic effects, while D-allulose exerts anti-diabetic and anti-obesity effects.In this study, we investigated the efficacy and safety of diabetes-specific ONS, including allulose, on glycemic and weight changes in overweight or obese patients with type 2 diabetes mellitus (T2DM). SUBJECTS/METHODS: A single-arm, historical-control pilot clinical trial was conducted on 26 overweight or obese patients with T2DM (age range: 30–70 yrs). The participants were administered 2 packs of diabetes-specific ONS, including allulose (200 kcal/200 mL), every morning for 8 weeks. The glycemic profiles, obesity-related parameters, and lipid profiles were assessed to evaluate the efficacy of ONS. RESULTS: After 8 weeks, fasting blood glucose (FBG) level significantly decreased from 139.00 ± 29.66 mg/dL to 126.08 ± 32.00 mg/dL (P = 0.007) and glycosylated hemoglobin (HbA1c) improved (7.23 ± 0.82% vs. 7.03 ± 0.69%, P = 0.041). Moreover, the fasting insulin (δ: −1.81 ± 3.61 μU/mL, P = 0.017) and homeostasis model assessment for insulin resistance (HOMA-IR) (δ: −0.87 ± 1.57, P = 0.009) levels decreased at 8 weeks, and body weight significantly decreased from 67.20 ± 8.29 kg to 66.43 ± 8.12 kg (P = 0.008). Body mass index (BMI) also decreased in accordance with this (from 25.59 ± 1.82 kg/m2 to 25.30 ± 1.86 kg/m2 , P = 0.009), as did waist circumference (δ: −1.31 ± 2.04 cm, P = 0.003). CONCLUSIONS The consumption of diabetes-specific ONS with allulose in overweight or obese patients with T2DM improved glycemic profiles, such as FBG, HbA1c, and HOMA-IR, and reduced body weight and BMI.

This study aimed to compare brain structural connectivity using graph theory between patients with alcohol dependence and social drinkers. The participants were divided into two groups; the alcohol group (N=23) consisting of patients who had been hospitalized and had abstained from alcohol for at least three months and the control group (N=22) recruited through advertisements and were social drinkers. All participants were evaluated using 3T magnetic resonance imaging. A total of 1000 repeated whole-brain tractographies with random parameters were performed using DSI Studio. Four hundred functionally defined cortical regions of interest (ROIs) were parcellated using FreeSurfer based on the Schaefer Atlas.The ROIs were overlaid on the tractography results to generate 1000 structural connectivity matrices per person, and 1000 matrices were averaged into a single matrix per subject. Graph analysis was performed through igraph R package. Graph measures were compared between the two groups using analysis of covariance, considering the effects of age and smoking pack years. The alcohol group showed lower local efficiency than the control group in the whole-brain (F=5.824, p=0.020), somato-motor (F=5.963, p=0.019), and default mode networks (F=4.422, p=0.042). The alcohol group showed a lower global efficiency (F=5.736, p=0.021) in the control network. The transitivity of the alcohol group in the dorsal attention network was higher than that of the control (F=4.257, p=0.046). Our results imply that structural stability of the whole-brain network is affected in patients with alcohol dependence, which can lead to ineffective information processing in cases of local node failure.