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For decades medical educators have continually emphasized medical professionalism, which is reflective response to the challenges of a rapidly changing medical environment. This study aimed to review the experience of implementing medical professionalism education at Yonsei University College of Medicine (YUCM). YUCM introduced a new curriculum in 2004 designed by Curriculum Development Project 2004 (CDP2004), a project that was launched in 2001. CDP2004 reorganized lectures as organ-based integrated lectures, introduced an introductory course for clinical medicine and medical humanities courses for premedical and medical students. Problem-based learning (PBL), elective courses, and self-study sessions in the afternoon were implemented in order to equip students with a self-directed learning attitude as medical professionals. Professors were asked by the CDP2004 curriculum to spend more time on student education and to adopt new teaching methods. Experiences of the CDP2004 curriculum reveals 1) difficulty of motivating professors to be PBL tutors 2) students' dissatisfaction with the medical humanities course (major critique was that the course was impractical and unrealistic), and 3) students' optimistic understanding about their future role as medical professionals in influencing and helping people in spite of their perception of the general medical environment not as promising. To foster professionalism, the following are necessary in our experiences: 1) faculty development of medical humanities and medical professionalism, 2) establishment of an environment throughout the whole institution to support medical professionalism education and to integrate the concept into praxis, 3) emphasis on the fact that medical professionalism education is not contradictory to biophysical medical education.
The tripartite mission of 'academic medicine' is education, research, and patient care. Academic medical centers (AMCs) are carrying out the mission and ultimately aiming to improve the health of people and communities. Globally, AMCs are facing a tremendous financial risk stemming from the changes in health insurance reimbursement plans and a shortage of human resources. Innovative AMCs in the United States are trying to transform their physician-centered, and siloed structure into a patient-centered, and integrated structure. They are also building integrated systems with primary healthcare groups to provide continuous patient care from primary to tertiary levels and making strategic networks based on value-based payment and the patient-centered model. These changes have been proven to improve outcomes of patient care and increase fiscal revenues, which are both crucial in supporting education and research. To address the shortage of human resources, programs are being built to develop newly appointed faculty for the future. AMCs have different approaches to bringing changes into their organizations; however, there is a common emphasis on 'a patient-centered approach,' which helps them set more explicit organizational values and make strategic decisions based on their values. Korean AMCs are facing similar challenges to AMCs in the United States in spite of many differences between the countries' healthcare systems. The innovative efforts of AMCs in the United States to address the challenges will be helpful, well-worked examples for Korean AMCs with similar challenges.
본 실험은 과다한 X-선에 머리부분이 노출되었을 때, 샘뇌하수체의 변화를 알아보기 위하여 시행하였다. 체중 200-250g의 Sprague Dawley계 숫흰쥐를 실험동물로 사용하였으며, 정상군과 방사선조사군으로 나누었다, 방사선조사군은 조사량에 따라 3,000 rad 조사군과 6,000 rad조사군으로 나누어, 방사선 조사후 6시간, 2일 및 6일 후에 도살하여 조직을 절취하였다. 방사선조사는 흰쥐를 sodium thiopental로 마취한 후 방사선선형가속기(Mitsubishi Linear Accelerator ML-4MV)를 사용하여 머리부위를 조사하였다. 조사조건은 조사거리 80 cm, 조사구역 30 cm X 30 cm, 조사깊이 1.2 cm(100% skin dose)였으며, 분당 200 rad씩 조사하였다. 샘뇌하수체는 1% glutaraldehyde- 1% paraformaldehyde액으로 일차 고정한후, 2% osmium tetroxide액에 이차고정하였으며, 고정이 끝난 조직은 alcohol과 acetone으로 탈수한 후 araldite혼합액에 포매하였다. 포매된 조직은 , LKB-V ultratome으로 60-70nm두께의 절편을 작성하여 300 mesh nickel grid에 붙인 다음 젖샘자극호르몬과 성장자극호르몬에 대한 단독면역염색 및 이중면역염색을 시행하였다. 면역염색이 끝난 절편은 uranyl acetate와 lead citrate로 염색한후, JEM 100CX-Ⅱ 전자현미경으로 관찰하여 다음과 같은 결과를 얻었다. 1. 젖샘자극호르몬분비세포는 불규칙한 모양을 한 큰 분비과립(300-700 nm)을 가진 성숙세포, 크기가 다양한 둥근 분비과립(150-200 nm)을 가진 중간 세포와 크기가 작은 둥근 분비과립(100-150 nm)을 가진 미성숙세포로 나눌 수 있었다. 2. 성장자극호르몬분비세포는 크고 둥근 분비과립(200-500 nm)을 가진 제 1 형 세포와 상대적으로 작고 둥근 분비과립 (150-200 nm)을 가진 제 Ⅱ형 세포로 나눌 수 있었다. 3. 방사선 조사후 6 시간군에서 3,000 rad에서는 큰 변화가 없었고, 6,000 rad에서는 사립체와 과립형질내세망의 수조 확장이 관찰되었다. 방사선 조사후 2일군에서는 큰 변화가 없었으며, 6일군에서는 핵막구조의 확장이 관찰되었다. 4. 세포의 종류도 젖샘자극호르몬분비세포는 3,000 rad 조사군과 6,000 rad 조사군 모두 2일군에서는 성숙형이 감소하고 중간형과 미성숙형이 자주 관찰되었으며, 6일군에서는 정상군과 같은 분포양상을 보였으나 분비과립의 금입자표지가 감소한 것을 관찰할 수 있었다. 성장자극호르몬분비세포에서는 뚜렷한 세포형이 분포변화는 관찰할 수 없었으나 금입자표지의 감소는 나타났다. 5. 방사선조사후 6시간군에서 부터 mammosomatography가 나타났는데, 한 세포 내에 젖샘자극호르몬과 성장자극호르몬을 지닌 분비과립이 함께 존재하였으며, 세포의 모양은 다핵세포의 형태를 하고 있는 것과 불규칙한 모양을 한 것이 있었는데, 이와같은 결과는 방사선조사 후 샘뇌하수체의 기능저하에 따른 보상작용으로 나타난 현상이라 생각된다. 이상의 결과로 보아 방사선 조사를 받은 초기에는 분비과립의 방출이 과다하게 일어나며, 방사선 조사의 영향으로 세포질소기관의 기능이 약화되어 6일이 지나면 샘뇌하수체의 호르몬분비능력이 저하되는 것 같다. This experiment was performed to study the morphological changes of the adenohypophysis of rat following X-ray irradiation. Male rats were divided into normal and X-ray irradiation groups. The heads of rat were exposed to 3,000 rads or 6,000 rads of radiation in a single dose. X-ray source was a Mitsubishi Linear Accelerator ML-4MV. Only the heads of animals were exposed at the distance of 80 cm, within the area of 30 X 30 cm, in the depth of 1 cm, with the speed of 200 rad/min. Animals of X-ray irradiation group were sacrificed on 6 hours, 2 days and 6 days after the irradiation. Tissue blocks of adenohypophysis were fixed in the 1% glutaraldehyde - 1% paraformaldehyde solution, followed by refixation in the 2% osmium tetroxide solution. Dehydradted blocks were embedded in araldite mixture. The sections were cut on a LKB V ultrotome, and ultrathin sections were places on bare nickel grid(200 mesh). The section-bearing grids were floated upside down on the solutions in a moisture chamber at room temperature. Sections were single immunostained or double immunostained for prolactin and/or growth hormone. And the sections were jet washed with distilled water. The immunostained sections were contrasted with uranyl acetate and lead citrate, and observed with JEM 100CX II electron microscope. The results were as follows: 1. Three types of the prolactin cells according to their size and shape of secretory granules were found; mature type cells contained large pleomorphic secretory granules(above 500 nm). intermediate type cells contained round granules of varying size(200-250 nm), and immature type cells contained small round granules(100 nm). 2. Two types of the growth hormone cells according to their size of secretory granules were found: type I cells contained large round secretory granules(200-300 nm) and type II cells contained small granules(100-200 nm). 3. Six hours after the irradiation, adenohypophysis showed swollen cisternae of granular endoplasmic reticulum and alterations of mitochondrial cristae, but only in doses of 6.000 rads. 4. Adenohypopysis showed decrease in number of mature type prolactin cells on 2 days after irradiatin, and recovered number of mature typer prolactin cell. but their immunoreactiveity were gradually decreased following the irradiation, as compared with that in normal adenohypophysis. 5. Six hours after the irradiation, mammosomatotrophs were found to contain prolactin and growth hormone within different granules each other. Some cells were multinucleated, and some cells exhibited irregular cytoplasmic processes. Summarizing the above results, adenohypophysis rapidly released the secretory granules after the irradiation, and cell organelles of prolactin cells and growth hormone cells were altered or degenerated. It means that adenohypophysis decreased its hormone producing activity on 6 days after irradiation.
This experiment was performed to study the morphological responses of the pigment epithelial cell and the Bruch's membrane of the retina of rat following X-ray irradiation. Male rats were divided into normal and experimental groups. The heads of the rats, under sodium thiopental anesthesia, were exposed to 3,000 rads or 6,000 rads of radiation in a single dose, respectively. The source was a Mitsubishi Linear Accelerator ML-4MV. The target to skin distance was 80cm, and the. dose rate was 200 rads/min. The experimental groups were sacrificed on the 6th hour, 2nd and 6th day after X-ray irradiation. Under anesthesia, 1% glutaraldehyde-1% paraformaldehyde solution(0.1M Millonig's phosphate buffer, pH 7.3) was perfused through the left ventricle and ascending aorta. Pieces of the tissue taken from the posterior region of the retina were fixed in 2.5% glutaraldehyde-1.5% paraformaldehyde(0.1M Millonig's phosphate buffer, pH 7.3) and 1% osmium tetroxide(0.1M Millonig's phosphate buffer, pH7.3), and embedded in araldite mixture. The ultrathin sections contrasted with uranyl acetate and lead citrate were observed with JEM 100 CX-II electron microscope. The results were as follow; 1. The morphological changes of the pigment epithelial cells were not pronounced after exposure to 3,000 rads of X-ray. But on the 6th hour after exposure to 6,000 rads of X-ray, bulging nuclear membrane protruding into the cytoplasm and nuclear chromatin clumped into numerous masses along the nuclear membrane were observed. At the 2nd and 6th day post-irradiation, partial cytolysis or necrosis were seen. 2. The thickness of the Bruch's membrane of the experimental groups were increased in the time and dose range covered by this study, and splitting or diffusing basal laminae of the choriocapillary layer were observed frequently in the experimental group. Above results suggest that large amount(6,000 rads) of head irradiation induce direct hazardous effects on the pigment epitherial cells and Bruch's membrane of the retina of the rat, but pigment epithelial cells are more radioresistant than Bruch's membrane.