연세대학교 의과대학 의학전문직업성 교육 경험의 반성적 고찰

안신기,부성희,An, Shinki,Bu, Sunghee 연세대학교 의과대학 2012 의학교육논단 Vol.14 No.1

For decades medical educators have continually emphasized medical professionalism, which is reflective response to the challenges of a rapidly changing medical environment. This study aimed to review the experience of implementing medical professionalism education at Yonsei University College of Medicine (YUCM). YUCM introduced a new curriculum in 2004 designed by Curriculum Development Project 2004 (CDP2004), a project that was launched in 2001. CDP2004 reorganized lectures as organ-based integrated lectures, introduced an introductory course for clinical medicine and medical humanities courses for premedical and medical students. Problem-based learning (PBL), elective courses, and self-study sessions in the afternoon were implemented in order to equip students with a self-directed learning attitude as medical professionals. Professors were asked by the CDP2004 curriculum to spend more time on student education and to adopt new teaching methods. Experiences of the CDP2004 curriculum reveals 1) difficulty of motivating professors to be PBL tutors 2) students' dissatisfaction with the medical humanities course (major critique was that the course was impractical and unrealistic), and 3) students' optimistic understanding about their future role as medical professionals in influencing and helping people in spite of their perception of the general medical environment not as promising. To foster professionalism, the following are necessary in our experiences: 1) faculty development of medical humanities and medical professionalism, 2) establishment of an environment throughout the whole institution to support medical professionalism education and to integrate the concept into praxis, 3) emphasis on the fact that medical professionalism education is not contradictory to biophysical medical education.

Academic Medicine은 환자 중심 의료이다

안신기,An, Shinki 연세대학교 의과대학 2019 의학교육논단 Vol.21 No.2

The tripartite mission of 'academic medicine' is education, research, and patient care. Academic medical centers (AMCs) are carrying out the mission and ultimately aiming to improve the health of people and communities. Globally, AMCs are facing a tremendous financial risk stemming from the changes in health insurance reimbursement plans and a shortage of human resources. Innovative AMCs in the United States are trying to transform their physician-centered, and siloed structure into a patient-centered, and integrated structure. They are also building integrated systems with primary healthcare groups to provide continuous patient care from primary to tertiary levels and making strategic networks based on value-based payment and the patient-centered model. These changes have been proven to improve outcomes of patient care and increase fiscal revenues, which are both crucial in supporting education and research. To address the shortage of human resources, programs are being built to develop newly appointed faculty for the future. AMCs have different approaches to bringing changes into their organizations; however, there is a common emphasis on 'a patient-centered approach,' which helps them set more explicit organizational values and make strategic decisions based on their values. Korean AMCs are facing similar challenges to AMCs in the United States in spite of many differences between the countries' healthcare systems. The innovative efforts of AMCs in the United States to address the challenges will be helpful, well-worked examples for Korean AMCs with similar challenges.

의료시스템과학: 의학교육은 급변하는 의료와 사회에 어떻게 대응할 것인가?

안신기 연세대학교 의과대학 2023 의학교육논단 Vol.25 No.3

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Wolff-Parkinson-White증후군의 임상상 및 전기생리학적 소견

안신기,이문형,장양수,오동진,최인석,하종원,임세중,김병옥,정남식,심원흠,조승연,김성순 대한순환기학회 1997 Korean Circulation Journal Vol.27 No.9

심방빈맥의 고주파 전극도자 절제술

안신기,이문형,편욱범,김성순 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.2

부정맥의 항응고 치료

안신기 약업신문사 2000 의약정보 Vol.2000 No.5

급성췌장염의 조기 예후평가 - 다단계판별분석법을 이용한 예후평가 -

안신기(Shin Ki Ahn),김원호(Won Ho Kim),정준표(Jun Pyo Chung),송시영(Si Young Song),강진경(Jin Kyung Kang),박인서(In Suh Park),최흥재(Heung Jai Choi) 대한내과학회 1994 대한내과학회지 Vol.47 No.4

N/A Objectives: Early prediction of the severity in patients with acute pancreatitis is very important because severe complications usually occur in the first 48-72 hours. Many studies have been carried out to identify clinical and objective criteria which can be used to predict the outcome of the disease. Multifactor-scoring systems adopted by Ranson et al. and Irmie et al. are generally accepted. But the systems have some disadvantages: (1) too many factors and values have to be assessed, (2) full assessment of the severity takes 48 hours or longer. We, therefore, undertook this study to assess a new method of the early identification of severity which was based on the admission data. Methods: We investigated 339 patients with acute pancreatitis admitted to Severance Hospital of Yonsei Medical Center between January, 1981 and December, 1990. The patients were divided into two groups: those who had no complications or mild complications were classified as mild group (Group I) and those who had severe, systemic complications including death were classified as severe group (Group II). The clinical courses and laboratory findings were analyzed. Results: 1) One hundred two patients experienced one or more complications. Forty patients were classified as severe group (11.8%) and twenty two patients among this group expired (mortality rate, 6.5%). 2) Complications of Group II had developed earlier than those of Group I (2.9 vs. 6.4 days, p<0.05). 3) By stepwise discrimination analysis, a discrimination equation was identified which was composed of calcium, aibumin, BUN, creatinine, uric acid, base deficit, and PaO2 on the admission. Z =4.55-039×Calcium -0.53×Albumin +0.53×BUN×10-1 -0.39×Creatinine+0.14×Uric acid+0.68×Base deficit×l0-1 -0.23×PaO2×10-1 4) The mean Z scores of Group I and Group II were 1.08±0.81 and 2.25±1.34, respectively. The cutting value (Zc) of Z score was identified by chi-square test and it was 1.0. When the cases with higher Z score than cutting value (Z) were considered as severe group, the sensitivity and specificity were 88.2% and 100.0%. The total accuracy of discrimination was 96.2% (p<0.001). The Z score revealed a good correlation with mortality raie (r =0.9825, p<0.01). Conclusion: This prognosis-discriminating equation (Z score) had reliable predictive ability and significant correlation with mortality. Because Z score is a summation of different influences of each factors to prognosis, this method may be more sensitive. And early and relatively simple prediction of severity ran be possible because the parameters of this system are usually obtained on admission. Use of this system should allow early intensive treatment and diagnosis of those who need it. We think that prospective studies should be followed to verify the predictive ability of the Z score of prognosis-discriminating equation.

머리부분에 방사선조사를 받은 흰쥐 샘뇌하수체의 변화에 대한 면역전자현미경적 연구

신기호,박경호,안의태,양남길,고정식 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.2

본 실험은 과다한 X-선에 머리부분이 노출되었을 때, 샘뇌하수체의 변화를 알아보기 위하여 시행하였다. 체중 200-250g의 Sprague Dawley계 숫흰쥐를 실험동물로 사용하였으며, 정상군과 방사선조사군으로 나누었다, 방사선조사군은 조사량에 따라 3,000 rad 조사군과 6,000 rad조사군으로 나누어, 방사선 조사후 6시간, 2일 및 6일 후에 도살하여 조직을 절취하였다. 방사선조사는 흰쥐를 sodium thiopental로 마취한 후 방사선선형가속기(Mitsubishi Linear Accelerator ML-4MV)를 사용하여 머리부위를 조사하였다. 조사조건은 조사거리 80 cm, 조사구역 30 cm X 30 cm, 조사깊이 1.2 cm(100% skin dose)였으며, 분당 200 rad씩 조사하였다. 샘뇌하수체는 1% glutaraldehyde- 1% paraformaldehyde액으로 일차 고정한후, 2% osmium tetroxide액에 이차고정하였으며, 고정이 끝난 조직은 alcohol과 acetone으로 탈수한 후 araldite혼합액에 포매하였다. 포매된 조직은 , LKB-V ultratome으로 60-70nm두께의 절편을 작성하여 300 mesh nickel grid에 붙인 다음 젖샘자극호르몬과 성장자극호르몬에 대한 단독면역염색 및 이중면역염색을 시행하였다. 면역염색이 끝난 절편은 uranyl acetate와 lead citrate로 염색한후, JEM 100CX-Ⅱ 전자현미경으로 관찰하여 다음과 같은 결과를 얻었다. 1. 젖샘자극호르몬분비세포는 불규칙한 모양을 한 큰 분비과립(300-700 nm)을 가진 성숙세포, 크기가 다양한 둥근 분비과립(150-200 nm)을 가진 중간 세포와 크기가 작은 둥근 분비과립(100-150 nm)을 가진 미성숙세포로 나눌 수 있었다. 2. 성장자극호르몬분비세포는 크고 둥근 분비과립(200-500 nm)을 가진 제 1 형 세포와 상대적으로 작고 둥근 분비과립 (150-200 nm)을 가진 제 Ⅱ형 세포로 나눌 수 있었다. 3. 방사선 조사후 6 시간군에서 3,000 rad에서는 큰 변화가 없었고, 6,000 rad에서는 사립체와 과립형질내세망의 수조 확장이 관찰되었다. 방사선 조사후 2일군에서는 큰 변화가 없었으며, 6일군에서는 핵막구조의 확장이 관찰되었다. 4. 세포의 종류도 젖샘자극호르몬분비세포는 3,000 rad 조사군과 6,000 rad 조사군 모두 2일군에서는 성숙형이 감소하고 중간형과 미성숙형이 자주 관찰되었으며, 6일군에서는 정상군과 같은 분포양상을 보였으나 분비과립의 금입자표지가 감소한 것을 관찰할 수 있었다. 성장자극호르몬분비세포에서는 뚜렷한 세포형이 분포변화는 관찰할 수 없었으나 금입자표지의 감소는 나타났다. 5. 방사선조사후 6시간군에서 부터 mammosomatography가 나타났는데, 한 세포 내에 젖샘자극호르몬과 성장자극호르몬을 지닌 분비과립이 함께 존재하였으며, 세포의 모양은 다핵세포의 형태를 하고 있는 것과 불규칙한 모양을 한 것이 있었는데, 이와같은 결과는 방사선조사 후 샘뇌하수체의 기능저하에 따른 보상작용으로 나타난 현상이라 생각된다. 이상의 결과로 보아 방사선 조사를 받은 초기에는 분비과립의 방출이 과다하게 일어나며, 방사선 조사의 영향으로 세포질소기관의 기능이 약화되어 6일이 지나면 샘뇌하수체의 호르몬분비능력이 저하되는 것 같다. This experiment was performed to study the morphological changes of the adenohypophysis of rat following X-ray irradiation. Male rats were divided into normal and X-ray irradiation groups. The heads of rat were exposed to 3,000 rads or 6,000 rads of radiation in a single dose. X-ray source was a Mitsubishi Linear Accelerator ML-4MV. Only the heads of animals were exposed at the distance of 80 cm, within the area of 30 X 30 cm, in the depth of 1 cm, with the speed of 200 rad/min. Animals of X-ray irradiation group were sacrificed on 6 hours, 2 days and 6 days after the irradiation. Tissue blocks of adenohypophysis were fixed in the 1% glutaraldehyde - 1% paraformaldehyde solution, followed by refixation in the 2% osmium tetroxide solution. Dehydradted blocks were embedded in araldite mixture. The sections were cut on a LKB V ultrotome, and ultrathin sections were places on bare nickel grid(200 mesh). The section-bearing grids were floated upside down on the solutions in a moisture chamber at room temperature. Sections were single immunostained or double immunostained for prolactin and/or growth hormone. And the sections were jet washed with distilled water. The immunostained sections were contrasted with uranyl acetate and lead citrate, and observed with JEM 100CX II electron microscope. The results were as follows: 1. Three types of the prolactin cells according to their size and shape of secretory granules were found; mature type cells contained large pleomorphic secretory granules(above 500 nm). intermediate type cells contained round granules of varying size(200-250 nm), and immature type cells contained small round granules(100 nm). 2. Two types of the growth hormone cells according to their size of secretory granules were found: type I cells contained large round secretory granules(200-300 nm) and type II cells contained small granules(100-200 nm). 3. Six hours after the irradiation, adenohypophysis showed swollen cisternae of granular endoplasmic reticulum and alterations of mitochondrial cristae, but only in doses of 6.000 rads. 4. Adenohypopysis showed decrease in number of mature type prolactin cells on 2 days after irradiatin, and recovered number of mature typer prolactin cell. but their immunoreactiveity were gradually decreased following the irradiation, as compared with that in normal adenohypophysis. 5. Six hours after the irradiation, mammosomatotrophs were found to contain prolactin and growth hormone within different granules each other. Some cells were multinucleated, and some cells exhibited irregular cytoplasmic processes. Summarizing the above results, adenohypophysis rapidly released the secretory granules after the irradiation, and cell organelles of prolactin cells and growth hormone cells were altered or degenerated. It means that adenohypophysis decreased its hormone producing activity on 6 days after irradiation.

성인학습이론에서의 성찰개념 분석

신기왕(Gi-Wang Shin),안병환(Byung Hwan Ahn) 한국홀리스틱융합교육학회 2022 홀리스틱융합교육연구 Vol.26 No.4

이 연구는 성인학습이론의 전개 속에서 성찰의 개념을 분석하고, 성찰에 대한 인지적·비판적·철학적 관점을 이해함으로써 성찰의 교육적 의미를 찾고자 하였다. 성찰은 경험학습 담론에서의 인지적 성찰에서 출발했다. 경험학습에서의 성찰은 사전 지식과 관련시킴으로써 의미 있는 결과를 생성하고자 하는 성찰이다. 성찰이 지향하는 최종목적은 지식을 습득하는 것에 머물지 않고 우리의 이전의 믿음과 가정, 그리고 그 의미에 대해 생각하는 것이다. 담론을 통해 편견을 없애려고 노력하며, 증거와 주장에 대한 비판적 검토를 통해 자신의 생각의 정당성에 대한 결정을 하는 것이다. 성찰이 완전하고 객관적인 결과에 도달할 수 없을 지라도 그 결과는 궁극적으로는 다수가 신뢰할 수 있는 합리적이고 이상적인 결과에 도달할 수 있다. 성찰개념의 교육적 의미는 첫째, 성찰개념은 학습과 관련된 접근방식을 확장시켰다. 둘째, 성찰개념은 우리사회의 구조적 변화에 능동적으로 대처할 수 있는 학습방법을 제시하였다. 셋째, 성찰개념은 학습을 인간 사회의 모든 수준에서 작동하는 것으로 확장시켰다. 넷째, 성찰은 학습을 교수자의 어떤 의도나 예상을 뛰어넘는 개인적·사회적·조직적 변형과정으로 확대시켰다. 우리가 살고 있는 사회는 급속한 변화와 복잡한 문제에 직면하고 있다. 성찰은 성인뿐만 아니라 아동의 종합적 사고능력을 개발을 위해 필요한 학습과정이다. 성찰은 단순한 지식습득을 넘어 종합적·총체적인 인간 성숙을 추구한다. 인간 본성에 대한 긍정적 신념으로 성찰학습에 대한 논의를 시작할 때이다. This study tried to find the educational meaning of reflection by analyzing the concept of reflection in the development of adult learning theory and understanding the cognitive, critical, and philosophical perspectives on reflection. Reflection started from cognitive reflection in experiential learning. Reflection in experiential learning is reflection that seeks to generate meaningful results by relating it to prior knowledge. The ultimate goal of reflection is not only to acquire knowledge, but to think about our previous beliefs and assumptions and their meaning. They try to eliminate prejudice through discourse, and they make decisions about the justification of their thoughts through critical examination of evidence and arguments. Although reflection may not reach a complete and objective result, it can ultimately reach a rational and ideal result that the majority can trust. The educational meaning of the concept of reflection. First, the concept of reflection extends the approach related to learning. Second, the concept of reflection suggests a learning method that allows learners to actively cope with structural changes in our society. Third, the concept of reflection extends learning to work at all levels of human society. Fourth, reflection extends learning into a process of personal, social, and organizational transformation that goes beyond any intention or expectation of the instructor. The society we live in is facing rapid change and complex problems. Reflection is a necessary learning process for developing comprehensive thinking skills in children as well as adults. The concept of reflection goes beyond simple knowledge acquisition and pursues comprehensive and holistic human maturity. It's time to begin the discussion of reflective learning with positive beliefs about human nature.

초고압 HVDC 용 에폭시/ 나노실리카 콤포지트의 전기적, 기계적 특성

안지후(Ahn Ji Hoo),박재형(Park Jae Hyoung),오해린(Oh Hae Rin),안동훈(An Dong Hun),신우제(Shin Woo Je),신기범(Shin Ki Bum),서세영(Seo Sae Young),박준우(Park Jun Woo),박주영(Park Joo Young),유해만(Hae Man Ryoo),박재준(Jae-jun Park) 대한전기학회 2019 대한전기학회 학술대회 논문집 Vol.2019 No.7