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명선정 연세대학교 의과대학 2019 의학교육논단 Vol.21 No.1
Patient safety and medical errors have emerged as global concerns and error disclosure has been established as standards of practice in many countries. Disclosure of medical errors to patients and their families is an important part of patient-centred medical care and is essential to maintaining trust. However, physicians still hesitate to disclose errors to patients despite their belief that errors should be disclosed. Multiple barriers such as fear of medical lawsuits and punishment, fear of damaging their professional reputation, and diminished patient trust inhibit error disclosure. These barriers as well as lack of training or education programs addressing error disclosure contribute to a low estimated disclosure rate in real situations. Nowadays, the importance of patient safety education including error disclosure is emphasized and related research is increasing. In this paper, we will discuss the background of medical error disclosure and studies on education programs related to error disclosure. In this regard, we will examine the content and methods currently being taught, discuss the effects or outcomes of such education programs and obstacles or difficulties in implementing them. Finally, the direction of future error disclosure education, support systems, and education strategies will also be covered.
주간문맥 혈전을 동반한 침윤성 간세포암종의 성공적인 경동맥화학색전술 치료 1예
명선정,윤정환,곽금연,신철민,안동원,유수종,유지원,조수정,정진욱,이효석 대한간학회 2006 Clinical and Molecular Hepatology(대한간학회지) Vol.12 No.1
A 63-year-old HBsAg-positive male patient was admitted for the evaluation of a liver mass that was detected on ultrasonography. Spiral computed tomography (CT) revealed infiltrative hepatocellular carcinoma (HCC) in the right hepatic lobe with main portal vein tumor thrombosis. His liver function was Child-Pugh class A and the serum alpha fetoprotein level was 7,400 ng/mL. Transarterial chemoembolization (TACE) via the right hepatic artery was performed. Following 3 sessions of TACE every 2 months, spiral CT revealed no evidence of viable tumor. The thrombi within the main portal vein disappeared with performing localized hepatic infarction at the site of the previous tumor. He is still alive 15 months after the third TACE without evidence of recurred tumor and his liver function remains well preserved. This case suggests that TACE might be effective and safe even in the patients with infiltrative HCC with main portal vein tumor thrombosis, if the extent of the tumor is limited and the liver function and portal flow via the collaterals are preserved. (Korean J Hepatol 2006;12:107-111) 간세포암종은 전세계적으로 가장 흔하고 또한 예후가 불량한 암 중의 하나로 이로 인한 연간 사망자 수는 100만 명에 이르는 것으로 추산된다.1 최근 영상학 기법의 눈부신 발전과 새로운 국소치료 기법들의 도입으로 간세포암종의 조기 진단과 치료가 가능하게 되면서, 간절제술, 간이식 및 국소치료를 포함한 근치적 치료 후 간세포암종 환자들의 5년 생존율은 50-75%에 이르게 되었다.2 그러나 이러한 근치적 치료는 간세포암종으로 진단받은 환자의 30% 미만에서만 가능할 뿐이고 여전히 대다수 의 환자들은 근치적 치료가 불가능한 진행된 병기에서 진단되고 있다.2 근치적 치료가 불가능한 간세포암종에서 전신 화학요법이나 방사선요법의 효과는 아직까지 정립되지 않았으며, 일부 연구자들이 이식형 약물 전달장치를 이용하여 간동맥을 통해 국소적으로 항암제를 투여하는 방법을 고안하여 소수의 환자에서 그 효과를 긍정적으로 보고하기도 하였으나 이에 대해서는 아직 객관적 검증이 필요한 단계이다.3 결과 근치적 치료가 불가능한 간세포암종의 치료에서 아직까지는 경동맥화학색전술이 보편적으로 이용되고 있으며, 이의 유용성은 최근 여러 무작위 대조군 연구와 중재 분석에 의해 뒷받침된 바 있다.4-6 그러나 주간문맥 혈전이 동반된 간세포암종의 경우에는 간부전의 위험도가 증가하기 때문에 그 치료법에서 경동맥화학색전술은 제외되는 것이 일반적이며,7,8 더구나 침윤성의 경우에는 보존적 치료와의 사이에 예후의 차이가 없다고 한다.9 하지만 근래에 저자들은 주간문맥 혈전을 동반한 침윤성 간세포암종 환자에서 경동맥화학색전술 후 장기간 재발과 간부전의 증거 없이 생존한 예를 경험하였기에 이를 보고하는 바이다.
Clinical-Performance Remediation Program for Dyscompetent Medical Students
명선정,임재준,박상민,신좌섭 한국의학교육학회 2013 Korean journal of medical education Vol.25 No.2
Purpose: Medical schools endeavor to ensure that students are competent with regard to clinical skills. Skills remediation is implemented in cases of poor clinical performance examination (CPX) grades, although little is known about the effectiveness of such techniques. In this study, we examined the effectiveness of a remediation program that was designed to improve the clinical performance of medical students. Methods: A 6-week remediation program, administered jointly by Seoul National University College of Medicine’s Departments of Internal Medicine (IM) and Family Medicine (FM), was initiated. The program was divided into 2 parts: 3 weeks each of IM classes that were run by specialists in various fields and FM classes that were conducted by a chief resident. Twenty-three students were required to undergo remediation after posting poor scores on 2 sessions of a CPX. On completion of the remediation program, the students’ clinical performance was re-evaluated, and the changes in clinical performance scores were analyzed. Results: After the remediation program, the students’ total scores and scores on history taking, physical examination, physician’s manner, and physician-patient interaction improved significantly. However, patient education did not improve. Most students found the remediation program to be instructive and helpful in preparation for the CPX. They were more satisfied with the chief resident’s serial tutoring than with specialists’ tutoring sessions. Conclusion: The remediation program improves clinical performance. Continued development and implementation of this program will help failing students be competent physicians.