“Medical education is all about how to make good doctors through education in a continuum. Because medicine is continually changing and something new is coming, you have to keep studying. Medical education starts from undergraduate studies and lasts a lifetime,” Professor Ahn Duck-sun said.
Ahn, recently designated as the winner of the Korea Medical Association-Pfizer International Cooperation Achievement Award, is a renowned physician, researcher, plastic surgeon, bioethics expert, and a pioneer of medical education in Korea.
|Professor Ahn Duck-sun makes a point regarding medical education in Korea and abroad, during an interview with Korea Biomedical Review on Friday.|
Ahn graduated from Korea University Medical College (KUMC), completed his residency at the University of Toronto and finished his fellowship at the University of California, Los Angeles’ ECFMG International Medical Education. He returned to Korea University after his studies to revamp the school’s medical education system and moved Korea's medical education to the international stage while promoting cooperation with foreign countries.
Ahn is most known for implementing a systematic approach to medical education and accreditation in a country that lacked such a system following the Korean War. In an interview with the Korea Biomedical Review Friday, Ahn recalled that when he was a student in the 1970s, Korea was under political turmoil led by a leader who used force to govern.
“The military government forced medical schools to close down every year, several times and in unpredictable ways. So I come from a generation that did not have a proper undergraduate medical education. We skipped many courses because we took part in anti-dictatorship demonstrations,” Ahn said.
It was paradoxically from this lack of proper undergraduate education that Ahn felt a need for change.
“I didn’t like the education system when I did my internship. Interns did simple chores - just simple labor - with no education. It was too hierarchical and very violent,” Ahn said. “The whole society then was kind of violent because of the postwar traumatic syndrome. That’s why I wanted to change it.”
He applied to the University of Toronto in Canada to complete his residency in the department of plastic surgery. And it was at the university that Ahn met his mentor, Professor Arnis Freiberg, who taught him how teachers should behave. The mentor, according to Ahn, was awarded by the student body as the teacher of the year for 14 consecutive years and the first person in North America to become a professor at the department based purely on his educational accomplishments.
“My mentor advised me that what I needed was a good medical education in Korea. The kind of education doesn’t focus on creating a ‘content expert’ in a particular skill,” he said. Ahn noted that despite being a plastic surgeon, his primary area of expertise and interest lied with medical education since.
He later returned to Korea and back to his alma mater where he created a Medical Education Department at KUMC in 2000 and served as its department head. Ahn then went on to become KUMC’s associate dean for academic affairs and also the associate dean for graduate studies at the university in 2003.
In 2010, Ahn decided to take a second sabbatical year to the European bioethics course sponsored by the European Commission as well as the Australian Medical Council to learn about medical school education and accreditation programs for specialists.
Bioethics, Ahn explained, helps to explain medicine as not just a natural science but as an integrated domain of humanities, science, and social science. Doctors in Korea are often blamed for not having social or communication skills and not understanding the patient or the patient’s family. The reason is Koreans did not have that kind of education before.
“To understand diseases, of course, you need biomedical knowledge like chemistry,” he said. “But when you apply it to human beings, you have to understand the human and society on a bigger scale – which you learn from different branches of science such as the humanities or social science.”
After getting his masters in bioethics, Ahn returned to Korea to serve as the president of the Korean Society of Medical Education in 2011, president of the Korean Institute of Medical Education and Evaluation (KIMEE) in 2010, and the Association for Medical Education in the Western Pacific Region (AMEWPR) in 2010. He also became the first to implement a two-track licensing examination comprised of a written test and a skill-based one, among his many other accomplishments.
Through his various international roles, partaking in more than 200 meetings a year around the world, Ahn gained a broader scope of medical education and applied that to the one in Korea.
Korean medical education lacks generalism
Medical education was simply another undergraduate course when Ahn was an undergraduate student, he said, explaining that Japan introduced medical education system in Korea, benchmarking Germany’s specialist system.
“The country was so poor that no one thought about how to create good doctors. When Korea first introduced the medical school system, nobody knew how to write medical school objectives well, and the curriculum was not defined well because nobody had the capacity,” he said.
“We thought that all we needed was research skill or clinical service skill. But running a medical school is different,” Ahn explained. Korea’s medical education took off when the law for examinations for specialists passed the National Assembly in 1951 when the country was on the verge of collapse due to the devastating fratricidal war.
“Now, we are one of the best countries that provide state-of-the-art technology, but good generalism in medicine is lacking,” he said, noting that Korea needs a more systematic structure of producing specialists.
“Right now we’re producing content experts, not professionals. Professionals refer to those that have a profound knowledge of not only technology but the skill, attitude, ethics, and professionalism – a well-rounded person who has the longest academic years compared to any other professions,” he added.
Another problem has to do with the lack of generalists. “Again, the biggest problem is generalism - we don’t have it. Patients are satisfied with quick access to specialists, but there is a lot of waste wondering which hospital they should go to when they are sick in a copayment system where you pay, and the government helps,” he said.
Mainly, Ahn noted, Korea’s system does not have the concept of family doctors to whom the patient can go for general issues and are referred to the right specialist for more severe problems.
To create a sound system, Ahn emphasized the importance of both classroom lectures and work-based training.
“We have endless subjects in medicine such as anatomy, physiology, microbiology; you name it. Instead of those subjects, we are now increasingly focusing on the patient. Instead of having each subject, we approach it by thinking, ‘What is the patient’s complaint?’ Schools must provide ethics, social, communication training. And more should be given to resident training.”
Despite these problems, Korea’s medical education has advanced to the point where neighboring countries are interested in its medical education history as a war- trodden country that pulled together an accreditation system independently without any foreign experts.
Korean experts, such as Professor Ahn, are now lending their expertise to those in other developing countries, going on frequent trips to advance medical education around the world.
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