With the rapid development of technology and societal change, a shift from traditional classroom instruction to more diverse educational methods in medical education is necessary. As an effective approach to providing flexibility and accessibility while maintaining the benefits of face-to-face interactions, blended learning, which integrates online and offline learning, has gained attention. This study examines the current status and best practices of the aforementioned blended learning, analyzes its application in domestic and international contexts, and derives effective instructional design strategies. A comprehensive review of previous research and empirical cases reveals a conceptual framework and core principles for designing such blended learning. Key considerations include strategic integration of online and offline activities, facilitation of self-directed learning and interaction, effective use of technology, and continuous quality improvement. Furthermore, we suggest contextually relevant strategies, such as designing curricula focused on clinical reasoning, providing iterative practice opportunities, enhancing reflection, and fostering future competencies. The case analysis establishes that blended learning is implemented in various forms across different medical schools and curricula. Common features include the linkage of online and offline learning, incorporation of learner-centered methods, and emphasis on practical competencies. However, the limited number of cases suggests that generalizations may be premature. Successful implementation requires multifaceted efforts, including gradual introduction, faculty support, flexible curricula, safety measures, and institutional support. Accumulating empirical research and evidence of their effectiveness can facilitate their wider dissemination. This study provides implications and future directions for innovative medical education using hybrid learning.

The incidence of diabetes is continuously increasing worldwide, resulting in a considerable socioeconomic burden. Glycemic control using traditional diabetes medications prevents microvascular complications; however, there is no objective evidence that it prevents macrovascular complications. In the 21st century, concerns have arisen that strict glycemic control and the diabetes drug rosiglitazone might increase mortality. This led the United States Food and Drug Administration to establish guidelines that require that cardiovascular outcome trials (CVOTs) with 3-point major adverse cardiovascular events (3-P MACE) as the primary endpoints be performed for new diabetes drugs. Since then, 20 CVOTs have been reported. Dipeptidyl peptidase 4 inhibitors do not increase the incidence of cardiovascular disease; however, saxagliptin increases the risk of heart failure. Sodium-glucose cotransporter inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) not only have proven cardiovascular safety but also have shown results beyond expectations by reducing the incidence of cardiovascular diseases. Additionally, SGLT2is have been reported to markedly prevent heart failure and kidney disease. The reduction in 3-P MACE by GLP-1RAs was observed only with long-acting agents; long-acting GLP-1RAs also markedly reduced renal endpoints. However, no preventive effect against heart failure was observed with GLP-1RAs. The preventive effects of both drug types against cardiovascular and kidney diseases appear to be independent of glycemic control. In conclusion, based on CVOT results, it is necessary to actively prescribe SGLT2is and GLP-1RAs to prevent cardiovascular disease in patients with diabetes, regardless of glycemic control.

Enterohemorrhagic Escherichia coli (EHEC) produces Shiga toxin, which causes diarrhea, hemorrhagic colitis, and hemorrhagic uremic syndrome. The Korea Center for Disease Control and Prevention (KCDC) has designated EHEC as a legal infectious disease and has conducted laboratory surveillance. This study aimed to compare the demographic, epidemiological, clinical, and laboratory characteristics of EHEC cases in Jeju Province between August 2017 and November 2023, notified by two registry routes. The data were sourced from the integrated disease health and health management system managed by the KCDC. Cases reported due to experiencing gastrointestinal symptoms, or contacts of each case were defined as the "symptomatic" group. In contrast, cases with positive findings during a health checkup or laboratory surveillance were defined as the "screening" group. The symptomatic and screening groups had 35 and eight patients, respectively. There were significant differences in the age and seasonal distribution. The selection group was 20-59 years old in the main age distribution and registered evenly throughout the four seasons. In comparison, the symptomatic group was younger or older and not registered in the winter. These findings may be used to establish a more appropriate surveillance system for diarrheal outbreaks.

Universities are essential in the educating medical school students and create an excellent educational environment for them. We checked the status of personnel turnover at a local medical school to determine the form of entry into the workplace after resignation. According to their intention, the total number of resignations was 54, with individuals being 42.22±5.92 years old (32-64 years old) and having 5.53±4.20 years of service. Resignations under 3 years were 20, and under 15 years or more were nine. By year, the number of professors resigned the most at 11 in 2020 and seven in 2022. Regarding present employment after resignation, 28 individuals (51%) moved to other universities or university hospitals, eight (14%) to general hospitals, 15 (27.8%) to clinics or employment, and three (5.6%) elsewhere. As a result of the analysis, by dividing into the metropolitan areas including Seoul, the area excluding the metropolitan area, and the Jeju area based on the area where a bachelor's degree was obtained, 65.5% and 42.9% of the metropolitan and non-metropolitan area were transferred to universities and university hospitals, respectively. Further, the Jeju area was employed in general or private hospitals. The resignation of a professor from a local medical school varies slightly depending on the demand for medical care in other regions, including metropolitan areas, but tends to continue. Therefore, it is necessary to determine directions for continuing education.

Adverse drug reactions (ADRs) are closely associated with increased morbidity and mortality rates, prolonged hospitalization durations, and higher healthcare costs. This study aimed to estimate the incidence, clinical features, and reporting status of ADRs to improve the current ADR reporting system and prevent recurrent ADRs in hospitals. This retrospective study was conducted at a regional referral hospital. Patients diagnosed with ADRs over a 5-year period (2009-2014) were recruited for this study. An ADR was identified as an ADR-related diagnosis in a patient's medical record or an ADR registered through the in-hospital ADR reporting system. The incidence, culprit drug, clinical manifestations, reporting source, severity, related management, and recurrence rate were assessed. Among 1,112 patients, 1,375 ADR events were collected, an estimated 0.06% of the total number of patient visits. Diagnostic contrast agents (46.4%) were the most common culprit drugs, followed by antibiotics (22.0%), nonsteroidal anti-inflammatory drugs (9.9%), and opioids (4.5%). Skin reactions (67.5%) such as rashes and hives were the most frequent manifestations. Additional ADR-related medical attention was necessary in two thirds of cases. One hundred eighty ADR events (13.1%) were categorized as severe, and 19 patients (1.4%) experienced re-exposure to the culprit drugs. Four patients (0.3%) experienced fatal ADRs. Physicians were the most frequent ADR reporters in the in-hospital ADR reporting system. In conclusion, many ADR events may be overlooked, and re-exposure to causative drugs commonly occurs. Continuous education and maintenance of a reporting system may be important for preventing recurrent ADRs.

This study investigated how the use of a conversational artificial intelligence (AI) chatbot improved medical students' patient-centered communication (PCC) skills and how it affected their motivation to learn using innovative interactive tools such as AI chatbots throughout their careers. This study adopted a one-group post-test-only design to investigate the impact of AI chatbot-based learning on medical students' PCC skills, their learning motivation with AI chatbots, and their perception towards the use of AI chatbots in their learning. After a series of classroom activities, including metaverse exploration, AI chatbot-based learning activities, and classroom discussions, 43 medical students completed three surveys that measured their motivation to learn using AI tools for medical education, their perception towards the use of AI chatbots in their learning, and their self-assessment of their PCC skills. Our findings revealed significant correlations among learning motivation, PCC scores, and perception variables. Notably, the perception towards AI chatbot-based learning and AI chatbot learning motivation showed a very strong positive correlation (r=0.72), indicating that motivated students were more likely to perceive chatbots as beneficial educational tools. Additionally, a moderate correlation between motivation and self-assessed PCC skills (r=0.54) indicated that students motivated to use AI chatbots tended to rate their PCC skills more favorably. Similarly, a positive relationship (r=0.68) between students' perceptions of chatbot usage and their self-assessed PCC skills indicated that enhancing students' perceptions of AI tools could lead to better educational outcomes.

Omental adhesions to the anterior abdominal wall are a common complication of abdominal surgery. Specific adhesions to the back of the umbilicus represent a challenge for safe laparoscopic access. In this case report, we describe a simplified two-port laparoscopic access procedure for retro-umbilical adhesiolysis. We concluded that successful adhesiolysis of retro-umbilical adhesions using the sequential Darwish and Lee-Haung points is feasible, and this procedure is a safe, minimally invasive alternative to the primary laparoscopic approach.

Spontaneous intraspinal and intracranial subdural hematomas (SDHs) are rare, potentially life-threatening complications. We present the case of a 38-yearold highly active antiretroviral therapy-naïve human immunodeficiency virus (HIV)-positive patient who developed simultaneous intraspinal and intracranial SDHs without hemostatic abnormalities. The patient presented with acute lower limb weakness and back pain, and later developed neurological symptoms, including diplopia and incontinence. This case highlights the importance of considering SDHs in HIV-positive patients presenting with neurological symptoms, and underscores the need for prompt diagnosis and multidisciplinary management.

Complete left bundle branch block (CLBBB) is a significant cardiac conduction abnormality often associated with dilated cardiomyopathy (DCM). This case report highlights the improvement in CLBBB and symptom relief through reverse cardiac remodeling in a patient diagnosed with DCM following an optimized heart failure treatment regimen consisting of an angiotensin-converting enzyme inhibitor, beta-blocker, and mineralocorticoid receptor antagonist. This case highlights the potential of electrical remodeling and conduction system improvement in patients with DCM receiving optimized medical therapy.

Fetal ventriculomegaly (VM) is a relatively common finding during prenatal examinations and occurs in approximately 0.2% of live births. Although there are various causes, obstructive VM due to cerebellar hemorrhage is exceedingly rare. A 33-year-old primigravida presented at 32 weeks of gestation with VM. At 36 weeks of age, a male infant was delivered via cesarean section. Postnatal imaging revealed severe bilateral hydrocephalus and space-occupying lesions in the cerebellum. Initial concerns about a potential germ cell tumor were raised due to elevated alpha-fetoprotein levels in both serum and cerebrospinal fluid. An external ventricular drain was placed to manage obstructive hydrocephalus. When the baby was 1 month old, surgical exploration revealed an old blood clot without any evidence of a tumor. Histopathological examination confirmed an old hemorrhage with no malignant cells. This case underscores the diagnostic challenges in distinguishing between hemorrhages and tumors in the context of fetal VM. Despite elevated alpha-fetoprotein levels, no tumors were identified. The underlying cause of cerebellar hemorrhage remains unclear despite extensive workups. Nevertheless, this case report details multifaceted diagnostic efforts to address the rare occurrence of cerebellar hemorrhage related to fetal VM, leading to a comprehensive case presentation.

Disseminated tuberculosis (TB), resulting from the hematogenous spread of tubercle bacilli, typically affects immunocompromised individuals, such as those infected with the human immunodeficiency virus. However, risk factors in immunocompetent populations are not well understood. Here, we report a rare case of disseminated TB with CD4+ T-cell depletion in a previously healthy 35-year-old man. The patient presented with a 2-month history of intermittent gross hematuria, dysuria, loose stools, and weight loss. His medical history was unremarkable except for a herpes zoster infection 4 years prior to presentation. Laboratory tests revealed microscopic hematuria and pyuria; however, the urine culture was negative. Urine specimens tested positive for TB-polymerase chain reaction. Abdominal computed tomography revealed a focal filling defect in the left kidney, segmental wall thickening of the terminal ileum, and multiple enlarged lymph nodes with central necrosis. Chest computed tomography revealed active pulmonary TB. Colonoscopy confirmed intestinal TB in the terminal ileum and ileocecal valve, with positive TB-polymerase chain reaction results from sputum and ileal ulcer tissue. The patient was diagnosed with disseminated TB and was treated with standard anti-TB drugs. Although the human immunodeficiency virus test results were negative, the patient's CD4+ T-cell count was significantly low (278/μL). Follow-up tests after 1 month showed negative TB cultures; however, the patient's CD4+ T-cell depletion persisted, with counts remaining low after 1 year. This case highlights the rare occurrence of disseminated TB in immunocompetent individuals with CD4+ T-cell depletion and emphasizes the importance of CD4+ T-cell assessment in healthy patients presenting with disseminated TB.

Bronchopleural fistulas (BPF) resulting from pulmonary resection, radiation, or a direct tumor mass effect are associated with significant morbidity, reduced quality of life, and increased risk of mortality. Diagnosing BPF can be challenging, even with computed tomography, magnetic resonance imaging, and bronchoscopy. We report a case in which retrograde methylene blue instillation during bronchoscopy successfully confirmed the diagnosis of BPF.