경북대학교 의과대학의 문제중심학습 시행과 그 평가

장봉현(Bong Hyun Chang),이유철(Yoo Chul Lee),김보완(Bo Wan Kim),강덕식(Duk Sik Kang),곽연식(Yun Sik Kwak),강이철(E-cheol Kang),서강석(Kang Suk Seo),김인겸(In Kyeom Kim),이종명(Jong Myung Lee),정성훈(Sung Hoon Jeong),김종열(Jong Yeol 한국의학교육학회 2001 Korean journal of medical education Vol.13 No.1

문제중심학습 (PBL)은 주어진 실제 환자문제를 학생 스스로 파악하여 학습과제를 설정하며, 학습한 내용을 논리적으로 적용하여 타당한 가설을 세워가는 과정을 거침으로써 학습이 이루어지는 새로운 교육 방법이다. 경북대학교 의과대학은 PBL을 도입하기 위하여 캐나다의 McMaster 의과대학을 단기 방문하여 그곳의 의학교육을 경험하고 PBL의 필요성을 절감하여, 1994년부터 2년간 시범적으로 PBL 수업을 운영한 후, 2년간 평가와 보완기간을 가졌다. 1994년부터 1996년까지 전학기에는 4학년과 3학년, 후학기에는 3학년과 2학년을 대상으로 6명을 한 조로, 45개의 소그룹을 만들고, 각 조에는 한 명의 지도교수를 배정하여 격주로 목요일 4교시에 PBL수업을 진행하였다. 설문조사 결과 4학년은 55.1%가, 3학년은 61.4%가 PBL이 필요하다고 응답하였으며 교수들은 83.9%가 필요하다고 답하였다. 이와 같은 결과에 근거하여 1999년도부터 시작하는 개편된 의학교육과정에 PBL이 정규과목으로 채택되었고, 이에 대비하여 1998년도 2학기에 의예과 2학년 학생을 대상으로 하여 PBL을 시행하여 그 결과를 평가하였다. 1999년도에는 의학과 1학년을 대상으로, 2000년도에는 의학과 2학년까지의 학생을 대상으로 PBL수업을 실시하였다. 본 연구자들의 조사에서, 학생들이 PBL에 대하여 상당히 이해하고 있으며, PBL의 학습목적을 대부분 달성한 것으로 나타나, 정규과목으로서의 PBL 시행에 전반적으로 긍정적인 평가를 한 것으로 판단되며, 조사결과에서 나타난 단점과 부족한 부분을 보완하고 개선한다면 PBL를 정착시키고 점차 확대 시행할 수 있을 것으로 생각된다. The effectiveness of Problem-based Learning (PBL) in medical education has already been acclaimed widely. Representatives of the curriculum committee at Kyungpook National University School of Medicine paid a visit to McMaster University School of Medicine in Canada in May, 1994 in order to learn mechanics and effectiveness of PBL in its medical education and they were impressed by the efficacy of PBL. Soon after that the school launched a pilot PBL tutorial for two years from 1994 through 1996 (4-semester) as a non-credit course for senior, junior and sophomore in medical school during one semester each, to introduce PBL to faculty members and students as well. After the pilot, opinion survey on PBL from both faculty and students revealed affirmative for PBL from 55.1% of seniors, 61.4% of juniors and 83.9% of faculty members. The faculty body at medical school was then encouraged by the pilot experience and decided to include the PBL as the part of medical education reform. During the fall semester in 1998, the senior at pre-medical course was given PBL experience to prepare for implementation of PBL at school of medicine. The PBL was implemented as an essential 2-credit-hour course in each semester commencing in 1999 to the freshmen class throughout the year; it was extended to the sophomore in 2000 and to the junior in 2001. Although there had been initial excitements of over expectations, confusion, and disappointments from faculty members and students, majority opinion of both parties on continuation of PBL was positive. The issues to be settled are preparation of study cases, students learning resources, and method of evaluating students performance. The PBL was started as an essential course in medical school in 1999 after 4 years of preparation and on the basis of our interim evaluations the following conclusions were made: we have reached the following consensus that students seem to follow the objectives of PBL and new PBL tutorial has well been accepted by students; and enhancing the program by correcting currently known weaknesses, the PBL tutorials could further be expanded to be a major modality of teaching in our medical school.

활로씨 4징증을 동반한 완전방실중격결손의 수술치험;1례 보고

김근,장봉현,이종태,김규태,Kim, Keun,Chang, Bong-Hyun,Lee, Jong-Tae,Kim, Kyu-Tae 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery Vol.25 No.8

A 25-month-old patient with complete atrioventricular septal defect and Tetralogy of Fallot underwent repair of both anomalies. The diagnosis was established preoperatively by 2D-echocardiography, cardiac catheterization and cardioangiogram, Repair was accomplished using cardiopulmonary bypass and profound hypothermia to 18C, Closing of the atrioventricular septal defect was achieved with the use of two Dacron patchs by an atrial approach alone. Infundibulectomy and outflow tract reconstruction with the transannular pericadial patch containing a monocusp were performed. Upon the postoperative evaluation by 2D-echocardiography, mitral regurgitation was absent, but a tiny dehiscence of ventricular patch and minimal tricuspid regurgitation were noticed.

심실중격결손의 크기 측정에 있어서 술전 검사의 의의

김근,장봉현,이종태,김규태,이상범,Kim, Keun,Chang, Bong-Hyun,Lee, Jong-Tae,Kim, Kyu-Tae,Lee, Sang-Bum 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery Vol.25 No.3

We evaluated the correlationship between the predicted defect size at preoperative examination and the actual defect size at operation room, by examining 69 cases of ventricular septal defect operated at the deparment of Thoracic and Cardiovascular surgery, Kyungpook University Hospital from January 1988 to December 1990. We excluded cases associated with other cardiac anomalies. Of the 69 cases, 39 are male and 30 female, forming 1.3:1 sex ratio in males favor. Their age range from 6 months to 16 year, and 4.3 on the average Their body weights are from 6 to 45kg and 15 on the average. According to Soto`s classification, perimembranous type costitutes 42 cases[61%], doubly committed subarterial type 23 cases[33%], and muscular type 4 cases[6%]. The average diameter of defect size is 8.0$\pm$3.5mm measured in 2D-echocardiogram, 5.6$\pm$3.4mm in angiogram, and 7.4$\pm$4.4mm in operative field. There is statistically significant correlation between the size from 2D-echocardiogram and actual defect size[p=0.001], and no significant difference between the two. Especially in the cases without anurysmal formation, they are nearly the same. Cardiothoracic ratio, pulmonary to systemic flow ratio, pressure ratio and resistance ratio also have statistically significant correlation. Main pumonary artery to descending aorta diameter ratio is correlated with the actual defect size. There is statistically significant correlation between the size from angiogram and actual defect size with some difference.

식도 자연파열[Boerhaave 증후군]의 외과적 치료;2례 보고

김근,장봉현,이종태,김규태,Kim, Keun,Chang, Bong-Hyun,Lee, Jong-Tae,Kim, Kyu-Tae 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery Vol.25 No.8

The spontaneous rupture of the esophagus is an uncommon disease, but without early diagnosis and treatment, the mortality rate is high. This report is on the two cases treated at the Department of Thoracic and Cardiovascular Surgery, College of Medicine, Kyu-ngpook National University. The first patient, after heavy drinking, had vomiting followed by chest pain, dyspnea and subcutaneous emphysema. After diagnosis using an esophagogram, an operation was perfomed. About a 4cm rupture was found at the lower left part of the esophagus and was primarily sutured with the intercostal muscle. The patient was weaned from the ventilator after 40 hours. The second patient had symptoms the same as the first case. Six days after the app-earence of the symptoms, the patient was treated by the Thais onlay gastric patch method. The leakage happened after the surgery and he received a conservative treatment. After discharge no abnormalities, such as leakage and stricture, were found on the eso-phagogram The two patients now live a normal life.

외과 집중치료실 환자의 임상적 고찰

김근,장봉현,이종태,김규태,Kim, Keun,Chang, Bong-Hyun,Lee, Jong-Tae,Kim, Kyu-Tae 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery Vol.26 No.5

We analyzed the patients who were admitted to Surgical Intensive Care Unit[SICU] of Kyungpook National University Hospital from January 1987 through December 1991. The results were as followings: The total number of patients for 5 years was 2446 and 1553[63.5%] were male,893[36.5%] were female. The average age was 34.1 years old and the greatest age group was the 1-9 age group.The number of the patients in the Department of Thoracic and Cardiovascular Surgery, which was the highest among all departments,was 1608 [65.7%].Congenital Heart disease was the most common among all diseases.The patients who had undergone any kinds of operations were 89.9% of all patients.The averge stay in SICU was 5.2 days.The overall mortality rate was 12.1% ,which included hopelessly discharged patients and the highest mortality rate occurred in the patients over 80 years old.The highest cause of death was cardiac problem[30.4%]. The next was sepsis.The proportion of patients who had received a mechanical ventilatory support was 35.7% and 52% of those patients belonged to the department of thoracic and cardiovascular surgery.

흉부 전산화 단층촬영상 임파절종대가 없는 비소세포암 환자에 있어서 술전 병기판정

차승익 ( Seung Ick Cha ),김창호 ( Chang Ho Kim ),박재용 ( Jae Yong Park ),정태훈 ( Tae Hoon Jung ),장봉현 ( Bong Hyun Chang ),강덕식 ( Duk Sik Kang ) 대한결핵 및 호흡기학회 1994 Tuberculosis and Respiratory Diseases Vol.41 No.6

일개 의과대학 의학과 학생의 학습양식

여상희(Sang Hee Yeo),이경우(Kyung Woo Lee),장봉현(Bong Hyun Chang),강이철(Echeol Kang),강덕식(Duk Sik Kang),곽연식(Yun Sik Kwak),김보완(Bo Wan Kim),이유철(Yoo Chul Lee),이종명(Jong Myung Lee),조희중(Hee Jung Cho),정제명(Jae Myung Chu 한국의학교육학회 2006 Korean journal of medical education Vol.18 No.1

Purpose: The purpose of this study is to investigate the learning styles of students at Kyungpook National University (KNU) School of Medicine and to assess its implications on teaching-learning methods in medical school. Methods: 571 students in all years of medical school were invited to complete a questionnaire via online. For this study, Felder s Index of Learning Styles (ILS) was used, which included 49 items. Felder s ILS measures the learner s relative preference for each of the five dichotomous learning style dimensions. Results: 242 (42.3%) students completed the questionnaire. More than 80% preferred sensitive information and more than 60% preferentially took in visual information. Both males and females preferred sensing and visual learning materials. On average, The students at KNU school of Medicine were reflective, sensing, visual, global and inductive. Conclusion: From these results, we suggested some effective methods of teaching-learning based on the students preferences and some perspectives for future works.

경북대학교 의학과 새 교육과정

이유철(Yoo Chul Lee),강덕식(Duk Sik Kang),강이철(Echeol Kang),곽연식(Yun Sik Kwak),김보완(Bo Wan Kim),장봉현(Bong Hyun Chang),조동규(Dong Kyu Cho),조희중(Hee Jung Cho) 한국의학교육학회 2001 Korean journal of medical education Vol.13 No.1

경북대학교 의과대학에서는 1996년 의학과 인정 평가시 지적된 교육과정의 문제점인 강의위주 및 과다한 강의 시간, 자율학습 기회 부족등의 문제점을 보완하고 또한 의학과 교육 목표를 구현하기 위한 새로운 교육과정을 1999학년도부터 도입 운영하고 있다. 새 교육과정의 기본 이념은 환자 중심으로 생각할 수 있는 의료인을 양성하기 위하여 임상실습을 강화하며, 학생 중심으로 자율 학습을 유도하고, 문제 중심 교육을 하며, 강의는 개념정립이 용이하도록 통합 교육을 시행하는 것이다. 전체 학점 및 강의시간수는 180학점 4395시간에서 170학점 4256시간으로 줄였으며, 변화하는 사회적 요구에 부응 할 수 있는 의사를 양성하기 위하여 1, 2학년 과정에 의료와 사회, 환자-의사 관계 강좌를, 문제중심 토의학습(PBL)을 1, 2, 3학년에 각 2학점씩 신설하였다. 사회 여러 방면에서 의료인으로써 활동할 수 있게 유도하기 위하여 4학년 과정에서 실시하던 자율선택 임상현장 실습을 4주로 늘리고 2학점을 배정하였다. 새 교육과정을 원활하게 시행하기 위하여 3개 교실을 신설하였으며, 교육환경을 대폭 개선하고 확충하였다. 그러나 유급생 및 복학생의 학점 취득/인정 문제, 분반 학습 강좌의 평가 및 강좌 진행의 복잡성, 교수 확보 문제와 같이 예상되었던 문제점들 이외에도 오후 강좌에서 나타나는 낮은 출석률 및 강의 집중도, 계획과 다른 강좌의 운용문제, 그리고 일부 통합강좌에서 나타난 강의내용의 실질적 통합문제 등은 해결해야할 과제로 생각된다. The curriculum reform was undertaken at Kyungpook National University School of Medicine (KNUSM) to meet new educational objectives in order to cope with a rapid societal changes anticipated occurring in 21st century. The KNUSM Curriculum Development Committee was charged to formulate a new curriculum, which consisted of enhancement of patient-centered care based clerkship, integrated courses based on organ systems, problem-based learning, and additional teaching on social medicine, medical informatics and biomedical engineering. The philosophy of this curricular reform has been to modify methods of teaching medical students toward self-directed learning and student-centered. This whole concept was a drastic departure from the traditional lecturing. In the new curriculum, total of 180 credit courses, 4395 hours to graduate medical school were reduced to 170 credit courses, 4250 hours. As a part of the social medicine course, a 2 credit-hour course on patient-doctor relationship was taught and two credit-hour PBL tutorials were added to freshman, sophomore and junior years. In order to carry out this education reform, three new departments were inaugurated such as Biomedical Engineering, Medical Informatics and Medical Education. The school facility has also been improved during this preparatory period. The new curriculum has been implemented in 1999 academic year after approximately 4 years of preparatory period and annual faculty workshops have been held to monitor the progress of the reform and improve courses by evaluating impact of the change on both faculty members and students as well. The interim evaluation revealed several issues remained to be resolved. In conclusion, the acceptance of this reform was excellent from both faculty members and students although there have been continuous problem solving and adjustments necessary. The real assessment of the outcome of the reform requires many years to come and there has to be continuous monitoring of the progress and adjustment of curriculum are the pivotal of a success of the sort of education reform.

경북의대 의학과 학사편입 시행 경험

이유철(Yoo Chul Lee),여상희(Sang Hee Yeo),이원기(Won Kee Lee),강덕식(Duk Sik Kang),강이철(Echeol Kang),곽연식(Yun Sik Kwak),김보완(Bo Wan Kim),이종명(Jong Myung Lee),장봉현(Bong Hyun Chang),정제명(Jae Myung Chung),조희중(Hee Jung Cho 한국의학교육학회 2003 Korean journal of medical education Vol.15 No.1

Purpose: Kyungpook National University School of Medicine initiated a pilot project to admit small number of qualified students who received BS degree or above in the field of sciences in 1996. This study was conducted to evaluate effectiveness of the pilot project. Methods: Students academic grades, outcome of their opinion surveys on adaptability to the school life, difficulties and problems from the classes of 1996 to 2001 were analyzed. Results: A total of 57 students were admitted to this program over the past 7-year period, 54.8% of them from natural science major and 36.8% from engineering. Students admitted with BS degree were performing above average in the class by % rank. There was no significant difference in academic performance between the natural science and the engineering major. Of 20 graduated, only one took career in basic medical science (physiology). The students thought undergraduate education was helpful in maturing personal characters than in knowledge or skill attainment. Conclusion: The achievement of medical students admitted after baccalaureate level was comparable to that of students with two years of premedical education.

팔로3징의 외과적 치료

천종록,전상훈,장봉현,이종태,김규태 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.2

목적 : 비교적 드물게 보는 선천성 심질환중의 하나인 팔로3징에 대한 본원에서의 진단 및 치료 경험을 임상적으로 관찰하여 보고함으로써 향후 이 질환의 개심술 성적을 향상시키는데 기여하고자 하였다. 대상 및 방법 : 경북대학교병원 흉부외과에서 1980년 3월부터 1997년 2월 사이에 개심술을 받았던 환자들 중에서 심도자검사 및 수술소견에 의해 팔로3징으로 진단되었던 8례를 대상으로 술전증상과 진찰소견, 술전의 심초음파검사, 심도자검사 및 심혈관조영술의 소견들을 검토하였고, 수술소견으로는 폐동맥협착과 심방중격결손의 해부학적 형태, 체외순환시간과 대동맥차단시간, 수술방법, 술후 합병증 및 수술사망률 등을 조사하였다. 그리고 평균 4.8년에 걸친 술후 추적관찰을 하였다. 결과 : 술전 진단에 있어서는 2례에서 오진되어 있었고, 술후 조기의 병원사망례는 없었으나 1례에서 류마치스성으로 추정되는 다발성 심장판막질환으로 8년후 인공판막치환술을 받았는데 패혈증으로 사망하였다. 나머지 환자들은 모두 양호한 경과를 취하였다. 결론 : 이 질환의 술전 진단에 있어서 과거에는 상당한 오진이 있었음을 알 수 있었고, 술전 증상이 심한 환자가 많았던 사실을 감안하면 개심술 성적과 술후 경과는 양호한 편이었다. Eight parients with trilogy of Fallot, characterized by the combination of pulmonary stenosism, atrial septal defect(ASD) and Rt-to-Lt shunt in the atrial level in the presence of an intact ventricular septum, underwent surgical correction between March 1980 and February 1997. Four patients were male and four were female. Their ages ranged from 2 months to 20 years with a mean age of 12.1 years. Cardiac catheterization and angiocardiogram were performed in all patients and 2D-Echocardiographic studies were obtained in 4 patients before operation. The preoperative diagnoses were tetralogy of Fallot(TOF) + ASD in 2 cases, trilogy of Fallot in 6 cases had combined pulmonary stenosis. The atrial septal defect was closed by primary suture in 6 cases and patch closure was done in 2 cases. The pulmonary stenosis was correctied by valvotomy in 2 cases, valvotomy + infundibulectomy in 2 cases, valvotomy + infundibulectomy + right venr tricular outflow tract reconstruction in one case, valvotomy + infundibulectomy + transannular patching in 3 cases. No operative death resulted, but one patient expired after undergoing mitral valve replacement and tricuspid annuloplasty for mitral insufficiency, tricuspid insufficiency and pulmonary valve insufficency 8 years later. All surviving patients have remained in good condition.