Primary care physicians who can deliver high quality primary care services are essential for strengthening the primary health care system. In Korea, primary care was regarded as substandard services practiced by any medical doctor without postgraduate education in primary care. The current and future health care systems are challenged by increasing complexity and co-morbidity and healthcare costs in medical care. The developed countries are preparing for the future by increasing support for basic, postgraduate, and continuing medical education in primary care. To strengthen the primary care in Korea, basic medical education programs should require experience in primary care clinics with a teaching and education function. Postgraduate primary care medical education must be enhanced to be qualified to practice in the community. The recognition of the importance of primary care and the need for changes in the current education and healthcare system among medical professionals and other stakeholders and support systems such as legislation and finance for primary care medical education.
Delivery of Health Care ; Developed Countries ; Education, Medical ; Education, Medical, Continuing ; Health Care Costs ; Humans ; Korea ; Physicians, Primary Care ; Primary Health Care ; Residence Characteristics

In addition to the traditional MCQ test, National Medical Licensing Examination Board (NMLEB) will introduce clinical skills assessment as an independent exam for MD qualification in 2009. The clinical skills test will evaluate six procedural skills and six clinical problems by using OSCE and CPX. The validity and reliability of the test should be established by continuing effort from experts and efficient administration. The test may change the curriculum of clinical education in many medical schools. National Health Personnel Licensing Examination Board (NHPLEB) is required to prepare this exam step by step and maintain the quality of the skills exam. There should be opportunity for medical students to participate in clinical practice during bedside teaching. Collaboration between exam institution and medical schools will be needed for a successful launching of the skills test.
Clinical Competence ; Cooperative Behavior ; Curriculum ; Health Personnel ; Humans ; Licensure ; Reproducibility of Results ; Schools, Medical ; Students, Medical

No abstract available.

PURPOSE: Standardized patients participate in clinical performance examinations not only to simulate case scenarios but also to evaluate the performance of students using a checklist. The accuracy in checking off checklist items is one of the most important factors determining the reliability of this examination. The purposes of this study were to determine the SP' s overall accuracy in recording checklist items, and whether their accuracy was affected by certain characteristics of checklist items. METHODS: Three professors, who have been fully involved in scenario development and SP training, reviewed videotapes of the examination and evaluated the performance of the students using the same checklist. SP' s checklists were marked on this 'correct checklist'. The checklists and checklist guidelines of the items marked under the score of 50 out of 100 were analyzed. RESULTS: Results showed that the accuracy of the SP' s in recording checklist items was 86.9% and was affected by certain characteristics, such as complexity or ambiguity of checklists and checklist guidelines. CONCLUSION: In this study, the SP' s accuracy in recording checklist items was good to very good, and the result suggested that the accuracy could be improved by the elaboration of checklists and checklist guidelines.
Checklist* ; Educational Measurement ; Humans ; Observer Variation ; Videotape Recording

No abstract available.

BACKGROUND: New educational objectives and evaluation methods in Korean medical schools have been suggested recently to cope with health care related environmental changes. Current status of family medicine clinical clerkships in Korean medical schools is to be known before establishing standards. METHODS: Educational Committee of Korean Academy of Family Medicine surveyed the family medicine clerkship in Korean medical school (about educational environment, subjects and evaluation methods) using structured questionnaires by e-mail and Fax from February through March in 2004. RESULTS: Family medicine clinical clerkship was run by 25 of 41 medical schools (65.9%). Educational subject areas included communication skill, observation in hospital based ambulatory office, primary care and family medicine, medical recording, diagnosis and treatment of common problems, residential out-hospital ambulatory programs, presentation of hospital based ambulatory programs, procedure skill, lifelong heath management plan, and health promotion, in descending order. Faculties of family medicine were directly in charge of educational subjects. However, educational methods were mainly composed of lectures and indirect observation. It should be noted that concrete and precise evaluation methods in the family medicine clerkship program had been lacking due to insufficient and obscure evaluation strategies. CONCLUSION: Clerkship period, educational environment, and number of class were variable among medical schools in Korea. Educational format needs to be standardized in terms of common educational subjects such as communication skill education, patient education, and ambulatory care clerkship. More valid methods are to be introduced for family medicine clerkship evaluation.
Ambulatory Care ; Clinical Clerkship* ; Delivery of Health Care ; Diagnosis ; Education ; Electronic Mail ; Health Promotion ; Humans ; Korea ; Lectures ; Medical Records ; Methods ; Patient Education as Topic ; Primary Health Care ; Schools, Medical* ; Surveys and Questionnaires

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: Hormone replacement therapy (HRT) is the most effective treatment for climacteric symptoms. It also has definitive role in reducing or preventing the risk of osteoporosis. However, compliance with HRT is very poor. This study was conducted to know the compliance of hormone replacement therapy and investigate the determining factors for compliance. METHODS: Review of charts and telephone questionnaires were completed among 107 women who had received HRT in a family medicine clinic at a university hospital. Compliance was determined by the medication availability ratio (MAR): (HRT treated days)/(total number of observed days). An individual with MAR less than 0.75 was considered as partial compliance, and more than 0.75 was considered as complete compliance group. RESULTS: The average age of 107 subjects was 57.4 years. Among the 107 study subjects, 59 persons (55.1%) were compliant with HRT. Mean observation period was 17.6 months. The compliance with HRT was 60.9%, 55.1%, 49.6% at 12, 24, 36 months, respectively. The compliance was higher in high-perception group compared to low- perception group (P=0.01). Education level, presence of osteoporosis, hysterectomised state, difference in doctor and past fracture history were not associated with compliance. The reasons for starting HRT were physician's recommendation, osteoporosis prevention, treatment of menopausal symptoms, and influence of mass media, in descending order. CONCLUSION: The compliance with HRT was 61% at one- year treatment and 50% at three-year teatment period. Positive attitude for HRT was related to higher compliance with HRT. Patient education on HRT is essential for successful compliance of HRT.
Climacteric ; Compliance* ; Education ; Female ; Hormone Replacement Therapy* ; Humans ; Mass Media ; Osteoporosis ; Patient Education as Topic ; Telephone ; Surveys and Questionnaires

BACKGROUNG: Family medicine clerkship gives undergraduate medical students the opportunity to integrate knowledge and skills taught in class. Impression from clerkship experience and preceptor's role model allow medical students to consider family medicine as a career choice. This study investigated the effect of family medicine clerkship on the preference for family medicine as a career choice in third-year medical students. METHODS: From July through December of 1995, one hundred third-year medical students attended family medicine clerkship at Hanyang University Medical School (HUMS). They were divided into 20 groups of 4~6 students. Seven half-days of clerkship teaching were provided in a private family medicine clinic and 2 half-days, in an university hospital family medicine clinic. The score of preference for family medicine was measured using the 10 cm visual analogue scale. RESULTS:The subjects' mean age was 24.1 years. Eighty eighty percent of students were males. The mean score of preference for family medicine as a career choice were 3.2 for pre-clerkship, 6.9 for post-clerkship, and 7.0 at the end of third-year semester exam, respectively. The group preference score was different among groups. Sex, age, hometown, parents' occupation, inhabitation type, religion, and lecture exam score were not related to the preference score. Eleven percent of students hoped to specialize in family medicine in the future. The students' main conception of family medicine were 'primary care', and 'comprehensive care', in descending order. CONCLUSION: Third-year family medicine clinical clerkship improved the students' preference for family medicine as a career choice. A continuous program needs to be developed to render positive effect into the final stage of resident selection.
Career Choice* ; Clinical Clerkship ; Education ; Family Practice ; Fertilization ; Hope ; Humans ; Male ; Occupations ; Schools, Medical ; Students, Medical*

BACKGROUND: Establishing effective communication between doctor and patient help doctors treat their patients easily and influence patient's compliance with medical regimen and treatment outcome. The objective of this study was to evaluate common characteristic of third-year medical student's behavior in their patient interview and apply these results to medical education of communication. METHODS: Ninety-one third-year medical students in Hanyang University College of Medicine through their clerkship in family medicine had been instructed to perform medical interviews of patients who visited the Department of Family Medicine of Hanyang University Hospital. Video-taped records of the interviews using CCTV were done. The evaluation was done with a rating scale table consisting of 20 items. The rating scale was categorized in to 5 areas: beginning the interviews, collection of information, doctor-patient relationship, structure of interview and ending the interview. RESULTS: Among the 62 students who were enrolled in the study, 55 students were males(84%). In the process of collecting information 33 students(53%) applied open-ended question at least once. Eighteen students(29%) used leading question. In the doctor-patient relationship, 3 students gave empathic verbal response among 58 records which were applicable. In the structure of interview, 25 students(40%) appropriately avoided to shift abruptly the focus of discussion. When ending their interviews, 6 students(10%) clarified the interview in whole. CONCLUSIONS: We conclude that there are several deficiencies in medical students' communication skills during their process of interviews that might influence information gathering and doctor-patient relation ship.
Compliance ; Education, Medical ; Humans ; Physician-Patient Relations ; Ships ; Students, Medical* ; Treatment Outcome