응급의학과 전공의 수련 현황과 개선을 위한 보고서 : 대한응급의학회 수련위원회

송근정,박정배,양혁준,이부수,이중의,임용수,최승필,허탁,황성오 대한응급의학회 2003 대한응급의학회지 Vol.14 No.3

Emergency Medicine is a medical specialty that provides comprehensive emergency care. The spectrum of emergency medicine includes humanity as well as medical care for emergency patients. Since the Korean Society of Emergency Medicine has been established and the training course for emergency residents has begun, quality improvement of the training course still remains to be one of the most important issues in emergency medicine. This report is to understand the current status of training of emergency residents and to improve the quality of training of emergency residents. The survey was performed with questionnaires regarding current status of training and opinions to improve quality of training. The questionnaires were sent to all emergency physicians and emergency residents registered to the Korean Society of Emergency Medicine via an electronic mail or a printed letter. The response rates were 49.6% for emergency physicians and 35.8% for emergency residents. On the basis of the result of this survey, we suggest five proposals for improving the quality of resident training course. These include complete adherence of each institution to training guidelines presented by the Korean Society of Emergency Medicine, development of the education program compatible to each institution, shortening of length of training duration from 4 years to 3 years, promotion of the training environment, and introduction of evaluation examination to the training course.

정신건강의학과의 역량 중심 전공의 수련과정 개발

견영기,김종우,심세훈,손인기,서정석,이강욱,Residency Training Committee of the Korean Neuropsychiatric Associatio 연세대학교 의과대학 2018 의학교육논단 Vol.20 No.1

Psychiatry residency training in South Korea currently has many limits in developing proper competencies of residents. To address this problem, the Korean Neuropsychiatric Association has been developing a new competency-based training program since 2015, using the educational systems of advanced countries such as Canada, the United Kingdom, the United States, and Australia as references. It was found that within the referenced countries’ residency training systems, objectives based on competencies are stated in detail by psychiatric topics as well as various assessment methods and feedback about the resident’s competency level. In addition, we surveyed psychiatric resident training hospitals, and found that more than 80% of the respondents answered positively in reference to the new training program. This paper briefly reviews competency-based residency training systems of advanced countries and compares them to the current training program in South Korea. Many resources are needed to run a new competency-based training program, and governmental supports are essential to improve the quality of the residency training system.

시뮬레이션을 응용한 심폐소생술 훈련의 반복이 피교육자의 교육에 대한 만족도에 미치는 영향

변경조,이현정,김해규,송봉재,김재연,염석란 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.2

Background: Simulation-based training is becoming more widespread in clinical education because of the increased technology of patient simulators in conjunction with their increased use by many medical centers. Simulation-based training enhances the learning,clinical skills and judgment of the trainees. However, the effect of repetition of simulation-based training has not yet been evaluated. The purpose of this presentation will be to examine whether the number of experiences could have an influence on the interest of the trainee. Methods: Simulation-based training was designed as an introductory course for new interns and residents. The training course was divided into three sessions: Airway management training, cardiac massage training and advance cardiac life support mega code training. All the trainees were divided into the new interns and residents group. The two group’s performances during conducting the three sessions were monitored by video equipment. All the trainees were debriefed and given a post intervention survey to assess their satisfaction with the simulation-based training. Results: A total of 110 trainees completed the survey. On a four point scale, the students rated their stimulation of interest, the usefulness of the knowledge that they learned and if they enjoyed the simulation. There were no significant differences in the effectiveness of the three sessions of simulation-based training among the groups. Conclusions: Simulation is a powerful tool to get trainees excited about applying the skills they learned in the classroom. Most trainees in both groups agreed that the exercises were a great experience helpful and exciting. We postulate that the repetition of simulation-based training will not decrease the effectiveness of the training. (Anesth Pain Med 2011; 6: 195∼201)

가정의학과 전공의의 노인의학 수련 태도와 제안

손보드리,원장원,김일신,김병성,최현림 대한가정의학회 2008 Korean Journal of Family Medicine Vol.29 No.9

Background: With the number of geriatric population on a steep increase, the roles of family physicians broaden to give comprehensive medical care to the elderly. Therefore, geriatrics is becoming increasingly more important for the residents of family medicine. The authors have surveyed and researched on resident’s current attention, actual training conditions, and future needs on geriatrics. Methods: Family medicine residents in 79 hospitals registered to Korean Family Medicine Resident Union were enrolled. By means of electronic and postage mail surveys, informations were gathered; including demographics, the order of importance of nine training curricula, the necessity of training itself, the facility and academic conference of geriatrics training. Results: A total of 173 residents in 45 hospitals replied with return rates of 51.9%. Among the total, 169 (97.7%) of the answered agreed on the necessity of geriatrics training. Of the nine curricula, geriatrics was considered the most important. And residents considered family medicine outpatient department and inpatient ward to be the most important place for geriatrics training. Furthermore, the residents considered elderly’s diseases or symptoms as more important conference title, but the parameters such as the quality of life, physiology of aging, care in nursing home were considered less important. Conclusion: The geriatrics training program is not up to the standards of residents’ satisfaction. This is considered to be due to the absence of a formal training program. To provide a better care for the elderly, it is compulsory to gain broad knowledge of geriatrics and actual experience out in the field. 연구배경: 노인인구가 급증하고 있는 현대사회에서 노인환자에게 지속적, 포괄적 의료를 제공해야 하는 가정의들의 역할과 책임이 커짐에 따라 가정의학과 전공의 수련과정에서 노인의학의 중요성이 강조되고 있다. 이에 본 저자들은 현재 가정의학과 전공의의 노인의학 수련에 대한 관심도 및 수련실태, 효과적인 노인의학 수련 커리큘럼에 필요한 요건들에 대해 알아보고자 이 논문을 계획하였다. 방법: 2007년 가정의학과 전공의 협의회에 등록되어 있는 79개의 가정의학과 수련병원의 가정의학과 전공의를 대상으로 전자메일 설문조사와 우편 설문조사를 시행하였다. 설문 내용은 일반적 특성, 노인의학 수련의 필요성 유무, 수련 프로그램 및 수련장소와 컨퍼런스 주제에 대한 중요도 평가로 구성하였다. 결과: 가정의학과 전공의 협의회에 등록되어 있는 79개 병원 중 45개 병원(56.9%)에서 설문에 응답하였으며 총 184명의 전공의가 응답하였다. 응답자의 180명(97.8%)이 노인의학 수련 프로그램이 필요하다고 응답하였다. 노인 환자 진료 시 자신감은 ‘별로 없다’(10.9%), ‘그저 그렇다’(56.5%)로 부정적인 의견이 긍정적인 대답보다 많았다. 또한 노인의학 수련장소로 가정의학과 외래(5점 만점에 3.91점)와 가정의학과 병실(3.66점), 요양병원(3.66점)의 순으로 중요하다고 평가하였으며, 노인의학 컨퍼런스 주제 평가에서는 노인의 질환이나 증상 위주의 주제를 높게 평가하였고 삶의 질, 노화의 생리, 요양원 간병 문제들을 덜 중요하다고 평가하였다. 결론: 가정의학과 전공의는 노인의학 수련에 대한 필요성은 절감하고 있으나, 노인환자 진료시 자신감은 낮은 것으로 나타나 전공의의 수련의지와 욕구가 충족되지 못하는 상태이다. 앞으로 급증하는 노인환자에게 양질의 의료를 제공하기 위해서는 노인의학에 대한 광범위한 지식 습득 뿐 아니라, 요양원이나 사회복지시설과 같은 구체적인 수련 장소에서의 경험을 통해 치료에 유용한 실제적인 임상지식과 노인환자에 대한 태도의 향상을 가져올 수 있는 노인의학 수련 프로그램의 개발이 요구된다.

우리나라 정신건강의학과 전공의의 수련 실태 설문 조사

김지훈,견영기,김종우,오홍석,이상민,서정석,정성원,이강욱,대한신경정신의학회 수련위원회 대한신경정신의학회 2019 신경정신의학 Vol.58 No.3

Objectives The authors evaluated the environment and conditions of Korean psychiatric residents to identify important factors for them in determining their satisfaction with training programs. Methods Questionnaires on the residency training program were administered to 513 Korean psychiatric residents from 2016 to 2017. The questionnaire was composed of sociodemographic background, work environment and status of the training program. The authors analyzed questionnaire according to the residents’ grade and hospital type and identified the significant factors for satisfaction with their training. Results Compared to the 1st grade, the 4th grade psychiatric residents have significantly less working time, duty days, and more sleep time, mealtime, and annual salary. In the hospital type, the residents of general hospitals and university hospitals have more working time, annual salary, and accessibility to educational material than mental hospitals. The satisfaction with their training is higher in the 1st grade than in the 4th grade, in those with more than six hours of sleep time, and in residents who are satisfied with the accessibility of educational materials. Conclusion Compared to the 1st grade, the working intensity of 4th grade psychiatric residents is lower and their welfare is better. To improve the satisfaction with the training program, it is necessary to make efforts to increase the sleep time of residents, improve the accessibility of educational material, identify the problem of the training program, particularly in the 4th grade, and make institutional improvements.

전공의법 시행에 따른 전공의 수련환경 변화

오수현,김진숙 한국디지털정책학회 2019 디지털융복합연구 Vol.17 No.12

The Medical Residents Act was enacted in December 2016 to protect the rights of residents, and to ensuring the safety of patients, and nurturing good medical human resources. This study analyzed the changes of training conditions according to the enforcement of The Medical Residents Act by comparing the results of two surveys conducted in 2015(1,793 Residents) and 2017(1,768 Residents). As a result, Residents worked over 80 hours per week on average('15=92.4h, '17=87.3h) and they worked twice as many times as 36 hours('15=89.4h, '17=70.1h). Female residents' leave before and after childbirth(’15=78.5day, ’17=82.2day), Preparation of Standard training contract('15=19.3%, '17=40.8%), Delivery of training contract('15=12.4%, '17=36.1%) did not comply with the regulations. The training conditions of the residents is directly related to the safety of patients and the public's health. National support is needed for the support of substitute workforces, fair training evaluation conditions and incentives based on the evaluation results, labor costs for residents and supervising medical specialists, and the cost of making training programs. 전공의법은 2015년 12월 전공의의 권리보호, 환자안전, 우수한 의료 인력을 양성하기 위해 제정되었다. 본 연구는 전공의를 대상으로 2015년(1,793명)과 2017년(1,768명) 두 차례 실시한 설문조사 결과를 비교하여 전공의법 시행에 따른 수련환경 변화를 분석하였다. 분석결과, 전공의들은 주당 평균 80시간을 초과하여 근무하고 있었으며(’15=92.4h, ’17=87.3h), 36시간의 두 배에 달하는 시간을 연속해서 근무하고 있었다(’15=89.4h, ’17=70.1h). 이 외 출산휴가(’15=78.5day, ’17=82.2day), 표준근로계약서 작성(’15=19.3%, ’17=40.8%) 및 계약서 교부(’15=12.4%, ’17=36.1%)도 규정을 준수하지 않고 있었다. 전공의 수련환경은 환자안전 및 국민 건강과 직결되는 문제로 대체인력에 대한 지원, 공정한 수련환경평가와 평가결과에 따른 인센티브 부여, 전공의 및 지도전문의 인건비, 전문과목별 수련 프로그램 개발 비용 등 국가의 지원이 필요하다.

국내 응급의학과 전공의의 24시간 연속근무 및 빈번한 야간근무 현황

임재관,이형민,조광현,기동훈 대한응급의학회 2019 대한응급의학회지 Vol.30 No.6

Objective: The newly implemented Training Rule Standard limits the amount of resident working hours to serve the interests of the patients and residents alike. On the other hand, the law does not sufficiently protect emergency medicine residents from a long shift length and frequent night shift. Excessive shift work can cause physical and neuropsychological problems for residents. Therefore, this study examined the 24-hour shifts and night shifts status of emergency medicine residents at the training hospitals. Methods: The 30 training hospitals were divided into three groups according to the number of residents (≤4, 5-8, and ≥ 9) and the associations between each group and the 24-hour shifts, night shifts, number of working days, working hours, and annual patients per resident were checked. The associations between the resident grades and 24-hour shifts, night shifts, number of working days and working hours were also examined. Results: Hospital groups with fewer residents had the highest number of patients per resident with the highest number of 24-hour shifts and the highest number of night shifts. The first year residents had the highest number of 24-hour shifts, the highest number of night shifts, and the highest number of working hours. Conclusion: More 24-hour shifts and more night shifts occur at hospitals that lack work force. Therefore, there is a need for new standards for limiting the working hours and frequency of night shifts in emergency rooms, and there is a need for discussions on reinforcing the work force.

외과 전공의 수련제도에 대한 설문조사

유문원(Moon-Won Yoo),이인규(In Kyu Lee),안혜성(Hye Seong Ahn),김종원(Jong Won Kim),이혁준(Hyuk-Joon Lee),이건욱(Kuhn Uk Lee),양한광(Han-Kwang Yang) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.1

Purpose: This study was aimed to evaluate the current status and problems of surgical residency training program in Korea and to compare ‘ward system’(WS) with ‘team system’(TS). In WS, residents assigned to a ward take care of the patients in their ward regardless of diseases or specific staffs. In TS, residents assigned to a team or a specific staff treat the patients with specific diseases. Methods: A questionnaire on residency training program was sent to 637 surgical residents working in 69 surgical training hospitals in September 2005. Twenty questions about education, patients’ care, and training system were included in the questionnaire and analyzed according to the training systems. Results: The response rate was 18%(113/637). Nineteen residents work in WS, 83 in TS and 11 in other system. Mean education time per week and mean operative time per weekday were longer in WS. The continuity of patients’ care was better in TS. The responders chose their own training system as the better one. Conclusion: WS residents considered the advantages of WS as comprehensive training and residents’ autonomy and TS residents regarded that of TS as consistent, specialized and intensive training for specific diseases. The results of this study can be used to improve and develop residency training program in surgery.

전공의를 대상으로 한 사례중심 의료윤리 (소그룹) 토론교육의 경험

오혜영,정유석,유상호 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.4

Background: Residents struggle with the evaluation and management of inpatient clinical ethical dilemmas. However, few residency programs include medical ethics education as part of their graduate medical training. This study aims to explore the perceived effectiveness, benefits, and learning experiences of residents with small group discussions about ethical dilemmas. Method: We instituted weekly residency ethical conferences to clarify residents’ understanding of medical ethics and to improve their medical ethics competence. Six to nine residents and two or more professors attended the ethical conferences and participated in the discussions. Each participant was given at least five minutes to share their thoughts and reasoning concerning a designated ethical dilemma. In the course of these meetings we also surveyed participants’ self-confidence, level of satisfaction, communication skills, moral motivation, attitudes, reasoning, and moral sensitivity. Result: Teaching residents by means of small group discussions on ethical dilemmas can enhance their ability to address these issues directly and to resolve clinical ethical dilemmas appropriately. Additionally, these group discussions were found to improve participants’ level of satisfaction and ability to communicate. Conclusion: Our experience with small group discussions based on cases involving moral dilemmas shows that discussion can be an effective and practical method of ethics education for residents. The results of this study may have implications for the future improvement of graduate medical education. Background: Residents struggle with the evaluation and management of inpatient clinical ethical dilemmas. However, few residency programs include medical ethics education as part of their graduate medical training. This study aims to explore the perceived effectiveness, benefits, and learning experiences of residents with small group discussions about ethical dilemmas. Method: We instituted weekly residency ethical conferences to clarify residents’ understanding of medical ethics and to improve their medical ethics competence. Six to nine residents and two or more professors attended the ethical conferences and participated in the discussions. Each participant was given at least five minutes to share their thoughts and reasoning concerning a designated ethical dilemma. In the course of these meetings we also surveyed participants’ self-confidence, level of satisfaction, communication skills, moral motivation, attitudes, reasoning, and moral sensitivity. Result: Teaching residents by means of small group discussions on ethical dilemmas can enhance their ability to address these issues directly and to resolve clinical ethical dilemmas appropriately. Additionally, these group discussions were found to improve participants’ level of satisfaction and ability to communicate. Conclusion: Our experience with small group discussions based on cases involving moral dilemmas shows that discussion can be an effective and practical method of ethics education for residents. The results of this study may have implications for the future improvement of graduate medical education.

외국 전공의 수련교육의 제도 및 시사점

이선우,Lee, Sun Woo 연세대학교 의과대학 2018 의학교육논단 Vol.20 No.3

Medical education, competency, and outcome-based medical education started as part of the basic medical education curriculum in advanced countries 20 years ago, and such an approach was adopted in residency training. General competency training is at the core of residency training in advanced countries, and it goes beyond competency and outcome-based training to the extent that in a milestone training system, competency development is expected and measured with set competency achievements at each level. Recently, for the purpose of ensuring that doctors uphold patient safety and fulfill their obligations, entrustable professional activities (EPA) were applied at the beginning of residency when doctors move away from clinical trials and start actual care. The adoption of EPA in all residency training curriculum has spread very rapidly in the United States, United Kingdom, and Canada. Presently, Korea lags behind other countries significantly as the adoption of competency and outcome-based medical education in residency training has just begun. It is time to identify the current state of the Korean residency training system, and then design and practice a well-established system with a long-term view based on cooperation across the whole medical industry.