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.
Background of the Minnesota Project
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 ##3D_LAYER##severe destruction and loss of human resources##3D_TEXT:The Department of Health reported that 58 physicians were killed, 17 physicians were kidnapped, 300 nurses were either killed or missing, and 15 officials were killed. Of the total 3,155 private hospitals, 450 hospitals were completely destroyed, and 1,065 hospitals were partially destroyed. In the case of public hospitals, of the 54 hospitals, 10 were completely destroyed and 36 were partially destroyed.##3D_LAYER_END## due to the war.
After World War II, the United States began to provide ##3D_LAYER##technical assistance##3D_TEXT: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.##3D_LAYER_END## 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.
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 ##3D_LAYER##three colleges##3D_TEXT:College of Medicine, College of Agriculture, and College of Engineering.##3D_LAYER_END## of Seoul National University (SNU) from 1954 to 1961. This project, known as the ##3D_LAYER##"Minnesota Project,"##3D_TEXT:In the United States, it was called the “SNU Cooperative Project.”##3D_LAYER_END## 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.
and The University of Minnesota, 1954]
Among 96 programs instituted by the ICA, the Minnesota Project enjoyed the largest funding, with a budget of about ##3D_LAYER##10 million USD##3D_TEXT:It was the largest program held in Asia after World War II. The United States aimed to establish a strong anti-communist block in the Far East by rehabilitating Korea in response to the Cold War.##3D_LAYER_END##. Originally, the ICA had considered supporting several universities in Korea. However, it finally decided to ##3D_LAYER##"select and concentrate"##3D_TEXT:The first advisor of the project, Maloney W. F., once commented that SNU was "a university that would take its position as a leader." This implied that the SNU Cooperative Project was aimed at training professors at SNU, an institution that would produce human resources for the entire nation of Korea. In actual fact, it was targeting the entire higher education of Korea rather than just the reformation of SNU. However, there was considerable opposition. Many argued that the funds should have been distributed among the six national universities throughout the country instead of being concentrated in just one, and others believed that the funds should have been invested in private institutions rather than public universities.##3D_LAYER_END## on one leading university, SNU. ##MORE_LAYER_BOX##It justified this decision by asserting that if one leading university could be resurrected, it would have a ripple effect on the others. Given that SNU enjoyed the highest status in the hierarchical culture of Korean academic society, it seemed the best choice for concentration.##MORE_LAYER_BOX_END##
Three Components of the Minnesota Project
The Minnesota Project consisted of three components: an overseas fellowship program, an advisory service, and facilities reconstruction and equipment supply.
Overseas Fellowship Program
A total of 226 academics from SNU and ##3D_LAYER##77 from SNUMC##3D_TEXT:Among the 77, there were 62 from the College of Medicine, 9 from nursing, 4 from the Graduate School of Public Health, and 2 from hospital administration.##3D_LAYER_END## 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. ##3D_LAYER##A short-term fellowship program##3D_TEXT:The short-term program was designed to create a supportive institutional environment for innovation at SNUMC by changing the mindset of leaders. When the project committee on the Korean side recommended that senior professors be given opportunities for long-term fellowship, the UM committee rejected the request, and recommending a short-term program instead.##3D_LAYER_END## was granted to higher level individuals, for example 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.
##MORE_LAYER_BOX##The language barrier was perhaps the most challenging aspect for the fellows. As well, most could not treat patients because they did not possess US medical licenses. However, they attended classes, observed and assisted clinical practices, and participated in laboratory procedures, and garnered new insights into advanced medicine. The University of Minnesota invited the highest authorities in each field to mentor the fellows.##MORE_LAYER_BOX_END##
During the project period, 59 advisors were dispatched to Korea. For the College of Medicine, ##3D_LAYER##11 came to Korea##3D_TEXT:Seven advisors came for medicine, three for nursing, and one for hospital administration.##3D_LAYER_END## 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 ##3D_LAYER##"wanted to teach the Korean professors how to fish, instead of giving them a fish."##3D_TEXT:Personal recollection of Dr. Kwon E. Hyeok (The former president of Seoul National University, the dean of the Minnesota School of Public Health)##3D_LAYER_END##
Specifically, ##3D_LAYER##the advisors##3D_TEXT:There were three levels of advisors: the chief advisor was in charge of management and monitoring of the entire project; three advisors were in charge of each college; and specialty advisors worked to upgrade each specialty area such as pediatrics, nursing, etc. For example, Professor Shimert G., a specialty advisor, demonstrated surgery on congenital mitral stenosis in October 1958.##3D_LAYER_END## 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.
##MORE_LAYER_BOX##The advisors helped to introduce clinical clerkships, internships, and residency programs into the Korean system, and assisted in the establishment of the Department of Nursing and the Graduate School of Public Health. 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.##MORE_LAYER_BOX_END##
Facilities and Equipment Supply
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 ##3D_LAYER##equipment and facilities.##3D_TEXT:Through the Minnesota Project 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.##3D_LAYER_END## 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.
Results of the Minnesota Project
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. ##3D_LAYER##This critical mass##3D_TEXT:The number or ratio of professors needed to cause a particular change in one institution.##3D_LAYER_END## 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 ##3D_LAYER##American model.##3D_TEXT: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.##3D_LAYER_END##
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. ##3D_LAYER##Several prominent leaps in clinical practice##3D_TEXT:The first cardiac surgery done by Korean doctors was ventricular septal defect surgery in August 1959.##3D_LAYER_END## in clinical practice were made due to the project, and many academic societies established by its influence.
But there were some negative outcomes as well. The project planted the seed of ##3D_LAYER##brain drain,##3D_TEXT: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.##3D_LAYER_END## which could be seen from the mid-1960s , increased Korean dependency on American medicine, and strengthened the market-oriented healthcare system.