의학과 4학년 종합평가로서의 객관적-구조적 임상능력평가(OSCE)의 경험

박훈기(Hoon-ki Park),김동원(Dong-won Kim),김덕언(Duck An Kim),최호순(Ho-soon Choi),김경태(Kyoung-tai Kim) 한국의학교육학회 1998 Korean journal of medical education Vol.10 No.1

BACKGROUND: Experiences on Objective Structured Clinical Examination(OSCE) for student assessment are limited in medical colleges in Korea. The purposes of this study were to develop an OSCE to fourth-year medical students after completion of all clerkships at Hanyang University Medical College. METHODS: The OSCE was a 8-station examination, with each station taking five minutes. We conducted two parallel OSCEs simultaneously by duplication. We checked each stage of the process in the development of OSCEs with recording of diary. We analysed validity and costs of the OSCE. We got feedback from all participants by questionnaires. RESULTS: Of the total 102 fourth-year students, only 74 persons(72.5%) were evaluated. The rate of pass was 63.5%. Cronbach alpha of the OSCE was 0.14. The scores were different between sites according to stations, especially in items related to attitude and physical. The total OSCE score was not significantly different either between duplication sites or among groups. OSCE scores didn t relate to those of both multiple choice tests and entrance exam for internship. Our use of only a few SP s contributed to relatively low cost of $85 per examinee. Both students and faculty were satisfied with the examination, and felt that the material tested was relevant and appropriate for primary care. The OSCE process served to identify weakness in the curriculum and/or teaching methods, and thus could serve as a mechanism to improve educational effectiveness. CONCLUSIONS: Problems of validity and reliability were detected in the developing process of the OSCE. It appeared financially feasible. Setting appropriate goal, optimum number of station, training of evaluators, development of good checklist, and enthusiastic support of the school s administartion were all needed more to success of such a program. 연구배경 : OSCE는 의학교육에서 임상능력을 평가하는 좋은 방법으로 인정받고 있다. 하지만 우리나라에서는 일부 의과대학을 중심으로 한정된 경험이 고작이다. 따라서 한양대학교 의과대학에서는 의학과 4학년을 대상으로 졸업시험의 일환으로 OSCE를 실시하고 그 개발과정, 운영에서의 문제점을 분석하고, 학생과 교수의 의견을 수렴하고자 이 연구를 수행하였다. 연구방법 : OSCE는 총 8개 문제로 구성되었으며 각 스테이션별로 5분이 배정되었다. 양측으로 동일하게 복제를 하였고 3개조로 나누어 실시하였으며 보안 유지를 위해 대기 학생은 슬라이드 시험을 치르도록 하였다. 운영상의 문제점을 단계별로 파악하기 위해 운영 책임자의 일기를 활용하였고, 학생 및 교수의 의견은 미리 준비된 자가설문지를 활용하였다. 결과 : 총 102명의 4학년 후보 학생 중 74명(72.5%)이 참가하였다. OSCE총점이 60인 학생은 전체의 63.5%였고, 일치도는 0.14였다. 과목별로 점수의 분포가 차이를 보였다. OSCE총점에서는 복제장소별로 차이가 없었으나 과목별로는 차이를 보였다. OSCE총점은 기존의 학업성적이나 후의 인턴 성적과 상관성이 없었다. 수험생 1인당 소요 경비는 75,676원 이었다. 학생이나 교수 모두 시험에 대해 긍정적인 평가를 하였으며, 시험문제의 내용이 일차의료에 중요하고 적절한 것으로 평가했으나 문제내용에 대한 실습교육의 강화를 지적했다. 이번 시험으로 학생과 교수 모두 현행 실습교육의 문제점을 볼 수 있었다. 결론 : OSCE는 4학년 졸업시험으로써 여러 면에서 용이한 것으로 판단된다. 하지만 좀 더 성공적으로 OSCE를 수행하려면 시험목표 설정, 적정 스테이션의 수 구성, 평가자의 훈련, 좋은 체크리스트의 개발, 의대의 행정적인 뒷받침 등이 앞으로 더 필요하다.

혈액투석치료를 받은 외과적 급성 신부전 환자의 임상 양상과 예후인자

박훈기(Hoon Ki Park),김동진(Dong Jin Kim),박경식(Kyoung Sik Park),강성원(Sung Won Kang),문창훈(Chang Hoon Moon),이규백(Kyu Baik Lee),김향(Hyang Kim),구자룡(Ja Ryong Koo),이영호(Young Ho Lee),장미경(Mi Kyoung Chang),권영주(Young Ju K 대한내과학회 1996 대한내과학회지 Vol.50 No.4

N/A Objectives: Acute renal failure continues to be a significant cause of postoperative morbidity and mortality, especially after operations or trauma. Post- operative renal failure carries a mortality rate over 50%. We had two goals-to identify preoperative and intraoperative risk facors for postoperative acute ranal failure in patients groups undergoing various types of surgery, and by the use of multivariate analysis, to assess the relative important of these risk factors to provide a means of estimating the probability of survival in an individual patient. Methods: Data review was carried out for the 68 adult patients with ARF treated at 6 hospitals over a 3-year period(January 1991-December 1993). These patients were surgical patients who developed ARF in the postoperative period and subsequently underwent hemodialysis. Thirty-five factors to be of potential relevance to the outcome in postoperative acute renal failure were tabulated and analyzed. Results: 1) The ratio of male to female was 2:1, and the mean age was 51±17 years. The prevalence reached peak over 60 years. The mean death rate, numbers of hemodialysis, duration of oligura, numbers of organ failed, interval from ARF to recovery and interval from ARF to death were 63%, 9±0.8, 11±1 days, 1.7±0.2, 28±2 days, 19±3 days respectively. 2) The complications which developed during ARF included pulmonary complication(57%), hypotension (51%) and sepsis(32%), etc. 3) In findings related to operation, the mean duration of operation, interval from operation to ARF, numbers of transfusion during operation, frequency of hypatension during operation and duration of hypotension during operation were 211±126 min, 3.5±4 days, 23±3pints, 55%, 39.95±8.84 min respectively. 4) In the univariate analysis, hypotension, pulmonary complication, numbers of organ faild, pH (pH<7.2 or pH>7.55), APACHE II score, sepsis, duration of operation and duration of hypotension during operation were the only factors among 35 risk factors that significantly correlated with post- operative acute renal failure. In the multivariate analysis, the only significant risk factors for postoperative renal failure were hypotension and the presence of underlying disease. Conclusion: From the above results. The physician caring for the postoperative ARF patient may depend on these risk factors to predict morbidity and mortality. Whether or not these factors help to prevent the severe morbidity and mortality associated with postoperative renal failure remains to be studied prospectively.

시험장 복제 (Duplication)가 객관적 구조적 임상 시험 (OSCE)의 신뢰도에 미치는 영향

박훈기(Hoon ki Park),이정권(Jung kwon Lee),김승룡(Seung ryong Kim),김경태(Kyoung tai Kim),박해영(Hae young Park) 한국의학교육학회 1999 Korean journal of medical education Vol.11 No.1

연구배경: 의과 대학 한 학년 학생 수가 많으면 고사장을 2개 이상으로 복제하여 OSCE를 치르게된다. 동일한 증례에 대하여 여러 명의 SP를 활용할 때 시험의 신뢰도에는 변함이 없다는 외국의 연구는 많았지만 국내의 연구는 아직 없다. 이에 저자는 OSCE 고사장 복제가 시험의 신뢰도에 어떤 영향을 주는 지 알아보고자 본 연구를 시행하였다. 연구방법: OSCE는 21개의 문제 스테이션과 18개의 증례로 구성되었으며 2개의 휴식 스테이션을 포함하여 학생들은 총 23개 스테이션을 순환하도록 구성되었다. 일차의료에서 흔하게 접할 수 있는 문제를 출제하였고 한 스테이션 당 7분을 배정했고 이 중 6분 내지 6분 30초는 문제 중심 병력청취, 신체검사, 수기, 처치에 관한 문제를 해결하는 데 배당하고, 30초에서 1분은 피드백 시간으로 할애하였다. 두 고사장간 OSCE총점과 문제별 점수 차를 비교함으로써 복제에 의한 OSCE 신뢰도를 분석하였다. 시험 후 학생 및 교수에게 설문지를 통해 OSCE에 대한 반응을 측정하여 복제에 대한 주관적인 신뢰도 평가를 함께 분석하였다. 결과: 의학과 4학년 학생 91명 모두 OSCE에 참가하였다. 시험의 Cronbach α 표준화 상수는 0.67이었다. 스테이션별 점수와 OSCE 총점은 두 고사장 간에 통계적으로 유의한 차이를 보였다. 두 고사장 간 3학년까지의 성적에는 차이가 없었으나 OSCE총점 차이는 2.3점이었다 (p=0.03). 총 19개 스테이션 점수 중 각 고사장마다 6개 스테이션씩 한쪽 고사장에서 유리한 점수를 얻었다. 측정분야별로는 처치, 수기, 총평에서 양 고사장간에 차이가 있었다. OSCE 성적은 학부 성적과 높은 상관성을 보였다. 시험시간에 따른 조별 성적 차이는 없었다. 학생의 50%와 교수의 1/3은 복제의 신뢰도에 부정적인 반응을 보였다. 학생들은 14개 스테이션의 SP 연기의 현실감에 대하여 ‘좋았다‘ 이상의 긍정적인 반응을 보였다. 평가자간의 차이가 복제에 의한 신뢰도 저하를 결정하는 주 요인이었다. 결론: 철저한 사전 준비가 없는 시험장 복제는 OSCE의 신뢰도를 떨어뜨린다. OSCE에서 시험장을 복제하고 시험의 신뢰도를 유지하려면 SP의 연기차이뿐 아니라 평가자간 차이를 사전에 충분히 점검 보완해야 한다. 시험장 복제시 OSCE 시험성적을 해석하는데 주의를 요한다. If large-scale testing programs are being used, OSCE stations may be duplicated into two or more sites. There are a few studies on the reliability of OSCE with duplicated stations in Korea. The purpose of this study was to investigate the effect of duplication on the reliability of OSCE. At Hanyang university college of medicine, an OSCE is given to all senior medical students(91 per class) upon completion of all clinical clerkship rotations. The examination consisted of twenty one stations and eighteen cases that represented commonly encountered problems in primary care. Each station required seven minutes for its administration, with 6 to 6.5 minutes for the student-SP or model encounter, during which the students performs a complete focused history and/or physical examination and/or procedure and/or management, and another 0.5 to 1 minutes for the evaluator to feedback case-related comments. We analysed the reliability of duplication by comparing total OSCE scores and case scores between two exam sites. We also evaluated the reliability of duplicated stations from student s and professor s subjective response to the OSCE. All 91 fourth-year students attended the OSCE. Standardized Cronbach coefficient of the OSCE was 0.67. The station scores and OSCE total scores were different between two duplication sites. The total OSCE score of one site was slight higher than that of the other site(p=0.03). Of total 19 stations in which students were evaluated by staff evaluator, six stations are more advantageous to one part compared with counterpart stations, other six stations are vice CONCLUSIONS: OSCE reliability can be affected by duplication of examination sites and inter-rater reliability is the most important determining factor. The results demonstrate a need for caution in the interpretation of scores obtained from OSCE with duplicated stations.

진료수행시험 (CPX: Clinical Performance Examination)에서 정보공유가 시험성적에 미치는 영향

박훈기(Hoon Ki Park),권오정(Oh Jung Kwon) 한국의학교육학회 2005 Korean journal of medical education Vol.17 No.2

Purpose: During the high-stake examinations such as OSCE (Objective structured clinical examination) or CPX (clinical performance exam), test security is generally accepted as a major concern for test validity. This study was conducted to investigate the effect on examinee s scores of repeated, serial administrations of essentially the same standardized patient (SP)-based performance exam. Methods: A performance-based examination using eight SP cases was administered to 123 senior medical students at Hanyang University School of Medicine. Students were randomly assigned to one of 16 groups of 8 students each. Three groups were tested serially each day, requiring 5 days for the complete administration of the examination. We compared the mean scores of the five groups of the examinees tested on different days with ANOVA and linear trends with multiple regression analyses. Results: For both checklist scores and written scores during the interstation work, the mean scores of the first day groups were significantly lower compared to subsequent groups. And, there were slight linear trends in the scores over the five days. Scores related to case-specific history taking, information sharing, and clinical courtesy were significantly affected by the sharing of information between students. Scores related to patient satisfaction, physical exam, and physician-patient interaction were not influenced by the same pattern of behaviour. Conclusion: Test security may be violated during SP-based performance exams even though the checklists are not accessible to the examinees. It would be desirable for the test-givers to prepare alternative forms of cases for maintaining the validity of SP-based performance exams.

의무기록 완성도에 대한 병동순회 의무기록사제도의 개입효과

강선희,박훈기,이금순,문옥륜,정풍만,Kang, Sunny,Park, Hoon Ki,Lee, Keum Soon,Moon, Ok Ryun,Jung, Poong Man 한국의료질향상학회 1999 한국의료질향상학회지 Vol.6 No.1-2

Background : With the CQI concepts, which emphasize doing the right things right the first time, we tried to enhance the timely completion of medical records by changing the review process from retrospective method to concurrent one. Methods : Against the current retrospective QA activity, Medical record administrator did the concurrent QA of the inpatient medical records with the deficiency sheets. One general surgery ward was chosen as a trial one. The deficiency rate of the medical records of the discharged patients was compared before and after the enforcement of the system. Job analysis of the medical record departments was done about four tertiary care hospitals located in Seoul to estimate the cost and the time consumed by current system. Results : There was a little improvement in the completion rate of the medical records after the trial. The new system was effective. And job analysis showed that much money and time were wasted by current retrospective feedback system. Conclusion : Though the result was not so satisfactory, it should be considered that this test was a voluntary one and the interns and residents were not forced to complete the medical records during this trial period. If there be any strong motivation to complete the medical record in time, this system is sure to be succeed. As the DRG system requires the concurrent review of the medical records to confirm severity of the patient's illness and to assure the timely discharge, it is desirable to enforce this method with the DRG system together. DRG coding and reducing deficiency rate of the medical records can be accomplished simultaneously.

광용적맥파 기반 고혈압 분류 모델을 통한 단계별 혈압 추정 모델 개발

김정훈(Jeong-Hoon Kim),박성률(Seong-Ryul Park),최영석(Young-Seok Choi),박훈기(Hoon-Ki Park) 대한전자공학회 2020 대한전자공학회 학술대회 Vol.2020 No.8

심박변이도를 이용한 정신적 스트레스의 객관적 지표 개발

박철진(CheolJin Park),안현준(Hyunjun An),이승재(SeungJae Lee),박훈기(Hoon-Ki Park),이종실(Jongshill Lee) 대한기계학회 2019 대한기계학회 춘추학술대회 Vol.2019 No.2

패치형 복합생체신호 측정 디바이스에 기반한 흉부에서의 비침습적 혈압 추정

김정훈(Jeong-Hoon Kim),박성률(Seong-Ryul Park),안현준(Hyun-Jun An),이종실(Jong-Shill Lee),박훈기(Hoon-Ki Park) 대한전자공학회 2021 대한전자공학회 학술대회 Vol.2021 No.6

생존 신호 분석을 위한 패치 타입 웨어러블 복합생체신호 측정 디바이스 개발

안현준(Hyunjun An),이승재(Seung-Jae Lee),김정훈(Jeong Hoon Kim),황호빈(Ho Bin Hwang),박성률(Seongryul Park),이종실(Jong-Shill Lee),박훈기(Hoon-Ki Park) 대한전자공학회 2020 대한전자공학회 학술대회 Vol.2020 No.8

류마티스 관절염 환자에서 대체의학의 이용실태 및 유용성

김예리 ( Ye Ree Kim ),유태석 ( Tae Seok Yoo ),박훈기 ( Hoon Ki Park ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),정성수 ( Sung Soo Jung ),유대현 ( Dae Hyun Yoo ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.3

Objective: The use of Complementary and Alternative Medicine (CAM) is common especially among patients with chronic conditions. The aim of this study was to investigate the percentage and characteristics of patients who make use of CAM and analyse the effect of CAM in RA. Methods: Two hundreds and twelve patients with RA were interviewed by a trained nurse according to structured questionnaire about sociodemographic features and type, effect and cost of CAM which was used. Results: Among 212 patients with RA, 73 patients had used CAM (34.4%). There was no difference in sociodemographic features between the user and non-user of CAM. The chinese medicine containing herbal medicine and acupuncture (43.8% and 24.7%) was most commonly used. There was no difference in the score of Korean Health Assessment Questionnaire (KHAQ) between the user and non-user of CAM. In the user group, the scores of the subjective effect and satisfaction for CAM were higher than those for the hospital services. The average yearly cost for CAM was 790,000 Won/person and it was about 67.5% of the one for hospital services. Conclusion: In patients with RA, the percentage of using CAM was 34.4%. Herbal medicine was most commonly used. CAM did not affect the outcome of the patients with RA. However, the scores of the subjective effect and satisfaction for CAM were higher than those for the hospital services. For the proper management of patients with RA, it is necessary to know further data about the effectiveness and side effects of CAM through experimental and clinical research.