[The Era of Medical Student Cartel]③ Groupthink in a Culture of Hierarchy, Control, and Obedience

Taking the Same Classes for Six Years and Sharing 'Jokbo' Study Guides
Peer and Senior Evaluations Are Crucial When Applying for Internships and Residency

Editor's NoteSince last February, when residents left hospitals in protest against the government's policy to increase medical school admissions, they have not returned for two years. Medical students who followed their seniors in boycotting classes and collectively taking leaves of absence have largely accepted the formality of returning to classes in response to warnings from the government and universities about failing grades or expulsion, but the possibility remains that they will continue their struggle through re-leaves and class boycotts. Even if the medical school environment appears to be barely normalizing, the collective nature of the medical students and the impact of their solidarity are unlikely to fade easily. Asia Economy analyzes, over six installments, how and why they can unite so tightly like a 'cartel.'

"Those who return to classes will not be considered colleagues and will not be able to participate in any academic activities related to studies with them in the future."

On the 13th of last month, when six second- and third-year students at Konkuk University College of Medicine attempted to return to classes without submitting leave of absence forms, their classmates issued a statement publicly criticizing them. The school immediately warned, "Serious unfair acts infringing on individual students' right to learn will be strictly investigated and disciplined according to school regulations," but among medical students, there was also dissatisfaction that "the government has divided students to the point of provoking such extreme attacks."

Until the end of March, when the government and universities urged medical students to return to classes by mentioning the possibility of failing grades or expulsion, most medical students refused to register for the new semester, maintaining a 'unified front.' Even professors joined in persuading students and conducting individual interviews, creating a stronger atmosphere than ever before. Although some students began to express a desire to attend classes, they only watched each other cautiously.

A medical student A from a Seoul-based medical school said, "My family worries and urges me to register quickly, but attending school while being branded a traitor is scarier than being expelled. I absolutely have no intention of returning alone," cutting off any doubt.

At least 10 years of shared hardship from the moment of medical school admission

Many medical students have expressed their intention to pay tuition and return to school to avoid a large-scale expulsion, but the possibility remains that they will not fully participate in classes. Medical industry insiders agree that the reason the collective leave of absence led by medical students has continued with strong solidarity for two consecutive years is due to "the apprenticeship-style teaching method within the medical school environment, and the hierarchy, control, and obedience culture formed within it."

Unlike general departments, medical schools have an entire grade complete the same curriculum over six years. Group projects and practical training are often done repeatedly with the same classmates. After admission, students go through two years of pre-medical courses and four years of medical courses, followed by one year as an intern and three to four years as a resident at training hospitals, living and working closely together for at least 10 years.

The 'jokbo' (study guides), which play a key role in individual subject exams and the national medical licensing exam, are managed at the student club or student council level within medical schools. These jokbo, which organize lecture PPTs and past exam questions learned in class, are essential for medical students who have insufficient physical time compared to the vast amount of study required. If a student does not receive this jokbo, passed down from seniors and shared among peers starting from the first year of medical courses when they seriously engage with medical studies, even the smartest students find it difficult to gain the insight needed to prioritize their studies.

The senior-junior relationship in medical schools is essentially that of professor and student. It is no exaggeration to say that the entire medical education process is apprenticeship-style. For example, in anatomy practice, professors directly demonstrate dissections on cadavers, and students follow their lead. Most professors are alumni seniors. Even during hospital training, students learn by shadowing professors and senior residents. Although less so than before, seniors rigorously train and discipline juniors. This is because the nature of the profession, dealing with human lives, cannot tolerate even the slightest mistake.

After graduation, relationships with seniors and peers continue in their careers. Most medical students continue their training as interns and residents at their alma mater university hospitals. To train in the desired specialty after graduation, peer reputation checks are important. The medical community consensus is that qualitative evaluations, such as "what kind of person they are to work with," weigh heavily alongside quantitative assessments like exam scores. The situation is no different even if they go to training hospitals other than their alma mater. One medical school professor hinted, "When applicants from other universities apply for training, because they are less known, reputation checks are conducted more meticulously through acquaintances such as residents from the respective university."

This educational process gradually makes medical students more closed off and collective. Living for over 10 years without becoming an 'outcast' among peers and without being 'targeted' by seniors or professors, the culture of control and obedience by grade and cohort is passed down through generations.

Fourth time since the 2000s: "The government cannot defeat doctors"

This collective leave of absence by medical students is also analyzed as a learned effect from past collective actions by doctors. Starting with the 2000 protest against the separation of drug prescribing and dispensing, followed by collective actions against telemedicine in 2014 and opposition to public medical schools in 2020, the medical community?including medical students, interns, and residents?has simultaneously engaged in struggles and secured some concessions from the government. This time, too, there was confidence that if key personnel such as residents and medical students held out until the end, the government would eventually 'wave the white flag.'

However, even as the medical crisis worsened, excessive remarks spread mainly through online communities of medical students and residents, and harsh criticism and ridicule were rampant against peers who left the group, causing public opinion toward this medical group to turn cold.

Professor Gu Jeong-woo of the Department of Sociology at Sungkyunkwan University said, "Collective action is fundamentally a basic right and legitimate act that any organization can exercise in a democratic society, but the current collective action of medical students is problematic because it is not a situation where members voluntarily agree, but rather where internal discipline and hierarchical logic prevent free speech." He interpreted, "The public, having witnessed acts that suppress individual choice and dignity and violate human rights within the elite medical student group in Korea, can no longer tolerate special treatment for medical students."