BACKGROUND: One of the main objectives of medical school is to provide high-quality primary care physicians. To fulfill this objective it is increasingly important to utilize ambulatory care setting, particularly community private practice clinic for medical students' clerkship. But program evaluation of this type of clerkship is lacking. The authors intended to evaluate the community primary care clerkship with a view to students' perspective. METHODS: We used students' and preceptors' evaluation forms with semi-structured questionnaires using 5-point Likert scale and students' essays for program evaluation. We analyzed 76 students' and 89 preceptors' evaluation forms by description, and categorized emergent themes from 89 students' essays using qualitative method. RESULTS: Over seventy percent of students rated overall satisfaction, achievement of knowledge, preceptors' educational effort, and practical application as excellent on the 5-point Likert scale. In the evaluation of the discussion topics with preceptors, they rated medical insurance and health care delivery system as relatively poor compared to other topics such as realities of private practice, management of private practice and equipments necessary in primary care. They understood positively the importance of patient characteristics and good patient-physician relationship in primary care, and the realities of private practice. They were also concerned about the problems of health care system and assumed a sound suspicion whether the education in medical school was practical in primary care. On the other hand, they showed ambivalence towards expressing the negative aspect of primary care in terms of the repetition of simple cases and lack of stimulation to achieve sophisticated medical knowledge. CONCLUSIONS: Community primary care clerkship was generally satisfactory in the students' perspective, which is necessary to standardize preceptor education and establish a role model of primary care in order to provide the soil for high-quality primary care physician.
Ambulatory Care ; Delivery of Health Care ; Education ; Education, Medical ; Hand ; Humans ; Insurance ; Physicians, Primary Care ; Primary Health Care* ; Private Practice ; Program Evaluation ; Schools, Medical ; Soil ; Surveys and Questionnaires

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive. It is a major cause of morbidity and mortality worldwide, leading to substantial and increasing economic and social burden. Palliative care for COPD patients aims to reduce symptoms and exacerbations and improve exercise tolerance and quality of life. It is difficult to make a prognosis for COPD patients due to the variable illness trajectory and advanced care of patients. However, severity of breathlessness, assessment of lung function impairment, and frequency of exacerbations can help to identify palliative care needs and determine effective methods to mitigate symptoms, which is discussed in this paper. In these patients, it is recommended to provide individualized palliative care along with curative/restorative care at the onset of COPD symptoms. Before launching a palliative care system in Korea, it is necessary to prepare pulmonary rehabilitation resources, patient-centered communication, timely palliative responsiveness, and a program for effective advanced care planning. A multidisciplinary approach involving collaboration with not only the respiratory and palliative care teams but also primary care offers a new model of care for these patients and should be considered with a priority.
Cooperative Behavior ; Dyspnea ; Exercise Tolerance ; Hospice Care ; Hospices* ; Humans ; Korea ; Lung ; Mortality ; Palliative Care* ; Primary Health Care ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Rehabilitation ; Respiratory Therapy

Although the result of low dose computed tomography (LDCT) screening for high risk smoker for lung cancer (National Lung Screening Trial, NLST) showed 20% of lower lung cancer death compare to chest X-ray screening, which published in 2011, after more than 8 years passed, no European or Asian country has implemented organized lung cancer screening with LDCT, and there are no National Lung Cancer Screening Program globally. In United States, where LDCT lung screening has become standard procedure, the screening rate is extremely low, less than 5%. That is because in spite of the considerable the benefit of the screening, the harms of screening; specifically, most notably due to the high level of false positives, and physical, psychological, and economical burdens. Recently the controversies regarding the harms of LDCT lung screening has been increasingly debated. Also, the novel strategies, such as artificial intelligence and volumetric measurement of suspicious nodules has been adopted for recently launched lung cancer screening clinical trials. However, amid of skeptical opinions increasing globally, Korean Government recently decided to include LDCT lung cancer screening as national cancer screening program, becoming Korea as the first and the only national lung cancer screening program worldwide. Without randomized trial proven to be effective for Korea population, hurried implementation of national lung cancer screening program could have more harmful effect than benefit in terms of public health perspectives.
Artificial Intelligence ; Asian Continental Ancestry Group ; Early Detection of Cancer ; Humans ; Korea ; Lung Neoplasms ; Lung ; Mass Screening ; Public Health ; Thorax ; United States

Although the result of low dose computed tomography (LDCT) screening for high risk smoker for lung cancer (National Lung Screening Trial, NLST) showed 20% of lower lung cancer death compare to chest X-ray screening, which published in 2011, after more than 8 years passed, no European or Asian country has implemented organized lung cancer screening with LDCT, and there are no National Lung Cancer Screening Program globally. In United States, where LDCT lung screening has become standard procedure, the screening rate is extremely low, less than 5%. That is because in spite of the considerable the benefit of the screening, the harms of screening; specifically, most notably due to the high level of false positives, and physical, psychological, and economical burdens. Recently the controversies regarding the harms of LDCT lung screening has been increasingly debated. Also, the novel strategies, such as artificial intelligence and volumetric measurement of suspicious nodules has been adopted for recently launched lung cancer screening clinical trials. However, amid of skeptical opinions increasing globally, Korean Government recently decided to include LDCT lung cancer screening as national cancer screening program, becoming Korea as the first and the only national lung cancer screening program worldwide. Without randomized trial proven to be effective for Korea population, hurried implementation of national lung cancer screening program could have more harmful effect than benefit in terms of public health perspectives.

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

With the early detection of cancer and improvement in cancer therapy, the number of cancer survivors is rapidly increasing. This number is expected to reach 2 million by the end of 2019. Cancer survivors struggle with not only cancer-related health problems but also diverse acute and chronic diseases. These health issues make cancer survivorship more complex, and proper care coordination is necessary. This study aimed to summarize the definition of cancer experience and management of cancer survivors, specifically focused on gastric, colorectal, lung, breast, thyroid, prostate, and cervical cancers. Furthermore, it aimed to discuss the role of primary care in cancer survivorship and survivorship care models and the National Policy for Cancer Survivors and Future Challenges.
Breast ; Chronic Disease ; Early Detection of Cancer ; Health Promotion ; Humans ; Lung ; Primary Health Care ; Prostate ; Survival Rate ; Survivors ; Thyroid Gland

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

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

BACKGROUND: Urinary incontinence (UI) is highly prevalent in the aging population. UI is one of the most common geriatric syndromes and affects overall health, quality of life, and economical burden in patients. The aims of this study were to investigate the characteristics of patients with UI and to assess its association with other geriatric health problems. METHODS: We used data from the Korean Longitudinal Study of Ageing obtained in 2006. Among the 10,254 individuals aged 45 years and older, we analyzed data from 2,418 women aged 65 years and older. Data were obtained using questionnaires for UI, comorbidities, and lifestyle factors. RESULTS: Among the 2,418 women aged 65 years and older, 506 (20.9%) had UI. Cerebrovascular disease (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.26 to 3.23), arthritis (OR, 1.44; 95% CI, 1.18 to 1.77), and fear of falling (OR, 1.62; 95% CI, 1.18 to 2.22) were significantly associated with UI, while chronic lung disease, psychiatric disease, difficulty in daily living due to visual and hearing problems, and experiencing a fall in the last 2 years were not associated with UI. CONCLUSION: Cerebrovascular disease, arthritis, and especially fear of falls were significantly associated with UI in elderly Korean women.
Accidental Falls ; Aged ; Aging ; Arthritis ; Cerebrovascular Disorders ; Comorbidity ; Female ; Geriatrics ; Hearing ; Humans ; Life Style ; Longitudinal Studies ; Lung Diseases ; Quality of Life ; Urinary Incontinence