문화 간 커뮤니케이션 능력의 중요성

http://www.koreapr.org/resource/opinion_view.php?n=35&no=36&start=20&mode=&field=&s_que=

 

http://www.ksa.or.kr/framework/customer/eksatrend.do?method=view&pbrd_seq_n=183&brd_seq_n=66099&cPage=2&skin_seq_n=7

Curriculum Inventory and Reports (CIR)

Curriculum Inventory and Reports (CIR), part of the AAMC's Medical Academic Performance Services (MedAPS) initiative, is designed to serve as the premier benchmarking and reporting tool on content, structure, delivery, and assessment of medical school curricula.

• The Curriculum Inventory serves as the centralized database of AAMC-member medical school curricula, including content, structure, delivery, and assessment in the U.S. and Canada.

• Curriculum Reports provide graphical interpretations of both aggregate and historical curriculum-related data that:

• assist in curriculum benchmarking and continuous quality improvement;
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• enhance medical education research; and
• inform legislators and the general public.

2015학년도 이후 의과대학 선발방식별 정원 변화

† 2017학년도 이후 5개 의전원 정원(218명): 강원(49), 동국(경주)(49), 건국(충주)(40), 제주(40), CHA의과(40); 

‡ 의전원 비도입 14개 의과대학 정원(890명): 순천향(93), 연세(원주) (93), 인제(93), 계명(76), 고신(76), 한림(76), 원광(76), 관동(49), 서남(49), 건양(49), 단국(40), 대구가톨릭(40), 울산(40), 을지(40)

참고자료:

• 전국 36개 의대 올해 얼마나 뽑나...2255명 
  (http://www.veritas-a.com/news/articleView.html?idxno=19662)

• 전국 36개 의대는 도대체 얼마나 확대될까..5년간 1302명 증가
  (http://www.veritas-a.com/news/articleView.html?idxno=19975)

• 학사편입으로 의대진학 길 열린다..올해 278명 첫 선발
  (http://www.veritas-a.com/news/articleView.html?idxno=21371)

[프리미엄] 좋은 머리만큼 '따뜻한 심장'도 지녔는가… 달라진 醫大 면접

[출처] 본 기사는 조선닷컴에서 작성된 기사 입니다

방 안엔 교수 면접관 2명이 앉아 있었다. 면접관들은 8분 동안 수험생에게 속사포 같은 질문 공세를 펼쳤다. 종료 벨 소리와 함께 수험생들은 한 칸씩 옆방으로 이동했고, 질문만 다를 뿐 똑같은 과정이 되풀이됐다. 수험생들은 이런 식으로 60분 동안 모두 6개의 면접실을 돌았다. 모든 과정은 마치 톱니바퀴가 돌아가는 듯했다. 중간에 쉬는 시간도 없었다

서울대 의대가 2012학년도부터 도입한 이 면접은 '다면(多面) 인·적성 면접(MMI·Multiple Mini Interview)'. 의사로서의 기본적인 인성과 적성을 검증하는 면접법이다. 처음엔 의학전문대학원 수시에 적용했고 이후 2013학년도 의대 수시, 2014학년도 의대 정시로 확대했다

◇의사, 인성과 적성이 중요하다

서울대 의대는 MMI 도입 취지에 대해 "의사소통 능력과 라포르(rapport·의사와 환자의 심리적 신뢰) 형성 능력이 있는 지원자를 선발하고, 공부만 잘하는 지원자는 걸러내기 위한 시도"라고 밝혔다.

의대생을 뽑을 때 인성과 적성을 중시해야 한다는 것은 의학계의 오랜 화두(話頭)다. 사정은 외국도 마찬가지다. 뉴욕타임스는 몇 년 전 '의사 지망생을 위한 새로운 인성·사회성 테스트'란 제목의 기사에서 "미국 의대 가운데 MMI를 도입하는 곳이 늘고 있다"고 전했다. 그 이유로는 ▲실력 좋은 의사들이 환자·간호사 등과 소통이 안 돼 충분히 막을 수 있었던 환자의 죽음을 막지 못하는 사례가 늘고 있으며 ▲현대 의술이 갈수록 팀플레이 위주로 전개돼 의사에게 소통 능력이 요구되고 있는 점을 꼽았다.

MMI는 지난 2001년 캐나다 맥마스터 의대가 처음 도입했으며, 현재는 캐나다 대부분 의대가 시행하고 있다. 이후 미국으로도 넘어가 뉴저지, 캘리포니아, 버지니아, 오하이오 등의 주요 주립 의대가 실시 중이다. 미국 명문 사립 의대 중엔 스탠퍼드가 2010년 도입했다.

우리나라에서는 강원대 의전원이 2008학년도 입시에서 처음 시행했고, 한림대 의대가 2011학년도 입시에 도입했다. 그 외 인제대 의대, 가천대 의대 등이 시행 중인 것으로 알려졌다. 또 최근 발표된 서울대 2015학년도 입시전형 안내에 따르면 이 대학 수의대·치대도 수시 전형에서 MMI를 실시할 계획이다.

◇학생들… "살아온 모습 드러나더라"

서울대 의대의 MMI는 총 6개의 방으로 구성됐다. 이 학교 입학 관계자는 "면접실 6개 중 1개는 학생들이 제출한 서류나 학생부 등을 확인·검토하는 방"이라며 "나머지 5개 방에서는 의대 산하의 문항개발위원회가 자체 개발한 문항으로 면접을 진행한다"고 설명했다.

서울대 의대 신입생들은 "면접에 나온 문항은 수학·과학 능력을 검증하는 것이 아니었다"고 입을 모았다. 예를 들어 '친구가 대학 입시 자기소개서에 허위·과장 내용을 기재해 제출한 사실을 알게 됐다. 어떻게 할 것인가' '친구 5명과 인도 여행을 떠나기로 했다. 경비 마련, 역할 분담 등을 어떻게 할 것인가' 등 일상적인 내용을 담은 문항이 주로 제시됐다고 했다. 방에서는 문항과 관련된 추가 질문이 쉴 틈 없이 이어졌다고 한다.

(출처 : http://blog.chosun.com/blog.log.view.screen?userId=besetohan&logId=7417996)

(출처 : http://jalt.org/test/bro_12.htm)

• Pearson r:

– 연속 변수들 간의 상관계수

– 선형적 관계를 가정

• Spearman's r.

– 서열척도들간의 상관계수

– 연속변수라 하더라도 극단적인 값들이 존재하면 Pearson Correlation 대신 Spearman 상관계수를 사용할 수 있음.

– 계산 방법은 자료의 서열을 정한 다음, 이 서열간의 Pearson 상관계수를 계산하면 됨.

• Phi(φ) coefficient.

– 두 범주 변수들간의 상관계수

– 각 범주 변수를 0과 1로 바꾼 다음, 이 둘 간의 Pearson 상관계수로 계산할 수 있음.

– 이 값은 부호가 의미가 없고, 최소값이 0은 아니다.

• Tetrachoric 상관계수

– 범주들간의 상관계수이나, 범주들이 인위적으로 이분화된 경우에 사용하는 이다.

– 이분화되기 전 원래 변수는 정규분포를 띠고 있다고 가정한다.

• 점이연 상관계수 (Point-biserial correlation)

– 하나가 연속변수이고 다른 하나고 이분변수일 때 사용하는 상관계수

– 이분변수를 0과 1로 코딩한 다음 Peason 상관계수를 계산하면이 상관계수가 된다.

– 검사에서 총점과 문항 (correct/incorrect 혹은 yes/no) 간의 상관계수를 구할 때 자주 사용된다.

– 두 집단의 t-검증과 밀접히 관련되어 있다.

• 이연 상관계수 (Biserial correlation)

– 하나가 연속변수이고 다른 하나고 이분변수일 때 사용하는 상관계수이지만 이분변수가 원래 연속변수인데 이분화한 경우에 상용한다.

– 이는 이분화되지 않았을 때 두 연속변수들간의 상관계수를 추정하는 방식으로 상관이 구해진다.

(출처 : http://qpsy.snu.ac.kr/teaching/multivariate/R_V.pdf)

If the sample is normally distributed (i.e., conditions for the computation of the biserial exist), then to obtain the biserial correlation from the point-biserial for dichotomous data:

Biserial = Point-biserial * f(proportion-correct-value)

Example: Specify PTBISERIAL=Yes and PVALUE=Yes. Display Table 14.

+-------------------------------------------------------------------------------------+

|ENTRY    RAW                   MODEL|   INFIT  |  OUTFIT  |PTBSE| P-  |              |

|NUMBER  SCORE  COUNT  MEASURE  S.E. |MNSQ  ZSTD|MNSQ  ZSTD|CORR.|VALUE| TAP          |

|------------------------------------+----------+----------+-----+-----+--------------|

|     8     27     34   -2.35     .54| .59  -1.3| .43   -.2| .65| .77| 1-4-2-3      |

Point-biserial = .65. proportion-correct-value = .77. Then, from the Table below, f(proportion-correct-value) = 1.3861, so Biserial correlation = .65 * 1.39 = 0.90

Here is the Table of proportion-correct-value and f(proportion-correct-value).

p-va f(p-val) p-va f(p-val)

0.99 3.7335   0.01 3.7335

0.98 2.8914   0.02 2.8914

0.97 2.5072   0.03 2.5072

0.96 2.2741   0.04 2.2741

0.95 2.1139   0.05 2.1139

0.94 1.9940   0.06 1.9940

0.93 1.8998   0.07 1.8998

0.92 1.8244   0.08 1.8244

0.91 1.7622   0.09 1.7622

0.90 1.7094   0.10 1.7094

0.89 1.6643   0.11 1.6643

0.88 1.6248   0.12 1.6248

0.87 1.5901   0.13 1.5901

0.86 1.5588   0.14 1.5588

0.85 1.5312   0.15 1.5312

0.84 1.5068   0.16 1.5068

0.83 1.4841   0.17 1.4841

0.82 1.4641   0.18 1.4641

0.81 1.4455   0.19 1.4455

0.80 1.4286   0.20 1.4286

0.79 1.4133   0.21 1.4133

0.78 1.3990   0.22 1.3990

0.77 1.3861   0.23 1.3861

0.76 1.3737   0.24 1.3737

0.75 1.3625   0.25 1.3625

0.74 1.3521   0.26 1.3521

0.73 1.3429   0.27 1.3429

0.72 1.3339   0.28 1.3339

0.71 1.3256   0.29 1.3256

0.70 1.3180   0.30 1.3180

0.69 1.3109   0.31 1.3109

0.68 1.3045   0.32 1.3045

0.67 1.2986   0.33 1.2986

0.66 1.2929   0.34 1.2929

0.65 1.2877   0.35 1.2877

0.64 1.2831   0.36 1.2831

0.63 1.2786   0.37 1.2786

0.62 1.2746   0.38 1.2746

0.61 1.2712   0.39 1.2712

0.60 1.2682   0.40 1.2682

0.59 1.2650   0.41 1.2650

0.58 1.2626   0.42 1.2626

0.57 1.2604   0.43 1.2604

0.56 1.2586   0.44 1.2586

0.55 1.2569   0.45 1.2569

0.54 1.2557   0.46 1.2557

0.53 1.2546   0.47 1.2546

0.52 1.2540   0.48 1.2540

0.51 1.2535   0.49 1.2535

0.50 1.2534   0.50 1.2534

To obtain the biserial correlation from a point-biserial correlation, multiply the point-biserial correlation by SQRT(proportion-correct-value*(1-proportion-correct-value)) divided by the normal curve ordinate at the point where the normal curve is split in the same proportions.

There is no direct relationship between the point-polyserial correlation and the polyserial correlation.

(출처 : http://www.winsteps.com/winman/biserial.htm)

Applied Statistics - Lesson 13

More Correlation Coefficients

Lesson Overview

• Why so many Correlation Coefficients
• Point Biserial Coefficient
• Phi Coefficient
• Measures of Association: C, V, Lambda
• Biserial Correlation Coefficient
• Tetrachoric Correlation Coefficient
• Rank-Biserial Correlation Coefficient
• Coefficient of Nonlinear Relationship (eta)
• Homework

Why so many Correlation Coefficients

For the purposes of correlation coefficients we can generally lump the interval and ratio scales together as just quantitative. In addition, the regression of x on y is closely related to the regression of y on x, and the same coefficient applies. We list below in a table the common choices which we will then discuss in turn.

Before we go on we need to clarify different types of nominal data. Specifically, nominal data with two possible outcomes are call dichotomous.

Point-Biserial

Phi Coefficient

As an example, consider the following data organized by gender and employee classification (faculty/staff). (htm doesn't provide the facility to grid only the table's interior).

Contingency tables are often coded as below to simplify calculation of the Phi coefficient.

With this coding: phi = (BC - AD)/sqrt((A+B)(C+D)(A+C)(B+D)).

For this example we obtain: phi = (25-100)/sqrt(15•15•15•15) = -75/225 = -0.33, indicating a slight correlation. Please note that this is the Pearson correlation coefficient, just calculated in a simplified manner. However, the extreme values of |r| = 1 can only be realized when the two row totals are equal and the two column totals are equal. There are thus ways of computing the maximal values, if desired.

Measures of Association: C, V, Lambda

One is called Pearson's contingency coefficient and is termed C whereas the second is called Cramer's V coefficient. Both utilize the chi-square statistic so will be deferred into the next lesson. However, the Goodman and Kruskal lambda coefficient does not, but is another commonly used association measure. There are two flavors, one called symmetric when the researcher does not specify which variable is the dependent variable and one called asymmetricwhich is used when such a designation is made. We leave the details to any good statistics book.

Biserial Correlation Coefficient

r_b = (Y₁ - Y₀) • (pq/Y) / _Y,

Tetrachoric Correlation Coefficient

Rank-Biserial Correlation Coefficient

Coefficient of Nonlinear Relationship (eta)

It is often useful to measure a relationship irrespective of if it is linear or not. The eta correlation ratio or eta coefficient gives us that ability. This statistic is interpretted similar to the Pearson, but can never be negative. It utilizes equal width intervals and always exceeds |r|. However, even though r is the same whether we regress y on x or x on y, two possible values for eta can be obtained.

데이터입력
5.1. Data Entry

Data entry for correlation, regression and multiple regression is straightforward because the data can be entered in columns. So, for each variable you have measured, create a variable in the spreadsheet with an appropriate name, and enter each subject’s scores across the spreadsheet. There may be occasions where you have one or more categorical variables (such as gender) and these variables can be entered in the same way but you must define appropriate value labels. For example, if we wanted to calculate the correlation between the number of adverts (advertising crisps!) a person saw and the number of packets of crisps they subsequently bought we would enter these data as in Figure 5.1.

예비분석 : 산점도

5.2. Preliminary Analysis of the Data: the Scatterplot

Before conducting any kind of correlational analysis it is essential to plot a scatterplot and look at the shape of your data. A scatterplot is simply a graph that displays each subject’s scores on two variables (or three variables if you do a 3-D scatterplot). A scatterplot can tell you a number of things about your data such as whether there seems to be a relationship between the variables, what kind of relationship it might be and whether there are any cases that are markedly different from the others. A case that differs substantially from the general trend of the data is known as an outlier and if there are such cases in your data they can severely bias the correlation coefficient. Therefore, we can use a scatterplot to show us if any data points are grossly incongruent with the rest of the data set.

이변수 상관관계

5.3. Bivariate Correlation

Once a preliminary glance has been taken at the data, we can proceed to conducting the actual correlation. Pearson’s Product Moment Correlation Coefficient and Spearman’s Rho should be familiar to most students and are examples of a bivariate correlation. The dialogue box to conduct a bivariate correlation can be accessed by the menu path AnalyzeÞCorrelateÞBivariate … and is shown in Figure 5.5.

피어슨 상관관계

5.3.1. Pearson’s Correlation Coefficient

피어슨 계수를 구하기 위해서는 모수적 데이터가 필요하나, 사실 이 통계법은 극도록 robust한 방법이다.

For those of you unfamiliar with basic statistics (which shouldn’t be any of you … !), it is not meaningful to talk about means unless we have data measured at an interval or ratio level. As such, Pearson’s coefficient requires parametric data because it is based upon the average deviation from the mean. However, in reality it is an extremely robust statistic.

만약 가지고 있는 자료가 nonparametric이라면 Pearson에 체크된 것을 해제해야 한다.

This is perhaps why the default option in SPSS is to perform a Pearson’s correlation. However, if your data are nonparametric then you should deselect the Pearson tick-box. The data from the exam performance study are parametric and so a Pearson’s correlation can be applied. The dialogue box (Figure 5.5) allows you to specify whether the test will be one- or two-tailed. 

단측검정과 양측검정의 활용

One-tailed tests should be used when there is a specific direction to the hypothesis being tested, and two tailed tests should be used when a relationship is expected, but the direction of the relationship is not predicted. 

Our researcher predicted that at higher levels of anxiety exam performance would be poor and that less anxious students would do well. Therefore, the test should be one-tailed because she is predicting a relationship in a particular direction. What’s more, a positive correlation between revision time and exam performance is also expected so this too is a one tailed test.

유의할 단어(1) : 인과관계

5.3.1.1. A Word of Warning about Interpretation: Causality

상관계수를 해석할 때는 매우 조심해야 하는데, 인과관계에 대해서 정보를 주는 것이 아니기 때문이다. 

A considerable amount of caution must be taken when interpreting correlation coefficients because they give no indication of causality. So, in our example, although we can conclude that exam performance goes down as anxiety about that exam goes up, we cannot say that high exam anxiety causes bad exam performance. This is for two reasons:

제3의 변수

·  The Third Variable Problem: In any bivariate correlation causality between two variables cannot be assumed because there may be other measured or unmeasured variables effecting the results. This is known as the ‘third variable’ problem or the ‘tertium quid’. In our example you can see that revision time does relate significantly to both exam performance and exam anxiety and there is no way of telling which of the two independent variables, if either, are causing exam performance to change. So, if we had measured only exam anxiety and exam performance we might have assumed that high exam anxiety caused poor exam performance. However, it is clear that poor exam performance could be explained equally well by a lack of revision. There may be several additional variables that influence the correlated variables, and these variables may not have been measured by the researcher. So, there could be another, unmeasured, variable that affects both revision time and exam anxiety.

인과관계의 방향

·  Direction of Causality: Correlation coefficients say nothing about which variable causes the other to change. Even if we could ignore the third variable problem described above, and we could assume that the two correlated variables were the only important ones, the correlation coefficient doesn’t indicate in which direction causality operates. So, although it is intuitively appealing to conclude that exam anxiety causes exam performance to change, there is no statistical reason why exam performance cannot cause exam anxiety to change. Although the latter conclusion makes no human sense (because anxiety was measured before exam performance), the correlation does not tell us that it isn’t true.

해석에 r2 사용하기

5.3.1.2. Using r2 for Interpretation

인과관계에 대해서 직접적인 결론을 내릴 수는 없지만 상관계수를 제곱하여 variability에 대한 결론을 낼 수 있다.

Although we cannot make direct conclusions about causality, we can draw conclusions about variability by squaring the correlation coefficient. By squaring the correlation coefficient, we get a measure of how much of the variability in one variable is explained by the other. 

For example, if we look at the relationship between exam anxiety and exam performance. Exam performances vary from subject to subject because of any number of factors (different ability, different levels of preparation and so on). If we add all of this variability (rather like when we calculated the sum of squares in chapter 1) then we would get an estimate of how much variability exists in exam performances. We can then use r 2 to tell us how much of this variability is accounted for by exam anxiety. These variables had a correlation of - 0.4410. The value of r2 will therefore be (-0.4410)2 = 0.194 . This tells us how much of the variability in exam performance that exam anxiety accounts for. If we convert this value into a percentage (simply multiply by 100) we can say that exam anxiety accounts for 19.4% of the variability in exam performance. So, although exam anxiety was highly correlated to exam performance, it can account for only 19.4% of variation in exam scores. To put this value into perspective, this leaves 80.6% of the variability still to be accounted for by other variables. 

r^2은 매우 유용하지만, 인과관계를 추론하는데 사용할 수는 없다.

I should note at this point that although r 2 is an extremely useful measure of the substantive significance of an effect, it cannot be used to infer causal relationships. Although we usually talk in terms of ‘the variance in Y accounted for by X’ or even the variation in one variable explained by the other, this says nothing of which way causality runs. So, although exam anxiety can account for 19.4% of the variation in exam scores, it does not necessarily cause this variation.

Spearman's Rho

5.3.2. Spearman’s Rho

비모수적 통계법으로서 parametric assumption이나 distributional assumption을 위반했을 때 사용한다. 

Spearman’s correlation coefficient is a nonparametric statistic and so can be used when the data have violated parametric assumptions and/or the distributional assumptions. Spearman’s tests works by first ranking the data, and then applying Pearson’s equation to those ranks. 

Spearman correlation은 변수가 interval이 아니라 ordinal일 경우에 사용한다.

As an example of nonparametric data, a drugs company was interested in the effects of steroids on cyclists. To test the effect they measured each cyclist’s position in a race (whether they came first, second or third etc.) and how many steroid tablets each athlete had taken before the race. Both variables are nonparametric, because neither of them was measured at an interval level. The position in the race is ordinal data because the exact difference between the ability of the runners is unclear. It could be that the first athlete won by several metres while the remainder crossed the line simultaneously some time later, or it could be that first and second place was very tightly contested but the remainder were very far behind. The Spearman correlation coefficient is used because one of these variables is ordinal not interval.

Kendall's Tau (비모수적)

5.3.3. Kendall’s Tau (nonparametric)

Kendall's tau역시 비모수적 상관관계이지만 데이터세트가 작고 동순위(동점자)가 많을 때 상요한다. Spearman이 더 유명하긴 하지만, Kendall's 방법이 상관관계를 더 잘 보여준다는 의견도 많다.

Kendall’s tau is another nonparametric correlation and it should be used rather than Spearman’s coefficient when you have a small data set with a large number of tied ranks. This means that if you rank all of the scores and many scores have the same rank, the Kendall’s tau should be used. Although Spearman’s statistic is more popular of the two coefficients, there is much to suggest that Kendall’s statistic is actually a better estimate of the correlation in the population (see Howell, 1992, p.279). As such, we can draw more accurate generalisations from Kendall’s statistic than from Spearman’s.

(출처 : http://www.statisticshell.com/docs/correlation.pdf)

"이제 막 의학이라는 배움의 길에 들어선 학생이 

가장 가지기 어려운 신념은 

그가 들어선 이 길이 

대학교육과정도 아니요, 

의학교육과정도 아니고, 

인생에 걸친 과정이라는 것이다."

Sir William Osler, 1st Baronet (/ˈɒz.lə/, July 12, 1849 – December 29, 1919) was a Canadian physician and one of the four founding professors of Johns Hopkins Hospital. Osler created the first residency program for specialty training of physicians, and he was the first to bring medical students out of the lecture hall for bedside clinical training.^[1] He has frequently been described as the "Father of Modern Medicine".^[2] Osler was a person of many interests, who in addition to being a physician, was a bibliophile, historian, author, and renowned practical joker.

Sir William Osler, Bt
William Osler
Born	July 12, 1849 Bond Head, Canada West
Died	December 29, 1919 (aged 70) Oxford, England
Residence	Canada United Kingdom
Nationality	Canadian
Fields	physician, pathologist, internist, educator, bibliophile, author and historian
Institutions	McGill University, Johns Hopkins School of Medicine, Johns Hopkins Hospital, University of Pennsylvania, University of Oxford
Alma mater	McGill University

(출처 : http://en.wikipedia.org/wiki/William_Osler)

What Do Medical Schools Value in Selecting Students?

Gabriel Garcia, MD

Associate Professor of Medicine

Associate Dean for Medical School Admissions

Stanford University School of Medicine

ggarcia@stanford.edu

입학 절차 설계

Designing an Admissions Process

1. Mission of the Medical School
2. Societal Expectations
3. Health care system manpower concerns

과외활동 참여에 대한 평가 방법

Barometer for Participation in Any Extracurricular Activity 

1. Showing up
2. Showing up for a long time
3. Leadership   
4. Advocacy
5. Innovation
6. Legacy

면접 Interview

• Does your interaction with the candidate conform to the expectations you derived from reading the application? If not, what are the discrepancies?
• Do you think the letters of support represent the candidate fairly?
• Does the candidate have a interest in the world outside of school and in the welfare of others? 
• Does the candidate have any significant knowledge of your program and how it would benefit her in pursuit of her stated goals?
• Are there specific concerns that the candidate may have about your school?
• Does the candidate have a reasonable understanding of the positive and negative aspects of a career in medicine?
• Do you detect any characteristics that cause you to question candidate’s suitability for a career in medicine or the ability to think logically and critically?
• Have you explored answers to questions raised by file reviewers?

왜 스탠포드인가? Why Stanford?

Distinct Core Values at Stanford

GOAL = Non-competitive Environment that Promotes Both Individual and Collaborative Achievement 

• No Grades
• No Ranking of Students
• No AOA or Awards Until Graduation

GOAL = No penalty for staying longer to continue to explore your education.

• Nominal tuition (fees only) after 13 quarters of attendance
• Generous financial aid. Our maximum grant for our neediest students pays 83% of tuition. 
• Mean debt for 2002 graduates: 
• $91,000 at public schools
• $124,000 at private schools 
• $63,000 at Stanford!

(출처 : http://www.stanford.edu/group/snma/text_files/Admissions%20Presentation%202003%20for%20website.ppt)

Undergraduate Medical Education "Fast Facts"

Data for "Fast Facts" are derived from the Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire. The questionnaire is sent annually to the deans of all LCME-accredited medical schools with enrolled students. Each year, the questionnaire is reviewed by AMA staff and attempts are made to verify information and obtain missing data.

The "Fast Facts" tables illustrate trend data for current topics of interest within undergraduate medical education. When available, data reflects responses, in five-year increments, from academic years 1989-1990 through 2009-2010.

입학위원회의 구성

Admissions committee composition

아래의 그룹을 입학위원회의 투표의원으로 포함시키는가의 여부

Table 1: Number and percent of medical schools including the indicated groups as voting members of the admissions committee: 2009-2010 

임상실습 기간

Clerkship length

과별 임상실습 기간과 각 과별 외래실습 비중

Table 2: Clerkship length and percent of time in the ambulatory setting: by academic year Hospital inpatient sites

임상실습에서 입원환자를 보는 병원

Hospital inpatient sites

임상실습에 활용되는 병원의 수와 종류

Table 3: Number of hospitals used as major inpatient sites for required clinical clerkships, by ownership and academic year

공동학위과정

Joint degree options

아래의 공동학위과정을 제공하는 학교의 수

Table 4: Medical schools offering the indicated joint degree options, by academic year 

전문직으로서의 행실

Professional behavior

학생이 교수/감독자의 전문직다운 행동(professional behavior)를 평가하는 학교의 수와 비율

Table 5: Medical students’ evaluation of their teachers/supervisors professional behavior, by academic year

학생의 전문직다운 행동(professional behavior)를 평가하는 방법

Table 6: Methods used to evaluate the professional behavior of medical students, 2009-2010 

NBME 과목시험

National Board of Medical Examiners (NBME) subject tests

NBME 과목시험을 요구하는 학교

Table 7: Number of medical schools that require NBME subject tests in one or more disciplines, by academic year

NBME 과목시험을 요구하는 학교 - 과목별 비교

Table 8: Number of medical schools that required NBME subject tests, by discipline and academic year 

야간 당직

Night call

필수 임상실습에서 야간 당직을 해야 하는 학교

Table 9: Requirement for night call in core clinical clerkships, by academic year 

OSCE 시험

Objective Structured Clinical Examination (OSCE)

임상실습에서 OSCE 시험을 요구하는 정도 (임상과별 OSCE, 종합 OSCE)

Table 10: Trends in medical schools’ use of OSCEs in required clinical clerkships and as a final comprehensive skills examination, by academic year

의사면허시험

USMLE

의사면허시험을 봐야하거나/통과해야 하는 학교

Table 11: Requirement to take and pass components of the United States Medical Licensing Examination (USMLE), by academic year

(출처 : www.ama-assn.org/ama/pub/education-careers/medical-education-facts/undergraduate-medical-education-facts.page)

Trends in Graduate Medical Education, 1999 through 2008

10 years of GME data collected through the National GME Census

As has been observed elsewhere, training in accredited subspecialty programs has increased dramatically in the past decade. By 2008, there were 916 more subspecialty programs and 4,470 more physicians training in them compared to 1999. There was a loss of 168 core specialty programs during this period, with a gain of 5,447 residents. Physicians training in subspecialty programs made up 47% of the overall increase in the number of physicians training in ACGME-accredited programs, although overall they made up 16% of the GME population.

Graduates of osteopathic medical schools are increasingly seeking and obtaining training positions in ACGME-accredited training programs. There are fewer training opportunities for DOs in AOA-accredited specialty and subspecialty programs compared to ACGME programs, so increasing participation in ACGME programs is not unexpected. The number of graduates of Canadian medical schools training in the US, never a large number, has declined by 39%. Until recently, the number of graduates of allopathic medical schools was flat, and therefore the number in ACGME-accredited programs overall has been relatively stable, particularly for entrants to GME, GY1 residents. Growth in the number of USMDs in GME has been in further specialty and subspecialty training.

Other substantial changes in the characteristics of residents includes the increase in the number of women in training, and the increase in the number of US citizen IMGs. The proportion of female trainees went from 38.1% to 45.1%; more than a quarter of that growth was in women in subspecialty programs. In total, the number of men in GME dropped by 1,150 (1.9%); this is borne entirely by the drop in the number of men in specialty programs. There were 1,707 more men in subspecialty training in 2008 compared to 1999, an increase of 19.6%. Echoing other reports, there are more US citizens going to medical school abroad and returning to the US for GME. The variability in reporting citizenship/visa status prevents too many comparisons, however the gain of 2,135 is substantial, a 43.3% increase.

Racial/ethnic changes over this time period have included increases in the Under-Represented Minorities (URM) of Hispanics and Native Americans/Alaskans, but not a noticeable increase in the number of blacks. All three categories of URM gained in subspecialty training. The number of Asian/Pacific Islander physicians training in specialty and subspecialty programs grew faster than the number of trainees overall.

Looking only at USMD and DOs, who are products of the US medical education system, the growth rate of blacks in specialty programs was only slightly more than the growth rate overall; however, the annual growth rate in subspecialty training was 45% higher than the the total annual growth rate. The largest annual growth rate was in the number of Native Americans/Alaskans, for both specialty and subspecialty training, growing at a rate of 7.15% and 24.7%, respectively. The number of Hispanic USMDs and DOs in both types of training has also grown substantially more than the growth overall. The number of Asian/Pacific Islander USMDs and DOs had nearly nearly doubled and tripled, in specialty and subspecialty training, respectively. The racial and ethnic characteristics of the US medical workforce, in the near future at least, will continue to not reflect the characteristics of the US population at large.

(출처 : http://www.ama-assn.org/resources/doc/med-ed-products/graduate-medical-education-trends-1999-2008.pdf)

브랜드네임 작성원칙

(1) 왜 중요한가? 

"마케팅이란 소비자의 마음 속에 브랜드를 각인시키는 것이다."

Marketing Is Building a Brand in the Mind of the Consumer

(2) 아홉 가지 원칙

• Branding Principle #1: Keep It Simple
• Branding Principle #2: Mass-Produced Word of Mouth (PR) Builds Brands
• Branding Principle #3: Focused Brands are More Powerful
• Branding Principle #4: Differentiation is Key
• Branding Principle #5: The First Brand Advantage
• Branding Principle #6: Avoid Sub-brands at All Cost
• Branding Principle #7: Perception vs. Quality
• Branding Principle #8: Be Consistent and Patient
• Branding Principle #9: Write Out Your Brand Definition

(출처 : http://www.polaris-inc.com/assets/pdfs/9_principles_of_branding.pdf)

브랜드네임 작성단계

대부분의 회사가 브랜드네임을 만드는 공식 지침을 주고 있지 않음. 

Since most companies do not have formalized guidelines for the creation of brand names, this paper provides a rich description of the task to undertake, the methods available, and the evaluation criteria to consider. In this regard, managers should:

1. 네이밍 과정의 목표를 분명히 함

1. Set out clear objectives for the naming process. 

This can be drawn from the marketing strategy, especially the positioning statement for the product.

2. 충분히 많은 리스트를 작성

2. Create a reasonably long list of candidate brand names. 

This will ensure a good pool of alternatives. 평균 46개. The average for this study was 46 names. Traditional methods of brainstorming and individual creative thinking are considered most useful and an excellent starting point.

3. 후보군을 두고 평가

3. Conduct a thorough evaluation of the candidate names. 

It is important to consider each criteria deemed appropriate for the product being introduced. Managers should plan carefully to ensure a complete and objective evaluation of the names. Experience suggests that a sample size of 74, the average for this study, is insufficient for reliable statistical conclusions.

4. 최종 브랜드네임에 대하여 목표와 기준을 잘 달성하고 있는지 다시 한번 평가함

4. Systematically apply the objectives and criteria choosing the final brand name.

5. 네 개에서 다섯 개를 선정하여 등록함

5. Choose four to five names for submission to the registration. 

While some of the names may be unacceptable specified in the earlier steps in Patent and Trademark Office for for registration, the problem does not seem to be as severe as suggested by several recent books and articles. Therefore, managers are well-advised to try to reflect the “marketing” objectives in the names without unduly constraining themselves with trademark concerns.

(출처 : https://www.wpi.edu/Pubs/E-project/Available/E-project-121510-165023/unrestricted/Creating_an_Effective_Brand_Name.pdf)

Creating Effective Brand Names: A Study of the Naming Process, Chiranjeev Kohli, Douglas W. LaBahn, California State University Fullerton ISBM REPORT 12-1995

Product Naming Principles

Principles[edit]

A key ingredient in launching a successful company is the selection of its name.^[2] Product names that are considered generally sound have several qualities in common.

• They strategically distinguish the product from its competitors by conveying its unique positioning
• They hold appeal for the product’s target audience
• They imply the brand’s benefit
• They are available for legal protection.
• They allow companies to bond with their customers to create loyalty.
• They have a symbolic association that fortifies the image of a company or a product to the consumers.
• They help motivate customers to buy the product.
• They can buy a product image and name.

(출처 : http://en.wikipedia.org/wiki/Product_naming)

(출처 : http://en.wikipedia.org/wiki/Note_(typography))

MLA Style Manual

Miscellaneous

abstract appendixes credit line figures (illustrations) footnotes Letters to the editor obituaries oral speeches and debates running heads

 abstract

Abstracts for all papers in the JMLA must be structured to include objectives, methods, results, and conclusions. The structured abstract should state the purposes of the study or investigation, basic procedures (e.g., selection of subjects, analytical methods), main findings (giving specific data and their statistical significance as appropriate), and the principal conclusions. It should emphasize new and important aspects of the study or observations and succinctly capture the important points made by the investigation, not preview what will appear in the article. Try to eliminate filler, e.g., “this report will show,” “a study was performed that,” or “we attempted to demonstrate that.”

 appendixes

Appendixes always appear at the end of an article, after the references, or online only in the PubMed archived version of a JMLA paper.

 credit line

Credit for a photograph or illustration may be included in the caption; for example, “Photograph by John Smith.” A tabular arrangement of data drawn from another source may be acknowledged in a footnote to the table. Illustrations or tables made by the author need no credit lines.

 figures (illustrations)

Never use “Figure 1, below.” Refer to each figure by its order in the text, not by position. If a figure is not referenced in the text, insert a citation: “(Figure 1).” Do not use “see.”

Students preferred electronic reserves to print reserves (Figure 1).

 footnotes

Footnote indicators should come in the following order: asterisk (*), dagger (†), double dagger (‡), section mark (§); then two asterisks (**), two daggers (††), two double daggers (‡‡) two section marks (§§), etc. Monograph, MLANET, and MLA News authors should avoid using footnotes.

 Letters to the editor

Do not use the salutation “To the Editor.” Assign an indexable title. See also “bylines” in the Names and Terms section.

 obituaries

In the heading of a JMLA obituary, give the name of the person being eulogized, followed by a comma and the birth and death years. An additional title may follow. When a photograph of the person accompanies the obituary, no caption is required. See also “bylines” in the Names and Terms section.

 oral speeches and debates

The transcript of anything spoken should not be edited, just as quotations from written works should not be edited. However, authors of written works have the opportunity to reread and edit the expression of their thoughts before they appear in print. People whose spoken words are put into print do not have this option.

For this reason, altering quoted spoken remarks is acceptable in two cases: the meaning conveyed by the quoted words is clearly different from what the speaker meant to say, or the text of what was actually said would embarrass the speaker for its incoherence.

Transcripts can and should be edited for capitalization, punctuation, spelling, and style considerations that do not alter what the speaker is reported as saying.

 running heads

Each running head should be no longer than fifty characters. The left running head in the JMLA is the author or authors’ names as follows below. The right running head gives a shortened version of the paper’s title.

Smith (for one author) 
Smith and Jones (for two authors) 

Smith et al. (for three or more authors)

(출처 : http://www.mlanet.org/publications/style/style_miscellaneous.html)

Frequently Asked Questions about the MLA Style Manual

What is new in the third edition of the MLA Style Manual? Will there be any corrections in the next printing of the MLA Style Manual? How do I cite an e-book? How do I cite a tweet? Should I use underlining or italics in my manuscript? How many spaces should I leave after a period or other concluding mark of punctuation? How do I create the indention that the MLA shows for a works-cited list? I am citing a work in a newspaper that paginates sections separately, and the sections are designated only by title, not by number or letter. How do I format the entry in the list of works cited? Does the MLA offer software for managing citations?

(출처 : http://www.mla.org/style_faq)

(출처 : http://www.docstoc.com/docs/12921887/Traditional-outline-format)

Types of outlines[edit]

Outline styles[edit]

Sentence outline[edit]

A sentence outline is a hierarchical outline composed of sentences. Each includes a heading or single sentence of a planned document about the subject of the outline. It is the type of outline typically used to plan the composition of books, stories, and essays. It can also be used as a publishing format, in which the outline itself is the end product.

Topic outline[edit]

A topic outline is a hierarchical outline composed of topics. Each entry is a subtopic of the subject of the outline. One application of topic outlines is the college course overview, provided by professors to their students, to describe the scope of the course. Another application is as a subject outline, such as for an encyclopedia.

A sample topic outline application: An outline of human knowledge[edit]

Propædia is the historical attempt of the Encyclopædia Britannica of presenting a hierarchical "Outline of Knowledge" in a separate volume in the 15th edition of 1974. The "Outline of Knowledge" was a project by Mortimer Adler. Propædia had three levels, 10 "Parts" at the top level, 41 "Divisions" at the middle level and 167 "Sections" at the bottom level, numbered, for example "1. Matter and Energy", "1.1 Atoms", "1.1.1. Structure and Properties of Atoms".

Outlines with prefixes[edit]

A feature included in many outlines is prefixing. Similar to section numbers, an outline prefix is a label (usually alphanumeric or numeric) placed at the beginning of an outline entry to assist in referring to it.

Bare outlines[edit]

Bare outlines include no prefix.

Alphanumeric outline[edit]

An alphanumeric outline includes a prefix at the beginning of each topic as a reference aid. The prefix is in the form of roman numerals for the top level, upper-case letters (in the alphabet of the language being used) for the next level, Arabic numerals for the next level, and then lowercase letters for the next level. For further levels, the order is started over again. Each numeral or letter is followed by a period, and each item is capitalized, as in the following sample:

Thesis statement: E-mail and internet monitoring, as currently practiced, is an invasion of employees' rights in the workplace.

I. The situation: Over 80% of today's companies monitor their employees.

A. To prevent fraudulent activities, theft, and other workplace related violations.

B. To more efficiently monitor employee productivity.

C. To prevent any legal liabilities due to harassing or offensive communications.

II. What are employees' privacy rights when it comes to electronic monitoring and surveillance in the workplace?

A. American employees have basically no legal protection from mean and snooping bosses.

1. There are no federal or State laws protecting employees.

2. Employees may assert privacy protection for their own personal effects.

B. Most managers believe that there is no right to privacy in the workplace.

1. Workplace communications should be about work; anything else is a misuse of company equipment and company time

2. Employers have a right to prevent misuse by monitoring employee communications

Some call the Roman numerals "A-heads" (for "A-level headings"), the upper-case letters, "B-heads", and so on. Some writers also prefer to insert a blank line between the A-heads and B-heads, while often keeping the B-heads and C-heads together.

If more levels of outline are needed, lower-case Roman numerals and numbers and lower-case letters, sometimes with single and double parenthesis can be used, although the exact order is not well defined, and usage varies widely.

The scheme recommended by the MLA Handbook,^[6] and the Purdue Online Writing Lab,^[7] among others, uses the usual five levels, as described above, then repeats the Arabic numerals and lower-case letter surrounded by parentheses (round brackets) – I. A. 1. a. i. (1) (a) – and does not specify any lower levels,^[6][7] though "(i)" is usually next. In common practice, lower levels yet are usually Arabic numerals and lower-case letters again, and sometimes lower-case Roman again, with single parentheses – 1) a) i) – but usage varies. MLA style is sometimes incorrectly referred to as APA style,^[8] but the APA Publication Manual does not address outline formatting at all.

A very different style recommended by The Chicago Manual of Style,^[1][9] based on the practice of the United States Congress in drafting legislation, suggests the following sequence, from the top to the seventh level (the only ones specified): I. A. 1.a) (1) (a) i) – capital Roman numerals with a period, capital letters with a period, Arabic numerals with a period, italic lowercase letters with a single parenthesis, Arabic numerals with a double parenthesis, italic lowercase letters with a double parenthesis, and italic lowercase Roman numerals with a single parentheses, though the italics are not required). Because of its use in the US Code and other US law books, Many American lawyers consequently use this outline format.

Another alternative scheme repeats all five levels with a single parenthesis for the second five – I) A) 1) a) i) – and then again with a double parenthesis for the third five – (I) (A) (1) (a) (i).^{[citation needed]}

Many oft-cited style guides besides the APA Publication Manual, including the AP Stylebook, the NYT Manual, Fowler, The Guardian Style Guide, and Strunk & White, are curiously silent on the topic.

One side effect of the use of both Roman numerals and upper-case letters in all of these styles of outlining is that, in most alphabets, "I." may be an item at both the top (A-head) and second (B-head) levels. This is usually not problematic, because lower level items are usually referred to hierarchically. For example, the third sub-sub-item of the fourth sub-item of the second item is item II. D. 3. So, the ninth sub-item (letter-I) of the first item (Roman-I) is item I. I., and only the top level one is item I.

Decimal outline[edit]

The decimal outline format has the advantage of showing how every item at every level relates to the whole, as shown in the following sample outline:

Thesis statement: ---

1.0 Introduction

1.1 Brief history of Liz Claiborne

1.2 Corporate environment

2.0 Career opportunities

2.1 Operations management

2.1.1 Traffic

2.1.2 International trade and corporate customs

2.1.3 Distribution

2.2 Product development

(출처 : http://en.wikipedia.org/wiki/Outline_(list))

APA 양식

구획[편집]

APA 양식 논문은 보통 다음과 같은 구획으로 구성되며, 각각은 새 쪽으로 시작한다.

• 제목 쪽
• 초록
• 본문
• 참고문헌
• 각주
• 표 (표마다 새 쪽)
• 그림 캡션
• 그림 (그림마다 새 쪽)

제목[편집]

수준별 제목 형식은 다음과 같다. (한글에는 대소문자가 없고 기울임체도 잘 쓰이지 않기 때문에 제목 형식을 따르는 경우는 별로 없다.)

• 1수준: Centered Uppercase and Lowercase Heading
• 2수준: Ideal Institute of Technology
• 3수준: Engineering college
• 4수준: Indented, italicized, lowercase paragraph heading ending with a period.
• 5수준: CENTERED UPPERCASE HEADING

인용[편집]

본문 중에 저자명, 간행연도, 페이지 등을 괄호로 묶어 표시하고(예: 홍길동, 2000), 논문 끝의 참고문헌에서 찾아볼 수 있도록 한다.

저자 1명

A recent study found a possible genetic cause of alcoholism (Pauling, 2005).

Pauling (2005) discovered a possible genetic cause of alcoholism.

저자 2명

A recent study found a possible genetic cause of alcoholism (Pauling & Liu, 2005).

Pauling and Liu (2005) discovered a possible genetic cause of alcoholism.

저자 3~5명

A recent study found a possible genetic cause of alcoholism (Pauling, Liu, & Guo, 2005).

Pauling, Liu, and Guo (2005) conducted a study that discovered a possible genetic cause of alcoholism.

Pauling et al. (2005) discovered a possible genetic cause of alcoholism.

A recent study found a possible genetic cause of alcoholism (Pauling et al., 2005).

저자 6명 이상

Pauling et al. (2005) discovered a possible genetic cause of alcoholism.

직접 인용

When asked why his behavior had changed so dramatically, Max simply said, "I think it's the reinforcement" (Pauling, 2004, p. 69).

인쇄물[편집]

1명이 저술한 책

• Sheril, R. D. (1956). The terrifying future: Contemplating color television. San Diego: Halstead.

2명 이상이 저술한 책

• Smith, J., & Peter, Q. (1992). Hairball: An intensive peek behind the surface of an enigma. Hamilton, ON: McMaster University Press.

편집된 책의 기사

• Mcdonalds, A. (1993). Practical methods for the apprehension and sustained containment of supernatural entities. In G. L. Yeager (Ed.), Paranormal and occult studies: Case studies in application (pp. 42–64). London: OtherWorld Books.

학술지에 실린, 개별적으로 쪽이 매겨진 논문

• Crackton, P. (1987). The Loonie: God's long-awaited gift to colourful pocket change? Canadian Change, 64(7), 34–37.

학술지에 실린, 연속적으로 쪽이 매겨진 논문

• Rottweiler, F. T., & Beauchemin, J. L. (1987). Detroit and Narnia: Two foes on the brink of destruction. Canadian/American Studies Journal, 54, 66-146.

주간지 기사

• Henry, W. A., III. (1990, April 9). Making the grade in today's schools. Time, 135, 28–31.

신문 기사

• Wrong, M. (2005, August 17). "Never Gonna Give You Up" says Mayor. Toronto Sol, p. 4.

정부 문서

• Revenue Canada. (2001). Advanced gouging: Manual for employees (MP 65–347/1124). Ottawa: Minister of Immigration and Revenue.

전자 매체[편집]

인쇄물이 원본인 인터넷 문서 (원본 형식 그대로인 것)

• Marlowe, P., Spade, S., & Chan, C. (2001). Detective work and the benefits of colour versus black and white [Electronic version]. Journal of Pointless Research, 11, 123–124.

인쇄물이 원본인 인터넷 문서 (원본과 형식이 다른 것)

• Marlowe, P., Spade, S., & Chan, C. (2001). Detective work and the benefits of colour versus black and white. Journal of Pointless Research, 11, 123–124. Retrieved October 25, 2007, from http://www.pointlessjournal.com/colour_vs_black_and_white.html

인터넷판만 있는 저널의 논문

• Blofeld, E. S. (1994, March 1). Expressing oneself through Persian cats and modern architecture. Felines & Felons, 4, Article 0046g. Retrieved October 3, 1999, from http://journals.f+f.org/spectre/vblofeld-0046g.html

인터넷판만 있는 신문의 기사

• Paradise, S., Moriarty, D., Marx, C., Lee, O. B., Hassel, E., et al. (1957, July). Portrayals of fictional characters in reality-based popular writing: Project update. Off the Beaten Path, 7 (3). Retrieved October 3, 1999, from http://www.newsletter.offthebeatenpath.news/otr/complaints.html

저자 및 작성일이 표시되지 않은 독자적 인터넷 문서

• What I did today. (n.d.). Retrieved August 21, 2002, from http://www.cc.mystory.life/blog/didtoday.html [Fictional entry.]

대학교 교육 프로그램 웹사이트의 문서^[1]

• Rogers, B. (2078). Faster-than-light travel: What we've learned in the first twenty years. Retrieved August 24, 2079, from Mars University, Institute for Martian Studies Web site, http://www.eg.spacecentraltoday.mars/university/dept.html [Fictional entry.]

저널 논문의 전자복제본, 3~5명 저자, retrieved from database

• Costanza, G., Seinfeld, J., Benes, E., Kramer, C., & Peterman, J. (1993). Minutiæ and insignificant observations from the nineteen-nineties. Journal about Nothing, 52, 475–649. Retrieved October 31, 1999, from NoTHINGJournalsdatabase. [Fictional entry.]

전자우편 또는 기타 개인적인 의견교환

(A. Monterey, personal communication, September 28, 2001)

CD 책

• Nix, G. (2002). Lirael, Daughter of the Clayr [CD]. New York: Random House/Listening Library.

테이프 책

• Nix, G. (2002). Lirael, Daughter of the Clayr [Cassette Recording No. 1999-1999-1999]. New York: Random House/Listening Library.

영화

• Gilby, A. (Producer), & Schlesinger, J. (Director). (1995). Cold comfort farm [Motion picture]. Universal City, CA: MCA Universal Home Video.

주석[편집]

1. 이동↑ APA 양식에서는 웹사이트(website) 대신 웹 사이트(Web site)로 표기한다.

(출처 : http://ko.wikipedia.org/wiki/APA_%EC%96%91%EC%8B%9D)

MLA 양식

MLA 양식은 미국현대어문학협회(Modern Language Association of America)에서 만든 영어권에서 널리 쓰이는 영어 문서 작성 양식 중 하나이다. 일반적으로 크기 12포인트의 Times New Roman 글꼴을 사용하며 줄 간격을 2.0으로 작성하고 페이지 설정은 상하좌우 1인치로 공백을 주나, APA와 달리 Times New Roman이 아니더라도 "알아볼 수 있으며 이탈릭체와 일반글꼴의 차이가 보이는" 글꼴이 사용될 수 있다.

(출처 : http://ko.wikipedia.org/wiki/MLA_%EC%96%91%EC%8B%9D)

FACULTY OF MEDICINE INSTITUTE OF MEDICAL EDUCATION CLINICAL EDUCATION DIRECTORATE MAASTRICHT 2003

THE NEW MAASTRICHT CURRICULUM YEAR3 : CHRONIC DISORDERS

Composed by M. van Santen and S.J. van Luijk, in cooperation with the cluster coordinators: H. Crijns, T. Delhaas, E. Heineman, R. Geesink and T. Schmidt; 

the coordinators of non-cluster-related education: R. Ottenheijm, J. van Eijk, J. Schouten, R. Houtepen, J.-J. Rethans, J. van Dalen; C. van der Vleuten and other members of the Department of Educational Development and Research

법과 윤리 

HEALTH LAW AND ETHICS

여기서는 윤리적/법적 문제들을 다루고 있다. 핵심 주제는 의사-환자 관계이며 네 개의 세부 주제로 나누어진다.

the professional, 

informed consent and autonomy, 

privacy,

representation of relatives. 

This part of the programme is based on ethical and legal issues the students meet in their contacts during the outpatient encounters and in practice. The central theme is the doctor-patient relationship, subdivided into four smaller themes: the professional, informed consent and autonomy, privacy and representation of relatives. 

학생들은 클러스터와 관련된 학습자료/과제를 받고 짝을 이루어 과제를 해야 한다. 주제는 다음과 같다.

The students are given cluster-related study materials and assignments they have to work on in pairs. 

The subjects are: 

Errors and mistakes, Conflicting insights (Circulation and lungs cluster); 

Protocols/Privacy/Professional secrecy (Locomotor apparatus cluster); 

Age and lifestyle, Compliance (Abdomen cluster); 

Informed consent (care giver) and Informed consent (patient) (Psychomedical cluster). 

과제에 대한 정보는 OPE동안 축적되며, 학생들은 짧은 보고서를 쓰고 그것을 base group 미팅에서 발표한다. 이 교육과정은 다음을 포함한다.

Information for the assignments is compiled during the outpatient encounters. The students write a short report and present it in their base group meeting. This part of the educational programme includes:

An introductory lecture at the beginning of the year, in which the organisation of the year programme is explained

Selection and electronic presentations of thematic case studies by students (in pairs)

Discussion about thematic cases led by a health law and ethics teacher

Year assignment resulting in a paper focussing on the application of information from ethical and legal literature into practical situations

Tutorial lecture to support students in their year assignments.

강의 LECTURES

강의는 interactive하며, 최대 1주에 4시간까지 있다.

The lectures are interactive and take up a maximum of four hours per week.

실습

PRACTICALS

임상표현에서 다뤄지는 주제들은 다음에 대한 실습을 포함한다.

The subjects addressed in the clinical presentations are supported by practicals about:

Anatomy

Imaging techniques

Physiology

Medical informatics and statistics

Medical microbiology.

술기 훈련

SKILLS TRAINING

OPE와 다른 field contact에서의 학습효과를 최대화하기 위해서 학생들은 술기훈련프로그램을 받아야 한다. Abd/Loco/Circ 클러스터의 첫 주에 술기 훈련이 시작된다. 

In order to maximize the learning effect of outpatient encounters and other field contacts, the students follow a skills training programme at the Skillslab. In the first weeks of the clusters Abdomen, Locomotor apparatus and Circulation and lungs, the skills training starts with super- vised patient encounters. 

Base group에서 학생들은 병력 청취와 신체 검진을 연습한다. 그 후 학습목표를 설정하고, 감독하 환자 접촉(supervised patient encounter)은 학생들이 독립적으로 field contact를 하기 위한 준비과정이다. Skillslab 훈련 외에도 수기훈련세션에 대한 통합적 리뷰세션이 해부학 재교육 세션에서 제공된다. 

In their base groups, the students practise history taking and physical examination in a patient with a chronic disorder, supervised by a Skillslab trainer or sometimes their base group coach. Subsequently, they formulate learning goals. These supervised patient encounters are meant to prepare the students for their independent field contacts. Besides the usual Skillslab training, integrated review skills training sessions that are organized simultaneously with anatomy refresher sessions. 

세션에서 학생들은 해부학지식을 refresh할 뿐만 아니라 신체검진기술을 익히게 된다.이 트레이닝 세션은 최대한 사례 학습을 중심으로 한다.

In one session the students can refresh their knowledge of anatomy as well as repeat physical diagnostic skills with the help of the Skillslab trainers and anatomy teachers present. The training sessions are as much as possible based on case studies.

평가

ASSESSMENT

도입

INTRODUCTION

시작점은 Blueprint 2001에 기술된 성취레벨이다. 즉, 평가가 교육의 한 부분이며, 학습과 학습에 대한 학생 스스로의 책임을 촉진해야 한다는 개념이다. 역량에 대한 평가는 밀러의 피라미드에 기반한다. 학생은 교육 프로그램의 요구조건이 달성되었다는 것을 보여줄 수 있는 포트폴리오를 작성하고, 멘토와 함께 토론한다. 클러스터 관련 평가와 클러스터 비관련 평가를 구분한다.

The starting points are the achievement levels stated in ‘Blueprint 2001: training of medical doctors in the Netherlands’, the concept that assessment is an integrated part of education and should stimulate learning, and the student’s own responsibility. Competence is assessed on the basis of the levels of Miller’s pyramid: knows (theoretical knowledge), knows how (knows how knowledge and skills should be applied) shows how (applies knowledge and skills in test situation), does (applies knowledge and skills in practice).5 The student composes a portfolio which proves that the requirements of the educational programme have been met and discusses it with the mentor. A distinction is made between cluster-related en non-cluster-related assessment.

클러스터 관련 평가

CLUSTER-RELATED ASSESSMENT

클러스터 관련 평가는 학생이 스스로의 발전과 수행능력에 대해 모은 포트폴리오를 바탕으로 한다. 이는 의사의 네 가지 역할에 대한 것과 관련이 있다. 의료전문가/과학자/보건의료인/사람. 

Cluster-related assessment is based on the cluster portfolios in which the students compile information about their progress and performance in the four roles of a medical doctor: medical expert, scientist, health care worker and person. 

학생이 모으는 정보는 예를 들면, 시험결과라든가, 윤리나 법과 관련된 보고서, 과제, 코치나 감독의 관찰결과, 환자 접촉을 바탕으로 한 보고서, psychomedical 클러스터 발표, 학생의 역할에 대한 평가, CAT 등이 있다. 이 자료들을 모으는 것은 학생 스스로의 책임이다.

The information consists of, for instance, results of written tests, a paper on ethics and health law, assignments, observations of the coach and supervisor of the practicals, reports based on patient encounters, psychomedical cluster presentation, evaluation of the student’s functioning and a CAT. It is the student’s own responsibility to compile this information in their portfolios.

코치는 클러스터 포트폴리오를 평가한다. 최종 평가와 별도로, 학생들은 네 가지 역할에 대한 피드백을 받게 된다. 평가를 담당한 teaching staff는 어떻게 피드백을 줘야 하며 포트폴리오를 기반으로 어떻게 평가를 해야 하는가에 대한 훈련을 받는다.

The coach assesses the cluster portfolios. Besides the final assessment of each cluster, the students receive feedback on their four different roles as a future doctor twice in each cluster. The teaching staff with assessment roles will be trained, particularly on how to provide feedback and assess students on the basis of a cluster portfolio.

클러스터 비관련 평가

NON-CLUSTER-RELATED ASSESSMENT

클러스터 비관련 평가는 전통적인 평가법(진단평가, 스테이션 평가)을 이용한다. 전문직으로서의 행동에 대한 평가 역시 여기에 포함된다. Station test는 술기와 지식을 모두 포함한다. 

Non-cluster-related assessment consists of traditional tests such as progress tests and a station tests. Assessment of professional behaviour is also part of the non-cluster-related assessment. Station tests cover both skills and knowledge. 

새로은 시험 포멧도 있다.

New test formats are: 

year assignment based on field contacts in general practices, 

health law and ethics and 

the year patient programme. 

또한 학생들은 일년간의 포트폴리오를 제출하는데, 클러스터 포트폴리오에서 일부 선택해서 포함시키는 것도 있으며, 의사의 역할에 대해서 약점/강점을 분석한 것, 학생에 대한 평가 등이 포함된다. 멘토와 학생은 최소 일년에 2회 이상 토론을 한다. 이 미팅의 주된 초점은 약점/강점을 분석해서 학생과 관련된 약속을 하는 것이다.

Also, the student has to submit a year portfolio. It includes a selection of information from the cluster portfolio, weakness/strength analyses per role of the medical doctor and the agreements made with the student. The portfolio is discussed at least twice a year by the mentor and the student. The main points of these meetings are to discuss the weakness/strength analyses per role and the appointments about it with the students.

교수

TEACHING STAFF

다음은 3학년에 teaching staff이 해야 하는 역할이다. 각각의 역할에 대해서 해당 기간과 전문영역, 주요 업무가 기술되어 있다. 클러스터 관련 교수역할은 매 10주마다 수행되어야 한다. 그러나 매 시기에 반드시 동일한 사람이 해야 하는 것은 아니다.

The following list outlines the teaching roles in year 3 in which the teaching staff is directly involved in the implementation of education and training. For each role, the period of the academic year it needs to be fulfilled, the required expertise and main tasks are indicated. Cluster-related teaching roles are to be fulfilled in every period of ten weeks. However, these roles do not have to be taken up by the same person in every cluster period.

ROLES OF TEACHING STAFF IN YEAR 3

Mentor

In years 3, 4 and 5 guidance of individual students; discussion and assessment portfolio.

Year coach

Coaching of a group of 10 students for YPP/SPE/Intervision throughout the year; general practitioner; specialized in cluster-related and non-cluster-related aspects of chronic disease.

Cluster coach

Coaching of a base group of 10 students during a cluster period; specialized in chronic disease; role in cluster-related assessment.

Clinical supervisor

Supervision in several clusters of the field contacts in mental health care, nursing homes and rehabilitation centres; specialized in chronic disease.

- Supervision during the entire year of the same students in a general practice; general practitioner; particularly specialized in generic aspects of chronic disease

- Supervision during student-centred outpatient encounters (OPE) at a student-centred azM outpatient clinic; specialized in chronic disease; provides feedback on activities and performance of the students during the OPEs.

Lecturer

Occasional; lectures are repeated in each of the four cluster periods; specialized in chronic disease.

Supervisor of the practicals

Depends on practical.

Skills trainer

Spread over the year; Skillslab trainer.

학생

STUDENTS

한 학생의 한 주 스케줄은 다음과 같으나 단지 사례일 뿐이다. 실제 스케줄은 클러스터 내에서, 클러스터간 다를 수 있다. 일부 OPE나 YPP등은 특정 시간에만 하는 것은 아니다. 예를 들어서 한 주는 base group meeting이 있었던 금요일 마지막 시간에 시작될 수도 있다.

To give an idea of how the activities will be spread over a week, a possible week schedule of a third-year student is described below. Please note that it is only an example! The real schedules may vary within a cluster and between clusters. Some educational activities (OPEs, base group meetings, YPP) do not take place on fixed days or times. A week may start, for instance, in the last hour of a base group meeting on Friday in which the outpatient encounter or other field of the coming week is prepared.

아래 그림은 교육 사이클에 대한 것이다. 이 사이클의 핵심은 base group meeting에서 OPE를 준비하는 것, 환자 접촉, 자습, 피드백과 토론이다.

This figure represents the educational cycle. The central part of the cycle includes preparation of the outpatient encounters (OPE) in the base group meeting, patient encounters, self-study and feedback/discussion in the base group. 

임상표현과 만성질환의 특정 클러스터 관련 측면에 초점을 두며, psychomedical cluster에서 OPE는 정신건강병원에서 하는 것으로 대체된다. YPP, CATs, 법과 윤리 등과 같은 다른 3학년 프로그램들이 OPE 사이클과 base group meeting을 지원하는 구조이다.

The emphasis is on the clinical presentation and cluster- related aspects of chronicity. In the psychomedical cluster, the OPEs at the student-centred outpatient clinic are replaced by field contacts in mental health care institutions. The cycle of OPEs and base group meetings is supported by the other activities in year 3: year patient programme (YPP), CATs, health law and ethics.

아래는 teaching staff와 학생이 만난느 것을 그린 것이다.

The figure below shows the student’s contacts with teaching staff.

FINALLY

3학년은 새 교육과정 중에서 교육과정이 가장 급격하게 변하는 학년이다. 이 프로그램은 학생과 교수 모두에게 큰 도전이다. 개발그룹은 실천 속에서 배우는 것(learning in practice)을 주요 원칙으로 삼았다. teaching staff는 임상실습 감독관으로서 학생이 경험을 기반으로 학습하는 것을 도울 수 있다. 또는 학생이 더 깊은 지식을 탐구하고 실제 진료에 대한 통찰을 얻으며, 어떻게 환자를 큰 맥락속에서 볼 수 있는가를 도와주는 코치일 수도 있다.

The third year is definitely the year in which changes of the new curriculum are most drastic. The programme contains many challenges for both teaching staff and students. The planning groups have developed a programme in which ‘learning in practice’ is the guiding principle. The teaching staff can be clinical supervisors and contribute to the student’s learning on the basis of their own expertise. Or they can be coaches who help the students to gain in-depth knowledge and insight of real practice and how to see a patient in context. 

교육과 감독과 코칭을 적절히 사용하는 것은 학생의 역할이며, 목표가 달성된다면 2001교육과정의 학생들은 임상실습에서 더 많은 것을 배우고, 더 독립적이 될 것이며, 의학적 의사결정을 비판적으로 내릴 수 있는 능력을 갖출 것이다. 

It is the student’s responsibility to make good use of the education, supervision and coaching that is offered. If the year goals are met, ‘Curriculum 2001’ students will be better able to learn from their clerkships and will be more self-reliant and critical with respect to their medical decisions and abilities. 

교육과정은 항상 계획대로 되지 않는다. 프로그램을 향상시키는 것은 학생과 교수 모두의 몫이다. 클러스터는 3학년동안 네 번 반복되기 때문에 한 해 안에서도 개선이 가능하다. 향후 학생과 교수 모두에게 있어서 새로운 가능성이 기대된다.

An educational programme may not always work according to plan. It is the responsibility of the students and the teaching staff to improve the programme. Since the clusters are repeated four times in year 3, it is possible to make improvements during the year. In conclusion, the third year is a challenging one for those who are organizing it; the logistics of the programme are very complex. It is a year to look forward to, for both students and teaching staff, because it offers many field contacts and new possibilities.

(출처 : http://members.home.nl/h.e.stoffers/UM_med_year3_2001.pdf)

FACULTY OF MEDICINE INSTITUTE OF MEDICAL EDUCATION CLINICAL EDUCATION DIRECTORATE MAASTRICHT 2003

THE NEW MAASTRICHT CURRICULUM YEAR3 : CHRONIC DISORDERS

Composed by M. van Santen and S.J. van Luijk, in cooperation with the cluster coordinators: H. Crijns, T. Delhaas, E. Heineman, R. Geesink and T. Schmidt; 

the coordinators of non-cluster-related education: R. Ottenheijm, J. van Eijk, J. Schouten, R. Houtepen, J.-J. Rethans, J. van Dalen; C. van der Vleuten and other members of the Department of Educational Development and Research

출발점

STARTING POINTS

The educational starting points of the third year are stated in the booklet about the New Maastricht Curriculum.1 The content of the third year is based on ‘Blueprint 2001: training of medical doctors in the Netherlands’.2,3 

요약하자면, 교육과정의 목적은 학생이 장차 의사로서 역할을 하면서, 점차 높아지는 독립성과 책임을 능숙히 다룰 수 있게 하는 것이다.

In summary, the aim of the curriculum is that students can handle increasing independence and responsibility in their role of medical doctor. 

Teaching staff의 역할은 학생이 독립적인 전문직으로 성장하기 위하여 필요한 지식과 술기를 습득하는 과정을 도와주는 코치의 역할이다. 학생들이 이론과 실제를 따로 배우는 것이 아니라 같이 학습하는 것이 중요하다.

The role of the teaching staff is mainly that of a coach who helps the student to acquire the knowledge and skills he or she needs to become a self-reliant professional. In order to learn effectively, it is important that the student does not explore theory and practice separately but in relation to each other. 

평가는 학습의 한 과정으로, 교육과정의 마지막이 아니라 교육의 한 부분이다. 과학적인 훈련과 전문직으로서의 바람직한 행동은 교육과정을 꿰뚫는 중요한 요소이다.

Assessment guides the learning process and is therefore not a final part but an integrated part of education. Scientific training and professional behaviour are the main threads throughout the curriculum.

3학년 교과과정에서는 학생의 책임과 능동적인 자세로 여러 환자를 만날 것을 강조함으로서 이러한 starting point를 반영하고 있다. Teaching Staff는 학생들이 환자와 접촉하게 되는 것을 준비할 수 있게 도와주고, 피드백을 주고, 과제를 평가한다. 이를 위해서 teaching staff는 튜터로서 뿐만 아니라 해당 분야에서 전문가여야 한다. 학생들은 피드백을 통해 필요한 학습목표를 설정하고 이로부터 지식/술기/전문직업성을 학습한다.

In year 3 these starting points are reflected in the emphasis on the student’s responsibility and the large number of patient encounters in which the student takes on an active role. The teaching staff helps the students to prepare for the encounter, provides feedback and assesses assignments. This requires the teaching staff to be experts in their field as well as skilled tutors. The feedback students receive should stimulate them to formulate useful learning goals that enhance their knowledge, skills, and professionalism.

평가의 한 부분으로서 cluster-related portfolio와 year portfolio를 작성하게 함으로서 학생들이 독립적으로 활동할 수 있는능력을 키워주고자 했다. 또한 학생들은 다양한 그룹과 환경에서 협력적으로 학습한다. Critical Appraisal of a Topic (CAT) assignments을 통해서 과학적 접근방법을 배운다. CAT에서 학생들은 임상에서 어떤 선택을 하고 진료를 하는 '근거'를 비판적으로 탐색하게 되며, 이 프로그램은 학생과 teaching staff 모두에게 그 아이디어와 initiative가 열려 있다.

As part of the assessment, the students’ ability to work independently is reflected in the responsibility to build a cluster-related portfolio and a year portfolio. Moreover, the students learn to work together in different groups and circumstances, for example in general practices, outpatient clinics, homes and care centres, or at a patient’s house. A scientific approach is particularly trained in the Critical Appraisal of a Topic (CAT) assignments, in which the students are to search critically for ‘evidence’ as a basis for clinical choices and practice. The programme is open to ideas and initiatives of both the students and the teaching staff.

3학년 : 만성 질환

CONTENT YEAR 3: CHRONIC DISORDERS

각각의 교육과정은 핵심 주제가 있다. 2001 교육과정에서 1학년은 급성질환을, 2학년은 생애 주기를, 3학년은 만성질환을 다루게 된다. 

Each curriculum year has its central theme. Where the first year of the 2001Curriculum focuses on acute disorders and the second year on the stages of life, the third year is centred around chronic disorders. The general starting points are the four areas of a medical doctor’s competence as stated in ‘Blueprint 2001: training of medical doctors in the Netherlands’: the doctor as a medical expert, scientist, health care worker and person.2 

이 프로그램에는 다음의 것들이 포함된다.

The programme includes...

the clinical aspects of chronic disorders, 

the effect on the patient’s life and the people around him, 

and the role of a doctor as care giver. 

만성질환과 모든 측면에 있어서 임상표현이 학생에게 주어지는데, 이들 임상표현은 최대한 실제와 비슷한 것으로 사용한다. 

Clinical presentations are used to confront the students with all aspects of chronic disorders. The presentations are as authentic as possible and deal with the problems patients see their doctor about. This means a lot of learning is based on the context of daily practice in health care. 

3학년은 10주단위로 된 4개 클러스터로 나눠진다. 각각의 클러스터에서는 아래의 것들을 다룬다.

The year is divided into four clusters of 10 weeks, each cluster covering a particular field with various themes and addressing several pathophysiological aspects. In addition, each cluster pays attention to general lines of knowledge, skills and personal aspects as well as disorders that fit into more than one particular cluster. Finally, the clusters include generic aspects with regard to the consequences of chronic disorders that are relevant in the patient encounters in general practice and in the longitudinal patient encounters.

수업 구성

INSTRUCTIONAL FORMATS

도입

INTRODUCTION

3학년의 내용은 네 개의 클러스터로 나눠진다. 한 학년은 네 그룹으로 나눠져서 서로 다른 순서로 네 개 클러스터를 돌게 된다. 

The content of the third year is divided over four clusters of ten weeks, each focussing on a particular subject area. The year group is split into four groups of students who will follow the clusters in a different order. So, each cluster is repeated four times during the year. The subject areas are: 

Abdomen, 

Locomotor apparatus, 

Circulation and lungs, and 

Psychomedical problems and mental health care. 

정규 수업 구성은 다음의 것들이 있다.

Regular instructional formats in year 3 include outpatient encounters (OPE) in a student-centred outpatient clinic at azM/base group meetings, field contacts, year patient programme (YPP)/simulated patients encounters (SPE)/Intervision, Health Law and Ethics, and Critical Appraisal of a Topic (CAT). 

추가로 다음의 것들이 있다.

In addition, lectures, practicals and skills training programmes are offered. The educational formats are discussed below. The diagram outlines the organisation of the educational programme in year 3.

외래환자

OUTPATIENT ENCOUNTERS (OPE)

복부/Locomotor/Circulation에서는 OPE가 있음. 특별히 마련된 학생중심의 외래에서 수행되며, 만성질환의 질환특이적 측면을 보게 됨. 학생은 서로 짝이 되어 한 사람은 의사, 다른 사람은 관찰자 역할을 해서 병력청취와 신체검진을 수행. OPE직후에 의사가 피드백을 제공.

During the clusters dedicated to Abdomen, Locomotor apparatus and Circulation and lungs, 

weekly outpatient encounters (OPE) take place a special student-centred outpatient clinic at azM. 

These encounters focus on the disease-specific aspects of chronic disease. 

In pairs, the students practice on a patient; one student acts as the doctor, the other observes. 

They take the patient’s history and examine the patient. 

Immediately after each OPE, a doctor of the outpatient clinic provides feedback on the students’ performance. 

Base group은 아래와 같다.10명의 학생과 1명의 클러스터 코치. 한 클러스터동안 동일하고, 매주 4시간 모임. 학생들은 한주간의 OPE경험을 바탕으로 발표.

Subsequently, the students have approx. two days for self-study and preparation to report on their OPE in their base group. A base group consists of ten students and a cluster coach. The group remains the same during one cluster and has fourhour meeting every week. 

During these meetings, the students present their findings based on their OPE or field contact in that week. The last hour of the meeting is used to prepare for the OPE of the following week. More detailed information about this educational format can be found in the text boxes below.

Psychomedical 클러스터에서의 field contacts

FIELD CONTACTS IN THE PSYCHOMEDICAL CLUSTER

정신건강병원(mental health care institution) 등에서 field contact가 있음.

There are no outpatient encounters in the psychomedical clusters, instead the students have field contacts in a mental health care institution, nursing home or general practice. The students work along with someone at their field contact address for one day a week. 

처음에는 학생은 관찰만 하지만 점차 참여가 늘어난다. OPE와 마찬가지로 base group meeting에서 발표하고 평가한다. 

First, the student only observes, but gradually his or her active participation increases. Similarly to the outpatient encounters, the field contacts are prepared and evaluated in the base group meetings. The focus is on gaining in-depth knowledge of aetiology, differential diagnosis, course and treatment options.

nursing home이나 general practice의 field contact는 학생들로 하여금 정신건강병원 바깥에서 이뤄지는 것을 가르치려는 목적임. 마지막 주간에 학생들은 plenary presentation을 함.

The field contacts in nursing homes and general practices aim to teach the students to recognize psychomedical problems outside the setting of a mental health care institution. During the last week of the psychomedical cluster, the students give plenary presentations.

모든 클러스터에서의 Field contact

FIELD CONTACTS IN ALL CLUSTERS

일년간 모든 학생은 한 general practice를 10~12회 방문하여 해당 클러스터 주제와 관련된 환자를 만난다. 이러한 general practice에서의 접촉은 직접적으로 질병과 관련되지 않은 만성질환의 일반적 문제를 경험하게 한다.

During the year, every student visits one general practice 10 to 12 times and meets patients with problems that are relevant to the subject area of the present cluster. In addition, these contacts at general practices enable the students to deal with generic aspects of chronic disease that are not directly disease-related. 

매 방문마다 학생은 2~5명의 환자를 보고, GP코치로부터 피드백을 받는다. 이 GP는 학생의 리포트에 대해서도 평가를 하고, 이 리포트는 클러스터 포트폴리오에 포함된다.

For each cluster period, goals and tasks have been formulated with respect to these aspects. During each visit, the student sees two to five patients and receives subsequent feedback from the ‘coaching’ GP. This GP also provides feedback on the student’s reports of his visits to the practice. The reports are included in the cluster portfolio. 

Field contact는 base group meeting에서 준비하고, 이 미팅에서 평가한다. 매 10주마다 만성질환의 특정 한 측면이 주어진다. 전체 1년간 1. Epidemiology and chronic disorders 과  2. Disease management 로 나뉘어서 만성질환의 진행/원인/치료에 대해 초점을 두게 된다. 

Field contacts are prepared and evaluated in the base group meetings. Every ten weeks, special attention is given to one particular generic aspect of chronical disease, both in the field contacts and in the year patient programme. During the entire year, attention is paid to the course, cause and therapy of chronic disorders, divided into 1. Epidemiology and chronic disorders and 2. Disease management (longitudinal aspects, care plans and care chains). These aspects are included in the theoretical part (in base groups) as well as in practice (in tasks with patients).

Locomotor와 Circulation에서는 재활센터에서의 field contact도 있다.

There are also field contacts in a rehabilitation centre during the clusters Locomotor apparatus and Circulation and lungs.

YPP/SPE/인터비젼

YEAR PATIENT PROGRAMME (YPP)/SIMULATED PATIENT ENCOUNTERS (SPE)/INTERVISION

이 부분은 실제 환자/가상 환자 등과 만나고 토론을 하게 된다. 10명의 학생과 일년간 맡아줄 코치가 한 그룹을 이룬다.

These parts of the educational programme include contacts with real patients, simulated patients and discussions in YPP/SPE/Intervision groups. These groups consist of 10 students and a year coach, and remain the same for the entire year. 

각각의 그룹에는 모든 클러스터의 학생들이 모두 속해있기 때문에 각각의 학생들은 서로 다른 경험을 가지고 있다. 코치는 일년간 이 그룹을 담당하기 때문에 학생의 발달을 꾸준히 따라갈 수 있다. 1년간 8회의 YPP 9회의 SPE/인터비전 미팅/1회의 시작미팅/1회의 최종미팅이 있다. 각 미팅은 일년 코치 외에 또 다른 teaching staff이 같이 진행한다.

Each group contains students of every cluster, so the students in each group have different content-related learning experiences. Since the year coach works with the same group of students for an entire year, he or she is well able to follow the student’s development (including professional behaviour) during the year. YPP, SPE and Intervision are explained in more detail below. In total there are 19 meetings: eight YPP-meetings and nine SPE/Intervision-meetings under the supervision of the year coach, and one introductory and one final meeting, that are lead by someone from the teaching staff other than the year coach.

통년 환자 프로그램

YEAR PATIENT PROGRAMME (YPP)

모든 학생은 일년 내내 담당할 환자와 짝을 이룬다. 환자와의 접촉은 'assignment'를 기반으로 이루어지며, 매10주마다 field contact의 주제와 연관된 assignment와 activities가 주어진다.

Every student is paired with a patient that he or she has to follow during the entire year. This enables the student to gain insight into the course of a chronic disorder. The contacts with the patient are based on assignments. Every ten weeks the assignments and activities are tailored to a topic coinciding with the generic themes of the field contacts in the general practices. 

주제는 다음과 같다.

1. Physical, cognitive and emotional restrictions due to chronic disease; 

2. Social participation; 

3. Problem solving ability of patients; 

4. Context of being chronically ill.

The topics are: 1. Physical, cognitive and emotional restrictions due to chronic disease; 2. Social participation; 3. Problemsolving ability of patients; 4. Context of being chronically ill. 

학생들은 정기적으로 설문조사와 health and costs diaries를 활용하여 '만성질환'에 대한 일반적인 측면에 대한 자료를 조사한다. 여기에 포함되는 것은 다음과 같다.

the disablement process, 

self-management, mood problems, 

continuity of care and 

cost effectiveness of care. 

The student regularly records data about generic aspects of chronicity by means of questionnaires and health and costs diaries. These aspects include the disablement process, self-management, mood problems, continuity of care and cost effectiveness of care. 

학생은 general practice나 병원이나 환자의 집에서 환자를 만날 수 있으며, 이 assignment는 학생 10명이 한 그룹으로 수행한다. assignment의 결과는 그룹 내에서 분석/평가된다. 리포트에 대한 코멘트를 받고 포트폴리오에 넣는다. YPP그룹은 일년에 8명 모이며, 각각의 모임은 90분정도 소요된다.

The student can see the patient in a general practice, in hospital or at the patient’s house. The assignments are prepared in groups of ten students. The results of the assignments are analysed and evaluated in the group. The reports are commented and included in the portfolios. The YPP-groups meet eight times a year, the meetings take 90 minutes.

가상환자 

SIMULATED PATIENT ENCOUNTERS (SPE)

매 년 시작시점에서 모든 학생들은 만성질환을 가진 가상환자를 만나게 된다. 학생은 SP의 주치의로서 역할을 하면서, 한 해동안 이 환자를 관찰하게 된다. 따라서 학생은 SP와 다음 약속을 잡아야 한다. 학생에게는 이런 것을 할 별도의 시간이 주어진다.

At the beginning of the year, all students (in pairs, one observer) see a simulated patient (SP) with a chronic disorder who has a complaint. The student has the role of the SP’s general practitioner and has to monitor the patient during the year. So, the student is expected to make new appointments with the SP. The students are given time to do this. 

매번 환자를 만나고 난 이후 SP는 학생에게 피드백을 준다. SP를 프로그램으로 짤 수 있기 때문에(programmability) 학생은 1년에 걸쳐서 SP를 수 회 이상 만나야 하며, 최소 4회는 만나게 된다. 환자에 대한 follow up을 위해서 실제 환자 기록이 만들어져야 한다.

After each contact, the SP provides feedback to the student. Because of the SP’s programmability, it is expected that the SP has to be seen several times in one year, probably with a minimum of four times (once every cluster). In order to follow the patient, a real patient record has to be made. 

학생들은 그 기록을 지속적으로 추적하고, 일년간 정보를 수집해간다. 이 정보에는 환자를 만나서 얻는 정보 뿐만 아니라, 검사결과와 specialist letter도 포함된다. SP와의 후속 만남을 통해 학생은 만성질환을 가진 환자를 대한다는 것이 작은 문제를 푸는 것이 아님을 알게 된다. SP와의 만남을 통해 학생은 YPP에서 실제 환자를 만났을 때 필요한 술기를 훈련할 수 있게 해준다.

The students keeps the record and adds information to it during the year. The record should not only contain information about the encounters, but also the possible (simulated) lab results and specialist letters. The follow-up contacts with the SP will show the students that dealing with patients with chronic disorders is more than just solving a small problem. The contacts with simulated patients enable the students to train the skills they need in the encounters with real patients in the year patient programme (YPP). 

SPE에서 다뤄지는 토픽은 YPP에서 다뤄지는 토픽과 동일하며, 한 해동안 학생들은 SP의 질병과 경험을 추적하게 된다. SP와 면담하는 것을 비디오 녹화(30분)하여 그룹의 모든 구성원과 함께 보면서 평가한다. 90분짜리 미팅을 9회 하게 된다.

The themes covered in SPE are the same as in the YPP. During the year the student thus follows the course of the disease and the experiences of the simulated patient. Video recordings of the simulated patient encounters (30 minutes) are watched and evaluated by all members of the group. There are nine meetings of 90 minutes each.

인터비전

INTERVISION

인터비전 미팅은 항상 SPE미팅과 바로 연결된다. 학생들은 SP환자와 실제환자 접촉에서 얻은 경험을 공유한다. 90분 미팅이 9회 있다.

The Intervision meetings are always directly linked to the SPE-meetings. Students exchange the experiences they have gathered from simulated and real patient encounters. There are nine meetings of 90 minutes.

주제 비판평가

CRITICAL APPRAISAL OF A TOPIC (CAT)

CAT은 임상활동의 과학적 접근을 연습하기 위한 것이며 다음의 단계를 밟는다.

CATs are meant to practise adopting a scientific approach to clinical acts (referral and test requests, choice of therapy). A CAT contains the following steps:

임상 시나리오 묘사

시나리오와 관련된 임상 질문 구성

검색 과정을 묘사 (자료 출처, 키워드, 배제 기준)

어떻게 과학적 연구를 구성하고 수행하는지 묘사. 연구의 질에 대한 평가

근거의 수준 표시

CAT과 구성된 결과에 대한 코멘트, 어떻게 적용될 수 있는가에 대한 코멘트.

Describe a clinical scenario (based on a patient of the OP encounter)

Formulate a relevant clinical question based on the scenario

Describe the search process with data sources, key words, and exclusion criteria for the articles found

Describe how a scientific study is set up and executed and assess the quality of the study

Indicate the degree of evidence

Comment on the CAT and formulate a conclusion about how the findings can be applied to the clinical scenario.

3학년의 CAT은 다음의 네 관련 영역이 있음.

진단

예후

치료/적응증/비적응증

관련 정책 평가

The CATs in year 3 refer to four clinically relevant domains:

Diagnostics

Prognosis

Therapy and (contra)indications

Evaluation of applied policy.

각 클러스터 기간동안 모든 학생들이 이 영역 중 하나 이상에 초점을 맞춘다. 즉 어떤 학생은 abdomen에서 진단을 하는 반면 다른 학생은 locomotor의 진단에 대해서 한다는 의미이다. 

During each cluster period the entire year group focuses one of these domains. This means that some students will do their CAT about diagnostics in a patient with intestinal complaints (Abdomen) whereas other students will do their CAT about diagnostics in a patient with shoulder complaints (Locomotor Apparatus). 

구성은 모든 학생에 대해서 동일하다.

an introductory lecture, 

a four-hour practical, 

one CAT the students set up as a group and 

one individual CAT. 

The organisation of this part of the programme is the same for all students: an introductory lecture, a four-hour practical, one CAT the students set up as a group and one individual CAT. 

CAT은 OPE를 기반으로 하며, 개별 CAT은 클러스터 포트폴리오에 포함되고 '과학자로서의 의사'의 역량을 평가하는데 활용된다.

The CATs are based on the patient encounters (OPE) in the student-centred outpatient clinic and in practice. The individual CAT is included in the cluster portfolio (see assessment) and is used to assess the competence level of the doctor as a scientist.

(출처 : http://members.home.nl/h.e.stoffers/UM_med_year3_2001.pdf)

The medical curriculum in Maastricht

Mirjam oude Egbrink, PhD

Programme Director Medical School FHML, University Maastricht

Maastricht 의학교육의 목표는 무엇인가?

What is our aim in medical education?

합리, 이론, 근거에 기반하며 최상의 학습 환경 구축을 통한 교육에 대한 과학적/학문적 접근 : 근거중심교육 

A scientific/academic approach to education, in which an optimal learning environment is created, which is based on rationality, theory and evidence: Evidence-based education

Three C's of education

Contextual

Constructive

Collaborative

Year 1 and 2

The tutorial group 

Composition : 8-10 students

- chair

- scribe

- tutor

Duration: 2 hours 

- 2 hours : 1 hour report +  1 hour new case prep

Frequency: 

- Twice per week

Year 3

Overview

• Chronic Disorders

• 4 clusters:

– Abdomen

– Locomotor system

– Circulation and Lungs

– Psychomedical problems and Mental Health Care

• Each 10 weeks, rotation

Group meetings

• 10 Students, 1 coach

• Once a week

• 4 hours

– 3 hours reporting

– 1 hour preparation

• 1-2 days later: patient encounter

• One week later: succeeding group meeting

Year 4 and 5

Structure: 

• start week: preparatory (theoretical) learning activities

• final week: evaluation, reflection, closure

Year 6

• Independent functioning and participation in health care and science

- Supervised independent work in a research environment : Thesis

- Supervised independent work in a clinical environment : Peer coaching, Built-in reflection moments

(출처 : https://www.google.co.kr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CCsQFjAA&url=http%3A%2F%2Fwww.maastrichtuniversity.nl%2Fweb%2Ffile%3Fuuid%3Dea9102fa-3faf-40f3-8948-a9d7ac362911%26owner%3D6e9dd91c-0658-43ab-9c16-0f4c18360aa6&ei=8jAyU5bsAsbskgW83oGoCQ&usg=AFQjCNH7ohLGfq3O_-5J_ckpq4FZyvoKLw&sig2=Am1ZGZ4Nk_UhbwPSK1-2Kw)

Journals that publish medical education work

Harvard University

Johns Hopkins University

UCLA

Maastricht University

미션 (강령)

Mission Statement

• 모든 미래 프로그램 개발 결정의 근본 지표
• 조직 내에서, 조직을 위해서 일하는 사람들의 이상(ideal)을 반영할 수 있게 서술되어야 함.
• 모든 사람이 미션에 대해서 자신의 것이라는 느낌(ownership)을 가지고 헌신할 수 있어야 함.
• 짧고, 간결, 분명해야 함.

미션의 구조

Structure of Mission

• 목적(Purpose)
• 성과와 결과에 초점을 둠
• 키워드 : 줄이다, 향상시키다, 늘리다 등
  
• 사업(Business)
• 어떤 활동/사업을 할 것인가
• '행동'과 관련한 단어(provide)가 들어가야 함
• by 나 through같은 접속사가 들어가야 함.
  
• 가치, 지침(Values or Guiding Principles)
• 한 조직에 기본적으로 공유되고 있는 신념
  
• 수혜자(Beneficiaries)
• 어떤 사람에게 도움을 주고 이익을 줄 것인가.
  

(출처 : SICME, 2014/2/14, ODA Program Development and Evaluation)

갈등의 고조단계

단호한 태도(Inflexibility) - 평가절하(Discounting) - 공격적 태도(Aggression)

• Inflexibility : Hardening, Persuasion, Manipulation
      => 회유(conciliation)가 효과적
• Discounting : Polarization, Loss of respect, Threats
      => 회유(conciliation), 중재(mediation)가 효과적
• Aggression : Verbal aggression, Physical aggression, Destructive behaviors
      => 중재(mediation), 구속력 있는 조정(binding arbitration)이 효과적

ㅗ

갈등의 유형

• Hardening : 난 내가 옳다고 생각해
• Persuasion : 내가 옳다고 생각하게끔 만들어야겠어
• Manipuation : 그들이 틀렸다는 것을 보여주기 위해서는 무엇이든 할거야
  

• Polarization : 내가 옳다고 생각하는 사람만 모여봐
• Loss of respect : 걔네들은 상대할 가치도 없어
• Threats : 우리와 같은 편이 아닌 사람들을 우리가 압도해야 해
  

• Verbal aggression : 그 인간은 @$#%@야
• Physical aggression : 이거나 가져가!
• Destructive behaviors : 내가 질 수도 있어. 그렇지만 그들이 승리한다고 해도 손해가 상당할 거야

갈등의 수준을 진단하기

• 전략적 갈등(Strategic conflict) : Decisional level에 근원. 전략을 수립할 때의 분열
• 깊숙히 자리잡은 갈등(Entrenched conflict) : Interpretive level에 근원. 가치관의 대립
• 유발된 정서적 갈등(Triggered emotional conflict) : Reflective level에 근원. 정서적 갈등
• 사실의 오해(Misunderstanding of Fact) : Objective level에 근원. 표면적 수준의 갈등.

(출처 : http://memorise.org/brain-articles/differences-vertical-lateral-thinking-00683.html)

Vertical Thinking vs Lateral Thinking

(출처 : info.sks.cz/users/jo/?download=8a_Creativity.ppt‎)

Six Thinking Hats is a book by Edward de Bono which describes a tool for group discussion and individual thinking involving six colored hats. "Six Thinking Hats" and the associated idea parallel thinking provide a means for groups to plan thinking processes in a detailed and cohesive way, and in doing so to think together more effectively.^[2]

In 2005, the tool found some use in the United Kingdom innovation sector, where it was offered by some facilitation companies and had been trialled within the United Kingdom's civil service.^[3]

Underlying principles

The premise of the method is that the human brain thinks in a number of distinct ways which can be deliberately challenged, and hence planned for use in a structured way allowing one to develop tactics for thinking about particular issues. De Bono identifies six distinct directions in which the brain can be challenged. In each of these directions the brain will identify and bring into conscious thought certain aspects of issues being considered (e.g. gut instinct, pessimistic judgement, neutral facts). None of these directions are completely natural ways of thinking, but rather how some of us already represent the results of our thinking.

Since the hats do not represent natural modes of thinking, each hat must be used for a limited time only. Also, many will feel that using the hats is unnatural, uncomfortable or even counter productive and against their better judgement.

A compelling example presented is sensitivity to "mismatch" stimuli. This is presented as a valuable survival instinct, because, in the natural world: the thing that is out of the ordinary may well be dangerous. This mode is identified as the root of negative judgement and critical thinking.

Six distinct directions are identified and assigned a color. The sixth meta thinking (Blue) is discussed in the next section. The other 5 directions are:

• Information (White) - considering purely what information is available, what are the facts?
• Emotions (Red) - intuitive or instinctive gut reactions or statements of emotional feeling (but not any justification)
• Discernment (Black) - logic applied to identifying reasons to be cautious and conservative
• Optimistic response (Yellow) - logic applied to identifying benefits, seeking harmony
• Creativity (Green) - statements of provocation and investigation, seeing where a thought goes

Coloured hats are used as metaphors for each direction. Switching to a direction is symbolized by the act of putting on a coloured hat, either literally or metaphorically. These metaphors allow for a more complete and elaborate segregation of the thinking directions. The six thinking hats indicate problems and solutions about an idea the thinker may come up with.

DEBONO 6 HATS 20 PAGES.pdf

DeBono 6 hats.pub

인간은 실수를 하기 마련이지만, 진짜로 일을 망치려면 컴퓨터가 필요하다.

"To err is human, but to really foul things up you need a computer."
–Paul Ehrlich

문제에만 집중해서는 결코 해답을 찾지 못할 것이다.
If you focus on the problem you'll never see the solution"
–patch adams

우리가 결정해야 할 것은 우리에게 주어진 시간 동안 무엇을 할 것인가이다.

All we have to decide is what to do with the time that is given to us.
–Lord of the Rings: The Fellowship of the Ring

삶은 초콜릿 상자와 같다. 어떤 것을 갖게 될지 알 수 없다.

Life is like a box of chocolates. You never know what you're gonna get.
–Forrest Gump

중요한 것은 공포가 아니라 거기에 어떻게 대응하는가이다. 이건 마치 마라톤선수에게 고통스럽냐고 묻는 것과 같다. 중요한 것은 고통을 느끼는지가 아니라 그것을 어떻게 다루는지이다.

Fear is not what's important, it's how you deal with it. It would be like asking a marathon runner if they feel pain. It's not a matter of whether you feel it, it's how you manage it.
–War Photographer

우리의 삶은 우리에게 온 기회에 의해서 정의된다. 비록 우리가 그것을 놓치더라도 말이다.

Our lives are defined by opportunities, even the ones we miss.
–The Curious Case of Benjamin Button

나의 첫 번째 원칙은, "최선을 기대하면서 최악에 대비하는 것"이다.

My number one rule is, ‘Hope for the best, plan for the worst.
–The Bourne Ultimatum

우리가 누구인지를 보여주는 것은 우리의 능력이 아니라 우리의 선택이다.

It is not our abilities that show what we truly are... it is our choices.
–Harry Potter and the Chamber of Secrets

모든 사람은 죽는다. 그러나 모든 사람이 진정으로 살아있는 것은 아니다.

"Every man dies, but not every man really lives."
–"Braveheart"

고대 이집트인들에게는 죽음에 대한 아름다운 믿음이 있었다. 그들의 영혼이 천국에 들어갈 때, 문지기들은 두 가지를 묻는다. 그리고 그 대답에 따라서 천국에 들어갈 수 있는지 없는지가 결정된다. 질문은 '삶을 살면서 즐거움을 찾았느냐?', '다른 사람에게 즐거움을 주었느냐?' 이다.

“You know, the ancient Egyptians had a beautiful belief about death. When their souls got to the entrance to heaven, the guards asked two questions. Their answers determined whether they were able to enter or not. ‘Have you found joy in your life?’ ‘Has your life brought joy to others?’”
–The Bucket List

역경 속에서 피어난 꽃이 모든 꽃 중에서 가장 드물고 아름답다.

“The flower that blooms in adversity is the most rare and beautiful of all.”
–Mulan

삶은 네가 쉰 숨의 양이 아니라, 숨을 멎을 것 같은 순간이야

“Life is not the amount of breaths you take, it’s the moments that take your breath away.”
–Hitch

둘 중 하나다. 하거나 하지 않거나. 한번 해보는 것 따위는 없다.

"Do or do not, there is no try."
– Star Wars Episode V

딜란, 피카소, 뉴튼같이 위대한 예술가들은 실패를 감수했다. 위대해지고 싶다면 우리도 그 위험을 감수해야 한다.

The greatest artists like Dylan, Picasso and Newton risked failure. And if we want to be great, we’ve got to risk it too.
– Jobs

큰 힘에는 큰 책임이 따른다.

"With great power comes great responsibility."
–Spider-Man

문제를 해결하는 첫 번째 단계는 문제가 있음을 인지하는 것이다.

First step in solving any problem is recognizing there is one.
–The Newsroom (U.S. TV series)

개개인들이 가능한 것의 한계를 스스로 늘려나가는 한, 그리고 집단의 노력을 통해서 어떻게 함께 일할 수 있는지 배울 수 있는 한 최첨단의 기술조차 우리를 돕지 못할 것이다.

Unless individuals can stretch the limits of what they believe possible, and unless we can learn how to work together in a collective effort, even the best technology can’t help us.
–Douglas Engelbart

지혜로운 사람은 누구인가? 바로 모든 사람들로부터 배우는 사람이다.

Who is a wise person? One who learns from all people
– The Talmud

우리가 겪는 첫 번째 고통의 근원은 우리가 말하기를 두려워하는 것에 있다. 그것은 우리 안에 있는 침묵이 축적될 때 태어난다.

What is the source of our first suffering? It lies in the fact that we hesitated to speak. It was born in the moment when we accumulated silent things within us
– Gaston Bachelard

바보도 '아는 것'은 할 수 있다. 중요한 것은 '이해하는 것'이다.

“Any fool can know. The point is to understand.”
– Albert Einstein

내일 죽을 것처럼 살아라. 평생 살 것처럼 배워라.

“Live as if you were to die tomorrow. Learn as if you were to live forever.”
– Mahatma Gandhi

나는 그렇게 머리가 좋지 않다. 다만, 질문과 더 오래 씨름할 뿐이다.

“It is not that I'm so smart. But I stay with the questions much longer.”
– Albert Einstein

나에게 말해주면 잊을 것이고, 가르쳐주면 기억할 것이고, 참여시켜주면 학습할 것이다.

“Tell me and I forget, teach me and I may remember, involve me and I learn.”
– Benjamin Franklin

나는 가르치는 사람(선생님)이 아닙니다. 나는 자각하도록 돕는 사람입니다.

“I am not a teacher, but an awakener.”
– Robert Frost