의학교육에의 교육순환모델(Learning Cycle)의 적용과 쟁점

김보현,김상현,Kim, Bo-Hyun,Kim, Sang-Hyun 연세대학교 의과대학 2008 의학교육논단 Vol.10 No.2

Purpose: The 'learning cycle' proposed by Guilbert in 1981 has been accredited as an effective and useful model for curriculum design. Three components of learning cycle, learning objective, instructional method, and assessment are connected organically and form basic structure of curriculum. In this study, we intend to analyze how the learning cycle and its three components are applied to present medical curriculum and examine the points at issue of the learning cycle in medical education. Also, we try to identify the educational significance of the leaning cycle in medical education. Results: First, concerning the learning objective, it was identified that impractical and abstract expressions are major controversial points. Also, there is a need to make learning objectives covering entire medical curriculum. Second, because of various structural problems, it is hard to practice new and various instructional methods. Third, even though there is a growing need for medical curriculum to develop and utilize more various and detailed assessment and evaluation, it was revealed that only are standardized and traditional assessments mainly used. Conclusion: Synthetically, we have some suggestions as follows. First, it is necessary to specify and actualize the learning objectives. Also, instructional methods and assessments should be diversified. And finally, there is a need to build organic and delicate medical curriculum by applying the learning cycle to medical education more actively.

간암 진료가이드라인의 현재와 전망

김보현,박중원,Bo Hyun Kim,Joong-Won Park 대한소화기암연구학회 2016 Journal of digestive cancer reports Vol.4 No.1

Hepatocellular carcinoma (HCC) is rather unique. Most of HCC patients have underlying chronic liver diseases with or without cirrhosis and the prognosis of HCC depends on the liver function, as well as the tumor extent. Non-invasive diagnosis of HCC can be made with certain risk factors and specific imaging findings (e.g. hypervascularity). Patients with HCC can receive surgical resection, radiotherapy, and systemic chemotherapy as other solid malignancies. HCC has more treatment options such as liver transplantation, transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). A variety of practice guidelines for HCC has been published by many academic societies. Different healthcare systems and availability of resources also affect the practice guidelines; therefore, practice guidelines have similarities and dissimilarities. Herein, we review the current status of practice guidelines for HCC and future perspectives for the improvement of guidelines are also discussed.

CO₂냉매용 제어밸브의 응답 특성

김보현,장지성,Kim, Bo Hyun,Jang, Ji Seong 유공압건설기계학회 2018 드라이브·컨트롤 Vol.15 No.4

Pilot operated control valve for $CO_2$ refrigerant is a valve that can perform various functions according to the user's intention by replacing pilot units, widely used for flow rate, pressure, and temperature control of refrigeration and air conditioning systems. In addition, $CO_2$ refrigerant, that requires high pressure and low critical temperature, can be installed and used in all positions of the refrigeration system, regardless of high or low pressure. In this paper, response characteristics are modeled and analyzed based on behavior of the main piston of the pilot-operated control valve. Although various factors influence operation of the main piston, this paper analyzes the effect of equilibrium pressure depending on valve installation position and application, and inlet and outlet orifice size of the load pressure feedback chamber to determine feedback characteristics of the main piston. As a result, it was possible to quantitatively analyze the effect of change in equilibrium and load pressure feedback chamber flow path size on the change in main piston dynamic and static characteristics.

플라즈마 산화방법을 이용한 질소가 첨가된 실리콘 산화막의 제조와 산화막 내의 질소가 박막트랜지스터의 특성에 미치는 영향

김보현,이승렬,안경민,강승모,양용호,안병태,Kim, Bo-Hyun,Lee, Seung-Ryul,Ahn, Kyung-Min,Kang, Seung-Mo,Yang, Yong-Ho,Ahn, Byung-Tae 한국재료학회 2009 한국재료학회지 Vol.19 No.1

Silicon dioxide as gate dielectrics was grown at $400^{\circ}C$ on a polycrystalline Si substrate by inductively coupled plasma oxidation using a mixture of $O_2$ and $N_2O$ to improve the performance of polycrystalline Si thin film transistors. In conventional high-temperature $N_2O$ annealing, nitrogen can be supplied to the $Si/SiO_2$ interface because a NO molecule can diffuse through the oxide. However, it was found that nitrogen cannot be supplied to the Si/$SiO_2$ interface by plasma oxidation as the $N_2O$ molecule is broken in the plasma and because a dense Si-N bond is formed at the $SiO_2$ surface, preventing further diffusion of nitrogen into the oxide. Nitrogen was added to the $Si/SiO_2$ interface by the plasma oxidation of mixtures of $O_2/N_2O$ gas, leading to an enhancement of the field effect mobility of polycrystalline Si TFTs due to the reduction in the number of trap densities at the interface and at the Si grain boundaries due to nitrogen passivation.

반월상연골 파열에 대한 관절경적 inside to out 봉합술의 결과

김보현,황인성,윤태봉,변재용,Kim, Bo-Hyun,Hwang, In-Sung,Yun, Tae-Bong,Byun, Jae-Yong 대한관절경학회 2004 대한관절경학회지 Vol.8 No.1

목적: 반월상 연골 파열에 대한 비흡수성 봉합사를 이용한 관절경적 inside to out봉합술후 임상적 치유와 환자의 만족도를 결과에 영향을 주는 인자에 따라 분석하였다. 대상 및 방법: 1999년 8월부터 2002년 6월까지 반월상 연골 파열에 대한 관절경적 Inside to out 봉합술을 비흡수성 봉합사를 이용하여 시행 후 12개월이상 추시가 가능하였던 95명 110례를 대상으로 하였다. 결과는 임상적 치유와 주관적 만족도로 평가 하였으며 이들 결과에 대한 나이, 수상 후 수술까지의 기간, 파열의 부위, 파열 길이, 파열의 종류, 관절 연골의 손상 정도, 동반된 전방 십자인대 수술이 미치는 영향을 분석하였다. 결과: 임상적 치유는 84례(76%)이었으며, 환자의 주관적 만족도는 98례(89%)이었다. 전방십자인대 파열을 동반한 경우에, 파열 길이가 2cm이하인 경우가 2cm이상인 경우보다. 관절 연골의 퇴행성 정도가 심하지 않은 경우가 심한 경우보다 임상적 치유율과 환자의 만족도가 유의하게 높았다. 내측 반월상 연골 파열의 경우에, 수상후 수술까지의 기간이 짧을수록, 파열의 종류가 종 파열인 경우 임상적 치유율이 높았다. 복잡 또는 퇴행성 파열의 경우 낮은 임상적 치유율에 비해 환자의 만족도는 높았다. 결론: 비흡수성 봉합사를 이용한 관절경적 반월상 연골 Inside to out 봉합술은 다양한 봉합이 가능하고 사용이 쉬운 술식이다. 반월상 연골의 봉합 여부 결정에 있어 환자의 연령은 절대적인 고려 대상이 아니며, 퇴행성 또는 복잡파열, 관절연골의 손상이 동반된 파열의 경우 환자선택과 수술에 신중을 기해야 할 것으로 사료 된다.증을 줄일수 있으며, PASTA 병변을 포함해서 후상방 파열과 동반되지 않은 견갑하건의 부분 파열은 매우 적합한 관절경하복원술의 적응증이 될 수 있다고 사료된다. Purpose: This study examined clinical cure and patients' satisfaction degrees by factors influencing surgical operation results, after arthroscopic inside to out repair as a nonabsorbable suture material, in case of meniscal rupture. Materials and Methods: Materials were 110 cases of 95 patients who could make paces for over 12 months from August 1999 to June 2002. Results were evaluated by clinical cure and subjective satisfaction degrees. This study, concerning those results, analyzed age, term from taking pictures to taking surgical operation, rupture section, rupture length, rupture types, lesion of articular-cartilage, and effects of anterior cruciate ligament operation accompanied. Results: 84 cases(76%) were clinically cured, 98 cases(89%) were subjectively satisfied. In case of accompanying anterior cruciate ligament rupture, and in case that rupture length was below 2 cm, rates of clinical cure and patients subjective satisfaction were significantly high. In case of complex or degenerative rupture, patients satisfaction rates were higher when comparing with clinical cure rates. Conclusion: Various sutures are possible as well as available in case of arthroscopic meniscal inside to out repair using nonabsorbable suture material. It can be concluded that patients age is not absolte consideration in determining the suture of meniscus. In cases of complex rupture, degenerative rupture, ruptures companied by joint-cartilage injuries, considerate consideratin need be paid to choose patients and operations.

신경 및 위장관 증세를 동반한 Erythropoietic Protoporphyria 환아 1예

김보현,박영년,정기섭,Kim, Bo Hyun,Park, Young Nyun,Chung, Ki Sup 대한소아소화기영양학회 2005 Pediatric gastroenterology, hepatology & nutrition Vol.8 No.2

본 저자들은 심한 간 부전과 함께 복통, 구토, 의식 변화, 사지 마비, 배뇨 장애 및 호흡부전을 동반한 EPP 예를 경험하였기에 보고하는 바이다. Erythropoietic protoporphyria is a genetic disorder due to a deficiency of ferrochelatase resulting in excessive accumulation and excretion of protoporphyrin. The predominant clinical feature is photosensitivity. Severe hepatic failure occurs in a small percentage of patients, and neurological symptoms are very rare. We report a case of erythropoietic protoporphyria associated with severe hepatic dysfunction and neurological symptoms. A 9-year-old girl presented with severe abdominal pain, nausea, weakness and pain of extremities, and urinary retention. Ultrasonogram and abdominal CT scanning revealed a diffuse infiltrated and enlarged liver. Liver biopsy showed deposition of dense dark brown pigment within the bile, hepatocytes and Kupffer cells. Plus, dense dark brown deposits gave a red birefringent under polarize light. Porphyrin studies demonstrated markedly elevated serum free erythrocyte protoporphyrin. This girl was diagnosed as erythropoietic protoporphyria with severe liver dysfunction and neurological symptoms.

예민한 갑상선 자가항체 검사의 해석

김보현 ( Bo Hyun Kim ),김인주 ( In Ju Kim ) 대한갑상선학회 2009 International Journal of Thyroidology Vol.2 No.2

갑상선 자가항체의 측정은 예민한 검사 방법의 개발로 인해 만성 자가면역성 갑상선염이나 그레이브스병 환자의 진단에 임상적으로 유용하게 이용되고 있다. Anti-TPO 항체의 측정은 만성 자가면역성 갑상선염이 의심되는 환자에서 Anti-Tg 항체보다 더 의미 있게 이용되며 임신한 여성에서 산후 갑상선염의 위험도를 예측하는데도 도움이 된다. Anti-Tg 항체의 측정은 만성 자가면역성 갑상선염이 특히 의심이 되나 Anti-TPO 항체가 정상인 경우 적응이 된다. 또한 갑상선암 환자의 수술 후 경과 관찰 중에 Anti-Tg 항체와 Thyroglobulin을 같이 측정하여야 한다. TBII의 측정은 다양한 측정 방법이 있으며 그레이브스병의 진단 및 Euthyroid Graves’ disease의 진단에 유용하며 그레이브스병을 가진 임신부 혹은 자가면역성 갑상선염 환자에서 신생아의 갑상선 기능항진증 혹은 기능저하증을 평가하는데 이용된다. 1세대 TBII측정법에 비해 2세대 및 3세대 측정법이 진단의 예민도는 크게 향상되어 향후 임상에서 널리 이용될 것으로 여겨진다. 하지만, 항갑상선제 치료 종료 시점에 TBII 활성이 관해 및 재발을 예측하는데 있어서 2세대 TBII 측정법이 더 우수한 검사인지는 추가 연구가 필요할 것으로 보인다. 최근 개발된 3세대 TBII측정법이 2세대 TBII 측정법보다 예민도와 특이도가 높다고 보고되고 있지만 이 또한 항갑상선제 복용 후 재발 및 관해를 예측하는데 있어서 1세대 및 2세대 측정법에 비해 더 우수한 검사법인지에 관한 추가 연구가 이루어져야 할 것이다. 마지막으로 자극형 혹은 차단형의 TSH 수용체 항체의 TSH 수용체와의 결합 부위에 있어서도 추가 연구가 필요 할 것으로 생각된다. Autoimmune thyroid diseases share common immunologic evidences including lymphocytic infiltration of the thyroid, circulating thyroid autoantibodies, and T cell immunity. In clinical practice, measurements of thyroid-directed antibodies can be clinically useful in the evaluation of some patients with chronic autoimmune thyroiditis or Graves’ disease. Thyroid peroxidase antibody (TPOAb) is the most sensitive test for detecting autoimmune thyroid disease. The types of methods developed for TSHR Ab measurements are classified relative to their functional activity. TSH binding inhibitory immunoglobulins (TBII) measurement has simplicity, precision, and cost-effectiveness, along with its commercial availability, have made it the most widely used test in clinical laboratories. A recently developed second-generation assay for TBII uses recombinant human TSHR, expressed in eukaryotic cells, this assay showed better diagnostic sensitivity and specificity than the conventional TBII assay. More recently, a human monoclonal antibody to TSHR (M22) with the characteristics of patient thyroidstimulating autoantibodies are developed. Further evaluations are warranted in application of more sensitive and specific assays for measuring TSHR Ab in routine clinical practice.

새로운 공정을 이용한 AIN 체적 탄성파 소자의 제작 및 다양한 금속 전극막에 따른 주파수 응답 특성 분석

金甫泫(Bo-Hyun Kim),朴昶均(Chang-Kyun Park),朴珍奭(Jin-Seok Park) 대한전기학회 2007 전기학회논문지 Vol.56 No.5

AIN-based film bulk acoustic resonator (FBAR) devices which adopt a membrane-type configuration such as Mo/AIN/bottom-metal/Si are fabricated by employing a novel process. The proposed resonator structure does not require any supporting layer above the substrate, which leads to the reduction in energy loss of the resonators. For all the FEAR devices, the frequency response characteristics are measured and the device parameters, such as return loss and input impedance, are extracted from the frequency responses, and analyzed in terms of the various metals such as A1, Cu, Mo, W used in the bottom-electrode. The mass-loading effect caused by the used bottom-electrode metals is found to be the main reason for the difference revealed in the measured characteristics of the fabricated FBAR devices. The results obtained in this study also show that the degree of match in lattice constant and thermal expansion coefficient between piezoelectric layers and electrode metals is crucial to determine the device performance of FBAR.

생활주제 “교통기관”, “우리나라”, “가을”에 기초한 유아 창의성 프로그램 개발 및 교육적 의미 탐색

김보현(Kim, Bo-Hyun) 학습자중심교과교육학회 2016 학습자중심교과교육연구 Vol.16 No.3

창의성에 관한 이론 및 기존의 창의성 프로그램들의 문제점, 누리과정에 기초한 유아 창의성 프로그램의 교수 학습 원리를 탐색하였으며 이를 토대로 3가지 생활주제를 중심으로 한 프로그램을 개발하였다. 프로그램의 교육적 의미 탐색을 위해 2015년 7월 27일부터 10월 31일까지 14주간 어린이집 만5세 두 학급의 유아 32명과 교사 2명을 대상으로 수집한 프로그램 진행과정 관찰, 면담, 교사의 일과 평가 내용을 분석하였다. 연구결과 3가지 생활주제를 중심으로 33개의 창의성 활동이 개발되었다. 또한 프로그램 적용과정을 분석한 결과 ‘일상 속 호기심· 민감성 증가’, ‘선호 하지 않고 어려워하는 활동에 관심 보이기’, ‘유아 발달에 적합한 지식 구성 및 개념 확장의 가능성 엿보기’, ‘ 협동하여 문제 해결하기’의 교육적 의미를 발견할 수 있었다. The purpose of this study was to develop, apply and evaluate a creativity program based on the Nuri Curriculum so that the creativity program can be related to the daily curriculums of early childhood education institutions. The study examined theories on creativity, problems of existing creativity programs, teaching and learning principles of the early childhood creativity program based on Nuri Curriculum. On this basis, a program was developed with 3 life topics. To examine educational meaning of the program, observation of program progress targeted to 32 children and 2 teachers at 2 classes of 5-year old children in the day care center, interview, assessment of teachers daily duty and reflective journal were analyzed. As a result, 33 creativity activities were developed from 3 life topics. And, when the program application process was analyzed, educational meanings such as ‘increase of curiosity and sensitivity on phenomenon and object in routine’, ‘showing interest in not favorite and difficult activities’, ‘composition of suitable knowledge on children development and possibility of conceptual expansion’ and ‘problem solving through cooperation were found.

국내 창작애니메이션 제작인력의 결합형태 연구

김보현(Bo-Hyun Kim) 한국애니메이션학회 2006 애니메이션연구 Vol.2 No.2