Introduction
An institution’s mission is to declare its purpose, identity, priorities, and direction of its existence [1]. Universities employ mission statements (MSs) to chart their courses, establish benchmarks for student admission and guide curriculum development. Similarly, medical schools utilize MSs to define their educational philosophy, goals, and learning outcomes, thereby shaping student education [2]. Furthermore, these statements may also reflect the complex web of relationships that medical schools maintain with stakeholders, such as clinical enterprises, faculty, students, healthcare professionals, patients, and families [2].
In Korea, the creation of MSs in medical schools is a relatively recent phenomenon. The catalyst for this transformation has been the accreditation system, specifically the Korean Institute of Medical Education and Evaluation (KIMEE), which certifies and evaluates medical schools [3]. The 2019 Accreditation Standards of KIMEE (ASK2019), aligned with the World Federation for Medical Education’s Basic Medical Education (BME) Standards 2015, underline the need for institutions to establish a mission rooted in their founding principles, incorporating feedback from a diverse range of stakeholders [3].
Accreditation is a valuable opportunity and resource for enhancing medical education, as it encourages the creation of a mission and helps define the identity and educational direction of the university [4]. According to ASK2019, the MS should serve as the foundation for setting outcomes for graduates, and it is recommended to align it with the national physician competency framework. The MS should indicate the kinds of experts the medical school wants to cultivate through education, and it is expected to align with graduate outcomes [2]. In Korea, the Korean Doctor’s Role (KDR) framework, developed by the Korean Medical Association, stands as the representative competency framework, emphasizing doctors’ societal roles in modern healthcare. The framework consists of five domains and eleven competencies. Each domain includes “patient care,” “communication and collaboration,” “social accountability,” “professionalism,” and “education and research.” KDR was first published in 2014 and was revised once to the 2022 version to reflect advances in medicine and changes in the health care environment [5].
Previous studies have investigated MSs in medical schools by coding, categorizing, and identifying their relationships [4,6]. According to a specific study, the features of MSs in U.S. medical schools were categorized into “traditional” and “emerging” themes, with the research outcome highlighting the dominance of “traditional” themes, particularly focusing on “education” and “research” [6]. While there is active research on MSs abroad, investigating or documenting such characteristics in the context of mission establishment is lacking in Korea due to its relatively short history in mission setting. Given this situation, we evaluated the collective attributes of MSs in all Korean medical schools using the KDR framework, aiming to examine the alignment between MSs and the KDR domains.
Methods
1. Study context
This research centers on the context of medical education in South Korea, where all 40 medical schools undergo periodic evaluations mandated by the Higher Education Act. Accreditation standards, specifically ASK2019, align with the World Federation for Medical Education’s BME Standards 2015 and necessitate the creation of MSs by medical schools that are linked to the KDR framework developed by the Korean Medical Association. In this study, we utilized the revised version of KDR, which was released in 2022, for the analysis.
2. Data collection
The data was collected from June 1 to July 31, 2022, encompassing all 40 medical schools in Korea. Researchers accessed MSs from each school’s official website and extracted institutional characteristics from the Korean Basic Medical Education Database (https://www.bmec.ac.kr/educ/educ.jsp), a repository managed by the Korea Association of Medical Colleges.
3. Data analysis
The research utilized a mixed-methods approach. In the quantitative phase, concept words were extracted from the MSs, excluding postpositions and prepositions. These were further modified into nouns to suit the characteristics of Korean words. For the qualitative analysis, content analysis was employed, incorporating both deductive and inductive methods [7]. The deductive approach involved aligning MSs with the predefined KDR framework categories, encompassing five domains and 11 competencies. Phrases that did not fit within categories were categorized as non-applicable. Two researchers independently assessed the remaining MSs, resolved any discrepancies, and reached a consensus on the deductive analysis outcomes through team discussion. The inductive analysis phase aimed to derive themes from phrases categorized as non-applicable.
4. Trustworthiness
The study sought to enhance credibility, conformity, and transferability, following the criteria proposed by Elo et al. [7], ensuring rigorous data collection, comprehensive analysis, and detailed context description.
Results
1. Characteristics of medical schools and their MSs
Table 1 presents the status of the analyzed Korean medical schools. There were 30 private medical schools (75.0%), and 27 medical schools located in non-metropolitan areas (67.5%). The current MSs were written between 2015 and 2021, with approximately 83.9% of medical schools reorganizing or revising their MSs after 2018. On average, the missions had a length of 79 characters and included 21.2 concept words.
2. KDR domain and competency frequencies with representative concepts in the MSs
Table 2 shows concept words frequencies in the MSs categorized into KDR domains with representative concepts. At the KDR domain level, “social accountability” (n=39) was the most frequent domain of medical school MSs, and “professionalism” had the lowest frequency (n=8). Similarly, for the KDR competency level, “involvement in public and global health initiatives” (3.1, n=36) was the most frequent, while there was no competency for “self-regulation based on professional leadership” (4.2) or “professionalism and self-management” (4.3). On average, the medical school’s mission included 2.88 domains (standard deviation [SD]=1.24; range, 0–5) and 3.3 competencies (SD=1.64; range, 0–7).
The number of concept words in each domain matched the frequency order. In domain 3, “social accountability” (n=92) was the highest, “society” (n=33) and “humanity” (n=28) appeared the most. On the other hand, the number of concept words included in “professionalism” was the smallest at 15.
Table 3 presents results from an inductive analysis of semantic units not assigned to the KDR domains or competencies during the deductive analysis. Many medical schools specified the founding or religion (Buddhist spirit or Catholic spirit) as a mission and provided the reason for the existence of the institution as “an institution that nurtures doctors.” The specific characteristics of the doctors to be trained were “doctors who volunteer and sacrifice” and “doctors with good attitudes.”
Discussion
This study aimed to analyze the characteristics of medical school MSs by matching them with the KDR framework. The conclusions of this study are summarized as follows.
First, the MSs exhibited a generally homogeneous pattern across all schools. The deductive analysis of the KDR divided the competencies into two groups: those commonly present (e.g., 3.1), and those infrequently found (e.g., 4.2 and 4.3) in medical schools. Also, the top 25 concept words (10%) accounted for approximately 50% (406 times) of the total frequency, confirming the homogeneity of MSs. This phenomenon may result from medical schools using similar vocabulary in a domain, possibly influenced by accreditation criteria such as ASK2019 standards, motivating nearly 84% of Korean medical schools to establish or revise their MSs between 2018 and 2021. This suggests that external factors, such as Korean medical education accreditation, may have motivated the establishment or revision of MSs in these schools.
Second, Korean medical schools’ MSs relatively undervalued the “communication and collaboration” and “professionalism” domains. Ironically, professionalism has been identified as an underdeveloped competency in the country’s medical profession [8]. A recent study found both the public and healthcare workers recognize the importance of communication with patients and families and ethical medical practice, yet dissatisfaction remains in these areas [9]. Notably, interpersonal skills, communication, teamwork, and professionalism tend to have the most significant self-other assessment discrepancies. In conclusion, the underemphasis of these domains may result in an insufficient recognition of deficiencies within the Korean medical field concerning societal demands.
Third, the MSs predominantly highlight the “traditional” roles of academic medicine, represented by “education,” “research,” and “service.” These roles are also explicitly outlined in the KDR (Domain 5. Education and research) or indirectly implied through domains closely associated with “service” (Domain 1. Patient care, Domain 3. Social accountability) [10]. Nevertheless, Valsangkar et al. [6] analyzed the MSs of 170 US medical schools and discovered emerging themes that go beyond the traditional focus, addressing the emerging healthcare agenda. These include “primary care,” “diversity,” “prevention,” “distribution ,” and “cost control.” Among these, however, only “diversity” was found to be included in the MS of three Korean medical schools.
The study has several important implications. First, MSs should review and emphasize missing elements. Omissions may imply a lack of awareness or commitment, even though inclusion does not guarantee visible performance [6]. MSs in Korean medical schools should precisely articulate themes like “service and sacrifice,” “good character,” and “excellent capability” to prevent confusion or misinterpretation. These themes might imply KDR framework domains; however, it is crucial to use clearer terms for effective communication. Second, medical schools must establish an MS reflecting emerging social needs alongside traditional triple mission roles (education, research, and service). While some Korean medical schools address issues like physician distribution and diversity, not all have proactively responded. Accreditation can drive changes in medical schools [4].
A MS signifies a concise organization’s core purpose, not an elaborate document; making an in-depth analysis was not feasible. Additionally, considering the macroscopic, long-term, and abstract nature of the MSs, it might be constrained in fully addressing all the roles and competencies outlines in the KDR. Finally, it is essential to acknowledge that an MS’s contents do not guarantee implementation and to continuously monitor medical schools’ MSs in response to societal changes.
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