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Korean J Med Educ > Volume 35(2); 2023 > Article
Kim, Yoo, and Park: Medical education program implementation experience in an elective course: a case study in South Korea

Abstract

Purpose

This study was conducted to examine the results of designing and implementing a teaching program for medical education as the elective course for 4th-year students of medical course.

Methods

In order to design the teaching program for medical education as an elective course, we conducted literature review, five medical education experts were interviewed, and the literature required in the design process was reviewed. A developing teaching program was implemented as an elective course in a medical school of Korea, and 4th-year students of medical course participated in the program.

Results

In the elective course, the medical education program process competencies were derived into three categories: theoretical educational knowledge, teaching competency, and research competency for education. Moreover, instructional materials were developed to help students achieve these competencies. And project-based learning strategy was selected and implemented for 4th-year students in medical course, and positive satisfaction was confirmed.

Conclusion

As a study designed and implemented in a medical education program in a medical school in Korea, it is expected to be helpful when introducing medical education to undergraduate students or developing a medical education program to strengthen the teaching capacity of residents.

Introduction

Elective course allows students to select and study part of the curriculum provided by schools according to their preference, and the curriculum is widely implemented in undergraduate and post-graduation courses [1]. The elective course is inherently different from the required courses. In the elective course, students choose subjects autonomously, and this autonomy enables in-depth learning in their field of interest and the development of their aptitude and potential. In addition, it provides students an opportunity to broaden their understanding and perspective on various fields needed by doctors and to explore career paths for advancement into society [2].
The educational goal of the elective course organized in 4th-year students of medical course in medical school is for students to rediscover their aptitudes and abilities and, based on this, to obtain information necessary for future career decisions [3]. Therefore, Korean medical school elective course provides students with the desired experience in nurturing primary care physicians, providing opportunities to gain experiences not only limited to schools and hospitals, but also those of media and law firms.
Elective courses can facilitate students’ career choices, induce learning motivation, and support both autonomous and in-depth learning. When medical school students search for careers, an elective course helps them with the selection process because they can be exposed in advance to the field they want to major in after graduation. In addition, because students can choose subjects according to their aptitude, interest, and motivation for learning can be enhanced [4]. Moreover, students are empowered to study freely, intensively, and deeply about their major of interest, and to develop an attitude of autonomous learning rather than the ability to memorize and enumerate fragmentary information. This can help students develop positive learning habits as lifelong learners [1].
The elective course in the 4th year of medical colleges in Korea is mainly practiced in hospitals for students to major in clinical medicine after graduation. Basic medicine can also be studied depending on the student’s interest. However, a study on elective course education 4th-year students of medical course (excluding clinical medicine) in Korea was confirmed by study for anatomy [3]. A related study on teaching medical education at the undergraduate level in Korean medical schools is confirmed by Lee et al. [2], whose study examined the experience of implementing an elective course. Although medical education is included in the elective course, it was difficult to ascertain what was taught. Even in the United States, the ability to teach handwriting is essential for American residents [5]. “Educating patients, families, students, residents, and other health professionals” as required competencies for residents by the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education was listed [6]. Medical students mainly use the near-peer teaching method to learn teaching skills, but it is an elective course [7], and 44% of 99 medical schools in the United States responded that they received education using this method [8]. In Harvard Medical School, medical students can learn the principles of medical education and how to teach manual skills as an elective course for 9 months [5]. The education of doctors as teachers often begins in medical schools, but its degree and scope in terms of medical education for medical students are not well explained [5]. Therefore, this study was conducted for the purpose of examining the results of designing and implementing a medical education program in elective course of 4th-year students of medical course.

Methods

1. Program development

The ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model, an instructional system development model, was selected to design the medical education program in the elective course of 4th-year students of medical course.
In the analysis stage, along with a literature review, course competences suitable for the level of medical students were derived for five medical education experts (Table 1). In the design stage, course outcomes were specified in the derived course competencies, and teaching strategies were adopted for students to achieve the purpose and course outcomes of the elective course. In addition, opinions were sought from five medical education experts. In the development stage, teaching materials were developed by examining the literature for data to achieve course outcomes. In the execution stage, Elective Clerkship I was conducted for 3 weeks from May 9 to June 4, 2022. Elective Clerkship II was carried out from June 6 to June 25, 2022, and the subjects were also practiced for 3 weeks as same as Elective Clerkship I. In the evaluation stage, questionnaires and interviews were conducted to check student satisfaction.

2. Participants

This study was conducted as a design study and an implementation study of the medical education program in the elective course of the 4th-year students of medical course. In order to design a medical education program in the elective course, the following was completed. Based on the results of the literature review, five medical education experts were interviewed by the researcher about the program design process, and the literature required for the design process was reviewed
The medical education program developed through this method was implemented in one medical school. In the medical school that became the research target, the elective course consisted of two subjects. A total of four students in medicine participated in this program, including two seniors in Elective Clerkship Ⅰ, and two seniors in Elective Clerkship Ⅱ. These four students participated in questionnaires and interviews to evaluate the program.

Results

In the analysis and investigation stage, an appropriate level of course competency for the 4th-year students of medical course was derived. To do this, related studies such as designing or evaluating medical education-related courses in medical schools were searched. While it was difficult to find related studies in Korea, some studies were able to confirm that medical education was taught in the course of medical school because educational capabilities are essential for residents in overseas studies. However, most of the studies were aimed at developing the educational capabilities required of residents. Therefore, the focus was primarily on educating juniors with clinical performance skills, including evaluation and feedback methods [5,9,10], medical education theories and recent journal publications [10], and individual feedback on teaching methods [5].
The elective course in the 4th year of the medical course of medical school in Korea will also require the development of educational competencies necessary for residents. In light of this, researchers of this study investigated the jobs of full-time faculty members belonging to the department of medical education in medical school and conducted interviews to help students in choosing a career path. Based on the duties derived from the literature review (medical education research, curriculum development and evaluation, faculty development, counseling), it was possible to derive the course competences suitable for 4th-year students of medical course in Korea with the theoretical knowledge, teaching competency, and research competency of medical education [11].
The course competencies derived from the design stage were specified to develop course outcomes and, accordingly, teaching strategies were selected. The course outcomes were developed as follows. Course outcome #1: Students can explain the paradigm shift in medical education by linking outcome-based education. Course outcome #2: Students can design, implement, evaluate, and improve classes according to the instructional system development model. Course outcome #3: Students can select a research topic related to medical education and prepare a research plan. In order to help students, achieve the merits of the elective course outcome and the course outcomes derived in this way, course outcome #1 use the lecture, course outcome #2 and #3 use the project-based learning.
In the development stage, course outcome #1 books to guide course outcomes were selected (Table 2), course outcome #2 books to help course outcomes (Table 2), and course worksheets were developed. Course outcome #3 a research plan worksheet was developed to help achieve course outcomes.
The research plan consisted of participatory observation, interviews, and surveys in which the researcher directly participates in and observes the research in the implementation and evaluation stages. In the implementation stage, except for course outcomes #1, #2 and #3 were carried out in the order of planning, execution, drafting, revision, and final product presentation according to the project-based learning procedure of Donnelly and Fitzmaurice [12]. In general, in the morning, lectures were given on the course outcomes of items #1, #2, and #3, or students presented assignments for items #2 and #3 and gave feedback (including professor feedback and peer feedback). In the afternoon, the students performed assignments. In order to achieve #2 course outcomes, the 4th-year students of the medical course of medical school conducted a 1-hour class for the 2nd year of the premedical course. To achieve #3 course outcomes, 4th-year students of medical course wrote a research plan, and some research plans are currently in progress with the institutional review board.
In the evaluation stage, both student- and program evaluations were conducted, and all students passed the evaluation by achieving attendance and the course outcomes. For program evaluation, a brief interview and questionnaire were conducted on four students who participated in this class. For Teaching competence and research competence, questions were asked on a 5-point scale to confirm the degree of help from lab meetings, need, satisfaction, and so forth. As a result, all were somewhat satisfied with a score of 3 or higher, but it was confirmed that the degree of help in the future was relatively low (Tables 3, 4).

Discussion

Since there were few studies on medical education programs the 4th-year students in medical course in Korea, this study is in the nature of a preliminary study. This study was conducted for the purpose of examining the empirical aspects of the design and implementation of medical education programs, and the results are respectively divided as follows.
The considerations derived from the design process can be referred to as medical education-related books, educational competencies required of medical students (education and medical education), and small group learning that can be effectively applied. First, while books related to medical education were available, most were translations of books published overseas. Moreover, there were no textbooks that were completely suitable for the 4th-year students in medical course in Korea because they were composed of content for experts. In addition, as medical education included social science aspects, there were limitations in using translated books from overseas. Social science is a study that explores social phenomena occurring in the relationship between humans and human social behavior [13] and regards the publicity of knowledge as the most important value. However, since the goal is not to specialize or popularize public knowledge, but to provide more people with useful knowledge for social life in the process [14], the social context must be considered.
Second, it is necessary to study what educational capabilities are required of medical students in Korea. Overseas, studies are being conducted on the ability to teach medical students skills or educate patients and guardians as essential competencies of residents, but research on such programs is lacking. Korea has developed RESPECT100 of Respect, Ethics, Patient Safety, Professionalism, Excellence, and Teamwork with the competency of majors based on the Future Roles of Korean Doctors. Here, among the two sub-subjects of Excellence (generic clinical competence, self-development), the major as an educator is specified in self-development, and the competency of “Resident-as-Learner and Teacher” is used as a clinical teacher, curriculum developer, educational scholar, social communicator, and so forth [15,16]. However, to cultivate these competencies, it is necessary to study whether there are educational competencies required in medical schools before students become residents, what these competencies are, and how and when they should be taught.
Third, because 4th-year students of medical course in Korea is generally conducted in the form of an intensive completion system and lasts for more than 1 week in small groups, the instructor can directly check the student’s academic progress and provide feedback. Therefore, it is possible to use various teaching methods for students’ active learning, away from large-scale lecture classes. In this study, active learning, project-based learning, peer learning, and feedback considering individual developmental levels (zone of proximal development) could be utilized.
As this study was conducted with only four students, there is a limitation to generalization. However, as a study designed and implemented in a teaching program for medical education in a medical school in Korea, it is expected that the research will be helpful when teaching medical education to undergraduate students or developing a medical education program to strengthen the educational capacity of residents.

Acknowledgments

None.

Notes

Funding
No financial support was received for this study.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
HJP, SMY, YRK designed the study. HJP and YRK was in charge of data collection, analysis, and interpretation. HJP drafted manuscript. SMY and YRK reviewed and finalized the manuscript. All authors approved the final version of the manuscript.

Table 1.
Medical Education Experts Who Became Research Subjects
No. Medical education career Medical major Education major Affiliationa)
1 More than 10 yr O E
2 More than 10 yr O K
3 More than 10 yr O E
4 More than 7 yr O Y
5 More than 7 yr O K

a) Due to personal information, the affiliated medical school is written in capital letters.

Table 2.
List of Books Reviewed as Textbooks
Relevant course outcomes Title Author (translation) Publisher Year of publication
#1 A practical guide for medical teachers Harden et al. (Kim et al.) Academy Press 2008
Understanding medical education: evidence, theory, and practice Swanwick & Tim (Kyung Hee University School of Medicine) Kyung Hee University Publication Center 2013
Educating physicians: a call for reform of medical school and residency Cooke et al. (Shin et al.) Hakjisa 2014
An introduction to medical teaching Huggett et al. (Kim et al.) Yeungnam University Press 2016
#2 Introduction to educational methods and educational technology Kang Yangseowon 2011
Educational evaluation Kwon Hakjisa 2016

#1: Students can explain the paradigm shift in medical education by linking outcome-based education. #2: Students can design, implement, evaluate, and improve classes according to the instructional system development model.

Table 3.
Satisfaction with Teaching Competence and Research Competencce in the Elective Course (Medical Education)
Teaching competence Research competence
Degree of help from lab meetings 3.75±1.89 4.25±0.96
Degree of need 3.50±1.29 4.00±1.15
Satisfaction 4.50±1.00 4.00±0.82
What the lab meeting helped? - Rehearsal feedback - Knowing the scope of what you can do
- Topic selection, class direction - I had no idea how to conduct research, but I learned how to create a survey
- Orientation of lecture topics, editing details, theoretical background class - Direction of the research topic selection; improved thesis direction of the thesis
- Help choose teaching strategies and refining - Helpful guidance on what to look for in the next step in research
- I was able to supplement the lack of evidence in the contents
What would you like to share with your next colleague? - Clarifying lecture topics - It would be more helpful if you select a topic you are interested in and find out if there is any related literature before choosing a topic
- Select a subject that interests you and underclassmen

Data are presented as mean±standard deviation.

Table 4.
Overall Satisfaction in the Elective Course (Medical Education)
Results
Overall satisfaction 4.25±0.96
Overall difficulty 4.25±0.96
Degree of future help 3.25±0.50
Strengths - Lectures for juniors and the lecture design process were interesting
Areas of improvement - It was difficult to understand the pedagogical theory
- Overall, hope to progress quickly

Data are presented as mean±standard deviation.

References

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13. Naver Knowledge Encyclopedia. Academic encyclopedia: social sciences. https://terms.naver.com/entry.naver?docId=2053685&cid=44412&categoryId=44412. Accessed January 9. 2023.

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15. Korean Medical Association, Research Institute for Healthcare Policy. Development of general competencies and EPA based on roles of doctors in South Korea. https://rihp.re.kr/bbs/board.php?bo_table=research_report&wr_id=285&page=2. Published November 2018. Accessed January 24, 2023. 2023.

16. Park J. Competency and curriculum of the resident as teacher: a review and suggestions. Korean Med Educ Rev 2021;23(1):23-36.
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