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After liberation from Japan, Korea faced a severe shortage of modern medical professionals and a devastated health infrastructure, worsened by the Korean War. Korea’s rapid medical advancement in later decades was achieved largely through a human resource–centered approach rather than reliance on material aid. The Minnesota Project (1954–1961), led by the United States, rebuilt Seoul National University’s College of Medicine and trained faculty in advanced clinical and educational methods, laying the foundation for institutional reform. The China Medical Board Project (1963–1986) continued this momentum, promoting self-development and research capacity through matching funds and broader academic exchange. These initiatives fit within an innovation diffusion framework, as knowledge and practices spread nationwide. Korea’s experience highlights how investing in human capital and institutional learning can drive sustainable health system transformation.
#health #human resources #education
Before the mid-19th century, the Korean people relied entirely on traditional Korean medicine which has its roots in Chinese medicine. Around the end of the 19th century, Western medicine was introduced to Korea by the Korean government and Western missionary doctors. However, during the time Korea was colonized by the Japanese, from 1910 to 1945, Japanese-style modern medicine became the main style of medicine practiced in the country.
During the colonial years, high positions in medical colleges and hospitals were monopolized by Japanese doctors. Korean doctors were very rarely exposed to advanced medical sciences, and could not be promoted to high positions. When Korea became independent in 1945, it encountered great challenges due to the shortage of well-trained health professionals and the lack of medical facilities and equipment.
Just five years after Korea’s liberation from Japan, the country faced another traumatic event, the Korean War (1950 to 1953), and its devastating aftermaths. In the mid-1950s, the country was suffering from a severe shortage of health personnel and facilities.
However, around the end of the 20th century, Korean medicine and healthcare had risen to become among the most advanced in the world. Here we will discuss what made this dramatic change possible. Among the many factors of miraculous change in medicine and healthcare in Korea, this theme will focus on three important development assistance projects for the educational development of human resources for health. The term “educational development” means not only “training and education,” but also educational system changes including curriculum, faculty development (on education, research, and clinical practice), institutional administration (on planning, implementation, evaluation of institutional policy, and fundraising), educational environment (library, lecture room, laboratory facility, and hospital environment), relationship between university and teaching hospital, licensing system, post-graduate education, and continuing education. All these components should be considered together for sustainable development.
Human resources for health (HRH) is a crucial factor under Universal Health Coverage (UHC) that needs to be realized in order to reach the health-related targets of the Sustainable Development Goals (SDGs). The five health-system attributes of the UHC—quality, efficiency, equity, accountability, and sustainability and resilience—are closely linked to HRH issues. There is much evidence to support investment in the health workforce as one of the “best buys” in public health. According to one research, investing in midwifery education, with deployment to community-based services, could yield a 16-fold return on investment in terms of lives saved and costs of caesarean sections avoided. Furthermore, HRH development can influence SDGs beyond UHC by improving population health, reducing disease burden, and promoting the rehabilitation of people.
This historical review is intended to assist leaders in developing countries in identifying the most effective paths for health professional education development toward realizing UHC and ultimately the health-related targets of the SDGs.
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Korea's medical system was completely devastated by the Korean War. Hospital buildings were destroyed, equipment was plundered, and many medical employees were killed or kidnapped. The Minnesota Project, a large-scale technical assistance program led by the United States, was launched at this time to help resurrect Korea's medical environment.
Korea was liberated from Japan in 1945. Five years after liberation, the Korean War broke out and lasted for three years from 1950 to 1953. Medical colleges, nursing education institutions, and hospitals suffered severe destruction and loss of human resources due to the war. [1]
After World War II, the United States began to provide technical assistance for developing countries in which it had diplomatic and military interest. By training professionals in urgent fields, providing essential equipment and facilities, and establishing educational institutions, the United States expanded the influx of advanced knowledge, skills, and technology into developing countries. This technical assistance was mainly carried out under agreements between the US government and professional institutions in the United States, including universities. By 1960, the International Cooperation Administration (ICA, former USAID) of the United States made agreements with 53 American universities and was running 96 technical assistance programs in 33 developing countries.
As one of the technical assistance programs of the International Cooperation Administration (ICA), the University of Minnesota (UM) assisted in the rehabilitation and capacity building of three colleges (College of Medicine, College of Agriculture, and College of Engineering) of Seoul National University (SNU) from 1954 to 1961. This project, known as the “Minnesota Project” greatly contributed to the reconstruction and development of SNU, which had been severely devastated by the Korean War. We will focus on SNU's College of Medicine (SNUMC) in this theme.
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A total of 226 academics from SNU and 77 from SNUMC were trained in the United States through the project. The fellowship program focused on training assistant professors and teaching assistants. Among 77 fellows, 33 were teaching assistants, the latter of whom were allowed to stay in the United States for two or three years, with some even earning an academic degree in their specialty.
A short-term fellowship program was granted to higher level individuals to create a supportive institutional environment for innovation at SNUMC by changing the mindset of leaders, including the deans of the medical college, hospital directors, and the senior-level staff of certain departments. Generally, these individuals stayed in the United States for several months to study advanced curriculums, teaching methods, faculty development programs, and university and hospital management systems.
In order to prevent brain drain, the contract between ICA and UM obligated that the Korean government and SNU guarantee a professorship of at least one year for exchange professors upon their return to Korea. Furthermore, fellows were not allowed to bring their families in order to prevent brain drain.
During the project period, 59 advisors specialized medicine, nursing, and hospital administration were dispatched to Korea. For the College of Medicine, 11 came to Korea and stayed from several months to 1.5 years. Advisors never worked in the place of Korean professors; rather they saw their role as "helping Korean professors to do the work themselves." One advisor explained that they "wanted to teach the Korean professors how to fish, instead of giving them a fish.”
Specifically, the advisors were responsible for: (1) formulating strategic directions for the development of SNU College of Medicine; (2) helping Korean professors make wise decisions on challenging issues by consultation based on educational, scientific, and administrative principles; (3) introducing new teaching, research, and clinical methods by special training sessions and demonstrations; and (4) acting as a symbol for change, so that Korean professors could feel more confident in provoking change themselves. Besides, advisors visited other medical colleges and attended governmental meetings for consultation purposes.
They also supported fellows who had returned from the United States to settle in each department, and advised the ICA on what sort of equipment should be supplied to each fellow. This principle of "build capacity first and then supply equipment" was effective in preventing fund abuses. However, it is true that some equipment was found unused even after the end of the project.
From the 9.54 million USD supported by the ICA, 6 million USD was allocated to equipment, and construction and repair of facilities. Matching funds from the Korean government which amounted to 7 million USD were also spent on equipment and facilities.
Through the project buildings destroyed by the war were reconstructed, and many modern ones were built. Facilities for electricity, hot water, and heating were repaired or replaced. Much new equipment for education, research, and clinical practice was also supplied. A central laboratory was built at Seoul National University College of Medicine Attached Hospital. The lab was equipped with a radiation therapy machine, electrocardiography, a blood gas analyzer, a tissue culture chamber, and 200 microscopes.
Several important changes occurred at SNUMC as a result of the project. By 1962, when the project concluded, other than three professors who decided to stay in the United States, 74 professors returned to Korea. At that time, the total number of professors was 106. The effect of having nearly 70 percent of the faculty influenced by new trends in American medicine and education was significant. This critical mass of faculty members could take Korean medical sciences to the next level by diffusing the new technologies and organizational culture they had learned in the United States throughout the Korean medical environment.
With the help of advisors, major events in the history of medical education in Korea occurred during the project period. These included the introduction of clinical clerkships in 1957, internships in 1958, and residency programs in 1959. These programs were the core of American medical education at that time. Japanese-style medical education started to be transformed into a more American model. Textbooks were changed to English books, cramming one-way lectures were changed to learning by doing, inter-departmental teaching was attempted, the portion of laboratory practice was increased, active clinical clerkships and medical grand rounds were introduced, and the hierarchical distance between teacher and student began to be narrowed.
The Graduate School of Public Health was newly established, and the Technical High School of Nursing was changed to the Department of Nursing under the College of Medicine in 1959. Several prominent leaps in clinical practice, such as the first cardiac surgery done by Korean doctors in August 1959, were made, and many academic societies were established.
But there were some negative outcomes as well. The project planted the seed of brain drain, which could be seen from the mid-1960s, increased Korean dependency on American medicine, and strengthened the market-oriented healthcare system. During the project period, students at SNUMC became familiar with American medicine, and some of them had a yearning for it. When the United States lowered the barrier to foreign medical school graduates after the outbreak of the Vietnam War, around half of SNUMC graduates were drained to the United States and settled there.
The Minnesota Project spurred "drastic and rapid change" in the areas of education, research, and clinical practice at SNUMC, increasing capacity in each. Many of the project’s stakeholders wanted to continue it. However, in the rapidly changing political and diplomatic environment of the 1960s, it could not be prolonged.
Fortunately, just after the Minnesota Project, the China Medical Board of the Rockefeller Foundations United States (CMB) agreed to support SNUMC (including the Department of Nursing and the Graduate School of Public Health) in its transition from the Minnesota Project. [2] Though the CMB's assistance for SNUMC can be traced back to 1953, full-scale support of 5.5 million USD began from 1963 and continued until 1986.
In 1963, when the Minnesota Project ended, the dean of SNUMC asked the CMB to send a consultant to solve the administrative and educational issues it was encountering due to the project's end. The CMB agreed, sending Dr. N.L. Gault Jr. who had served as the advisor of the Minnesota Project at SNUMC. From that point onwards, CMB assistance to SNUMC grew rapidly.
The two projects had similarities and differences: both projects shared the same objectives but differed in the scope of assistance and the target institution. The CMB limited its assistance to health sciences: medicine, nursing, and public health. Support was not limited to SNU but expanded to include other universities as well. The CMB continued the overseas fellowship program (44), dispatch of advisors (7), and equipment and facilities supply for SNUMC. However, a fairly large portion was allocated to the construction of a library and multidisciplinary laboratory (MDL), hospital renovations, books and journals, and research funds.
There were still professors, including newly appointed ones, who had not been trained in the overseas fellowship program of the Minnesota Project (though nearly 70 percent had). Thus, the CMB helped the remaining professors obtain overseas training opportunities. In the Minnesota Project, fellowship was mostly limited to the University of Minnesota. The CMB recommended, however, that the Korean professors rather select countries that possessed smaller technological gaps with Korea compared to the United States. This recommendation mostly fell on deaf ears since the majority of the professors desired fellowships in the United States, which was a symbol of advanced science to the Korean people at that time.
The professors who returned after their fellowships had a broadened view accompanied with a strong desire to improve Korean teaching, research, and clinical practice. They faced barriers in doing so, however, since Korea lacked adequate books, journals, laboratory equipment, hospital facilities, and research funds. The CMB Project answered these urgent needs.
The biggest difference was in matching funds. While the CMB Project obligated beneficiary institutions to contribute matching funds as a requirement for assistance, in the Minnesota Project the Korean government was responsible for matching funds. In order to meet the CMB requirements, SNUMC organized a fundraising campaign. In other words, the responsibility of the beneficiary institution was heavier in the CMB Project compared to the Minnesota Project. The former's method provided more momentum for self-development.
The Minnesota Project brought "drastic and rapid change" in SNUMC. However, without the CMB Project, the sustainability of such innovation may have been lost: in other words, the CMB Project enabled the continuation and stabilization of such change. And as already mentioned, the matching fund method of the CMB Project spurred a stage of self-development in Korea.
The CMB Project induced Korean medicine, nursing, and public health education and research to follow the stream of American trends within a short period of time. Compared to the Minnesota Project, the CMB Project greatly contributed to the self-development of medicine, nursing, and public health at SNU. So we can say that Korea received the baptism of American medicine in the 1950 to 1960s, but that Korean medicine, which appropriated American medicine and adapted it to the Korean environment, was itself formed in around the mid-1970s.
It was during the CMB Project that the Korean government established the National Teacher Training Center for Health Personnel (NTTC) at SNUMC (March 1975). Actually initiatives for the center began in 1972, when SNUMC launched the Institute of Continuing Medical Education to develop nationwide continuing educatino programs. The institute, supported by the CMB Project, offered postgraduate, continuing medical education, and faculty development programs for all medical colleges in Korea. At the end of 1973, Audio-Visual Resource Center, which allowed medical education on abnormal heartbeat, pathology films, and microscopic photos, was opened at SNUMC.
In 1974, the Korean government requested that SNUMC carry out a feasibility study for the establishment of the NTTC. This request was based on a recommendation from the World Health Organization (WHO), which believed that developing countries needed "comprehensive, coordinated long-term programs for teachers of medical and allied health sciences" in order to improve the competencies of health professionals. A document published in 1966 noted that the "insufficiency of teachers continues to be a basic problem. Many academically qualified workers, despite their knowledge of subject matter, often lack special preparation in education science, particularly with respect to pedagogy and learning process. In order to tackle this serious problem, the WHO will promote the development of teacher training centers in medical and allied sciences to serve inter-regional, regional and country needs.”
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It was under the WHO's plan to develop teacher training centers that the Inter-regional (Global) Teacher Training Center for Health Personnel (IRTTC) was established at the Center for Educational Development, University of Illinois College of Medicine in September 1970. From 1971 to 1973, regional teacher training centers (RTTCs) were established in the six regions of the WHO. In the Western Pacific region, an RTTC was established at the University of New South Wales, Australia. And in 1975, national teacher training centers (NTTCs) were established at SNUMC and at the University of the Philippines in Manila.
The IRTTC was designed to assist the RTTCs, and the RTTCs to help the NTTCs. Korean professors began to be invited to the RTTC in Australia in 1973 to be trained in health professional education theory and practice. Until 1990, over 50 professors had attended training sessions conducted by the RTTC. Some of them completed graduate degrees in health professional education.
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These professors functioned as core members of the NTTC. They designed, developed, and implemented effective training programs based on what they had learned at the RTTC. The NTTC organized nationwide continuing medical education programs for provincial hospitals and faculty development programs for all medical and nursing colleges, and teaching hospitals.
The NTTC received financial support from the CMB and technical support from the WHO Western Pacific Regional Office. The two centers at SNUMC, the Institute of Continuing Medical Education and the Audio-Visual Resource Center, were integrated into the NTTC. The NTTC had four divisions: training, research, learning resource production, and the audio-visual resource archive division.
The NTTC published textbooks for continuing education and organized national and international symposiums on key topics in each era. Furthermore, it functioned as the administrative office of the Korean Association of Medical Colleges and the Council of Deans of National Medical Colleges. Until 1988 when Korea was removed from the list of developing countries, the NTTC organized overseas fellowship programs funded by the WHO and the Overseas Economic Cooperation Fund (OECF) of Japan.
We reviewed three projects that greatly contributed to innovating healthcare and medicine in Korea and to developing the capacity of Korean health professionals. However, without the rapid economic growth which is often referred to as "The miracle of the Han River," sustained development would have been impossible. In particular, such economic development enabled expansion of the healthcare market, spurred higher expectations among the Korean people for better healthcare which in turn inspired a drive for innovation in the field, and attracted talented people to the healthcare field due to the relatively high income of doctors. And healthcare development itself also had a positive influence on economic development by improving population health, reducing disease burden, and promoting the rehabilitation of the people.
Despite many objections, the Minnesota Project selected and focused on a single institution, SNU. This is of particular importance in terms of the impact of the project, because if the ICA had dispersed its limited funds across several institutions, the results would have been far smaller.
In 1961, 70 percent of the professors at SNUMC had studied abroad through the program—a high enough percentage to form a critical mass for institutional change. If only 20 or 30 percent had studied abroad, fewer changes and innovations would have been made in the Korean medical environment, especially given the country's conservative, hierarchical system.
Concentration was also applied to the selection of fellows for the program. Among 77 fellows, 33 were teaching assistants without salaries who were awaiting paid positions. These assistants were allowed to stay in the United States for two or three years, and some earned an academic degree in their specialty. These young professionals, full of patriotism and ambition after a long period of hardship caused by colonialism and the Korean War, saw an opportunity to make a huge difference in their country.
The principle of selection and concentration was closely linked to the plan for diffusion of innovation. From the beginning years of the Minnesota Project, through to the CMB project and onwards to the NTTC initiative, professors at the SNUMC functioned as evangelists of new American medicine.
As members of a privileged institution, SNUMC professors were often invited to other medical colleges to give special lectures. They also influenced the curriculum of other medical colleges, led almost all academic societies, published articles on what they had experienced in the United States, and translated English-language American textbooks into the Korean language. Furthermore, the SNUMC spread what they learned through the NTTC, which was officially recognized as a center for faculty development by the Korean government.
The most significant characteristic of the three projects was the program design, which focused on the development of human resources. Many different forms of assistance for developing countries had come into existence from the end of World War II. But assistance focused on material supply, such as buildings, equipment, tools, and medication carried a high probability of failure.
Projects for the SNUMC, however, were different. They focused first on developing the capacity for human resources and then on supporting them with the facilities and equipment they would need to reach their full potential. Regarding institutional change, the projects did not build new systems or institutions directly, but facilitated the decision-making of members of the recipient organization so that new systems could be established that were compatible with their own academic, political, and cultural environment.
Advisory services also emphasized sustainable HRH development. Advisors were not there to replace Korean professors; rather, they were there to pass on their knowledge and skills to Korean professors to enable the latter to do the job on their own.
As we reviewed in this paper, the SNUMC received technical assistance from the Minnesota Project (1954 to 1961), the CMB Project (1963 to1986), and the NTTC Project (1975 to ongoing). Each project was supported by different organizations, but in a well-coordinated continuum.
In the international cooperation field, we can observe many beneficiary institutions that passively wait for the favors of donor institutions. Two years after the end of the Minnesota Project, the dean of the SNUMC contacted the CMB to request a consultant, and the CMB answered that requesting by sending Dr. Gault, who had served as the advisor of the Minnesota Project. This became the momentum to increase the size of CMB support. What we can take away from this example is the absolute importance of the beneficiary institution taking a proactive attitude toward assistance programs.
After liberation from Japan, Korea faced a severe shortage of modern medical professionals and a devastated health infrastructure, worsened by the Korean War. Korea’s rapid medical advancement in later decades was achieved largely through a human resource–centered approach rather than reliance on material aid. The Minnesota Project (1954–1961), led by the United States, rebuilt Seoul National University’s College of Medicine and trained faculty in advanced clinical and educational methods, laying the foundation for institutional reform. The China Medical Board Project (1963–1986) continued this momentum, promoting self-development and research capacity through matching funds and broader academic exchange. These initiatives fit within an innovation diffusion framework, as knowledge and practices spread nationwide. Korea’s experience highlights how investing in human capital and institutional learning can drive sustainable health system transformation.
#health #human resources #education
Before the mid-19th century, the Korean people relied entirely on traditional Korean medicine which has its roots in Chinese medicine. Around the end of the 19th century, Western medicine was introduced to Korea by the Korean government and Western missionary doctors. However, during the time Korea was colonized by the Japanese, from 1910 to 1945, Japanese-style modern medicine became the main style of medicine practiced in the country.
During the colonial years, high positions in medical colleges and hospitals were monopolized by Japanese doctors. Korean doctors were very rarely exposed to advanced medical sciences, and could not be promoted to high positions. When Korea became independent in 1945, it encountered great challenges due to the shortage of well-trained health professionals and the lack of medical facilities and equipment.
Just five years after Korea’s liberation from Japan, the country faced another traumatic event, the Korean War (1950 to 1953), and its devastating aftermaths. In the mid-1950s, the country was suffering from a severe shortage of health personnel and facilities.
However, around the end of the 20th century, Korean medicine and healthcare had risen to become among the most advanced in the world. Here we will discuss what made this dramatic change possible. Among the many factors of miraculous change in medicine and healthcare in Korea, this theme will focus on three important development assistance projects for the educational development of human resources for health. The term “educational development” means not only “training and education,” but also educational system changes including curriculum, faculty development (on education, research, and clinical practice), institutional administration (on planning, implementation, evaluation of institutional policy, and fundraising), educational environment (library, lecture room, laboratory facility, and hospital environment), relationship between university and teaching hospital, licensing system, post-graduate education, and continuing education. All these components should be considered together for sustainable development.
Human resources for health (HRH) is a crucial factor under Universal Health Coverage (UHC) that needs to be realized in order to reach the health-related targets of the Sustainable Development Goals (SDGs). The five health-system attributes of the UHC—quality, efficiency, equity, accountability, and sustainability and resilience—are closely linked to HRH issues. There is much evidence to support investment in the health workforce as one of the “best buys” in public health. According to one research, investing in midwifery education, with deployment to community-based services, could yield a 16-fold return on investment in terms of lives saved and costs of caesarean sections avoided. Furthermore, HRH development can influence SDGs beyond UHC by improving population health, reducing disease burden, and promoting the rehabilitation of people.
This historical review is intended to assist leaders in developing countries in identifying the most effective paths for health professional education development toward realizing UHC and ultimately the health-related targets of the SDGs.
Korea's medical system was completely devastated by the Korean War. Hospital buildings were destroyed, equipment was plundered, and many medical employees were killed or kidnapped. The Minnesota Project, a large-scale technical assistance program led by the United States, was launched at this time to help resurrect Korea's medical environment.
Korea was liberated from Japan in 1945. Five years after liberation, the Korean War broke out and lasted for three years from 1950 to 1953. Medical colleges, nursing education institutions, and hospitals suffered severe destruction and loss of human resources due to the war. [1]
After World War II, the United States began to provide technical assistance for developing countries in which it had diplomatic and military interest. By training professionals in urgent fields, providing essential equipment and facilities, and establishing educational institutions, the United States expanded the influx of advanced knowledge, skills, and technology into developing countries. This technical assistance was mainly carried out under agreements between the US government and professional institutions in the United States, including universities. By 1960, the International Cooperation Administration (ICA, former USAID) of the United States made agreements with 53 American universities and was running 96 technical assistance programs in 33 developing countries.
As one of the technical assistance programs of the International Cooperation Administration (ICA), the University of Minnesota (UM) assisted in the rehabilitation and capacity building of three colleges (College of Medicine, College of Agriculture, and College of Engineering) of Seoul National University (SNU) from 1954 to 1961. This project, known as the “Minnesota Project” greatly contributed to the reconstruction and development of SNU, which had been severely devastated by the Korean War. We will focus on SNU's College of Medicine (SNUMC) in this theme.
A total of 226 academics from SNU and 77 from SNUMC were trained in the United States through the project. The fellowship program focused on training assistant professors and teaching assistants. Among 77 fellows, 33 were teaching assistants, the latter of whom were allowed to stay in the United States for two or three years, with some even earning an academic degree in their specialty.
A short-term fellowship program was granted to higher level individuals to create a supportive institutional environment for innovation at SNUMC by changing the mindset of leaders, including the deans of the medical college, hospital directors, and the senior-level staff of certain departments. Generally, these individuals stayed in the United States for several months to study advanced curriculums, teaching methods, faculty development programs, and university and hospital management systems.
In order to prevent brain drain, the contract between ICA and UM obligated that the Korean government and SNU guarantee a professorship of at least one year for exchange professors upon their return to Korea. Furthermore, fellows were not allowed to bring their families in order to prevent brain drain.
During the project period, 59 advisors specialized medicine, nursing, and hospital administration were dispatched to Korea. For the College of Medicine, 11 came to Korea and stayed from several months to 1.5 years. Advisors never worked in the place of Korean professors; rather they saw their role as "helping Korean professors to do the work themselves." One advisor explained that they "wanted to teach the Korean professors how to fish, instead of giving them a fish.”
Specifically, the advisors were responsible for: (1) formulating strategic directions for the development of SNU College of Medicine; (2) helping Korean professors make wise decisions on challenging issues by consultation based on educational, scientific, and administrative principles; (3) introducing new teaching, research, and clinical methods by special training sessions and demonstrations; and (4) acting as a symbol for change, so that Korean professors could feel more confident in provoking change themselves. Besides, advisors visited other medical colleges and attended governmental meetings for consultation purposes.
They also supported fellows who had returned from the United States to settle in each department, and advised the ICA on what sort of equipment should be supplied to each fellow. This principle of "build capacity first and then supply equipment" was effective in preventing fund abuses. However, it is true that some equipment was found unused even after the end of the project.
From the 9.54 million USD supported by the ICA, 6 million USD was allocated to equipment, and construction and repair of facilities. Matching funds from the Korean government which amounted to 7 million USD were also spent on equipment and facilities.
Through the project buildings destroyed by the war were reconstructed, and many modern ones were built. Facilities for electricity, hot water, and heating were repaired or replaced. Much new equipment for education, research, and clinical practice was also supplied. A central laboratory was built at Seoul National University College of Medicine Attached Hospital. The lab was equipped with a radiation therapy machine, electrocardiography, a blood gas analyzer, a tissue culture chamber, and 200 microscopes.
Several important changes occurred at SNUMC as a result of the project. By 1962, when the project concluded, other than three professors who decided to stay in the United States, 74 professors returned to Korea. At that time, the total number of professors was 106. The effect of having nearly 70 percent of the faculty influenced by new trends in American medicine and education was significant. This critical mass of faculty members could take Korean medical sciences to the next level by diffusing the new technologies and organizational culture they had learned in the United States throughout the Korean medical environment.
With the help of advisors, major events in the history of medical education in Korea occurred during the project period. These included the introduction of clinical clerkships in 1957, internships in 1958, and residency programs in 1959. These programs were the core of American medical education at that time. Japanese-style medical education started to be transformed into a more American model. Textbooks were changed to English books, cramming one-way lectures were changed to learning by doing, inter-departmental teaching was attempted, the portion of laboratory practice was increased, active clinical clerkships and medical grand rounds were introduced, and the hierarchical distance between teacher and student began to be narrowed.
The Graduate School of Public Health was newly established, and the Technical High School of Nursing was changed to the Department of Nursing under the College of Medicine in 1959. Several prominent leaps in clinical practice, such as the first cardiac surgery done by Korean doctors in August 1959, were made, and many academic societies were established.
But there were some negative outcomes as well. The project planted the seed of brain drain, which could be seen from the mid-1960s, increased Korean dependency on American medicine, and strengthened the market-oriented healthcare system. During the project period, students at SNUMC became familiar with American medicine, and some of them had a yearning for it. When the United States lowered the barrier to foreign medical school graduates after the outbreak of the Vietnam War, around half of SNUMC graduates were drained to the United States and settled there.
The Minnesota Project spurred "drastic and rapid change" in the areas of education, research, and clinical practice at SNUMC, increasing capacity in each. Many of the project’s stakeholders wanted to continue it. However, in the rapidly changing political and diplomatic environment of the 1960s, it could not be prolonged.
Fortunately, just after the Minnesota Project, the China Medical Board of the Rockefeller Foundations United States (CMB) agreed to support SNUMC (including the Department of Nursing and the Graduate School of Public Health) in its transition from the Minnesota Project. [2] Though the CMB's assistance for SNUMC can be traced back to 1953, full-scale support of 5.5 million USD began from 1963 and continued until 1986.
In 1963, when the Minnesota Project ended, the dean of SNUMC asked the CMB to send a consultant to solve the administrative and educational issues it was encountering due to the project's end. The CMB agreed, sending Dr. N.L. Gault Jr. who had served as the advisor of the Minnesota Project at SNUMC. From that point onwards, CMB assistance to SNUMC grew rapidly.
The two projects had similarities and differences: both projects shared the same objectives but differed in the scope of assistance and the target institution. The CMB limited its assistance to health sciences: medicine, nursing, and public health. Support was not limited to SNU but expanded to include other universities as well. The CMB continued the overseas fellowship program (44), dispatch of advisors (7), and equipment and facilities supply for SNUMC. However, a fairly large portion was allocated to the construction of a library and multidisciplinary laboratory (MDL), hospital renovations, books and journals, and research funds.
There were still professors, including newly appointed ones, who had not been trained in the overseas fellowship program of the Minnesota Project (though nearly 70 percent had). Thus, the CMB helped the remaining professors obtain overseas training opportunities. In the Minnesota Project, fellowship was mostly limited to the University of Minnesota. The CMB recommended, however, that the Korean professors rather select countries that possessed smaller technological gaps with Korea compared to the United States. This recommendation mostly fell on deaf ears since the majority of the professors desired fellowships in the United States, which was a symbol of advanced science to the Korean people at that time.
The professors who returned after their fellowships had a broadened view accompanied with a strong desire to improve Korean teaching, research, and clinical practice. They faced barriers in doing so, however, since Korea lacked adequate books, journals, laboratory equipment, hospital facilities, and research funds. The CMB Project answered these urgent needs.
The biggest difference was in matching funds. While the CMB Project obligated beneficiary institutions to contribute matching funds as a requirement for assistance, in the Minnesota Project the Korean government was responsible for matching funds. In order to meet the CMB requirements, SNUMC organized a fundraising campaign. In other words, the responsibility of the beneficiary institution was heavier in the CMB Project compared to the Minnesota Project. The former's method provided more momentum for self-development.
The Minnesota Project brought "drastic and rapid change" in SNUMC. However, without the CMB Project, the sustainability of such innovation may have been lost: in other words, the CMB Project enabled the continuation and stabilization of such change. And as already mentioned, the matching fund method of the CMB Project spurred a stage of self-development in Korea.
The CMB Project induced Korean medicine, nursing, and public health education and research to follow the stream of American trends within a short period of time. Compared to the Minnesota Project, the CMB Project greatly contributed to the self-development of medicine, nursing, and public health at SNU. So we can say that Korea received the baptism of American medicine in the 1950 to 1960s, but that Korean medicine, which appropriated American medicine and adapted it to the Korean environment, was itself formed in around the mid-1970s.
It was during the CMB Project that the Korean government established the National Teacher Training Center for Health Personnel (NTTC) at SNUMC (March 1975). Actually initiatives for the center began in 1972, when SNUMC launched the Institute of Continuing Medical Education to develop nationwide continuing educatino programs. The institute, supported by the CMB Project, offered postgraduate, continuing medical education, and faculty development programs for all medical colleges in Korea. At the end of 1973, Audio-Visual Resource Center, which allowed medical education on abnormal heartbeat, pathology films, and microscopic photos, was opened at SNUMC.
In 1974, the Korean government requested that SNUMC carry out a feasibility study for the establishment of the NTTC. This request was based on a recommendation from the World Health Organization (WHO), which believed that developing countries needed "comprehensive, coordinated long-term programs for teachers of medical and allied health sciences" in order to improve the competencies of health professionals. A document published in 1966 noted that the "insufficiency of teachers continues to be a basic problem. Many academically qualified workers, despite their knowledge of subject matter, often lack special preparation in education science, particularly with respect to pedagogy and learning process. In order to tackle this serious problem, the WHO will promote the development of teacher training centers in medical and allied sciences to serve inter-regional, regional and country needs.”
It was under the WHO's plan to develop teacher training centers that the Inter-regional (Global) Teacher Training Center for Health Personnel (IRTTC) was established at the Center for Educational Development, University of Illinois College of Medicine in September 1970. From 1971 to 1973, regional teacher training centers (RTTCs) were established in the six regions of the WHO. In the Western Pacific region, an RTTC was established at the University of New South Wales, Australia. And in 1975, national teacher training centers (NTTCs) were established at SNUMC and at the University of the Philippines in Manila.
The IRTTC was designed to assist the RTTCs, and the RTTCs to help the NTTCs. Korean professors began to be invited to the RTTC in Australia in 1973 to be trained in health professional education theory and practice. Until 1990, over 50 professors had attended training sessions conducted by the RTTC. Some of them completed graduate degrees in health professional education.
These professors functioned as core members of the NTTC. They designed, developed, and implemented effective training programs based on what they had learned at the RTTC. The NTTC organized nationwide continuing medical education programs for provincial hospitals and faculty development programs for all medical and nursing colleges, and teaching hospitals.
The NTTC received financial support from the CMB and technical support from the WHO Western Pacific Regional Office. The two centers at SNUMC, the Institute of Continuing Medical Education and the Audio-Visual Resource Center, were integrated into the NTTC. The NTTC had four divisions: training, research, learning resource production, and the audio-visual resource archive division.
The NTTC published textbooks for continuing education and organized national and international symposiums on key topics in each era. Furthermore, it functioned as the administrative office of the Korean Association of Medical Colleges and the Council of Deans of National Medical Colleges. Until 1988 when Korea was removed from the list of developing countries, the NTTC organized overseas fellowship programs funded by the WHO and the Overseas Economic Cooperation Fund (OECF) of Japan.
We reviewed three projects that greatly contributed to innovating healthcare and medicine in Korea and to developing the capacity of Korean health professionals. However, without the rapid economic growth which is often referred to as "The miracle of the Han River," sustained development would have been impossible. In particular, such economic development enabled expansion of the healthcare market, spurred higher expectations among the Korean people for better healthcare which in turn inspired a drive for innovation in the field, and attracted talented people to the healthcare field due to the relatively high income of doctors. And healthcare development itself also had a positive influence on economic development by improving population health, reducing disease burden, and promoting the rehabilitation of the people.
Despite many objections, the Minnesota Project selected and focused on a single institution, SNU. This is of particular importance in terms of the impact of the project, because if the ICA had dispersed its limited funds across several institutions, the results would have been far smaller.
In 1961, 70 percent of the professors at SNUMC had studied abroad through the program—a high enough percentage to form a critical mass for institutional change. If only 20 or 30 percent had studied abroad, fewer changes and innovations would have been made in the Korean medical environment, especially given the country's conservative, hierarchical system.
Concentration was also applied to the selection of fellows for the program. Among 77 fellows, 33 were teaching assistants without salaries who were awaiting paid positions. These assistants were allowed to stay in the United States for two or three years, and some earned an academic degree in their specialty. These young professionals, full of patriotism and ambition after a long period of hardship caused by colonialism and the Korean War, saw an opportunity to make a huge difference in their country.
The principle of selection and concentration was closely linked to the plan for diffusion of innovation. From the beginning years of the Minnesota Project, through to the CMB project and onwards to the NTTC initiative, professors at the SNUMC functioned as evangelists of new American medicine.
As members of a privileged institution, SNUMC professors were often invited to other medical colleges to give special lectures. They also influenced the curriculum of other medical colleges, led almost all academic societies, published articles on what they had experienced in the United States, and translated English-language American textbooks into the Korean language. Furthermore, the SNUMC spread what they learned through the NTTC, which was officially recognized as a center for faculty development by the Korean government.
The most significant characteristic of the three projects was the program design, which focused on the development of human resources. Many different forms of assistance for developing countries had come into existence from the end of World War II. But assistance focused on material supply, such as buildings, equipment, tools, and medication carried a high probability of failure.
Projects for the SNUMC, however, were different. They focused first on developing the capacity for human resources and then on supporting them with the facilities and equipment they would need to reach their full potential. Regarding institutional change, the projects did not build new systems or institutions directly, but facilitated the decision-making of members of the recipient organization so that new systems could be established that were compatible with their own academic, political, and cultural environment.
Advisory services also emphasized sustainable HRH development. Advisors were not there to replace Korean professors; rather, they were there to pass on their knowledge and skills to Korean professors to enable the latter to do the job on their own.
As we reviewed in this paper, the SNUMC received technical assistance from the Minnesota Project (1954 to 1961), the CMB Project (1963 to1986), and the NTTC Project (1975 to ongoing). Each project was supported by different organizations, but in a well-coordinated continuum.
In the international cooperation field, we can observe many beneficiary institutions that passively wait for the favors of donor institutions. Two years after the end of the Minnesota Project, the dean of the SNUMC contacted the CMB to request a consultant, and the CMB answered that requesting by sending Dr. Gault, who had served as the advisor of the Minnesota Project. This became the momentum to increase the size of CMB support. What we can take away from this example is the absolute importance of the beneficiary institution taking a proactive attitude toward assistance programs.
Before the mid-19th century, the Korean people relied entirely on traditional Korean medicine which has its roots in Chinese medicine. Around the end of the 19th century, Western medicine was introduced to Korea by the Korean government and Western missionary doctors. However, during the time Korea was colonized by the Japanese, from 1910 to 1945, Japanese-style modern medicine became the main style of medicine practiced in the country.
During the colonial years, high positions in medical colleges and hospitals were monopolized by Japanese doctors. Korean doctors were very rarely exposed to advanced medical sciences, and could not be promoted to high positions. When Korea became independent in 1945, it encountered great challenges due to the shortage of well-trained health professionals and the lack of medical facilities and equipment.
Just five years after Korea’s liberation from Japan, the country faced another traumatic event, the Korean War (1950 to 1953), and its devastating aftermaths. In the mid-1950s, the country was suffering from a severe shortage of health personnel and facilities.
However, around the end of the 20th century, Korean medicine and healthcare had risen to become among the most advanced in the world. Here we will discuss what made this dramatic change possible. Among the many factors of miraculous change in medicine and healthcare in Korea, this theme will focus on three important development assistance projects for the educational development of human resources for health. The term “educational development” means not only “training and education,” but also educational system changes including curriculum, faculty development (on education, research, and clinical practice), institutional administration (on planning, implementation, evaluation of institutional policy, and fundraising), educational environment (library, lecture room, laboratory facility, and hospital environment), relationship between university and teaching hospital, licensing system, post-graduate education, and continuing education. All these components should be considered together for sustainable development.
Human resources for health (HRH) is a crucial factor under Universal Health Coverage (UHC) that needs to be realized in order to reach the health-related targets of the Sustainable Development Goals (SDGs). The five health-system attributes of the UHC—quality, efficiency, equity, accountability, and sustainability and resilience—are closely linked to HRH issues. There is much evidence to support investment in the health workforce as one of the “best buys” in public health. According to one research, investing in midwifery education, with deployment to community-based services, could yield a 16-fold return on investment in terms of lives saved and costs of caesarean sections avoided. Furthermore, HRH development can influence SDGs beyond UHC by improving population health, reducing disease burden, and promoting the rehabilitation of people.
This historical review is intended to assist leaders in developing countries in identifying the most effective paths for health professional education development toward realizing UHC and ultimately the health-related targets of the SDGs.
Korea's medical system was completely devastated by the Korean War. Hospital buildings were destroyed, equipment was plundered, and many medical employees were killed or kidnapped. The Minnesota Project, a large-scale technical assistance program led by the United States, was launched at this time to help resurrect Korea's medical environment.
Korea was liberated from Japan in 1945. Five years after liberation, the Korean War broke out and lasted for three years from 1950 to 1953. Medical colleges, nursing education institutions, and hospitals suffered severe destruction and loss of human resources due to the war. [1]
After World War II, the United States began to provide technical assistance for developing countries in which it had diplomatic and military interest. By training professionals in urgent fields, providing essential equipment and facilities, and establishing educational institutions, the United States expanded the influx of advanced knowledge, skills, and technology into developing countries. This technical assistance was mainly carried out under agreements between the US government and professional institutions in the United States, including universities. By 1960, the International Cooperation Administration (ICA, former USAID) of the United States made agreements with 53 American universities and was running 96 technical assistance programs in 33 developing countries.
As one of the technical assistance programs of the International Cooperation Administration (ICA), the University of Minnesota (UM) assisted in the rehabilitation and capacity building of three colleges (College of Medicine, College of Agriculture, and College of Engineering) of Seoul National University (SNU) from 1954 to 1961. This project, known as the “Minnesota Project” greatly contributed to the reconstruction and development of SNU, which had been severely devastated by the Korean War. We will focus on SNU's College of Medicine (SNUMC) in this theme.
A total of 226 academics from SNU and 77 from SNUMC were trained in the United States through the project. The fellowship program focused on training assistant professors and teaching assistants. Among 77 fellows, 33 were teaching assistants, the latter of whom were allowed to stay in the United States for two or three years, with some even earning an academic degree in their specialty.
A short-term fellowship program was granted to higher level individuals to create a supportive institutional environment for innovation at SNUMC by changing the mindset of leaders, including the deans of the medical college, hospital directors, and the senior-level staff of certain departments. Generally, these individuals stayed in the United States for several months to study advanced curriculums, teaching methods, faculty development programs, and university and hospital management systems.
In order to prevent brain drain, the contract between ICA and UM obligated that the Korean government and SNU guarantee a professorship of at least one year for exchange professors upon their return to Korea. Furthermore, fellows were not allowed to bring their families in order to prevent brain drain.
During the project period, 59 advisors specialized medicine, nursing, and hospital administration were dispatched to Korea. For the College of Medicine, 11 came to Korea and stayed from several months to 1.5 years. Advisors never worked in the place of Korean professors; rather they saw their role as "helping Korean professors to do the work themselves." One advisor explained that they "wanted to teach the Korean professors how to fish, instead of giving them a fish.”
Specifically, the advisors were responsible for: (1) formulating strategic directions for the development of SNU College of Medicine; (2) helping Korean professors make wise decisions on challenging issues by consultation based on educational, scientific, and administrative principles; (3) introducing new teaching, research, and clinical methods by special training sessions and demonstrations; and (4) acting as a symbol for change, so that Korean professors could feel more confident in provoking change themselves. Besides, advisors visited other medical colleges and attended governmental meetings for consultation purposes.
They also supported fellows who had returned from the United States to settle in each department, and advised the ICA on what sort of equipment should be supplied to each fellow. This principle of "build capacity first and then supply equipment" was effective in preventing fund abuses. However, it is true that some equipment was found unused even after the end of the project.
From the 9.54 million USD supported by the ICA, 6 million USD was allocated to equipment, and construction and repair of facilities. Matching funds from the Korean government which amounted to 7 million USD were also spent on equipment and facilities.
Through the project buildings destroyed by the war were reconstructed, and many modern ones were built. Facilities for electricity, hot water, and heating were repaired or replaced. Much new equipment for education, research, and clinical practice was also supplied. A central laboratory was built at Seoul National University College of Medicine Attached Hospital. The lab was equipped with a radiation therapy machine, electrocardiography, a blood gas analyzer, a tissue culture chamber, and 200 microscopes.
Several important changes occurred at SNUMC as a result of the project. By 1962, when the project concluded, other than three professors who decided to stay in the United States, 74 professors returned to Korea. At that time, the total number of professors was 106. The effect of having nearly 70 percent of the faculty influenced by new trends in American medicine and education was significant. This critical mass of faculty members could take Korean medical sciences to the next level by diffusing the new technologies and organizational culture they had learned in the United States throughout the Korean medical environment.
With the help of advisors, major events in the history of medical education in Korea occurred during the project period. These included the introduction of clinical clerkships in 1957, internships in 1958, and residency programs in 1959. These programs were the core of American medical education at that time. Japanese-style medical education started to be transformed into a more American model. Textbooks were changed to English books, cramming one-way lectures were changed to learning by doing, inter-departmental teaching was attempted, the portion of laboratory practice was increased, active clinical clerkships and medical grand rounds were introduced, and the hierarchical distance between teacher and student began to be narrowed.
The Graduate School of Public Health was newly established, and the Technical High School of Nursing was changed to the Department of Nursing under the College of Medicine in 1959. Several prominent leaps in clinical practice, such as the first cardiac surgery done by Korean doctors in August 1959, were made, and many academic societies were established.
But there were some negative outcomes as well. The project planted the seed of brain drain, which could be seen from the mid-1960s, increased Korean dependency on American medicine, and strengthened the market-oriented healthcare system. During the project period, students at SNUMC became familiar with American medicine, and some of them had a yearning for it. When the United States lowered the barrier to foreign medical school graduates after the outbreak of the Vietnam War, around half of SNUMC graduates were drained to the United States and settled there.
The Minnesota Project spurred "drastic and rapid change" in the areas of education, research, and clinical practice at SNUMC, increasing capacity in each. Many of the project’s stakeholders wanted to continue it. However, in the rapidly changing political and diplomatic environment of the 1960s, it could not be prolonged.
Fortunately, just after the Minnesota Project, the China Medical Board of the Rockefeller Foundations United States (CMB) agreed to support SNUMC (including the Department of Nursing and the Graduate School of Public Health) in its transition from the Minnesota Project. [2] Though the CMB's assistance for SNUMC can be traced back to 1953, full-scale support of 5.5 million USD began from 1963 and continued until 1986.
In 1963, when the Minnesota Project ended, the dean of SNUMC asked the CMB to send a consultant to solve the administrative and educational issues it was encountering due to the project's end. The CMB agreed, sending Dr. N.L. Gault Jr. who had served as the advisor of the Minnesota Project at SNUMC. From that point onwards, CMB assistance to SNUMC grew rapidly.
The two projects had similarities and differences: both projects shared the same objectives but differed in the scope of assistance and the target institution. The CMB limited its assistance to health sciences: medicine, nursing, and public health. Support was not limited to SNU but expanded to include other universities as well. The CMB continued the overseas fellowship program (44), dispatch of advisors (7), and equipment and facilities supply for SNUMC. However, a fairly large portion was allocated to the construction of a library and multidisciplinary laboratory (MDL), hospital renovations, books and journals, and research funds.
There were still professors, including newly appointed ones, who had not been trained in the overseas fellowship program of the Minnesota Project (though nearly 70 percent had). Thus, the CMB helped the remaining professors obtain overseas training opportunities. In the Minnesota Project, fellowship was mostly limited to the University of Minnesota. The CMB recommended, however, that the Korean professors rather select countries that possessed smaller technological gaps with Korea compared to the United States. This recommendation mostly fell on deaf ears since the majority of the professors desired fellowships in the United States, which was a symbol of advanced science to the Korean people at that time.
The professors who returned after their fellowships had a broadened view accompanied with a strong desire to improve Korean teaching, research, and clinical practice. They faced barriers in doing so, however, since Korea lacked adequate books, journals, laboratory equipment, hospital facilities, and research funds. The CMB Project answered these urgent needs.
The biggest difference was in matching funds. While the CMB Project obligated beneficiary institutions to contribute matching funds as a requirement for assistance, in the Minnesota Project the Korean government was responsible for matching funds. In order to meet the CMB requirements, SNUMC organized a fundraising campaign. In other words, the responsibility of the beneficiary institution was heavier in the CMB Project compared to the Minnesota Project. The former's method provided more momentum for self-development.
The Minnesota Project brought "drastic and rapid change" in SNUMC. However, without the CMB Project, the sustainability of such innovation may have been lost: in other words, the CMB Project enabled the continuation and stabilization of such change. And as already mentioned, the matching fund method of the CMB Project spurred a stage of self-development in Korea.
The CMB Project induced Korean medicine, nursing, and public health education and research to follow the stream of American trends within a short period of time. Compared to the Minnesota Project, the CMB Project greatly contributed to the self-development of medicine, nursing, and public health at SNU. So we can say that Korea received the baptism of American medicine in the 1950 to 1960s, but that Korean medicine, which appropriated American medicine and adapted it to the Korean environment, was itself formed in around the mid-1970s.
It was during the CMB Project that the Korean government established the National Teacher Training Center for Health Personnel (NTTC) at SNUMC (March 1975). Actually initiatives for the center began in 1972, when SNUMC launched the Institute of Continuing Medical Education to develop nationwide continuing educatino programs. The institute, supported by the CMB Project, offered postgraduate, continuing medical education, and faculty development programs for all medical colleges in Korea. At the end of 1973, Audio-Visual Resource Center, which allowed medical education on abnormal heartbeat, pathology films, and microscopic photos, was opened at SNUMC.
In 1974, the Korean government requested that SNUMC carry out a feasibility study for the establishment of the NTTC. This request was based on a recommendation from the World Health Organization (WHO), which believed that developing countries needed "comprehensive, coordinated long-term programs for teachers of medical and allied health sciences" in order to improve the competencies of health professionals. A document published in 1966 noted that the "insufficiency of teachers continues to be a basic problem. Many academically qualified workers, despite their knowledge of subject matter, often lack special preparation in education science, particularly with respect to pedagogy and learning process. In order to tackle this serious problem, the WHO will promote the development of teacher training centers in medical and allied sciences to serve inter-regional, regional and country needs.”
It was under the WHO's plan to develop teacher training centers that the Inter-regional (Global) Teacher Training Center for Health Personnel (IRTTC) was established at the Center for Educational Development, University of Illinois College of Medicine in September 1970. From 1971 to 1973, regional teacher training centers (RTTCs) were established in the six regions of the WHO. In the Western Pacific region, an RTTC was established at the University of New South Wales, Australia. And in 1975, national teacher training centers (NTTCs) were established at SNUMC and at the University of the Philippines in Manila.
The IRTTC was designed to assist the RTTCs, and the RTTCs to help the NTTCs. Korean professors began to be invited to the RTTC in Australia in 1973 to be trained in health professional education theory and practice. Until 1990, over 50 professors had attended training sessions conducted by the RTTC. Some of them completed graduate degrees in health professional education.
These professors functioned as core members of the NTTC. They designed, developed, and implemented effective training programs based on what they had learned at the RTTC. The NTTC organized nationwide continuing medical education programs for provincial hospitals and faculty development programs for all medical and nursing colleges, and teaching hospitals.
The NTTC received financial support from the CMB and technical support from the WHO Western Pacific Regional Office. The two centers at SNUMC, the Institute of Continuing Medical Education and the Audio-Visual Resource Center, were integrated into the NTTC. The NTTC had four divisions: training, research, learning resource production, and the audio-visual resource archive division.
The NTTC published textbooks for continuing education and organized national and international symposiums on key topics in each era. Furthermore, it functioned as the administrative office of the Korean Association of Medical Colleges and the Council of Deans of National Medical Colleges. Until 1988 when Korea was removed from the list of developing countries, the NTTC organized overseas fellowship programs funded by the WHO and the Overseas Economic Cooperation Fund (OECF) of Japan.
We reviewed three projects that greatly contributed to innovating healthcare and medicine in Korea and to developing the capacity of Korean health professionals. However, without the rapid economic growth which is often referred to as "The miracle of the Han River," sustained development would have been impossible. In particular, such economic development enabled expansion of the healthcare market, spurred higher expectations among the Korean people for better healthcare which in turn inspired a drive for innovation in the field, and attracted talented people to the healthcare field due to the relatively high income of doctors. And healthcare development itself also had a positive influence on economic development by improving population health, reducing disease burden, and promoting the rehabilitation of the people.
Despite many objections, the Minnesota Project selected and focused on a single institution, SNU. This is of particular importance in terms of the impact of the project, because if the ICA had dispersed its limited funds across several institutions, the results would have been far smaller.
In 1961, 70 percent of the professors at SNUMC had studied abroad through the program—a high enough percentage to form a critical mass for institutional change. If only 20 or 30 percent had studied abroad, fewer changes and innovations would have been made in the Korean medical environment, especially given the country's conservative, hierarchical system.
Concentration was also applied to the selection of fellows for the program. Among 77 fellows, 33 were teaching assistants without salaries who were awaiting paid positions. These assistants were allowed to stay in the United States for two or three years, and some earned an academic degree in their specialty. These young professionals, full of patriotism and ambition after a long period of hardship caused by colonialism and the Korean War, saw an opportunity to make a huge difference in their country.
The principle of selection and concentration was closely linked to the plan for diffusion of innovation. From the beginning years of the Minnesota Project, through to the CMB project and onwards to the NTTC initiative, professors at the SNUMC functioned as evangelists of new American medicine.
As members of a privileged institution, SNUMC professors were often invited to other medical colleges to give special lectures. They also influenced the curriculum of other medical colleges, led almost all academic societies, published articles on what they had experienced in the United States, and translated English-language American textbooks into the Korean language. Furthermore, the SNUMC spread what they learned through the NTTC, which was officially recognized as a center for faculty development by the Korean government.
The most significant characteristic of the three projects was the program design, which focused on the development of human resources. Many different forms of assistance for developing countries had come into existence from the end of World War II. But assistance focused on material supply, such as buildings, equipment, tools, and medication carried a high probability of failure.
Projects for the SNUMC, however, were different. They focused first on developing the capacity for human resources and then on supporting them with the facilities and equipment they would need to reach their full potential. Regarding institutional change, the projects did not build new systems or institutions directly, but facilitated the decision-making of members of the recipient organization so that new systems could be established that were compatible with their own academic, political, and cultural environment.
Advisory services also emphasized sustainable HRH development. Advisors were not there to replace Korean professors; rather, they were there to pass on their knowledge and skills to Korean professors to enable the latter to do the job on their own.
As we reviewed in this paper, the SNUMC received technical assistance from the Minnesota Project (1954 to 1961), the CMB Project (1963 to1986), and the NTTC Project (1975 to ongoing). Each project was supported by different organizations, but in a well-coordinated continuum.
In the international cooperation field, we can observe many beneficiary institutions that passively wait for the favors of donor institutions. Two years after the end of the Minnesota Project, the dean of the SNUMC contacted the CMB to request a consultant, and the CMB answered that requesting by sending Dr. Gault, who had served as the advisor of the Minnesota Project. This became the momentum to increase the size of CMB support. What we can take away from this example is the absolute importance of the beneficiary institution taking a proactive attitude toward assistance programs.