Finally, the tug-of-war over medical education between the MEST* and the Korean Association of Medical Colleges (KAMC) is over. Universities have earned independent rights to decide on their medical education system. Let us look at the original intentions behind adopting medical schools.
*MEST: Ministry of Education, Science and Technology
STUDENTS PREPARING for medical school panicked when several universities, including Yonsei, announced last
July that they would gradually abolish their medical schools. Originally, Korean universities had medical colleges
that accepted only high school graduates; these students would then study medical science for six years, as
undergraduates. From 2003, some universities started to adopt the medical school system, which accepts students from other majors who have finished four years of undergraduate courses. However, after six years of probation, several major universities have come to the conclusion that it would be better to abolish medical schools completely. In other words, the MEST failed to establish medical schools in Korea: but is the medical school system really good-for-nothing?
Medical schools: phasing in and out
Discussions over converting medical colleges into medical schools first arose in the early 1990s. It was in 1998 when these were translated into action. The Presidential Commission for the New Education Community attempted to change the 2+4 education system* into a 4+4 education system** in the medical education program of every university; in other words, to introduce medical schools. The establishment of medical schools was intended to improve the standards of medical science in Korea by accepting students from diverse academic backgrounds and so developing research doctors. It was also expected that students with varied experiences during their ndergraduate years would be mature and have more solid motivation, thereby decreasing the drop-out or flunk rate. Cooling down the excessive competition heat for college entrance was also a secondary purpose for adopting the medical school system.
* 2+4 education system: a medical education system that includes 2 years of pre-medicine courses and 4 years of medical education in the department of medicine at a medical college.
** 4+4 education system: a medical education system that includes 4 years of undergraduate education and 4 years of medical science education at a medical school.
The attempt, however, faced huge opposition from a large circle of doctors and professors within the medical
establishment. Finally, in 2002, the MEST and medical college deans agreed to set up medical schools in universities that wanted to do so. In the following year, medical schools were introduced in several universities, such as Kyunghee University and Konkuk University. 2010 was set as the year of evaluation to decide whether to keep the new medical education system.
The decision was made last July. The Improvement Committee of Medical & Dental Education determined to grant universities the freedom to adopt medical schools, taking into account the voices of opposition from the medical world. Starting from next year, universities have to choose between a medical college or a medical school system. The ones that have already adopted a medical school can only abolish this system starting from 2014, for the sake of the many students currently preparing for medical school. Full liberalization of student admission for medical education would be given from 2019. Major universities such as Yonsei University, Seoul National University, Korean Catholic University and Korea University declared that they will reintroduce the medical college structure.
Side effects of medical school
What went wrong then? "Medical schools did not help to relieve the intense college entrance competition [thus not meeting the original intention of adopting medical schools],"says Kim Jae-sam (Researcher, Korean Higher Education Research Institute). "It only resulted in deferring the competition [until after college graduation]. The entry barriers for receiving a medical education became higher for students from a poor economic background. Now, not only are there the tuition fees spent on undergraduate education, but also money put into private education to prepare for medical school, not to mention the school's tuition fees as well once you get in."
Professors in the department of medicine point out that engineering and natural sciences major undergraduates rush to medical schools. This is usually because those students have less difficulty in preparing for the MEET*, and the perks that are given to doctors spur them to seek entry into medical school. "Establishing medical schools gave many people the chance to study medicine, even those who never really had any interest in the field in the first place, especially those studying engineering and natural sciences and those who have proper jobs already," says Yu Seung-heum (Prof., Dept. of Medicine, Yonsei Univ.). He explains that the brain drain is a great economic loss: people capable of working in other areas swarm to study medicine. "After all, medical school isn't the ideal place to nurture research doctors, since most of the graduates become clinical doctors," adds Yu.
The raison d’être of medical schools
No wonder deans of medical schools and medical colleges object to the expansion of medical school quotas, then. However, the potential of medical schools has yet to be realized, considering their short history in Korea. "Medical schools would blow a fresh breeze through medical circles, which have a closed and oppressive atmosphere," says Song Meong-gun (Prof., Cardiothoracic Surgery, Konkuk University Medical Center).
For one thing, the coursework in the medical department is extremely demanding, leaving students who study medicine little time to study something else. Students in medical college follow a specialized course focused on medicine for six years, making them lack broad understanding in the basic sciences or other fields. Students from other majors, on the other hand, get a synergy effect by converging medical sciences with other fields of study. Song says his worldrenowned innovative research methods, CARVAR* and COMVAR**, could not have come to life if he was not highly conversant with physics and mathematics. "Unlike many students who had their eyes only fixed on the school curriculum, I was very interested in mathematics and physics. So I delved into them on my own. Therefore, when I finished high school, my level of physics and math were equivalent to that of graduates in the same fields of studies," explains Song. As Song's case shows, accepting students from various academic backgrounds would help improve the medical industry and enhance national health care. "I believe my knowledge in psychology would be very helpful when I communicate with patients, but it is also true that psychology cannot suggest a definite answer without studying medical science which deals with our body. For instance, studying the brain is necessary to fully explain the underlying biological causes behind human mentalities caused by physiological factors," says Cho Eul-ah (Sr., Dept. of Psychology), who is currently preparing for medical school.
Though the 2+4 education system is more efficient than the 4+4 education system, in that it produces clinical doctors in a shorter period of time, the current medical education system is based on an oppressive and military-style approach. Therefore, it is likely that medical college students have poor communication and social skills. "We need more sociable and mature students with diverse experiences. Medical school students or college graduates in the medical colleges would help change the repressive atmosphere of the medical world," says Song.
*MEET: Medical Education Eligibility Test
*CARVAR: Comprehensive Aortic Root & Valve Repair
**COMVAR: Comprehensive Mitral Valve Apparatus Reconstruction
Why was the medical school system not fully embraced?
Despite their potential, then, why has it been so tough for medical schools to settle down in Korea? At first, the medical profession and MEST argued over this issue (establishing medical schools in every university) for more than ten years. Then, they finally found a middle ground in which the MEST did not force all universities to adopt medical schools, but allowed those willing to do so, and then they discussed the issue again after a six year trial. "Some universities adopted medical schools reluctantly, due to the administrative and inancial restrictions set by the overnment. Moreover, six years of trial were not sufficient to judge the positive influence of medical schools, since doctors graduating from medical school have not been produced yet. It is no wonder that professors of medical colleges are against the medical school system," says Kim.
Song points out that the deans of each university should view this problem interms of improving national health care y reforming the medical education system, instead of prioritizing the interests of individual universities and professors. They fear that outstanding students would all enter medical college after high school, while medical schools accept college graduates who could not enter medical college through the CSAT*. "Professors in the department of medicine prefer to maintain the original system [medical college] because they think that students screened through CSAT with top scores would have better academic capabilities than students in other departments. However, this is not always true, because many students once admitted in the departments of natural science or engineering retake the CSAT to enter medical college. Moreover, the CSAT is not the only criterion to measure students' aptitude in medical science," says Song.
Song also mentions that some professors prefer students who have finished high school and are used to a restrictive atmosphere, as they obey professors more easily, which makes teaching more comfortable for them. "Professors might have difficulties in preparing courses for students in medical school. Students of the medical school sometimes happen to raise objections during the lecture when professors explain something wrongly. This never happens among medical college students, who are used to a repressive atmosphere and the cramming education method."
* CSAT (College Scholastic Aptitude Test): Sooneung in Korean
The future for medical schools
So, is there any room for improvement to solve the current problems of medical schools?
Medical school students and medical college students in the department of medicine study under almost the same curriculum for four years. However, students who graduated from the medical college receive a bachelor's degree, while those who entered medical school get a master's degree on their diploma. Song says, "The standardized degree, MD (Doctor of Medicine), as offered in the United States, should be given for both groups of students studying medicine."
Currently, universities abolishing the medical school system are supposed to accept 30% of college graduates after 2014. For now, it is not determined whether the same quota for college graduates at medical colleges will be maintained after 2018. The 2+4 system has its own benefits, as it is more efficient in producing clinical doctors in a short period of time, while students studying under a 4+4 system can contribute to the diversity of the medical world. Having both student groups, one screened from the CSAT and the other that entered after experiencing a broader campus life, would be beneficial to the medical world, considering the advantages of both education systems.
Finally, the high tuition fees of medical schools should be adjusted, so as not to raise the entry barriers. "Everybody knows that the curricula of medical schools and the department of medicine in medical colleges are not different. It is absurd that medical school requires double the tuition fees of medical college," says Yu. In addition to the adjustment of tuition fees, there should also be discussion of greater scholarship provisions.
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Many students kill themselves to enter medical school and to become a doctor. Indeed, doctors are thought to have high job security and earn great respect within the Korean society. "Students, especially those majoring in biologyrelated fields, prepare for MEET only focused on getting a high score, without having any definite motivation or serious consideration of their aptitude as doctors," says Cho. It is true that medical school has its merits for students themselves, as well as society to a certain degree. Still, students applying for medical school should also seriously ponder their reasons for studying medicine: is it because of an ambiguous fantasy about becoming a doctor or a sincere vocation to care for sick people?