Survey Study on the Impact of Pulse Diagnosis Device Implementation on Understanding and Proficiency in Pulse Diagnosis and Strategies for Improving the Educational Environment in a Korean Medical Diagnostics Course

Article information

J Korean Med. 2025;46(2):1-19

Publication date (electronic) : 2025 June 1

doi : https://doi.org/10.13048/jkm.25014

Hyungsun Jun ¹

, Hanbit Jin ²

, Dasol Park ¹

, Nahyun Cho ¹^,³

, Kyungtae Park ⁴

, Jungtae Leem ⁵^,⁶^,

, Hyun-Jong Jung ¹^,⁵^,

¹Department of Diagnostics, College of Korean Medicine, Wonkwang University

²Department of Preventive Medicine, College of Korean Medicine, Dongshin University

³East-West Cancer Center, Cheonan Korean Medical Hospital, Daejeon University

⁴Magok PyeonHanMom Korean Medicine Clinic

⁵Research Center of Traditional Korean Medicine, College of Korean Medicine, Wonkwang University

⁶Department of Il-won Integrated Medicine, Wonkwang University Korean Medicine Hospital

Correspondence to: Jungtae Leem, College of Korean Medicine, Wonkwang University, 460 Iksandae-ro, Iksan, 54538, Republic of Korea, Tel:+82-63-850-6914, Fax:+82-63-850-7324, E-mail:julcho@naver.com

Correspondence to: Hyun-Jong Jung, College of Korean Medicine, Wonkwang University, 460 Iksandae-ro, Iksan, 54538, Republic of Korea, Tel:+82-63-850-6914, Fax:+82-63-850-7324, E-mail:jhjkendu@naver.com

Received 2024 November 6; Revised 2025 March 31; Accepted 2025 May 22.

Abstract

Objectives

Pulse diagnosis, a tactile method, is limited in expressibility and heavily reliant on practitioner experience, making it subjective and challenging for new learners. Pulse diagnosis devices were developed to address these issues, yet studies on their educational use remain limited. This study explores limitations in pulse diagnosis training for Korean medical students and examines changes in understanding and proficiency after device use.

Methods

This survey study included 90 students from a diagnostic practice course at a Korean medical college in 2024. A 42-question survey assessed educational improvements, changes in understanding and proficiency, and evaluated the device, with participation limited to volunteers.

Results

A total of 40 students responded. Most found the pulse diagnosis device helpful for improving knowledge and proficiency, though limited practice time was noted as an area needing improvement. After practicing with the pulse diagnosis device, both understanding and proficiency improved overall, with notable gains in proficiency, especially for superficial and deep pulses. Slippery and hesitant pulses remained the most challenging. The primary difficulty students faced in studying pulse diagnosis was a lack of standardization, though 66.7% reported improvement after practice. While measurement challenges were the most common drawback, 97.5% expressed satisfaction with the device, and 75.0% showed willingness to use it clinically.

Conclusions

Integrating pulse diagnosis devices in courses improves students’ understanding and proficiency, supporting their educational value. Expanding applications, such as incorporating pattern identification in future device training, may further enrich pulse diagnosis education.

Keywords: Pulse diagnosis device; Education; Survey; Korean medicine; OSCE

Fig. 1

Box plot of changes in pulse diagnosis understanding and proficiency before and after pulse diagnosis device practice

In a box plot, the top and bottom edges of the box represent the third and first quartiles, respectively, with the thick horizontal line inside the box indicating the median. The lower whisker extends to 1.5 interquartile range below the first quartile, and the upper whisker extends to 1.5 interquartile range above the third quartile, adjusted to the nearest actual data points.

Fig. 2

Pre- and post-practice average changes by subgroup based on pulse diagnosis understanding and proficiency levels before pulse diagnosis device practice

Before the pulse diagnosis device practice, pulse diagnosis understanding or proficiency scores of 0–4 were classified as the Low group, and scores of 5–10 were classified as the High group.

Table 1

Evaluation of pulse diagnosis device practice training (N=40)

Table 2

Suggested improvements for pulse diagnosis device practice training (N=40)

Table 3

Changes in understanding and proficiency of pulse diagnosis before and after pulse diagnosis device practice (N=40)

Table 4

Subgroup analysis of pulse diagnosis understanding and proficiency levels before pulse diagnosis device practice

Table 5

Challenges encountered during pulse diagnosis study and issues resolved after pulse diagnosis device practice (N=40)

Table 6

Evaluation of the pulse diagnosis device (N=40)

Table 7

Challenges encountered when using the pulse diagnosis device (N=40)

Table 8

Students’ utilization of the pulse diagnosis device (N=40)

References

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Appendices

Appendix 1. Survey

jkm-46-2-1-Appendix-1.pdf

Appendix Figure S1. Histogram of the appropriate usage time per person for the pulse diagnosis device

jkm-46-2-1-Appendix-Fig-1.pdf

Appendix Tables

Appendix Table S1. Median, 1st quartile, and 3rd quartile of pulse diagnosis understanding and proficiency before and after pulse diagnosis device practice

Appendix Table S2. Median, 1st quartile, and 3rd quartile of pulse diagnosis understanding and proficiency by subgroup levels before pulse diagnosis device practice

jkm-46-2-1-Appendix-Table.pdf

Article information Continued

Fig. 1

Box plot of changes in pulse diagnosis understanding and proficiency before and after pulse diagnosis device practice

Fig. 2

Pre- and post-practice average changes by subgroup based on pulse diagnosis understanding and proficiency levels before pulse diagnosis device practice

Before the pulse diagnosis device practice, pulse diagnosis understanding or proficiency scores of 0–4 were classified as the Low group, and scores of 5–10 were classified as the High group.

Table 1

Evaluation of pulse diagnosis device practice training (N=40)

Evaluation of pulse diagnosis device practice training	n (%)
Awareness of the pulse diagnosis device before class and practice

Not aware at all	5 (12.5)
Unaware	15 (37.5)
Aware	15 (37.5)
Very aware	5 (12.5)

Helpfulness of pulse diagnosis device practice in expanding knowledge

Strongly disagree	0 (0.0)
Disagree	0 (0.0)
Agree	29 (72.5)
Strongly agree	11 (27.5)

Helpfulness of pulse diagnosis device practice in improving proficiency

Strongly disagree	0 (0.0)
Disagree	3 (7.5)
Agree	28 (70.0)
Strongly agree	9 (22.5)

Relevance of pulse diagnosis practice to device practice

Strongly disagree	0 (0.0)
Disagree	4 (10.0)
Agree	33 (82.5)
Strongly agree	3 (7.5)

Data are presented as frequency and percentage.

Table 2

Suggested improvements for pulse diagnosis device practice training (N=40)

Evaluation of the sufficiency of materials and time for pulse diagnosis device practice	n (%)
Sufficiency of materials and equipment

Strongly disagree	5 (12.5)
Disagree	12 (30.0)
Agree	16 (40.0)
Strongly agree	7 (17.5)

Sufficiency of time

Strongly disagree	4 (10.0)
Disagree	18 (45.0)
Agree	18 (45.0)
Strongly agree	0 (0.0)

Data are presented as frequency and percentage.

Table 3

Changes in understanding and proficiency of pulse diagnosis before and after pulse diagnosis device practice (N=40)

	Before	After	Mean change	p-value^‡
Total

Understanding	4.30 ± 2.00	7.08 ± 1.23	2.78 ± 1.79	<0.001^*†
Proficiency	3.45 ± 2.14	6.60 ± 1.13	3.15 ± 2.32	<0.001^*

Strong pulse (有力脈), Weak pulse (無力脈)

Understanding	4.85 ± 2.61	6.88 ± 1.70	2.03 ± 1.78	<0.001^*
Proficiency	4.45 ± 2.57	7.00 ± 1.65	2.55 ± 2.30	<0.001^*

Superficial pulse (浮脈), Deep pulse (沈脈)

Understanding	5.05 ± 2.37	7.23 ± 4.49	2.18 ± 1.85	<0.001^*
Proficiency	4.18 ± 2.31	7.00 ± 1.41	2.83 ± 2.10	<0.001^*

Slow pulse (遲脈), Rapid pulse (數脈)

Understanding	6.15 ± 2.29	7.68 ± 1.40	1.53 ± 1.83	<0.001^*
Proficiency	5.73 ± 2.41	7.83 ± 1.28	2.10 ± 2.15	<0.001^*

Slippery pulse (滑脈), Hesitant pulse (澁脈)

Understanding	3.75 ± 2.56	5.88 ± 2.09	2.13 ± 2.08	<0.001^*
Proficiency	3.00 ± 2.42	5.48 ± 2.10	2.48 ± 1.95	<0.001^*

Tight pulse (緊脈)
Understanding	4.35 ± 2.41	6.38 ± 1.76	2.03 ± 1.99	<0.001^*
Proficiency	3.48 ± 2.25	5.88 ± 1.98	2.40 ± 2.13	<0.001^*

Data are presented as mean ± standard deviation.

Statistically significant when p < 0.05.

^†

Paired t-test was used for parametric data.

^‡

The p-value for comparing means before and after pulse diagnosis practice was calculated using the Wilcoxon signed-rank test for non-parametric data and the paired t-test for parametric data.

Table 4

Subgroup analysis of pulse diagnosis understanding and proficiency levels before pulse diagnosis device practice

	Low, n	High, n	Low			High			p-value^‡

			Before	After	Mean change	Before	After	Mean change
Total

Understanding	25	15	3.00 ± 0.82	6.72 ± 1.28	3.72 ± 1.37	6.47 ± 1.41	7.67 ± 0.90	1.20 ± 1.21	0.011^*
Proficiency	27	13	2.26 ± 1.26	6.56 ± 1.05	4.30 ± 1.88	5.92 ± 1.26	6.69 ± 1.32	0.77 ± 0.83	0.890

Strong pulse (有力脈), Weak pulse (無力脈)

Understanding	20	20	2.70 ± 1.34	5.75 ± 1.41	3.05 ± 1.54	7.00 ± 1.56	8.00 ± 1.12	1.00 ± 1.38	<0.001^*
Proficiency	18	22	2.17 ± 1.29	6.50 ± 1.62	4.33 ± 1.97	6.32 ± 1.67	7.41 ± 1.59	1.09 ± 1.31	0.083^†

Superficial pulse (浮脈), Deep pulse (沈脈)

Understanding	16	24	2.69 ± 1.01	6.50 ± 1.55	3.81 ± 1.42	6.63 ± 1.56	7.71 ± 1.27	1.08 ± 1.18	0.010^*†
Proficiency	22	18	2.45 ± 1.26	6.59 ± 1.47	4.14 ± 1.81	6.28 ± 1.32	7.50 ± 1.20	1.22 ± 1.06	0.058

Slow pulse (遲脈), Rapid pulse (數脈)

Understanding	10	30	3.00 ± 1.25	6.70 ± 1.70	3.70 ± 1.89	7.20 ± 1.42	8.00 ± 1.14	0.80 ± 1.10	0.030^*
Proficiency	11	29	2.73 ± 1.19	7.55 ± 1.13	4.82 ± 1.33	6.86 ± 1.64	7.93 ± 1.33	1.07 ± 1.33	0.574

Slippery pulse (滑脈), Hesitant pulse (澁脈)

Understanding	27	13	2.19 ± 1.18	4.96 ± 1.81	2.78 ± 2.10	7.00 ± 1.15	7.77 ± 1.17	0.77 ± 1.24	<0.001^*
Proficiency	29	11	1.79 ± 1.40	4.83 ± 1.98	3.03 ± 1.84	6.18 ± 1.40	7.18 ± 1.33	1.00 ± 1.41	<0.001^*†

Tight pulse (緊脈)

Understanding	21	19	2.43 ± 0.93	5.62 ± 1.69	3.19 ± 1.91	6.47 ± 1.61	7.21 ± 1.47	0.74 ± 1.10	0.003^*†
Proficiency	27	13	2.22 ± 1.19	5.37 ± 1.98	3.15 ± 2.05	6.08 ± 1.61	6.92 ± 1.55	0.85 ± 1.34	0.018^*†

Before the pulse diagnosis device practice, pulse diagnosis understanding or proficiency scores of 0–4 were classified as the Low group, and scores of 5–10 were classified as the High group.

Data are presented as mean ± standard deviation.

Statistically significant when p < 0.05.

^†

Independent t-test was used for parametric data.

^‡

The p-value for comparing means between the Low and High subgroups in the 'After' data was calculated using the Mann-Whitney U test for non-parametric data and the independent t-test for parametric data.

Table 5

Challenges encountered during pulse diagnosis study and issues resolved after pulse diagnosis device practice (N=40)

	(a)	(b)	(c) = b/a×100

	Challenges before device practice in pulse diagnosis study, n (%)	Issues resolved after device practice, n (%)	Improvement rate, %
Lack of consistency due to lack of standardization	33 (82.5)	22 (55.0)	66.7
Differences in tactile sensation	29 (72.5)	14 (35.0)	48.3
Lack of understanding of the 3D aspects	25 (62.5)	12 (30.0)	48.0
Insufficient understanding of normal pulse	22 (55.0)	13 (32.5)	59.1
Limited understanding of appropriate pressure levels	21 (52.5)	11 (27.5)	52.4
Variety of pulse types	17 (42.5)	3 (7.5)	17.6
Inconsistency in pulse descriptions across texts	5 (12.5)	2 (5.0)	40.0
Various measurement methods	4 (10.0)	4 (10.0)	100.0
None	0 (0.0)	1 (2.5)	-

Data are presented as frequency and percentage.

Multiple responses allowed.

Table 6

Evaluation of the pulse diagnosis device (N=40)

Evaluation of the pulse diagnosis device	n (%)
Objective measurement device

Strongly disagree	0 (0.0)
Disagree	6 (15.0)
Agree	29 (72.5)
Strongly agree	5 (12.5)

Drawback^*

Difficulty in measurement	20 (50.0)
Variation in results due to posture and environment	15 (37.5)
Discrepancy between manual pulse diagnosis and device results^*	12 (30.0)
Slippery pulse (滑脈), Hesitant pulse (澁脈)	6 (50.0)
Superficial pulse (浮脈), Deep pulse (沈脈)	5 (41.7)
Strong pulse (有力脈), Weak pulse (無力脈)	3 (25.0)
Tight pulse (緊脈)	2 (16.7)
Slow pulse (遲脈), Rapid pulse (數脈)	1 (8.3)
None	7 (17.5)
Inconsistency with general pulse definitions	0 (0.0)

Satisfaction level

Strongly dissatisfied	0 (0.0)
Dissatisfied	1 (2.5)
Satisfied	34 (85.0)
Strongly satisfied	5 (12.5)

Willingness to use in future clinical practice

Not at all	1 (2.5)
No	9 (22.5)
Yes	26 (65.0)
Definitely yes	4 (10.0)

Data are presented as frequency and percentage.

Multiple responses allowed.

Table 7

Challenges encountered when using the pulse diagnosis device (N=40)

	n (%)
Difficulty using the pulse diagnosis device

Strongly disagree	2 (5.0)
Disagree	26 (65.0)
Agree	12 (30.0)
Strongly agree	0 (0.0)

Reasons for difficulty in using the device

Difficulty in measurement
“Maintaining an accurate posture was difficult, resulting in prolonged measurement times.”
“Even after locating the radial artery, results were often inaccurate; easier and more precise measurement would be preferable.”
“Finding the radial artery and positioning the device correctly was challenging, often resulting in errors and repeated attempts.”
“It was unfamiliar because it was my first time using it.”
“Difficulty in finding the exact location.”
“Difficulty wearing the device.”
“Measurement often failed.”
Insufficient availability of devices
“During the initial practice, only one device was available, so observations were brief; later, practicing individually was challenging due to unfamiliarity.”
“The number of devices was very limited compared to the number of students, and frequent errors occurred.”
“Limited devices relative to the number of students led to insufficient practice time.”
Variability in results
“Inconsistent results with each use caused confusion.”
Lack of understanding of the device’s measurement principles
“Limited understanding of the principles used to differentiate pulses.”

Data are presented as frequency and percentage.

Table 8

Students’ utilization of the pulse diagnosis device (N=40)

Utilization of the pulse diagnosis device	n (%)
Additional usage frequency outside practice time

0	9 (22.5)
1	8 (20.0)
2	8 (20.0)
3	9 (22.5)
4	3 (7.5)
5	3 (7.5)

Purpose of additional usage (if used more than once)^*

Assignment submission	25 (62.5)
Observing changes in device results based on condition changes	21 (52.5)
Comparison of pulse diagnosis with device results	8 (20.0)
Insufficient practice time with the device	7 (17.5)
Observing changes in device results based on main symptoms	6 (15.0)
Observing changes in device results over time	4 (10.0)
Observing changes in device results before and after treatment	0 (0.0)

Data are presented as frequency and percentage.

Multiple responses allowed.