The career choices of medical students are significant for both individual students and society, which relies on a robust public healthcare system. Medical schools should provide a conducive environment and diverse information to enable students to make mature career decisions. Yonsei University College of Medicine conducts extracurricular programs for students’ career development, including the Career Choice Expo, Career Path Survey, Special Lecture on Career Development, and a Visible Radio Show focused on career counseling. Additionally, the intracurricular activities offered by the college include career advising to students through faculty advisors in learning communities based on students’ reflective writing about career-related activities. Medical students, in the process of forming their career decisions, compare what they have learned in the medical school curriculum with information acquired through extracurricular activities, taking into consideration their individual characteristics. Through longitudinal discussions with faculty advisors in learning communities, medical students not only gain recognition for the validity of their exploratory activities but also develop a sense of self-efficacy in making career decisions. The career education program at Yonsei University College of Medicine aligns with recent perspectives emphasizing the integration of career counseling for medical students into the curriculum in order to increase effectiveness.

A physician’s empathy plays a crucial role in patient-centered care, and in modern medicine, patients, their caregivers, and society demand a high level of empathy from healthcare providers. The conceptualization of clinical empathy, which has emphasized cognitive empathy since the mid-20th century, has been widely accepted in medical schools and the healthcare industry without much critical reflection. This study provides an overview of the ongoing debates on empathy versus sympathy and cognitive empathy versus affective empathy to clarify the concept of empathy. Based on recent research findings, clinical empathy is proposed to encompass three components: cognitive empathy, affective empathy, and empathic motivation. It is suggested that fully demonstrating these components requires empathic communication skills. Additionally, the cognitive characteristics of medical students and the features of the academic environment demonstrate the need for education to strengthen their empathy skills. Considering this, proposed intervention methods that medical schools can consider include utilizing tutoring programs and debriefing processes for team activities, which can facilitate problem-solving as a coping strategy for stress. Learning communities can create an environment where students can receive social support and recover from stress. Medical schools can contribute to the development of students' professional identities as practicing clinicians who embody empathy and respect by cultivating professors as positive role models. Additionally, utilizing scales to assess the empathic nature of doctor-patient communication or incorporating patients and caregivers as evaluators can actively improve empathic communication skills.

PURPOSE: To report the anatomic and visual results of vitrectomy without scleral buckling in rhegmatogenous retinal detachment. METHODS: Primary vitrectomy without scleral buckling for the treatment rhegmatogenous retinal detachment was done in 41 eyes (41 patients) and followed up for a mean period of 21.5 months(range 6~65 months). Indications of primary vitrectomy were uncertain preoperative breaks, the presence of large breaks, the presence of breaks near equator, multiple breaks, proliferative vitreoretinopathy not related to breaks and presence of inferior vitreous hemorrhage. RESULTS: The anatomic success rate after a single operation was 90.2%. Visual acuity was improved or stable in 37 eyes (90.2%). Progression of lens opacity (35.7%) and formation of epiretinal membrane (12.2%) constituted the major complications after primary vitrectomy. CONCLUSIONS: Primary vitrectomy without scleral buckling can be a safe, effective method to repair primary rhegmatogenous retinal detachments in selective cases.
Cataract ; Epiretinal Membrane ; Retinal Detachment* ; Retinaldehyde* ; Scleral Buckling ; Visual Acuity ; Vitrectomy* ; Vitreoretinopathy, Proliferative ; Vitreous Hemorrhage

PURPOSE: To report a case of temporal hemianopsia of a healthy eye occurring in the contralateral silicone oil-filled eye due to migration of silicone oil into the optic chiasm and lateral ventricle. CASE SUMMARY: A 56-year-old man visited our clinic with temporal hemianopsia for 10 days in the left eye. Three months before, the patient had presented with decreased vision and ocular pain in the right eye as well as a headache. The patient underwent vitrectomy at another hospital for the management of retinal detachment occurring in the right eye 8 years earlier. In addition, for recurred retinal detachment, reoperations were performed twice with silicone oil injection. Funduscopy revealed findings such as glaucomatous optic disc and an intraocular pressure of 54 mmHg in the right eye. On visual field examination, the temporal hemianopsia was detected in the left eye. Under the suspicion of cerebral lesions, a magnetic resonance imaging (MRI) examination was performed. On the right side of the optic chiasm and the suprasellar region, materials were present whose signal intensity was identical to silicone oil in the right vitreal cavity. During a follow-up, the migration of silicone oil into the lateral ventricle and the alteration of its location with the positional change were observed. CONCLUSIONS: In a patient who received silicone oil injection following vitrectomy, the silicone oil migrated to the optic chiasm and induced the occurrence of visual field defect in the contralateral eye. The visual field defect improved because of the migration into the lateral ventricle.
Eye ; Follow-Up Studies ; Glaucoma ; Headache ; Hemianopsia ; Humans ; Intraocular Pressure ; Lateral Ventricles ; Magnetic Resonance Imaging ; Middle Aged ; Optic Chiasm ; Retinal Detachment ; Silicone Oils ; Vision, Ocular ; Visual Fields ; Vitrectomy

Scedosporium apiospermum is a rising opportunistic fungus that may infect immunocompetent individuals and may cause often fatal disease among the increasing immunosuppressed patient population. This pathogen is typically difficult to treat because of its particular resistance to commonly used antimycotic drugs. We describe an 83-year-old male patient with a history of long-term corticosteroid treatment for chronic prurigo simplex, who developed multiple suppurative nodules on a erythematous plaque at the right forearm. Histological examinations revealed granulomatous infiltration with hyphae and spores in dermis and fungal cultured isolation for definitive diagnosis showed S. apiospermum. Treatment was started with oral fluconazole, but skin lesions were getting worse. Then patient was treated with 200 mg of intravenouse itraconazole daily. Skin lesions showed a marked improvement after 1 week, and completely healing after 3 weeks.
Aged, 80 and over ; Dermis ; Fluconazole ; Forearm ; Fungi ; Humans ; Hyphae ; Itraconazole ; Male ; Methylmethacrylates ; Polystyrenes ; Prurigo ; Scedosporium ; Skin ; Spores

PURPOSE: To report late complications of hydrogel buckles (MIRAgel explant, MIRA, Waltham, U.S.A.) from use in scleral buckling surgery for retinal detachment. METHODS: The clinical records of 10 patients who underwent MIRAgel removal between January 1993 and March 2005 were reviewed. Preoperative computerized tomography (CT) scans were examined in three patients with suspected orbital mass. The unused and removed MIRAgel were examined by scanning electron microscopy (SEM). RESULTS: The average interval to MIRAgel removal was 9.4 years. Patients presented with complaints of restricted gaze (6 cases), exposed buckle (6 cases), palpebral mass (5 cases), and periorbital swelling (3 cases). Initially, 4 patients were misdiagnosed with orbital tumor or cellulitis. MIRAgel were removed by transconjunctival or skin incision, (totally in 7 eyes and partially in 3 eyes). CT scans showed circumferential soft tissue mass surrounding the globe with a peripherally-enhancing rim. SEM showed that unused samples had a smooth surface and uniformly sized micropores. The surfaces of the removed MIRAgel were uneven, with micropores that were distorted in shape and irregular in size. CONCLUSIONS: Because late complications with MIRAgel have various clinical aspects, complete history taking and ophthalmic examination are essential in making an accurate diagnosis and choosing proper treatment. Patients with MIRAgel should be followed up periodically, and its timely removal should be considered.
Cellulitis ; Diagnosis ; Humans ; Hydrogel* ; Microscopy, Electron, Scanning ; Orbit ; Retinal Detachment ; Scleral Buckling* ; Skin ; Tomography, X-Ray Computed

PURPOSE: To report late complications of hydrogel buckles (MIRAgel explant, MIRA, Waltham, U.S.A.) from use in scleral buckling surgery for retinal detachment. METHODS: The clinical records of 10 patients who underwent MIRAgel removal between January 1993 and March 2005 were reviewed. Preoperative computerized tomography (CT) scans were examined in three patients with suspected orbital mass. The unused and removed MIRAgel were examined by scanning electron microscopy (SEM). RESULTS: The average interval to MIRAgel removal was 9.4 years. Patients presented with complaints of restricted gaze (6 cases), exposed buckle (6 cases), palpebral mass (5 cases), and periorbital swelling (3 cases). Initially, 4 patients were misdiagnosed with orbital tumor or cellulitis. MIRAgel were removed by transconjunctival or skin incision, (totally in 7 eyes and partially in 3 eyes). CT scans showed circumferential soft tissue mass surrounding the globe with a peripherally-enhancing rim. SEM showed that unused samples had a smooth surface and uniformly sized micropores. The surfaces of the removed MIRAgel were uneven, with micropores that were distorted in shape and irregular in size. CONCLUSIONS: Because late complications with MIRAgel have various clinical aspects, complete history taking and ophthalmic examination are essential in making an accurate diagnosis and choosing proper treatment. Patients with MIRAgel should be followed up periodically, and its timely removal should be considered.
Cellulitis ; Diagnosis ; Humans ; Hydrogel* ; Microscopy, Electron, Scanning ; Orbit ; Retinal Detachment ; Scleral Buckling* ; Skin ; Tomography, X-Ray Computed

IgG4-related disease (IgG4-RD) is a new disease entity characterized by elevated serum IgG4 and infiltration of IgG4+ plasma cells in tissue. IgG4-RD can involve various organs, and skin could also be affected. The manifestations of IgG4-related skin disease (IgG4-RSD) are not characteristic, however it usually presents with multiple erythematous nodules or plaques with itching sensation. We report two cases of IgG4-RSD. Histological studies of these cases revealed infiltration of numerous plasma cells and mononuclear cells in the entire dermis. Some plasma cells were strongly positive for IgG4 stain. IgG4-RSD is a treatable disease with systemic corticosteroids. Thus, clinicians should obtain a biopsy and identify IgG4-positive cells for an accurate diagnosis.
Adrenal Cortex Hormones ; Biopsy ; Dermis ; Diagnosis ; Immunoglobulin G ; Plasma Cells ; Pruritus ; Sensation ; Skin Diseases* ; Skin*

OBJECTIVES: To report cubital tunnel syndrome due to repetitive motions. METHODS: A worker complaining muscle weakness and atrophy of the right hand intrinsic muscles admitted to a hospital. We evaluated him with blood tests, neurophysiologic studies (NCV & EMG), plain X-ray and US at the both elbows. We investigated his occupational history, and videotaped his work motions based on the work cycle at his previous work site. Finally, an ergonomics expert analyzed the motions using rapid upper limb assessment (RULA). RESULTS: NCV & EMG studies reveals slow conduction velocity on both ulnar nerve across the elbow, more severely in the right side. US shows us compatible finding with diffuse neuritis of both ulnar nerves at both elbows. RULA score is 7. CONCLUSION: We confirmed that the workers symptoms were related to his previous jobs demanding repetitive motions using the elbow joints. It is necessary that we should prepare appropriate measures to evaluate, prevent, rehabilitate, and help injured workers to return to work.
Atrophy ; Cubital Tunnel Syndrome* ; Cumulative Trauma Disorders ; Elbow ; Elbow Joint ; Hand ; Hematologic Tests ; Human Engineering ; Muscle Weakness ; Muscles ; Neuritis ; Return to Work ; Ulnar Nerve ; Upper Extremity ; Workplace

BACKGROUND: Langerhans cell histiocytosis (LCH) is a well-known neoplastic disorder of Langerhans cells which has characteristic findings, however, LCH has not been adequately studied in Korea. METHODS: We analyzed the clinicopathologic features of 20 patients with LCH who were diagnosed between 1997 and 2006 at the Korea University Guro and Anam Hospitals. RESULTS: The M:F ratio was 3:1 and the age ranged from 2-60 years (mean, 23.8 years [4 in 1st decade, 6 in 2nd decade, 2 in 3rd decade, 5 in 4th decade and 3> or =40 years of age). The cases were classified as unifocal unisystemic in 13 patients, multifocal unisystemic in 4 patients, and multifocal multisystemic in 3 patients. The bone was the most commonly involved organ (14), followed by lymph node (5), lung (2), skin (2) and ureter (1). The Langerhans cells were immunohistochemically stained with Langerin, CD1a, S-100 protein, and CD68. Langerin and CD1a were specific for Langerhans cells. CONCLUSIONS: The distribution of the involved organs in patients with LCH was similar to the distribution in Western countries, but lymph node involvement was more frequent, whereas lung involvement was less common. Langerin is considered to be a specific marker for Langerhans cells.
Histiocytosis, Langerhans-Cell ; Humans ; Korea ; Langerhans Cells ; Lung ; Lymph Nodes ; S100 Proteins ; Sensitivity and Specificity* ; Skin ; Ureter