Training future Korean medicine doctors to perform bee venom acupuncture and obtain informed consent using an objective structured clinical examination

Eunbyul Cho; Hyesoo Jeon; O Sang Kwon; Jiseong Hong; Jaehoon Lee; Eunho Jung; Jiwon Park; Wookcheol Seo; Kyu Sang Lim; Nam geun Cho; Cho, Eunbyul; Jeon, Hyesoo; Kwon, O Sang; Hong, Jiseong; Lee, Jaehoon; Jung, Eunho; Park, Jiwon; Seo, Wookcheol; Lim, Kyu Sang; Cho, Nam geun

doi:10.13048/jkm.22002

JKM > Volume 43(1); 2022 > Article

Cho, Jeon, Kwon, Hong, Lee, Jung, Park, Seo, Lim, and Cho: Training future Korean medicine doctors to perform bee venom acupuncture and obtain informed consent using an objective structured clinical examination

Original Article

The Journal of Korean Medicine 2022; 43(1): 6-17.

Published online: March 1, 2022

DOI: https://doi.org/10.13048/jkm.22002

Training future Korean medicine doctors to perform bee venom acupuncture and obtain informed consent using an objective structured clinical examination

Eunbyul Cho¹

, Hyesoo Jeon¹

, O Sang Kwon²

, Jiseong Hong³

, Jaehoon Lee³

, Eunho Jung⁴

, Jiwon Park⁵

, Wookcheol Seo⁶

, Kyu Sang Lim⁷^{, 8}

, Nam geun Cho¹^{, *}

¹Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea

²Department of Meridian and Acupoint, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea

³Center for International Cooperation & Education on Korean Medicine, Wonkwang University, Iksan, Republic of Korea

⁴Department of Korean medicine, Jangsu Health Center and County Hospital, Jangsu, Republic of Korea

⁵Department of Acupuncture and Moxibustion Medicine, Jeonju Korean Medicine Hospital of Wonkwang University, Jeonju, Republic of Korea

⁶Department of Acupuncture and Moxibustion Medicine, Wonkwang University Gwangju Medical Center, Gwangju, Republic of Korea

⁷Professional Graduate School of Korean Medicine Wonkwang University, Iksan, Republic of Korea

⁸Korean Traditional Medicine Institute

Correspondence to : Nam geun Cho Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Wonkwang University Iksan, Jeollabuk-do, 54538, Republic of Korea Tel : +82-63-859-2812, Fax: +82-63-841-0033, E-mail : choandle@hanmail.net

Received September 28, 2021 Revised November 22, 2021 Accepted January 18, 2022

Abstract

Objectives

This study describes the implementation of a training course that aimed to increase the competency of undergraduate students of Korean medicine at a single college to obtain informed consent and perform bee venom acupuncture using an objective structured clinical examination (OSCE).

Methods

We developed and implemented a short training course for 111 fourth-year students of Korean medicine during their clinical rotation at the Department of Acupuncture and Moxibustion Medicine. Lectures were conducted on the effects of and hypersensitivity reactions to bee venom acupuncture, obtaining informed consent, performing skin test and bee venom acupuncture. Due to the COVID-19 pandemic, some students were offered online lectures, and some could not experience the performance of OSCE in person. A survey with 16 closed and three open questions was used to investigate self-efficacy, opinions about the online lectures, and the OSCE.

Results

Out of 111 questionnaires, 104 were completed (94%). Students were generally satisfied with the online lectures and OSCE. For the subjective questionnaire about what was helpful in the training of bee venom acupuncture techniques and OSCE, the authenticity of the teaching method was recorded the highest.

Conclusions

This study showed that online lectures were effective in teaching clinical skills of Korean Medicine. It is necessary to produce standard educational materials for clinical skills of Korean Medicine, and studies to analyze the reliability and validity of OSCE are needed.

Keywords: Authenticity, Bee venom acupuncture, Clinical skills, Informed consent, Objective Structured Clinical Examination

Fig. 1

Overall process of the training and objective structured clinical examination.

Fig. 2

Analysis of the open-ended questions asked regarding the bee venom acupuncture training and OSCE. The training contents and methods were largely regarded as helpful. The training contents included information on obtaining informed consent, performing a skin test, the bee venom acupuncture procedure, and possible issues. The training methods included authenticity, online lectures, practice sessions, materials, OSCE, and feedback.

Table 1

Objective Structured Clinical Examination Checklist for Obtaining Informed Consent and Training Bee Venom Acupuncture

Question Number	Detailed Checklist	Points
Obtaining informed consent
1	Was the patient information (name, patient number) checked and written in the consent form with a diagnosis?	2
2	Was the purpose and necessity of bee venom acupuncture treatment, the expected benefits and effects, and the time required for the procedure explained?	2
3	Were the past and present medical history taken to evaluate the possibility of hypersensitivity reactions and side effects? Were precautions given?	2
4	Were possible symptoms and countermeasures after bee venom acupuncture treatment explained?	2
5	Was the name of the doctor giving the consent written down with a signature?	2
6	Was the patient’s full consent and signature obtained?	2
7	Were sufficient understanding and additional questions checked?	2
Performing skin test and bee venom acupuncture
8	Was the bee venom solution injected into the syringe well?	2
9	Was the needle changed after the bee venom solution was injected into the syringe?	2
10	Was the guide to appropriate and safe position conducted?	2
11	Were wounds in the skin test area and treatment area checked?	2
12	Was proper hand hygiene done before the skin test?	2
13	Was the skin test site well disinfected before and after the injection?	2
14	Was the skin test done with an amount less than 0.1ml intradermally	2
15	Was the presence of an adverse reaction confirmed and written after 15 minutes of the skin test?	2
16	Was the procedure conducted in an appropriate and safe position?	2
17	Was proper hand hygiene done before performing the bee venom acupuncture?	2
18	Was the treatment area well disinfected before and after the bee venom was injected?	2
19	Was the bee venom acupuncture performed well?	2
20	Were the general medical and perishable wastes used in the procedure properly disposed of?	2
21	After the procedure, was the patient induced to wait for 15 minutes and then the treatment was terminated?	2
22	Was consideration for the patient taken during the procedure?	2

Table 2

Title and Learning Objectives of the Online Lecture

Number	Title of the lecture	Learning objectives
1	Efficacy and hypersensitivity reactions of bee venom acupuncture	Understand and explain the components and pharmacological action of bee venom Understand hypersensitivity reactions to bee venom acupuncture and how to deal with the reactions
2	Obtaining informed consent for bee venom acupuncture	Understand and be able to explain the process of bee venom acupuncture and obtain informed consent from the patient
3	Skin test	Understand the purpose of the skin test and can perform it
4	Performing bee venom acupuncture	Perform bee venom acupuncture in a hygienic and appropriate manner

Table 3

Students' Opinions on Bee Venom Acupuncture and OSCE

Survey questions	Strongly disagree (score 1)	Disagree (score 2)	Agree (score 3)	Strongly agree (score 4)	Total	Mean±SD
I am willing to use bee venom acupuncture in the clinical field.	1 (1.0%)	8 (8.3%)	53 (54.6%)	35 (36.1%)	97	3.26±0.65
The test time (10 minutes) was sufficient.	2 (2.1%)	19 (19.6%)	43 (44.3%)	33 (34.0%)	97	3.10±0.78
The models used in training and evaluation were adequate.	2 (2.1%)	5 (5.2%)	56 (57.7%)	34 (35.1%)	97	3.26±0.65
The clinic is an appropriate venue to implement OSCE.	1 (1.0%)	8 (8.3%)	47 (48.5%)	41 (42.3%)	97	3.32±0.67
OSCE helped me develop my clinical skills.	1 (1.0%)	3 (3.1%)	46 (47.4%)	47 (48.5%)	97	3.43±0.61

Table 4

Students' Opinions on Online Lectures

Survey questions	Strongly disagree (score 1)	Disagree (score 2)	Neutral (score 3)	Agree (score 4)	Strongly agree (score 5)	Total	Mean±SD
Was the average class time for online prior learning appropriate?	0 (0.0%)	1 (1.2%)	12 (14.1%)	42 (49.4%)	30 (35.3%)	85	4.19±0.72
Are learning videos attractive to promote learning?	0 (0.0%)	2 (2.4%)	15 (17.7%)	36 (42.4%)	32 (37.7%)	85	4.15±0.79
Were the learning videos used for review?	3 (3.6%)	12 (14.3%)	13 (15.5%)	32 (38.1%)	24 (28.6%)	84	3.74±1.13
Does prior online learning increase your understanding of classes?	0 (0.0%)	1 (1.2%)	7 (8.2%)	38 (44.7%)	39 (45.9%)	85	4.35±0.68
Were you able to study freely at your desired time and place?	1 (1.2%)	0 (0.0%)	2 (2.4%)	35 (41.2%)	47 (55.3%)	85	4.49±0.67

참고문헌

1. Korean Acupuncture and Moxibustion Society Textbook Compilation Committee. Acupuncture medicine. 4th ed. Seoul: Hanmi Medical Publishing Company;2020. p. 223–228.

2. Lee EJ, Ahn YC, Kim YIl, Oh MS, Park YC, Son CG. 2020; Incidence rate of hypersensitivity reactions to bee-venom acupuncture. Frontiers in Pharmacology. 11:October. 1–7. https://doi.org/10.3389/fphar.2020.545555

3. Kim CW, Lee YH, Lee KH. 2011; The case report of an anaphylaxis occurred when using sweet bee venom and common bee venom at the same time. Journal of Pharmacopuncture. 14:4. 59–61. https://doi.org/10.3831/kpi.2011.14.4.059

4. Kim JH, Kim MS, Lee JY, Yeom SR, Kwon YD, Kim DW. 2015; The case report of anaphylaxis after treated with bee-venom acupuncture. Journal of Korean Medicine Rehabilitation. 25:4. 175–182. https://doi.org/10.18325/jkmr.2015.25.4.175

5. Jeoung YO, Yang TK, Bak YI, Lim IS, Sim KB. 2014; An ideal model of informed consent communication. Korean Journal of Medical Education. 26:1. 9–17. https://doi.org/10.3946/kjme.2014.26.1.9

6. Anderson TN, Kaba A, Gros E, Schmiederer IS, Shi R, Aalami LR, et al. 2021; A novel blended curriculum for communication of informed consent with surgical interns. Journal of Graduate Medical Education. 13:3. 411–416. https://doi.org/10.4300/jgme-d-20-01057.1

7. Koller SE, Moore RF, Goldberg MB, Zhang J, Yu D, Conklin CB, et al. 2017; An Informed Consent Program Enhances Surgery Resident Education. Journal of Surgical Education. 74:5. 906–913. https://doi.org/10.1016/j.jsurg.2017.02.002

8. Korean Acupuncture and Moxibustion Society Textbook Compilation Committee. Clinical practice guideline of acupuncture medicine. 1st ed. Seoul: Hanmi Medicine Publish Company;2020. p. 3–188.

9. Kyunghee University College of Korean Medicine Clinical Skills Compilation Committee. Korean medicine clinical skills OSCE. 1st ed. Seoul: Korea Medical Book Publishing Company;2019. p. 1–178.

10. Cho HW, Hwang EH, Shin BC, Sul JU, Hong JW, Shin SW, et al. 2012; The analysis of satisfaction with clinical training and the related factors-especially in oriental rehabilitation medicine. Korean Journal of Oriental Preventive Medical Society. 16:2. 1–15.

11. Sim SB, Kweon JH, Kim HW, Hong JW, Shin SW. 2013; Student satisfaction study of clinical skills training in Korean medical education. Journal of Korean Medicine. 34:3. 37–53. https://doi.org/10.13048/jkm.13011

12. Yang S-J, Park K-M, Cho S-H. 2020; The analysis of satisfaction with clinical training and the related factors in the Korean medicine obstetrics and gynecology. Korean Journal of Obstetrics and Gynecology. 33:1. 116–127. https://doi.org/10.15204/jkobgy.2020.33.1.116

13. Cho E, Lee J-H, Kwon OS, Hong J, Cho NG. 2021; Assessment of acupuncture and moxibustion medicine clinical practice using the objective structured clinical examination. Journal of Acupuncture Research. 38:3. 219–226. https://doi.org/10.13045/jar.2021.00122

14. Kim MJ. 2020; Usage of informed consent form for Bee-venom pharmacopuncture therapy at Korean medicine hospitals and proposal for development of a standard informed consent form. Journal of Korean Medicine. 41:3. 66–80. https://doi.org/10.13048/jkm.20026

15. George JH, Doto FX. 2001; A simple five-step method for teaching clinical skills. Family Medicine. 33:8. 577–578.

16. Wearne S. 2011; Teaching procedural skills in general practice. Australian Family Physician. 40:1/2. 63–67.

17. Medical Association of Pharmacopuncture Institute. Pharmacopuncturology. Seoul: Elsevier Korea L.L.C;2008. p. 167–199.

18. Medical Association of Pharmacopuncture Institute. Pharmacopuncture medicine. Seoul: Gaonhaemedia;2016. p. 11–20.

19. Lim C, Han H, Hong J, Kang Y. 2016; 2016 competency modeling for doctor of Korean medicine & application plans. Journal of Korean Medicine. 37:1. 101–113. https://doi.org/10.13048/jkm.16010

20. Lee S. 2018; Development of evaluation scale of flipped-learning course operation suitability in a university. The Korean Journal of Educational Methodology Studies. 25:1. 159–181. https://doi.org/10.15334/fle.2018.25.1.159

21. Miller GE. 1990; The assessment of clinical skills/competence/performance. Academic Medicine. 65:9. 563–567.

22. Harden RM, Lilley P, Patricio M. 2016. The definitive guide to the OSCE: the objective structured clinical examination as a performance assessment. Edinburgh (UK): Elsevier.

23. Kim JD. 2011. Research on the realistic acupuncture model: towards objective structured clinical examination (OSCE) (Masters dissertation). Pusan National University;Pusan:

24. Pacific Academy of Sciences. 5 minutes OSCE. 5th ed. Seoul: Pacific Books;2018. p. 314–319.

25. Im SJ. 2012; Strategies for effective teaching in clinical clerkship. Hanyang Medical Reviews. 32:1. 51–58. https://doi.org/10.7599/hmr.2012.32.1.51