Reflection on the Experience of Medical Professionalism Education at Yonsei University College of Medicine

ᩑᖙݡ⦺Ʊ
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᮹⦺ᱥྙḢᨦᖒ
Ʊᮂ
Ğ⨹᮹ ၹᖒᱢ
Łₑ

ᦩᝁʑⰒᇡᖒ⯍

ᩑᖙݡ⦺Ʊ
᮹ŝݡ⦺
᮹⦺Ʊᮂ⦺ŝ

ŽĚŽŒ’˜—ȱ˜—ȱ‘Žȱ¡™Ž›’Ž—ŒŽȱ˜ȱŽ’ŒŠ•ȱ›˜Žœœ’˜—Š•’œ–ȱžŒŠ’˜—ȱŠȱ˜—œŽ’ȱ

—’ŸŽ›œ’¢ȱ˜••ŽŽȱ˜ȱŽ’Œ’—Ž

Shinki An · Sunghee Bu

Department of Medical Education, Yonsei University College of Medicine, Seoul, Korea

ᕽ
ು

⡍ť

⡍

⡍ ᙹ ť ť a ᙹ ᙹ ᱽ a a ᮹ ᱢᬊᮥ ၼ۵ ၼ ၼ ḩ⪹ᨱ ݡ⧕ ᙹᚁ Ñᇡ௝۵ ௝ ௝ ݡ⃹

ႊᦩᯕ ݡ⦽᮹ᔍ⩲⫭ෝ ☖⧕ ӹ᪅Ł ᯩ݅(ݡ⦽᮹ᔍ⩲⫭, 2012). ݡᵲๅℕ᪡ ᨙುᨱᕽ۵ እ❱᮹ ༊ᗭญa ҫᯕḡ ᦫ۵ ᦫ ᦫ

݅.

݅

݅ ݡ⦽᮹ᔍ⩲ ᔍ ᔍ ⫭۵ ḥഭ᮹ ḩᱢ ᙹᵡ᮹ ᱡ⦹a ⦹ ⦹ ᬑಅࡹအಽ ၹ ݡ⦽݅ ⦽ ⦽ Ł ݅ ݅ ⦹ḡ ⦹ ⦹ อ ᅕÕᅖḡᇡ᮹ č⧕۵ ᯕ᪡۵ ᦥᵝ ᦥ ᦥ ݅෕ ݅ ݅ ݅ ෕ ෕ . ݅ ݅ ℉

ᩩ⦽ ݡพᯕ݅. ݅ ݅ ᮹ŝݡ⦺ ⦺ᔾ ⦺ ⦺ ᯕ ᯕ౑ ᔢ⫊ ᔢ ᔢ ᮥ ⫊ ⫊ ċᨕԕ۵ äᮡ ᯝ

ၹᯙŝ۵ ə ᮹ၙa ݅ෝ äᯕ݅. ݅ ݅ ⦽ 4⦺֥ ⦺ᔾ ⦺ ⦺ ŝ᮹ ŝ ŝ ໕ݕ ᵲᨱ ˈᳬᮡ ᮹ᔍ௡ ྕᨨᯙaෝ ݅᜽ ݅ ݅ Łၝ⦹í ⦹ ⦹ ࡹᨩ݅ˉ۵ ᯕ᧝ʑෝ

ॄ۵݅. ݅ ݅ ⪹ᯱ ⪹ ⪹ อ ᯹ ⊹ഭ⦹ ഭ ഭ ໕ ᳬᮡ ᮹ᔍa ᔍ ᔍ ࢁ ᙹ ᯩᮥ ᯩ ᯩ äᯕ௝ ᔾ b⧩۵ߑ əäᯕ ᦥܭ ä z݅۵ ᯕ᧝ʑ݅. ݅ ݅ ˈə౨ʑ ভྙᨱ ⦺ Ʊᨱ

Ʊ

Ʊ ᕽ ᮹ഭ᪡ ᔍ⫭ ᔍ ᔍ , ᮹⦺᮹ ᯕ⧕௝۵ ௝ ௝ ŝ༊ॅᮥ }ᖅ⦹Ł ⦹ ⦹ Ŗᇡ

⦹۵ äᯕ᯷ᦥ?ˉ ᯕ౨í ၹྙ ၹ ၹ ⧩ᮥ ভ ⦺ᔾ ⦺ ⦺ ᮡ ᯕ౨í ݡݖ⧩݅. ݅ ݅ ˈօ, ə౨ʑ۵ ⦹ḡ ⦹ ⦹ ᫵. ə్ӹ ᳬᮡ ᮹ᔍa ᔍ ᔍ ࡹ۵ äᨱ ᯕ౨í Ñ

᜽ᱢᯕŁ ⓑ ᮹ഭ⪹ ഭ Ğ ⪹ ⪹ ᮹ ྙᱽ ྙ ྙ a ᯩ۵ ᯩ ᯩ äᯙ ᵥ ᝅq⦹ḡ ⦹ ⦹ ༜⧩ᨩ For decades medical educators have continually emphasized medical professionalism, which is reflective re-

sponse to the challenges of a rapidly changing medical environment. This study aimed to review the experience of implementing medical professionalism education at Yonsei University College of Medicine (YUCM). YUCM in- troduced a new curriculum in 2004 designed by Curriculum Development Project 2004 (CDP2004), a project that was launched in 2001. CDP2004 reorganized lectures as organ-based integrated lectures, introduced an in- troductory course for clinical medicine and medical humanities courses for premedical and medical students.

Problem-based learning (PBL), elective courses, and self-study sessions in the afternoon were implemented in order to equip students with a self-directed learning attitude as medical professionals. Professors were asked by the CDP2004 curriculum to spend more time on student education and to adopt new teaching methods. Expe- riences of the CDP2004 curriculum reveals 1) difficulty of motivating professors to be PBL tutors 2) students’ dis- satisfaction with the medical humanities course (major critique was that the course was impractical and unreal- istic), and 3) students’ optimistic understanding about their future role as medical professionals in influencing and helping people in spite of their perception of the general medical environment not as promising. To foster professionalism, the following are necessary in our experiences: 1) faculty development of medical humanities and medical professionalism, 2) establishment of an environment throughout the whole institution to support medical professionalism education and to integrate the concept into praxis, 3) emphasis on the fact that medi- cal professionalism education is not contradictory to biophysical medical education.

Keywords: Medical Professionalism, Educational environment, Faculty development

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᜖ܩ݅. ݅ ݅ ᮹ᔍॅᯕ ᩑᯝ ᯕ౨í እ❱ŝ ❱ ❱ ŖĊᮥ ݚ⦹۵ ᔢ⫊ ᔢ ᔢ ᮥ ݡ⦹Ł ⦹ ⦹ ᕽ᧝ እಽᗭ ᝅq⦹í ⦹ ⦹ ࡹօ᫵. Ʊᙹ Ʊ Ʊ ܹ ᙹ ᙹ , ᳬᮡ ᮹ᔍa ᔍ ᔍ ࡹ۵ äᯕ௡ ྕᨨᯝʭ᫵ ʭ ʭ ?ˉ

ᔩಽᬕ ಽ ಽ ၡ౩ܩᨥ᮹ ᜽ݡ௝໑ ᗭ௡ ᗭ ᗭ ᜅ ௡ ௡ ౞í ᜽᯲⧩ ᯲ ᯲ ޹ 2000֥ᨱ ݡ

⦽ၝǎ᮹ ᮹ഭĥ۵ ə᧝ ə ə ัಽ ั ั ᩎᔍᨱ ᨧ޹ ᱥ⩡ ᔩಽᬕ ಽ ಽ Ğ⨹ᮥ ⧕

᧝ ⧩݅. ݅ ݅ ᮹᧞ᇥ ᧞ ᧞ ᨦ᮹ ᱥĊᱢᯙ ᜽⧪ᯕ௝۵ ௝ ௝ ˄ᔍ ˄ ┽˅ ᦿᨱᕽ ݚ᜽ ݚ ݚ ᮹ഭ ĥᨱᕽ۵ ˄᮹ഭ❭ᨦ˅ᯕ௝۵ ௝ ௝ Ⅹᮁ᮹ Ⅹvᙹ v v ಽ ᙹ ᙹ ݡ᮲⧩Ł ⧩ ⧩ , ᯕäᮡ ˄᮹ ഭݡ

ഭ ഭ ௡˅ᯕ௝ ᯝ⍍ᨕḥ đŝಽ ŝ ŝ ᯕᨕᲭ݅. ݅ ݅ ᯕ ᔍÕ ᔍ ᔍ ᮥ ˈ➉ᯱॅ᮹ ॅ ॅ ᱥᰢˉ ᯕ௝ ⧩޹ ᔍ⫭ ᔍ ᔍ ⦺ᯱ ⦺ ⦺ ᘂ⪙ ᘂ ᘂ ɝ ⪙ ⪙ (2001)ᮡ ᯕ ᯝᮥ ☖⧕ᕽ ˈ᮹ᔍॅᮡ Ḣ ᨦᱢ ᱶℕᖒŝ ᳕ᨥᖒᮥ ᯤᨩŁ ᨩ ᨩ , ᱶᇡ۵ ᬱ⊺ ᨧᯕ ⮵ॅ ⮵ ⮵ ಙᮝ ಙ ಙ ໑ ᮝ ᮝ , ǎ ၝॅᮡ ᮹ഭእ ഭ ഭ ᯙᔢŝ ᔢ ᔢ ᇩ⠙ᮥ qᙹ q q ⧕᧝ ⧩݅ˉŁ ḡᱢ⧩݅. ݅ ݅ ᯕ⃹ౝ

ᩍ్ ݅᧲⦽ ᮹č, ᯲ɩ᮹ ⡍ťᙹ ť ť ŝᱽ ŝ ŝ (ݡ⦽᮹ᔍ⩲⫭ ᅕࠥᯱഭ ᯱ ᯱ , 2012)᪡ zᮡ z z ℉ᩩ⦽ ݡพŝ i॒ i i ᯕ ᯩ۵ ᯩ ᯩ ᵝᰆॅᯕ ∊࠭⦹۵ ᔍ⫭ ᔍ ᔍ aᬕߑᕽ ᱥྙḢᮥ ᙹ⧪⦹۵ ᱥྙᯙ(profe ff ssional)ᮝಽᕽ᮹ ᩎప ᨱ۵ ᔾ᮹⦺ᱢ ⦺ ⦺ ᯙ ḡ᜾ᨱ ޵⦽ ݅ෙ ݅ ݅ ᩢᩎ᮹ ᩎపᯕ ᯩᨕ᧝ ⧉ᮡ ⧉ ⧉ ᇥ

໦⦹݅ ⦹ . ݅ ݅ 1970֥ݡ ⬥ၹᮥ ၹ ॅᨕ᪅໕ ᪅ ᪅ ᕽ ၙǎᨱᕽ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒᨱ š⦽

š

š ໦᜽ᱢᯙ ם᮹a ᜽᯲ࡹ ᯲ ᯲ Ł 90֥ݡ ᯕ⬥ᨱ۵ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ᮹ ᅙḩ ᱢᯙ ᇡᇥᮝ ᇥ ᇥ ಽᕽ ᯙᱶࡹᨕ ᱢɚᱢᯙ ᯦ࠥ ࠥ ࠥ ᮥ ⦽ äᮡ ᮹ᔍॅᯕ ᱥྙ

aಽ a

a ᕽ ⪽࠺ ⪽ ⪽ ⧕᧝ ⦹۵ ᔍ⫭ ᔍ ᔍ ᱢ ⪹Ğ ⪹ ⪹ ᨱ ݡ⦽ ḥḡ⦽ Łၝŝ ၹᖒ ၹ ၹ ᮹ đŝᯕŁ(Stern & Pap aa adakis, 2006), əäᮡ ᬑญ ᔍ⫭ ᔍ ᔍ ᪡ ᬑญ ᮹⦺

Ʊᮂ

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Ʊ ࠥ ᮂ ᮂ ษ₍ ษ ษ a ₍ ₍ ḡ a a ௝ ᩍĉḥ݅. ݅ ݅ 1990֥ ⬥ၹᇡ ၹ ၹ ░ ᮹ഭ᮹ ᮅญᖒ ⪚ᮡ

ᯙᖒƱᮂ Ʊ Ʊ ᨱ š⦽ š š ḥḡ⦽ ם᮹a ᜽᯲ࡹ ᯲ ᨩŁ ᨩ ᨩ , 2000֥ᨱ Ğ⨹⦽ ∊Ċ ᱢᯙ ᔍ⫭ ᔍ ᔍ ᱢ ⩥ᝅᮡ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ᨱ š⧕ š š šᝍ š š ᮥ aḡ a a Ł ᯩ

޹ Ʊᙹ Ʊ Ʊ ॅᨱí ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ᨱ ᄡ⪵a ⪵ ⪵ ၹऽ ၹ ၹ ᜽ ⦥᫵⦹ ᫵ ᫵ ݅ ⦹ ⦹ ۵ ⪶ᝁ ⪶ ⪶ ᮥ ᵝí ᵝ ᵝ

ࡹᨩᮥ ᨩ äᯕŁ ᯕ۵ ᮹ഭᯙྙ⦺ ྙ ྙ Ʊŝŝ ŝ ŝ ᱶ᮹ ᯦ࠥ ࠥ ࠥ ᮝಽ ऽ్ԍ݅(๚

Ų⪙

Ų

Ų , 2008; ᱶ℁ᬕ, ᬕ ᬕ 2004).

⦽⠙

⦽

⦽ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ᮹ ᱶ᮹a ๅᬑ ݅᧲⦹Ł ⦹ ⦹ ᩎ࠺ᱢᯕ໑ ᯝ⊹

ࡽ ၵa ၵ ၵ ᨧᨕ ə ᱶ᮹ᨱ ݡ⧕ ם᮹⦹ʑ ⦹ ⦹ ᨱ۵ ᨕಅᬕ ᱱᯕ ᯩ݅(Passi et al., 2010). ᩎᔍᱢᮝಽ 1910֥ Flexnera rr ┢ᬵ⦽ Ʊᮂ Ʊ Ʊ ŝ ᮂ ᮂ ⪶Ł ⪶ ⪶ ⦽ Ł Ł ŝ⦺

ŝ

ŝ ᱢ ⦺ ⦺ ☁ݡ ☁ ☁ ᭥ᨱ ᮹ᔍෝ ᧲ᖒ⦽݅ ⦽ ⦽ ۵ እᱥᮥ ᱽ᜽⦹ᩡŁ ᩡ ᩡ , əa ᱽ

᜽⦽ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ᮹ ✡ᮡ ḡӽ 1ᖙʑෝ ᯕҭᨕ᪵ᮝ ᪵ ᪵ ໑(Cooke et al., 2006; Irb r y et al., 2010) ᪅۹ ᪅ ᪅ ᮹ ᮹⦺ၽᱥ ၽ ၽ ᮥ ᯕ൉۵ ☁ݡ ☁ ☁ a ࡹᨩ݅. ݅ ݅ ə్ӹ ᮹ᔍa ᔍ ᔍ ᱥྙa ྙ ྙ ಽ a a ᕽ᮹ ᩎపᮥ w⇵ w w ࠥ ⇵ ⇵ ಾ ࠥ ࠥ ⦹۵ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦ ᖒ Ʊᮂ Ʊ Ʊ ᨱ۵ ᮹ᔍ᪡ ᔍ ᔍ ⪹ᯱ ⪹ ⪹ ᪡ ᯱ ᯱ ᮹ ᪡ ᪡ šĥ š š ෝ ᔾ᮹⦺ᱢ ⦺ ⦺ ᯙ šᱱ š š ᮝಽอ ಽ ಽ ᯕ⧕

⦹۵ äᯕ ᦥܩ௝, ௝ ௝ ə ʑⅩ ᭥ᨱ ⪹ᯱ ⪹ ⪹ ௝۵ ௝ ௝ ᯙĊᮥ ᯙeᱢ e e ᮝಽ ݡ⧁

ᙹ ᯩ۵ ᯩ ᯩ ᩎప, ప ప ੱ⦽ ੱ ੱ ᔍ⫭ ᔍ ᔍ ᱢᮝಽ ᮹ഭĥa Ḣ໕⦹Ł ⦹ ⦹ ᯩ۵ ᯩ ᯩ ࠥᱥᯕӹ

⧕đ⧕᧝ ⧁ ŝᱽ ŝ ŝ ෝ ݅൑ ᙹ ᯩ۵ ᯩ ᯩ ᔍ⫭ ᔍ ᔍ ᱢᯕŁ Ñ᜽ᱢᯙ ᩎప᮹ ᧲ ᖒᯕ ⦥᫵⦹ ᫵ ᫵ Ł ⦹ ⦹ , ᯕෝ ᭥⧕ᕽ۵ ᯙྙᔍ ྙ ྙ ⫭ ᔍ ᔍ ⦺ᱢ ⦺ ⦺ ᯙ Ʊᮂ Ʊ Ʊ , ᮂ ᮂ ᷪ ᮹ഭᯙྙ⦺ ྙ ྙ (medical humanities)ᯕ ⦥᫵⦹ ᫵ ᫵ ݅ ⦹ ⦹ (᪅۹ ᪅ ᪅ ԁ ۹ ۹ ᮹ ᮹ŝݡ⦺ ⦺ᔾ ⦺ ⦺ ॅᯕ Ŗ ᇡ⦹۵ ᮹ŝݡ⦺ॅŝ ॅ ॅ ݡ⦺ᇡ ⦺ ⦺ ᗮᄲᬱॅ᮹ ॅ ॅ ⪹Ğ ⪹ ⪹ ᮡ ᱥྙ⪵ ྙ ྙ ࡽ ḥഭa

޵ ᖙᇥ⪵ ᇥ ᇥ ࡹ ⪵ ⪵ ᨕaŁ a a ᯩŁ ᯩ ᯩ , ᮹ഭʑš᮹ š š ݡ⩶⪵-Ḳᵲ⪵ ᵲ ᵲ ᨱ ঑௝ ݉᭥ ݉ ݉

᜽eݚ e e ᯕ൉ᨕḡ۵ ᮹ഭ⧪ ഭ ഭ ᭥᮹ Ḳᵲࠥ ᵲ ᵲ ᪡ ӽᯕࠥa ŝÑ ŝ ŝ ᨱ እ⧁ ᙹ

ᨧᮥ อⓝ ׳ᦥᲭᮝ Ჭ Ჭ ໑ ᮝ ᮝ , ঑௝ᕽ ௝ ௝ əอ ə ə ⓝ ၵ዁Ჭ݅. ݅ ݅ əญŁ Ʊᙹ Ʊ Ʊ ॅᮡ

ᩑǍᨱ ۹ ἴʕ݅. ݅ ݅ ᯙeᱢ e e ᯙ Ʊqᮥ q q aḩ อ⦽ อ อ ᜽eᱢ e e ᯙ, ᱶᕽᱢᯙ Ŗe

Ŗ

Ŗ ᮥ aḥ ᮹ᔍ-⪹ᯱ ⪹ ⪹ šĥ š š ෝ Ğ⨹⦹ʑ ⦹ ⦹ a ᛞḡ ᦫ݅. ݅ ݅ ᯥᔢᨱᕽ᮹ ᵲ᫵

ᵲ

ᵲ ⦽ ᫵ ᫵ đᱶᮡ ᨕਅ ℉݉ʑ ݉ ݉ ʑ᮹ áᔍ đŝᨱ ঑௝ᕽ ௝ ௝ đᱶᱢᮝಽ đ ᱶࡹ۵ äŝ zᮡ z z ۱ӭᮥ ᵡ݅. ݅ ݅ ᯕ౑ ⪹Ğ ⪹ ⪹ ᨱᕽ ⦺ᔾ ⦺ ⦺ ॅᮡ ᮹ᔍࡹ ᔍ ᔍ ʑ

ෝ ႑ᬭe݅. ݅ ݅ v᮹ᝅᨱᕽ ⦺ᔾ ⦺ ⦺ ॅᮡ ᮹ᔍಽ ᔍ ᔍ ᕽ᮹ ʑᅙᱢᯙ ₦ྕ۵

⪹ᯱ

⪹

⪹ ᮹ ᯱ ᯱ ᯕᯖᮥ ↽ᬑᖁᮝಽ ⧕᧝ ⦹۵ äᯕ௝ ႑ᬑŁ ᬑ ᬑ ੱ ݡݖ⦹ḡ ⦹ ⦹ อ,

อ

อ ᱶݚ⦽ ݚ ݚ ᅕᔢ ᅕ ᅕ ᮥ ᔢ ᔢ ၼ۵ ၼ ၼ Ḣᨦᯙᮝಽᕽ ᮹ᔍॅᯕ ᯱᝁ᮹ ᯕᯖᮥ ᨕ ਜí ⇵Ǎ⧕᧝ ⦹۵a ۵ ۵ ᨱ ݡ⧕ᕽ۵ v᮹ᝅᨱᕽ ႑ᬕ äŝ۵ ᔍྨ

݅ෙ

݅

݅ ԕᬊ᮹ ີ᜽ḡෝ ᝅᱽ ᮹ഭ᮹ ⩥ᰆᨱ ᯩ۵ ᯩ ᯩ ᖁ႑ॅಽ ॅ ॅ ᇡ ಽ ಽ ░ ႑ ᬕ݅. ݅ ݅ ᔢݡᱢᮝಽ ๅᬑ ʕ Ʊᮂ Ʊ Ʊ ᮹ ŝᱶᮥ ☖⧕ᕽ ᔍ⫭ ᔍ ᔍ ᱢᮝಽࠥ ๅ ᬑ ᵲ᫵ ᵲ ᵲ ⦹ ᫵ ᫵ ݅ ⦹ ⦹ Ł ݅ ݅ ᯙᱶၼ۵ ၼ ၼ ᱥྙa ྙ ྙ a a a ࡹ۵ äᯕḡอ ᱶ᯲ ᔍ⫭ ᔍ ᔍ aᬕߑ ᕽ ᱥྙa ྙ ྙ ಽ a a ᕽ ᱥྙa ྙ ྙ ݅ a ᬕ ᩢ⨆ಆŝ ḡࠥಆᮥ ᨕਜí ၽ⭹ ၽ ၽ ⧁ äᯙ aᨱ ݡ⧕ᕽ۵ ᜅᜅಽ ႑ᬭaŁ a a ᯩᨩ޹ äᯕ݅) ݅ ݅ .

1908֥ᨱ ℌ 7໦᮹ ᮹ᔍෝ ႑⇽⦽ ⇽ ⇽ ᩑᖙݡ⦺Ʊ ⦺ ⦺ ᮹ŝݡ⦺(ᩑᖙ᮹ ݡ)ᮡ 1971֥ᨱ ᯕ෕్ᕽ᧝ China Medical Boardʑɩᮝ ɩ ɩ ಽ ᮹⦺Ʊ ⦺ ⦺

ᮂ᮹ ༊ᱢŝ ༊⢽ ༊ ༊ ᨱ ݡ⦽ ᩑǍ᯲ᨦᮥ ḥ⧪⦹ᩍ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ᮹ ༊ᱢŝ

༊⢽

༊

༊ ෝ ⢽ ⢽ ໦᜽⪵⦹ ⪵ ⪵ ʑ ⦹ ⦹ ᨱ ᯕෙ݅(ᩑᖙݡ⦺Ʊ ⦺ ⦺ ᮹ŝݡ⦺ CDP2004 ᭥ᬱ

⫭, 2002). 1996֥ᨱ۵ ǎԕᨱᕽ۵ ⃹ᮭᮝ ᮭ ᮭ ಽ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ⦺ ᮂ ᮂ ŝ ⦺ ⦺ ෝ ࠦพ

ࡽ ŝಽ ŝ ŝ ᕽ }ᖅ⦹ᩡ݅. ݅ ݅ 1886֥ ၙǎᯙ ᮹ᔍ ᦭౭ᨱ ᮹⧕ ᕽ᧲᜾ ᮹

⦺Ʊ

⦺

⦺ ᮂ Ʊ Ʊ ᯕ ᜽᯲ࡽ ᯲ ᯲ ᯕ௹ ᮹ŝݡ⦺ᨱᕽ ⧪⧕ḡ۵ ༉ु ༉ ༉ Ʊᮂ Ʊ Ʊ ᯕ ݚᩑ⯩

᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ᯙߑ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ⦺ ᮂ ᮂ ŝ ⦺ ⦺ ௝۵ ௝ äᯕ ᄥࠥಽ ⦥᫵⦽ ᫵ ᫵ a ⦽ ⦽ ௝۵ ௝ ᯙ᜾

ᯕ ᯩᨩ޹ äᮥ ᔾb⧁ b b ভ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ⦺ ᮂ ᮂ ŝ ⦺ ⦺ ᮹ ŝ ŝ }ᖅᯕ௡ ᔩಽᬕ ಽ ಽ ᇥ᧝ෝ ᧝ ᧝ }⃺⦹۵ ᯝᯕᨩ݅. ݅ ݅ ᯕ᪡ zᮡ z z ᄡ⪵۵ ᮹ഭ⪹Ğ ⪹ ⪹ ᮹ ᄡ⪵, ⪵ ⪵ ⦺ᔾ ⦺ ⦺ ॅ᮹ ॅ ॅ a⊹

a

a šŝ š š ᔾ⪽ႊ ⪽ ᜾ ႊ ႊ ᮹ ᄡ⪵ ၰ ᮹⦺ḡ ⦺ ⦺ ᜾ŝ ʑᚁ᮹ ᚁ ᚁ ၽᱥ ၽ ၽ ᨱ ঑௝ Ʊᮂ Ʊ Ʊ ԕᬊ᮹ ᄡ⪵ ⦥᫵ᖒ ᫵ ᫵ ᯕ ݡࢱࡹ۵ äᨱ ⬉ŝᱢᮝಽ ݡ⃹⦹ʑ ⦹ ⦹ ᭥⦽ ä ᯕ௝ ⧁ ᙹ ᯩ݅. ݅ ݅

᮹ഭĥᨱ ᯝᨕӽ ᄡ⪵۵ ⓍŁ ḡᗮᱢᯕᨩ݅. ݅ ݅ ᮹ᔍ᮹ ᔍ ᔍ ᩎ⧁ŝ ⧁ ⧁ ᱥ

ྙ ᇥ᧝a ݅᧲⪵ࡹ ⪵ ⪵ Ł, ᮹ഭᱶᅕ ᱲɝࠥ ɝ ɝ ᮹ ᝁᰆᨱ ঑ෙ ঑ ঑ ᮹ഭ᮹ ḩ ᱢ ᙹᵡᨱ ݡ⦽ ᫵Ǎ ᫵ ᫵ ᮹ ᷾a ᷾ ᷾ , a a י֥ י י ᮹⦺ŝ ⦺ ⦺ zᮡ z z ᔩಽᬕ ಽ ಽ ᇥ᧝᮹ ᖒᰆ, ᰆ ᰆ ᱶᅕ ᇥ᧝᮹ ၽݍ ၽ ၽ ᨱ ঑ෙ ঑ ঑ Ʊᮂ Ʊ Ʊ , ᮂ ᮂ ḥഭ, ᄲᬱ šญ⪹Ğ ⪹ ⪹ ᮹ ᄡ⪵, ⪵ ⪵ ᮹ഭᨱ ݡ⦽ ǭญ᮹᜾᮹ v⪵ v v ᨱ ঑ෙ ঑ ঑ ᮹ഭ᮹ Ŗᱢ ᅪᔍ ᅪ ᅪ ᮹ ᔍ ᔍ ᖒĊ v⪵ v v ᪡ ⪵ ⪵ z

ᮡ ᄡ⪵a ⪵ ⪵ ᇥ໦⧕Ჭ݅. ݅ ݅ ݡℕ᮹⦺ŝ ⦺ ⦺ ᅕ᪥ ᅕ ᅕ ᮹ ᪥ ᪥ ⦺᮹ ᖒᰆᨱ ݡ⦽ ݡ⃹a

⦥᫵⧕ ᫵ ᫵ ḡŁ, ǎᱽ ǎ ǎ ⪵ᨱ ঑ෙ ঑ ঑ ǎᱽ ǎ ǎ ᱢ ᔍŁ ᔍ ᔍ ᮹ ᝁᰆŝ ᰆ ᰆ ⡎մŁ ǎᱽ ǎ ǎ ⪵ࡽ

ᦩ༊

ᦩ

ᦩ ᯕ ⦥᫵⦹ ᫵ ᫵ í ⦹ ⦹ ࡹᨩ݅. ݅ ݅ ࠺᜽ ࠺ ࠺ ᨱ ݡ⦺᮹ ᯱᮉᖒᨱ ঑ෙ ঑ ঑ ࠦ₞ᱢ ₞ ₞ Ʊ

ᮂŝ

ᮂ

ᮂ ᱶ᮹ ᙹพ᮹ a܆ᖒᯕ ᷾ḥࡹᨩ݅. ݅ ݅ ᯕᨱ ᩑᖙ᮹ݡ۵ 2001֥

Curriculum Deve vv lopment Proj o ect 2004 (CDP2004)ෝ ⇽ჵ᜽┉݅. ݅ ݅ CDP2004 ᭥ᬱ⫭۵ 1971֥ᨱ ᱽᱶ⦽ Ʊᮂ Ʊ Ʊ ༊⢽ ༊ ༊ ෝ ⢽ ⢽ á☁⦽ ☁ ☁ đŝ Ʊ

ᮂ༊ᱢŝ ༊⢽ ༊ ༊ a ᮹ŝݡ⦺ᮥ ⦺ ⦺ ᳙ᨦ⦽ ᮹ᔍᨱí ʑݡ⦹ʑ ⦹ ⦹ ᨕಅᬕ ᯕ ᔢᱢ

ᔢ

ᔢ ᯙ(idealistic) c ᮹ᔍᔢ ᔍ ᔍ ᯕ௝۵ äŝ, ŝ ŝ ༊⢽ ༊ ༊ ᯱℕ ᯱ ᯱ a ⡍ťᱢ ť ť ᯕŁ ⇵ ᔢᱢ

ᔢ

ᔢ ᯕᨕᕽ Ʊŝŝ ŝ ŝ ᱶŝ ⦺᜖ ⦺ ⦺ ༊⢽ ༊ ༊ ಽ Ǎℕ Ǎ Ǎ ⪵⦹ ⪵ ⪵ ʑ ⦹ ⦹ ᨕಖ݅۵ ⠪a ᦥ

௹ ⦺ᔾ ⦺ ⦺ ॅᯕ ǎᱽ ǎ ǎ ᱢᯙ ḡࠥಆᮥ ၽ⭹ ၽ ၽ ⦹۵ ḡࠥᯱ᮹ ᯱ ᯱ ᗭ᧲ᮥ aḡ a a ࠥ

ಾ ⦹ʑ ⦹ ⦹ ᭥⧕ ⦥ᙹᱥྙƱ ྙ ྙ ᮂ Ʊ Ʊ (general profe ff ssional educat aa ion)ᮥ ⦹

ࡹ ⫮ᯝᱢᯕ ᦥܭ }}ᯙ᮹ ⦺ᔾ ⦺ ⦺ ᨱ ฿۵ ฿ ฿ ݅᧲⦽ Ʊᮂ Ʊ Ʊ ŝ ᮂ ᮂ ᱶᮥ ḡ⨆

⦹۵ ႊ⨆ ႊ ႊ ᮝ ⨆ ⨆ ಽ ᔩ೎í ೎ ೎ Ʊᮂ Ʊ Ʊ ༊ᱢŝ ༊⢽ ༊ ༊ ෝ ⢽ ⢽ ᖅᱶ⦹ᩡ݅. ݅ ݅ əญŁ ə

༊ᱢᨱ ঑௝ Ʊᮂ Ʊ Ʊ ŝ ᮂ ᮂ ᱶᮥ }ᱶ⦹í ⦹ ⦹ ࡹᨩ݅. ݅ ݅ Ʊᙹ Ʊ Ʊ ᵲᝍ᮹ v᮹᜾ Ʊᮂ Ʊ Ʊ ᨱᕽ ᯱᮉᱢ ⦺᜖ ⦺ ⦺ ┽ࠥෝ ࠥ ࠥ v᳑ v v ⦹ ᳑ ᳑ Ł ⦹ ⦹ ⦺ᔾ ⦺ ⦺ ॅ᮹ ॅ ॅ ᖁ┾᮹ ⡎ᮥ մ⯭ ⦺ ᔾᵲᝍ᮹ Ʊᮂ Ʊ Ʊ ᮝ ᮂ ᮂ ಽ᮹ ᱥ⪹, ⪹ ⪹ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ᨱᕽ ᱩᝅ⯩ ⦥᫵

⧩޹ ᮹ഭᯙྙ⦺ ྙ ྙ ᮹ ᯦ࠥ, ྙᱽᵲᝍ⦺᜖(problem-based learning, PBL) L ŝ zᮡ z z ᔩಽᬕ ಽ ಽ ⦺᜖ ⦺ ჶ᮹ ᯦ࠥ ࠥ ࠥ ॒ CDP2004 curriculumᯕ a Კ᪉ ᄡ⪵۵ ⫮ʑᱢᯕᨩ݅. ݅ ݅ ᯕ⃹ౝ CDP2004ෝ ☖⧕ ᮹ഭᯙྙ⦺ ྙ ྙ ᯕ ᱢɚᱢᯕŁ ℕĥᱢᮝಽ ᯦ࠥ ࠥ ࠥ ࡹŁ, ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ᯕ௝۵ ௝ ௝ }

ֱᯕ v᳑ v v ࡹʑ ᜽᯲⦹ᩡʑ ভྙᨱ ḡӽ 9֥e᮹ CDP2004 Ʊŝŝ ŝ ŝ ᱶ᮹ ᜽⧪Ğ⨹ᮥ ၹᖒ ၹ ၹ ᱢᮝಽ Łₑ Ł Ł ⦹۵ äᮡ ᯕ⬥᮹ ၽᱥ ၽ ၽ ᮥ ᭥⧕ᕽ

⦥᫵⦽ ᫵ ᫵ ᯝᯕ௝ ⧁ ᙹ ᯩ݅. ݅ ݅

ݡᔢ
ၰ
ႊჶ

ᩑᖙ᮹ݡ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ᮹ Ğ⨹ᨱ ݡ⦽ ၹᖒ ၹ ၹ ᱢ Łₑ Ł Ł ᮥ ₑ ₑ ᭥

⦹ᩍ ℌṙ, ᮹ഭᯙྙ⦺ ྙ ྙ v᮹ෝ Ʊŝŝ ŝ ŝ ᱶᮝಽ ℕĥᱢᮝಽ ᯦ࠥ ࠥ ࠥ ⦹í ⦹ ⦹

ࡽ CD2004᮹ ᱥ}ŝᱶᮥ }ť⦹Ł ⦹ ⦹ }ᱶࡽ Ʊŝŝ ŝ ŝ ᱶ᮹ ᮹ၙෝ ᮹

⦺ᱥ

⦺

⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ᮹ ᮂ ᮂ ⊂໕ᨱᕽ ⠪a⦹ a a Ł ⦹ ⦹ ᯱ ⦹ᩡ݅. ݅ ݅ ࢹṙ ࢹ ࢹ , CDP2004 Ʊŝŝ ŝ ŝ ᱶᮥ ☖⧕ ႑⇽ࡽ 2009⦺֥ࠥᇡ ࠥ ࠥ ░ 2012⦺֥ࠥʭḡ ʭ ʭ ᳙ᨦᔾ

ᮥ ݡᔢᮝ ᔢ ᔢ ಽ ᝅ᜽⦽ ᳙ᨦᖅྙḡᨱᕽ ᮹ഭᯙྙ⦺ ྙ ྙ ŝ ⦺ ⦺ ᱶᯙ ˈ᮹ഭ᪡ ᔍ

⫭ˉᨱ ݡ⦽ v᮹⠪a ၰ อ᳒ อ อ ࠥ ᳒ ᳒ , ᖁ┾ŝ༊ᨱ ݡ⦽ อ᳒ อ อ ࠥ ᳒ ᳒ , ᮹⦺ŝ ⦺ ⦺ ᮹ᔍḢᨱ ݡ⦽ ᯱʑ ᯱ ᯱ ᯕ⧕, Wo W W rl rr d Health Organizat aa ion (WHO)ᨱ ᕽ ᱶ᮹⦽ ᮹ᔍ᮹ ᔍ ᔍ ᩎ⧁ᨱ ݡ⦽ ᯙ᜾ᨱ ݡ⦽ ᖅྙ đŝෝ ᇥᕾ⦹ᩡ

Ł, 2009–2011֥ࠥᨱ Ų⩽Ʊᮂ Ʊ Ʊ ᭥ᬱ⫭ᨱᕽ ᝅ᜽⦽ 1-2⦺֥ᮥ ݡᔢ ᮝಽ ⦹ᩍ ᝅ᜽⦽ ˈ᮹ഭ᪡ ᔍ⫭ˉᨱ ݡ⦽ ᖅྙ᳑ᔍ đŝ, ŝ ŝ əญŁ Curriculum Deve vv lopment Proj o ect 2013 (CDP2013) ᭥ᬱ⫭ᨱᕽ ᮹

⦺ŝ

⦺

⦺ ᰍ⦺ᔾ ⦺ ⦺ 252໦ᮥ ݡᔢᮝ ᔢ ᔢ ಽ ᜽⧪⦽ ᖅྙ᳑ᔍᨱᕽ ˈ᮹ഭ᪡ ᔍ

⫭ˉ Ʊŝŝ ŝ ŝ ᱶᨱ ݡ⧕ ᵝš᜾ š š ᮝಽ ݡݖ⦽ đŝෝ ჵᵝ⪵ ᵝ ᵝ ⦹ ⪵ ⪵ ᩍ ⠪a đŝෝ ᇥᕾ⦹ᩍ ᩑᖙ᮹ݡ᮹ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ŝ ᮂ ᮂ ᮹ഭᯙྙ⦺ ྙ ྙ Ʊᮂ

Ʊ

Ʊ Ğ⨹ᮥ ၹᖒ ၹ ၹ ᱢᮝಽ Łₑ Ł Ł ⦹ᩡ݅. ݅ ݅

đ
ŝ


$%1
Ʊŝŝᱶᨱᕽ
ḡ⨆⦽
᮹⦺ᱥྙḢᨦᖒ
Ʊᮂ

CDP2004᮹ Ʊŝŝ ŝ ŝ ᱶ }ᱶᮡ Ⓧí ˄ྕ ˄ ᨨᮥ a෕ a a ⋁ äᯙa˅ a a ᪡ ˄ᨕ ਜí a෕ a a ⋁ äᯙa˅ a ᨱ ݡ⦽ ᄡ⪵ᯙߑ, ᯕäᮡ ᩑᖙ᮹ݡ᮹ ᮹⦺ᱥ ⦺ ⦺ ྙ Ḣᨦᖒ Ʊᮂ Ʊ Ʊ ᮹ ḡ⨆ᱱᮥ ၹᩢ⦹۵ ᯲ᨦᯕᨩ݅Ł ݅ ݅ ⧁ ᙹ ᯩ݅. ݅ ݅ ᬑᖁ v᮹ԕᬊᨱ ᯩᨕᕽ۵, ℌṙಽ ᮹⦺ŝ ⦺ ⦺ 1, 2⦺֥ᮡ v᮹, 3, 4⦺֥ᮡ

ᝅ᜖ᮝ ᜖ ᜖ ಽ Ǎᖒ⦹ࡹ v᮹۵ Ʊᝅ Ʊ Ʊ ᄥ-ŝ༊ᄥ v᮹ᨱᕽ ᰆʑ-ĥ☖ᄥ

☖⧊

☖

☖ v ⧊ ⧊ ᮹ಽ ᱥ⪹⦹ ⪹ ⪹ ᩍ ⦺ᔾ ⦺ ⦺ ॅᯕ ʑⅩ᮹⦺ŝ ⦺ ⦺ ᯥᔢ᮹⦺ᮥ ⦺ ⦺ ☖⧊ ☖ ☖ ᱢ ⧊ ⧊ ᦩ

༊ᮝ

༊

༊ ಽ ᅝ ᙹ ᯩࠥ ᯩ ᯩ ಾ ࠥ ࠥ ⦹ᩡ݅. ݅ ݅ ᯕᨱ ঑௝ ݡ⩶ v᮹⩶┽᮹ ᙹᨦ᜽e

ᮡ 2,531᜽eᨱᕽ 1,440᜽eᮝ e e ಽ qᗭ q q ⦹ ᗭ ᗭ ᩡ۵ ᩡ ᩡ ߑ, ᯕ౑ đᱶᮡ ˈ⦺ᔾ ⦺ ⦺

ॅᨱí۵ ⦥᫵⦹ ᫵ ᫵ ḡ ⦹ ⦹ ᦫᮡ ᦫ ᦫ ŝࠥ ŝ ŝ ⦽ ࠥ ࠥ ᱶᅕෝ ᅕ ᅕ ᵝᨕ ⦺ᔾ ⦺ ⦺ ᮝಽ ⦹ᩍɩ v᮹ ԕᬊᮥ ᗭ⪵⦹ ⪵ ⪵ ۵ߑ ɪɪ⦹ ɪ ɪ í ⦹ ⦹ ⦹۵ ᙹ࠺ᱢᯙ ⦺᜖ ⦺ ᮥ ⦹ࠥ ⦹ ⦹ ಾ ࠥ ࠥ ⦹۵ äᯕ ᦥܩ௝ ᳡ ޵ ⬉ᮉ ⬉ ⬉ ᱢᮝಽ ⦥᫵⦽ ᫵ ᫵ ԕᬊᮥ a෕ a a ⊹ᯱ۵ ༊ᱢˉᮝ ˉ ಽ ᯕ൉ᨕḥ äᯕ݅(ᩑᖙݡ⦺Ʊ ⦺ ⦺ ᮹ŝݡ⦺ CDP2004 ᭥ᬱ⫭, 2002).

v᮹᮹ ԕᬊᮡ ⦺ᔾ ⦺ ⦺ ᮝಽᕽ ၹऽ ၹ ၹ ᜽ ᦭ᦥ᧝ ⧁ ԕᬊᯕ ྕᨨᯙaᨱ ݡ⦽ ݕݚ ݕ ݕ Ʊ ݚ ݚ ᙹ Ʊ Ʊ ॅ᮹ ॅ ॅ ☁᮹ෝ ☖⧕ đᱶ⦹ᩡ݅. ݅ ݅ ࢹṙ ࢹ ࢹ ಽ ᯥᔢ᮹⦺᯦ྙ

ŝᱶ(introduction to clinical medicine)ᮥ ᝁᖅ⦹ᩍ 1, 2⦺֥ॅಽ ॅ ॅ

⦹ᩍɩ ᯥᔢᨱ ᳑ʑ י⇽ י י ࢁ ᙹ ᯩࠥ ᯩ ᯩ ಾ ࠥ ࠥ ⦹ᩡᮝ ᩡ ᩡ ໑ ᮝ ᮝ , ᖬṙಽ۵ ಽ ಽ ⦺ᔾ ⦺ ⦺ ॅ ᯕ ᔍ⫭ ᔍ ᔍ ෝ ᯕ⧕⦹Ł ⦹ ⦹ , ⪹ᯱ ⪹ ⪹ ෝ ᔾᝍญᔍ⫭ ᔍ ᱢ(bio-psyc yy ho-social) š ᱱ, ᷪ ☖ᱥᱢᯙ šᱱ š š ᨱᕽ ᅝ ᙹ ᯩ۵ ᯩ ᯩ ᦩ༊ ᦩ ᦩ ᮥ ┅ᬭᵝʑ ᵝ ᵝ ᭥⦽ ŝᱶᮝ ಽᕽ ˈ᮹ഭ᪡ ᔍ⫭ ᔍ ᔍ ˉ Ʊᮂ Ʊ Ʊ ŝ ᮂ ᮂ ᱶᮥ }ၽ⦹ᩡ݅. ݅ ݅

ᯕᨕ ˄ᨕਜí a෕ a a ⋁ äᯙa˅ a a ᷪ, ᷪ ᷪ Ʊᙹ Ʊ Ʊ -⦺᜖ ⦺ ⦺ ᮹ ᜖ ᜖ ႊჶᨱ ᯩᨕᕽ۵ ᯱ ʑᵝࠥ ᵝ ᵝ ⩶ ࠥ ࠥ ⦺᜖ ⦺ ⦺ ੱ۵ ੱ ੱ ᯱᮉᱢ ⦺᜖ ⦺ ┽ࠥෝ ࠥ ࠥ w⇵ w w ʑ ᭥⦽ ᄡ⪵ෝ ᜽ࠥ

⦹ᩡ݅. ݅ ݅ ℌṙಽ Ʊᙹ Ʊ Ʊ a ᙹ ᙹ v᮹ෝ ☖⧕ ᱶᅕෝ ᅕ ᅕ ᱥݍ⦹۵ äᯕ ᦥܩ௝

⦺ᔾ

⦺

⦺ ॅಽ ॅ ॅ ⦹ᩍɩ ᯱʑ ᯱ ᯱ ᵝࠥ ᵝ ᵝ ᱢᯙ ⦺᜖Ğ⨹ᮥ ⦹ࠥ ⦹ ⦹ ಾ ࠥ ࠥ ࠶۵ ⛽░(t (( u- tor) r ⪚ᮡ Ⅺḥᯱ(fa ff cilitat aa or) r ಽᕽ ᩎ⧁⦹۵ PBL Ʊŝŝ ŝ ŝ ᱶᮥ ᝁᖅ

⦹ᩡ۵ ᩡ ᩡ ߑ ᯕ ŝᱶᮡ 1⦺֥ 4ᇥʑ ᇥ ᇥ ᪡ 2⦺֥ᨱ ᵝݚ ᵝ ᵝ 4᜽eᦊ ḥ⧪⦹ࠥ ⦹ ⦹

ಾ ⦹ᩍ ⅾ 80᜽eᮥ ႑ᱶ⦹ᩡ݅. ݅ ݅ ࢹṙ ࢹ ࢹ ಽ ᖁ┾ŝ༊ᮥ ⪶ᰆ ⪶ ⪶ ⦹ᩍ ⦺ ᔾॅಽ ॅ ॅ ⦹ᩍɩ šᝍ š š ᇥ᧝ᨱ ݡ⧕ ᯱၽᱢ ၽ ၽ -ᵝࠥ ᵝ ᵝ ᱢᮝಽ ᖁ┾⦹ᩍ ᝍ

⪵⦺

⪵

⪵ ᜖ ⦺ ⦺ ᮥ ⧁ ᙹ ᯩࠥ ᯩ ᯩ ಾ ࠥ ࠥ ⦹ᩡ݅. ݅ ݅ ᖁ┾ŝ༊ᮡ ᯥᔢ ၰ ʑⅩ᮹⦺ ᇥ᧝

ᨱᕽ 2004֥ 28} ŝ༊ᯕ }ᖅࡽ ᯕ⬥ 2011֥ʭḡ ʭ ʭ ᵲᦺs ᦺ ᦺ 50}᮹ ᖁ┾v᮹a ๅ֥ }ᖅࡹᨩŁ ᨩ ᨩ , ᮹ഭ᪡ ᔍ⫭ ᔍ ᔍ ᮹ Ğᬑᨱࠥ ݅᧲⦽ ᵝ ᱽಽ ᖁ┾ŝ༊ᮥ }ᖅ⦹ᩍ ⦺ᔾ ⦺ ⦺ ॅ᮹ ॅ ॅ ᖁ┾ᨱ ঑௝ ݅᧲⦽ ⦺᜖ ⦺ ᯕ a܆⦹ࠥ ⦹ ⦹ ಾ ࠥ ࠥ ⦹ᩡ݅. ݅ ݅ ᖬṙಽ ᮹⦺ŝ ⦺ ⦺ 1, 2⦺֥᮹ Ğᬑ ᪅⬥ ᪅ ᪅ ᜽eᨱ۵ a܆⦽ ܆ ܆ v᮹᜽eᮥ ႑ᱶ⦹ḡ ⦹ ⦹ ᦫᦥ ⦺ᔾ ⦺ ⦺ ॅᯕ ᯱᮉᱢᮝಽ ⦺᜖⧁ ᜖ ᜖ ᙹ ᯩ۵ ᯩ ᯩ ᜽eᮝ e e ಽ ᱥ⪹⦽ ⪹ ⪹ ä ੱ⦽ ੱ ੱ ᯱʑ ᯱ ᯱ ᵝࠥ ᵝ ᵝ ⩶ ࠥ ࠥ ⦺᜖ ⦺ ⦺ ᮥ v᳑ v v ⦽ ᳑ ᳑ đᱶ ᯕ௝Ł ௝ ௝ ⧁ ᙹ ᯩ݅. ݅ ݅


᮹ഭᯙྙ⦺
Ʊᮂᮥ
᭥⦽ⲱ᮹ഭ᪡
ᔍ⫭Ⲳ
Ʊŝŝᱶ
ᝁᖅ CDP2004 Ʊŝŝ ŝ ŝ ᱶ᮹ ⓑ ᄡ⪵۵ ˈ᮹ഭ᪡ ᔍ⫭ ᔍ ᔍ ˉ Ʊŝŝ ŝ ŝ ᱶ᮹ ᝁ ᖅᯕ݅. ݅ ݅ ᯕ ŝᱶᮡ ⦺ᔾ ⦺ ⦺ ॅಽ ॅ ॅ ⦹ᩍɩ ᯙྙᔍ ྙ ྙ ⫭ ᔍ ᔍ ⦺ᱢ ⦺ ⦺ ᗭ᧲ᮥ ⫮ा⦹ࠥ ⦹ ⦹

ಾ ⧉ᮥ ⧉ ༊ᱢᮝಽ ⦹ᩡ݅. ݅ ݅ CDP2004ᨱᕽ ᯙྙᔍ ྙ ྙ ⫭ ᔍ ᔍ ⦺ᱢ ⦺ ⦺ ᯙ ᗭ᧲ᯕ

௡ ℌṙ, ᯱᝁŝ ݅ෙ ݅ ݅ ┡ᯙ, ┡ Ḳ݉ᨱ ݡ⧕ ᯕ⧕⦹Ł ⦹ ⦹ əॅ ə ə ŝ ॅ ॅ ⧉̹ ⧉ ⧉

޵ᇩᨕ ᔍ۵ ܆ಆ, ࢹṙ ࢹ ࢹ , ྙᱽ ྙ ྙ ᮹᜾ᮥ aḡ a a Ł əᨱ ə ə ݡ⦹ᩍ ᔾb⦹Ł ⦹ ⦹

⧪࠺⦹ᩍ ⧕đ⧁ ᙹ ᯩ۵ ᯩ ᯩ ܆ಆ, ᷪ ᯙe, e e ᔍ⫭ ᔍ ᔍ , ᩎᔍ, ᔍ ᔍ ᯱᩑ, ⪹Ğ ⪹ ⪹ , ḥญ

॒ᨱ ݡ⦽ ḩྙᮥ ޹ḩ ᙹ ᯩŁ ᯩ ᯩ , Łၝ⦹Ł ⦹ ⦹ , əᨱ ə ə ݡ⦽ ⧕đᮥ ⇵Ǎ⧁ Ǎ Ǎ ᙹ ᯩ۵ ᯩ ᯩ ๅᬑ ⡍ť ⡍ ⡍ ᱢ ť ť ᯙ ḡᱢ ܆ಆ, ň ݉ᙽ ݉ ݉ ⦽ ᙽ ᙽ ᮹⦺ḡ ⦺ ⦺ ᜾อᮥ อ อ aḡ a a Ł ۵ ᯕ൑ ᙹ ᨧ۵ ܆ಆᮥ ᮹ၙ⦹Ł ⦹ ⦹ ᯕᨱ ޵⦹ᩍ ᔾb᮹ Ɂ⩶ŝ ᔗᮥ ᔗ ᔗ

⣮ᇡ⦹í ⦹ ⦹ ٥ญŁ q࠺ q q ⧁ ࠺ ࠺ ᙹ ᯩ۵ ᯩ ᯩ ܆ಆᮝಽ ᯕ⧕⦹ᩡ݅(ᩑᖙݡ⦺Ʊ ⦺ ⦺ ᮹ŝݡ⦺ CDP2004 ᭥ᬱ⫭, 2002).

ᬑᖁ ᮹ᩩŝ Ʊŝŝ ŝ ŝ ᱶᮡ 2004֥ᇡ░ ˄᮹ഭᯙྙ⦺ ྙ ྙ ˅ v᮹ಽ }ᖅ

ࡹᨩ݅a ݅ ݅ 2008֥ᨱ۵ ˄᮹⦺᮹ ᯕ⧕˅ ŝᱶᮝಽ }ᱶࡹ໕ᕽ ᙹᨦႊ᜾ ႊ ႊ

ᮡ ᯕು v᮹, ࠦᕽ ☁ು ☁ ☁ , ᳑ᄥ ၽ⢽ ၽ ၽ ॒ᮝ ॒ ॒ ಽ ḥ⧪⧩Ł ⧩ ⧩ , Ğ⨹⦺᜖᮹ ᜖ ᜖

ʑ⫭ෝ ᱽŖ⦹Ł ⦹ ⦹ ᯱ ⦹ᩡ݅. ݅ ݅ ᯕ్⦽ ᙹᨦŝᱶᨱ ݡ⧕ᕽ ၹᖒ ၹ ၹ ᱢ ᔍŁ ᔍ ᔍ

ෝ ☖⦽ ☖ ☖ ɡᥑ ɡ ɡ ʑ ᯲ᨦᮥ ŝᱽ ŝ ŝ ಽ ᇡŝ⦹ ŝ ŝ ᩍ ⡍✙⡕ ✙ ✙ ญ᪅ෝ ᪅ ᪅ ᯲ᖒ ᯲ ᯲ ⦹ࠥ ⦹ ⦹ ಾ ࠥ ࠥ

⦹ᩡ݅. ݅ ݅ ⦺ʑ ⦺ ⦺ ั ⦥ʑ᜽⨹ᮡ םᚁ⩶ ྙᱽ ྙ ྙ ಽ ⇽ᱽ ⇽ ⇽ ⦹ᩍ ⦺ᔾ ⦺ ⦺ ॅ᮹ ॅ ॅ ྙᱽ ྙ ྙ ᯙ᜾, םญᱢ ᱥ}, םÑ ם ם ᮹ ᱢᱩᖒ, əญŁ đು᮹ ┡ݚ ┡ ┡ ᖒ ݚ ݚ ॒ᮥ ⠪a

⧉ᮝ

⧉

⧉ ಽ៉ ᮹⦺ᨱ ݡ⦽ šᱱ š š ᮥ ᨕਜí ⩶ᖒ⧕ aŁ a a ᯩŁ ᯩ ᯩ , ੱ əᨱ ə ə ݡ

⧕ᕽ ᨕਜí ᯱʑ ᯱ ᯱ ᵝᰆᮥ ᰆ ᰆ ⧁ ᙹ ᯩ۵ ᯩ ᯩ ḡෝ ⠪a⦹ a a ᩡ݅. ݅ ݅ 2010֥ᇡ░۵

˄ᔾ

˄ -ಽ - - ಽ ᄲ-ᔍ˅ ᔍ ᔍ ௝۵ ௝ ௝ ᔾᧁᵝʑ ᵝ ᵝ ෝ ᵲᝍᵝᱽಽ Ǎᖒ⦹ᩡ݅(Ta T T b a le 1). ᯕ

ෝ ᔍḥ, ᩑɚ, ɚ ɚ user creat aa ed contents, ᗭᖅŝ zᮡ z z ₞᯲ ₞ ₞ ŝ ᯲ ᯲ ᱽ ŝ ŝ ᪡ ⧉̹ ⧉ ⧉

➉ձ ☁ು ☁ ☁ , ⛽░Ʊᙹ Ʊ Ʊ ᪡ ᙹ ᮹ ᪡ ᪡ ᗭə൚ ə ə ☁ು ☁ ☁ ॒ŝ ॒ ॒ zᮡ z z ݅᧲⦽ ႊ᜾ ႊ ႊ ᮝಽ

⦺᜖

⦺

⦺ ⦹ࠥ ⦹ ⦹ ಾ ࠥ ࠥ ᮁࠥ ᮁ ᮁ ⦹ ࠥ ࠥ ᩍ ŝ⦺ ŝ ŝ ᱢ ⦺ ⦺ ᵝᱽॅᨱ ݡ⧕ ₞᮹ᱢᯙ ᯙྙ⦺ ྙ ྙ ᱢ ⦺ ⦺ ᔍ

ᮁ᪡ Ğ⨹ᮥ aḡ a a ࠥಾ ࠥ ࠥ ⦹ᩡ݅(ᩑᖙݡ⦺Ʊ ⦺ ⦺ ᮹ŝݡ⦺ CDP2013 ᔍᨦ

݉,

݉

݉ 2012). ⦺ᔾ ⦺ ⦺ ॅᯕ ᵝࠥ ᵝ ᵝ ᱢᮝಽ ₙᩍ⦹ʑ ⦹ ⦹ ᭥⧕ᕽ۵ ᱢᱩ⦽ ᧲᮹ ŝ ᱽa ᵝᨕḡ۵ äᯕ ᮹ၙ ᯩ۵ ᯩ ᯩ ࠺ʑ ࠺ ࠺ ᇡᩍෝ ⦹Ł ⦹ ⦹ ᯩ݅۵ äᮥ šₑ š š

⧁ ᙹ ᯩᨩ݅(ᦩᰍ ᦩ ᦩ ⯍᪡ ᱥᬑ┾, 2011).

᮹⦺ŝ ⦺ ⦺ ŝᱶᮡ ᮹ഭ᪡ ᔍ⫭ ᔍ ᔍ Ʊᮂ Ʊ Ʊ ŝ ᮂ ᮂ ᱶ᮹ ༊⢽ ༊ ༊ ᮹ ᔢݚ ᔢ ᔢ ᇡᇥᮥ ᯕ

ၙ ݅൉ ݅ ݅ Ł ൉ ൉ ᯩ޹ ʑ᳕ Ʊŝŝ ŝ ŝ ᱶ(ᩩႊ᮹⦺, ⦺ ⦺ ⧪࠺ŝ ࠺ ࠺ ⦺ ŝ ŝ , ⦺ ⦺ ᮹ഭᮅ ഭ ഭ ญ, ᮹ഭ ჶ, ⦽᮹⦺) ⦺ ⦺ ᮹ ԕᬊᮥ ᅕv⦹ᩍ ⡍ť⦹ᩡŁ ᩡ ᩡ , ᦥḢ ݅൉ḡ ༜⧩޹

ᇡᇥᮥ ᔩಽᬕ ಽ ಽ Ʊŝ༊ᮝ ༊ ༊ ಽ }ᖅ⦹ᩡ݅. ݅ ݅ ᯕᨱ ঑௝ ᮹ഭᔍ⫭ ᔍ ᔍ ⅾು, ญ޵ᛞŝ ⍅စܩ⍡ᯕᖹ, ᮹ഭᱶ₦ŝ Ğᩢ, ☖⧊ ☖ ☖ ᮹⦺ŝ ⦺ ⦺ zᮡ z z Ʊŝ༊

ᯕ ᔩ೎í ೎ ೎ }ᖅࡹᨩ݅. ݅ ݅ ⃹ᮭ Ʊŝŝ ŝ ŝ ᱶᯕ ⠙ᖒࢁ ভ۵ Ʊŝ༊ᯕ ት

ಾv᳭ v v ⩶ ᳭ ᳭ ┽ಽ ႑ᩕࡹ۵ Ǎ᳑ᩡᮝ ᩡ ᩡ ӹ ᮝ ᮝ 2009֥ᇡ░۵ Ʊŝ༊᮹ Ǎᖒ

ᮥ ⦺ᔾ ⦺ ⦺ ॅಽ ॅ ॅ ⦹ᩍɩ ၹᅖ ၹ ၹ י⇽ י י ࡹ ⇽ ⇽ ໕ᕽ ᝍ⪵⦺ ⪵ ⪵ ᜖ ⦺ ᯕ ࡹࠥಾ ࠥ ࠥ ⦹۵ ӹ ᖁ⩶ Ǎ᳑ಽ ⠙ᖒ⦹ᩡ݅(Ta T T b a le 2). ᯕᨱ ঑௝ ˄⥥ ˄ ಽ⟹ᖵձญ᷹˅ Ʊ ŝ༊᮹ Ğᬑ۵ ญ޵ᝎ(1⦺֥)-ḥಽᖁ┾ŝ ญ޵ᝎ(2⦺֥)-ḥಽᖁ┾

(3⦺֥)-ḥಽᖁ┾ ၰ Ḣᨦᱥྙᖒᯕ⧕(4 (( ⦺֥)᪡ zᮡ z z Ǎᖒᮥ ᯕ൉í

ࡹᨩ݅. ݅ ݅ ᮹ഭᮅ ഭ ഭ ญ᮹ Ğᬑࠥ ᬑ ᬑ ᅙŝ 3⦺֥ 4ᇥʑ ᇥ ᇥ ᨱ ᯕ൉ᨕḡ޹ äᮥ 2

Table 1. Medical humanities courses for pre-medical students in Yonsei College of Medicine after CDP2004

Year Course title Contents & remark

2004–2007 Medical humanities Series of lectures coordinated by professors

2008–2009 Understanding of medicine Lectures, book discussion, group mission and presentation, reflective writings, making portfolios 2010–present Understanding of medicine Series of 4 courses based on the life cycle: birth-aging-disease-death

Lectures, book discussion led by tutoring professors

Students are required to present their understanding of medicine through photography, UCC, drama, and creative writings such as short novel, group mission project, reflective writings and making portfolios

CDP2004, Curriculum Development Project 2004; UCC, user created contents.

Table 2. Comparison of medical humanities course-“medicine and society” between 2 periods (period I: 2004-2008, period II: 2009-present) Year

Period I Period II

1st quarter 2nd quarter 3rd

quarter 4th quarter 1st quarter 2nd quarter 3rd

quarter 4th quarter 1 M&S

1

Introduction to M&S (8 wk)

M&S 2

Behavioral science (8 wk)

E 1 M&S 3 Leadership

& com- munica- tion

M&S 1

Introduction to M&S Understanding of

humans and so- ciety

M&S 2

History of medicine (4 wk) Behavioral science

(4 wk)

E 1 M&S 3

Research methodol- ogy

Professionalism 1:

leadership

2 PM 1 Epidemiology PM 2 Environment and industrial health

E 2 PM 3 Healthcare manage- ment

PM 1 Epidemiology M&S 4

Professionalism 2:

career develop- ment and leader- rr ship

Medical ethics

E 2 PM 2 Environment and industrial health

3 M&S 4

Healthcare policy and administration

M&S 5

Alternative medicine

E 3 M&S 6 Medical ethics

M&S 5

Alternative medi- cine (4 wk) Medical ethics

(4 wk)

PM 3 Healthcare management

E 3 M&S 6

Professionalism 3:

career develop- ment (3 wk) Medical law (5 wk) 4 M&S

7

Medical law M&S

7

Professionalism 4: career choice (4 wk) Professionalism

5: understand-

ing on profes-

sionalism (4 wk)

M&S 1-7, medicine and society 1-7; PM 1-3, preventive medicine 1-3; E 1-3, elective 1-3.

⦺֥ŝ 3⦺֥ᨱ ӹ٥ᨕ ⠙ᖒ⦹ᩡ݅. ݅ ݅ ⅾು᮹ Ğᬑᨱ۵ ᯙeŝ e e ᔍ⫭ ᔍ ᔍ ᨱ ݡ⦽ ᯕ⧕ಽᕽ ᳡ ޵ ԕᬊᮥ ᝍ⪵⦹ ⪵ ⪵ ᩡŁ ᩡ ᩡ , ᯕᨱ ঑௝ ⧪࠺ŝ ࠺ ࠺ ⦺ ŝ ŝ ᮹

᜽eᮥ ᵥᯕ໕ᕽ ᮹⦺ᔍ ⦺ ⦺ v᮹ෝ ⇵a ⇵ ⇵ ⦹ a a ᩡ݅. ݅ ݅ ᯕ۵ ᮹⦺ᨱ ݡ⦽ ☖

᜽ᱢᯕŁ ݅໕ᱢᯙ ᯕ⧕ əญŁ ᯙྙ⦺ ྙ ྙ ᱢ ⦺ ⦺ ᯙ ᯙe ᯕ⧕ෝ ࠥ༉⦹ ༉ ༉ Ł ⦹ ⦹

ᯱ ⦽ äᯕ௝Ł ௝ ௝ ⧁ ᙹ ᯩā݅. ݅ ݅ Ŗ☖ŝ ☖ ☖ ᱶᨱ ޵⦹ᩍ ᮹⦺ŝ ⦺ ⦺ 1–3⦺֥᮹ 3ᇥʑ ᇥ ᇥ ᨱ۵ ᖁ┾ŝ༊ᮥ ᙹv⧁ v v ᙹ ᯩí ⦹ᩡ۵ ᩡ ᩡ ߑ, 2004֥ 5ŝ༊ᮥ

}ᖅ⦽ ᯕ௹ ᩩᚁŝ ᚁ ᚁ ᮹⦺, ⦺ ⦺ ྙ⪵ ྙ ྙ ᱢ ᯕ⧕, ᯙǭŝ ᮹ഭᮅ ഭ ഭ ญ, ᅕÕᱶ₦, ᮹ᔍᗭ ᔍ ᔍ ☖ŝ ☖ ☖ ݅໕ᱢᯙ ᯙeᯕ⧕ əญŁ ᮹⦺ŝ ⦺ ⦺ ʑࠦƱ ࠦ ࠦ ᪡ zᮡ z z ݅᧲

⦽ ᵝᱽಽ ⅾ 25}᮹ ᖁ┾v᳭ v v a ᳭ ᳭ }ᖅࡹᨩᮝ ᨩ ᨩ ໑ ᮝ ᮝ }ᖅ ŝ༊ᙹa ᙹ ᙹ ᷾a ᷾ ᷾

⦹۵ ⇵ᖙᨱ ᯩ݅(Ta T T b a le 3).


⦺ᔾ
⦝ऽ႒ᮥ
☖⦽
᮹⦺ᱥྙḢᨦᖒ
Ʊŝŝᱶ᮹
⠪a ᮹ഭ᪡ ᔍ⫭ ᔍ ᔍ Ʊŝŝ ŝ ŝ ᱶᨱ ݡ⦽ ɮᱶᱢᯙ ⠪a۵ ᮹ഭᨱ ݡ⦽ ᯕ

⧕᪡ šᱱ š š ᮥ ⩶ᖒ⧁ ᙹ ᯩᨩŁ ᨩ ᨩ (4 (( 8.1%), ᯱᝁŝ ┡ᯙᨱ ݡ⦽ ᯕ⧕᪡

ᖒₑ᮹ ʑ⫭a ࡹᨩᮝ ᨩ ᨩ ໑ ᮝ ᮝ (39.3%), ݅᧲⦽ ᇥ᧝᮹ ݅᧲⦽ Ğ⨹ᮥ a ḥ ᱥྙᯙᔍॅᮥ อԁ อ อ ᙹ ᯩ۵ ᯩ ᯩ ʑ⫭a ࡹᨕ əॅ ə ə ᮹ ॅ ॅ እᱥŝ Ğ⨹ᮥ

Ŗᮁ⧁ ᮁ ᮁ ᙹ ᯩᨕ ᯙྙᔍ ྙ ྙ ⫭ ᔍ ᔍ ⦺ᱢ ⦺ ⦺ ᯙ ᗭ᧲ᮥ ⧉᧲⧁ ᙹ ᯩ۵ ᯩ ᯩ ʑ⫭a ࡹ ᨩ݅(28.6%)۵ äᯕᨩ݅. ݅ ݅ ᯕᨱ ޵⦹ᩍ ᮹ᔍ᮹ ᔍ ᔍ ᩎ⧁ŝ ⧁ ⧁ ₦ᯥᨱ ݡ⧕

ᕽ ᯱb ᯱ ᯱ ⧁ b b ᙹ ᯩ۵ ᯩ ᯩ ʑ⫭a ࡹᨩ݅۵ ä(21.4%)ŝ }ᯙᱢ šᝍ š š ᇥ᧝

᮹ ĥၽ᮹ ʑ⫭a ࡹᨩ݅۵ äᯕᨩ݅(Fig. 1A).

᮹ഭ᪡ ᔍ⫭ ᔍ ᔍ Ʊŝŝ ŝ ŝ ᱶᯕ ӹᖁ ӹ ӹ ⩶ Ʊᮂ Ʊ Ʊ ༉ ᮂ ᮂ ߙ ༉ ༉ ᮥ ☖⧕ ⦺ᔾ ⦺ ⦺ ॅᯕ ⦺᜖ ⦺ ᮹ ᵝᱽॅᨱ ၹᅖ ၹ ၹ ᱢᮝಽ י⇽ י י ࡹ ⇽ ⇽ ࡹ ᝍ⪵ࡽ ԕᬊᮝ ᬊ ᬊ ಽ Ğ⨹⧉ᮝ ⧉ ⧉ ಽ៉

⬉ŝᱢᯙ ⦺᜖ ⦺ ⦺ ᯕ ࡹࠥಾ ࠥ ࠥ ĥ⫮⦹ᩡᮝ ᩡ ᩡ ӹ ᮝ ᮝ zᮡ z z ᵝᱽa ၹᅖ ၹ ၹ ࡹ۵ Ğᬑ ᨱ ə ԕᬊ᮹ ₉ᄥᖒᯕӹ ᝍ⪵a ⪵ ⪵ ૽ಘ⦹ḡ ⦹ ⦹ ᦫᦥ ⦺ᔾ ⦺ ⦺ ॅಽ ॅ ॅ ᇡ ಽ ಽ ░ zᮡ z z ԕᬊᮥ ၹᅖ ၹ ၹ ⦽ ᅖ ᅖ ݅ ⦽ ⦽ ۵ ၹ᮲ ၹ ၹ ŝ ᮲ ᮲ ⠪aෝ ၼᦹ݅. ݅ ݅ ᔢݚ ᔢ ᔢ ᙹ ݚ ݚ ᮹ ŝᱶᯕ ᩍ్

໦᮹ vᔍ v v ᨱ ᮹⧕ᕽ ḥ⧪ࡹ໕ᕽ v᮹ԕᬊᯕ vᔍ v v ॅ eᨱ ∊ᇥ⯩

Table 3. Elective courses for ³medicine and society´ from 2004 to 2011 ´

Themes Courses

Academic year

2004 2005 2006 2007 2008 2009 2010 2011

5 8 11 10 10 10 12 13

Art and philosophy (6) Medicine and literature • • • • • •

Medicine and philosophy •

Medicine and music • • • •

Medicine and culture •

Medicine and art •

Clinical art therapy • • • • •

Cultural understanding (2)

Medicine and culture in the aged •

Understanding the contemporary world for medical personnel

• • • •

Human rights and ethical issues (6)

Women in medicine • • • • • • •

Medicine and the disabled • • • •

Medicine & human rights • • • • •

Refugees and forced migration •

Controversies in innovative medical care and research with human subjects

•

Current issues of the Korean healthcare system • • • • •

Healthcare policy (2) WHO and international health policy • •

Understanding National Health Insurance •

Comprehensive under- rr standing of human (3)

The design of life • •

Understanding of personality: enneagram • • • • • • •

Human sexuality & medicine •

Communication and relational dynamics (3)

Communicating with today’s patient: communi- cation skill training for med students

• • • • • •

Understanding of family dynamics for medical professionals

• •

Application of psychological knowledge to clinical practice

•

Christianity and medicine (2)

Understanding of modern science in Christian perspective

• • •

Introduction to medical missions • • • • • • •

Future of medicine (1) Future of medicine •

᳑ᮉࡹḡ ༜⧕ ݅ෙ ݅ ݅ ᱽ༊ᯥᨱࠥ ᇩǍ⦹Ł ⦹ ⦹ zᮡ z z ԕᬊᯕ ၹᅖ ၹ ၹ ࡹ۵ Ğᬑa ᬑ ᬑ ᱢḡ ᦫᦥ ⦺ᔾ ⦺ ⦺ ॅಽ ॅ ॅ ⦹ᩍɩ ə ԕᬊ ໕ᨱᕽ ᄥಽ ॅᮥ äᯕ ᨧ݅۵ ၹ᮲ ၹ ᮥ ᅕᯕ ᅕ ᅕ í ⦹ᩡ݅. ݅ ݅ ᯕ్⦽ ᔍᝅᮡ ჵᵝ⪵ ᵝ ᵝ ࡽ ⦺ᔾ ⦺ ⦺ ॅ᮹ ॅ ॅ እ❱ᨱᕽ ⪶ᯙࡹᨩ݅. ݅ ݅ ŝᱶᨱ ݡ⦽ እ❱ ᵲ aᰆ ኩჩ⦹í ⦹ ⦹ ऽ్ӽ äᯕ ŝᱶᯕ እᝅᱽᱢᯕŁ ⇵ᔢᱢ ᔢ ᔢ ᯕ໑ ⦝ᔢᱢ ᔢ ᔢ ᯙ ԕᬊᯕ௝۵ ௝ ௝ äᯕ ᨩ݅(4 (( 2.1%). ᯕᨕ v᮹ᵝᱽ᮹ ᵲᅖŝ ᅖ ᅖ ԕᬊ᮹ እᩑĥᖒ(28.6%), ᔢ

⪙᯲

⪙

⪙ ᬊ ᯲ ᯲ ᮹ đᩍ(21.8%), ᇡᱢᱩ⦽ vᔍ v v ᖁ ᔍ ᔍ ᱶŝ ᙹᨦ᜽e ᇥ႑(20.6%)

᮹ ྙᱽ ྙ ྙ ॒ᯕ ḡᱢࡹᨩ݅. ݅ ݅ ✚ʑ ✚ ✚ ⧁ äᮡ ᯕ ŝᱶ᮹ ⦺᜖ ⦺ ⦺ ᖒŝ⠪aႊ

᜾ᯕ ᱢᱩ⦹ḡ ⦹ ⦹ ༜⦹݅ ⦹ ⦹ ۵ ḡᱢᯕ 32.9%ಽ ࢱ ჩṙಽ ฯᯕ ӹ┡ӽ እ

❱ᯕᨩ݅۵ äᯕ݅(Fig. 1B). ᯕ్⦽ ᔍᝅॅᮡ ᮹ഭ᪡ ᔍ⫭ ᔍ ᔍ Ʊŝŝ ŝ ŝ ᱶᮥ โᦥ ᬕᩢ⦹۵ ₦ᯥƱᙹ Ʊ Ʊ ᮹ ᩎ⧁ᯕ ๅᬑ ᵲ᫵ ᵲ ᵲ ⦹ ᫵ ᫵ ໑ ᯕ ŝᱶᨱ ₙᩍ⦽ Ʊᙹ Ʊ Ʊ ॅ eᨱ ᔍᱥ ᳑ᮉŝ ᮉ ᮉ ᱥℕᱢᯙ v᮹ᬕᩢĥ⫮ᮥ Ǎℕ Ǎ Ǎ ᱢ ᮝಽ ᙹพ⦹۵ äᯕ ᵲ᫵ ᵲ ᵲ ⦽ ᫵ ᫵ ᔍᝅᯥᮥ ᦭ ᙹ ᯩ݅. ݅ ݅

v᮹อ᳒ อ อ ࠥ ᳒ ᳒ ᨱ ݡ⦽ Ų⩽Ʊᮂ Ʊ Ʊ ᭥ᬱ⫭᮹ ᖅྙ đŝෝ ᅕ໕ ᅕ ᅕ 1⦺֥

Fig. 1. Curriculum Development Project 2013 Committee student survey on ³medicine and society´ curriculum. (A) Strength of ´ ³medicine and society´ course. (B) Weak ´ - ness of ³medicine and society´ course. ´

Formation of perspectives on medicine

Extension of understanding about oneself, others and the world

Sharing visions & experiences from various professionals

Encouraging and building a vision in becoming a good doctor

Development of personal interest

121 48.1%

39.3%

28.6%

21.4%

11.1%

0 50 100 150 200 252

99 72 54

28

$

Inappropriate selection of lecturers

Impractical and superficial content 106 42.1%

9.5%

0 50 100 150 200 252

Inappropriate evaluation 83 32.9%

Repetition of content 66 28.6%

Lack of interaction 55 21.8%

Inappropriate time allotment 28 11.1%

24

%

Table 4. Result of Gwanghye Curriculum Committee survey for 1st and 2nd year medical students on medicine and society

2011 2010 2009

Grade Year 1 Year 2 Year 1 Year 2 Year 1 Year 2

Total 105 78 108 80 105 111

Adequacy of content Yes* 59 (56.2) 41 (52.6) 56 (51.9) 20 (25.0) 43 (40.9) 32 (28.8)

Mean

^†

± SD 3.59 ± 0.92 3.40 ± 0.90 3.44 ± 0.98 2.96 ± 0.97 3.32 ± 0.87 3.01 ± 0.93

Adequacy of depth Yes 50 (47.6) 39 (50.0) 57 (52.8) 18 (22.5) 41 (39.4) 33 (29.7)

Mean ± SD 3.47 ± 0.97 3.41 ± 0.92 3.40 ± 1.00 3.06 ± 0.91 3.31 ± 0.80 2.98 ± 0.94

Adequacy of evaluation Yes 44 (41.9) 33 (42.3) 45 (41.7) 22 (28.2) 21 (20.0) 35 (31.5)

Mean ± SD 3.21 ± 1.15 3.71 ± 0.81 3.15 ± 1.08 3.04 ± 0.95 2.82 ± 0.96 3.05 ± 0.93

Overall satisfaction Yes 44 (41.9) 13 (16.7) 48 (44.4) 22 (28.2) 38 (36.2) 36 (32.4)

Mean ± SD 3.39 ± 0.95 3.05 ± 0.72 3.34 ± 1.04 2.99 ± 1.03 3.20 ± 0.96 3.01 ± 1.03

Values are presented as number (%) or mean ± SD.

*Number of students who answered µstrongly agree¶ and µagree¶

^†

Sum of chosen score of following sliding scale: strongly agree (5)-agree (4)-neutral (3)-disagree (2)-strongly

disagree (1).

ᯕ 2⦺֥ᅕ݅ ᅕ ᅕ v᮹อ᳒ อ อ ࠥ ᳒ ᳒ a ׳ᦹ݅(Ta T T b a le 4). 2009֥ 1⦺֥ᯕᨩ޹

⦺ᔾ

⦺

⦺ ᯕ 2010֥ 2⦺֥ᯕ ࡹᨩᮥ ᨩ ᨩ ভ, ੱ⦽ ੱ ੱ 2010֥ 1⦺֥ᯕᨩ޹ ⦺ᔾ ⦺ ⦺ ᯕ 2011֥ 2⦺֥ᯕ ࡹᨩᮥ ᨩ ᨩ ভ᮹ อ᳒ อ อ ࠥ ᳒ ᳒ a ᮁ᮹⦹í ⦹ ⦹ qᗭ q q ࡹ۵ äᮥ š ₑ⧁

ₑ

ₑ ᙹ ᯩᨩ݅. ݅ ݅ 1, 2⦺֥ ⦺ᔾ ⦺ ⦺ ॅ ༉ࢱ ༉ ༉ a ࢱ ࢱ ݅ ᮹ഭ᪡ ᔍ⫭ ᔍ ᔍ ᮹ v᮹⠪a ᮹ ᱢᱩᖒᨱ ݡ⧕ᕽ ԏᮡ ԏ ԏ อ᳒ อ อ ࠥ ᳒ ᳒ ෝ ࠥ ࠥ ᅕᯕ ᅕ ᅕ ۵ äᮝಽ šₑ š š ࡹ ₑ ₑ ᨩ݅. ݅ ݅ v᮹ ᨱ ݡ⦽ ᳦⧊ ᳦ ᳦ ᱢ ⧊ ⧊ ᯙ อ᳒ อ อ ࠥ ᳒ ᳒ ⠪Ɂᯕ 3.01–3.39ᩡ۵ߑ, v᮹ᨱ ݡ⧕ᕽ อ᳒

อ

อ ⦽ ᳒ ᳒ ݅ ⦽ ⦽ ۵ ɮᱶ ᱱᙹa ᙹ ᙹ 4ᱱ ᯕᔢᯙ äᮥ Łಅ⧁ ভ ᯕ v᮹ᨱ ݡ

⦽ อ᳒ อ อ ࠥ ᳒ ᳒ a ׳ᮡ ᦫᮡ ᦫ ᦫ äᮥ ᜽ᔍ⦹ ᔍ ᔍ ۵ äᯕ௝ ⦹ā݅. ݅ ݅


ᩑᖙ᮹ݡ
᳙ᨦᔾॅ᮹
ᱥྙḢᮝಽᕽ᮹
᮹ᔍᨱ
ݡ⦽
ᯱʑ
ᯕ⧕

2005֥ᇡ░ 2012֥ʭḡ ʭ ʭ ᳙ᨦᔾᮥ ݡᔢᮝ ᔢ ᔢ ಽ ᖅྙ᳑ᔍ᮹ ᔍ ᔍ đŝ ᱥ

ྙḢᮝಽᕽ ᮹ഭᯙᨱ ݡ⦽ ᔍ⫭ ᔍ ᔍ ᱢ ⠪a ၰ ᱥ฾ᨱ ݡ⦽ ᳙ᨦᔾॅ

᮹ ᯙ᜾ᮥ ᅕ໕ ᅕ ᅕ (Ta T T b a le 5) ℌṙ, ᱥྙḢᮝಽᕽ ᮹ᔍᨱ ݡ⦽ Ğᱽᱢ ᅕ ᔢŝ

ᔢ

ᔢ ᔍ⫭ ᔍ ᔍ ᱢ ᳕Ğᨱ ݡ⧕ᕽ۵ ᇡᱶᱢᯙ ᱥ฾ᮥ ฾ ฾ aḥ Ğ⨆ᯕ ૽ಘ⦹

Ł ࢹṙ ࢹ ࢹ , ᮹ᔍಽ ᔍ ᔍ ᕽ᮹ ₦ᯥᮥ ݅⦹ ݅ ݅ ʑ ⦹ ⦹ ᭥⧕ᕽ۵ }ᯙᱢᯙ ᔗ᮹ ⯍ᔾ ᯕ ᩍᱥ⯩ ⦥᫵⦹ ᫵ ᫵ ݅ ⦹ ⦹ ۵ ᯙ᜾ᮥ ᅕᩡ݅. ݅ ݅ ᯕ౨ॐ ᮹ഭḢᨱ ݡ⦽ ᔍ⫭ ᔍ ᔍ ᱢ ᱥ฾ŝ ฾ ฾ }ᯙᱢᯙ ᔗᨱ ݡ⦽ ᇡᱶᱢᯙ ⠪aᨱࠥ ᇩǍ⦹Ł ⦹ ⦹ ᮹ŝ⦺ ŝ ŝ ᮹ ၽᱥ

ၽ

ၽ ᨱ ݡ⦽ ᝁ഑, əญŁ ᮹ഭᯙ᮹ ᔍ⫭ ᔍ ᔍ ᱢ ᩢ⨆ಆᨱ ݡ⦽ ɮᱶᱢᯙ ᯙ᜾ᮡ ᩍᱥ⯩ čḡ⦹Ł ⦹ ⦹ ᯩᨩ݅. ݅ ݅ ḩᄲ᮹ ⫭ᅖᅕ ᅖ ᅖ ݅ ᅕ ᅕ ۵ ⪹ᯱ ⪹ ⪹ ෝ Ł☖ Ł Ł ᮝ ☖ ☖ ಽᇡ

ಽ

ಽ ░ ᯱᮁ೎í ೎ ೎ ⦹۵ äᯕ ᮹ᔍ᮹ ᔍ ᔍ aᰆ ᵲ᫵ ᵲ ᵲ ⦽ ᫵ ᫵ a⊹ a a ௝Ł ௝ ௝ ᯙᱶ⦹

۵ ⦺ᔾ ⦺ ⦺ ᯕ ᄡ⧉ᨧᯕ ฯᦥ ᄲु ᰆʑ ᰆ ᰆ a ᦥܩ௝ ᦥ❭ ᦥ ᦥ ⦹ ❭ ❭ ۵ ᯙeᮝ e e ಽ

⪹ᯱ

⪹

⪹ ෝ ᅕŁ ݡ⧕᧝ ⦽݅ ⦽ ⦽ ۵ ᮹ᔍ᮹ ᔍ ᔍ ₦ᯥᨱ ݡ⧕ᕽ ḡḡෝ ᅕԕ ᅕ ᅕ Ł

ᯩᮭ

ᯩ

ᯩ ᮥ ᦭ ᙹ ᯩ݅. ݅ ݅ ḡɪ܆ಆᨱ šĥ š š ᨧᯕ ᱢᱩ⦽ ḥഭෝ ഭ ഭ ၼᮥ ၼ ၼ ᯱĊ ᯕ ᯩᨕ᧝ ⦽݅ ⦽ ⦽ ۵ äᨱ ݡ⧕ᕽ۵ ݅ᗭ ݅ ݅ ₉ᯕa ᯩᮝ ᯩ ᯩ ӹ ᮝ ᮝ ə౨݅۵ ḡ ḡෝ ᅕԙ ᅕ ᅕ ᳙ᨦᔾॅᯕ ޵ ฯᮡ ฯ ฯ Ğ⨆ᮥ ᅕᯙ݅. ݅ ݅ ə్ӹ }ᯙᱢᯙ ₉ ᬱᨱᕽ ⪹ᯱ ⪹ ⪹ a ᯱ ᯱ ⫭ᅖࡹ۵ äᮥ ḡḡ⦹۵ äᨱ እ⧕ᕽ۵ ᔢݡᱢᮝಽ ḡḡ⦹۵ ᙹa ᙹ ᙹ ᱢᨕ ᮹ഭ᮹ ᔍ⫭ ᔍ ᔍ ᱢ ₦ᯥŝ ᇥ႑᮹ ྙᱽ ྙ ྙ ᨱ ݡ⧕ᕽ۵

޽ šᝍ š š ᮥ ᅕᯕ ᅕ ᅕ Ł ᯩ۵ ᯩ ᯩ äᮝಽ ⇵ᱶࡽ݅. ݅ ݅

ᯙ▕ᮝಽᕽ᮹ ʑᅙᱢᯙ ḡ᜾ŝ ᚁʑ ᚁ ᚁ ᮹ ᜖ाᯕ ᯕ൉ᨕᲭ۵ Ჭ Ჭ a ۵ ۵ ෝ

ྜྷᨩᮥ ᨩ ভ۵ ᚁʑ ᚁ ᚁ ᮹ ᜖ाᨱ ݡ⧕ ᇡ᳒⧉ ᳒ ᳒ ᮥ ⧉ ⧉ ۱ӝ۵ Ğ⨆ᯕ ᯩᮭ ᯩ ᯩ ᮥ

᦭ ᙹ ᯩᨩᮝ ᨩ ᨩ ӹ ᮝ ᮝ 2010֥ ᳙ᨦᔾᇡ░ ᚁʑ ᚁ ᚁ ᨱ ݡ⧕ ə౨݅Ł ݅ ݅ ᮲ݖ ᮲ ᮲ ⦽ ⦺ ᔾ ᙹa ᙹ ᙹ ⩥ᱡ⯩ ᷾a ᷾ ᷾ ⦹ a a ᩡ۵ ᩡ ᩡ ߑ əäᮡ 2009֥ 9ᬵ }ᗭ⦽ ᗭ ᗭ ᯥᔢᚁ ᔢ ᔢ ʑ ᚁ ᚁ Ʊᮂ

Ʊ

Ʊ ᖝ░ᨱᕽ᮹ ᚁʑ ᚁ ᚁ Ʊᮂ Ʊ Ʊ ᮹ đŝ௝ ⧁ ᙹ ᯩā݅. ݅ ݅ ᮹ᔍᗭ ᔍ ᔍ ☖ ܆ಆᨱ ݡ⦽ ᯱʑ ᯱ ᯱ ⠪aӹ a a ᮅญᱢ, ᱥྙa ྙ ྙ ᱢ a⊹ a a ᨱ ݡ⧕ᕽ ᙺḡ ᙺ ᙺ ᱶࠥᨱ ݡ⦽

ᯱʑ

ᯱ

ᯱ ⠪aࠥ a a 2008֥ ᯕ⬥ಽ ⬥ ⬥ Йᵡ⯩ ᷾a ᷾ ᷾ ⦹۵ Ğ⨆ᮥ ᅕᯕ ᅕ ᅕ Ł ᯩᨕ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊŝŝ ŝ ŝ ᱶᮥ ☖⦽ ☖ ☖ ᮹ഭᮅ ഭ ഭ ญ᪡ ᮹ᔍᗭ ᔍ ᔍ ☖ᨱ š⦽ š š ԕ ᬊ᮹ ᱥݍᯕ ᯕ൉ᨕḡŁ ᯩᮭ ᯩ ᯩ ᮥ ⇵⊂⧁ ⊂ ⊂ ᙹ ᯩ݅. ݅ ݅

WHOa ᱶ᮹⦽ ࠭ᅥᱽŖᯱ Ŗ Ŗ (care giver) r , ᮹ᔍđᱶᯱ(decision make k k r) r , ᮹ᔍᗭ ᔍ ᔍ ☖ᯱ ☖ ☖ (communicat aa or) r , ḡᩎᔍ⫭ ᔍ ᔍ ḡࠥᯱ(community leader) r , šญᯱ(manager) r ಽᕽ᮹ ᮹ᔍᩎపᨱ ݡ⦽ CDP2004 ᳙ᨦ ᔾॅ᮹ ॅ ॅ ᮲ݖ ᮲ ᮲ ᮥ ݖ ݖ ᅕ໕ ᅕ ᅕ , ᮹ŝݡ⦺ Ʊᮂ Ʊ Ʊ ᯕ ࠭ᅥᱽ ᅥ ᅥ Ŗᯱ Ŗ Ŗ , ᯱ ᯱ ᮹ᔍđᱶᯱಽ ᯱ ᯱ ᕽ ᮹ ᩎపᮥ w⇵ w w ۵ ࠥᬡ ࠥ ࠥ ᮥ ᵝᨩ݅۵ ɮᱶᱢᯙ ᮲ݖ ᮲ ᮲ ᮥ ݖ ݖ ⦽ ⦺ᔾ ⦺ ⦺ ᯕ ⅾ ᮲ݖ

᮲

᮲ ᯱ ݖ ݖ 456໦ ᵲ bb b b 316໦(69.3%), 317໦(69.5%)ᩡ޹ äᨱ እ⦹ᩍ ḡᩎᔍ⫭ ᔍ ᔍ ḡࠥᯱಽ ᯱ ᯱ ᕽ᮹ ᩎపᮥ w⇵ w w ۵ߑ ࠥᬡ ࠥ ࠥ ᮥ ᵝᨩ݅۵ ᮲ݖ ᮲ ᮲ ᙹ Table 5. Self-understanding on doctors as professionals of Curriculum Development Project 2004 graduates

2012 2011 2010 2009 2008

(n = 107)* (n = 110)* (n = 113)* (n = 123)* (n = 120)*

Doctors in the future will not be able to receive the same financial reward as doctors in the past 84 (78.5) 79 (71.8) 83 (73.5) 86 (69.9) 97 (80.8) Doctors in the future will not be able to build as much social respect 74 (69.2) 72 (65.5) 79 (69.9) 74 (60.2) 89 (74.2) Recent changes in the medical system are decreasing the independence of doctors as professionals. 67 (62.6) 55 (50.0) 59 (52.2) 80 (65.0) 70 (58.3) The job demanded of doctors hinders them from building a close family relationship and satisfying their

private life (well-being).

78 (72.9) 78 (70.9) 78 (69.0) 82 (66.7) 80 (66.7)

Work often prevents doctors from persuing other interests. 75 (70.1) 77 (70.0) 71 (62.8) 79 (64.2) 74 (61.7) The role of the general physician is more important than specialists 51 (47.7) 41 (37.3) 53 (46.9) 70 (56.9) 64 (53.3) Success in hospital management and business is guaranteed only by hard work. 22 (20.6) 20 (18.2) 32 (28.3) 46 (37.4) 30 (25.0) Every individual has a right to receive appropriate medical treatment regardless of his/her economic ability 68 (63.6) 66 (60.0) 78 (69.0) 67 (54.5) 76 (63.3) Doctors can develop more influence in health improvements and the prevention of diseases. 82 (76.6) 78 (70.9) 77 (68.1) 70 (56.9) 89 (74.2) The medical professions will become more challengingand meaningful if the development of medical science

can be well-applied to patient care.

77 (72.0) 68 (61.8) 71 (62.8) 76 (61.8) 83 (69.2)

The most important goal of medicine is to heal and care for patients 64 (59.8) 61 (55.5) 68 (60.2) 69 (56.1) 69 (57.5) The most important thing for which medicine persue is to help patients become free of diseases. 87 (81.3) 78 (70.9) 74 (65.5) 92 (74.8) 98 (81.7)

The acquisition of clinical knowledge as an intern 71 (66.4) 71 (64.5) 65 (57.5) 74 (60.2) 69 (57.5)

The mastery of clinical skills as an intern 65 (60.7) 76 (69.1) 63 (55.8) 35 (28.5) 30 (25.0)

The achievement of communication skill 77 (72.0) 74 (67.3) 71 (62.8) 75 (61.0) 70 (58.3)

The recognition on the ethical, professional values as a professionals. 74 (69.2) 76 (69.1) 70 (61.9) 73 (59.3) 69 (57.5) Values are presented as number (%).

*Total number of respondants among graduates.

۵ 227໦(4 (( 9.8%)ಽᕽ ᔢݡᱢᮝಽ ᮲ݖ ᮲ ᮲ ᙹ ݖ ݖ a ᙹ ᙹ ᱢᨩ݅(Fig. 2).

Ł
ₑ

᮹⦺ᱥྙḢᨦᖒ
Ʊᮂᮡ
ᔾ᮹⦺ᱢ
᮹⦺Ʊᮂŝ
ᔢ⊹ࡹ۵
äᯕ

ᦥܩ݅

⪹ᯱ

⪹

⪹ ᪡ ᯱ ᯱ ᔍ⫭ ᔍ ᔍ a ᫵Ǎ ᫵ ᫵ ⦹۵ ᮹ഭෝ ഭ ഭ ᱽŖ⧁ Ŗ Ŗ ᙹ ᯩ۵ ᯩ ᯩ ᮹ᔍෝ ᧲ᖒ⦹

۵ äᯕ ᮹ŝݡ⦺ᨱᕽ᮹ Ʊᮂ Ʊ Ʊ ᮹ ᯝ₉ᱢᯙ ༊ᱢᯕ௝Ł ௝ ௝ ⧁ ভ ᯕᨱ ݡ⧕ ᱥᬑ┾ ᫙(2010)۵ ݅ᮭŝ ᮭ ᮭ zᯕ ʑᚁ⦹ ᚁ ᚁ ᩡ݅. ݅ ݅

ᳬᮡ ᮹ᔍಽ ᔍ ᔍ ⪽࠺ ⪽ ⪽ ⦹ࠥ ⦹ ⦹ ಾ ࠥ ࠥ Ʊᮂ Ʊ Ʊ ᜽ ᮂ ᮂ ┉݅۵ äᮡ. ᮡ ᮡ .. ᯙeᨱ ݡ⦽

ʫᮡ ᯕ⧕(ᯙྙ⦺ ྙ ྙ ᱢ ⦺ ⦺ Ŗq܆ q q ಆ)᪡ ᔍ⫭ ᔍ ᔍ ᨱ ݡ⦽ Ñ᜽ᱢ ᜽b(ᔍ ((

⫭ŝ⦺ ŝ ŝ ᱢ ⦺ ⦺ ܆ಆ)ᮥ w⇹ w w , ⇹ ⇹ ࠥ޶ ࠥ ࠥ ᱢᯕŁ ᮅญᱢᯙ ঑ஜ⦽ ஜ ஜ ᮹ᔍa ᔍ ᔍ ࡹ ᨕ᧝อ əॅ ə ə ᯕ aḡ a a Ł ᯩ۵ ᯩ ᯩ ᮹⦺ᱢ ⦺ ⦺ ḡ᜾ŝ ʑᚁᯕ ᱽݡಽ ᯲࠺ ᯲ ᯲

ࢁ ᙹ ᯩ݅Ł ݅ ݅ ᅕ۵ ᅕ ᅕ äᯕ݅. ݅ ݅ ᯕäᮥ ⦽ ݉ᨕಽ ᫵᧞ ᫵ ᫵ ⦽݅ ⦽ ⦽ ໕ ˄᮹ᔍ ಽᕽ᮹ ၵ௭Ḣ ௭ ௭ ⦽ ⥥ಽ⟹ᖵձญ᷹(profe ff ssionalism)ᮥ aḥ ᮹ ᔍෝ ┅ᬭԕ۵ ä˅ᯕ௝Ł ௝ ௝ ั⧁ ั ั ᙹ ᯩ݅. ݅ ݅

ᯕ⃹ౝ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ, ⪚ᮡ ⥥ಽ⟹ᖵձญ᷹ᯕ௝۵ ௝ ௝ ᬊᨕ۵ ᮹

⦺ šಉ ḡ᜾ŝ ᚁʑ ᚁ ᚁ ܆ಆᨱ š⦽ š š ᔾ᮹⦺ᱢ ⦺ ⦺ Ʊᮂ Ʊ Ʊ ᮝ ᮂ ᮂ ಽอ ಽ ಽ ᮡ อ อ ᳬᮡ ᮹ ᔍෝ ᧲ᖒ⦹۵ äᯕ ᨕಖ݅۵ ၹᖒ ၹ ၹ ᱢᯙ ᯙ᜾ŝ ⧉̹ ⧉ ⧉ ᮹ഭ᪡ šಉ

ࡽ ᯙྙᔍ ྙ ྙ ⫭ ᔍ ᔍ ⦺ᱢ ⦺ ⦺ ᯙ ḡ᜾ŝ šญ܆ಆ əญŁ ࠥ޶ ࠥ ࠥ ᱢ ₦ྕᖒ, ᯕ┡ᱢ ᯙ ᔍ⫭ ᔍ ᔍ ḡࠥᯱ᮹ ᯱ ᯱ ᩎ⧁ᨱ š⦽ š š ᯙྙᔍ ྙ ྙ ⫭ ᔍ ᔍ ᮹⦺ Ʊᮂ Ʊ Ʊ ᯕ v᳑ v v ࡹ໑ ᔍᬊ

ࡹᨩʑ ভྙᨱ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ᯕ௝۵ ௝ ௝ äᯕ ษ⊹ ษ ษ ᔾ᮹⦺ᱢ ⦺ ⦺ ᯙ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ŝ ᮂ ᮂ ۵ ᔢ⊹ࡹ۵ ä⃹ౝ ᯕ⧕ࡹ۵ ⊂໕ᯕ ᯩᨩ݅. ݅ ݅ ǎԕ᮹ ᮹

⦺ᱥ

⦺

⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ᯕ Ʊ᧲ Ʊ Ʊ Ʊ ᧲ ᧲ ᮂ Ʊ Ʊ ᱢᯙ ✚ᖒᮥ ฯᯕ ᅕᩡ݅۵ ႊᰍ ႊ ႊ ჵ

᫙(2008)᮹ ᅕŁӹ Ł Ł CDP2004ෝ ḥ⧪⦹໕ᕽ Ʊᙹ Ʊ Ʊ ॅᯕ ᔾ᮹⦺ᱢ ⦺ ⦺ ᯙ

᮹⦺ḡ ⦺ ⦺ ᜾ᮥ a෕ a a ⊹ʑᨱ ᜽eᯕ ᇡ᳒⦽ ᳒ ᳒ ߑ ə ᜽eᮥ ᵥᯕŁ ᯙྙ⦺ ྙ ྙ ᱢᯙ Ʊᮂ Ʊ Ʊ ᮥ ⦹۵ äᯕ ŝᩑ ┡ݚ ┡ ┡ ⦽ ݚ ݚ äᯙa ᬑಅෝ ᅕᯙ äࠥ ၵಽ ၵ ၵ ᯕ్⦽ ᯕ⧕ᨱ ɝÑ ɝ ɝ ⦽ äᯕ௝ ⧁ ᙹ ᯩ݅. ݅ ݅ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒᨱ ݡ⧕

᮹ᔍ݅ ᔍ ᔍ ᬕ ᮹ᔍa ᔍ ᔍ w⇵ w w ᨕ᧝ ⦹۵ ⧪࠺, ࠺ ࠺ Ƚჵ ੱ۵ ੱ ੱ ᔢ┽ಽᕽ ᯕ⧕⦹

Ł ᯩ۵ ᯩ ᯩ ᩍ్ ʑᚁᮥ Łಅ⧕ᅝ ভ(American Board of Int n n ernal Med- icine Foundat aa ion et al., 2002; Canadian Medical Associat aa ion, 2002;

Swick, 2000) ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒᮡ ᔾ᮹⦺ᱢ ⦺ ⦺ ᯙ šᱱ š š ᨱᕽ᮹ ᮹⦺ᱢ ⦺ ⦺ ᯙ ᩎపᨱ ޵⦹ᩍ ᝍญᱢ, ᔍ⫭ ᔍ ᔍ ᱢ, ӹᦥa ᦥ ᦥ ᩢᱢᯙ ⊂໕ʭḡ ʭ ʭ ᦥᬑ ᦥ ᦥ ෕ ᬑ ᬑ ۵ ෕ ෕ ᅕ݅

ᅕ

ᅕ ⡍ť ⡍ ⡍ ᱢ ť ť ᯙ }ֱᮝಽ ᯕ⧕⧁ ᙹࠥ ᙹ ᙹ ᯩ݅. ݅ ݅ ᯕ౑ ⡍ť ⡍ ⡍ ᱢ ť ť ᯙ ᦩ༊ ᦩ ᦩ ᮥ w⇵

w

w ۵ äᯕ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒᮥ w⇵ w w ۵ äᮥ ᮹ၙ⦹ʑ ⦹ ⦹ ᨱ ᱥᬑ┾ ᫙ (2010)۵ ˈᰆ௹ ᮹ᔍa ᔍ ᔍ ࡹʑ ᭥⧕ ᯥᔢᔢ ᔢ ᔢ ⫊ ᔢ ᔢ ᨱᕽ ᫵Ǎ ᫵ ᫵ ࡹ۵ ᱥྙ᮹⦺

ᱢ ḡ᜾, ᯥᔢᚁ ᔢ ᔢ ʑ ᚁ ᚁ ᪡ ⧉̹ ⧉ ⧉ ᱥྙa ྙ ྙ ᱢ ᯱḩᮥ ⧉᧲᜽ ᧲ ᧲ ┅ʑ ᭥⦽ˉ Ʊᮂ Ʊ Ʊ ᯕ໑, ঑௝ᕽ ௝ ௝ ə Ʊᮂ Ʊ Ʊ ᮡ ˈᯥᔢᔢ ᔢ ᔢ ⫊ ᔢ ᔢ ᨱᕽ ᯱᩑᜅ౞í ⪹ᯱ ⪹ ⪹ ෝ ݡ⦹໕ ᕽ a෕ a a ⊹۵ äᯕ ᯕᔢᱢ ᔢ ᔢ ˉᯕ௝Ł ௝ ௝ ʑᚁ⦽ ᚁ ᚁ ݅ ⦽ ⦽ . ݅ ݅ ə్အಽ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦ ᖒ Ʊᮂ Ʊ Ʊ ᯕ௡ ᔾ᮹⦺ᱢ ⦺ ⦺ ᯙ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ŝ ᮂ ᮂ ᔢ⊹ࡹÑӹ ݅ෙ ݅ ݅ ᩢᩎ᮹ Ʊᮂ Ʊ Ʊ ᯕ ᦥܩ௝ ᔾ᮹⦺ᱢ ⦺ ⦺ ᯙ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ᮥ ⡍ť ⡍ ⡍ ⦹۵ }ֱᮝಽ ᯕ⧕ࡹᨕ᧝

⧁ äᯕ݅. ݅ ݅ Ʊŝŝ ŝ ŝ ᱶᨱᕽ ⦺ᔾ ⦺ ⦺ ॅ e᮹ Ğᰢ əญŁ ŝᵲ⦽ ᵲ ᵲ ᜽⨹ᨱ ݡ⦽ ᇡݕ ᇡ ᇡ ᯕ ᯩᮥ ᯩ ᯩ ভ ┡ᯙᮥ ᯕ⧕⦹۵ Ŗqಆ(v (( icarious empat aa hy h h ) yy ŝ zᮡ z z ᯙྙᔍ ྙ ྙ ⫭ ᔍ ᔍ ᮹⦺ᱢ ⦺ ⦺ ᩎప ⩶ᖒᨱ ᇡᱶᱢᯙ ᩢ⨆ᮥ ᵝ۵ äᯕ ᱥ⨆ᱢ šₑ š š ᨱ ᮹⧕ ᅕŁࡹᨩ۵ ᨩ ᨩ ߑ(Newton et al., 2008) ᯕ౑ ᮹ၙ

ᨱᕽ ᩑᖙ᮹ݡ CDP2004᮹ Ʊŝŝ ŝ ŝ ᱶᨱᕽ ᯕ൉ಅ ⧩޹ ʑⅩ᪡ ᯥ ᔢᮥ

ᔢ

ᔢ ☖⧊ ☖ ☖ ⦹۵ Ʊᮂ Ʊ Ʊ , ᮂ ᮂ ŝࠥ ŝ ŝ ⦽ ࠥ ࠥ ᱶᅕෝ ᅕ ᅕ ᱽŖ⧉ Ŗ Ŗ ᮝ ⧉ ⧉ ಽ៉ ᙹ࠺ᱢᮝಽ ⦺

᜖⦹۵ Ʊᮂ Ʊ Ʊ ᯕ ᦥܩ௝, ௝ ௝ ⦥ᙹᱢᯙ ԕᬊᮥ ⦺᜖ ⦺ ⦺ ⦹ࡹ ⦹ ⦹ ⦺ᔾ ⦺ ⦺ ॅᯕ ܆࠺

ᱢᮝಽ ₙᩍ⧁ ᙹ ᯩ۵ ᯩ ᯩ ⦺᜖ ⦺ , ᜖ ᜖ əญŁ ⫮ᯝ⪵ࡽ Ʊŝŝ ŝ ŝ ᱶᯕ ᦥܩ௝

ᖁ┾ŝ༊ᮥ ☖⧕ ᯱᝁ᮹ šᝍ š š ᨱ ঑௝ ᵝࠥ ᵝ ᵝ ᱢᮝಽ ᖁ┾⦹ᩍ ᝍ⪵ၽ ⪵ ⪵ ᱥᮥ ᜽┍ ᙹ ᯩ۵ ᯩ ᯩ ܆࠺ᱢᯕŁ ᯱʑ ᯱ ᯱ ᵝࠥ ᵝ ᵝ ᱢᯙ ⦺᜖ ⦺ ┽ࠥෝ ࠥ ࠥ aḡ a a ໑ ᯙ

ྙᔍ

ྙ

ྙ ⫭ ᔍ ᔍ ⦺ᱢ ⦺ ⦺ ᯙ ᩎపᮥ aḥ ᮹ᔍෝ ┅ᬭԕŁᯱ ⦽ ᩑᖙ᮹ݡ᮹ ᮹⦺

ᱥྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ႊ⨆ ႊ ႊ ᮥ ᅕᯕ ᅕ ᅕ ۵ äᯕ௝ ⦹ā݅. ݅ ݅



᮹⦺ᱥྙḢᨦᖒ
Ʊᮂᮡ
ᯕෝ
ḡḡ⦹۵
⪹Ğ᮹
Ǎ⇶ᯕ

⦥᫵⦹݅


᮹ഭᯙྙ⦺
Ʊŝŝᱶᮡ
᮹ŝݡ⦺
v᮹ᝅᨱ
ǎ⦽ࡹḡ
ᦫ۵݅

Ų⩽Ʊᮂ Ʊ Ʊ ᭥ᬱ⫭ ᖅྙ᮹ đŝᨱᕽ ᮹ഭ᪡ ᔍ⫭ ᔍ ᔍ Ʊŝŝ ŝ ŝ ᱶᨱ ݡ⦽

⦺ᔾ

⦺

⦺ ॅ᮹ อ᳒ อ อ ࠥ ᳒ ᳒ a ԏᦹ۵ ᦹ ᦹ ߑ, ⦺ᔾ ⦺ ⦺ ॅ᮹ ᵝࡽ እ⠪ᮡ v᮹ԕᬊᯕ ᝅᱽᱢᯕḡ ᦫŁ ᦫ ᦫ ⇵ᔢᱢ ᔢ ᔢ ᯕ໑ ⦝ᔢᱢ ᔢ ᔢ ᯕ௝۵ ௝ ௝ äᯕ݅. ݅ ݅ ⦺ᔾ ⦺ ⦺ ॅ᮹ ॅ ॅ ᯕ్

⦽ እ⠪ᮡ ᯕၙ šₑ š š ࡹ ₑ ₑ ᨕ ᅕŁࡽ Ğ⨹ŝ ݅෕ ݅ ݅ ḡ ᦫ݅(Goldstein et al., 2006; Shap aa iro et al., 2009) ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ᨱ š⦹ š š ᩍ ₞᮹ ᱢᯙ ᱲɝᮥ ⦹Ł ⦹ ⦹ ᯩ۵ Wa W W shingtonݡ⦺᮹ Ğ⨹ᮥ ᗭ}⦽ Gold- stein et al. (2006)ᮡ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊŝŝ ŝ ŝ ᱶᨱ ݡ⦽ ᅕŁᨱᕽ

˄profe ff ssionalism˅ᯕ௝۵ ௝ ௝ ݉ᨕa ḡӹ⊹ ӹ ӹ í ฯᯕ ᯱᵝ ᔍᬊࡹŁ, ᇡ ᱶᱢᯙ ᮹ၙಽ ᔍᬊࡹŁ ᯩ۵ ᯩ ᯩ äŝ ⦺ᔾ ⦺ ⦺ ॅᯕ ᯕ Ʊŝŝ ŝ ŝ ᱶᮥ ḡӹ

⊽ ḡ᜽, v᮹, Ƚᮉ əญŁ ࠥ޶ ࠥ ࠥ ᱢᯙ ᨙɪᮥ ᵲᅖ⦹ᩍ ༉ᦥ ༉ ༉ ״ᮡ ä ᯕ௝Ł ௝ ௝ ⠪a⦽ a a äᮥ ᅕŁ⦽ Ł Ł ݅ ⦽ ⦽ . ݅ ݅ ᯕෝ á☁⦽ ☁ ☁ ⬥ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊ Self-evaluation about competencies as a doctor defined by World Health

Organization (response graduate of CDP2004 between 2009 and 2012)

Care giver

Manager

Community

leader Communicator

Decision maker 317 (69.5%)

227 (49.8%) 279 (61.2%) 251 (55.0%)

316 (69.3%)

2009 (n = 125) 2010 (n = 111) 2011 (n = 110) 2012 (n = 110) Overall (n = 456)

Fig. 2. Result of graduation survey done by Curriculum Development Project 2004

graduates between 2009 and 2012.

ᮂᨱ ᯩᨕᕽ ⇵ᔢ⪵ ᔢ ᔢ ࡽ }ֱᮥ v᮹ಽ ᱥݍ⦹۵ äᮥ ᵥᯕŁ ᮹ഭ ᱥྙa ྙ ྙ ಽ a a ᕽ ʑݡࡹ۵ ⧪࠺ᮥ Ǎℕ Ǎ Ǎ ᱢᯕŁ Ḣᱲᱢᮝಽ ʑᚁ⦹Ñ ⦹ ⦹ ӹ

⦺ᔾ

⦺

⦺ ॅᯕ ᝅᱽಽ ⩥ᰆᨱᕽ ᮹ഭᱥྙa ྙ ྙ ಽ a a ᕽ ᨕਅ ᩎ⧁ᮥ ⧁ ⧁ ⧕᧝ ⦹۵ ḡᨱ ݡ⧕ᕽ ႑ᬙ ᙹ ᯩࠥ ᯩ ᯩ ಾ ࠥ ࠥ Ʊŝŝ ŝ ŝ ᱶᮥ ᱥ⪹⦹ ⪹ ⪹ ʑ ⦹ ⦹ ᨱ ᯕෙ݅. ݅ ݅ ⦺ᔾ ⦺ ⦺

ॅᮡ ᝅᱽಽ ḥഭᨱ ₙᩍ⦹۵ aᬕߑ ᯝᨕӹ۵ ԕ్❑ቭ(narra- tive)ෝ ☖⧕ᕽ vಆ⦽ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ Ğ⨹ᮥ aḡ a a í ࡹŁ (Passi et al., 2010), ᝅᱽ ᮹ഭ⧪ ഭ ഭ ᭥ ⩥ᰆ᮹ ԕᰍᱢ Ʊᮂ Ʊ Ʊ ŝ ᮂ ᮂ ᱶᨱ ᮹⧕

޵ vಆ⦽ ᩢ⨆ᮥ ၼ۵ ၼ ၼ ݅(Goldstein et al., 2006; Ro R R ge gg rs et al., 2012).

⦺ᔾ

⦺

⦺ ॅᯕ v᮹ᝅ᮹ Ʊŝŝ ŝ ŝ ᱶᨱᕽ ႑ᬑ۵ ä(fo ff rmal curriculum) ŝ ᝅᱽಽ ⩥ᰆᨱᕽ ႑ᬑ۵ ԕᰍᱢᯙ Ʊŝŝ ŝ ŝ ᱶ(hidden curricu- lum)᮹ a⊹ a a ॅᯕ ᕽಽ ᔢ∊ ᔢ ᔢ ࡹ ∊ ∊ ໕ đǎ ⦺ᔾ ⦺ ⦺ ॅಽ ॅ ॅ ⦹ᩍɩ i॒ i i ᮥ ᯝᮝ

┅Ł ᳙ᨦ⧁ ভ Ԫᗭᱢᯕ ࡹࠥಾ ࠥ ࠥ อु อ อ ݅(Stern & Pap a adakis, 2006).

Ʊᙹ Ʊ

Ʊ ॅᮡ ᮹ࠥᱢᯕÑӹ ⪚ᮡ ᮹ࠥᱢᯕḡ ᦫí ӹᦥa ᦥ ᦥ ᦭í ༉෕í ɮᱶᱢᯕु ᇡᱶᱢᯕु ⦺ᔾ ⦺ ⦺ ॅᨱí ᩎ⧁༉ ⧁ ⧁ ߙಽᕽ ḡᗮᱢᯙ ᩢ⨆

ᮥ ᵝŁ ᵝ ᵝ ᯩŁ ᯩ ᯩ ə ᩢ⨆ಆᯕ ๅᬑ Ⓧ݅ Ⓧ Ⓧ ۵ äᯕ ⩥ᝅᯕ݅(Berman et al., 2008; Ro R R gers et al., 2012). ᯕ⃹ౝ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ᮡ ᮹ŝ ݡ⦺อ ⦺ ⦺ ᯕ ᦥܩ௝ ᱥŖ᮹ Ŗ Ŗ ᙹಉ əญŁ ᄲᬱ ᱥℕ᮹ ༉ु ༉ ༉ ݉ĥ ݉ ݉ ᮹ ᫵ ᗭॅᯕ ⧉̹ ⧉ ⧉ ʕၡ⦹í ⦹ ⦹ ᩑšࡹ š š ᨕ ᯕ൉ᨕḡအಽ(๚Ų⪙ Ų Ų , 2007; ᱥᬑ

┾ ᫙, 2010; Newton et al., 2008; Stern & Pap aa adakis, 2006), Gold- stein (2006)ᮡ ⦺ᔾ ⦺ ⦺ ॅᯕ Ğ⨹⦹۵ Ʊᮂ Ʊ Ʊ ᱢ ⪹Ğ ⪹ ⪹ ᱥℕෝ ᮹⦺ᱥ ⦺ ⦺ ྙḢ ᨦᖒ᮹ ᔾ┽ĥ(ecology of profe ff ssionalism)௝Ł ௝ ௝ ⦹ᩡ݅. ݅ ݅



᮹ഭᯙྙ⦺ᮥ
ᯕ⧕⦹Ł
ə
ᩎపᖒ≉ෝ
ᱢᱩ⯩
⠪a⧁
ᙹ
ᯩ۵

Ʊᙹ}ၽᯕ
⦥᫵⦹݅

᮹ഭᯙྙ⦺ ྙ ྙ ŝᱶᮥ ḥ⧪⦹۵ vᔍ v v ᖁ ᔍ ᔍ ᱶᯕ ᱢᱩ⦹ḡ ⦹ ⦹ ༜⦹݅ ⦹ ⦹ ۵ ⦺ ᔾॅ᮹ ॅ ॅ ⠪a۵ እ᮹ഭᯙᯙ Ğᬑ ᮹ഭ᮹ ⩥ᝅᨱ ݡ⦽ ᯕ⧕a ᇡ᳒⧁ ᳒ ᳒ äᯕ௝۵ ௝ ௝ ᯙ᜾ᯕŁ, ᮹ഭᯙᯙ vᔍ v v ᯙ Ğᬑᨱ۵ ᯙྙ⦺ ྙ ྙ ᱢ ⦺ ⦺ ᯙ Ʊŝŝ ŝ ŝ ᱶᮥ โᦥ ḥ⧪⦹ʑ ⦹ ⦹ ᨱ ᱢ⧊⦹ḡ ⦹ ⦹ ༜⧩݅۵ ၹ᮲ ၹ ၹ ᯝ ᙹ ᯩ݅(ᱥᬑ┾

᫙, 2010). ᯕ్⦽ ⦺ᔾ ⦺ ⦺ ॅ᮹ ॅ ॅ ⠪a۵ Ʊŝŝ ŝ ŝ ᱶᮥ ᭥⦽ Ʊᙹ Ʊ Ʊ } ᙹ ᙹ ၽᯕ ⦥

᫵⧉

᫵

᫵ ᮥ ⧉ ⧉ ᱢ᜽⦽݅ ⦽ ⦽ . ݅ ݅ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ᨱ ᯩᨕᕽ ᮹ഭᯙྙ⦺ ྙ ྙ ᮹ ᵲ

᫵ᖒ

᫵

᫵ ᮡ Йᵡ⯩ v᳑ v v ࡹᨕ ᪵ḡ ᪵ ᪵ อ ⩥ᰍ Ʊᙹ Ʊ Ʊ ॅ᮹ ॅ ॅ ݡᇡᇥᮡ ᮹ഭᯙྙ

⦺ᮥ

⦺

⦺ Ŗ᜾ᱢᯙ Ʊᮂ Ʊ Ʊ ŝ ᮂ ᮂ ᱶᮝಽᕽ Ğ⨹⧕ᅕḡ ᦫᦹ݅. ݅ ݅ ᯖᙺ⦹ḡ ⦹ ⦹ ᦫᮡ ᦫ ᦫ

ᩢᩎᨱ ݡ⧕ᕽ v᮹ෝ ḥ⧪⦹۵ äᮡ ᛍᬕ ᯝᯕ ᦥܩŁ ޵Ǎӹ ᯖ ᙺ⦹ḡ ⦹ ⦹ ᦫᮡ ᦫ ᦫ ᱥݍႊ᜾ ႊ ႊ ŝ ⠪aႊ᜾ ႊ ႊ ᮡ ޵ᬒ ᨕಅᬕ ᯝᯕ݅. ݅ ݅ ə్အಽ ᝅᱽಽ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ᮥ โŁ โ โ ᯩ۵ ᯩ ᯩ Ʊᙹ Ʊ Ʊ ॅᨱí ᮹ഭᯙྙ⦺ ྙ ྙ ŝ ⦺ ⦺ ᮹⦺ᱥ ⦺ ⦺ ྙ Ḣᨦᖒ Ʊᮂ Ʊ Ʊ ᯕ௡ ŝᩑ ྕᨨᯙḡෝ ם᮹⦹Ł ⦹ ⦹ ᯕ⧕⦹໑, ᮹ഭ⩥ ഭ ഭ ᰆŝ ᰆ ᰆ Ʊᮂ

Ʊ

Ʊ ⩥ᰆᨱᕽ ᨕਜí ᱢᬊ⦹Ł ⦹ ⦹ a෕ a a ⋁ äᯙḡෝ ₟ࠥ ₟ ₟ ಾ ࠥ ࠥ ⦹۵ Ʊᙹ Ʊ Ʊ }ၽᯕ ᜽ɪ⦹ ɪ ɪ ݅ ⦹ ⦹ Ł ݅ ݅ ⧁ ᙹ ᯩā݅. ݅ ݅

Ų⩽Ʊᮂ Ʊ Ʊ ᭥ᬱ⫭ ᖅྙ đŝᨱᕽ ᅕ໕ ᅕ ᅕ ⦺ᔾ ⦺ ⦺ ॅᮡ ᮹ഭ᪡ ᔍ⫭ ᔍ ᔍ ᮹ Ʊ ŝŝ

ŝ

ŝ ᱶ᮹ ⦺᜖ ⦺ ᖒŝ⠪aa a a ᱢᱩ⦹ḡ ⦹ ⦹ ᦫᦹ݅۵ እ❱ᯕ ᯩᨩ݅. ݅ ݅ ᔍᝅ ᮹ഭᯙྙ⦺ ྙ ྙ ⦺᜖ ⦺ ᖒŝෝ ݉ᙽ ݉ ݉ ⯩ ᚌᯱ ᚌ ᚌ ಽ ᯱ ᯱ ĥప⪵⦹ ⪵ ⪵ ۵ äᮡ ᯙྙᔍ ྙ ྙ ⫭ ᔍ ᔍ ᮹⦺ᱢ ⦺ ⦺ ᯙ ᗭ᧲᮹ ⫮ाᨱ ݡ⦽ ⠪aಽ a a ᕽ۵ ᱢᱩ⦹ḡ ⦹ ⦹ ᦫ݅(ᱥᬑ┾

᫙, 2010; Shrank et al., 2004). ޵Ǎӹ ⦺ᔾ ⦺ ⦺ ॅᮡ əॅ ə ə ᯕ ᨕਜí ⠪a

ࡹ۵a ۵ ۵ ᪡ a a ə ⠪a᮹ a a đŝa ŝ ŝ ၙ⊹۵ ᩢ⨆ᨱ ๅᬑ ၝq⦹݅ ⦹ ⦹ . ݅ ݅ ᯙ▕ŝ ᱥŖ᮹ Ŗ Ŗ ᖁၽᯕ ⦺ᔾ ⦺ ⦺ ॅ᮹ ॅ ॅ ᖒᱢᨱ ᮹⧕ᕽ Ⓧí ᳭ᬑࡽ݅۵ ᔍᝅᮥ

᦭í ࡹ໕ ⦺ᔾ ⦺ ⦺ ॅᮡ əॅ ə ə ᮹ ॅ ॅ ⦺ᱱ ⦺ ⦺ ᮥ šญ⦹۵ ἞ᮝ ἞ ἞ ಽ ᰍ዁෕ ዁ ዁ í ᬡ Ḣᯙ݅. ݅ ݅ ə్အಽ ⦺ᔾ ⦺ ⦺ ॅಽ ॅ ॅ ⦹ᩍɩ ᮹⦺Ḣ ⦺ ⦺ ᨦᱥྙa ྙ ྙ Ʊŝŝ ŝ ŝ ᱶᮥ ☖

⧕ ᱥݍ⦹Ł ⦹ ⦹ ᯱ ⦹۵ a⊹ a a ᨱ ঑௝ ┽ࠥ᪡ a⊹ a a š᮹ š š ᄡ⪵a ⪵ ⪵ ᯝᨕӹࠥ ӹ ӹ

ಾ ⦹ಅ໕ ᱢᱩ⦽ ⠪aa a a ၹऽ ၹ ၹ ᜽ ⦥᫵⦹ ᫵ ᫵ ݅ ⦹ ⦹ . ݅ ݅

ᯕෝ ᭥⧕ᕽ۵ ᱢᱩ⦽ ⩶ᖒ⠪a(fo ff rmat aa iv ii e vv evaluat aa ion)a ᱢɚᱢ ᮝಽ ᱢᬊࡹᨕ᧝ ⧁ äᯕ݅. ݅ ݅ ˈ⩶ᖒ⠪a۵ ŝᱶᨱ Ⅹᱱᮥ ฿⇹ ฿ ฿ äᮝ ಽˉ

ಽ

ಽ (Amin et al., 2006) ⦝ऽ႒ ऽ ऽ ᮥ ၼᮡ ၼ ၼ ⦺ᔾ ⦺ ⦺ ॅᮡ ᯱᝁ᮹ ᇡ᳒⦽ ᳒ ᳒ ä ᯕӹ ᙹᱶ⧁ ᇡᇥᮥ Ʊᱶ⧁ ᙹ ᯩ۵ ᯩ ᯩ ʑ⫭ෝ aḩ ᙹ ᯩí ⦹۵ äᯙ ߑ ⩥ᰍ ᮹ŝݡ⦺᮹ Ʊᙹ Ʊ Ʊ -⦺ᔾ ⦺ ⦺ šĥ š š ᮹ ᔢ⫊ ᔢ ᔢ ŝ ⫊ ⫊ Ʊŝŝ ŝ ŝ ᱶᮝಽ۵ ಽ ಽ ᮹

⦺ᱥ

⦺

⦺ ྙḢᨦᖒᨱ ݡ⦽ ⩶ᖒ⠪aa a a ᨕಖ݅. ݅ ݅ ᔾ᮹⦺ᱢ ⦺ ⦺ ḡ᜾ᨱ ݡ⦽ ⩶ ᖒ⠪a۵ ၹᅖ ၹ ၹ ࡹ۵ ḡ⦥Łᔍෝ ☖⧕ᕽ ᨕ۱ ᱶࠥ a܆⦹݅ ⦹ ⦹ . ݅ ݅ ə్

ӹ ᮹⦺ᱥ ⦺ ⦺ ྙḢᨦᖒ Ʊᮂ Ʊ Ʊ ᨱ ݡ⦽ ⠪a۵ ᯕ్⦽ ႊჶᮝಽ ᯕ൉ᨕḩ ᙹ ᨧ݅. ݅ ݅ ˈᅙ ˈ ŝ 3⦺֥ᮡ ⦺֥ ัᨱ ᯩ۵ ᯩ ᯩ ᯥᔢ᳦ ᔢ ᔢ ⧊ ᳦ ᳦ ᜽ ⧊ ⧊ ⨹ ⦽ႊᨱ a᫵ a a ˉ ᫵ ᫵

௝Ł

௝

௝ ⦺ᔾ ⦺ ⦺ ॅᯕ ั⦹۵ߑ ə౨݅໕ əॅ ə ə ᯕ ᯥᔢ᳦ ᔢ ᔢ ⧊ ᳦ ᳦ ᜽ ⧊ ⧊ ⨹ᨱ ᯕ෕ʑ ᱥʭḡ ʭ ʭ ᮹ ᝅ᜖ŝ ᜖ ᜖ ⦺᜖ ⦺ ⦺ ᮹ ᜖ ᜖ ŝᱶᮥ ᨕਜí ᅕԙ ᅕ ᅕ ݅Ł ݅ ݅ ⧁ ᙹ ᯩā۵a ۵ ۵ ?

⦺ᔾ

⦺

⦺ ॅᨱí ʑݡ⦹۵ ၵa ၵ ၵ ໦⪶⦹ ⪶ ⪶ Ł ⦹ ⦹ ə ᩎపᮥ ᖒ≉⦹ʑ ⦹ ⦹ ᭥⧕ ྕᨨ

ᮥ ⧕᧝ ⦹۵ḡa Ǎℕ Ǎ Ǎ ᱢᮝಽ ᦭ಅḡ໑, ə đŝ۵ ᨕਜí ⠪a⧁ a a äᯕ໑, ⠪aᨱ ঑ෙ ঑ ঑ ⦺ᔾ ⦺ ⦺ ॅ᮹ ॅ ॅ ₦ᯥᯕ ྕᨨᯙḡa ᇥ໦⯩ ᱽ᜽ࡽ a ᬕߑ ⩶ᖒ⠪aෝ ☖⧕ ∊ᇥ⦽ ᇥ ᇥ Ʊᱶŝ ၽᱥ ၽ ၽ ᮹ ʑ⫭ෝ ᵝᨕᲭᮥ Ჭ Ჭ ভ

⦺ᔾ

⦺

⦺ ॅᮡ ᯱᝁ᮹ ⦺᜖ ⦺ ⦺ ᖒŝᨱ ݡ⦽ ↽᳦ ⠪a đŝᨱ Ԋा Ԋ Ԋ ⦹Ł ⦹ ⦹ ᙹ ɮ⧁

ɮ

ɮ ᙹ ᯩᮥ ᯩ ᯩ äᯕ݅(Shrank et al., 2004).

Ʊᙹ Ʊ

Ʊ อᯕ ⠪aᯱ a a a ᯱ ᯱ ࡹ۵ äᯕ ᦥܩ௝ ⦺ᔾ ⦺ ⦺ ॅᯕ ᜅᜅಽᨱ ݡ⧕ᕽ

⠪aᯱ a a ಽ ᯱ ᯱ ₙᩍ⦹ᩡᮥ ᩡ ᩡ ভ ࠺ഭ ࠺ ࠺ ෝ ഭ ഭ ⠪a⦹ a a ໕ᕽ ⠪aᯱ a a ಽ ᯱ ᯱ ᕽ ~š⪵ š š ⦹ ⪵ ⪵ ۵ ܆ಆᮥ ႑ᬑŁ ᬑ ᬑ ੱ⦽ ੱ ੱ əॅ ə ə ᮹ ॅ ॅ ⠪aŝ a a ᱶᯕ ᨕਜí ᯙeš e e ĥ š š ᨱ ᩢ⨆

ᮥ ၙ⊹۵ḡෝ Ğ⨹⦹۵ ʑ⫭a ࢁ ᙹ ᯩ۵ ᯩ ᯩ ߑ ᯕäᮡ ❡ ญ޵ಽᕽ

⪽࠺

⪽

⪽ ⦹í ⦹ ⦹ ࢁ ᮹ഭᱥྙa ྙ ྙ a a a w⇵ w w ᨕ᧝ ⧁ ⧖ᝍᩎప ᵲ᮹ ᵲ ᵲ ⦹ӹ ⦹ ⦹ ᯕ݅. ݅ ݅ ᯕ ᨱ ޵⦹ᩍ e⪙ e e ᔍ, ᔍ ᔍ əญŁ ⪹ᯱ ⪹ ⪹ ॅࠥ ॅ ॅ ⠪aᯱ a a ಽ ᯱ ᯱ ₙᩍ⦹۵ äᯕ ݅໕

⠪a᮹ a a ႊჶᯕ ࢁ ᙹ ᯩ݅. ݅ ݅ ᝅᱽಽ Ʊᙹ Ʊ Ʊ ॅᮡ ⦺ᔾ ⦺ ⦺ ॅᯕ ݚḢ ݚ ݚ ᮥ ᖅ ভ ۵ ᨕਅ ⧪┽ෝ ᅕᯕ ᅕ ᅕ ۵ḡ, ੱ⦽ ੱ ੱ ࠺ഭ ࠺ ࠺ ॅ ഭ ഭ aᬕߑᕽ۵ ❡ᬱᮝಽᕽ ᨕ ਜí ə ᩎ⧁ᮥ ⧁ ⧁ ⦹۵ḡෝ ᱶ⪶⯩ ⪶ ᦭ ᙹ ᨧ۵ Ğᬑa ᬑ ᬑ ฯ݅. ݅ ݅ ᝅᱽ ᮹ഭ

⪹Ğ

⪹

⪹ ᨱᕽ۵ ᔢɪᯱ ɪ ɪ อᯕ ᦥܩ௝ ⪹ᯱ ⪹ ⪹ , ᯱ ᯱ ࠺ഭ ࠺ ࠺ , əญŁ ݅ෙ ݅ ݅ Ḣᬱ ॒ᮝ ॒ ॒ ಽᇡ

ಽ

ಽ ░᮹ ݅໕ᱢᯙ ⠪aᨱ ঑௝ ⬭෎⦽ ෎ ෎ ᮹ᔍᯙḡ ᦥܭḡa đᱶࡹ

ʑ ভྙᯕ݅. ݅ ݅ ӹᦥa ᦥ ᦥ እᱥྙa ྙ ྙ ݅ a a ᬕ ⧪࠺ᮥ ᱶ᮹⦹Ł ⦹ ⦹ ᯕෝ Ʊᱶ⦹ʑ ⦹ ⦹

᭥⦽ Ǎℕ Ǎ Ǎ ᱢᯙ ᇡᇥᮥ ḡᱢ⦹۵ ⠪a᪡ a a ࠺᜽ ࠺ ࠺ ᨱ ┢ᬵ⦽ ᩎపᮥ ᅕ ᯕ۵ ⦺ᔾ ⦺ ⦺ ॅಽ ॅ ॅ ⦹ᩍɩ Ċಅၼࠥ ၼ ၼ ಾ ࠥ ࠥ ⦹ʑ ⦹ ⦹ ᭥⧕ᕽ۵ ᯕᨱ š⦹ š š ᩍ ɮᱶ ᱢᯙ ᅕᔢ ᅕ ᅕ ŝ ᔢ ᔢ ᯙᱶᮥ ⧕ᵝ۵ äᯕ ⦥᫵⧁ ᫵ ᫵ äᯕ݅. ݅ ݅

⦺ᔾ

⦺

⦺ ॅᯕ ᯱᝁᯕ ၼᮡ ၼ ၼ ⠪aෝ ᙹɮ⦹ ɮ ɮ Ł ⦹ ⦹ ᯙᱶ⦹ಅ໕ ᯱᝁᮥ ⠪a

⦹۵ Ʊᙹ Ʊ Ʊ a ᙹ ᙹ ᯱᝁᮥ ᦭Ł ᦭ ᦭ ᯩᮭ ᯩ ᯩ ᮥ ᯙᱶ⧁ ᙹ ᯩᨕ᧝ ⦽݅ ⦽ ⦽ . ݅ ݅ ᯕäᮡ ↽ ɝ᮹

ɝ

ɝ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ᯕ ḡ⨆⦹۵ ᩎపɝÑ ɝ ɝ ᮹⦺Ʊ ⦺ ⦺ ᮂ Ʊ Ʊ ᨱᕽ۵ ޵ᬒ ə్⦹

݅.

݅

݅ ᩎపɝÑ ɝ ɝ ⦺᜖᮹ ⧖ᝍᮡ ⦺ᔾ ⦺ ⦺ }}ᯙ᮹ ⧖ᝍᩎప ᖒ≉ ᩍᇡෝ

⪶ᯙ ⬥ ݅ᮭ ݉ĥ ݉ ݉ ಽ aࠥ a a ಾ ࠥ ࠥ ⦹۵ }ᄥ⪵ࡽ Ʊᮂ Ʊ Ʊ ŝ ᮂ ᮂ ᱶᯕ௝ ⧁ ᙹ ᯩ