외국 의과대학에서의 성과중심교육과정 개발

한재진,Han, Jae-Jin 연세대학교 의과대학 2013 의학교육논단 Vol.15 No.1

In medicine, rapid changes in information, technology, socio-economic interests, and globalization affect the medical education focused on the competencies of doctors, and the number of medical schools that are adopting an outcome-based curriculum (OBC) is increasing worldwide. This paper introduces the OBC model of 5 trailblazing medical schools from the UK, US, and Australia, comparing their unique features, followed by brief comment about Canada and the EU as well. On developing an OBC, the process of establishing the top outcomes for graduates is similar and the outcomes comprise knowledge, skills, and attitudes about science, patients, colleagues, society, and themselves. Implementing the outcomes down into the sub-levels of the curriculum is much more complicated and time-consuming. Assessing the achievement of every outcome is essential and requires the use of many tools in addition to the traditional written examination. From the perspective of adult learning theory, self-directed learning, team-learning, and individual and flexible achievement are tested and executed in an OBC. The gradual expansion and further innovation of an OBC is expected so that tomorrow's doctors will be able to meet the challenges of the future.

폐혈류감소를 동반한 선천성 심장기형에서 술전 폐동맥발육과 조기 술후 혈역학적 변화와의 관계

한재진,김용진,Han, Jae-Jin,Kim, Yong-Jin 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.4

We sought the relationship between the pulmonary artery development and cardiac performance from the analysis of the 36 cyanotic congenital heart disease patients [mainly TOF] who were operated and indwelled the pulmonary artery and left atrial pressure monitoring catheters for the postoperative care at the department of Thoracic and Cardiovascular Surgery SNUH in 1988. They were pre-evaluated of the pulmonary artery index from the cineangiographic films and post-operatively, calculated the cardiac index from the arterial and mixed venous blood gas and also measured the mean left atrial pressure and total inotropic supporting amount after operation. The post-operative cardiac indices were 3.46 * 1.03 1/min/M2 [immediate postoperative], 3.31 [ 1.08 [postoperative 6 hrs], 3.29 [ 1.01 [12 hrs], 3.54 * 1.02 [24 hrs], 3.92 * 1.14 [48 hrs], respectively. We divided the patients the group A and group B from the size of the pulmonary artery index, that is, group A was below 200 mm2/M2 and group B above 200 mm2/M2 of the pulmonary artery index. The cardiac indices and left atrial pressure between the group A and B were not different in the view of the statistical significance but the total post-operative inotropic amount of group A was more than group B and it was significant statistically. We concluded that the smaller the pulmonary artery index is, the more postoperative supportive treatment [for example, inotropics] for the enhancement of cardiac performance is needed, and indirectly, which means that the pulmonary artery index was correlated with the postoperative cardiac performance in cyanotic congenital heart disease.

식도천공의 외과적 치료

한재진,성숙환,김주현,Han, Jae-Jin,Seong, Suk-Hwan,Kim, Ju-Hyeon 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.1

We have experienced twenty-eight patients of esophageal perforation at the department of thoracic and cardiovascular surgery, Seoul National University Hospital during the period from Jan. 1957 to Jun. 1989. The ratio between male and female patients was 17:11, and their age ranged from 2 years to 61 years old. [average: 30.4 years old] The cause of esophageal perforation were instrumental trauma in 9 cases, caustic perforation in 6 cases, spontaneous perforation in 6 cases, surgical trauma in 2 cases, and others in 5 cases. The most frequent location of perforation was in the lower third portion of the esophagus [13 case, 46 %]. Patients complained of chest pain [86 %], dyspnea [57 %], fever [57 %], subcutaneous emphysema [43 %], and others. The frequent complications of esophageal perforation were empyema [13 cases, 46 %] and mediastinitis [11 cases, 39 %]. The first treatment was supportive care in 3 cases, primary closure and reinforced procedures in 13 cases with 3 deaths, open drainage in 5 cases with 2 deaths, diversion in 4 cases with 2 deaths and closed thoracostomy drainage in 3 cases. After the first treatment, 6 patients received multi-staged operations for several months. Overall mortality was 25 %, and the most frequent cause of death was sepsis[57 %]. We thought that factors affecting the outcome of esophageal perforation are;[1] early diagnosis and adequacy in the first treatment, [2] intensive perioperative management including multi-stage surgical approach, [3] patient`s condition at the diagnosis

Fontan 수술후 저심장박출증 및 지속성 흉막 삼출액이 발생되는 해부생리학적 원인

한재진,서경필,Han, Jae-Jin,Seo, Gyeong-Pil 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.2

We have experienced 62 cases of modified Fontan operations in Seoul Nat’l University Hospital from Apr. 1986 to Jul. 1989, They were 38 males and 24 females, and their age was ranged from 16 months to 15.5 years of age. [mean age : 5.73$\pm$2.99 years] There were 16 operative deaths and 2 late deaths, therefore 29% of overall mortality. Their diagnoses were as follows; 28 single ventricle, 11 tricuspid atresia, 6 DORV with LV hypoplasia, 3 pulmonary atresia with hypoplastic RV, 3 TGA with hypoplastic RV, 3 cor\ulcornerGA with hypoplastic LV and PA, 6 AV canal defects with PA, and 2 others. Low cardiac output and pleural effusion were developed frequently, so we divide 40 patients into some groups to analyze the physiologic and anatomic causes of them. By the degree of the LCO, group A was no LCO[mean amount of inotropics used: 0-5 \ulcornerg/kg/min] with 17 cases, B mild LCO [5-10] with 11, C moderate to severe LCO but alive[>10] with 8, D severe LCO to death with 4 cases. For the pleural effusion, group 1 was to be removed the chest tube within 1 week with 8 cases, group II within 3 weeks with 21 cases, group III beyond 3 weeks with 12 cases. We considered their age, diagnosis, pulmonary artery size[PA index], pulmonary artery abnormality, palliative shunt, systemic ventricular type, pulmonary artery wedge pressure, as preoperative factors, and operative methods, and as postoperative factors, CVP, LAP, arrhythmia, thrombosis, atrioventricular valvular insufficiency, etc. In the view of LCO, pulmonary artery size and PCWP were statistically significant [P<0.05], and arrhythmia, A-V valve insufficiency were inclined to the group C and D Pleural effusion was influenced by the pulmonary artery size, pulmonary artery resistance, PCWP, and CVP significantly. [P<0.05] And arrhythmia, residual shunt, and A-V valvular insufficiency were inclined to group II and III, too. As a results, the followings are to be reminded as the important factors at the care of post-Fontan LCO, and persistent pleural effusion [1] pulmonary artery size, [2] pulmonary artery resistance, [3] PCWP, [4] CVP, [5] arrhythmia, [6] residual shunt, [7]A-V valvular insufficiency.

우리나라 의사양성체제의 관점에서 본 의과대학 교육의 문제점과 개선방향

한재진,Han, Jae Jin 연세대학교 의과대학 2018 의학교육논단 Vol.20 No.2

Observation of the current Korean medical education and training system shows that certain negative traits of unchangeable solidification engraft themselves so deeply into the overarching system that they are now hampering the state of the national health welfare. Focusing only on undergraduate medical education, we can point out some glaring side-effects that should be of concern to any stakeholder. For instance, a graduate can legally begin his career as an independent practitioner immediately after passing the licensing exam and return to the old stuck school-year system of 2-year-premedical and 4-year-medical programs where outcome-based and integrated curricula are incomplete and unsatisfactory. In terms of learning opportunities, the balance between patient care and public health, as well as that between in-hospital highly specialized practice and community-based general practice, has worsened. Every stakeholder should be aware of these considerations in order to obtain the insight to forge a new direction. Moreover, our medical schools must prepare our students to take on the global roles of patient care within the Fourth Industrial Revolution, health advocacy for the imminent super-aged society, and education and research in the bio-health industry, by building and applying the concept of academic medicine. We will need to invest more resources, including educational specialists, into the current undergraduate medical education system in order to produce proper outcomes, smart curriculum, innovative methods of teaching and learning, and valid and reliable monitoring and evaluation. The improved quality of undergraduate medical education is the starting point for the success of the national system for public health and medical care as a whole, and therefore its urgency and significance should be emphasized to the public. The medical society should go beyond fixing what is broken and usher in a new era of cooperation and collaboration that invites other health professionals, governmental partners, law-makers, opinion leaders, and the general public in its steps toward the future.

아급성 심내막염을 동반한 대동맥륜 하부 대동맥류의 수술치험 -1례 보고-

한재진,이원용,채헌,Han, Jae-Jin,Yi, Won-Yong,Chae, Hurn 대한흉부심장혈관외과학회 1989 The Korean Journal of Thoracic and Cardiovascular Vol.22 No.6

Subannular aortic aneurysm is a word-wide rare disease entity occurring predominantly in young black men. In Korea, there has been no report. We report one patient, 46 years old man, who had been operated urgently because of acute aortic insufficiency and aortic valvular vegetation after antibiotics treatment of Subacute bacterial endocarditis for 6wks. At the operative field, We found the bulging aneurysmal mass between the aorta and superior vena cava above the right pulmonary artery, which has subannular communicating opening into the left ventricular cavity, beneath the anterior commissure of the bicuspid aortic valve. Pathologic findings are consistent with "portion of vascular wall with features of aneurysm.* The patients survived aortic valve replacement and patch closure of subannular aneurysm, with no symptoms at one-year postoperative follow-up.w-up.

Celestin Tube 를 이용한 진행된 식도암환자에서의 고식적 수술치료 - 6례보고-

한재진,조재일,심영목,Han, Jae-Jin,Jo, Jae-Il,Sim, Yeong-Mok 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.2

Dysphagia is common symptom in patients with advanced esophageal cancer, which is not to be resected surgically. Especially when esophagorespiratory fistula is complicated, it leads to rapid deterioration and death due to pulmonary infection. Esophageal intubation relieves dysphagia as simple surgical execution and offers rapid effectiveness. For six patients with inoperable esophageal cancer including three esophago-respiratory fistulas, the palliative esophageal intubation was performed in Korea Cancer Center Hospital, in 1988. Traction technique via high gastrotomy with Celestin tube was used. Adequate palliation of dysphagia was achieved in 5 patients, but wound infection was developed in 2 patients, tube migration in 2 patients, and 2 died in hospital due to sepsis on the 16th and 42nd postoperative day, respectively. In 3 patients with esophagorespiratory fistula complicated after radiation therapy, the intubation was performed urgently and the result was satisfactory in 2 of them that the fistula was occluded successfully and aspiration or pulmonary infection was prevented.

소아에서 인공심폐기 충전액의 첨가용액으로서 사용한 crystalloid와 colloid 용액에 관한 임상연구

한재진,서경필,Han, Jae-Jin,Seo, Gyeong-Pil 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.5

Searching for the clinical effects of colloid solutions that used to increasing the oncotic pressure of priming solutions at the cardiopulmonary bypass, 29 patients [who were diagnosised as simple VSD around 10kg of body weight and scheduled to be operated from June 1990 to December 1990 at Sejong General Hospital] were divided randomly and prospectively to the two groups: A group [15] was received 4gm% albumin as addition to the priming solutions and B Group [14] the same amount of Ringer`s lactated solution. 34 clinical parameters [Body weight, sex, age, body surface area, Qp/Qs, pulmonary arterial pressure, cardiopulmonary bypass time, anesthetic time, intraoperatively infused crystalloid and colloid amount, hemoglobin, hematocrit, serum sodium concentration, serum osmolarity, urine osmolarity, urine specific gravity, serum concentration, serum osmolarity, urine osmolarity, urine specific gravity, serum protein, serum albumin concentration, urine output, central venous pressure, postoperatively infused colloid amount, immedediate post-operative peak inspiratory pressure, cardiac index, blood pressure and pump flow during cardiopulmonary bypass, inotro-pic assist, diuretics, extubation period, total drain amount, duration of ICU] were measured and compaired between the two groups. There were no differences of preoperative and operative clinical parameters. And postoper-atively, practically there were no nearly differences at the clinical outcomes between the two groups, but some parameters [cardiac index, PIP, BP and pumpflow during CPB, etc] contributed to being preferable to the Group A at certain times [P<0.05]. Conclusively, it might be thought that the priming solution of cardiopulmonary bypass added by colloid solution had some beneficial effects on the patients, especially younger and associated with complex anomaly to be expected taken longer time of cardiopulmonary bypass, and more studies about the neonatal and complex anomaly cases were needed in that points.

Multi-detector Computed Tomography에서 환자의 자세 변화에 따른 Esophageal Cancer 진단의 유용성

한재진(Jae Jin Han),김현석(Hyun Seok Kim),김영덕(Yong Deok Kim),이종호(Jong Ho Lee),최남길(Nam Kil Choi) 대한CT영상기술학회 2010 대한CT영상기술학회지 Vol.12 No.1

Purpose The purpose of this study was to assess die utility of multi-detector computed tomography with a patient position change for die diagnosis of esophageal cancer. Material and methods Sixty nine patients with esophageal cancer underwent computed tomography(CT) in supine and prone positions. CT scans were performed in supine position at first, and in prone position followed. CT images were evaluated for perception esophageal cancer, findings of paraesophageal infiltration and presence of paraesophageal lymphadenopathy. The detectabilities of esophageal cancer, paraesophageal infiltration and paraesophageal lymphadenopathy were evaluated on prone position CT and compared with those of supine position CT, by scoring systems(1-3). In addition, findings on were correlated with those on endoscopy and post operatetive findings. Results The mean score for detectability of esophageal carcinoma on prone position CT (2.58±0.7367) was higher than on supine position CT(2.42±0.829). The mean score for detectability of paraesophageal infiltration was higher on prone position CT(2.91±0.29) than on supine position CT(2.65±0.48). The mean score for detectabiliry of paraesophageal infiltration in patient with esophagectomy was higher on prone position CT(2.39±0.85) than on supine position CT(2.06±0.73). Conclusion Multi-detector CT with prone position has advantages for evaluation of esophageal cancer by improving deteaability of mass lesion and paraesophageal infiltration.

시나리오 플래닝을 통한 국내 전자결제 산업의 활성화 전략

한재진(Chejin Han),조근태(Keuntae Cho) 한국경영과학회 2016 經營 科學 Vol.33 No.1

The domestic simple payment service was not activated yet compared to foreign countries and there are many things to complement in the legal, institutional, and technical aspects. The future image of the domestic electronic payment propulsion was considered by the scenario planning focusing on the simple payment. Total 6 future scenarios were drawn through the scenario planning, and 3 major strategy directions for attaining the preferred future scenario were drawn. This study drew a meaningful scenario through various analyses and industry specialist questionnaire about the future of the simple payment service which will be a crucial change of the domestic electronic payment under the uncertain future situation, and suggested an implication for the government and every interested party who provides the industrial service to prepare for the future.