Korean Journal of Family Medicine

"Family Medicine"

Original Article

Articles Published in Korean Journal of Family Medicine: Impact of COVID-19 on Study Trends: Byung Ho Kong, Jae Kyung Choi, San-Sung Lee, Ji Young Kim; Received January 31, 2024 Accepted April 18, 2024 Published online August 2, 2024; DOI: https://doi.org/10.4082/kjfm.24.0023 [Epub ahead of print]

Abstract
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Background
The Korean Journal of Family Medicine (KJFM), which is an official journal of the Korean Academy of Family Medicine, is an English-text medical journal published since 2009. Although nearly 15 years have passed since the journal was launched, to the best of our knowledge, no study has reviewed articles published in the KJFM. Accordingly, we analyzed articles published in the KJFM for the first time.
Methods
Articles published in the KJFM between January 2018 and November 2023 were categorized according to article type. Information about author affiliations, study subjects, research methods, and modes of data collection was then scrutinized. Moreover, we compared the frequencies of subjects, research methods and modes of data collection before, during, and after the coronavirus disease 2019 pandemic.
Results
Original article was the most common article type. Approximately 52% of the articles were published by authors affiliated with departments other than family medicine, and 40% were published by family medicine. Approximately 60% and 38% of the articles were published by Korean authors and authors of international affiliations, respectively. Throughout the pandemic periods, research subjects focusing on “diseases & symptoms” have diminished, while “principles of family medicine” have progressively increased. Additionally, the use of cross-sectional study methods has declined. In terms of data collection, the use of “big data,” “medical records,” and “questionnaires” has decreased, whereas the use of “study results” has increased.
Conclusion
KJFM is journal with wide and international participation covering various research subjects and study methods. We believe that our study provides valuable data for the future direction and development of the KJFM.

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Review Article

Shared Decision-Making Training in Family Medicine Residency: A Scoping Review: Apichai Wattanapisit, Eileen Nicolle, Savithiri Ratnapalan; Korean J Fam Med 2024;45(3):134-143. Published online May 20, 2024; DOI: https://doi.org/10.4082/kjfm.23.0273

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Shared decisions, in which physicians and patients share their agendas and make clinical decisions together, are optimal for patient-centered care. Shared decision-making (SDM) training in family medicine residency is always provided, but the best training approach for improving clinical practice is unclear. This review aims to identify the scope of the literature on SDM training in family medicine residency to better understand the opportunities for training in this area. Four databases (Embase, MEDLINE, Scopus, and Web of Science) were searched from their inception to November 2022. The search was limited to English language and text words for the following four components: (1) family medicine, (2) residency, (3) SDM, and (4) training. Of the 522 unique articles, six studies were included for data extraction and synthesis. Four studies referenced three training programs that included SDM and disease- or condition-specific issues. These programs showed positive effects on family medicine residents’ knowledge, skills, and willingness to engage in SDM. Two studies outlined the requirements for SDM training in postgraduate medical education at the national level, and detailed the educational needs of family medicine residents. Purposeful SDM training during family medicine residency improves residents’ knowledge, skills, and willingness to engage in SDM. Future studies should explore the effects of SDM training on clinical practice and patient care.

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Original Article

Perception of Nutrition Education and Subjective Competency in Nutrition Topics among Korean Family Medicine Residents: Seung Guk Park, Yonchul Park; Korean J Fam Med 2024;45(1):37-43. Published online October 27, 2023; DOI: https://doi.org/10.4082/kjfm.23.0086

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Background
Appropriate nutrition is necessary for maintaining good health in the general population. During primary physician training, it is important to educate residents on the basic concepts of nutrition and methods to manage nutritional aspects according to various disease. However, little is known about the perception of nutritional education among Korean family medicine residents. This study analyzed the recognition of the importance of nutritional education, the amount received, and satisfaction with it as well as self-perceived competency in various nutrition topics among residents.
Methods
Web-based questionnaires were sent via mobile messages to all the residents registered with the Korean Academy of Family Medicine (KAFM). Out of 566 residents, 68 voluntarily participated in the study. The questionnaire consisted of 41 items related to perceptions of nutrition education, self-perceived competency in nutrition topics, and demographic characteristics.
Results
The response rate was 12.01%. Residents rated their satisfaction with nutrition education at 4.78 out of 10, and 83.3% considered it important. However, only 13.24% of the participants felt that it was adequate. The most common training method for nutrition education was lectures at KAFM conferences. Among the 29 nutritional topics, the residents reported highest confidence in subjects related to chronic diseases such as obesity (77.94%), diabetes (75%), cardiovascular disease (67.65%), gastrointestinal disorders (67.65%), and weight loss management (67.65%). Conversely, topics related to women (36.76%), children and adolescents (38.23%), drug-nutrient interactions (39.7%), eating disorders (42.64%), and food labels (42.64%) showed low self-perceived confidence rates.
Conclusion
Korean family medicine residents value nutrition education but believe that more education is necessary and they demonstrate differences in self-perceived competency in various nutrition topics.

Citations

Citations to this article as recorded by

Guidelines for nutrition counseling in primary healthcare clinics
Gyeongsil Lee, Seung-Won Oh
Journal of the Korean Medical Association.2024; 67(4): 278. CrossRef

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Review Article

Teaching Family Medicine and General Practice: Muhammad Jawad Hashim; Korean J Fam Med 2022;43(2):93-100. Published online March 17, 2022; DOI: https://doi.org/10.4082/kjfm.20.0223

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The teaching of family medicine and general practice should aim to develop an appreciation of the unique nature and role of the specialty. Teachers should relate patient cases to the principles of family medicine. These principles include (1) compassionate care; (2) a generalist/holistic approach focusing on the whole person, family, and community; (3) continuity of relationship, i.e., building a patient-physician bond of trust; (4) reflective mindfulness; and (5) lifelong learning. The curriculum, instructional strategy, and assessment should be carefully aligned. Core competencies include patient-centered communication, physical examination skills, clinical procedures, palliative care, humanities in medicine, holistic care, shared decision-making, family therapy, home and community visits, chronic disease care, problem-based documentation, team-based care, data-driven improvement, information mastery, ethics and professionalism, and work-life balance. Family medicine/general practice is defined as the medical specialty that manages common and long-term illnesses, focusing on overall health and well-being. Hence, clerkship schedules should maximize clinical exposure and opportunities for self-reflection. A learner-centered approach should begin with a self-identified inventory of learning needs based on the curriculum; next, these needs should be chosen as topics for student presentations. Teaching methods should include mini-workshops: a combination of didactic lectures and small-group exercises. Individual face-to-face formative feedback should occur at midcourse and culminate in a group reflection on the learning experience. Clinical supervision should gradually decrease as each resident demonstrates safe patient care. Procedure skills training should be closely supervised, formally documented, and constitute about one-fourth of learning sessions.

Citations

Citations to this article as recorded by

Use of audio-visual aids and case studies to enhance understanding of family medicine among medical students
Stephen T. Engmann
African Journal of Primary Health Care & Family Medicine.2024;[Epub] CrossRef
Guidelines for nutrition counseling in primary healthcare clinics
Gyeongsil Lee, Seung-Won Oh
Journal of the Korean Medical Association.2024; 67(4): 278. CrossRef
Disease prevention measures applicable to primary healthcare clinics
Jae-Heon Kang
Journal of the Korean Medical Association.2024; 67(4): 226. CrossRef
Perception of Family Medicine Residents on the Use of Small Group Discussion in Comparison to Standard Lectures
Ahmed Mohammed Gharawi, Abdullah Mohammed Alateeq, Ghada Alarfaj, Ayman Afify, Saad Albatal, Alaa Alahmari, Mostafa Kofi
European Journal of Contemporary Education and E-Learning.2024; 2(5): 3. CrossRef
Strengthening Primary Health Care through Medical Education
Seung-Won Oh
Korean Journal of Family Medicine.2023; 44(4): 181. CrossRef

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Original Articles

Defining Essential Topics and Procedures for Korean Family Medicine Residency Training: Youhyun Song, Jinyoung Shin, Yonghwan Kim, Jae-Yong Shim; Korean J Fam Med 2021;42(6):477-482. Published online November 20, 2021; DOI: https://doi.org/10.4082/kjfm.20.0244

Abstract
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Background
This study aims to create a comprehensive list of essential topics and procedural skills for family medicine residency training in Korea.
Methods
Three e-mailed surveys were conducted. The first and second surveys were sent to all board-certified family physicians in the Korean Academy of Family Medicine (KAFM) database via e-mail. Participants were asked to rate each of the topics (117 in survey 1, 36 in survey 2) and procedures (65 in survey 1, 19 in survey 2) based on how necessary it was to teach it and personal experience of utilizing it in clinical practice. Agreement rates of the responses were calculated and then sent to the 32 KAFM board members in survey 3. Opinions on potential cut-off points to divide the items into three categories and the minimum achievement requirements needed to graduate for each category were solicited.
Results
Of 6,588 physicians, 256 responded to the first survey (3.89% response rate), 209 out of 6,669 to the second survey (3.13%), and 100% responded to the third survey. The final list included 153 topics and 81 procedures, which were organized into three categories: mandatory, recommended, and optional (112/38/3, 27/33/21). For each category of topics and procedures, the minimum requirement for 3-year residency training was set at 90%/60%/30% and 80%/60%/30%, respectively.
Conclusion
This national survey was the first investigation to define essential topics and procedures for residency training in Korean family medicine. The lists obtained represent the opinions of Korean family physicians and are expected to aid in the improvement of family medicine training programs in the new competency-based curriculum.

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Comparison of Research Trends in Korean and International Family Medicine in Journals of Family Medicine: Jin-Kyung Jeon, Jungun Lee, Dong Ryul Lee; Korean J Fam Med 2014;35(6):265-275. Published online November 21, 2014; DOI: https://doi.org/10.4082/kjfm.2014.35.6.265

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Background

Research is important for the development of family medicine as a professional field in primary care. The aim of this study was to suggest directions for the development of family medicine research by analyzing research trends in original papers published in the Korean Journal of Family Medicine (KJFM) and international journals.

Methods

We investigated original research papers published in KJFM and 4 international journals from August 2009 to July 2010. Analysis was conducted according to research topics, authors, methods, participants, and data sources.

Results

'Clinical research' was the most common research topic in both the KJFM (88.3%) and international journals (57.3%); however, international journals had more studies in other domains ('education and research,' 'health service,' and 'family medicine'). More authors other than family physicians participated in international journals than in the KJFM (58% and 3.3%, respectively). Most studies were 'cross-sectional' in KJFM (77.0%) and international journals (51.5%): however, the latter had more 'qualitative' studies, 'cohort' studies, and 'systematic reviews' than the former. The largest study population was 'visitors of health promotion center' in the KJFM and 'outpatients' in international journals. Most of the study sources were 'survey' and 'medical records' in both.

Conclusion

There were limitations of diversity in the papers of the KJFM. Future investigation on papers of other than family medicine journals should be planned to assess research trends of family physicians.

Citations

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Analysis of evidence appraisals for interventional studies in family medicine using an informatics approach
Alain Nathan Sahin, Andrew Goldstein, Chunhua Weng
Primary Health Care Research & Development.2019;[Epub] CrossRef
Current status of health services research in primary care in Korea
Hee-Young Lee, Jong-Heon Park, Yong-Jun Choi
Journal of the Korean Medical Association.2016; 59(11): 888. CrossRef

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Satisfaction and Difficulties of Korean Family Medicine Resident Training Faculty: Jung-Ha Kim, Ju Young Kim, Kil Young Kwon, Chul-Min Lee, Tae-Hee Jeon, Seung Soo Hyun; Korean J Fam Med 2013;34(5):357-363. Published online September 26, 2013; DOI: https://doi.org/10.4082/kjfm.2013.34.5.357

Abstract
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Background

Practitioners of family medicine are essential to primary care practices in Korea. Resident training staffs in Korean family medicine departments have a crucial role in producing well-trained family physicians. This study assesses the aspects of satisfaction and difficulties of Korean family medicine resident training staffs.

Methods

We surveyed the resident training staffs of various Korean family medicine departments using an online survey tool. The survey used in this study was modified from previously used questionnaires. Respondents rated items using a five-point Likert scale and a 0-10 visual analogue scale.

Results

The response rate was 43.9% (122/278). The mean satisfaction score with regard to current family medicine residency programs was 7.59 out of 10. Resident training staffs found the administrative aspects of their role to be the most difficult. There were considerable differences in the reported difficulties of resident training according to the differing characteristics of each staff member, including age, sex, type of hospital, number of staff members, role as chief, and duration of staff. Most respondents (91.9%) cited a need for faculty development programs.

Conclusion

Korean family medicine resident training staffs need faculty development programs for the improvement of resident training. For the strengthening of core competencies among resident training staffs, faculty development programs or courses should be designed and implemented in Korea.

Citations

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Current status and challenges of faculty development in Korean medical education and strategies for advancement
Dong Hyeon Lee
Korean Journal of Medical Education.2024; 36(4): 415. CrossRef

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1 Crossref

Misinterpreting Odds Ratio in the Articles Published in Korean Journal of Family Medicine: Ju Heon Kim, Min Young Kim, Soo Young Kim, In Hong Hwang, En Jin Kang; Korean J Fam Med 2012;33(2):89-93. Published online March 30, 2012; DOI: https://doi.org/10.4082/kjfm.2012.33.2.89

Abstract
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Background

In reporting results of case-control studies, odds ratios are useful methods of reporting findings. However, odds ratios are often misinterpreted in the literature and by general readers.

Methods

We searched all original articles which were published in the Korean Journal of Family Medicine from 1980 to May 2011 and identified those that report "odds ratios." Misinterpretation of odds ratios as relative risks has been identified. Estimated risk ratios were calculated when possible and compared with odds ratios.

Results

One hundred and twenty-eight articles using odds ratios were identified. Among those, 122 articles were analyzed for the frequency of misinterpretation of odds ratios as relative risks. Twenty-two reports out of these 122 articles misinterpreted odds ratios as relative risks. The percentage of misinterpreting reports decreased over years. Seventy-seven reports were analyzed to compare the estimated risk ratios with odds ratios. In most of these articles, odds ratios were greater than estimated risk ratios, 60% of which had larger than 20% standardized differences.

Conclusion

In reports published in the Korean Journal of Family Medicine, odds ratios are frequently used. They were misinterpreted in part of the reports, although decreasing trends over years were observed.

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Nota epidemiológica: razón de ODDS (OR)
Guillermo Sánchez Vanegas, Ana Milena Diaz Dominguez, Daniela Colmenares Rojas
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Javier Perez-Rodriguez, Alejandro de la Fuente
The American Journal of Bioethics.2017; 17(9): 36. CrossRef
Comments on Statistical Errors for May Issue 2012
Yong Gyu Park
Korean Journal of Family Medicine.2012; 33(3): 186. CrossRef

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The Quality of Reporting of Cohort, Case-Control Studies in the Korean Journal of Family Medicine: Mi Ra Kim, Min Young Kim, Soo Young Kim, In Hong Hwang, Yeo Jung Yoon; Korean J Fam Med 2012;33(2):79-88. Published online March 30, 2012; DOI: https://doi.org/10.4082/kjfm.2012.33.2.79

Abstract
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Background

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was developed to improve the reporting of observational studies. We aimed to evaluate the quality of reporting in cohort studies and case-control studies among observational studies published in the Korean Journal of Family Medicine.

Methods

We searched for cohort studies and case-control studies published as original articles in the Journal of the Korean Academy of Family Medicine during the period January 1992 through December 2009. The main outcome measures were the number and proportion of cohort studies and case-control studies that reported each of 22 checklist items of STROBE.

Results

We identified a total of 84 articles, of which 46 articles were cohort studies and 38 were case-control studies. Concerning methods, study designs (10%), bias (13%), study size (0%), statistical methods (12-c and 12-e items, 0%; 12-d item, cohort study, 6%) have been poorly reported. Of results, participants (5-6%), descriptive data (14-b item, 5%), and funding (1%) among other information have been poorly reported.

Conclusion

The degree of adherence the STROBE recommendations was relatively low in cohort studies and case-control studies published in the Korean Journal of Family Medicine. An effort to improve the reporting of observational studies by application and recommendation of the STROBE statement is required.

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Cody L. Nesvick, Clinton J. Thompson, Frederick A. Boop, Paul Klimo
Journal of Neurosurgery.2014; 121(2): 285. CrossRef

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Statistical Trends in Family Medicine Journals: Hae-Jin Kwon, Yong-Gyu Park; Korean J Fam Med 2012;33(1):9-16. Published online January 31, 2012; DOI: https://doi.org/10.4082/kjfm.2012.33.1.9

Abstract
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Background

This study proposed a desirable direction for the future development of the Korean Journal of Family Medicine (KJFM) by comparing with the overseas SCI journals, Family Medicine (FM) and The Journal of Family Practice (JFP) based on the statistical viewpoints.

Methods

All of the original articles published in KJFM from January 1981 to June 2011, FM from January 1998 to June 2011, and JFP from January 1978 to June 2011, were reviewed and compared in terms of content, data size, research design, and statistical method.

Results

Of 3,226 total original articles, KJFM published 1,549, FM 322, and JFP 1,355, respectively. Both JFP and KJFM mainly focused on biomedical topics (67.2% and 61.7%), while FM focused on education (55.9%). Most of the studies in three journals used the data size of between 100 to 300 cases. The most frequently used research design was cross-sectional, FM 66.8%, JFP 58.4%, and KJFM 72.4%, respectively. The statistical methods in KJFM were gradually diversified.

Conclusion

The quality of the original articles in KJFM has been improved over the years, but still has conducted based on the relatively weak research designs. Under the circumstances that the higher ranked SCI journals demand the prospective design and large size of data, and most researchers in Korea could not use the large scaled prospective data, we need to collaborate to accumulate the small sized data sets and try to make a registry. More refined statistical method such as a propensity score matching analysis for retrospective data could be an alternative.

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An analysis of the articles published in the Journal of Korean Academy of Oral Health, from 1995 to 2012
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Journal of Korean Academy of Oral Health.2013; 37(1): 53. CrossRef

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Case Report

Implementation of a Videoconferencing System between Multiple Family Medicine Departments: Kee Hyuck Lee, Ju Young Kim, Kiheon Lee, Belong Cho, Jeong Hee Yang, Eurah Goh, Woo Kyung Bae; Korean J Fam Med 2011;32(5):311-316. Published online July 28, 2011; DOI: https://doi.org/10.4082/kjfm.2011.32.5.311

Abstract
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Attending conferences is important for doctors and residents in family medicine. Nevertheless, departments of family medicine at many hospitals find it difficult to hold regular conferences. Holding joint videoconferences between Family Medicine Departments of several hospitals through a videoconferencing system could solve this problem. Therefore, Family Medicine Departments of Seoul National University Hospital, Seoul National University Bundang Hospital, and Kangwon National University Hospital decided to hold regular joint videoconferences via a videoconferencing system. Eighty-one joint videoconferences were held from April 1 to October 29, 2010. PowerPoint slideshows were transferred to the other two locations in the same resolution as presenter's monitor. Image and voice of the speaker were transferred in real time and in acceptable quality. Joint videoconferences are feasible, satisfactory and useful for medical education, especially when individual family medicine departments are small and lack resources to hold face-to-face conferences. We expect that more family medicine departments will choose to participate in implementing similar joint videoconferencing systems in the future.

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology.2014; 03(01): 20. CrossRef
Satisfaction and Difficulties of Korean Family Medicine Resident Training Faculty
Jung-Ha Kim, Ju Young Kim, Kil Young Kwon, Chul-Min Lee, Tae-Hee Jeon, Seung Soo Hyun
Korean Journal of Family Medicine.2013; 34(5): 357. CrossRef
Satisfaction and Effectiveness of a Videoconference System for Family Physicians
Jong-Soo Han, Kee Hyuck Lee, Hyun-Hee Noh, Belong Cho, Jeong-Hee Yang, Dong-Ryul Lee, Soshin Ke, Woo-Kyung Bae
The Journal of the Institute of Webcasting, Internet and Telecommunication.2013; 13(3): 79. CrossRef

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Original Articles

Comprehension of Lung Sounds for Family Medicine Residents in Daegu, Gyeongbuk.: Jung Jae Park, Dong Wook Lee, Ki Heum Park, Hwee Soo Jeong, Sin Hyeung Lee, Zoo Young Yun; Korean J Fam Med 2010;31(10):793-797. Published online October 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.10.793

Abstract
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Background
Understanding lung sound is important physical examination of chest. We studied to identify the state of the understanding, the education and the self-learning experience for lung sound's interpretation during the residentship training period. Methods: Data were collected from 45 family medicine residents who had trained in Daegu and Gyeongbuk from April 1st to May 31th 2008. Residents completed self-administered questionnaire about the education and the self-learning experience for lung sound's interpretation and had been estimated the understanding of lung sound by using the audio file of five lung sounds. Results: The median score (inter-quartile range, IQR) of lung sound's interpretation was 2 (1, 3) between 0 and 5 range. The number of residents who were educated for the interpretation of lung sounds during the training period were 10 (22.2%). Twenty-four (53.3%) had the self-learning experience for lung sounds. Conclusion: The understanding for lung sounds of family medicine residents in Daegu, Gyeungbuk was not high and the majority of residents were not educated the interpretation of lung sounds during the training period. Directors of family medicine should consider to make the regular education program for interpretation of lung sound during the training period.

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Factors Contributing Patients' 'Self Requested Referral' in University Hospital Family Medicine Clinic.: Hyun Jung Choi, Jun Su Kim, Ji Yeon Jung, Ka Young Lee, Tae Jin Park; Korean J Fam Med 2009;30(12):951-961. Published online December 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.12.951

Abstract
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Background
After the referral system had been established, a tendency of patients who prefer to consult themselves to a specialist with 'self requested referral' is increasing in university hospital family medicine clinics. This study was conducted to know which factors of patients who for the fi rst time visited university hospital family medicine clinic to require medical request for 'self requested referral' to a specialist infl uence 'self requested referral' tendency. Methods: Among 905 patients, 647 agreed to the questionnaire were included in this study. We divided the patients in two, the 'self requested referral' group and the 'general patients' group that does not. Patients completed a four-item, selfadministered questionnaire. Results: 'Self requested referral' group tended to have no experience in family medicine and tended to be negative about the need for family medicine (P < 0.001) The factors that have effect on 'self requested referral' are age, occupation, education, experience of family medicine, and recognition degree of necessity of family medicine. Patients in 20-39 of age, who were white colored, higher education had higher tendency of 'self requested referral' and patients who had no experience in family medicine and lower degree of recognition about the necessity of family medicine had higher tendency of 'self-referral'. Conclusion: It is necessary to fi nd ways to increase satisfaction of patients who have factors that have effect on their 'self requested referral' tendency such as age, occupation, education, experience of family medicine, and degree of recognition about the necessity of family medicine.

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Trend of the Subjects and Participants of the Korean Academy of Family Medicine Conference.: Seon Je Lim, Yoo Seock Cheong, Eal Whan Park, Eun Young Choi, Sa Ra Lee, Sam Lee, Bit Noony Song, Hee Jung Kim, Hwa Yeon Seong; Korean J Fam Med 2009;30(10):805-812. Published online October 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.10.805

Abstract
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Background
Throughout the past 20 years in the Korean academy of family medicine seasonal conference, on-going study is done to promote overall development and satisfaction of the conference participants and to overlook the trend of the conference subject, the number of classes, the number of participants, etc. Methods: About 2,132 topics during the conference from the year 1992 to 2007 collected from the Korean academy of family medicine website were categorized by subject based on the standard of the contents of the latest textbook. There were a total of 7 main classifi cations including 5 categories like 'principles of family medicine', 'disease prevention and health promotion', 'symptoms', 'clinical procedures', 'diseases' and adding 2 categories such as each committee' classes and other subjects. The scope of the changes of the main and sub-titles were categorized as in the 1990s and 21 century. Results: The number of attendees has increased during the past 20 years, especially the residents were the main portion of the participants. On the proportion of the clinical topics, there was a remarkable increase of geriatric medicine, palliative medicine, obesity, exercise, nutrition, gastroscopy, and colonoscopy procedure in the later half rather than the former half period. In the fi eld of the main category, the core principle subjects of family medicine seemed to be decreased in contrast to disease category. Conclusion: During the last 20 years, the titles of family medicine conference are changing with the trend of practice. The core knowledge of family medicine should be maintained and balanced for the future of family medicine conference.

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Quality Assessment of Randomized Controlled Trials in the Journal of the Korean Academy of Family Medicine.: Woobin Chung, Kyung Woo Lee, In Hong Hwang, Dong Hee Lee, Soo Young Kim; Korean J Fam Med 2009;30(8):626-631. Published online August 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.8.626

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Background
Because low quality trials may lead to wrong conclusions, quality assessments are necessary. Thus, this study scrutinizes randomized controlled trials (RCTs) in the Journal of the Korean Academy of Family Medicine (KAFM) to assess the quantity and the quality. Methods: Upon extracting randomized controlled trials from all the articles published in the Journal of the KAFM from 1980 to 2005, assessments were made on the Jadad scale and the adequacy of allocation concealment. The selections and assessments were performed independently by two researchers, and adjustment of the differences were done by a third-party researcher. In addition, the factors that may affect the quality levels were analyzed. Results: Twenty-three trials were included. In 1980s, there were only 1.09% of the total original articles, but in 2000s, 2.63% were RCTs. The mean total Jadad score increased from 1 point in 1980s to 2.17 in 2000s, and the "good quality" trials also increased from 0% to 33.33%. As for the adequate allocation concealment, however, only two studies were observed in 2000s. The most lacking aspect was the appropriate double-blinding. Also, studies intervened by medicine or funded or examined by Institutional Review Boards (IRBs) tended to receive higher quality assessments. Conclusion: Although RCTs consistently increased in quantity and quality, in future studies, researchers should continue to strive towards achieving adequate allocation concealment and appropriate double-blinding. In addition, researchers must become more interested in receiving funds and examination by IRBs.

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Comparative Study

Quality Assessment of Non-Randomized Studies in the Korean Journal of Family Medicine.: Hyung Joon Kim, Soo Young Kim; Korean J Fam Med 2009;30(2):129-137. Published online February 10, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.2.129

Abstract
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Background
Since the Korean Journal of Family Medicine (KJFM) started publishing from 1980, randomized cotrolled trials (RCTs) and non-randomized controlled studies (NRSs) consistently have increased in quality and quantity. Although there have been several studies about the quality assessment of RCTs in Korea, there has been no study about quality assessment of NRS. Thus, this study scrutinies NRS in the KJFM to assess the quantity and quality. Methods: Upon extracting NRSs for assessing a intervention effects from all the articles published in the KJFM from 1980 to 2006, assessments were made on methodological index for non-randomized studies (MINORS). Also the analysis were made upon the proportion of NRSs within original articles according to two categories (comparative study, non-comparative study). The mean scores by research methods and years, and total scores and mean scores of yearly research methods were analyzed. Results: 34 trials on NRSs were selected. In 1980s, 0.65% of the total selected original articles, in 1990s, 1.54%, and in 2000s 5.11% were NRSs. According to the research designs, the mean scores of MINORS were before and after study 8.5, interrupted Time Series 9.7 (out of 16), controlled before and after 13.5, quasi randomized trial 12.6, and non randomized trial 13 (out of 24). Before and after design was the most frequent used (55.9%). Conclusion: Although NRSs consistently increased in quantity, the assessed mean scores were low and most articles used before and after design. Thus, there should be studies using appropriate research methods in the future.

Citations

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Original Articles

Perception and Experience of CAM Education for Family Practice Residents by Family Practice Training Faculty in South Korea.: Sun Myeong Ock, Chul Min Kim, Whan Seok Choi, Sang Yhun Ju, Ho Cheol Shin, Chan Hee Song; J Korean Acad Fam Med 2008;29(12):932-938. Published online December 10, 2008

Abstract
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Background: Complementary and alternative medicine (CAM) use is popular and current trend suggests a demand for CAM education during residency training. Our objective was to assess perception, the need and experience of CAM education for family practice residents by training faculty. Methods: A questionnaire was administered to family physicians (n=262) who were registered in the Korean Academy of Family Medicine as residency training faculty between February and May 2006. Results: One hundred and seven (40.8%) of 262 faculty completed the questionnaires. Eighty three (77.6%) respondents recognized the need of CAM education during residency training and fifty two (46.8%) respondents have already educated some kind of CAM. Thirty nine (36.4%) respondents replied that partial CAM educational contents were given out at conferences. Seventy eight (72.9%) respondents recognized the need for educating residents on the general outlines of CAM along with education on verified CAM. Sixty six (61.7%) respondents replied that the Korean Academy of Family Medicine should host such education. Conclusion: Most family practice training faculty recognized the need for providing CAM education for family practice residents during residency training, but about an half of family practice training faculty did not have experiences of CAM education. (J Korean Acad Fam Med 2008;29:932-938)

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Geriatrics in Family Medicine Residency Program: Training Conditions and Suggestions.: Bodri Son, Chang Won Won, Il Sin Kim, Hyun Rim Choi, Byung Sung Kim; J Korean Acad Fam Med 2008;29(9):687-694. Published online September 10, 2008

Abstract
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Background: With the number of geriatric population on a steep increase, the roles of family physicians broaden to give comprehensive medical care to the elderly. Therefore, geriatrics is becoming increasingly more important for the residents of family medicine. The authors have surveyed and researched on resident's current attention, actual training conditions, and future needs on geriatrics. Methods: Family medicine residents in 79 hospitals registered to Korean Family Medicine Resident Union were enrolled. By means of electronic and postage mail surveys, informations were gathered; including demographics, the order of importance of nine training curricula, the necessity of training itself, the facility and academic conference of geriatrics training. Results: A total of 173 residents in 45 hospitals replied with return rates of 51.9%. Among the total, 169 (97.7%) of the answered agreed on the necessity of geriatrics training. Of the nine curricula, geriatrics was considered the most important. And residents considered family medicine outpatient department and inpatient ward to be the most important place for geriatrics training. Furthermore, the residents considered elderly's diseases or symptoms as more important conference title, but the parameters such as the quality of life, physiology of aging, care in nursing home were considered less important. Conclusion: The geriatrics training program is not up to the standards of residents' satisfaction. This is considered to be due to the absence of a formal training program. To provide a better care for the elderly, it is compulsory to gain broad knowledge of geriatrics and actual experience out in the field. (J Korean Acad Fam Med 2008;29:687-694)

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Family Physician's Encounter Increases Patients' Satisfaction during Self-referral in a University Hospital.: Youn Pyo Kim, Seung Woo Ko, Jin Sook Hwang, Hwan Sik Hwang, Hoon Ki Park; J Korean Acad Fam Med 2008;29(5):325-329. Published online May 10, 2008

Abstract
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Background
After referral system had been established, patients wishing to consult with a specialist with 'self- referral' in mind is increasing in university hospital family medicine clinics. This study was conducted to know whether those by self-referral to a specialist in a university hospital could benefit from family physician's consultation or not. Methods: Three hundred and sixty patients were serially assigned to either 'simple referral' group provided with a referral note without consultation or 'referral after consultation' group with consultation from a family physician. Patient satisfaction was rated by using questionnaires with 5-point Likert scale. Results: Patients in the 'simple referral' group were more satisfied with the whole process of family physicians' consultation compared to the 'referral after practice' group in both the appropriateness and patient satisfaction of the consultation (both, P＜0.001). Males, longer encounter time, and shorter waiting time were significantly influenced patient satisfaction compared to each counterpart. Conclusion: Patients who want only a referral note from a family physician in a university hospital may received some benefit from the coordination and comprehensive care by a family physician. Health delivery system should be rectified according to the consideration of the role of the primary care physician such as a family physician. (J Korean Acad Fam Med 2008;29:325-329)

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Motivation and Time to Apply for Family Medicine Resident.: Se Jun Bak, Eun Jung Jo, Jae Eun Lee, Jun Seok Lee, Mee Young Kim, Jong Lull Yoon; J Korean Acad Fam Med 2007;28(12):931-936. Published online December 10, 2007

Abstract
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Background
As of 2006, the residents of family medicine occupies about 9 percent among the total. However, expansion of more general practice doctors is in demand to conduct desirable general practice. Accordingly, this study was conducted to survey the motivation to apply for family medicine residency and the actual situation. Methods: A questionnaire survey of 862 residents of nationwide family medicine from June 2006 to July 2006 was performed via e-mails. Hospital, size, years, gender, age, university, career, time and motivation to apply, and existence and nonexistence of lecture in medical school or clinical practice of family medicine for students were reviewed. Results: Among the total, 415 (48.14%) residents from 72 training hospitals answered. For the motivation, 'the necessity to diagnose and treat various patients' was 53.49%, 'advantageous to start practice' was 21.93%, and 'relatively short training period' was 11.33%. For the time, during 'intern' was 49.40%, 'on getting a job' 16.63%, and as a 'student' 15.42%. When they had lectures of family medicine in medical school, decision made as a student was 19.93%, and during clinical practice was 21.61%. Conclusion: Among the reasons that motivated to apply for family medicine, 'the necessity to diagnose and treat various patients' was the biggest, which conforms to the training goal of Academy of Family Physicians. Since there is a tendency to select family medicine residency earlier when they are exposed to lectures of family medicine or clinical practices in medical school, the effort to expand substantial lectures and clinical practices is needed. (J Korean Acad Fam Med 2007;28:931-936)

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Curriculum and Training Difficulties of Family Medicine Residency Programs in Korea.: Yu Jin Paek, Ho Cheol Shin, Cheol Hawn Kim, Youn Seon Choi, Hang Lee, Ae Kyung Cho, Eon Sook Lee, Jin Ho Park, Yoon Jung Chang, Min Jung Kim; J Korean Acad Fam Med 2007;28(5):367-374. Published online May 10, 2007

Abstract
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Background
This study was conducted to survey the current status of family medicine residency programs and to evaluate the difficulties in training of the curriculums. Methods: Questionnaires on residency programs were sent to all the centers of residency programs by mail in April 2006. The questionnaire included detailed characteristics of residency programs, curriculum schedule, reasons for failed specific curriculum, and review and measures by the program center and the Korean Academy of Family Medicine to resolve problematic curriculums. Results: A total of 113 residency programs responded. Among the 93 residency programs except for the 20 subsidiary hospitals, inadeguate subjects were mainly dermatology (12 programs, 12.3%), psychiatry (6 programs, 7.5%), ophthalmology (5 programs, 7.1%), and otolaryngology (5 programs, 7.1%). Training rejection rate was higher in dermatology (13 programs, 14.4%), radiology (11 programs, 13.1%), gastrofibroscopy (8 programs, 9.5%), and psychiatry (5 programs, 6.2%). Emergency me-dicine in 4 programs and general surgery in 3 programs had a longer duration of training than initially planned. Difficulties in training some subjects were due to failed establishment of specific curriculums in non-university hospital. Commonly established clinics were health promotion center, obesity clinic, smoking cessation clinic, geriatric clinic, stress clinic, and clinical nutrition clinic. Family medicine center programs included gastrofibroscopy, obesity, smoking cessation, geriatrics, hospice care, and evidence-based medicine. Conclusion: There is repeated demand for taking measures to promote better curriculum in the nation-wide view of family medicine. Dermatology, radiology, psychiatry, and otolaryngology were the subjects difficult to receive training. Measures to strengthen the weak subjects are urgently needed. (J Korean Acad Fam Med 2007;28: 367-374)

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Is Primary Care of Family Medicine better in Quality than that of Other Specialties?.: Kuk Hyun Baek, Eal Whan Park, Nam Eui Hong, Jun Woo Jo, Eun Young Choi, Yoo Seock Jung; J Korean Acad Fam Med 2005;26(7):404-411. Published online July 10, 2005

Abstract
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Background
: The purpose of this study was to assess the quality of primary care by patient-completed questionnaire, and to investigate whether the results of the assessment were different among the specialties of doctors (especially family medicine) and according to the existence of a family doctor.

Methods : The questionnaire, which covers 7 components of primary care (accessibility, continuity, accountability, comprehensiveness, integration, sustained partnership with patients, whole person orientation), was administered to the applicants of health screening center of a university hospital, and factory workers in Cheonan, and residents living in Seoul. Statistical analysis was performed through the collected samples.

Results : Total of 574 subjects were analyzed. The mean score (%) of each component of the total sample was as follows; accessibility 45.8, continuity 47.8, comprehensiveness 22.5, accountability 55.5, integration 41.8, sustained partnership with patients 48.9, and whole person orientation 31.8. The mean score (%) of all components were 42.0. Doctors were classified into internists, general surgeons, family physicians, general physicians, and others. Family physicians had the best score in accessibility (P=0.01). The mean score of all components of family physicians was better than that of internists and the other specialties (P＜0.05). The number of respondents who had family doctors was 129 (22.5%). The mean score of each component was higher than those without a family doctor (P＜0.05).

Conclusion : Family physicians are providing high quality primary care compared to internists and other specialists. Patients who have a family doctor are provided with higher quality primary care than those who do not. Especially, comprehensiveness and whole person orientation need to be improved.

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Knowledge and Attitudes of Family Physician and Oncologist toward Cancer Pain Management in Korea.: Young Ho Yun, Sang Min Park, Kiheon Lee, Ki Young Son, So Yeon Chung, Dae Seog Heo, Si Young Kim, Young Seon Hong, Bong Yul Huh; J Korean Acad Fam Med 2005;26(7):397-403. Published online July 10, 2005

Abstract
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Background
: Two representative groups of family physicians and oncologists were surveyed concerning their knowledge and attitudes toward cancer pain management (CPM).

Methods : A questionnaire, designed to assess knowledge (13 items) and attitudes (6 items) toward CPM, was sent to 2,200 members of Korean Association of Family Medicine and 800 members of Korean Cancer Association.

Results : Three hundred and eighty eight family physicians (17.6%) and one hundred and forty seven oncologists (18.4%) responded and completed the questionnaire. They had inadequate knowledge toward CPM, especially, chance of respiratory depression, tolerance to adverse effect, ceiling effect, risk of addiction, and use of adjuvants. Most of the physicians had positive attitude toward importance of CPM, best judge of pain severity, and priority of CPM but had negative attitude toward concerns about potential problem of addiction and earlier prescription of maximum dose of opioid. Family physicians displayed more lack of knowledge about CPM in 9 of 13 items and more negative attitudes toward 4 of 6 items. Adjustment for demographic characteristics and experiences in cancer patients with pain showed that while family physicians had poor knowledge of tolerance to confusion, they had more adequate knowledge on the effect of antidepressant and had positive attitude towards best judge of pain severity and priority of CPM. Poor knowledge about CPM was rated by 66.3% of physicians as the most important barrier to adequate CPM.

Conclusion : These findings that most of the physicians had poor knowledge and negative view toward CPM suggest a continuous need for comprehensive education program focused on CPM for physicians.

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The Survey of Family Medicine Clinical Clerkships in Medical Schools in Korea.: Chang Jin Choi, Bom Taeck Kim, Sang Woo Oh, Chang Won Won, Sun Mi Yoo, Hoonki Park; J Korean Acad Fam Med 2004;25(12):895-900. Published online December 10, 2004

Abstract
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Background
: New educational objectives and evaluation methods in Korean medical schools have been suggested recently to cope with health care related environmental changes. Current status of family medicine clinical clerkships in Korean medical schools is to be known before establishing standards.

Methods : Educational Committee of Korean Academy of Family Medicine surveyed the family medicine clerkship in Korean medical school (about educational environment, subjects and evaluation methods) using structured questionnaires by e-mail and Fax from February through March in 2004.

Results : Family medicine clinical clerkship was run by 25 of 41 medical schools (65.9%). Educational subject areas included communication skill, observation in hospital based ambulatory office, primary care and family medicine, medical recording, diagnosis and treatment of common problems, residential out-hospital ambulatory programs, presentation of hospital based ambulatory programs, procedure skill, lifelong heath management plan, and health promotion, in descending order. Faculties of family medicine were directly in charge of educational subjects. However, educational methods were mainly composed of lectures and indirect observation. It should be noted that concrete and precise evaluation methods in the family medicine clerkship program had been lacking due to insufficient and obscure evaluation strategies.

Conclusion : Clerkship period, educational environment, and number of class were variable among medical schools in Korea. Educational format needs to be standardized in terms of common educational subjects such as communication skill education, patient education, and ambulatory care clerkship. More valid methods are to be introduced for family medicine clerkship evaluation.

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Review

A Brief Discussion on Family Medicine in Edmonton, Alberta, Canada.: Lina Bohee Kim, Chang Won Won, Yun Jin Kim; J Korean Acad Fam Med 2003;24(7):605-611. Published online July 10, 2003

Abstract
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In early May 2003, a small group of four, including three family physicians and a media person, visited various family medicine education and training facilities in Edmonton, Alberta, Canada. This paper is a brief discussion of what knowledge and insight was gained during this trip.

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Original Articles

Assessing the Clinical Competence of Family Medicine Clerkship Students Using the OSCE.: Soo Hyun Kim, Do Haeng Lee, Young Mee Lee, Youn Seon Choi, Kyung Hwan Cho, Myung Ho Hong; J Korean Acad Fam Med 2002;23(5):583-592. Published online May 31, 2002

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Comparison of family medicine and internal medicine residents: fine needle aspiration cytology of thyroid nodul.: Young Kwon Song, Woong Kwan Song, Yu Heon Huh, Sang Yeoup Lee, Yun Jin Kim; J Korean Acad Fam Med 1999;20(3):259-268. Published online March 1, 1999

Abstract
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Background
: Fine needle aspiration cytology is an effective and important diagnostic procedure to distinguish benign from malignant thyroid nodule. The purpose of this study is to compare the results of thyroid fine needle aspiration cytology performed by the residents of family medicine and internal medicine.

Methods : Among patients who underwent fine needle aspiration cytology for differential diagnosis of thyroid nodule at the department of family medicine, Pusan National University Hospital from July 1996 to June 1998, we randomly selected 96 patients. We also selected 96 control patients at the department of internal medicine. We assessed the patients' age, sex, accompanying symptoms, diagnostic procedures, pathologic results of fine needle aspiration cytology from the medical records and biopsy records. For statistical analysis, we used t-test and Chi-square test.

Results : Mean age of 96 patients of family medicine was 44.4 years. Females were 89(92.7%) and males 7(7.3%). Age and sex distributions were not significantly different from that of internal medicine patients(p>0.05). Patients with thyroid nodule had undergone fine needle aspiration cytology(100.0%), thyroid function test(76.0%), thyroid scan(49.0%), and thyroid ultrasound(35.4%). There were more thyroid scans performed in the internal medicine department, as there were more ultrasonograms done in the family medicine department(p<0.05). Pathology results of 96 cases showed benign in 51 cases(53.1%), malignant in 8(8.3%), indeterminate in 16(16.7%), and insufficient in 21(21.9%). Among the 51 benign cases, there were cystic nodule(27.1%), adenomatous hyperplasia(22.9%), and thyroiditis(3.1%). All 8 malignant cases were papillary carcinoma. The frequency of malignancy thyroid nodules and insufficient specimens were not significantly different between the two departments(p>0.05). Complications of aspi-ration were rare and not significantly different between the two departments(p>0.05).

Conclusion : Pathology results and complications of fine needle aspiration cytology performed by residents of family medicine and internal medicine were not significantly different.

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The coincidence of the english keywords of the journal of korean academy of family medicine with MeSH and selection validity.: Byung Sung Kim, Soo Young Kim; J Korean Acad Fam Med 1998;19(7):531-537. Published online July 1, 1998

Abstract
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Background
: As the importance of keywords useful for indexing increases with the development of evidence based medicine, the importance of the English keywords also increases with the commencement of Koreamed. Though the information of authors recommends using MeSH terms for key-words, many authors do not stick to this principle. The objectives of this study are to investigate how much of the English keywords of the Journal of Korean Academy of Family Medicine(JKAFM) are used with precise MeSH terms and how well the keywords stand for the articles.

Methods : The English keywords were analyzed from the 455 articles of JKAFM published from Jan. 1992 to Dec. 1997. The authors investigated the frequently used keywords and what percentage of the keywords coincide with MeSH using MeSH browser. And for the ten randomly chosen articles from each of the six volumes, we examined what percentage of the English keywords coincide with the MeSH terms which had consensus of two family physicians and evaluated the validity.

Results : The total number of the English keywords used was 897, and 23 kinds of keywords including depression were used 5 or more times. The number of terms precisely coincident with MeSH was 161(17.9%), the number of terms with trivial difference(order or singular/pleural) was 34(3.8%) and 702 terms(78.2%) were not MeSH terms. Among the 202 MeSH terms determined with consensus from the randomly chosen 60 English abstracts, 51 terms(25.2%) were precisely coincident, 38 terms(18.8%) showed trivial difference, and 113 terns(55.9%) were not used.

Conclusion : Many of the English keywords of JKAFM does not coincide with MeSH, and over half of the keywords does not validly stand for the contents of the articles.

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Clinical Trial

Analysis of Papers Published in Journal of the Korean Academy of Family Medicine.: Kyeung Won Sim, Kie Jung Lee, Eung Sam Lee, Wol Mi Park, Sang Hwa Lee, Hong Soo Lee, Eun Hee Ha; J Korean Acad Fam Med 1998;19(4):353-363. Published online April 1, 1998

Abstract
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Background
: Research is essential for the development of family medicine as a professional field in primary care, Since information is available through the articles in the Journals of Family Medicine which contain subjects such as disease mechanism, pathophysiology, drug or new treatment method, and it is necessary to evaluate the contribution of recent researches in this field. The paper is intended to evaluate the current status of the quality of papers published in the Journal of the Korea Academy of Family Medicine (below JKAFM) and provide statistical data & direction of studies in the future.

Methods : 1218 articles in 185 editions of JKAFM were analyzed among 188 editions published from Nov.1980 to Dec. 1996. The papers were classified into Case Report, Original Article, Review Article by the type of papers, and then categorized into descriptive studies, analytic studies, and clinical trials by its methodology. In each category, the papers were stratified by the topic. Also, the analysis was conducted according to the authors, research subjects, sampling methods and the statistical methods, and observed the changes each year through 1980s to 1990s.

Results : The portion of original articles has increased from 18.6% in 1980s to 73.9% in 1990s. In terms of research methodology, the portions of analytical studies and clinical trials occupy 28.8% and 2.1% in 1990's respectively, compared with those of 1.8% and 0.6% in 1980's. When the papers were stratified by study topics, topics on family medicine showed the highest of 34.9% of the total. According to the detailed stratification, the principle of family medicine recorded 24.2%. In terms of sampling method, 89% and above was from the clinical data when current data were used, and 69.1% was by questionnaires when the data were newly collected. The most of the study subjects were outpatients of family medicine departments. The portion of papers in which the statistical analysis was not included was 29.9% in 1980s which decreased to 15.7% in 1990s. In terms of the statistical analysis methodology, the Chi-square test was the most frequently used(26.2%), followed by Descriptive(19.6%), t-test(18.2%) and ANOVA(8.7%) were the next.

Conclusion : The academic performance of family medicine can be most effectively measured by the analysis of the journals on family medicine. According to the analysis, the papers based on clinical activity is increasing in recent years with substantial contribution, which means that the field of family medicine has found its own position in medical science and is developing actively. In terms of study methodology, the portion of analysis study is getting larger, and the various method are being tried. The application of statistical methods is being developed in its quality and quantity. It should be noted that research on family medicine should provide the basis for new knowledge and promote public health by the integrated and intensive efforts.

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Original Article

A survey on change of perception and satisfaction of family medicine (From patients add in one general hospital in seoul).: Young Ju Kim, Kyu Ho Kim, Kyoung Kon Kim, Hyuk Jung Kweon, Bang Bu Youn; J Korean Acad Fam Med 2001;22(4):517-527.

Abstract

BACKGROUND
The author surveyed and analyzed the changes of perception and satisfaction about family medicine. So that the outcome may bring us a reference to advance family medicine more.
METHODS
247 in and out patients in one general hospital in Seoul were surveyed by the questionnaire from July 26, 2000 to June 20. The date was analyzed statistically by SAS program.
RESULTS
As for the knowledge of family medicine, 61.5% of the patients answered that they knew what it is, and the most of them, 54%, via medical institution. The office workers, married , and highly educated people tend to know more about family medicine (P<0.05). As for attitude, 68% of the group answered that family medicine is necessary, because "family medicine doctors give proper advice and consult through out all fields of medicine"(58.8%). As for the preference so prirate doctor, 56.7% of the group answered that they would register for family medicine clinic, and students and office workers are fond of family medicine(P<0.05). As for the satisfaction, 34.4% were ever been to family medicine clinic, and 35.5% out of them were dissatisfied, mainly due to the lack of knowledge of physicians about their diseases(70.1%).
CONCLUSION
The perception of family medicine are still scanty compared to the old studies.