COMMENTARIES AND OPINIONS

Medical education: addressing questions that require attention Hong Sik Lee Department of Gastroenterology and Hepatology, Korea University College of Medicine, Seoul, Korea

Medical schools have a clear and practical educational

most of Korea’s medical education programs have

objective: to cultivate professional medical doctors. A

returned to a 6-year undergraduate curriculum, con-

doctor’s professional development should be maintained

sisting of 2 years of premedicine and 4 years of

and developed through continuous medical education and

medicine, as was historically the case. Medical education

experience throughout his or her professional career;

in Korea faces many challenges. Some of these chal-

acquiring a medical license after 6 years of education at

lenges have left unsolved questions in Korea, such as the

a medical school is therefore only the end of the

usefulness of premedical education, the effectiveness of

beginning. In other words, graduation from medical

basic foundational medical education, and the reforma-

school is the first step, and it is necessary to ensure

tion of degree programs at graduate schools of medicine.

continuous education thereafter.

The first question is as follows: Is it still useful to

The curriculum and pedagogy of medical education are

separate the 6 years of medical education into the

evolving based on the role and competencies of doctors

premedical course and the medicine program? Among

and according to society’s needs. Medical education is

those countries that require 6 years of medical educa-

based on profound academics to a lesser extent, and is

tion, including certain European nations and Japan, it is

more concerned with the highly practical objective of

believed that Korea is the only country where the

producing expert professionals. The education system is

premedicine course is still legally binding. The term

extremely important as it is the mold that shapes the

“premedicine” is defined as the 2-year preparation

contents and methods of medical education. The

process during which one acquires the prerequisite

government-driven, graduate-entry, 4-year medical

knowledge necessary for enrollment in medical school. It

school program introduced in 2005 has been considered

is now considered unnecessary, however, to distinguish

inadequate in Korea for a number of reasons. At present,

between medical education at medical school and pre-

Received: July 27, 2017 • Revised: August 24, 2017 • Accepted: August 24, 2017 Corresponding Author: Hong Sik Lee (https://orcid.org/0000-0001-9726-5416) Department of Gastroenterology and Hepatology, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82.2.920.5312 Fax: +82.2.927.1036 email: [email protected]

Korean J Med Educ 2017 Sep; 29(3): 199-201. https://doi.org/10.3946/kjme.2017.66 eISSN: 2005-7288 Ⓒ The Korean Society of Medical Education. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

199

Hong Sik Lee : Medical education: addressing questions that require attention

paratory knowledge of science or the humanities.

crisis of basic MD scientists is structural rather than

Moreover, longitudinal, integrated education is becoming

temporal. In this situation, we should also address how

increasingly important, calling into question the useful-

medical students are taught and how to increase the

ness of 2 years of premedical education. In fact, many

number of basic MD scientists.

students are largely concerned about not being able to

Thirdly, how are we going to reinforce the future

make the most of the 2-year premedicine period. The

competencies of doctors? The era of uncertainty has

abolishment of the Professional Graduate School of

come to an end. Our contemporary reality is charac-

Medicine resulted in a return to the 6-year medical

terized by the Fourth Industrial Revolution, with the

education system, and the Law of Education still main-

recent development of information communication and

tains a clear distinction. We have thus now reached a

artificial intelligence. Accordingly, modern medicine

point when we must to answer the following questions:

pursues personally tailored treatments through precise

Must we maintain the distinction between premedicine

medicine. Didactic lecture-based education in large

and medicine? If we do maintain this distinction, what

classrooms is gradually declining, and there is a growing

are the implications and objectives of doing so?

demand for student-centered, self-directed, and per-

The second question concerns foundational education

sonalized education, such as small-group education,

in basic science. In the absence of basic medical

simulation teaching, and flipped classrooms [1-3]. The

scientists with medical degrees, how should we educate

objective of education has shifted from the simple

future doctors in the scientific foundations of medicine?

delivery of knowledge to an effective understanding and

When educating medical students, it is highly important

application of knowledge in real situations. Therefore,

to help students to understand the scientific foundations

the existing curriculum certainly limits the production of

of the human body and its diseases. Instruction should

more diverse competencies, since it is rigidly scheduled

ideally be provided by basic science teachers who

and focused on major courses in traditional subjects. All

graduated from medical schools and who understand

medical schools now face the challenge of developing an

diseases and the healthcare system. In reality, however,

innovative medical curriculum providing various learn-

the number of doctor-educators capable of providing

ing opportunities based on medicine, which cultivates

basic medical education is falling rapidly. This situation

students’ holistic capabilities. In addition to the reforma-

– the apparent lack of basic scientists with medical

tion of curricular contents, medical schools should

degrees – should be taken seriously. We should establish

establish a solution to the challenge of classroom

solutions based on this reality that explore different

reformation through efficient use of current digital

approaches to realizing the provision of education on the

technology, including computers, the internet, and smart

scientific foundations of medicine. The shortage of basic

devices.

medical scientists with Doctor of Medicine (MD) degrees

The final question concerns whether or not graduate

is multifactorial. Medical research transcends the role of

medical programs achieve their intended purpose. The

doctors alone and is developed through the participation

residency training program is a type of specialized

of engineers and life scientists. Moreover, an increasing

professional vocational education. Conversely, the degree

number of clinical doctors conduct not only clinical

program in a graduate school of medicine involves

research but also basic research into human disease. The

academic education based on research. In fact, Korea is

200

Korean J Med Educ 2017 Sep; 29(3): 199-201.

Hong Sik Lee : Medical education: addressing questions that require attention

unique in that it offers a system that allows students to

what extent we apply smart devices and technologies in

complete these two different types of programs simul-

classrooms and educational fields.

taneously. This inevitably results in a structural short-

Living in a condition of good health and wellness is a

coming with the poor quality of both and leads to a crisis

human right that can be assured through the provision of

in academic education and the research function of

effective and high-quality healthcare. All healthcare

graduate schools. Given that the university operates

stakeholders

based on the two different engines of medical schools

education. We desperately need open minds for the

and graduate schools, the weaknesses of the graduate

future.

are

devoted

to innovating

medical

schools undermine the function, status, and continued development of studies. This leads to doctors lacking basic medical research competencies and could seriously

ORCID:

hinder the development of medical science in Korea.

Hong Sik Lee: https://orcid.org/0000-0001-9726-5416

Medical educators and school leaders have diligently

Acknowledgements: None.

made attempts over a number of years to overcome many

Funding: None.

challenges; however, the aforementioned questions still

Conflicts of interest: None.

need to be addressed in Korea. Problem solving needs to be timely. How many challenges in medical educational issues have thus far been solved in a timely fashion? Are

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