성형외과 전문의 자격시험에서 객관구조화진료시험(OSCE) 도입

김석화,임소영,문구현,신좌섭 한국의학교육학회 2006 Korean journal of medical education Vol.18 No.2

Purpose: The evaluation of clinical skills and attitudes is an essential component of any examination assessing clinical competency. Objective structured clinical examination(OSCE) was introduced in the 1980's to medical educators for the objective evaluation of clinical competency. In this study, the authors describe and analyse their experience with developing and implementing the OSCE for the board licensure examination of plastic surgeons in Korea. Methods: We developed a 50-minute long OSCE consisting of ten 5-minute(4.5 minute for examination at each station and 0.5 minute for transfer) stations, duplicated. We divided 74 applicants into 8 groups(about 10 applicants per group). Four stations out of the ten in each station-set used a standardized patient(SP). We compared the scores of the duplicated station-sets to assess the reliability of scoring between station-sets. And we analysed the applicants' questionnaire survey feedbacks on this experience administered at the end of the examination. Results: The passing rate of the examination was 100%. The total scores were statistically different between the two station-sets. Applicants were satisfied with the examination, and felt that the problem-solving processes adopted in each station were valid and appropriate for the assessment of clinical competency for board licensure examination. Conclusion: We conclude that the OSCE can be widely applied to board licensure examinations of various specialties.

일측성 및 양측성 구순열에서 삼각판 술식 후에 생긴 구순기형에 대한 교정술

김석화 大韓成形外科學會 1993 Archives of Plastic Surgery Vol.20 No.4

외측 안면열 교정술 후 구순각의 외측변위

김석화,박종주,박철규 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.5

반안면왜소증에서 점진적 신연술을 이용한 하악골 연장

김석화 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.4

Gradual distraction on living tissues creates stress that stimulates growth and regeneration. Timing and rate of distraction are one of the major factors affecting callus distraction. Slow rate of distraction often led to premature consolidation of the lengthening bone, while rapid rate of distraction often resulted in undesirable change within lengthening bone. Since Dr. McCarthy reported the successful lengthening of mandible in hemifacial microsomia, most of craniofacial bone lengthening has been done at a rate of 1.0 ㎜ per day. The purpose of this study is to present my experience of rapid and multidirectional distraction of mandible in hemifacial microsomia. I have performed distraction osteogenesis of mandible in 33 patients of hemifacial microsomia with an age of 2-9 years from November, 1995 to October 1997. A complete osteotomy was made at the angle of mandible posterior border of the ramus proximal to the osteotomy and two threaded wires were inserted aling the lower border of the body distal to the osteotomy. Long PennigMinifixator(Orthofix, Bussolengo, Italy) maintained the mandible in fixation for 4 days. Following this period, the device was lingthened serially 1 ㎜ every 12 hours by turning the nut. After the period of active lingthening was complicated, the mandible was maintained in external fixation until the radiological consolidation of the bone was confirmed. According to a study protocol, photographs, cephalograms(lateral and frontal), and panoramic view of mandible were obtained preoperatively, just before the active lengthening, at the time of removal of the device, and at 6 months intervals thereafter. The amount of vertical distraction along the posterior border of the ramus was from 19 to 32 ㎜ and horizontal distraction along the lower border of the body was from 3 to 18 ㎜. The total amount of distraction was from 25 to 47 ㎜. The period of rapid distraction was from 13 to 27 days. Following the period of rapid distraction the mandible was maintained in external fixation for an average of 8.5 weeks(ranging from 7 to 11 weeks). There was no preoperative complications, and the length of clinical follow-up tangles from 3 to 26 months. Early reconstruction with minimal morbidity of rapid and multidirectional mandibular distraction in the hemidacial microsomia was successful without relapse. Orthodontic treatment can begin as soon as possible after gradual distraction in order to establish normal dental occlusion.

벤처산업으로서의 공예문화상품 개발연구

김석화 檀國大學校 出版部 1999 論文集 Vol.34 No.3

선천성 혈액 응고 인자 X(10번) 결핍증 환아에서 구개성형술의 증례보고

김석화,최태현,정의철,윤병민,강형진 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.6

Purpose: Clotting factor X deficiency is one of the most uncommon coagulation disorders. The authors describe a case of cleft palate in a patient with a congenital clotting factor X deficiency. Methods: In pediatric patients with a cleft palate, the coagulation problem is more worrisome, because they are more sensitive to blood than adults, and because postoperative bleeding can cause blood ingestion with subsequent vomiting, aspiration, and airway obstruction. To prevent hemorrhagic complications in the described case, fresh frozen plasma (FFP) was administered every 24 hrs from the day before surgery to the second postoperative day. Results: Good hemostasis, normal healing, and no complications was shown postoperatively. Conclusion: The replacement of fresh frozen plasma was useful in the case of congenital clotting factor deficiency for bleeding prophylaxis in cleft palate operation.

임상수행 능력 평가의 의의 및 전개방향

김석화 한국간호교육학회 2006 한국간호교육학회 학술대회 Vol.2006 No.6

조직공학

金石華 대한의사협회 1998 대한의사협회지 Vol.41 No.4

소이증에서 자가늑연골 이식수혜부의 합병증

김석화,안승현 대한성형외과학회 2008 Archives of Plastic Surgery Vol.35 No.6

Purpose: Microtia is a congenital anomaly resulting from abnormal development of the branchial apparatus. Although significant modification and improvement of operative procedures for the reconstruction of the auricle with a natural appearance have been reported, postoperative complications, such as infection, flap necrosis and deformity, still remain serious problems in patients. Many studies with long-term results have focused mainly on operative procedures for an acceptable auricular shape without consideration of possible complications. Methods: We conducted a retrospective study on postoperative complications at the recipient sites of 183 patients who underwent auricular reconstruction with autologous rib cartilage grafts from November 1987 to January 2007 at the Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital. Patients were analyzed in terms of the kinds and incidences of complications, and their treatment options. Results: Postoperative complications included wound dehiscence, flap necrosis, infection, hypertrophic scar, auricular deformity and absorption of rib cartilage grafts. The complications occurred in 47 patients with a complication rate of 25.7%. Fourteen patients were successfully managed with conservative treatment. However, surgical treatment was required in 51 reoperations(33 patients) of total 329 operations. Conclusion: Postoperative complications at the recipient sites of autologous rib cartilage grafts occurred with relatively high incidences and required long-term treatments and multiple surgeries. The results of this study may provide information on the causes and proper management of postoperative complications as well as safe procedures for the reconstruction of the auricle.

환자안전: 유비쿼터스 병원

김석화,Kim, Seok-Hwa 대한병원협회 2007 대한병원협회지 Vol.36 No.5