연명의료결정법 시행 이후 일반인과 의대생 대상 죽음교육 개선을 위한 예비연구

김정아,안경진,Kim, Claire Junga,Ahn, Kyongjin 연세대학교 의과대학 2022 의학교육논단 Vol.24 No.2

Considering the recent medicalization of death, the importance of preparing both laypersons and medical students to have meaningful end-of-life conversations, which is among the objectives of death education, will grow. The Act of Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life provided a new source of momentum to death education for both laypersons and medical professionals, as the importance of education on death is widely recognized. However, problems remain regarding how to prepare people for productive conversations at the end-of-life and how to secure the continuity of care. Different focuses and deficiencies are observed in death education programs for each category of learner. In education for laypeople, tangible information on how to actualize one's existential and personal understanding of death through real-life options is lacking, except for presenting the "protocol" of the Act. Conversely, basic medical education lacks an understanding of or confrontation with death on the existential and personal levels. Death education should aim to build a shared understanding that can facilitate communication between the two groups. The scant overlap between layperson education and basic medical education even after the Act's enactment is worrisome. Further fundamental changes in death education are required regarding its content. Topics that patients and doctors can share and discuss regarding death and end-of-life care should be discovered and provided as educational content both to laypeople and future medical professionals.

한국의 환자-의사 관계와 생명의료윤리의 원칙들

김정아 ( Claire Junga Kim ) 한국윤리학회 2021 윤리학 Vol.10 No.2

비첨과 칠드레스가 ‘생명의료윤리의 적절한 출발점인 공통도덕의 일반적인 규범들을 표현하기 위해 의도된 분석 틀로서 기능’한다고 제안한 생명의료윤리의 4원칙은 생명윤리 분야에서 큰 영향력을 누려왔다. 그러나 이 원칙들을 그 원칙이 태동한 문화적 구획 밖에서 적용하고자 하는 시도들은 종종 실패를 마주하였다. 본 논문에서는 이 4원칙 중 동아시아 사회에서 가장 많은 불협화음을 낸다고 일컬어지는 자율성 존중의 원칙을 한국의 환자-의사 관계라는 맥락 속에서 살펴본다. 이 논문은 (1) 이 원칙이 한국의 환자-의사 관계에 실제로 성공적으로 적용되고 있는지와 (2) 이 원칙의 번역가능한 대응물을 유교 문화권의 이론적 배경인 유학에서 찾을 수 있을지, 그리고 (3) 번역 가능한 대응물의 모색이라는 (2)와 같은 방식이 전략적으로 유의미할 것인지를 따져본다. 번역 가능한 대응물의 모색은 짜이가 시도한 방식이기도 한데, 이러한 방식을 한국에 적용하는 것이 전략적으로 유의미해지려면 자율성 존중의 원칙을 포함한 생명의료윤리의 4원칙을 공통도덕으로 가정하는 동시에 이론으로서의 유학을 의료 맥락에 적용될, 현재 한국인의 신념체계의 중요한 축으로 가정하면서 이 둘 사이에 매끄러운 번역이 가능할 것이라고 기대할 수 있어야 한다. (1), (2), (3), 각각의 질문에 회의적으로 답하며 저자가 결론적으로 제안하는 바는 낙관적 전제들에 대한 점검과 실증 연구에 근거한 “한국의 생명윤리학”이 필요하다는 것이다. 한국의 생명윤리학은 생명의료윤리의 4원칙이 공통도덕의 일부라는 검증되지 않은 가정에서 출발할 필요가 없으며, 반드시 유교 이론과 같은 전통 사상 구획에 구속될 필요도 없이, 현재 우리가 필요로 하는 규범 체계가 무엇인지에 대한 답이 되어야 할 것이다. The four principles of biomedical ethics, suggested by T. L. Beauchamp and J. F. Childress as “an analytical framework intended to express general norms of the common morality that are a suitable starting point for biomedical ethics,” have enjoyed great influence in the field of bioethics. However, attempts to apply these principles outside the cultural sphere in which these principles were born often faced failures. In this paper, the author examines the principle of “respect for autonomy,” which is said to produce the most discord within East Asian societies among these four principles, in the context of a patient-doctor relationship in Korea. This paper examines whether (1) this principle is successfully applied to Korean patient-doctor relationships, (2) this principle is compatible with Confucianism, and (3) the approaches like (2) are strategically sound. Such approaches of searching for translatable counterpart were tried by D. F. C. Tsai. However, adopting these approaches in Korean context requires critical examination on unproven assumptions: the four principles of biomedical ethics are part of common morality. Confucianism as a theory is an important part of the current Korean belief system that can be applied to medical context; these two four principles and Confucianism are translatable. In answering each question of (1), (2), and (3), the author reaches the conclusion that Korean bioethics, which is based on critical examination on unproven assumptions, and on empirical researches is direly needed. Korean bioethics should be the answer to what the framework of moral norms would be like for our current needs in biomedicine. This does not need to start from the unproven assumptions that the principles of biomedical ethics are part of common morality, or that a traditional theory such as Confucianism is the basic mindset that we use in the current context of biomedicine.

의예과 글쓰기 교과목에서의 동료 평가와 상호 되먹임의 효과

김정아 이화여자대학교 의과학연구소 2017 EMJ (Ewha medical journal) Vol.40 No.1

Objectives: There are several problems which hamper the successful teaching of writing in medical education. To deal with these problems, teachers should be conscious of two general questions; what to teach in writing class for premedical students; and how to utilize the writing class time. This paper examines the value of peer assessment and peer feedback in dealing with those questions. Methods: This paper reviews a subject in premedical education, Logical Thinking and Writing , from the perspective of peer assessment and peer feedback. Results: Students accomplished the learning objectives and they recognized the value of peer assessment and feedback. Conclusion: Peer assessment and peer feedback foster students’ participation in class and accelerate the learning process. This strategy reminds students of the fact that they are writing an essay for an audience.

교수개발로서의 생명의료윤리 교육 : 신임교원 대상 교육개발과 시행 경험을 바탕으로

김정아,오승민,김평만 이화여자대학교 생명의료법연구소 2014 생명윤리정책연구 Vol.8 No.2

Biomedical ethics education as a faculty development program has crucial role in medical education for student, interns, and residents. It helps clinical faculties to educate their trainees about the importance of medical ethics in clinical situation, and to encourage the trainees to integrate the knowledge, skills, and attitude they have been taught in formal medical ethics education program with the new clinical context they are dealing with. However, the need for faculty development in this area has been neglected. This article introduces an attempt for faculty development on medical ethics education which is provided to new faculty members in one medical center. We developed workshop program for two days and also wrote a book on medical ethics for clinicians. We found changed perception on medical ethics education and received positive feedbacks. New faculty members came to have more self-efficacy on medical ethics and perceive more need on medical ethics education. This would help them to be a good role model for their trainees as well as a good doctor for patients. 본 논문은 생명의료윤리 교육, 특히 의학교육 내에서의 생명의료윤리 교육 중 필수적 부분인 교수개발(faculty development)의 분야를 다룬다. 생명의료윤리 교육이 의학교육 내에서 받아들여지고 그 중요성을 인정받고 있으나, 이를 의(醫)의 실무 속에서 행함으로써 학생과 전공의를 위한 롤모델이 되어 줄 의학교육자를 대상으로 한 교육은 지금까지 크게 부각되지 못하였다. 본 논문에서는 일개 의료원에서 신임교원을 대상으로 제공한 생명의료윤리 교육을 교수개발의 측면에서 접근하여 분석한다. 새로운 구성원에게 기관의 윤리적 사명을 명시적으로 표명하는 것은 구성원들로 하여금 그들이 받고 있는 기대가 무엇인지 이해할 수 있게 하고 진료 현장과 교육의 현장에서 윤리적 실천을 할 수 있도록 도와준다. 교재 개발과 워크숍으로 이루어진 본 교수개발 프로그램에 대하여 학습자들은 생명의료윤리 지식에 관한 자기평가와 필요성 인식 모두 증가한 양상을 보였고, 연구진은 이러한 결과를 만족도 결과와 더불어 교육에 대한 긍정적인 평가로 해석하였다. 결과적으로 본 연구는 앞으로 교수개발의 차원으로 생명의료윤리 교육이 확대되어야 한다는 당위와 긍정적 가능성을 보여준다.

의과대학 학생의 의예과 교육과정에 대한 인식에 관한 질적 연구

김정아,이화영,박영미,이희정 이화여자대학교 의과학연구소 2020 EMJ (Ewha medical journal) Vol.43 No.1

Objectives: A Womans University College of Medicine faces curriculum reform in 2020. To determine what reforms are needed in the premedical curriculum, a needs assessment was conducted. Methods: This study utilizes qualitative study method. A focus group interview was conducted with four students who completed premedical courses from November to December 2018. Interviews were conducted in two groups by grade level, and each interview was recorded. After transcribing the recorded contents, four researchers analyzed the data using conventional content analysis. Results: Students chose A Womans University College of Medicine considering their future careers as female medical professionals and other considerations such as scholarships. The students expected diverse experiences, exchanges with students in different departments, and fusion of medicine with other fields during their premedical years. Overall, these expectations were met during the course, but individual needs for customized education, such as liberal arts, were unmet. In general, students’ attitudes toward premedical courses were very motivated and they actively used resources provided by the university. Conclusion: Qualitative research can provide a better understanding of quantitative data, such as a student survey performed to prepare for curriculum reform. Based on this understanding, the curriculum will be reformed to reflect the educational needs of students, to motivate students and to provide satisfactory education.

기존 교육과정에서의 성과바탕 의학교육 이론 적용

홍영선,한재진,김정아,최희정,윤주천,정혜경,김한수 이화여자대학교 의과학연구소 2017 EMJ (Ewha medical journal) Vol.40 No.1

Objectives: This paper aims to describe an outcome-based curriculum development process at a medical school that has difficulty in advancement from the higher stage outcomes to the individual lesson outcomes, and to propose a way to implement it practically. Methods: We reviewed the objectives, strategies and previous products of the school’s taskforce activities and suggested the principle of bidirectional approaches of outcome based curriculum development. Results: The developing strategy identified such as firstly, the evaluation of present curriculum and then, the review of the outcomes developed previously with considering the nation-wide environmental change in medical education. Then, we selected one example course which was focused the resources of the school to, and finally the product of the example course was propagated to the other courses with central monitoring. Conclusion: Bidirectional model of ‘Top-down’ plus ‘Bottom-up’ approaches could be an efficient way to develop the outcome-based curriculum in a medical school, which has difficulties to advance the developing process due to various reasons including limited resources.