A qualitative thematic content analysis of medical students' essays on professionalism

BACKGROUND

Physicians in both Western and Eastern countries are being confronted by changes in health care delivery systems and medical professionalism values. The traditional concept of "In-Sul" (benevolent art) and the modern history of South Korea have led to cultural differences between South Korea and other countries in conceptualizing medical professionalism; thus, we studied medical students' perceptions of professionalism as described in essays written on this topic.

METHODS

In 2014, we asked 109 first-year medical students who were enrolled in a compulsory ethics course to anonymously write a description of an instance of medical professionalism that they had witnessed, as well as reflecting on their own professional context. We then processed 105 valid essays using thematic content analysis with computer-assisted qualitative data analysis software.

RESULTS

Thematic analysis of the students' essays revealed two core aspects of professionalism in South Korea, one focused on respect for patients and the other on physicians' accountability. The most common theme regarding physician-patient relationships was trust. By contrast, distributive justice was thought to be a non-essential aspect of professionalism.

CONCLUSIONS

In Western countries, physicians tend to promote justice in the health care system, including fair distribution of medical resources; however, we found that medical students in South Korea were more inclined to emphasize doctors' relationships with patients. Medical educators should develop curricular interventions regarding medical professionalism to meet the legitimate needs of patients in their own culture. Because professionalism is a dynamic construct of culture, medical educators should reaffirm cultural context-specific definitions of professionalism for development of associated curricula.

Burden of Disease Study and Priority Setting in Korea: an Ethical Perspective

When thinking about priority setting in access to healthcare resources, decision-making requires that cost-effectiveness is balanced against medical ethics. The burden of disease has emerged as an important approach to the assessment of health needs for political decision-making. However, the disability adjusted life years approach hides conceptual and methodological issues regarding the claims and value of disabled people. In this article, we discuss ethical issues that are raised as a consequence of the introduction of evidence-based health policy, such as economic evidence, in establishing resource allocation priorities. In terms of ethical values in health priority setting in Korea, there is no reliable rationale for the judgment used in decision-making as well as for setting separate and distinct priorities for different government bodies. An important question, therefore, is which ethical values guiding the practice of decision-making should be reconciled with the economic evidence found in Korean healthcare. The health technology assessment core model from the European network for Health Technology Assessment (EUnetHTA) project is a good example of incorporating ethical values into decision-making. We suggest that a fair distribution of scarce healthcare resources in South Korea can be achieved by considering the ethical aspects of healthcare.

Physicians' attitude toward the withdrawal of life-sustaining treatment: A comparison between Korea, Japan, and China

End-of-life care decision making has become a matter of serious ethical and legal concern in the three Far East Asian Countries of China, Japan, and Korea. Researchers in the three countries collaboratively conducted a comparative descriptive study with respect to physicians' perspectives concerning end-of-life care decisions. In spite of cultural similarities, each country has its own unique set of social, cultural, and political circumstances. So the content and scope of policies and laws on end-of-life decision reflect the differing views of people based on their social status, moral values, religious beliefs, and economic status.

The International Xenotransplantation Association consensus statement on conditions for undertaking clinical trials of xenocorneal transplantation

To develop an international consensus regarding the appropriate conditions for undertaking clinical trials in xenocorneal transplantation, here we review specific ethical, logistical, scientific, and regulatory issues regarding xenocorneal transplantation, and propose guidelines for conduct of clinical xenocorneal transplantation trials. These proposed guidelines are modeled on the published consensus statement of the International Xenotransplantation Association regarding recommended guidelines for conduct of clinical islet xenotransplantation. It is expected that this initial consensus statement will be revised over time in response to scientific advances in the field, and changes in the regulatory framework based on accumulating clinical experience.

Physicians' perspectives on social competency education in academic medicine

PURPOSE

This study aims to explore the improvement of medical curriculums by examining the relationship between attributes of the Korean physicians and their needs for specialized departments and professionals for enhancing Korean physicians' social competence.

METHODS

The uniqueness of this study is in its conduction a survey about the Korean physicians' needs of specialized departments and professionals for physicians' social competence or not, unlikely that previous studies focused on reviews. Subjects of this study are 288 physicians among the members of the Korean Society of Medical Education and The Korea Intern Resident Association. The hierarchical regression analyses are conducted.

RESULTS

The authors present the results. First, the needs of specialized departments decline if physicians have ever majored on basic medical and learned professionalism ethics. Second, the older physicians are, the much more learned professionalism ethics and the needs of leadership competence physicians have, the necessities of specialized professionals are reduced. Finally, the physicians' needs of patient-oriented communication and sympathy of human in society as well as professionalism ethics increase recognitions of the importance of specialized professionals.

CONCLUSION

These results show that strengthening systemic and educators' individual capacity for successful social competence curriculums is important.

[Medical ethics as professional ethics]

Contemporary medical ethics is far from the traditional concept of "In-Sul (benevolent art)" or "Yul-Li (倫, ethics), which emphasizes so much the personality or the character of a doctor. Nowadays, medical ethics should be considered as "professional ethics" which regulates the acts and medical practices of ordinary doctors in their daily practice. The key concepts of the professional ethics are "autonomy", "integrity", and "professional standard" established by medical organizations such as medical societies or associations. Most of Korean doctors have not been familiar with the concept of professional ethics or professionalism, which is due to the modern history of Korea. However, the concept of professional ethics is really critical to Korean doctors from the perspective of professional dignity and social respect to this profession. The current healthcare system of Korea is suffering from many problems of both private and public sector. Nonetheless, the professional ethics is urgently demanded for that very reason.

Korean attitudes to Xenotransplantation: a survey conducted in 2009

BACKGROUND

Xenotransplantation research has been being actively conducted in Korea. However, there are numbers of socio-ethical issues involved in this research, and it is necessary to know public attitudes toward the research, inducing "public consensus" for the sound development of the technology.

MATERIALS AND METHODS

A telephone survey consisting of 10 questionnaire items was conducted to investigate the attitudes of Koreans on social and ethical issues related to xenotransplantation. Participants were randomly selected in proportion to the 2009 Korean population census. The response rate was 22.3%. Finally, 500 sets of data were collected and analyzed with SPSS® 12. A statistical analysis was performed using the chi-square test.

RESULTS

In the first phase of the study, 69.8% of the respondents were positive about xenotransplantation while 29.0% were negative. However, after being informed of the specific benefit and risk, 58.4% of the respondents stated that xenotransplantation research should be continued, while 38.6% of them indicated that these studies should be prohibited; 63.0% of the respondents agreed with lifelong surveillance after xenotransplantation, while 34.0% disagreed. To avoid triggering immune response in the transplantees, 63.0% of the respondents also approved of the necessity of genetic modification of pigs. If xenotransplantation proves to be safe, 56.8% of the respondents said that they would accept it if necessary; 69.8% of the respondents would recommend it for their family members and friends as a therapeutic option if they are in need. Men were more positive than women about the necessity of animal experimentation for xenotransplantation research, the necessity of lifelong surveillance, and the necessity of genetic modification of pigs. There was no significant difference between the religious and non-religious group except about the issue of lifelong surveillance.

CONCLUSION

Korean people have relatively positive attitudes toward xenotransplantation research and animal experiments regarding xenotransplantation.

Analytical case study of evaluation of curriculum at a medical school

PURPOSE

This study aims at to make intermediate-term evaluations of a curriculum by investigating its development, operation and outcomes 2 years after its revision.

METHODS

A survey using 5-point-Lickert scale questionnaires was given to the group of directors who developed the curriculum, instructors who only used it in their classes, and a student group from the first and second grades. Focus group interviews were performed in the professor groups.

RESULTS

Curricular reform was evaluated as being systematic, democratic, and positive in general. Both groups answered questions positively about the relevance of the integrated curriculum and introduction of clinical medicine (ICM), graded as 3.4 (professor) and 3.5 (student). As for problem-based learning (PBL) and the patient-doctor-society (PDS), the professor group responded more positively than students. The 'web-based learning center' was recognized positively by many more students (4.01) than professors (2.75). With regard to the education outcome, professors gave 3.3 points and students 3.5 to an item that asked 'whether students attained the learning goal or not?' Professors, through interviews, showed their satisfaction with the attempt to reform the curriculum, but they pointed out that long-term evaluations should be performed.

CONCLUSION

The interim evaluation of the revised curriculum, from its planning to its effects, affirmed by several suggestions to be successful in the long run through 1) enhancement of systematic participation and communication, 2) further integration, 3) steady evaluation, 4) greater effort on professional development, and 5) active interaction between professors and students.

Current status of water reuse systems in Korea

In Korea, the current water resources will fall short by 2.6 billion tons to meet the 38 billion ton water demand in the year 2020. To overcome the future water shortage, it is desirable to minimize water consumption and to reuse treated wastewater. There are a total of 99 on-site water-recycling systems in the country. The potential capacity of the 99 systems is 429 thousands tons/day, which is 3.6% of the total service water. Compared to other industrialized countries, the number of the water recycling systems in Korea is extremely small. This is mainly due to the following reasons. First, in Korea, any building with more than 60,000 m2 of total floor space is required to install a water reuse system by law. However, only less than 0.5% of the total buildings have more than 10,000 m2. Therefore, the regulation is ineffective and merely nominal. Second, service water is supplied at low charge (0.20 US-dollar/m3 water). The inexpensive service water often discourages people to recycle treated wastewater. Third, people still think recycled water is not clean enough and can cause diseases. Therefore, they should be informed that a well-maintained recycling system does not fail to produce water with high quality.

Brillouin frequency shifts in silica optical fiber with the double cladding structure

We report theoretical and experimental analysis on Brillouin frequency shift in silica optical fibers with the double cladding structures that are comprised of GeO2-doped core, P2O5- and F-codoped inner cladding and silica outer cladding. The intrinsic Brillouin frequency shift was calculated for various fiber parameters utilizing boundary conditions for longitudinal acoustic waves. Optical fibers with different fiber parameters were fabricated and the Brillouin frequency shifts were measured in the wavelength region of 1.55m. We confirmed that the inner cladding in an optical fiber could provide a new degree of freedom in controlling the Brillouin frequency shift.

Genes that co-cluster with estrogen receptor alpha in microarray analysis of breast biopsies

The estrogen receptor plays a critical role in the pathogenesis and clinical behavior of breast cancer. To better understand the molecular basis of estrogen-dependent forms of this disease we studied gene expression profiles from 53 primary breast cancer biopsies. Gene expression data for more than 7000 genes were generated from each tumor sample with oligo microarrays. A standard correlation-clustering algorithm identified 18 genes that co-clustered with estrogen receptor alpha. Eleven of these genes had previously been associated with estrogen regulation or breast tumorigenesis including trefoil factor 1 and estrogen regulated LIV-1. Additional study of these 18 genes may further delineate the role of estrogen receptor in breast cancer, generate new predictive biomarkers for response to endocrine therapies and identify novel therapeutic targets.

Heterologous expression and characterization of endoglucanase I (EGI) from Trichoderma viride HK-75

Endoglucanase I (EGI) secreted from Trichoderma viride HK-75 has a unique transglycosylation activity. The genomic and cDNA clones encoding EGI (egl1) of T. viride HK-75 were isolated and characterized. The coding region of egl1, composed of 1392 bp, was found to encode a polypeptide of 464 amino acids that has extensive similarity (93.8%) with EGI of T. reesei. Expression of the egl1 gene in E. coli as a fusion protein (with N-terminal thioredoxin and C-terminal histidine tag) led to a large production of a nonglycosylated protein of 62.5 kDa. However, it formed an insoluble inclusion body. Upon denaturation with 8 M urea followed by dialysis and successive purification, the enzymatically active recombinant EGI (rEGI) was obtained at a level as high as 18.3 mg/l of 1,000 ml of culture. The rEGI had 67.8% activity for carboxymethyl cellulose (CMC), compared to native EGI (nEGI). The optimum pH and optimum temperature of rEGI were lower than those of nEGI by 0.5 and 5 degrees C, respectively. The rEGI also had narrower CMCase ranges than nEGI in pH and temperature stabilities. However, the catalytic and transglycosylation abilities against cellotriose of rEGI were comparable to those of nEGI. These results suggest that the glycosylation is important for the stabilities of EGI but not critical for the essential enzymatic capacity.

Functional analysis of HO gene in delayed homothallism in Saccharomyces cerevisiae wy2

Saccharomyces cerevisiae wy2 exhibits a novel life cycle, with delayed homothallism caused by a defective HO gene. In this strain, gradual diploidization occurs during successive subcultures. Three amino acids of wy2 HO were different from those of wild-type (wt) HO, which included a nonsense mutation (TAG) from Trp-292 and two amino acid changes of His-475 to Leu and Glu-530 to Lys. The ho gene of heterothallic strain CG379 was also sequenced in this study. Four amino acids of ho were different from those of HO. Among different amino acids in wy2 HO and ho, the alteration of His-475 to Leu was common between them. His-475 in HO was previously suggested to be involved in the DNA binding. We constructed a variety of chimeric HO genes by exchanging the corresponding restriction fragments generated from the wt HO, wy2 HO and ho genes. These results and the site-directed mutagenesis studies allowed us to draw the following conclusions: (a) Gly-223 is essential for HO activity; (b) mutation of His-475 to Leu significantly reduces the HO activity; (c) amber mutation (TAG) in wy2 HO car be suppressed inefficiently.

Functional analysis of O-linked oligosaccharides in threonine/serine-rich region of Aspergillus glucoamylase by expression in mannosyltransferase-disruptants of yeast

The glaA gene encoding glucoamylase I (GAI) of Aspergillus awamori var. kawachi was heterologously expressed in mannosyltransferase mutants of Saccharomyces cerevisiae, in which the pmt1 gene and the kre2 gene were disrupted. The GAI enzymes expressed in these yeast mutant cells exhibited a lesser extent of O-glycosylation. Secretion of GAI expressed in the pmt1-disruptant and in the kre2-disruptant, respectively, was almost the same as that of GAI expressed in wild type (wt) strains. The number of O-linked mannose in GAI from wt yeast strain ranged in size from one (Man1) to five (Man5). On the other hand, the O-linked oligosaccharides of GAI from the pmt1-disruptant ranged in size from Man1 to Man4. Man5 was not detected and Man2-Man4 were reduced in proportion to the reduction of Man1. The O-linked oligosaccharides of GAI from the kre2-disruptant ranged from Man1 to Man4, and the molar amount of Man4 was reduced to 27.3%, compared to that of the wt strain. The hydrolyzing abilities for soluble starch and the adsorbing abilities on raw starch were comparable between both disruptants and wt strains. However, the digesting abilities for raw starch of the disruptants were decreased to 70% of those of the wt strains. Stabilities of GAI of the disruptants were reduced toward extreme pH and high temperature, compared to those of the wt strains. These results demonstrate that the O-linked oligosaccharides of GAI are responsible for the enzyme stability and activity toward insoluble substrates but not for secretion.

Functional analysis of a hybrid endoglucanase of bacterial origin having a cellulose binding domain from a fungal exoglucanase

A cellulose binding domain (CBD) of an endo-beta-1,4-glucanase (Ben) from the bacterium Bacillus subtilis BSE616 was replaced with the CBD of exoglucanase I (TexI) from the fungus Trichoderma viride HK-75. The resultant hybrid enzyme Ben'-CBDTexI, comprising the catalytic domain (Ben') of Ben and the CBD (CBDTexI) of TexI, was highly expressed at 20% of the total protein in Escherichia coli. The molecular mass of the hybrid enzyme was estimated to be ca. 38 kDa by SDS-PAGE, which was in good agreement with that calculated from 305 amino acids of Ben and 42 amino acids of CBDTexI. The hybrid enzyme exhibited almost the same activity as that of the original Ben toward soluble substrates, such as cellooligosaccharides. The hybrid enzyme showed higher binding ability and hydrolysis activity toward microcrystalline cellulose (Avicel), even though the length of the CBD of TexI was four times smaller than that of Ben. The hybrid enzyme was more resistant to tryptic digestion than the original Ben. The efficient binding ability of the hybrid enzyme to Avicel permitted purification of the enzyme using an Avicel-affinity column to the extent of ca. 90% purity.

Purification and characterization of a fibrinolytic enzyme produced from Bacillus sp. strain CK 11-4 screened from Chungkook-Jang

Bacillus sp. strain CK 11-4, which produces a strongly fibrinolytic enzyme, was screened from Chungkook-Jang, a traditional Korean fermented-soybean sauce. The fibrinolytic enzyme (CK) was purified from supernatant of Bacillus sp. strain CK 11-4 culture broth and showed thermophilic, hydrophilic, and strong fibrinolytic activity. The optimum temperature and pH were 70 degrees C and 10.5, respectively, and the molecular weight was 28,200 as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The first 14 amino acids of the N-terminal sequence of CK are Ala-Gin-Thr-Val-Pro-Tyr-Gly-Ile-Pro-Leu-Ile-Lys-Ala-Asp. This sequence is identical to that of subtilisin Carlsberg and different from that of nattokinase, but CK showed a level of fibrinolytic activity that was about eight times higher than that of subtilisin Carlsberg. The amidolytic activity of CK increased about twofold at the initial state of the reaction when CK enzyme was added to a mixture of plasminogen and substrate (H-D-Val-Leu-Lys-pNA). A similar result was also obtained from fibrin plate analysis.