Education of Rehabilitation Medicine

Education of Rehabilitation Medicine in Korea Education of Rehabilitation Medicine in Korea Department of Rehabilitation Medicine, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine Abstract: In Korea, western medicine was introduced in 1885, when Dr. Horace Allen, an American missionary, established the first western medical hospital, 'Kwanghye Won', which was the original Severance Hospital, Yonsei University College of Medicine. Then, the hospital renamed as ' Chechung Won'. In 1886, the first education of medical students was started in 'Chechung Won'. Later, in 1958, an educational course on Rehabilitation Medicine was introduced at Yonsei University College of Medicine for the first time. Education of Rehabilitation Medicine is included in the syllabuses of 40 among total 41 medical schools. Resident training requires the completion of a six year course in medical school and a year of rotating internship. A physiatrist is also required to undergo a four year course of resident training in an approved program. The number of resident training hospitals for Rehabilitation Medicine has increased since 1971, and the proportion of resident training hospitals for Rehabilitation Medicine among the total resident training hospitals has steadily increased. In addition, the number of residents in Rehabilitation Medicine training has increased. At present, 328 residents are undergoing Rehabilitation Medicine training in 2001. In 1983, twenty-two physiatrists were board certified in Korea for the first time, and the number of board certified physiatrists has increased gradually. In 2001, there were 591 board certified physiatrists practicing in Korea. The requirements for the board certification examination include a four year resident training, experiences with more than 300 patients, 200 cases of electromyographic studies, 12 out-hospital seminar attendances, 200 in-hospital seminar attendances and the publication of more than 3 scientific articles. The criterion for a pass at the board certification examination is a score of more than 60 of total 100 (score 60). In Korea, modern Rehabilitation Medicine has grown rapidly. However, education of Rehabilitation Medicine in Korea should overcome many

problems still faced. For example, we should calculate and make a plan for adequate numbers of board certified physiatrists and related medical personnels in the future, and we should have a national license system for related medical personnel such as speech therapists and clinical psychologists. In addition, we need to establish a more adequate educational system for physical therapy, occupational therapy, speech therapy and prosthetics and orthotics. Introduction The Korea Peninsula extends southwards from the north eastern Asian continent, and represents an area of 222, 154 square kilometers. The total population of Korea is 47 million, and the ratio of board certified physiatrist among this population is approximately 1:80,000. Given current trends, this ratio will be approximately 1:36,000 in 10 years time.1) Modern western medicine was introduced in 1885, when Dr. Horace Allen established the first western medical hospital 'Kwanghye Won', which was the original Severance Hospital, Yonsei University College of Medicine. Then, the hospital was renamed 'Chechung Won'. In the 19th century, medical missionaries introduced special educational programs for the blind in Korea.2, 3) The concept and programs used in Rehabilitation Medicine for disabled people, in a modern sense, were introduced to Korea during the Korean War, which broke out in 1950. During the war, disabled people became commonplace. In 1953, Amputee Rehabilitation Centers were established in Daejun and Seoul, especially at the Severance Hospital with the financial support of the Korea Church World Service. In addition, the National Rehabilitation Center was established in Pusan in 1953, and now it is located in Seoul. This Rehabilitation Center was equipped with modern technology and included the treatment of disabled veterans, prosthetic and vocational training. ' Then, in 1959, Children's Rehabilitation Center was established with the financial support of the Korea Church World Service in Yonsei University College of Medicine. It was rebuilt as the first university based modern Rehabilitation Hospital with 140 beds in 1987. Dr. Howard Rusk trained Korean medical doctors in the techniques and practice of Rehabilitation Medicine and helped to form the Korean Society for Rehabilitation of the Disabled Persons. Beginning in 1954, he sent a number of Korean medical doctors to New York University every year to train them in Rehabilitation Medicine, and thus provided Koreans the opportunity to develop Rehabilitation Medicine at an early stage in the country's development. In 1958, an educational course on Rehabilitation Medicine was introduced at Yonsei University College of Medicine for the first time. Later, in the 1960s, some medical doctors, who had been trained in United States, returned to Korea and began the process of creating Departments of Rehabilitation Medicine in major hospitals. In 1964, junior college was established to train physical therapists, and in 1971, the resident training program of physiatrists started in Wooseok University, currently named Korea University. In 1972, the Korean Academy of Rehabilitation Medicine was established, and in 1983, twenty-two physiatrists were board certified for the first time. The Paralympic Games were held in 1988 in Seoul and brought public awareness to the issue of disability and the need for rehabilitation to the highest level in Korea. As a result, the Rehabilitation Medicine has grown up rapidly. In terms of the status of disabled people in Korea, the total number of disabled people was estimated to be 1.5 million, approximately 3 of the Korean population. The registration system of disabled people started in 1991, but the rate of registration has been low in Korea. According to a survey conducted in 1995, those with physical handicaps accounted for the highest percentage of the population of disabled 22 Jpn J Rehabil Med VOL. 39 No. 1 2002

Education of Rehabilitation Medicine in Korea persons (58.3%), this was followed by those with multiple disabilities, deafness and blindness, in that order. Moreover, 88% of all cases with disability were caused by acquired factors such as disease, accidents and disasters. The number of disabled people has increased because the accident rates has also increased. About 98% of the disabled are not in institutions, and only 32% of them are employed. The average monthly income of the disabled is approximately $1,000, which is a half of the income of the average urban household. Education of Rehabilitation Medicine 1. Education of Medical Students Since the first education of medical students was started in 'Chechung Won' in 1886, an educational course on Rehabilitation Medicine was introduced at Yonsei University College of Medicine in 1958. Later, some medical doctors, who had been trained in United States, returned to Korea and began to lecture Rehabilitation Medicine to medical students. 3} In Korea, students take the medical school entrance examination after an elementary, middle and high school education period of 12 years. Medical students are enrolled in a six year educational program, which includes a two year pre-medical school. The lecture of Rehabilitation Medicine is currently run at 40 of total 41 medical schools, and clinical polyclinic practice is also performed in 36 medical schools. Medical students study Rehabilitation Medicine for average 18. 8 hours until they will graduate from medical school. The lectures include rehabilitation topics, relating to spinal cord injury, stroke, brain injury, amputee, cerebral palsy, musculoskeletal disorder, cardiopulmonary rehabilitation, prosthetics, orthotics, electrodiagnosis, pain, exercise and sports injury. 2. Program of Resident Training in Rehabilitation Medicine In Korea, there are two post-graduate programs. One is a resident training program for board certified physiatrists, and the other is a post-graduate school for MS. and PhD degrees. For resident training in Rehabilitation Medicine, one must complete a six year program of medical education in a medical school, followed by one year rotating internship training. A physiatrist is required to undergo a four year training course in an approved program, which places the emphasis of the clinical management of problems associated with disability for the purpose of restoring the disabled person to his optimum level. The main disorders encountered in Rehabilitation Medicine are spinal cord injury, stroke, traumatic brain injury, cerebral palsy, chronic pain, amputation and musculoskeletal disorders. And the major practices involved are electromyographic study, urodynamic study, videofluorography, gait analysis, pain management including trigger point, epidural, facet and intra-articular injections, and motor point block for spasticity management. Korean Academy of Rehabilitation Medicine (KARM) provides two annual meetings (spring and fall), monthly seminars and summer training lecture. In addition, KARM conducts an in-training examination to evaluate the quality of resident training annually. The related department of resident training includes Radiology, Rheumatology, Orthopaedics, Internal Medicine, Neurology and Neurosurgery. We have 62 approved hospitals for resident training for Rehabilitation Medicine among total 148 resident training hospitals in Korea. As the trends for hospitals and doctors, the number of resident training hospitals for Rehabilitation Medicine has increased remarkably from 1 in 1971 to 62 in 2000 (Table 1), and the proportion of resident training hospitals for Rehabilitation Medicine among the total resident training hospitals has gradually increased from 5.5% in 1980 to 41.9% in 2000 (Table 2). In addition, the number of residents in Rehabilitation Medicine has steadily increased from 13 in 1983 to 322 in 2000 with the increasing

Table 1 Trend of the number of resident training hospitals for rehabilitation medicine in Korea Table 3 Trend of the number of residents in rehabilitation medicine training in Korea Table 2 Trend of the proportion of rehabilitation training hospitals among total training hospitals Table 4 Trend of the number of board certified physiatrists in Korea number of hospitals. At present, total 328 residents are involved in Rehabilitation Medicine in 2001 (Table 3). The post-graduate Rehabilitation Medicine M. S. course exists at 23 medical colleges, and the PhD course is running at 12 medical colleges now. 3. Board Certification System for Physiatrists In 1983, the national board certification system for physiatrists was established, and 22 physiatrists were board certificated for the first time in Korea. The number of board certified physiatrists has also increased from 22 in 1983 to 591 in 2001 (Table 4). Currently, over 80 new board certified physiatrists are produced annually. The requirements for board certification include a four year resident training period with satisfactory educational criteria including the experiences of more than 300 patients, 200 cases of electromyographic studies, 12 out- 24 Jpn J Rehabil Med VOL. 39 No. 1 2002

Education of Rehabilitation Medicine in Korea hospital seminar attendances, 200 in-hospital seminar attendances, the publication of more than 3 scientific articles and training at related departments. Board certification examination include stroke and brain injury rehabilitation, spinal cord injury rehabilitation, pediatric rehabilitation, neuromusculoskeletal disorders, cardiopulmonary rehabilitation, prosthetics and orthotics, electrodiagnosis and physical medicine. At present, the board certification examination is divided into two parts. The 1st part is a written examination (100 questions including multiple choice questions) and the 2nd part consists of an oral test and slide test. The examination is held annually and supervised by the Korean Academy of Medical Sciences and the Korean Academy of Rehabilitation Medicine. Candidates must have the score of more than 60 of total 100 (score 60) to pass in each examination. 4. Education of Physical Therapists In Korea, a student who wants to be a physical therapist enters college or university, and completes a three or four year physical therapy educational program. Departments of Physical Therapy were firstly established in junior colleges in 1963,1) and currently, we have 23 three year colleges and 9 four year universities. Therefore, physical therapy lectures are delivered in a total 32 schools, and the total number of annual entrants is 1, 800 in 2000. The lectures include basic science, clinical medicine, physical therapy and clinical practice. 4) In 1965, the national license examination of physical therapists was introduced in Korea for the first timer and the number of national licensed physical therapists has increased rapidly. At present, national licensed physical therapists were 16, 165 and it seems that the number of physical therapists is already oversaturated. Therefore, it is apparent that the emphasis should be more on quality of education quantity in the future. than on 5. Education of Occupational Therapists A student must undergo three or four year educational program to be a occupational therapist. Currently, there are 7 three year junior colleges and 5 four year universities in Korea, and the total number of annual entrants is 575 now. Lectures are composed of three categories, namely, basic and clinical medicine, the principles and application of occupational therapy, and clinical practice. 4~ In 1969, national license system for the occupational therapist was introduced, and then, the number of national licensed occupational therapists has increased gradually. Currently, there are 480 national licensed occupational therapists. Despite the fact that occupational therapy is an important area of Rehabilitation Medicine, there are not enough training programs for occupational therapists in Korea, and the number of licensed occupational therapists is disproportionably lower than that of licensed physical therapists. 6. Education of Speech Therapists In Korea, the formal education of speech therapists started in 1988. 0 This has now expanded to 5 four year universities and 7 post-graduate schools. However, no national license system exists for speech therapists yet. Instead, we currently adopt a certification system by the Korean Academy of Speech-Language Pathology and Audiology. This certification system began in 1997, and there are 97 certified speech therapists now. In addition, It is estimated that over 400 speech therapists are engaged in speech therapy in comprehensive welfare centers for disabled people. 7. Education of Prosthetists and Orthotists According to statistics issued by the Korean Orthotics and Prosthetics Association in 2000, approximately 600 prosthetists and orthotists were working at hospitals and private orthotic and prosthetic manufacturers. Until 1996, there was no educational institute for orthotics and

prosthetics in Korea, and therefore, orthotists and prosthetists could only acquire the skills by working as apprentices.1) However, at present, there are 2 four year universities, 2 two year colleges for orthotics and prosthetics and 1 post-graduate course for M. S. degree in Korea, and in 2000, a national license system was introduced in this field, and 268 prosthetists and orthotists got national license for the first time. 8. Education of Psychologists Despite the importance of the clinical psychologists to manage and support patients receiving rehabilitation treatment, there is no national license system in Korea. Instead, they are certified by Korean Clinical Psychological Association. In addition, psychologists carry different names such as counselor, psychotherapist, clinical psychologist, counseling teacher and so on. In Korea, there are 25 four year universities containing Department of Psychology, and those who majored in Psychology can be engaged in this clinical area. Currently, we have 215 clinical psychology specialists and 253 clinical psychologists now. Therefore, we need to train them to work in Rehabilitation Hospitals. 9. Education of Rehabilitation Nurse Since the rehabilitation nurse program was firstly introduced in the Presbyterian Medical Center in 1974, many departments of Rehabilitation Medicine employed rehabilitation nurse after education of them in each hospital, but there is no national license system for rehabilitation nurses. However, recently, formal educational programs for rehabilitation nurse has been developed at Rehabilitation Hospital, Yonsei University College of Medicine and National Rehabilitation Hospital. But these programs are not so enough to supply rehabilitation nurses in whole Korea. was started in Korea only 50 years ago, it has grown up rapidly. In terms of the education of Rehabilitation Medicine, the number of medical students, schools, lectures, training residents and hospitals has steadily increased, and the number of board certified physiatrists and related medical personnels such as physical therapists, occupational therapists, speech therapists, prosthetists, orthotists, psychologists and rehabilitation nurses have increased and will continue to increase in the future. However, Rehabilitation Medicine in Korea should overcome many problems still faced. For example, we should calculate and make a plan for adequate numbers of board certified physiatrists and related medical personnels in the future, and we should have a national license system for related medical personnel such as speech therapists and clinical psychologists. In addition, we need to establish a more adequate educational system for physical therapy, occupational therapy, speech therapy and prosthetics and orthotics. References 1) Korea Research Meeting for A/P Decade: Policy and Program for Persons with Disability-Korea--. 1st Ed, Il-Jin, Seoul, 1997 2) Yonsei University College of Medicine: Medical Science for 100 Years. 1st Ed, Dong-a, Seoul, 1986 3) Yonsei University College of Medicine: Severance Hospital, 1st Ed, Kim's communications, Seoul, 1996 4) Chun SI: Rehabilitation Therapeutics. 1st Ed, Gye Chuk, Seoul, 1998 Conclusions Although modern Rehabilitation Medicine 26 Jpn J Rehabil Med VOL. 39 NoO. 1 2002