The Global Role of the Doctor in Health Care의 Country Report (대한민국)

안덕선,한재진,박정율,안덕선,김명곤,한희진 대한의사협회 의료정책연구소 2012 대한의사협회 의료정책연구소 연구보고서 Vol.- No.-

양측성 수근관 증후군에서 수술을 시행하지 않은 반대편 손에서의 술 후 임상적 결과

안덕선,박수완,윤을식 대한성형외과학회 2001 Archives of Plastic Surgery Vol.28 No.4

한국 의료에서 의학전문직업성의 발전과정

안덕선 대한의사협회 2011 대한의사협회지 Vol.54 No.11

Consensus on an accurate translation of ‘professionalism' for the Korean language has not been reached. Therefore, it is not surprising that medical professionalism as a concept is in a stage of infancy in Korea. The rudimentary nature of collective professionalism in East Asia can be attributed to the historical and sociocultural differences found in Western countries. In this study, the author identifies and describes the facilitating and hindering factors for the development of the concept of collective professionalism in Korean medicine. The collective nature of professionalism could not naturally develop in an authoritarian and hierarchical social environment such as Korea. Furthermore, the recent trend of commercialization and industrialization of medicine as a major business enterprise has also contributed to the medical community's lack of knowledge on this issue. Nevertheless, the global trend reappraisal of professionalism has shed light on theoretical discourse on professionalism in Korean medicine. It is essential for Korea, as one of the developed nations, to explore not only the historical trajectory of the current Japanese-style Western medicine, but also to understand the sociocultural background of the original Western medicine with knowledge of the professionalism that developed subsequently in the West. If Korean medicine is to rise above its colonial roots and guarantee its prosperity and survival as a profession, it has no choice but to put effort into the establishment of medical professionalism.

인턴제도 폐지

안덕선 대한의사협회 2013 대한의사협회지 Vol.56 No.5

The abolishment of the internship training program in Korea has become a hot issue in Korea. The internship has traditionally been a general competency build-up process to becoming a practicing doctor. However, despite its relatively long history, there is still no oversight or guidelines for the educational program itself. It is operated individually department-by-department on a rotation basis with no central supervision or clear goals and objectives. Very often,interns are abused as sources of simple cheap labor, performing not only medical duties but also menial administrative tasks as required by each department, without proper educational activity or training. This significant lack of system and structure is a chronic grievance among those who experience it, yet perhaps due to its short duration, is something that is endured and then forgotten. Medical students, however, have largely opposed the abolition, citing the loss of the opportunity for anthropologic exploration of various clinical departments and the chance to build networks to pursue specialty training in the fields of their choice. The key issue at hand is then whether the current problematic student clerkship training can be improved enough to replace the internship program. To do so would require overcoming the fragmented nature of the clinical education culture, which is still quite clannish in nature and based on family values. Whether these cultural barriers can be broken to develop a clerkship training curriculum sufficient to achieve general competency before specialty training is the determining factor for the fate of the internship program.

의학교육 평가인증의 국제적 동향

안덕선 연세대학교 의과대학 2020 의학교육논단 Vol.22 No.1

Currently, accreditation within medical education is a priority on the agenda for many countries worldwide. The World Federation for Medical Education's (WFME) launch of its first trilogy of standards in 2003 was a seminal event in promoting accreditation within basic medical education (BME) globally. Parallel to that, WFME also actively spearheaded a project to recognize the accrediting agencies within individual countries. The introduction of competency-based medical education (CBME) with the two key concepts of “entrusted professional activity” and milestones has enabled researchers to identify the relationship between patient outcomes and medical education. Recent data driven by CBME has been used for the continuous quality improvement of trainees and training programmes as well. The goal of accreditation has shifted from the single purpose of quality assurance to balancing quality assurance and quality improvement. Even though there are a plethora of types of postgraduate medical education (PGME), it may be possible to accredit resident programmes on a global scale by adopting the concept of CBME. In addition, the alignment of the accreditation for BME and PGME, which center on competency, will be achievable. This argument may extend the possibility of measuring the outcomes of the accreditation itself against patient outcomes as well. Therefore, evidence of the advantages of costly and labor-consuming accreditation processes will be available in the near future and quality improvement will be the driving force of the accreditation process.

의과대학 평가인증의 현황과 개선방향

안덕선 대한의사협회 의료정책연구소 2015 의료정책포럼 Vol.13 No.2

줄기감각 (Stem Sense)

안덕선,김승현 한국영상문화학회 2012 영상문화 Vol.0 No.19

이 논문에서는 햅틱이 매개된 영상이 인간 상호관계를 어떻게 변화시키 고 있는가에 대한 이론적 고찰과 변화되는 인간 상호관계의 기저에 있는 인간 감각의 불완전성에 대한 재조명을 가장 일반적이고 포괄적이며 근본 적인 태생학적 감각으로 환원시킨 줄기감각(stem sense)으로 설명하였다. 촉각은 시각, 청각, 후각, 미각 등의 감각이 입자나 파동의 ‘접촉'을 통해 이루어진다는 점에서 오감의 일부가 아닌 원천적 감각으로 볼 수 있으며, 원천 감각으로서의 촉각은 ‘줄기감각(stem sense)', 또는 가장 일반적 의미 에서의 감각으로 표현될 수 있다. 철학자 한센은 퐁티의 lived body로도 표 현되는 정동적인 몸(affective body 또는 body of affect)이라는 개념을 통해 ‘모든 감각은 haptic'이라 이야기한 바 있으며, 저자는 이것이 줄기감각(stem sense)과 맥을 같이 한다고 본다. 동아시아에서의 감각에 대한 사고는 마음(mind-heart)에 기반을 둔 유교 의 심학(心學)에서 찾을 수 있다. 심학(心學)에서는 몸의 감각만이 아닌 마 음이 체화되어 생각하는 것을 인생가치의 중심 사고로 여겼다. 이러한 사고 는 ‘마음이 아프다', ‘가슴이 저민다'와 같은 표현으로 우리 국어 속에도 녹아 있으며, 일찍이 인간에게는 몸과 마음을 포함한 여섯 가지 감각이 있다고 한 불교의 사상과도 통하고 있다. 촉각 없이 살아 있는 인간이란 있을 수 없으며, 이는 haptic이라는 개념 과 결부될 때, 종을 구별하고 제한하던 ‘personhood'의 논점에 새로운 확장 된 사고를 부여한다. 또한, 촉각(줄기감각)을 활용하면 인간의 종을 넘어 기계, 나아가 동물과의 의사소통도 가능해짐을 추론할 수 있다. 인간과 기계간의 상호작용에 의한 디지털 시대의 혁명은 haptic 미디어로 불리는 새로운 감각적 미디어에 대한 일리적(一理的)인 고찰을 이끌어낸 다. 화상 시대를 넘어 삼차원 기술을 이용한 실제의 물리적인 것이 촉감으 로 진화하고 있는 과정은 전통적 keep in touch의 개념을 바꾸고 있다. 예 술에서 가상의 세계로 다시 haptic의 세계로의 변화는 대인, 사회, 정치, 윤 리적인 시공간적인 환경속의 우리 몸을 새로운 materiality로 재구성한다. 외부세계와의 인터페이스로 작용하는 피부는 단순히 외부와 내부가 접 하는 생물학적 표피의 개념을 넘어서 감각과 감각이 상호 교차하는 지점이 며, 주체와 객체가 하나 되는 장소이다. 정동적 감각의 유물론적 현상학에 근거한 실제성과 주체성을 가진 피부는 윤리의 인터페이스인 동시에 윤리 의 주체가 출현하는 곳이기도 하다. 교육철학자 Martin Buber의 저서 나와 너(i and thou)에서 진정한 인간관 계는 대화 관계에서 출발한다고 하였다. ‘나와 너'의 진정한 대화관계는 경 우에 따라 언어적·비언어적 대화, 더 확장하면 줄기감각의 작동에 의한 상 호 인정으로도 해석할 수 있다. 앞에서 열거한 감각적 몸이나 또는 lived body등의 개념과 연관지어 본다면 몸과 몸의 만남이라는 것은 즉, 체와 체 의 교감이라는 것이고 몸이 세상의 통로라면 인간의 진정한 관계(‘I and you', ‘I and Thou')는 줄기감각이 작동하는 것으로 확장설명이 가능하다. 그러므로 줄기감각은 초월적이며 반드시 시공간의 존재를 의미하지 않을 수도 있다는 가능성을 열어 놓고 있다. 결론적으로 저자는 새로운 시대의 새로운 사조인 햅틱은 영상을 포함하 는 인간과 기계의 상호작용에서 그리고 인간과 타 종의 상호작용에서 그리 고 인간과 인간의 상호작용의 변화에 대한 흐름과 해석을 가능하게 할 공통 적인 담론의 근거제공은 줄기감각으로 가능함을 제시하였다. Tactile sensation is as other four senses : visual, auditory, olfactory, gustatory, delivered by contact. Tactile sensation is also the most fundamental sense, in the most general sense. In this respect the author claims that tactility is the 'stem sense'. By the same token, Hansen proclaims that all the senses are haptic from the viewpoint of the French philosopher Merlow-Ponty's lived body or his account of affective body, the body of affect. The concept of 'haptics' can be found in the traditional Confucian study of mind and heart in East Asia. Sensation itself is the bodily mind and heart, which stand at the center of the value of life. This can be explained in our own language as "broken heart, cold mind." Mind and heart are considered as the most basic bodily senses of the human body. Similarly, the mind and heart are included in the six senses in Buddhism. It is not conceivable to think about a human being without tactility. One can survive without hearing, sight, or even both. This allows us to expand the concept of haptics into the personhood dimension. The author claims that haptics comprise the unique characteristics of personhood in this information technology era. Also, it may be possible to understand the communication between the species once the research can uncover the secret of this bodily stem sense.The revolution of the digital era brings with it the issue of rethinking the traditional oculo-centric paradigm in media. New digital media of human-machine interaction must undergo by rigorous ethical examination. Haptic media allows the world new capabilities of tele-communicatively keeping in touch with others. The transition from the world of art via virtuality to the haptic world has led the bodily materiality in such a way that it is reconstituted in interpersonal, social, political, and ethical dimensions of time and place. Now the skin transcends its biological concept of surface; it is the interface between the senses and it is the interface where the subject and the object become one. The skin of the affective body with the reality of phenomenological materialism is therefore the interface of ethics and the place where the ethical subject emerges. The true relation between persons is the true dialogical relationship by Marin Buber. This true relationship can be extended into the dimension of nonverbal, haptic or even to the dimension of stem sense. The body of affect, the lived body, or the bodily mind and heart is the window to the world. In this haptic era, the interpersonal lies relationship lies where the stem senses are interfaced.

양측성 수근관 증후군에서 수술을 시행하지 않은 반대편 손에서의 술 후 임상적 경과

안덕선,박수완,윤을식 大韓成形外科學會 2001 Archives of Plastic Surgery Vol.28 No.4

의학전문직업성, 왜 지금인가?

안덕선 대한의사협회 의료정책연구소 2018 의료정책포럼 Vol.16 No.2

영국의사회의 거버넌스

안덕선 대한의사협회 2020 대한의사협회지 Vol.63 No.6

It is regrettable that in recent years, the Korean Medical Association (KMA) has held special meetings of the house of delegates almost annually, purely for the removal of the president of the KMA from his/her office. There could be several reasons for this, but the failure of communication caused by the fragmentation of the KMA's governance structure may be a major contributing factor. It may therefore be helpful to benchmark the governance of other professional organizations like the British Medical Association (BMA) to identify differences in the practice of consensus building, which leads to policy making. Due to the unexpected COVID-19 (coronavirus disease 2019) outbreak, this study was limited to internet resources. It was impossible for the author to conduct participant observation or direct face-toface interviews to get essential information about the governance of the BMA. Nevertheless, the findings provide valuable lessons for the KMA. There seem to be chasms among the house of delegates, the regional association and the board of directors in the KMA; better integration among major bodies within the KMA is required. Furthemore, the time spent by these bodies on generating policies and strategies is not sufficient. The BMA is a union with its professional activities secured by labor laws, whereas major players of the KMA do not have a protected time for their professional trade association. The KMA needs to remodel the current governance which is characterized by inadequate communication and subsequent fragmentation among the acting bodies of the Association. Continuous professional development for the leaders and members of the KMA might enable this change in governance.