Kosin Medical Journal

From articles published since 2021.

Review articles

How to conduct well-designed clinical research: Da Jung Kim, Song Yi Kil, Jongwon Son, Ho Sup Lee; Kosin Med J. 2022;37(3):187-191. Published online September 27, 2022; DOI: https://doi.org/10.7180/kmj.22.122

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Clinicians and healthcare decision-makers conduct their clinical practice based on the results of clinical trials. However, some health problems remain unresolved; in such cases, further research is required. To ensure reliable research results, it is important to understand the study design and conduct well-designed clinical trials. Many study designs can be chosen within the two broad categories of observational and interventional. Clinical studies have a variety of designs, including case series, case-control, cross-sectional, and prospective and retrospective cohort studies. Well-designed clinical studies can clarify important differences between treatment options and provide data on long-term drug efficacy and safety. Interpreting the results of clinical trials can be difficult because weaknesses in research design, data collection methods, analytic methods, and reporting can compromise their value and usefulness. However, although randomized controlled trials are limited owing to ethical and practical issues, they are optimal for investigating the effects of therapy and establishing causality. Here we present an overview of different clinical research designs and review their advantages and limitations.

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Evaluation of automated calibration and quality control processes using the Aptio total laboratory automation system
Namhee Kim, Yein Kim, Jeongeun Park, Jungsoo Choi, Hyunyong Hwang
Kosin Medical Journal.2022; 37(4): 342. CrossRef
The effects of rebamipide, sucralfate, and rifaximin against inflammation and apoptosis in radiation-induced murine intestinal injury
Won Moon, Sangwook Lim, Yeonsoon Jung, Yuk Moon Heo, Seun Ja Park, Moo In Park, Sung Eun Kim, Jae Hyun Kim, Kyoungwon Jung
Kosin Medical Journal.2022; 37(4): 320. CrossRef

Psychosomatic Approach to Fibromyalgia Syndrome: Concept, Diagnosis and Treatment: Sang-Shin Lee; Kosin Med J. 2021;36(2):79-99. Published online December 31, 2021; DOI: https://doi.org/10.7180/kmj.2021.36.2.79

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Fibromyalgia syndrome (FMS) has chronic widespread pain (CWP) as a core symptom and a variety of associated somatic and psychological symptoms such as fatigue, sleep problems, cognitive disturbances, multiple somatic pain, and depression. FMS is the subject of considerable controversy in the realm of nosology, diagnosis, pathophysiology, and treatment. Moreover, the fact that FMS and mental illness are closely associated with each other might intensify the confusion for the distinction between FMS and mental disorders. This narrative literature review aims to provide the concept, diagnosis, and treatment of FMS from the integrative biopsychosocial and psychosomatic perspective. This article first explains the concepts of FMS as a disease entity of biopsychosocial model, and then summarizes the changes of diagnostic criteria over past three decades, differential diagnosis and comorbidity issue focused on mental illnesses. In addition, an overview of treatment of FMS is presented mainly by arranging the recommendations from the international guidelines which have been developed by four official academic associations.

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The prevalence and correlates of depression in Korean adults with rheumatoid arthritis: Results from the Korea National Health and Nutrition Examination Surveys
Hyunseuk Kim, Haeyoung Lee, Sang‐Shin Lee
International Journal of Rheumatic Diseases.2022; 25(4): 454. CrossRef

Original article

Antinociceptive Effect of BPC-157 in the Formalin-induced Pain Model: Sang Yoong Park, So Ron Choi, Jeong Ho Kim, Seung Cheol Lee, Seong Yeop Jeong, Joon Ho Jeong, Tae Young Lee; Kosin Med J. 2021;36(1):1-13. Published online June 30, 2021; DOI: https://doi.org/10.7180/kmj.2021.36.1.1

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Objectives

Body protective compound-157 (BPC-157) is a stable gastric pentadecapeptide that has been effective in trials aiming to increase wound healing capabilities and decrease inflammatory cell influx, including studies on the healing of muscles and tendons. There are no studies about the effect of BPC-157 on pain transmission via nociception. This study examined the antinociceptive effects of BPC-157 using formalin tests and immunohistochemistry.

Methods

Rats were randomly divided into the control, morphine and BPC-157 groups. Pain behavior was quantified periodically at 5- and 35- min intervals (representative values of phases 1 and 2) by counting the number of flinches exhibited by the injected paw after injection. The dorsal root ganglia (DRG) and spinal cords (SC) were collected, and then, the number of cytokine-positive cells was determined via immunostaining.

Results

BPC-157 dose-dependently decreased the number of flinches during phase 1 but did not decrease the number of flinches during phase 2. During phase 1, interleukin-1β (IL-1β) in the DRG tissue was significantly different in the morphine, 10 μg/kg BPC-157, and 20 μg/kg BPC-157 groups. During phase 2, statistical significance was achieved in the DRG tissue in the morphine, 20 μg/kg BPC-157, and 40 μg/kg BPC-157 groups. During phase 1, interleukin-6 was significantly different in the DRG tissue in the morphine group and the SC tissue in the 10 μg/kg BPC-157 group. During phase 2, statistical significance was achieved in the morphine group and the BPC-157 20 μg/kg group in both the DRG and SC tissues. There were no significant differences in tumor necrosis factor-α between the DRG and SC tissues.

Conclusions

BPC-157 was effective during phase 1 but not during phase 2, as determined by the formalin test. BPC-157 decreased the expression of IL-1β in the DRG tissue in phases 1 and 2.

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Stable Gastric Pentadecapeptide BPC 157 May Recover Brain–Gut Axis and Gut–Brain Axis Function
Predrag Sikiric, Slaven Gojkovic, Ivan Krezic, Ivan Maria Smoday, Luka Kalogjera, Helena Zizek, Katarina Oroz, Hrvoje Vranes, Vlasta Vukovic, May Labidi, Sanja Strbe, Lidija Baketic Oreskovic, Marko Sever, Marijan Tepes, Mario Knezevic, Ivan Barisic, Vlad
Pharmaceuticals.2023; 16(5): 676. CrossRef
The anti-nociceptive effect of BPC-157 on the incisional pain model in rats
Young-Hoon Jung, Haekyu Kim, Hyaejin Kim, Eunsoo Kim, Jiseok Baik, Hyunjong Kang
Journal of Dental Anesthesia and Pain Medicine.2022; 22(2): 97. CrossRef
Stable Gastric Pentadecapeptide BPC 157 as Useful Cytoprotective Peptide Therapy in the Heart Disturbances, Myocardial Infarction, Heart Failure, Pulmonary Hypertension, Arrhythmias, and Thrombosis Presentation
Predrag Sikiric, Mario Udovicic, Ivan Barisic, Diana Balenovic, Gordana Zivanovic Posilovic, Dean Strinic, Sandra Uzun, Suncana Sikiric, Ivan Krezic, Helena Zizek, Haidi Yago, Slaven Gojkovic, Ivan Maria Smoday, Luka Kalogjera, Hrvoje Vranes, Marija Sola,
Biomedicines.2022; 10(11): 2696. CrossRef
Stable Gastric Pentadecapeptide BPC 157 and Striated, Smooth, and Heart Muscle
Mario Staresinic, Mladen Japjec, Hrvoje Vranes, Andreja Prtoric, Helena Zizek, Ivan Krezic, Slaven Gojkovic, Ivan Maria Smoday, Katarina Oroz, Eva Staresinic, Vilim Dretar, Haidi Yago, Marija Milavic, Suncana Sikiric, Eva Lovric, Lovorka Batelja Vuletic,
Biomedicines.2022; 10(12): 3221. CrossRef

Review articles

Safety issues regarding melatonin use in child and adolescent patients with sleep problems: Eunsoo Moon, Jung Hyun Lee; Kosin Med J. 2022;37(4):264-270. Published online December 23, 2022; DOI: https://doi.org/10.7180/kmj.22.142

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Abstract PDF PubReader ePub Crossref - TDM: Several studies have reported that melatonin may be effective in treating sleep problems in children and adolescents. However, evidence regarding the safety of melatonin use in children and adolescents in their growth and developmental stages is warranted. Therefore, we aimed to summarize the literature on the safety of melatonin use in children and adolescents with insomnia and sleep disturbances. According to existing evidence, there are no serious adverse effects of long-term melatonin use in children and adolescents. The common adverse effects reported in long-term studies are fatigue, somnolence, and mood swings. In addition, there is no evidence that long-term use of melatonin inhibits the natural secretion of melatonin. It is necessary to monitor potential drug interactions with medications such as inhibitors and enhancers of cytochrome P450 1A2 (CYP1A2). Furthermore, low CYP1A2 expression in young children requires proper dose adjustment. Although sufficient experience of melatonin use in children and adolescents has yet to be attained, accumulating evidence suggests that the use of melatonin in children and adolescents with sleep problems might be effective and tolerable. Considering the abuse or overdose risk of hypnotics or benzodiazepines, melatonin supplements may be a good therapeutic alternative. Future studies on the long-term safety of melatonin for physiological and mental function in children and adolescents are required to establish certainty about melatonin use in children and adolescents.

Role of biomarkers in the heart failure clinic: Bong-Joon Kim, Jae-Hyeong Park; Kosin Med J. 2022;37(1):4-17. Published online March 29, 2022; DOI: https://doi.org/10.7180/kmj.22.019

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Abstract PDF PubReader ePub Crossref - TDM: Heart failure (HF) is a common cardiovascular disease that has a complex pathophysiology. Because it is the final stage of many cardiovascular diseases, proper diagnosis and treatment are crucial for prolonging patients’ survival and improving their well-being. Several biomarkers have been identified in HF, and their roles in diagnosis and prognostication have been widely investigated. Among them, natriuretic peptides are key for diagnosing HF, predicting its prognosis, and monitoring the effectiveness of HF treatment. Moreover, natriuretic peptides can also be used to treat HF. In addition to natriuretic peptides, several other biomarkers were included in the most recent HF management guidelines. Thus, we reviewed the role of the biomarkers included in these guidelines and discussed future perspectives.

Case report

A case report of successfully treated metachronous gastrointestinal stromal tumor and colon cancer: Young Jin Heo, Ji Young Lee; Kosin Med J. 2023;38(1):60-65. Published online March 8, 2023; DOI: https://doi.org/10.7180/kmj.22.138

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Abstract PDF PubReader ePub Crossref - TDM: The diagnosis of gastrointestinal stromal tumor (GIST) has become relatively common in recent years, but little is known about its association with other malignancies. We present a rare case of successfully treated metachronous GIST and colon cancer with concurrent FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) chemotherapy and imatinib. A 63-year-old man presented with abdominal pain that had started 2 weeks ago, and endoscopic ultrasonography showed masses that were compatible with GIST on the duodenum. He underwent Whipple surgery. One year after the GIST diagnosis, two liver masses were found on abdominal computed tomography images taken for surveillance. A liver biopsy showed metastatic adenocarcinoma, not GIST. Colonoscopy was then performed to identify the primary site of the metastatic adenocarcinoma in the liver, and sigmoid colon cancer was found. He received 12 cycles of adjuvant FOLFOX concurrently with adjuvant imatinib. There were no serious adverse events of grade 3 or higher from either imatinib or chemotherapy. He has completed adjuvant imatinib and FOLFOX chemotherapy and there is no evidence of disease recurrence. When a synchronous or metachronous tumor is found in a GIST patient, the clinician should keep in mind the possibility of another primary tumor of different histopathology, as well as GIST recurrence.

Original articles

Effectiveness of prophylactic calcium and vitamin D supplementation for preventing post-thyroidectomy hypocalcemia: a meta-analysis: Hyeyeon Moon, Ju Won Seok, Keunyoung Kim, Hye Young Kim, Mi Kyoung Park, In Joo Kim, Kyoungjune Pak, Sunghwan Suh; Kosin Med J. 2022;37(3):213-219. Published online August 31, 2022; DOI: https://doi.org/10.7180/kmj.22.101

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Background
Postsurgical hypocalcemia is the most common and troublesome consequence of thyroidectomy. We investigated the potential role of routine calcium or vitamin D supplementation in preventing postsurgical hypocalcemia.
Methods
We searched MEDLINE and Embase for English-language publications using the keywords “calcium,” “vitamin D,” and “thyroid cancer.” The primary outcome was any postoperative hypocalcemia, and the secondary outcome was symptomatic hypocalcemia.
Results
Four studies that included 381 patients were eligible for this meta-analysis. A random-effects model showed no significant difference in the occurrence of hypocalcemia between calcium/vitamin D treatment and placebo/no treatment. However, the occurrence of symptomatic hypocalcemia was lower in patients with calcium/vitamin D treatment. In the combined results, preoperative calcium and vitamin D supplementation were associated with a reduced incidence of symptomatic hypocalcemia.
Conclusions
Our findings support the use of preoperative calcium and vitamin D supplementation in conjunction with routine postsurgical supplementation for patients after total thyroidectomy.

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Is there enough evidence to recommend preoperative calcium and vitamin D in patients who undergo total thyroidectomy?
Hyoung Shin Lee
Kosin Medical Journal.2022; 37(3): 173. CrossRef

Revascularization of immature retinas with retinopathy of prematurity using combination therapy of deferred laser treatment after a single intravitreal bevacizumab injection: Ju Seouk Lee, Ki Yup Nam, Ji Eun Lee, Joo Eun Lee, Sang Joon Lee; Kosin Med J. 2023;38(1):28-35. Published online March 28, 2023; DOI: https://doi.org/10.7180/kmj.22.145

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Background
This study aimed to observe the extent of retinal vascularization in patients with retinopathy of prematurity (ROP) who underwent deferred laser treatment (LT) after a single intravitreal bevacizumab injection (IVB).
Methods
This study retrospectively evaluated 40 consecutive eyes in 21 infants who received a single IVB or LT. Deferred LT was performed in cases of ROP recurrence after a single IVB. To assess the amount of retinal vascularization between the initial IVB and deferred LT, the cases were divided into three groups based on treatment: single IVB, deferred LT after a single IVB, and prompt LT. The growth and associated complications were compared between groups.
Results
There were 12, 16, and 12 eyes in the single IVB, deferred LT, and prompt LT groups, respectively. Deferred LT was performed at an average of 7.9 weeks after a single IVB. In the single IVB group, retinal vascularization proceeded to zone III, whereas the prompt LT group did not show any growth of vascularization beyond the laser scars. In the deferred LT group, during the window period before LT, retinal vascularization progressed from zone I to zone II posterior and from zone II posterior to zone II anterior, respectively, without further ROP recurrence.
Conclusions
Retinal vascularization progressed during the deferred window period, thereby reducing the area of the retina ablated by LT. A single IVB followed by deferred LT can be an alternative treatment option to prevent ablation of zone I or multiple IVBs.

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What is the effect of deferred laser treatment on reactivated retinopathy of prematurity after anti-VEGF injection?
Ji Hye Jang
Kosin Medical Journal.2023; 38(1): 1. CrossRef

Review article

How to write an original article in medicine and medical science: Gwansuk Kang, Sung Eun Kim; Kosin Med J. 2022;37(2):96-101. Published online June 24, 2022; DOI: https://doi.org/10.7180/kmj.22.105

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Excellent research in the fields of medicine and medical science can advance the field and contribute to human health improvement. In this aspect, research is important. However, if researchers do not publish their research, their efforts cannot benefit anyone. To make a difference, researchers must disseminate their results and communicate their opinions. One way to do this is by publishing their research. Therefore, academic writing is an essential skill for researchers. However, preparing a manuscript is not an easy task, and it is difficult to write well. Following a structure may be helpful for researchers. For example, the standard structure of medical and medical science articles includes the following sections: introduction, methods, results, and discussion (IMRAD). The purpose of this review is to present an introduction for researchers, especially novices, on how to write an original article in the field of medicine and medical science. Therefore, we discuss how to prepare and write a research manuscript for publication, using the IMRAD structure. We also included specific tips for writing manuscripts in medicine and medical science.

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How does quiz activity affect summative assessment outcomes? An analysis of three consecutive years’ data on self-directed learning
Chi Eun Oh, Hyunyong Hwang
Kosin Medical Journal.2022; 37(3): 228. CrossRef
The effects of rebamipide, sucralfate, and rifaximin against inflammation and apoptosis in radiation-induced murine intestinal injury
Won Moon, Sangwook Lim, Yeonsoon Jung, Yuk Moon Heo, Seun Ja Park, Moo In Park, Sung Eun Kim, Jae Hyun Kim, Kyoungwon Jung
Kosin Medical Journal.2022; 37(4): 320. CrossRef

Original article

Comparison of the radiation dose between dual-acquisition coronary computed tomography angiography and coronary angiography for coronary spasm: Soo-Jin Kim, Moo Hyun Kim, Eun-Ju Kang; Kosin Med J. 2022;37(1):46-51. Published online March 16, 2022; DOI: https://doi.org/10.7180/kmj.21.035

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Abstract PDF PubReader ePub Crossref - TDM: Background
Coronary computed tomography angiography (CCTA) is an imaging technique that can be used to evaluate and diagnose coronary artery stenosis. Dual-acquisition CCTA (DA-CCTA) with additional nitrate infusion is a promising alternative noninvasive diagnostic tool, as conventional CCTA has limitations in the diagnosis of variant angina compared to conventional angiographic coronary spasm tests. However, DA-CCTA may pose a potential risk due to radiation exposure. We compared the radiation dose between DA-CCTA and the coronary angiographic spasm provocation test.
Methods
Patients with clinically suspected variant angina at a single hospital between March 2013 and October 2018 were screened and underwent DA-CCTA or a coronary angiographic spasm provocation test. The effective radiation dose required for each approach was compared.
Results
In total, 211 suspected variant angina patients underwent DA-CCTA or the coronary angiographic spasm provocation test. Of these, 49 patients (mean age, 59.8 years; 67.3% men) received DA-CCTA and 162 patients (mean age, 60.5 years; 66.2% men) received a coronary angiographic spasm provocation test. There was a significant difference in the effective radiation dose, with a median dose of 5.1 mSv (interquartile range [IQR], 4.1–9.2 mSv) required for DA-CCTA and a median dose of 10.9 mSv (IQR, 8.4–15.2 mSv) for the coronary angiographic spasm provocation test (p<0.001).
Conclusion
DA-CCTA showed a significantly lower effective radiation dose than the coronary angiographic spasm provocation test required to diagnose variant angina.

Review article

Future directions of online learning environment design at medical schools: a transition towards a post-pandemic context: Sejin Kim; Kosin Med J. 2023;38(1):12-20. Published online March 27, 2023; DOI: https://doi.org/10.7180/kmj.23.110

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Abstract PDF PubReader ePub Crossref - TDM: Coronavirus disease 2019 (COVID-19) has had an extremely large impact on methods of teaching and learning, and the need for online learning has grown enormously during the COVID-19 pandemic. Because most professors and students adjusted their mode of teaching and learning to this new context, online learning seemed to be going well. The problem is that distance learning was abruptly adopted as an alternative method of classroom instruction. To increase the effectiveness of online learning, more consideration is needed to explore future directions of creating learning environments. Therefore, this study suggests seven design guidelines for designing learning environments at medical schools based on a theoretical background and experiences from the pandemic. Constructivism and situated learning theory are introduced as the theoretical background for learning environment design, and the basic principles of learning environment design with the paradigm shift to learner-centered classrooms and experiences using EdTech, including HyFlex learning, flipped learning, learning management systems, and interactive learning tools, were used to develop the design guidelines. Each design guideline is strategically matched with the basic principles: learner-centeredness, real-world tasks and contexts, problem-solving, new roles of professors as facilitators or tutors, collaboration, and new perspectives of evaluation and assessment.

Case report

A rare case of pure-type embryonal carcinoma in a 75-year-old woman mimicking epithelial ovarian carcinoma: Hyun Been Jo, Eun Taeg Kim, Nam Kyung Lee, Kyung Un Choi, Eon Jin Kim, Yun Joo Shin, Ki Hyung Kim, Dong Soo Suh; Kosin Med J. 2022;37(3):249-254. Published online June 16, 2022; DOI: https://doi.org/10.7180/kmj.22.026

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Abstract PDF PubReader ePub Crossref - TDM: Embryonal carcinoma, a very rare ovarian germ cell tumor, involves pure and mixed phenotypes. Pure-type embryonal carcinoma has never been reported in postmenopausal women. The current case was, thus, misdiagnosed as an epithelial ovarian carcinoma based on radiologic findings. Herein, we describe the case of ovarian embryonal carcinoma in a 75-year-old woman along with a literature review. Magnetic resonance imaging findings were suggestive of epithelial ovarian malignancy associated with endometrioma, including ureteral invasion. The patient underwent complete surgical staging, and a pathologic diagnosis of pure-type embryonal carcinoma was made. The patient’s postoperative course was uneventful, and adjuvant chemotherapy was administered. Embryonal carcinoma in the postmenopausal woman is a clinical challenge owing to the possibility of its misdiagnosis as epithelial ovarian carcinoma. To the best of our knowledge, this is the first report of pure-type ovarian embryonal carcinoma in a postmenopausal woman, with a description of the clinicopathologic characteristics and review of the relevant literature.

Review articles

Remote health monitoring services in nursing homes: Jiwon Kim, Hyunsoo Kim, Sungil Im, Youngin Park, Hae-Young Lee, Sookyung Kwon, Youngsik Choi, Linda Sohn, Chulho Oak; Kosin Med J. 2023;38(1):21-27. Published online March 29, 2023; DOI: https://doi.org/10.7180/kmj.22.131

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Abstract PDF PubReader ePub Crossref - TDM: Aged people are challenged by serious complications from chronic diseases, such as mood disorder, diabetes, heart disease, and infectious diseases, which are also the most common causes of death in older people. Therefore, elderly care facilities are more important than ever. The most common causes of death in elderly care facilities were reported to be diabetes, cardiovascular disease, and pneumonia. Recently, the coronavirus disease 2019 (COVID-19) pandemic have a great impact on blind spots of safety where aged people were isolated from society. Elderly care facilities were one of the blind spots in the midst of the pandemic, where major casualties were reported from COVID-19 complications because most people had one or two mortality risk factors, such as diabetes or cardiovascular disease. Therefore, medical governance of public health center and hospital, and elderly care facility is becoming important issue of priority. Thus, remote health monitoring service by the Internet of Medical Things (IoMT) sensors is more important than ever. Recently, technological breakthroughs have enabled healthcare professionals to have easy access to patients in medical blind spots through the use of IoT sensors. These sensors can detect medically urgent situations in a timely fashion and make medical decisions for aged people in elderly care facilities. Real-time electrocardiograms and blood sugar monitoring sensors are approved by the medical insurance service. Real-time monitoring services in medical blind spots, such as elderly care facilities, has been suggested. Heart rhythm monitoring could play a role in detecting early cardiovascular disease events and monitoring blood glucose levels in the management of chronic diseases, such as diabetes, in aged people in elderly care facilities. This review presents the potential usefulness of remote monitoring with IoMT sensors in medical blind spots and clinical suggestions for applications.

Faculty development: the need to ensure educational excellence and health care quality: Hyekyung Shin, Min-Jeong Kim; Kosin Med J. 2023;38(1):4-11. Published online March 27, 2023; DOI: https://doi.org/10.7180/kmj.23.109

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Abstract PDF PubReader ePub Crossref - TDM: The definition of faculty development has been refined and expanded over the past few decades, and various definitions have been used in higher education. Initially, faculty development was defined as activities that help teachers improve teaching skills, design better curricula, and improve the organizational environment for education. Since then, as the focus of faculty development has shifted from individual professors to institutional needs, faculty development is now defined as the personal and professional development of professors, clinicians, researchers, and managers to meet institutional goals, visions, and missions in social terms and moral responsibility to the community. Faculty development in medical education is universally needed to recognize and cope with widespread changes in education, including the traditional role of professors, advances in pedagogical theory, changes in learning styles, innovative curriculum models, and evaluation philosophy. However, critics have pointed out that most universities could not actively implement faculty development or accept professors’ various demands. In this paper, various reports related to faculty development are reviewed to summarize how faculty development has progressed and present future directions for accepting various opinions to improve educational excellence and the quality of health care.

Editorial

What is the effect of deferred laser treatment on reactivated retinopathy of prematurity after anti-VEGF injection?: Ji Hye Jang; Kosin Med J. 2023;38(1):1-3. Published online March 17, 2023; DOI: https://doi.org/10.7180/kmj.23.108

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