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Korean J Med Educ > Volume 36(1); 2024 > Article
Kang, Lee, Lee, and Kim: Analyzing the characteristics of mission statements in Korean medical schools based on the Korean Doctor’s Role framework

Abstract

Purpose

This study assessed the alignment between Korean medical schools’ mission statements (MSs) and Korean Doctor’s Role (KDR) domains, considering school characteristics.

Methods

We analyzed the South Korean medical school’s MS characteristics using a mixed-methods approach. Quantitative analysis preprocessed MS text data to identify concept words, while qualitative content analysis categorized information into predefined KDR domains and extracted themes from other parts.

Results

At the KDR domain level, “social accountability” was the most frequent, followed by “education and research” and “patient care,” while “professionalism” had the least frequency. At the competency level, the most frequent domains were “involvement in public and global health initiatives,” while “self-regulation based on professional leadership” and “professionalism and self-management” were not present.

Conclusion

The study found that the majority of MSs had a homogeneous pattern and included traditional themes. Medical schools should evaluate and incorporate missing elements in their MSs to reflect the institution’s own purpose and current societal needs.

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.

5. Ethics statement

Ethical approval and informed consent were waived by the Institutional Review Board of Hanyang University (HYUIRB-202211-012) because the data for this study were voluntarily published online by medical schools.

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.

Acknowledgments

None.

Notes

Funding
This work was supported by the research fund of Hanyang University (HY-202300000003548).
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
YJK and DHK developed the concept and design of the study. SML and DHK acquired the data. SML and DHK analyzed and interpreted the data. YJK, DHK, and HJL drafted the manuscript. YJK, DHK, and HJL contributed to the discussions. All the authors have read and approved the manuscript.

Table 1.
Descriptive Statistics
Category Value
Total no. of medical schools 100.0 (40)
Medical school
 Ownership
  National/public 25.0 (10)
  Private 75.0 (30)
 Geographical location
  Metropolitan area 32.5 (13)
  Non-metropolitan area 67.5 (27)
 No. of size of a class 76.5±32.6 (40–142)
Mission statements
 The year of revisiona)
  2015 2.94 (1)
  2016 5.88 (2)
  2017 8.82 (3)
  2018 23.5 (8)
  2019 32.6 (11)
  2020 17.6 (6)
  2021 8.82 (3)
 No. of characters 79.0±65.3 (7–336)
 No. of unique concept words (only unique) 19.2±11.9 (3–53)

Data are presented as % (number) or mean±standard deviation (range).

a) The analysis excluded six medical schools because data on the year their mission was established or revised were unavailable in the Korean Basic Medical Education Database.

Table 2.
Frequency and Representative Concepts of Korea Doctors’ Role Domain and Competency in the Mission Statements
Domain 1. Patient care Domain 2. Communication and collaboration Domain 3. Social accountability Domain 4. Professionalism Domain 5. Education and research
1. No. of frequency in the mission statementsa)
 Domain-level 68 (27) 28 (11) 98 (39) 20 (8) 75 (30)
 Competency-levelb)
  1 Level 68 (27) 8 (3) 90 (36) 15 (6) 25 (10)
  2 Level 3 (1) 10 (4) 43 (17) 0 70 (28)
  3 Level 0
2. Most frequent concept words
 Total no. of unique concept words 56 18 92 15 58
 No. of most frequent concept wordsc) Doctor (16), medical practitioner (11), medical care (8), competence (8), patient (5), knowledge (4), centeredness (4) Communication (4), collaboration (3), ability (3) Society (33), humanity (28), health (20), region (16), serve (16), medical care (9), enhancement (8), country (8), responsibilities (7), international (7), contribution (7) Medical professional (3), ethics (3) Research (26), medical science (15), development (12), creativity (11), leading (9), learning (4), medical scientist (4)

Data are presented as % (number) or number. Numbers in parentheses indicate the frequency of the corresponding concept word.

a) Total medical schools (100%, N=40).

b) The names of competencies corresponding to each number are 1.1. Medical knowledge and clinical skills, 1.2. Patient safety, 2.1. Communication and collaboration with patients, their families, and caregivers, 2.2. Communication and collaboration with other healthcare professionals and the community, 3.1. Involvement in public and global health initiatives, 3.2. Participation in healthcare policy, 4.1. Clinical practice and patient-physician relationship based on ethics and autonomy, 4.2. Self-regulation based on professional leadership, 4.3. Professionalism and self-management, 5.1. Education, and 5.2. Research.

c) A word whose frequency ranking is within 10% of all concept words included in the domain.

Table 3.
Analysis of Phrases Not Assigned to Korea Doctors’ Role Domains or Competencies
Theme Representative concepts words
An organization adheres to the founding philosophy Founding philosophy, Buddhist spirit, Catholic spirit
An institution that nurtures doctors Education, cultivate, foster
A doctor who volunteers and sacrifices Service, sharing
A doctor with a good attitude Personality, attitude, character
A doctor with excellent capability Talent, knowledge, skill

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