Introduction
The standardized education of Korean medicine began at 'University of Oriental Medicine' in 1948, and since then it has been establishing and expanding education for over 70 years. One of the most important turning points in current Korean medicine education is the launch of the Institute of Korean Medicine Education & Evaluation (IKMEE) in 2005. IKMEE develops evaluation and accreditation standards for Korean medicine education and sets minimum standards to promote the cultivation of high-quality Korean medicine manpower and qualitative improvement of Korean medicine education. On that basis, it aims to support Korean medicine education institutions to improve their educational conditions and programs on their own1).
The first proposal for an integrated curriculum in Korean medicine colleges was made in 19982). As an extension of this, Professor Ji proposed a 7-year reform of Korean medicine colleges in 2009 and advocated for the implementation of integrated medical education3). In 2021, IKMEE announced the Korean medicine education Accreditation Standards 2022 (KAS2022). KAS2022 stipulates that horizontal integration (vertical integration is also recognized) in the curriculum must be implemented in at least 3 subjects throughout the entire course to organize overlapping educational content, suggesting the necessity of an integrated curriculum in the Korean medicine college curriculum.
There are three main characteristics of the integrated curriculum. First, it increases the interrelationship between knowledge areas and minimizes overlapping content between subjects, thereby reducing the burden on learners and enabling them to actively respond to the changing characteristics of academic disciplines. Second, it promotes individual growth and self-realization of students through curriculum composition based on students’ interests and enables learning that suits the psychological development characteristics of students. Finally, it enables approaches from various perspectives to solve ‘real-life situations’ and provides opportunities for cooperation among learners4).
Musculoskeletal diseases are among the most frequently treated diseases in Korean medicine. Korean medicine students learn about musculoskeletal diseases from various perspectives through subjects such as acupuncture and moxibustion medicine, Korean rehabilitation medicine, Chuna manual medicine, and meridian & acupoint medicine. If an integrated curriculum between various subjects that deal with musculoskeletal diseases is introduced, there is an advantage in that it can minimize overlapping content by unit while securing hours of musculoskeletal practice that will help solve problems in clinical settings.
Since the publication of KAS2022, prior studies have been conducted to emphasize the necessity of introducing an integrated curriculum and preparing specific implementation plans. According to related studies, to successfully introduce an integrated curriculum, a process of persuading and embracing the need for change is essential. In addition, smooth communication and active interaction between professors participating in the curriculum are suggested as important factors5).
There is active discussion about the prerequisites and expected results for implementing integrated education, but there is also criticism that the changing curriculum is only a superficial form for satisfying evaluation and certification6). In the trend of education changing from teacher-centered to learner-centered, it is necessary to reflect the opinions of learners more to establish a practical integrated curriculum for training professional Korean medicine manpower and improving the level of Korean medicine education.
This study aimed to investigate the learners' comprehension and satisfaction with the implementation of integrated courses in the musculoskeletal field as part of a study to introduce an integrated curriculum. To this end, a survey was conducted on third and fourth year students in the college of Korean medicine at University A, which currently operates Korean rehabilitation medicine and acupuncture and moxibustion medicine as an integrated subject, musculoskeletal medicine, and University B, which operates them as two separate courses. The number of students enrolled in each course of University A and University B is approximately 70 and 50 students, respectively.
The third year students at University A, who adopted an integrated musculoskeletal curriculum from 2024, were taught by using passive learning methods. This teaching methods were also applied to the fourth year students in the previous year, who had their courses into two distinct subjects which are Korean rehabilitation medicine and acupuncture and moxibustion medicine.
At University B, third and fourth year students enrolled in separate Korean rehabilitation medicine and acupuncture and moxibustion medicine courses. They not only followed passive learning methods but also engaged in active learning strategies including Problem-Based Learning (PBL), Team-Based Learning (TBL), and discussion & presentation sessions.
Through a comparative analysis of the acquired samples, we suggest the direction of implementation of integrated musculoskeletal medicine.
Method
1. Research object
The survey was conducted on 217 third and fourth year students at the college of Korean medicine at University A in Daejeon and University B in Busan who were taking classes in acupuncture and moxibustion medicine, Korean rehabilitation medicine or musculoskeletal medicine. Out of the total 114 respondents, 112 had valid responses (third year students at University A: 27, fourth year students at University A: 10, third year students at University B: 31, fourth year students at University B: 44).
2. Research method
‘Musculoskeletal Integrated Education Questionnaire’ was developed by three researchers (ODH, BJH, PCW) and then verified for validity by three researchers (SJC, KCY, KSK) who specialized in musculoskeletal medicine or education
The questionnaire was created through Google Forms, and the web address of the questionnaire was distributed to all students through the representative of each grade in each college. To encourage participation, the purpose of the survey was explained to the representatives and students were asked to actively participate in the survey.
The questionnaire consists of 25 questions, and the contents of each question are as follows: 1~5 are about personal information, 6~8 are about the comprehension of the current course, 9~16 are about the operation and learning strategy for integrated musculoskeletal medicine, and 17~25 are about the learning and clinical practice strategy of the current courses7).
When investigating the subjective feelings of the students in each item, a 6-point scale modified from the 5-point Likert scale was used. By subdividing ‘③ Average’ into ‘③ Not so much’ and ‘④ Slightly so’, we aimed to avoid the central tendency of the subject to give an intermediate answer as an opportunity to avoid responding in situations where it is psychologically difficult to answer8).
The reliability Cronbach's α value of the item was 0.603, and generally, Cronbach's α value above 0.60 is considered a moderately consistent reliability9).
3. Analysis method
For data preprocessing, two results that did not agree with the survey and cases of errors or non-response were excluded from the analysis, and only meaningful results were processed. The third year students of University A, who mainly take integrated musculoskeletal medicine, the third year students of University B, who take separate courses of acupuncture and moxibustion medicine and Korean rehabilitation medicine, and the fourth year students of University A and the fourth year students of University B, who take the same separate courses, were compared and analyzed. The responses by university and grade were compared using chi-square tests, independent sample t-tests, etc. Cases with a P value of less than 0.05 were considered statistically significant. The analysis of the survey results was conducted using SPSS version 18.0 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel Office 16 (Microsoft, Redmond, WA, USA).
Result
A survey was conducted among third and fourth year students at the colleges of Korean medicine at University A and B to analyze their comprehension and satisfaction with the integrated curriculum. The following are the key results derived from the survey items.
1. Comprehension of the Subjects
In students' subjective comprehension of each subject, there was a significant difference between the fourth year students from University A and those from University B in acupuncture and moxibustion medicine. The fourth year students from University A demonstrated a significantly higher level of comprehension (5.1±0.9) compared to those from University B (4.0±1.0) (t=3.209, p=0.002) (Table 1).
2. Necessity of Integrated Education for Musculoskeletal Disorders
The average score for the perceived necessity of integrated education of third year students at University A was 4.2(±1.5), whereas the average score of third year students at University B was significantly higher at 5.0(±0.8) (t=−2.594, p=0.012). For the fourth year students at University A and University B, the average scores were 4.5(±1.0) and 4.4(±1.4), respectively, showing no significant difference.
In the detailed items, particularly regarding the necessity of integration for “Wei syndrome and paralytic disorders,” third year students at University B reported significantly higher scores than those at University A (p=0.030).
3. Components of Integrated Education for Musculoskeletal Disorders
1) Items Requiring Improvement in Integrated Education
Students provided various opinions on what needs to be added or improved for the integrated musculoskeletal curriculum.
Among the six options (epidemiology, diagnosis, examination, treatment, research, and practice) the need for practice (57 students, 23.75%), treatment (65 students, 27.08%), diagnosis (44 students, 18.33%), and examination (41 students, 17.08%) ranked high.
2) Preconditions for Implementing Integrated Education
The most frequently mentioned precondition for implementing integrated musculoskeletal education was the need for a “new integrated textbook” with 54 students (48.2%) identifying this as important. Following this, 47 students (41.9%) selected the “unification of terminology,” and 41 students (36.6%) highlighted the need for “consistency in teaching methods.”
3) Distribution of Class Hours in Integrated Education
The evaluation of the appropriateness of class hours showed differences among musculoskeletal medicine, acupuncture and moxibustion medicine, and Korean rehabilitation medicine (Table 2). The satisfaction level regarding the class hours for Korean rehabilitation medicine among fourth year students at University A was significantly higher (3.9±0.8) compared to fourth year students at University B (3.0±0.9) (t=2.476, p=0.017). Additionally, when the students were asked the appropriate academic year for taking musculoskeletal courses, the responds were in the following order: second year, third year, first year, fourth year in the clinical program, second year and first year in the pre-clinical program.
4) Appropriateness of Evaluation Methods in Integrated Education
5) Preferred Learning Methods in Integrated Education
(1) Appropriateness of Memorization
Students responded that memorization was appropriate as a preliminary learning method across all three subjects: musculoskeletal medicine (4.1±1.2), acupuncture and moxibustion medicine (4.1±1.3), and Korean rehabilitation medicine (4.0±1.2).
(2) Appropriateness of Theory and Practice Proportions
Regarding the proportion of practical training in acupuncture and moxibustion medicine and Korean rehabilitation medicine, students from University B had tendency to reckon the proportion of practical training as low compared to those from University A. In particular, the fourth year students from University A rated the appropriateness of the practical training proportion in Korean rehabilitation medicine significantly higher than those from University B (t=2.094, p=0.041) (Table 3).
6) Preferred Teaching Methods in Integrated Education
(1) Appropriateness of Teaching Methods
Among the various teaching methods, audiovisual materials, lectures, experiential learning, and demonstrations were all rated above 4.0 on a 6-point scale (Table 4).
(2) Preference for Participatory vs. Passive Learning Methods
In a scale where 1 point represents a preference for more passive learning methods and 5 points for more participatory learning methods, the average of students’ response was 2.9±1.1, indicating a slight preference towards passive learning methods. The preferences for each teaching method are illustrated in Figure 1 and Figure 2.
7) Clinical Training Methods in Integrated Education
(1) Need for Observational and Participatory Clinical Training
For the question regarding the necessity of observational and participatory clinical training, the average scores for each subject were as follows: musculoskeletal medicine 4.6(±1.1), acupuncture and moxibustion medicine 4.6(±1.1), and Korean rehabilitation medicine 4.7(±1.1). All three subjects recorded scores above 4.6.
(2) Need for Clinical Practice (OSCE, CPX)
Regarding the necessity of clinical practice such as OSCE and CPX, students rated 4.3(±1.1) in musculoskeletal medicine, 4.3(±1.1) in acupuncture and moxibustion medicine, and 4.3(±1.1) in Korean rehabilitation medicine. All subjects scored above 4.0.
Discussion
This study investigated the necessity and demand for an integrated curriculum in the musculoskeletal field in Korean medicine based on the comprehension and satisfaction of third and fourth year students from University A in Daejeon and University B in Busan.
Discussions about the introduction of an integrated curriculum in Korean medicine education have been ongoing since the curriculum improvement proposal in 1998. One notable example is the establishment of the graduate school of Korean medicine at Pusan National University in 2008, where an integrated curriculum with a 20-week per year quarter system was implemented. Additionally, an attempt to reorganize subjects by reducing major courses and increasing elective courses while enhancing the interconnection between subjects was made through the curriculum innovation plan developed by the college of Korean medicine, Kyung Hee University in the same year. However, this effort was not fully realized10). It wasn’t until the Korean medicine education Accreditation Standards 2021 by the IKMEE that the practical implementation of an integrated curriculum was initiated. Furthermore, KAS2022 explicitly requires colleges of Korean medicine and graduate schools to implement three or more horizontally integrated courses (vertical integration is also permitted) in the overall curriculum.
When referring to the latest research trends on the domestic Korean medicine curriculum, the demand for integrated education to overcome the gap between basic and clinical studies is increasing. For example, 'integrated education' was presented as one of the keywords in the main papers on the topic of Korean medicine curriculum11). The operation of an integrated curriculum in Korean medicine maximizes the interrelationship between knowledge from various subjects while minimizing redundant content, reducing the burden on learners. It also has the potential advantage of providing diverse problem-solving abilities by allowing students to tackle real-life situations through student-centered curricula and teaching methods.
According to the survey results on the necessity of integration, the demand for an integrated curriculum was high among all students. Especially, the third year students from University B, which does not offer an integrated curriculum, showed a significantly higher score in the perceived necessity for integration compared to the third year students from University A, where the integrated curriculum was implemented. However, there was no significant difference between the fourth year students from both universities regarding this aspect.
The difference in perception of the necessity for an integrated curriculum could be attributed to the reduced academic burden experienced by students when theoretical courses are efficiently integrated. Korean medicine students often face high levels of academic stress due to the large volume of study material and limited study time, with concerns particularly centered on passing exams and avoiding academic probation12). Integrated curricula may reduce this burden by streamlining theoretical content.
Moreover, acupuncture and moxibustion medicine and Korean rehabilitation medicine are highly interconnected, with similar patient groups treated in clinical practice. The textbooks used in both subjects, “Acupuncture and moxibustion Medicine13)” and “Korean Rehabilitation Medicine14)” show significant overlaps in areas such as spinal disorders, joint disorders, Wei syndrome and paralytic disorders, Bi syndrome and other pain-related conditions. Given these academic and clinical overlaps, teaching these subjects together would allow students to study more efficiently without confusion caused by redundant content.
Both subjects also emphasize the importance of students developing clinical skills. Acupuncture and moxibustion medicine focuses on techniques like acupuncture, cupping, and moxibustion15), while Korean rehabilitation medicine involves Chuna therapy, Korean physical therapy, and rehabilitation treatment. These areas require practical experience, as mere observation or theoretical learning is insufficient for mastery16). Therefore, retaining adequate practical training time is essential, and integrating theoretical lessons could help achieve this by freeing up more time for hands-on practice.
This study examined the perceptions and satisfaction of students from University A and University B regarding the curricula of musculoskeletal medicine, acupuncture and moxibustion medicine, and Korean rehabilitation medicine, with the following results:
1. Comprehension of the Subjects
When analyzing the comprehension of each subject based on university and academic year, there was no significant difference among most groups. The only notable difference was the significantly higher comprehension of acupuncture and moxibustion medicine among fourth-year students from University A compared to those from University B (t=3.209, p=0.002). Therefore, the comprehension of subjects does not appear to be correlated with the presence of an integrated curriculum.
2. Necessity of Integrated Education for Musculoskeletal Disorders
The necessity for integrated education was rated highly, with scores in the 4-point range across all universities and academic years. This suggests that the overall demand for integrated education among students is high. When comparing by school and academic year, the third year students from University B (5.0±0.7), where the curriculum is not integrated, showed significantly higher scores in perceived necessity for integration compared to their counterparts at University A (4.2±1.4) (t=−2.594, p=0.012). This suggests that students in non-integrated courses have a greater need for integration, indicating the importance of investigating the underlying reasons for this perception.
3. Components of Integrated Education for Musculoskeletal Disorders
1) Areas for Improvement in Integrated Education
The majority of students (65 respondents, 58%) requested a stronger focus on “treatment” among the six categories (epidemiology, diagnosis, examination, treatment, research, practice). In contrast, only 8 students (7.1%) and 25 students (22.3%) requested more focus on “epidemiology” and “research,” respectively. This reflects students’ desire for practical clinical experience, which aligns with the need for increased practical training opportunities.
2) Preconditions for Implementing Integrated Education
Before implementing integrated education for musculoskeletal disorders, the most common request was for “new integrated textbook” (53 respondents, 47.3%). This indicates the students’ demand for consistency and standardization in the curriculum.
3) Distribution of Practical Training Hours
Students generally felt that practical training hours were insufficient compared to theoretical classes. However, third year students from University A, which operates an integrated curriculum, responded that the time allotted for practical training was “somewhat sufficient” (4.0±1.1), suggesting that the integration of theoretical lessons may help secure more time for practical training.
4) Appropriateness of Evaluation Methods in Integrated Education
Students showed a preference for the semester system over the block system. However, the overall evaluation score for the appropriateness of the evaluation methods was only “somewhat appropriate” (3.7±1.4), indicating that further discussion and review are needed when determining the appropriate educational methods. Additionally, students responded that the introduction of Objective Structured Clinical Examinations (OSCE) (4.1±1.3) and Clinical Performance Examinations (CPX) (4.0±1.3) in integrated subjects was appropriate. This suggests that students perceive a need for practical evaluation methods aligned with the integrated curriculum.
5) Preferred Learning Methods in Integrated Education
(1) Appropriateness of Memorization-Based Learning
In all three subjects (musculoskeletal medicine, acupuncture and moxibustion medicine, and Korean rehabilitation medicine), students responded that it is appropriate for memorization to precede other learning methods. The average response for the appropriate balance between passive and participatory learning methods was 2.9, indicating that students value structured information organization and memorization-based learning, while preferring a balanced mix of passive and participatory learning methods.
(2) Appropriateness of Prior Learning of Non-Integrated Units
Third year students from University A responded that it was appropriate to first study non-integrated units (4.0±1.0). However, the overall average was 3.7±1.3, indicating that most students found some degree of prior learning of non-integrated units to be suitable. This suggests that students may prefer to thoroughly study each non-integrated subject before engaging with the integrated curriculum, reflecting the importance of considering the proper sequence of learning in curriculum design.
(3) Appropriateness of Theory and Practice Proportions
The third year students at University A rated the proportion of practical training in Musculoskeletal medicine at 4.0±1.1, indicating that the time allotted for practice was “somewhat sufficient.” In comparison, the third year students at University B rated the proportion of practical training in acupuncture and moxibustion medicine and Korean rehabilitation medicine both at 2.5±1.1, showing a significant difference. Therefore, the additional practice hours gained through the integrated curriculum may contribute to a higher sense of satisfaction among students, but the potential burden of increased learning time should be carefully considered.
6) Preferred Teaching Methods in Integrated Education
Among the preferred teaching methods, “use of visual and auditory materials” (4.6±1.0) and “lecture-based classes” (4.6±1.0) were the most favored. These methods are information-centered and help students process large amounts of information in a structured way. This is consistent with the earlier finding that students value memorization, as these teaching methods align with their preference for systematic information delivery.
Among participatory learning methods, Problem-Based Learning (PBL) was the most preferred (52.7%), while among passive learning methods, demonstration-centered lectures (64.3%), auditory-centered lectures (56.3%), and visual-centered lectures (50%) were preferred. These responses reflect the students' appreciation for hands-on problem-solving opportunities and direct guidance from instructors.
Therefore, it can be inferred that students consider memorization important in the early stages of learning, but later, they prefer experiential learning through visual and auditory materials and practical application of memorized knowledge.
7) Clinical Training Methods in Integrated Education
(1) Need for Observational and Participatory Clinical Training
All three subjects received scores above 4.0, reflecting a strong recognition among students of the importance of clinical practice. This suggests that expanding learning opportunities in real clinical settings is essential.
(2) Need for OSCE and CPX
Similarly, the need for OSCE and CPX in all subjects scored above 4.0, indicating that students perceive practical evaluations of their learned skills as highly appropriate.
(3) Need for Job-Oriented and Clinical Performance (CP) Education
The need for job-oriented clinical education also scored above 4.0 in all subjects, showing that students value gaining practical experiences directly related to their future professional roles. Notably, the need for CP education was rated very high, at an average of 4.9±0.9, indicating that students highly value the ability to express and communicate in clinical settings.
4. Limitations and Suggestions for Future Research
This study reflects the opinions of students from only 2 out of 11 Korean medicine colleges in Korea, and because the survey was conducted on a voluntary basis, it may not fully represent the views of all third and fourth year students at University A and University B. Therefore, there are limitations in generalizing the results. While the differences in student responses due to the characteristics of the instructors were not considered in this study, it is possible that the instructors' characteristics may have influenced the participants' responses. Additionally, only experts in acupuncture and moxibustion medicine and education participated in the development of the questionnaire, without the inclusion of Korean rehabilitation medicine experts, which poses a limitation. This absence may have led to a questionnaire design lacking specialized perspectives from the rehabilitation field. This could lead to potential bias in the survey results and may affect the assessment of the actual effectiveness of the integrated lectures. Future studies should aim to incorporate perspectives from experts in Korean rehabilitation medicine and other relevant fields to enhance the comprehensiveness of expert input, as well as to obtain a larger sample size and gain a clearer understanding of the current curriculum implemented across various Korean medicine colleges.
In addition, based on the results of this survey, we propose a study to develop a specific musculoskeletal integrated education lesson plan. According to the results of the survey, overlapping units such as ‘Wei syndrome and paralytic disorders’ should be integrated, and the proportion of actual clinical learning such as ‘practice’ and ‘treatment’ should be increased. In addition, student-participatory classes such as PBL and TBL should be actively introduced. If integrated education of the two subjects is implemented, overlapping units can be integrated and studied to secure spare time. The spare time can be replaced by not conducting classes to reduce the academic burden on students or by practical and student-participatory classes. Discussions on specific class hours, teaching methods, etc. should be added to future studies.
Conclusion
The objective of this study was to examine the perceptions of third and fourth year students from two colleges of Korean medicine regarding the implementation of an integrated curriculum. The survey findings indicated no significant differences in subject comprehension between universities that had adopted an integrated curriculum and those that had not. However, irrespective of the curriculum model, all groups expressed a clear demand for integrated education.
In this regard, integrating common units in acupuncture and moxibustion medicine, as well as Korean rehabilitation medicine, would enhance the efficiency of leveraging the strengths of the competency-based curriculum and facilitate the attainment of students' graduation competencies.
Further research is required to explore class structure in greater detail, including not only course outlines but also specific teaching strategies for effective integration in actual classroom settings. Should in-depth topics, teaching methods, and evaluation approaches be developed based on the results of this study, the integration of these subjects would elevate the quality of education through meaningful, synergistic integration rather than a mere physical combination of the two fields.
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