The governance of medical education in Korea is overly government-driven compared to that of foreign countries, an expert pointed out recently.

To realize medical education development in Korea, the expert said that the country should pursue decentralized governance where professional organizations delegated by the government develop and implement policies while closely cooperating with the government.

Professor Jung Sung-soo of the Department of Internal Medicine at Chungnam National University College of Medicine made these and other points in “A Comparison of Japanese and Singaporean Medical Education Policies Focusing on Governance: Implications for Korea” presented in the latest issue of Korean Medical Education, a journal published by Yonsei University College of Medicine.

Improving medical education is associated with improving physicians’ competence, which in turn is linked to treatment outcomes, including patient safety. Improving medical education requires efforts from medical schools, as well as supportive government policies. Ideally, the government would implement these policies in cooperation with stakeholders and using appropriate resources.

However, Professor Jung said that while there is support for investing in facilities, including medical school buildings, few policies support improving medical education. The hard work of improving medical education is left to medical schools and other medical education-related organizations.

Professor Jung said that increasing the number of medical students is also a government-led policy. “The ostensible problem is the stakeholder conflict in the policy-making and implementation process. However, if you look at it in a bigger context, it is a matter of governance.”

Jung compared it with the medical education policies of Japan and Singapore, two Asian countries with top-ranked medical quality.

Government-expert collaborative governance in Japan; private initiative in Singapore

In Japan, the government decides medical education policies. However, due to criticism from professional organizations, the two sides are now working together in collaborative governance.

For example, the model core curriculum (MCC) policy for medical schools was shaped by the Ministry of Education, Culture, Sports, Science, and Technology in the 1990s through research by advisory groups and was pushed by the government in 2001, making it easier for cooperative universities to receive financial support. In the consequent policy-designing stage, medical schools jointly contributed to developing the MCC, and in 2022, professional organizations, including medical schools and the Medical Education Association, have also proposed revisions.

Other policies, such as the mandatory internship training for two years after graduation and the regional allocation system of the Ministry of Health, Labor and Welfare, were also implemented by the government but faced various limitations, including the lack of participation by the medical community. As a result, expert organizations are taking the lead in developing alternatives.

“In Japan, the policy governance of medical education had been seen as bureaucratic governance led by the government until the 2010s,” Professor Jung said. “However, as the problem of lack of stakeholder participation emerged, the subsequent policies were transformed into collaborative governance with expanded stakeholder participation.”

Professor Jung noted that in Singapore, the policy has been implemented in a private-sector-driven manner, marked by government support for medical education innovations led by medical schools.

For instance, when Duke-NUS Medical School was established in 2008, the government supported it through programs such as Research, Innovation and Enterprise 2015 and 2020 (RIE2015 and RIE2020). RIE is a collaborative effort between the government, universities, and businesses to establish Singapore as a global research and development hub, with the government focusing on financial support.

According to Professor Jung, the Health Manpower Development Plan (HMDP), which focuses on training medical professionals, is the only policy related to medical education that the Singaporean government has put forth. Major medical organizations participate in decision-making, and the government continues to support them.

In Korea, however, all policies are government-led, and stakeholder participation is lacking. Furthermore, Jung pointed out that the evidence base for the policies is “nonexistent."

According to the professor, the amendment to the enforcement decree of the Higher Education Act to consolidate medical school into a six-year program is the only policy where the government accepted the medical community's proposal.

“The policies related to medical education, including the sudden increase in the number of medical school students that triggered the ongoing government-doctor conflict, were decided and announced suddenly without prior discussion or consultation with stakeholders, especially professional organizations,” Jung said. ”This is a manifestation of arbitrary governance with no participation from medical schools or related expert organizations from formulating to implementing policies.”

Japan, Singapore actively support medical education, while Korea invests only in facilities

The government’s financial support level to implement medical education policies also varied among the three countries.

In Japan, the government supports universities that apply for (doctors’) regional allocation programs to train doctors. The government also supports the development of medical curricula to implement MCC. In Japan, 75 percent of medical schools are public. Except for a few private medical schools, most medical schools receive direct or indirect government support.

Singapore also has the government’s financial support for the healthcare system. As major healthcare policies are proposed and implemented by the Budget Committee of Parliament, financial support is guaranteed, and the government also supports the effective distribution of healthcare resources.

In Korea, however, there is no financial support for program and faculty development to improve the quality of medical education other than investment in facilities.

Professor Jung pointed out that medical education costs rise over time, such as the introduction of practical exams and computer-based exams, but medical schools are shouldering the cost.

“Even national medical schools do not have financial support, so they cover the cost of education through university hospital transfers and alumni association donations,” Jung said. “Medical schools are often excluded from educational projects, and even when they are allowed to participate, they do not receive actual financial support because they do not meet the business objectives designated by the Ministry of Education.”

Jung said the preferred governance model is “decentralized governance,” in which professional organizations with a government mandate work in partnership with the government to develop policy and implement it.

He emphasized that the increase in the medical school enrollment quota, which is the cause of the current healthcare turmoil, is also a problem caused by the lack of proper governance. Therefore, it is necessary to initiate a governance initiative that involves stakeholders such as medical students, doctors, professors, and medical schools.

“Although not surveyed, it is believed that many medical schools and medical education-related professional organizations have not escaped from bureaucratic governance,” Jung said. ”Above all, we have not achieved collaborative governance, which has led to executives-driven decision-making and policy implementation.”

“Policy governance for medical education in Korea needs to move away from the government's initiative toward strengthening partnerships with professional organizations to build a more transparent and collaborative system,” Professor Jung said. “It is important for the government to limit its role to financial and institutional support.”