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.

전자빔을 이용한 공기중 VOC 분해반응 특성

원양수,한도흥,박완식,Tatiana Stuchinskaya,이홍승 영남대학교 환경문제연구소 2000 環境硏究 Vol.20 No.1

공기중 휘발성유기화합물의 처리를 위해 전자빔 가속기를 이용하여 Trichloroethylene(TCE)의 분해특성에 대해 연구하였다. TCE를 포함한 공기는 서로 다른 반응분위기, 초기농도의 변화, 수증기 존재유무와 같은 변수하에서 분해실험이 행해졌다. 산소를 반응분위기가스로 사용하였을 경우 최대분해율이 나타났는데, TCE 초기농도 2000 ppm에 대해 20kGy에서 99%의 분해율을 보였다. TCE 농도는 산소와 공기 조건하에서 지수함수적으로 감소했으며, TCE 분해효율에 대한 수증기 효과가 행해졌다. 수증기 (5600ppm) 존재하에서 TCE분해율은 수증기가 존재하지 않을 경우보다 약 10% 높게 나타났다. 1차 생성물로 Dichloroacetic acid, Dichloroacethyl chloride, Dichloroacethyl ester acetic acid 등이 생성되었고 분해와 산화반응을 통해 CO, CO2로 전환되었다. 또한 Perchloroethylene, Hexachloroethane, Chlorofona Carbon tetrachloride와 같은 과염소탄소 화합물이 생성되었다. Decomposition of trichloroethylene (TCE) in electron beam irradiation was examined in order to get information on treatment of VOC/air. Air containing vaporized TCE has been studied in a flow reactor with different reaction environments, various initial TCE concentration and in presence and absence of water vapor. Maximum decomposition was observed in oxygen reaction environment and degree of decomposition was about 99 % at 20 kGy for 2000 ppm initial TCE. The concentration of TCE exponentially decreased with dose in oxygen and air. The effect of water vapor on TCE decomposition efficiency was examined. The decomposition of TCE in presence of water vapor (5600 ppm) was by ca. 10% higher than in absence of water vapor. Dichloroacetic acid, dichloroacethyl chloride and dichloroethyl ester acetic acid which were identified as primary products, were decomposed and oxidized to give CO and CO2. Perchloroethylene, hexachloroethane, chloroform and carbon tetrachloride were also observed as highly chlorinated products.

食道 및 氣道異物의 統計的 考察

柳恒熙,姜炳吉,秋淵秀,朴載勳,金春吉,朱良子 대한이비인후과학회 1976 대한이비인후과학회지 두경부외과학 Vol.19 No.4

만남집단과 환자집단의 집단정신치료 비교

방양원,이규황,이후경,함웅,윤성철 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.4

Objects : This study was conducted to understand the essential group phenomena of Encounter group and Patient group through the global comparison of short-term group psychotherapy between two groups. Methods : The Encounter group consisted of 17 normal persons and Patient group consisted of 19 patients with schizophrenia. all the members of the two groups were unmarried females. The mean rank of therapeutic factors of two groups was compared by short-form of Yalom's Q-sort. The differences between each therapeutic factor of two groups was compared by Mann-Whitney test. Also the global differences between two groups were compared by analyzing both the individuals within the groups and the groups as a whole. Results : The results of the comparison of the therapeutic factors of the two groups are as follows : 1) Existential factor was set a high value by all the two groups. 2) Encounter group set a high value an interpersonal learning(Input), but Patient group set a high value on instillation of hope and group cohesiveness. 3) Identification was set a high value by Encounter group, but was set a low value by Patient group. The results of the global analysis of two groups are as follows : 1) It was more difficult for Encounter group to maintain the motivation of attendance and to recognize their own problems than Patient group. 2) All the leaders and the members of Encounter group showed more positive attitude than those of Patient group. On the contrary all the leaders and the members of Patient group showed more negative attitude than those of encounter group. 3) Patient group expressed more intense feelings and expressed the feelings more frankly and more simply than Encounter group. 4) Encounter group dealt with the matters pertaining to "self realization", that is, fundamental question of human beings more than Patient group. Patient group dealt with the matters pertaining to social adaptation, that is , "ego strengthening" more than Encounter group. 5) In Encounter group, the feeling of in feriority was the major cause of the dropout. But in patient group, the discharge from hospital was the major cause of th dropout. Conclusion : We have found out the various differences between encounter group and patient group by the comparison of therapeutic factors and analytic understanding of the two groups. These results are the basic data for understanding of Encounter group and Patient group. And these results can be applied to the development of the skills of group psychotherapy for the treatment of the patients.

豫測方法에 관하여 : 마케팅을 중심으로

金恒錫,盧德煥,梁鍾烈 군산대학교 1987 論文集 Vol.14 No.-

This paper review the emprical research on forecasting in marketing.We offer a framework for discussing forecasts in the area of marketing, and then review the literatare in light of that framework.Particular emphasis is given to pragmatic interpretation of the literature and finding.We hope to (1) summarize the more important empirical research that relates to the choice and application of forecasting methods in marketing, (2) show how the research from this special issue links with the existing research on the forecasting and (3) provide an agenda for furture research. The paper is organized to Provide a framework for forcasting and then to examine research contributions within that framework. Exhibit 1.A Framework for Forecasts in Marketing. This paper is centered around what forecasts are needs.These needs are listed as A Framework for Forecasts in Marketing.(page 4) Significant gains have been made in forecasting for marketing in the past quarter century.Advances have occurred in the development of qualitative methods such as delphi, role playing, intentions and opinion surveys and bootstrapping.They have also occurred for quantitative methods suchas extrapolation and econometrics.The challenge now is to build up experience in applying these methods so generalizations can be made about which methods are most appropriate in the different areas where forecast are needs in marketing.The evidence and research needs discussed in this paper are now summarized.

日本經濟의 長期的 低成長과 政策對應

姜盈求,梁恒鎭 진주여자전문대학 2001 論文集 Vol.24 No.-

The Japanese economy have fallen in long-run stagnation since 1990's. So this article would like to suggest two cause about the long-run stagnation and policy responses in Japanese economy during the 1990s. From the viewpoint of the long-run stagnation, First, In middle of 1989 the bank of Japan started to raise interest rates so as to calm the asset price inflation which had started in the middle of 1980s. After the asset price bubble was bursted, stock and land prices started falling extremely. Finally, the uncertainty of the future as the collapse of bubble caused to lower the consumer spending and the corporate investment. Second, During the asset price bubble, the banks lent a large amounts of money to firms using land as collateral. With the steady fall in land price since the collapse of the asset price bubble, many of these loans have stopped performing. And accumulation of bad loans in financial institution gave rise to instability of financial system, which is induced to a bad effect and the long-run stagnation. At that time, the stimulative steps of Japanese government used to improve economic recovery with a number of policy packages in the financial and fiscal sectors during the 1990s. Although the Japanese government had unveiled a number of fiscal packages aimed at reviving the economy over the 1990s, most of these packages contained a limited effect. The stimulative steps of Japanese policy have no effect in this country owing to the slump of the asset prices, the reduction of the consumer spending enthusiasm and corporate investments in the beginning of the 1990s. It seemed that the steps had trend to recover Japanese economy temporarily in the middle of 1990s, but Japanese economy have fallen extremely recession again and again by fiscal reform in 1997. After that time, this situation is continued until now. Finally, this article is to present some suggestive point of policies in establishing a stable growth basement without a bubble phenomenon in our economy from the Japanese s experience.

304 Stainless Steel 板材의 SCC에 관한 硏究

崔鎔湜,梁源鎬,李桓祐 成均館大學校 1978 論文集 Vol.25 No.-

Since Irwin reported the concept of crack-tip stress intensity factor many researchers have payed much effort for introducing Linear Elastic Fracture Mechanics (LEFM) techniques into the practical fracture problems of engineering materials and in the field of simple uniaxial load fatigue freature the power law, da/dN=C(ΔK)^m is well recognized applicable to the practical material fracture over the wide range of engineering materials applied. Environmental fracture problems are the most complicated for both theoretical analysis and application to the practical problems. So far concerning to the macro fatigue crack growing behaviors in stress corrosion cracking (SCC), crack growing rate da/dt has been widely known having a good functional relation with the crack-tip stress intensity factor, K. Thus, many combinations of engineering materials in various environmental conditions have been studied by using LEFM methods. In this paper SCC crack growing behaviors in the corrosive MgCl_2 solutions on 304 austentic stainless steel plates were studied and analyzed. Conclusions are summarized as follows; 1). In 20 to 30% MgCl_2 solutions at room temperature SCC occurred and crack growth was slightly observed. 2). Crack growth rate, da/dt has good agreeable relation with SIF K in every corrosive environment, 20%, 25%, and 30% MgCl_2 solutions. 3). In the relalion of da/dt=CK^m, the values of constant, m, were found between 9.4 and 16.5.

민간부문 건설사업관리 활성화방안

이정희,장홍진,구교진,김옥규,현창택,김양현 대한건축학회 2004 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.24 No.1

Since, korean government introduced Construction Management system by the law in 1997, only a few public construction projects have been adopted the system Nevertheless there are many laws which are related in public construction projects, Construction Management is positively carried out by non-government. About the activation plan of Construction Management questionnaire was inquired by experts in construction. The purpose of this study is to give a solution by finding out the problem of the laws, reconstructions remodelings.

구리 이온의 김치산패 억제작용에 관한 연구

채경연,유양자,경규항,박세원,김연순 한국조리과학회 2002 한국식품조리과학회지 Vol.18 No.1

Effect of copper ions (Cu^+ and Cu^2+) on the fermentation of kimchi, especially on their effect on the prevention of over-acidification of kimchi, was investigated. The effect of Cu^2+ ion on the growth of individual lactic acid bacterium originally isolated from kimchi was also investigated. The addition of Cu^+(≥4.0mM) or Cu^2+(≥3.0mM) ions in kimchi effectively inhibited growth of lactic acid bacteria and maintained a titratable acidity of less than 1.0% for a periods of 14 days. Leuconostoc mesenteroides significantly decreased at the 10th day of fermentation in control kimchi, whereas the group with Cu^+ and Cu^2+ showed 10^5-10^6 CFU/㎖ at the 14th day of fermentation. This indicates that the addition of Cu^+ and Cu^2+ inhibited the production of excessive acids by inhibiting lactic acid bacteria, and allowed Leu. mesenteroides stay alive longer. Fe^2+ and SO_4^2- ions did not have any effect on the fermentation of kimchi. Cu^2+ inhibited growth of all lactic acid bacteria tested, such as Leu. mesenteroides 6, Streptococcus faecalis 12, Lactobacillus plantarum 14, Lac. brevis 15, Leu. mesenteroides LA 10, and Lac. plantarum LA 97.

일본 지역사회의 노인복지정책에 대한 고찰

방성수,김한양 韓國福祉行政學會 2002 복지행정논총 Vol.12 No.1

급속한 고령화가 진행되고 있는 현재, 노인복지의 문제는 심각하게 생각해야 할 중요한 사회 문제이다. 세계 각 국에서 다양한 공공측면에서의 노인복지정책이 추진되고 있지만 노인문제가 개인차원의 문제로 보기는 어렵다. 심리적 안정·안전·쾌적 이라고 하는 말은 현대의 공공정책을 말하는 중요한 키워드이지만, 그 첫 번째 '심리적안정', 즉 장래에 대해 각자가 준비를 하고 안심할 수 있는 노후를 맞이할 수 있도록 하기 위해서는 국가로서의 체계적인 노인복지정책의 확립이 불가결하다. 특히 현재 우리나라에서 고령화가 현저하게 나타나고 있고, 고령자, 재정적인 부담을 안고 있는 젊은 세대의 입장에서 볼 때도 근본적인 제도개혁·제도개선에 의한 노인복지정책의 확충이 급선무이다. 고령자복지의 문제는 국가로서의 제도확립과 함께 지방자치단체에 의한 적극적인 계획이 필요한 정책영역이다. 왜냐하면 복지 문제 자체가 우리들의 일상생활과 상당히 깊은 관계가 있으며, 지역, 또는 그보다 더 가까운 거리인 커뮤니티(지역사회) 마다 각기 그 수요가 다르다는 성격을 지니고 있기 때문이다. 따라서, 본 연구는 다른 나라와는 비교도 되지 않을 만큼 빠른 속도로 고령화가 진행되고 있는 일본의 노인복지정책의 수요 파악과 정책의 실시과정에 있어서 지역사회(커뮤니티)가 완수해야하는 역할에 대해서 고찰하는 것을 목적으로 하고 있다. 특히, 복지정책과 같이 가족이나 지역내의 인간관계와 밀접한 관계를 가지고 있는 정책영역에서는 개인과 행정사이에 존재하는 지역사회(커뮤니티)의 어떤 부분이 큰 영향을 주고 있다. 그러므로 향후 각 자치단체에 있어서 다양한 복지서비스를 제공하기 위해 예전에 그 중요한 역할 담당자로서 일정한 역할을 해온 지역집단의 움직임을 파악하고, 지역사회(커뮤니티)에 있어서 행정과 역할분담 방법을 모색하는 것이 중요하다.