If large-scale testing programs are being used, OSCE stations may be duplicated into two or more sites. There are a few studies on the reliability of OSCE with duplicated stations in Korea. The purpose of this study was to investigate the effect of duplication on the reliability of OSCE. At Hanyang university college of medicine, an OSCE is given to all senior medical students(91 per class) upon completion of all clinical clerkship rotations. The examination consisted of twenty one stations and eighteen cases that represented commonly encountered problems in primary care. Each station required seven minutes for its administration, with 6 to 6.5 minutes for the student-SP or model encounter, during which the students performs a complete focused history and/or physical examination and/or procedure and/or management, and another 0.5 to 1 minutes for the evaluator to feedback case-related comments. We analysed the reliability of duplication by comparing total OSCE scores and case scores between two exam sites. We also evaluated the reliability of duplicated stations from student's and professor's subjective response to the OSCE. All 91 fourth-year students attended the OSCE. Standardized Cronbach coefficient of the OSCE was 0.67. The station scores and OSCE total scores were different between two duplication sites. The total OSCE score of one site was slight higher than that of the other site(p=0.03). Of total 19 stations in which students were evaluated by staff evaluator, six stations are more advantageous to one part compared with counterpart stations, other six stations are vice CONCLUSIONS: OSCE reliability can be affected by duplication of examination sites and inter-rater reliability is the most important determining factor. The results demonstrate a need for caution in the interpretation of scores obtained from OSCE with duplicated stations.
Clinical Clerkship ; Humans ; Korea ; Physical Examination ; Primary Health Care

PURPOSE: Evaluation and feedback are fundamental components in a residency program. A portfolio assessment system is an appropriate option for making formative assessments, particularly for a family medicine resident whose training includes rotations through various disciplines at multiple locations. However, a paper-based portfolio assessment system has limitations when applied to a clinical environment due to how it is managed and cared. This study assessed the satisfaction and utility of a paper-based portfolio assessment system, and then designed and implemented a web-based portfolio assessment system for family medicine residents. METHODS: A self-administered questionnaire focusing on the satisfaction and utility of a paperbased portfolio assessment system was given to 23 family medicine residents. A web-based portfolio assessment system was then designed using the component-based development approach. RESULTS: The overall satisfaction and utility with the paper-based portfolio assessment system were low. Fifteen residents (62.5%) reported that following a paper-based portfolio assessment system was sometimes a waste of time and only three (13.0%) reported having no problems. The web-based portfolio assessment system was successfully designed to be easy to implement and user-friendly. CONCLUSION: The web-based portfolio assessment system is expected to overcome the shortcomings of a paper-based portfolio assessment system and improve the level of satisfaction of medical residents. It is expected that the web-based portfolio assessment system designed in this study will be an additional tool for family medicine residencies.
Education ; Educational Measurement ; Humans ; Internship and Residency* ; Korea* ; Surveys and Questionnaires

BACKGROUND: Being underweight has been related to health risks. However, little is known about the relationship between suicidal ideation and attempting to lose weight. This study was conducted to examine if there is an association between suicidal ideation and attempting to lose weight among underweight adults. METHODS: A cross-sectional study of 1,122 underweight adults (range, 19 to 69 years) was conducted based on the Korea National Health and Nutrition Examination Survey, 2007-2012. We examined suicidal ideation, doctor-diagnosed depression, depressive mood, stress, physical activity, health-related behavior, comorbidity, and socioeconomic status by weight loss attempts. Logistic regression analysis was performed to examine the association between suicidal ideation and weight loss attempts. The following covariates were controlled for: age, sex, physical activity, alcohol problem, marital status, education, income, occupation, self-perception of body image, chronic disease, and body mass index. RESULTS: There were 101 subjects in the weight loss attempt group and 1,021 in the non-attempt group. The attempt group had a higher risk of suicidal ideation (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.35 to 4.53) and depressive symptoms (OR, 2.17; 95% CI, 1.19 to 3.98). After depressive symptoms were added to the covariates, the risk of suicidal ideation was also significant (OR 2.11, 95% CI: 1.03 to 4.35). The two groups did not significantly differ in doctor-diagnosed depression and stress. CONCLUSION: Weight loss attempts were associated with suicidal ideation in underweight Korean adults.
Adult* ; Body Image ; Body Mass Index ; Chronic Disease ; Comorbidity ; Cross-Sectional Studies ; Depression ; Education ; Humans ; Korea ; Logistic Models ; Marital Status ; Motor Activity ; Nutrition Surveys* ; Occupations ; Self Concept ; Social Class ; Suicidal Ideation* ; Thinness* ; Weight Loss

Metastatic tumors to the hand are rare and often overlooked by clinicians. Here, we report a rare case of phalangeal metastasis of right 4th finger in a patient with hepatocellular carcinoma. Treatment was given with right 4th finger disarticulation. This report suggests that physicians must take consideration into the possibility of metastatic tumors in patients with bone lesions on hands and a history of malignancy.
Carcinoma, Hepatocellular ; Disarticulation ; Fingers ; Hand ; Humans ; Neoplasm Metastasis

PURPOSE: A high degree of agreement between standardized patients (SP) check-list recordings and those of faculty will be necessary if SPs are to eventually replace faculties in the OSCE evaluaton process. This study was conducted to know to what degree SPs' checklist recordings agree with those of faculties during an OSCE. METHODS: One hundred and twenty one fourth-year medical students of Hanyang University College of Medicine took an OSCE. In each of two study stations, a student saw an SP for four minutes and the SP recorded the same checklists as a faculty examiner did, for the following fifty seconds. RESULTS: For the 'bad news delivery' station, SP evaluations were more lenient compared to those of faculties (56 vs 45, p< 0.01), but in the case of 'chest pain', there was no significant difference. Pearson correlation coefficients for the 'bad news delivery' station and for the 'chest pain' case were 0.60 and 0.65, respectively. The mean percentages of agreement for the 'bad news delivery' and the 'chest pain' checklists were 71% and 82%, respectively. The mean kappa statistics for the 'bad news delivery' and the 'chest pain' check-lists were 0.19 and 0.49, respectively. CONCLUSION: The ratings by SPs were found to be consistent with those of faculties only in moderate degree. The exactness of scoring criteria, and the optimal SP training are to be the premise for the replacement of faculties by SPs during OSCE checklist recordings.
Checklist* ; Clinical Competence ; Educational Measurement ; Humans ; Observer Variation ; Patient Simulation ; Students, Medical

BACKGROUND: Grip strength has been found to be closely related to mortality and disease morbidity. In this study, we aimed to evaluate the relationship between grip strength and mortality in middle aged and elderly Koreans.METHODS: Study subjects were selected from the participants of the Korean Longitudinal Study of Ageing from 2006 to 2016. The Cox proportional hazards model was used to analyze the association between grip strength, all-cause mortality, and cause-specific mortality according to age and sex, after adjusting for covariates.RESULTS: The adjusted hazard ratio (HR) for all-cause mortality was decreased in the high grip strength group (male: HR=0.580, 95% confidence interval [CI]=0.478–0.704; female: HR=0.601, 95% CI=0.483–0.747) compared to the low grip strength group in both sexes. In male, cardiovascular mortality (middle group: HR=0.453, 95% CI=0.278–0.738; high group: HR=0.538, 95% CI=0.332–0.871) and cancer mortality (middle group: HR=0.697, 95% CI=0.514–0.945; high group: HR=0.589, 95% CI=0.427–0.812) were significantly lower in the middle and high grip strength groups compared to the low grip strength group. The HR for mortality due to stroke in male decreased significantly according to grip strength, but this became nonsignificant after adjusting for covariates. No association between cause-specific mortality and grip strength was found in female.CONCLUSION: In this study, grip strength was inversely associated with all-cause mortality, with similar effects on cause-specific mortality due to heart disease and cancer in male. Grip strength is a useful predictor of health status, and further studies are needed to evaluate its clinical relevance in Koreans.
Aged ; Female ; Hand Strength ; Heart Diseases ; Humans ; Korea ; Longitudinal Studies ; Male ; Middle Aged ; Mortality ; Proportional Hazards Models ; Stroke

BACKGROUND: A considerable portion of patients in primary care are thought to have mental disorders in Korea. But they are not easily noticed and are thus underdiagnosed and approached improperly. This study was done to assess the prevalence of common mental disorders in a hospital-based family practice and to evaluate the utility of a diagnostic tool, the Patient Health Questionnaire (PHQ). METHODS: Ten or more patients each day were systematically selected in family practice clinics for two weeks in a university and a community hospital-based family practice clinics in Seoul, Korea. Routine care was delivered as a control during the first week and the PHQ was administered to patients during the second week and the physicians were allowed to review the PHQ just before making clinical decisions. Physicians were asked to answer whether they recognized patients' with mental disorders before reviewing the PHQ. RESULTS: The prevalence of mental disorders was higher in the test group than the control except for eating disorders and other anxiety disorders (P <0.05)(test vs. control group): major depressive disorders 1.75% vs. 3.8%, other depressive disorders 6.8% vs. 11.4%, panic disorders 0.6% vs. 2.3, somatoform disorders 3% vs. 5%, alcohol abuse 2.2% vs. 8.7%, and any mental disorders 20.9% vs. 29.4%. In the test group, the percentage (95% confidence interval in parenthesis) of newly diagnosed mental disorders after physicians' review of the PHQ were 66% (49~82) in major depressive disorders, 70% (50~90) in panic disorders, 70% (56~83) in somatoform disorders, 84% (75~92) in alcohol abuse, and 68% (62~74) in any mental disorders. Patients' response to the PHQ was overall very receptive. CONCLUSION: One-week prevalence of common mental disorders in the hospital-based family practice was 29.4% and the PHQ tool was efficient to help the family physicians recognize hidden mental disorders.
Alcoholism ; Anxiety Disorders ; Confidence Intervals ; Depressive Disorder ; Depressive Disorder, Major ; Diagnosis ; Eating Disorders ; Family Practice* ; Humans ; Korea* ; Medical History Taking ; Mental Disorders* ; Panic Disorder ; Physicians, Family ; Prevalence* ; Primary Health Care ; Seoul ; Somatoform Disorders ; Surveys and Questionnaires

The secondary amyloidosis (AA type), a complication of inflammation or infection, is caused by the deposition of serum amyloid protein A in various organs. The clinical manifestations of amyloidosis are various according to involved organs. The gastrointestinal tract is one of the commonly affected organs. However, the endoscopic findings of gastrointestinal amyloidosis are nonspecific, and symptoms are diverse. Hepatic involvement of amyloidosis rarely leads to hepatic dysfunction, threfore is not a clinical concern. We report a 54-year-old women with intestinal tuberculosis whose major symptom was watery diarrhea lasting several months. The amyloid deposits were histologically proven in the rectum of which mucosa showed redness and swelling endoscopically and hepatic involvement of amyloidosis was suspected on abdominopelvic CT scan. After anti-tuberculosis medication for 6 months, abdominopelvic CT scan showed resolution of hepatic involvement and colonoscopy revealed improvement of redness and loss of vascularity of the rectum.
Amyloidosis* ; Colonoscopy ; Diarrhea ; Female ; Gastrointestinal Tract ; Humans ; Inflammation ; Middle Aged ; Mucous Membrane ; Plaque, Amyloid ; Rectum ; Serum Amyloid A Protein ; Tomography, X-Ray Computed ; Tuberculosis*

The secondary amyloidosis (AA type), a complication of inflammation or infection, is caused by the deposition of serum amyloid protein A in various organs. The clinical manifestations of amyloidosis are various according to involved organs. The gastrointestinal tract is one of the commonly affected organs. However, the endoscopic findings of gastrointestinal amyloidosis are nonspecific, and symptoms are diverse. Hepatic involvement of amyloidosis rarely leads to hepatic dysfunction, threfore is not a clinical concern. We report a 54-year-old women with intestinal tuberculosis whose major symptom was watery diarrhea lasting several months. The amyloid deposits were histologically proven in the rectum of which mucosa showed redness and swelling endoscopically and hepatic involvement of amyloidosis was suspected on abdominopelvic CT scan. After anti-tuberculosis medication for 6 months, abdominopelvic CT scan showed resolution of hepatic involvement and colonoscopy revealed improvement of redness and loss of vascularity of the rectum.
Amyloidosis* ; Colonoscopy ; Diarrhea ; Female ; Gastrointestinal Tract ; Humans ; Inflammation ; Middle Aged ; Mucous Membrane ; Plaque, Amyloid ; Rectum ; Serum Amyloid A Protein ; Tomography, X-Ray Computed ; Tuberculosis*