An overview of the Publicly Funded Medical Education System in Taiwan

Jen-Hung Yang,Chung-Liang Shih 대한의사협회 의료정책연구소 2020 의료정책포럼 Vol.18 No.3

저자 楊仁宏教授(Jen-Hung Yang, MD, Ph D)는 대만 양명의대 공비생으로 입학하여 피부과 전문의가 되고 이후 대학교수와 타이완 ‘추치(慈濟 Tzu Chi) 의대학장’을 역임하고, 현재 彰化基督教醫院의 교육주임과 카오슝의과대학 교수로 재직하고 있다. 우리나라에서 논의되고 있는 공공의대를 몸소 경험하고 졸업생으로서 공공의대에 대한 의견을 기술하고 있다. 타이완은 1975년 정부 주도로 취약지역과 제대 군인을 위한 ‘원호 의료’ 등을 목적으로 하는 현재 우리나라의 공공의료대학의 설립취지와 동일한 ‘국립양명의대(國立陽明大學)’를 설립하였다. 양명의대는 입학생 모두를 ‘공비(公費) 장학생’으로 선발하였고 등록금과 생활비까지 지원했다. 그럼에도 1988년에 자비로 부담하는 일반 학생의 입학도 허용하기 시작하였고 이후 단독 의과대학에서 여러 보건의료계열을 거느린 국립양명대학교로 지난 1994년에 개편되었다. 저자는 현재까지 3가지 유형의 공비장학생과정에 대한 자세한 설명을 도표와 함께 하고 있다. 그럼에도 공통적인 것은 6년간의 의무기간 중 4년은 전공의교육 그리고 2년이 실제 취약지역, 공중보건, 국제보건 등의 직무를 위한 의무 복무 기간 이었다. 과거 별도로 1년간의 군복무 의무도 부여되었으나 지금은 군복무 기간이 4개월로 줄어들었다고 한다. 2년간의 의무 복무기간 면허는 개인 소유가 아니어서 양명대 학생들은 이에 헌법소원을 제기하였으나 2년간의 의무 복무기간 중 정부 차원의 면허의 관리는 ‘합헌’으로 판정받기도 하였다. 과거 장학금에 대한 1:1 배상을 하면 의무복무도 면제되었으나 최근 2016부터 자신이 공비(公費)로 받은 금액의 4배를 배상하여야 해제된다고 한다. 이것은 2016년부터 속칭 비인기과 전공을 지원하는 정책으로 입학전형이 바뀌었기 때문이다. 공비 장학생은 점차 줄기 시작하여 2009년에 와서는 소수 몇 명의 도서지방 출신 학생을 제외하고 학생 전원 자비 교육생으로 바뀌었다고 한다. 34년간의 공비학생제도가 자비학생으로 전환되었던 이유는 2년의 의무 복무로 더 이상 졸업생들을 보낼 지역이 없었다는 점이다. 지난 1982년~2017년 사이 양명대 졸업생 4,111명을 대상으로 한 취업 현황 파악을 살펴보면, 약 31.7%는 의료원에서, 38.5%는 지역병원, 29.8%는 1차(기층) 진료에 종사하고 있는 것으로 분석됐다. 총 6,557명의 졸업생 중 84%는 도시에 남았고, 전체 16%만이 취약지에 남았다. 양 교수는 도시와 시골간의 불균형은 공공의대로 해결할 수 없는 문제라고 지적하고 있다. 보다 더 정교한 공공성이 강화된 의학교육제도의 구축과 혁신이 필요함을 주장하고 있다. We briefly review the origin, planning, development, and outcome of the publicly funded medical education program (PFMP) in Taiwan. The general PFMP was launched in National Yang-Ming University School of Medicine in 1975. Approximately 6,600 PFMP graduates filled the gap of medical needs at that time, and at least a part (16%) of graduates still served at medically underserved areas. We demonstrated the contributions of the PFMPs to improve the healthcare in medically underserved areas and our public health system. We recognize that PFMP alone cannot overhaul the inadequacy of healthcare resources and physician supplies between the urban and rural underserved areas. We need more efforts and innovations to construct a more sophisticated public-funded medical education system to achieve an even and fair distribution of good healthcare resources.

Thyroid Fine-Needle Aspiration in Taiwan: The History and Current Practice

Jen-Fan Hang,Chiung-Ru Lai,Chih-Yi Hsu 대한병리학회 2017 Journal of Pathology and Translational Medicine Vol.51 No.6

In Taiwan, thyroid cancer is the most common endocrine gland malignancy and the incidence of thyroid cancer has increased four-fold in the past two decades. Fine-needle aspiration is an accurate and cost-effective method of evaluating thyroid nodules and has been the gold-standard diagnostic tool for thyroid tumors in Taiwan since the 1980s. This article reviews the history, current practice, reporting systems, training, and quality assurance for thyroid fine-needle aspiration cytology in Taiwan.

An Improvement on Robust H<SUB>∞</SUB> Control for Uncertain Continuous-Time Descriptor Systems

Hung-Jen Lee,Shih-Wei Kau,Yung-Sheng Liu,Chun-Hsiung Fang,Jian-Liung Chen,Ming-Hung Tsai,Li Lee 대한전기학회 2006 International Journal of Control, Automation, and Vol.4 No.3

This paper proposes a new approach to solve robust H∞ control problems for uncertain continuous-time descriptor systems. Necessary and sufficient conditions for robust H∞ control analysis and design are derived and expressed in terms of a set of LMIs. In the proposed approach, the uncertainties are allowed to appear in all system matrices. Furthermore, a couple of assumptions that are required in earlier design methods are not needed anymore in the present one. The derived conditions also include several interesting results existing in the literature as special cases.

Simplified Design Equation of Minimum Interior Joint Depth for Special Moment Frames with High-Strength Reinforcement

Hung-Jen Lee,Hsi-Ching Chen,Tsung-Chieh Tsai 한국콘크리트학회 2018 International Journal of Concrete Structures and M Vol.12 No.7

To avoid excessive slip of beam longitudinal bars at the joints of an earthquake-resisting moment frame, ACI 318 Building Code set a minimum joint depth of 20 times the diameter of the largest longitudinal beam bars passing through the joint, which is based on prior experimental verification of beam-column joints with Grade 420 ㎫ reinforcement. In view of that the 20-bar-diameter criterion cannot be simply extended for concrete frame joints with higher grade reinforcement, this paper summarizes international existing design criteria and proposes a simplified equation for the minimum joint depth. The equation applicability is assessed by evaluating the cyclic testing results of beam-column joints conducted in East Asian and Pacific Countries, where Grade 490, 590, and 690 ㎫ reinforcement have been used for earthquake-resistant concrete structures. Beam-column joints that satisfy the proposed equation can demonstrate satisfactory hysteresis behavior at an interstory drift of 4%.

On Establishing a New Fee Schedule for General Surgical Procedure Using Fuzzy MCDM

Hung, Chih-Young,Huang, Yuan-Huei,Chang, Pei-Yeh,Wang, Kuei-Ing,Chang, King-Jen,Liu, Yi-Hsin Korean Institute of Industrial Engineers 2005 Industrial Engineeering & Management Systems Vol.4 No.2

In this research a model for establishing a new, rational fee schedule for general surgical procedures in a national health insurance program is developed. A fuzzy multiple criteria decision-making (FMCDM) model is proposed. The relative values of eleven surgical procedures were obtained through an empirical study based on the FMCDM model. Consequently, a new fee schedule obtained from the FMCDM model. This new fee schedule is more convincing than previous schedule and more persuasive to the references for the policy setting.

Enhancement of Ordering Temperatures of La<SUB>0.67</SUB>Ca<SUB>0.33</SUB>MnO₃ Thin Films by Adding Ho Atoms

Jen-Hwa Hsu,S. H. Hung,Subhayan Biswas,J. G. Lin 한국자기학회 2007 한국자기학회 학술연구발표회 논문개요집 Vol.- No.-

Determining the influence of heterogeneity in graduate institutions on university–industry collaboration policy in Taiwan

Hung-Jen Weng,Dian-Fu Chang 서울대학교 교육연구소 2016 Asia Pacific Education Review Vol.17 No.3

In this study, we assumed that organizational heterogeneity is a key factor influencing the effects of university–industry cooperation policy in higher education institutes. Gender difference, faculty position, faculty member nationality, and diversity in academic expertise were considered as the indicators of heterogeneity. One-hundred graduate institutes with doctoral programs were selected from 881 departments offering doctoral programs in Taiwan as our target group. Correlation analysis, regression analysis, and curve estimation according to the concept of Blau’s index were conducted to determine the effects of graduate institute heterogeneity. Gender difference in graduate institutes played a crucial role on the effect of university–industry collaboration. The results reveal that excessive or insufficient differentiation among faculty positions has an adverse effect on university–industry collaboration, presenting both advantages and disadvantages in this case. A Blau’s index value of 0.56 for faculty position differentiation indicated optimal performance in university–industry collaboration. To enhance university–industry collaboration, this study suggests that the optimal fit proportion of faculty numbers in graduate institutes is seven professors to two associate professors to one assistant professor. Diversity in expertise in graduate institutes also indicated improved performance in university–industry collaboration. Determining how to diversify the expertise in graduate institutes is critical for improving performance and must be considered at specific institute level. The findings provide specific strategies for graduate institutes to reallocate their human resources to optimize their performance in this field.

Prognostic Factors in Adult Patients with Solid Cancers and Bone Marrow Metastases

Hung, Yu-Shin,Chou, Wen-Chi,Chen, Tai-Di,Chen, Tse-Ching,Wang, Po-Nan,Chang, Hung,Hsu, Hung-Chih,Shen, Wen-Chi,Cheng, Wei-Hong,Chen, Jen-Shi Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.1

Background: Solid cancers with bone marrow metastases are rare but lethal. This study aimed to identify clinical factors predictive of survival in adult patients with solid cancers and bone marrow metastases. Methods: A total of 83 patients were enrolled consecutively between January 1, 2000 and December 31, 2012. Bone marrow metastases were confirmed by biopsies. Patient clinical features and laboratory data were analyzed for associations. Results: The median age of the patients was 54 years (range, 23-88 years), and 58% were male. The 3 most common primary tumor locations were the stomach (32 patients, 39%), prostate (16 patients, 19%), and lungs (12 patients, 15%). The median overall survival was 49 days (range, 3-1423 days). Patients with Eastern Cooperative Oncology Group performance status 1, cancers of prostate origin, platelet counts over 50,000/ml, and undergoing antitumor therapies had a significantly better prognosis in the multivariate analysis. The median survival times were 173 and 33 days for patients with 2-3 more favorable parameters (n=24) and those with 0-1 (n=69), respectively (hazard ratio 0.30; 95% CI 0.17-0.52, p<0.001). Conclusions: Solid cancers with bone marrow metastases are dismal and incurable diseases. Understanding prognostic factors to these diseases helps medical personnel to provide appropriate treatments and better inform patients about outcomes. Antitumor therapies may improve outcomes in selected patient cohorts.

Activation of Small GTPases RhoA and Rac1 Is Required for Avian Reovirus p10-induced Syncytium Formation

Hung-Jen Liu,Ping-Yuan Lin,Ling-Rung Wang,Hsue-Yin Hsu,Ming-Huei Liao,Wen-Ling Shih 한국분자세포생물학회 2008 Molecules and cells Vol.26 No.4

The first ORF of the ARV S1133 S1 segment encodes the nonstructural protein p10, which is responsible for the induction of cell syncytium formation. However, p10-dependent signaling during syncytium formation is fully unknown. Here, we show that dominant negative RhoA, Rho inhibitor C3 exoenzyme, ROCK/Rho-kinase inhibitor Y-27632 and Rac1 inhibitor NSC23766 inhibit p10-mediated cell fusion. p10 over-expression is concomitant with activation and membrane translocation of RhoA and Rac1, but not cdc42. RhoA and Rac1 downstream events, including JNK phosphorylation and transcription factor AP-1 and NF-B activation, as well as MLC expression and phosphorylation are simultaneously activated by p10. p10 point mutant T13M possessed 20% fusion-inducing ability and four p10 fusion-deficient mutants V15M, V19M, C21S and L32A reduced or lost their ability to activate RhoA and Rac1 signaling. We conclude that p10-mediated syncytium formation proceeds by utilizing RhoA and Rac1-dependent signaling.

A 138.24-MHz Continuous-Time Band-Pass Sigma Delta Modulator for Digital IF Application

Jen-Shiun Chiang,Ming-Hung Tu,Hsin-Liang Chen,Yu-Chen Sung 대한전자공학회 2005 ITC-CSCC :International Technical Conference on Ci Vol.2005 No.3