2024 Medical Crisis and Clinical Narratives

Conditions for Sustaining Professional Judgment and Care in a Medical Crisis

Moral injury refers to the distress healthcare professionals experience when institutional and organizational constraints make it difficult to provide the care they believe is right. The 2024 medical crisis raised questions about medical school professors’ responsibilities for patient care and the education of students and residents, as well as their authority to fulfill those responsibilities. Examining professional development requires attention to what healthcare professionals know alongside the relationships and systems in which they apply that knowledge.

Moral Injury Arising from Responsibilities and Authority in Medical Education

The editorial on the 2024 medical crisis frames the frustration experienced by medical school professors as moral injury and examines the foundations for sustaining education and clinical practice. It addresses developments as of June 12, 2024. It traces the conflict from the government’s announcement of a 2,000-student increase in medical school admissions on February 6, through residents’ resignations and students’ requests for leaves of absence beginning February 19. It then addresses the government’s decision on June 4 to permit the acceptance of residents’ resignations and suspend administrative penalties for those returning to work. The medical school admission quota for the 2025 academic year, set by the Korean Council for University Education, was 4,567, an increase of 1,509 over the previous quota.

The editorial criticizes the government for portraying physicians as pursuing collective interests rather than treating them as collaborators in reform. It argues that this policy language affects trust between physicians and patients. It observes that those responsible for implementing the medical school quota expansion were excluded from discussions of educational conditions and feasibility. This raises questions about both educational responsibility and decision-making authority.

Discussions of changes to training standards illustrate this problem. According to the editorial, 96.7% of interns required to complete a one-year training period had not begun their training at the time. The Ministry of Health and Welfare proposed adjusting the standards governing the duration of intern training to allow applications to resident programs the following year. For specialist training, the editorial also mentions the option of taking the exam first and completing the remaining training later. It presents these policy responses as conflicting with professors’ responsibility to maintain educational quality.

Journal Reorganization for Sharing the Experiences of Professionals and Students

The editorial announcing the journal’s reorganization presents a plan to broaden the channels for discussing current issues in medical education amid the 2024 medical crisis and the growth of knowledge and information. The existing Special Issue becomes Special Section, and Scholarly Perspectives is introduced as an invited manuscript type. This provides a flexible format for expert opinions and analyses, which undergo academic evaluation, as do reviews and original articles. The newly introduced Commentaries comprise Editorial Comment and Expert Opinions, providing a peer-reviewed forum for timely discussion of key issues.

Healing Narratives provide a space for narrative knowledge through patients’ stories, educators’ concerns, and reflections on clinical experiences. Students’ Voice offers a forum for sharing learning experiences and proposals through students’ opinions, essays, and letters. The editorial also outlines plans to continue the Korean Medical Education Review Student Researcher Award, which began in 2024.

Video-based academic materials include dialogues with specially invited authors, researchers’ introductions to their articles, examples of educational innovation, and content involving students. The reorganization is scheduled to take effect in Volume 27, Issue 2 of the Korean Medical Education Review.

The Loss and the Learning of Becoming a Physician Embedded in an Autopsy Request

The Healing Narrative about an encounter with a bereaved family member who requested an autopsy connects a first-year internal medicine resident’s clinical experience with a reunion in the fourth year. The patient was admitted with heart failure due to acute aortic regurgitation. Severe inflammation of the proximal aorta and a perivalvular abscess caused by Behçet’s disease were later confirmed. At the time, the captopril titration protocol involved starting at 6.25 mg and increasing the dose every 6 hours. Blood pressure was measured before administration, immediately afterward, 5 minutes later, and 1 hour later. If the patient’s condition was stable, the same process was repeated 5 hours later. The narrative describes learning to connect the schema of ‘blood pressure = cardiac output × vascular resistance’ with the patient’s responses. It also describes the experience of explaining the meaning of treatment to the patient and his wife.

The patient subsequently underwent heart valve surgery but died after complications that included difficulty controlling inflammation. His wife returned during the resident’s fourth year of training and requested an examination of her husband’s heart and lungs to help save patients with the same disease. She added, “And please make sure you are there at the autopsy.” The narrative describes an initially defensive reaction prompted by concern about possible complaints. It then reflects on the failure to fully absorb the news of death and the sorrow of loss conveyed by those words. The autopsy was conducted with the cooperation of the attending physician, a professor of cardiovascular pathology, and the chief of cardiovascular surgery. The resident whose presence had been requested also attended.

The autopsy request expressed the family’s intention to turn the husband’s death into learning that could save other patients, alongside the need to confirm the cause of death. The narrative describes attentive listening as attending to patients’ words, manner of expression, silence, and physical condition. Recounting the experience after 30 years constitutes representation. The enduring connection between the family’s request and life as a physician gives rise to affiliation.

Phronesis in Understanding the Meaning of a Pacemaker Procedure Through Family Relationships

The patient in the Healing Narrative about a refused pacemaker procedure was an 84-year-old woman admitted with complete atrioventricular block and a pulse of about 30 beats per minute. The chief cardiology resident spent over 1 hour explaining the procedure but did not obtain consent. A physician training in arrhythmias, who had completed a two-year cardiology fellowship after obtaining internal medicine board certification, also tried to explain it to her. Despite explanations of local anesthesia and the device’s size using simple words and drawings, the patient declined, saying that she had lived long enough and was content as she was.

The next day, the attending physician met the patient and said, “Ma’am, if you do not receive treatment, your children will suffer.” She then decided to undergo the procedure. The narrative notes that she lived an active life for several more years. It attributes this change to a judgment grounded in an understanding of the family relationships she valued, rather than to the influence of professional status. Complete atrioventricular block provided the medical reason for treatment, while avoiding a burden on her children gave the patient a reason to accept it.

In this case, phronesis emerges as the judgment that connects electrocardiogram interpretation and procedural competence with the patient’s reasons for living and desire to care for her family. The narrative describes practical wisdom as developing through participation in specific situations and reflection on those experiences. Experiences in which interests and moral judgments interact, such as end-of-life care or the aftermath of medical errors, offer examples of such learning.

Reading notes

For research spanning HRD and medical education, opportunities to reflect on experience and channels for sharing those reflections with colleagues and students can be examined as organizational conditions that support professional development. As educational material, the two narratives invite examination of the response to the autopsy request and the conversation leading to treatment consent. Whether family relationships carry similar meanings for other patients requires listening to their own words.

References

안신기. (2024). 아픔에도 일어서야 하는 심연: 2024년 의료위기와 의과대학 교수의 도덕적 손상. 의학교육논단, 26(2), 125–132. https://doi.org/10.17496/kmer.24.023

안신기. (2025). 새로운 체제로 나아가는 의학교육논단. 의학교육논단, 27(1), 1–2. https://doi.org/10.17496/kmer.25.003

안신기. (2025). 그날, 부검을 요청받았다. 의학교육논단, 27(2), 181–183. https://doi.org/10.17496/kmer.25.017

안신기. (2025). 자식들이 고생합니다: 의료 현장에서 만난 프로네시스. 의학교육논단, 27(3), 227–229. https://doi.org/10.17496/kmer.25.036