CPX 성적과 기존의 실습성적 및 필기시험 성적과의 상관관계

박완범(Wan Beom Park),이성아(Sung A Lee),김은아(Eun A Kim),김연수(Yon Su Kim),김석화(Suk Wha Kim),신좌섭(Jwa-Seop Shin),이윤성(Yoon Sung Lee) 한국의학교육학회 2005 Korean journal of medical education Vol.17 No.3

Purpose: Recently, the clinical performance examination (CPX) using standardized patients has been introduced to several Korean medical schools. The purpose of this paper is to evaluate the correlation of CPX scores with the scores of other clinical clerkship assessments and written examinations. Methods: We evaluated the correlation of the scores of CPX, which was administered to third-year medical students (n=230) at Seoul National University College of Medicine in January 2005, with the scores of a slide examination in internal medicine, an objective structured clinical examination (OSCE) in pediatrics and obstetrics/gynecology, and the written examinations in internal medicine and general surgery. Results: CPX scores showed a mild correlation with the scores of the slide examination in internal medicine and OSCE in pediatrics and obstetrics/gynecology (r=0.19, 0.28, 0.30). CPX scores were also mildly correlated with written examination scores in internal medicine but not associated with those in general surgery. Conclusion: Considering the mild correlation of CPX scores with scores of other clinical clerkship assessments and written examinations, CPX should be affirmatively considered as an examination complementary to previous examinations.

내과 임상실습에서 문제바탕학습 (Problem-based Learning)을 응용한 항생제 교육

박완범(Wan Beom Park),김홍빈(Hong Bin Kim),김남중(Nam Joong Kim),오명돈(Myoung -don Oh),최강원(Kang Won Choe),이윤성(Yoon Sung Lee),신좌섭(Jwa-Seop Shin) 한국의학교육학회 2007 Korean journal of medical education Vol.19 No.1

Purpose: The purpose of this study is to develop a course to teach through problem-based learning the use of antibiotics during an internal medicine clerkship, and to evaluate the responses of students to it. Methods: The course was designed to teach third-year medical students how to prescribe antibiotics to be given to real patients. A qualitative evaluation for the modified problem-based learning was performed by tutor’s observation and focus group interview, and a quantitative evaluation by questionnaires before and after the course. Results: Seventy-nine students experienced the modified problem-based learning during the infectious disease section of an internal medicine clerkship. Most students participated actively and gave a positive evaluation expressing a need for problem-based learning on prescribing antibiotics. The course significantly increased the students’ self-confidence in both approaching patients and prescribing antibiotics. Conclusion: Modified problem-based learning is a useful educational tool in clinical clerkship.

감염 ; 일개 대학병원의 내과학생 술기실습 현황

박완범 ( Wan Beom Park ),허민 ( Min Hur ),김아름 ( Ah Reum Kim ),서미성 ( Mi Sung Seo ),김주성 ( Joo Sung Kim ),권성택 ( Sung Tack Kwon ),이윤성 ( Yoon Seong Lee ),신좌섭 ( Jwa Seop Shin ) 대한내과학회 2009 대한내과학회지 Vol.76 No.4

목적: 의과대학 학생들이 내과임상실습에서 실제 환자를 대상으로 얼마나 기본 술기를 시행하고 있는지, 그 성공률은 어떤지 살펴보고자 하였으며, 그와 더불어 내과 실습 중 임상 술기센터의 술기 교육에 대한 학생들의 반응을 확인하였다. 방법: 169명의 3학년 의과대학 학생들을 대상으로 내과 실습을 마친 시점에서 설문 조사를 시행하였다. 실습 중에 실제 환자를 대상으로 정맥혈채취나 말초정맥카테터삽입술을 시행한 적이 있는지, 실제 환자를 대상으로 처음 시도한 술기가 성공했었는지, 술기교육에 있어 임상술기센터에서의 교육이 유용했는지 등을 질문하였다. 결과: 3학년 첫 실습으로 내과실습을 한 39명 중 2명(5%) 은 8주의 내과실습기간 동안 환자를 대상으로 혈액을 채취해 본적이 없다고 하였으며, 22명(56%)은 말초정맥카테터 삽입술을 해 보지 못했다고 하였다. 다른 3학년 임상실습을 마치고 마지막으로 내과실습을 한 35명 중 2명(56%)은 32주의 3학년 실습 전체 기간 동안 정맥혈채취를 해보지 못 했고 8명(23%)은 말초정맥카테터삽입술을 해보지 못했다고 응답하였다. 부분적인 성공을 성공으로 간주하였을 때 첫 환자 대상의 술기성공률은 정맥혈채취의 경우 93%, 말초정맥카테터삽입술의 경우 79%이었다. 결론: 의과대학 학생들의 환자 대상 기본술기성공률은 비교적 높은 편이었으나, 상당수의 학생들이 임상실습 중에 환자를 대상으로 기본 술기를 시행해보지 못하고 있었다. 실습 학생들이 실제 환자를 대상으로 기본 술기를 시행할 수 있는 실습체계가 필요하다. Background/Aims: This study evaluated medical students` experience performing basic clinical skills with real patients in a tertiary hospital and their response to clinical skill training in the Skills Center during their clerkship in internal medicine. Methods: We surveyed 169 third-year students at the end of the internal medicine clerkship. The questionnaire included questions on their experience sampling blood and inserting intravenous (IV) catheters with real patients, success with their first patient, and the usefulness of the Skills Center during the clinical clerkship. Results: Of the 169 students, 145 (86%) answered the questionnaire. Two (5%) of 39 students had not sampled blood and 22 (56%) had not inserted an IV catheter during the 8 weeks of the internal medicine clerkship. Two (6%) of 35 students had not sampled blood and 8 (23%) had not inserted an IV catheter during 32 weeks of the 3rd-year clinical clerkships. The partial or complete success rate for performing the skills with real patients was 93% for blood sampling and 79% for IV catheter insertion. Ninety (62%) students stated that skill training in the Skills Center during the clinical clerkship improved their basic clinical skills and 62 (43%) agreed that it increased their confidence to perform those skills on real patients. Conclusions: A significant number of medical students do not experience basic clinical skills with real patients during the clinical clerkship in a university hospital, although they had relatively high success rates performing those skills. (Korean J Med 76:451-458, 2009)

진료수행시험에서 시험 시간 경과에 따른 표준화 환자 채점의 정확도 분석

박완범(Wan Beom Park),김아름(Ah Reum Kim),이성아(Sung A Lee),김은아(Eun A Kim),장선영(Sun-young Chang),김연수(Yon Su Kim),김석화(Suk Wha Kim),신좌섭(Jwa -Seop Shin),이윤성(Yoon Sung Lee) 한국의학교육학회 2007 Korean journal of medical education Vol.19 No.1

Purpose: The purpose of this study is to evaluate the accuracy of standardized patients’ (SP) rating according to the order of examinees in clinical performance examination. Methods: In the clinical performance examination which was administered in 2005 at Seoul National University College of Medicine, each SP evaluated 16 students consecutively. For all 16 SPs (2 SPs per station), accuracy of rating was evaluated by comparing the individual records of each SP to the ‘recording keys’ made by two SPs from reviewing a video recording of performances by examinees. Results: The average number of items incorrectly rated by SP was 3.8 (range, 0~12), 2.8 in female SPs and 4.8 in male SPs (p<0.001). No statistical correlation was observed between the number of errors and the order of examinees (p=0.843). Even after stratification by gender or age of the SPs or domains of examination, the number of items incorrectly rated did not differ significantly according to the order of examinees. Conclusion: An increase in SP’s rating error with time after the start of examinations was not observed within the 16 consecutive encounters in clinical performance examination. The effect of SP’s fatigue on the accuracy of simulation as an examination progresses remains to be studied.

최초 전이성 감염으로 생각되었던 Macrophagic Myofasciitis 1예

한미연 ( Mi Yeun Han ),박준원 ( Jun Won Park ),류한희 ( Han Hee Ryu ),최인아 ( In Ah Choi ),박완범 ( Wan Beom Park ),이은봉 ( Eun Bong Lee ),송영욱 ( Yeong Wook Song ),정혜연 ( Hae Yoen Jung ),이은영 ( Eun Young Lee ) 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.5

자발성 세균성 복막염에서 균혈증 동반이 가지는 임상적 의미

조재현 ( Jae Hyun Cho ),박경화,방지환,박완범 ( Wan Beom Park ),김홍빈 ( Hong Bin Kim ),김남중 ( Nam Joong Kim ),오명돈 ( Myoung Don Oh ),최강원 ( Kang Won Choe ),( Chang Seop Lee ) 대한내과학회 2005 대한내과학회 추계학술대회 Vol.2005 No.1

증례 : 수술없이 치료한 Erysipelothrix rhusiopathiae 아급성 심내막염 1예

조재현 ( Jae Hyun Cho ),이창섭 ( Chang Seop Lee ),박완범 ( Wan Beom Park ),김남중 ( Nam Joong Kim ),오명돈 ( Myoung Don Oh ),김홍빈 ( Hong Bin Kim ),최강원 ( Kang Won Choe ) 대한내과학회 2006 대한내과학회지 Vol.71 No.5

E. rhusiopathiae에 의한 심내막염은 흔하지 않은 감염증이지만, 적절히 치료하지 않는 경우 치명적이고 수술적 치료가 필요한 판막 손상 등으로 진행할 수 있다. 저자들은 수술적 치료 없이 항균제 투여만으로 완치한 E. rhusiopathiae 심내막염 1예를 경험하여 보고한다. Erysipelothrix rhusiopathiae is an uncommon pathogen in humans, and it is caused by zoonotic infection. It usually induces localized skin infection (erysipeloid) in most cases of human infection. Endocarditis due to E. rhusiopathie is very rare, but it causes various cardiac valve complications including valve replacement. We reported here on a case of E. rhusiopathiae endocarditis in a 71 years old man who had liver cirrhosis and no underlying cardiac disease. This case was treated with intravenous penicillin G for 30 days and he improved without any surgical intervention.(Korean J Med 71:558-561, 2006)

그람양성균으로 인한 감염 척추염에서 Linezolid의 효과와 안전성

정종탁 ( Jongtak Jung ),이은영 ( Eunyoung Lee ),송경호 ( Kyoung-ho Song ),최평균 ( Pyoeng Gyun Choe ),박완범 ( Wan Beom Park ),방지환 ( Ji Hwan Bang ),김의석 ( Eu Suk Kim ),김홍빈 ( Hong Bin Kim ),박상원 ( Sang Won Park ),김남중 ( 대한내과학회 2018 대한내과학회지 Vol.93 No.5

목적: 감염 척추염은 장기간의 항생제 치료를 필요로 하며, 이 기간 동안의 정주 항생제의 사용은 입원으로 인한 사회적 손실과 비용을 유발한다. Linezolid는 경구 생체 이용률이 100%이며 신기능과 간기능에 따라 linezolid의 약동학이 영향받지 않는 장점이 있다. Beta-lactam 항생제에 내성을 보이는 그람양성균에 의한 감염 척추염에서 linezolid의 임상적, 미생물학적 치료 효과를 분석하였다. 방법: 2006년부터 2016년까지 서울대병원, 분당서울대병원, 보라매병원에서 감염 척추염으로 진단된 환자 중 linezolid가 4주 이상 투약된 사례에서 임상정보를 후향적으로 수집하여 분석하였다. 결과: Linezolid가 4주 이상 투약된 환자는 총 20명이었다. 가장 흔한 원인균은 methicillin-resistant Staphylococcus aureus 였으며(n = 15), 다음으로 methicillin-resistant coagulase-negative Staphylococcus가 많았다(n = 3). 20명의 환자 중 14명을 성공적으로 치료하였고 4명에서는 치료에 실패하였다. 2명의 환자는 감염 척추염이 아닌 다른 원인으로 사망하였다. Vancomycin 치료 실패 환자 13명 중 10명에서 linezolid로 치료에 성공하였다. 지속적인 균혈증을 보인 10명의 환자 중 8명에서 linezolid 투약 이후 균음전이 확인되었다. Linezolid 사용 기간의 중앙값은 40.5일(28-90)이었다. 약물 이상 반응 평가에서 항생제 중단을 고려할 만한 심한 혈구감소증은 호중구감소증 11.11%, 빈혈 12.96%, 혈소판감소증이 20.37%였다. 결론: Linezolid는 감염 척추염에서 치료제로 효과적으로 사용할 수 있으며 특히 1차 치료제의 치료 실패가 예상되는 경우 구제 치료로 사용할 경우 높은 치료 성공률을 기대할 수 있다. Background/Aims: Infectious spondylitis requires long-term antibiotic treatment; however, the use of intravenous antibiotics during this period has high social and monetary costs due to hospitalization. Linezolid has high oral bioavailability and is not affected by changes in renal or hepatic function. We investigated the clinical and microbiological effects of linezolid in infectious spondylitis caused by beta-lactam resistant gram-positive bacteria. Methods: Clinical data from patients who were treated with linezolid for at least four weeks were collected retrospectively from electronic medical records at the Seoul National University Hospital, Seoul National University Bundang Hospital, and Boramae Medical Center from 2006 to 2016. Results: Twenty Korean patients were treated with linezolid for at least four weeks during the study period. Of these, 14 patients were cured, four failed, and two cases of mortality occurred due to other causes than infectious spondylitis. Ten of 13 patients who had previously been assessed as vancomycin treatment failure were cured by linezolid. Bacteremia occurred in 14 patients, and 10 of these showed persistent bacteremia at the time of linezolid administration. Eight of these cases of persistent bacteremia were cured by linezolid. Median duration of linezolid treatment was 40.5 days (28-90 days). Severe cytopenia (grade II or more of National Cancer Institute criteria) was the most common adverse event, with incidences of 11.11% for neutropenia, 12.96% for anemia, and 20.37% for thrombocytopenia. Conclusions: Linezolid can be used as an effective antibiotic agent in patients with infectious spondylitis, especially when treatment failure of the first-line treatment is expected. (Korean J Med 2018;93:464-472)

성인의 만성 기침에 대한 감별진단으로서의 백일해

박완범,박상원,이기덕,이창섭,장희창,김홍빈,김의종,오명돈,최강원 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

목적 : 백일해는 소아기에 발생하는 전염병으로 오랫동안 알려져 왔다. 그러나, 미국과 유럽에서는 1990년대에 들면서 성인에서도 백일해가 유행하며, 만성 기침 환자의 20% 정도가 백일해를 앓는 것으로 보고하고 있다. 저자들은 국내에서 성인 만성기침의 원인으로 백일해의가능성을 확인하고자 하였다. 재료 및 방법 : 2002년 9월부터 2003년 5월까지 서울의 일개 대학보건진료소 또는 일개 시립병원 외래를 방문한 환자 중 기저 폐질환 없이 1주 이상 기침을 하는 성인을 대상으로 Bordetetlla pertussis에 대한 배양검사와 중합효소 연쇄반응검사(PCR)를 시행하였다. 결과 : 1주 이상의 기침을 하는 성인 102명 중 배양검사에서 양성인 환자는 없었으나 3명(2.7%)에서 PCR 양성이었으며 이들 모두 3주 이상 기침이 지속되었고 백일해의 특징적인 증상을 호소하였다. 결론 : 국내에도 성인에서 백일해가 발생하고 있음을 확인하였고 따라서 성인 만성기침의 원인으로 백일해를 감별 진단해야 한다. Background : Pertussis was long considered a childhood illness. However, in the last two decades, it has been reported as a cause of prolonged cough in adolescents and adults in other countries. Infection of Bordetella pertussis was prospectively searched among adults with a persistent cough. Materials and Methods : Adult patients, who visited either the outpatient clinic of a municipal hospital or a university health service center due to cough of more than six days' duration without underlying pulmonary disease, from September 2002 to May 2003, were enrolled. The culture and polymerase chain reaction (PCR) were used for confirming of B. pertussis infection. Results : 102 adult patients with persistent cough were evaluated. 3 (2.9%) patients were PCR positive for B. pertussis. There were no patients with positive culture. All patients with positive PCR had one or more classic symptoms of pertussis and their cough persisted for 3-7 weeks. Conclusion : We confirmed the morbidity of pertussis in Korean adults with persistent cough. Pertussis should be considered as a differential diagnosis of chronic cough in adults.

간경변증 환자에서 Escherichia coli 균혈증 합병 시 간기능 장애에 따른 C-reactive protein 생성 능력에의 영향

박완범,강철인,김동민,이기덕,장희창,김홍빈,오명돈,이효석,최강원 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

목적 : C-reactive protein(CRP)은 간에서 생성되는 급성 반응물질이다. 하지만 간부전증 환자에서 CRP의 반응이 간기능에 따라 어느 정도 영향을 받는지는 별로 알려진 바가 없다. 본 연구에서는 간기능에 따른 CRP 생성 능력을 평가하고자 하였다. 방법 : E. coli 균혈증이 있는 간경변증 환자 30명을 대상으로 하였고 간기능은 균혈증이 발생하기 전 2개월 이내에 측정된 혈청 빌리루빈, 혈청 알부민, 프로트롬빈시간, Child-Pugh 점수로 평가하였다. 대조군 A는 간질환이 없으면서 E. coli 균혈증이 발생한 환자 30명으로 하였고 대조군 B는 간경변증이 있으면서 급성 감염의 증거가 없는 환자 30명으로 하였다. 환자군과 대조군 간에 CRP의 최대값을 비교하였다. 결과 : CRP의 최대값은 환자군에서 7.3±5.0㎎/dL, 대조군 A에서 17.9±8.3㎎/dL로 환자군에서 유의하게 낮았다.(P<0.001). 간경변증 환자에서 CRP의 생성은 Child-Pugh 점수에 비례하여 감소하였으나(P=0.004) Child=Pugh class C의 간기능을 가진 환자군에서도 대조군 B와 비교하여 의미있는 CRP의 생성을 보였다(5.3±3.2 vs. 0.5±0.4㎎/dL, P<0.001). 결론 : 간기능부전 환자에서 CRP 반응은 간기능 저하 정도에 따라 둔화되지만 심한 간기능 장애를 가진 환자에서도 CRP의 생성은 유지된다. Background : C-reactive protein (CRP) is an acute phase reactant produced in the liver. To assess the influence of liver dysfunction on the production of CRP, we evaluated CRP response to E. coli bacteremia in patients with or without liver cirrhosis (LC). Methods : 30 LC patients who developed spontaneous peritonitis with E. coli bacteremia were enrolled in the study. Baseline values of total bilirubin, serum albumin, and prothrombin time were obtained within 2 months prior to infection. Liver dysfunction was categorized according to the Child-Pugh score. 30 patients with E. coli bacteremia who had no underlying liver dysfunction were included as a control group. Matched-control of 30 LC patients without evidence of acute infection was also included. The peak CRP values were compared among the groups. Results : In the patients with E. coli bacteremia, the mean value of peak CRP was 7.3 (+/- 5.0) ㎎/dL in LC patients, 17.9 (+/- 8.3) mg/dL in patients without liver dysfunction (p<0.001). In the advanced LC patients with Child-Pugh class C, the level of CRP was 5.2 (+/- 3.3) ㎎/dL in patients with E. coli bacteremia, 0.5 (+/- 0.4) ㎎/dL in patients without acute infection (P<0.001). Child-Pugh score had correlation with decrease of CRP (linear regression test, P=0.004). Conclusion : CRP response during E. coli bacteremia was attenuated but maintained even in patients with advanced liver dysfunction.