A Focus on University Counseling Centers and Counselors

학위논문(박사)--서울대학교 대학원 :사범대학 교육학과(교육상담전공),2019. 8. 김동일.한국 사회를 이루고 있는 인구는 최근 몇 년 동안 급속하게 다양화되고 있으며, 그에 따라 다양한 문화적 배경을 가진 사람들이 삶의 여러 문제를 가지고 심리 상담 서비스를 점점 더 많이 찾고 있다. 따라서 문화적 요인이 상담 및 치료 환경에 어떻게 영향을 미치는지에 대한 이해가 더욱 요구되고 있다. 한국의 주요 다문화 내담자 집단에는 국제결혼 이주 여성, 탈북자, 외국인 노동자 외에도 외국인 유학생들이 포함된다. 2018년 교육부 통계에 따르면 국내 대학에 등록한 외국인 유학생은 86,036명이며 56,169명의 비학위 프로그램 등록 학생들을 추가하면 총 142,205명의 외국인 유학생이 국내 대학 캠퍼스를 누비고 있다. 한국 정부와 대학들이 더 많은 외국인 유학생을 모집하기 위해 적극적으로 나서고 있기 때문에 최근 몇 년 동안 나타나고 있는 외국인 유학생 수의 증가 추세는 계속될 것으로 보인다. 이러한 맥락에서 대학 내 상담센터들은 외국인 유학생들에게도 상담서비스를 제공해야 한다는 부담을 안게 되었다. 외국인 유학생들은 내국인 학생들과 비슷한 발달과제를 안고 있으면서 그 외에도 언어 장벽, 생소한 학업 시스템, 문화적 차이, 인종 차별 등의 고유한 문제들에 직면하게 된다. 심리상담은 익숙한 사회적 지원망이 결여된 채 타지에서 고군분투하는 외국인 유학생들을 위해 꼭 필요한 지원이 될 수 있지만, 사실상 이들을 위한 적절한 상담 서비스를 제공하는 것은 쉽지 않다. 외국인 유학생 상담을 위한 예산과 제도적 지원이 부족할 뿐만 아니라 외국인 유학생에 특화된 다문화 상담 전문성을 갖춘 상담자들이 많지 않기 때문이다. 외국인 유학생과 같은 다문화 내담자들의 관심사를 효과적으로 다루기 위해서는 상담 전문가들과 센터들은 다문화 상담 역량을 적용할 필요가 있으나, 지금까지 상담학 분야에서 이루어진 다문화 상담 역량 연구는 대부분 오랜 다문화 인구 역사를 지닌 국가 맥락에서 진행되었기 때문에 한국 맥락에 바로 적용하는 데에 무리가 있다. 더구나 외국인 유학생이라는 독특한 다문화 집단에 초점을 둔 다문화 상담 역량 연구는 전세계적으로 부재한 상황이다. 따라서 본 연구의 목적은 외국인 유학생 상담을 하는 국내 대학 상담센터와 상담자의 다문화 상담 역량을 개념도 방법론을 사용하여 탐색적으로 확인하는데 있다. 이를 위해 현재 국내 대학 상담센터에서 외국인 유학생에게 상담을 제공하고 있는 상담자들을 인터뷰하여 이들이 인식하는 외국인 유학생 상담에 요구되는 센터와 상담자 수준의 다문화 상담 역량 요소들을 추출하였다. 먼저 상담자 11명으로 인터뷰를 실시하여 관련 아이디어들을 획득하였고, 그 아이디어들은 외국인 학생 상담을 위한 다문화 역량의 구체적인 행동 지표 진술문으로 제작되었다. 그 결과, 총 48개의 센터 역량 진술문과 78개의 상담자 역량 진술문이 도출되었다. 다음으로, 센터와 상담자 역량 진술문에 대하여 13명의 상담자들이 카드소팅을 통해 유사성 분류 작업을 수행하였으며, 19명의 상담자들이 각 진술문에 대해 중요도와 현재 실행도를 5점 리커트 척도에서 평정하였다. 이러한 과정을 통해 수집된 자료를 바탕으로 다차원척도분석과 군집분석을 실시한 결과, 외국인 유학생 상담을 위한 대학 상담 센터의 다문화 상담 역량은 2개의 차원과 5개의 군집으로 이루어지는 것으로 나타났다. 가로축인 1차원은 대학 상담센터의 지원 대상 차원으로, 세로축인 2차원은 대학 상담센터 자원의 원천으로 해석되었다. 5개의 군집은 군집 1 지속적인 서비스를 위한 협력 및 옹호 역량, 군집 2 상담자 지원 역량, 군집 3 외국인학생 친화적인 환경 구축 역량, 군집 4 외국인학생을 위한 적극적인 홍보 역량, 그리고 군집 5 상담 서비스의 다양화 역량으로 명명되었다. 또, 외국인 유학생 상담을 위한 상담자의 다문화 상담 역량은 2개의 차원과 6개의 군집으로 이루어지는 것으로 나타났다. 가로축인 1차원은 상담자 자원의 원천 차원으로, 세로축인 2차원은 상담자 노력의 방향으로 해석되었다. 6개의 군집은 군집 1 외국인 학생 상담을 위한 인식, 태도, 능력, 군집 2 외국인 학생 이해를 위한 지식, 군집 3 문화적으로 민감한 상담 전략, 군집 4 지지적인 환경 구축을 위한 절차적 전략, 군집 5 확장된 상담자 역할, 그리고 군집 6 자기관리 및 전문성 개발로 명명되었다. 본 연구는 외국인 학생 상담에 요구되는 다문화 상담 역량이 무엇인지에 대해 상담자와 기관 차원에서 살펴보고, 그 결과 행동으로 실천할 수 있는 다문화 상담 역량 지표들을 도출해내고 그 구조를 파악하였다는데 의의가 있다.This study used an idiographic research design using the concept mapping methodology to explore a very specific, unstudied topic. Specifically, this study helped raise the understanding of how counselors think about the construct of multicultural counseling competence required for international student counseling. Considering the importance of engaging the counseling center in vitalizing international student counseling, the study examined the institutional-level competence of university centers in addition to the individual-level competence of counselors. Ideas obtained from brainstorming interviews of 11 counselors were turned into specific behavioral indicator statements of multicultural competence for international student counseling (48 for university centers, 78 for counselors). Subsequently, 13 counselors categorized these statements on the basis of relatedness and their cluster solutions summed up to create the group similarity matrices for the center competence and counselor competence. Through multivariate concept-mapping statistical analyses, the center competence indicators were organized into five clusters along two dimensions, and the counselor competence indicators were structured into six clusters along two dimensions. Each competence indicator statement was rated for importance and degree of execution. Specifically, the concept map for multicultural counseling competence of university counseling centers working with international students shows 48 competence indicator statements grouped into five clusters laid out on a 2-dimensional map. Dimension 1 (X-axis) describes the target of institutional support provided by the university counselor center. Specifically, statements that involved client support were placed in the right sector of the map, and statements that involved counselor support factor were placed in the left sector of the map. Dimension 2 (Y-axis) describes the capacity of the center. Specifically, the upper half of the map is comprised of items dealing with internal capacity (utilizing in-house resources to enhance international student counseling), while the bottom half includes statements dealing with external capacity (utilizing outside resources to enhance international student counseling). The five categories of center competence for international student counseling were: (1) Engaging in active partnership/advocacy for sustainability, (2) Providing counselor support, (3) Creating International Student-Friendly Place, (4) Reaching out to international students, and (5) Diversifying counseling services. As for the concept map for multicultural counseling competence of counselors working with international students, 78 competence indicator statements were grouped into six clusters laid out on a 2-dimensional map. The two dimensions that characterized this map were the source of counselor capacity (Dimension 1) and the direction of counselor efforts (Dimension 2). The six categories of counselor competence for international student counseling were: (1) Sustaining awareness, attitude, abilities for international student counseling, (2) Acquiring knowledge to understand international students, (3) Utilizing culturally responsive counseling strategies, (4) Employing procedural strategies to create an open and supportive environment, (5) Engaging in extended roles, and (6) Practicing self-care and professional development. This study represents the first formal research attempt to systematically examine the multicultural competence of university counseling centers and counselors working with international students. The number of international students on Korean university campuses will continue to increase and their need for counseling services present real challenges. Accessible and appropriate counseling services provided by competent university counseling centers and counselors will play a pivotal role in helping international students as they deal with diverse issues related to adapting to a new cultural and academic environment. To date, university counseling centers and counselors in Korea and elsewhere in the world are not equipped with practical guidelines, trainings, or resources to work with this special population. This study will serve as a foundational starting point in the efforts to increase greater proficiency and to improve counseling outcomes for international students. The scope of this study was to look at the multicultural competence of both the university counseling centers and counselors; it is hoped that the university counseling centers and counselors move forward together in advancing the much-needed international student counseling services.Chapter 1. Introduction 1 1.1 Study Background 1 1.2 Purpose of Research 8 1.3 Research Questions 10 Chapter 2. Literature Review 11 2.1 International Students in Korean Universities 11 2.2 Counseling Needs of International Students 14 2.3 Counseling Services for International Students at University Counseling Centers in Korea 17 2.4 Multicultural Counseling and Multicultural Counseling Competence 18 2.5 Multicultural Counseling Competence for Counseling International Students 26 Chapter 3. Methods 32 3.1 Concept Mapping 32 3.2 Participants 33 3.3 Procedures 34 Chapter 4. Results 41 4.1 Multicultural counseling competence of university counseling centers working with international students 41 4.2 Multicultural counseling competence of counselors working with international students 58 Chapter 5. Discussion 80 5.1 Multicultural counseling competence of university counseling centers working with international students 81 5.2 Multicultural counseling competence of counselors working with international students 87 5.3 Significance and utilization of results 96 5.4 Limitations 98 5.5 Further discussion points and ideas for future studies 99 References 101 Appendix 113 Abstract in Korean 124Docto

Right Ventricular Acupuncture Needle Embolism Detected on Coronary Computed Tomography Angiography

ope

Braid-like appearance of the coronary artery in Kawasaki disease: typical computed tomography and angiography findings

ope

Aortic Unfolding Determined Using Non-Contrast Cardiac Computed Tomography: Correlations with Age and Coronary Artery Calcium Score

OBJECTIVE: Aortic unfolding occurs with aging and reflects proximal aortic dilation, aortic arch widening, and decreased curvature. This study 1) evaluated the relationship between aortic unfolding measured using non-contrast cardiac-gated computed tomography (CT) and age, 2) assessed factors influencing aortic unfolding, and 3) determined the association of this measurement with coronary artery calcium (CAC) score. METHODS: We reviewed the charts of 219 subjects (142 men, 77 women; mean age 54.2±9.3 years) who underwent coronary artery calcium scanning during routine health screening from December 2010 to May 2011. Multivariate regression analysis according to cardiovascular risk factors was performed. We also analyzed the relationship between aortic unfolding measurements and CAC score using stepwise multiple linear regression. RESULTS: Mean aortic unfolding was 103.7±13.9 mm (men, 106.5±13.5 mm; women, 98.4±12.9 mm). Age, body surface area, and hypertension were exclusively associated with aortic unfolding. The association between aortic unfolding and CAC score was significant after adjustment for age and gender (β = 1.89, p = 0.017) and for Framingham risk score (β = 2.83, p<0.001). CONCLUSIONS: Aortic unfolding defined by measuring aortic width was a reproducible and practical method with non-contrast cardiac CT and associated with age, body surface area, and hypertension. CAC score, a well-established surrogate marker of cardiovascular disease, is positively associated with aortic unfolding. Further study to evaluate aortic unfolding as a potential predictor of cardiovascular risk is warranted.ope

Anomalous origin of the right coronary artery from the left coronary sinus with an interarterial course: subtypes and clinical importance

PURPOSE: To classify anomalous origins of the right coronary artery (RCA) from the left coronary sinus (AORL) with an interarterial course into two subtypes and to evaluate the clinical importance of each. MATERIALS AND METHODS: Institutional review board approval was obtained for this retrospective study, and informed consent was waived. Through a retrospective review of 22,925 consecutive cardiac computed tomographic (CT) scans, 124 cases of AORL with an interarterial course were identified. These anomalies were classified into two subtypes according to the location of the anomalous RCA ostium: high interarterial course (between the aorta and the pulmonary artery) and low interarterial course (between the aorta and the right ventricular outflow tract). The clinical records were evaluated, and differences in prevalence of typical angina and major adverse cardiac events (MACEs) between the subtypes were analyzed through the χ(2) contingency tables or Fisher exact test. RESULTS: After excluding patients with combined cardiac disease, 87 patients (51 [59%] men, 36 [41%] women; mean age, 56.0 years) were enrolled. Of the 87 patients, 53 had a high interarterial course and 34 had a low interarterial course. A significant difference in the prevalence of typical angina (high [43%] vs low [6%], P = .001) and MACE (high [28%] vs low [6%], P = .012) was observed between the two subtypes. For patients with a high interarterial course, the odds ratio for typical angina was 12.3 (95% confidence interval: 2.7, 56.6), and the odds ratio for MACE was 6.3 (95% confidence interval: 1.3, 29.7). CONCLUSION: The prevalence of typical angina and that of MACE were significantly higher in patients with a high interarterial course than in those with a low interarterial course.ope

Cardioembolic stroke: dual-energy cardiac CT for differentiation of left atrial appendage thrombus and circulatory stasis

PURPOSE: To assess the diagnostic performance of dual-energy cardiac computed tomography (CT) in the detection of left atrial appendage (LAA) thrombi and differentiation between thrombus and circulatory stasis in patients with stroke, by using transesophageal echocardiography (TEE) as the reference standard. MATERIALS AND METHODS: The institutional review board approved this study, and patients provided informed consent. Thirty-two patients with stroke who had atrial fibrillation (AF) and either thrombus or the spontaneous echo contrast (SEC) echo pattern at TEE were prospectively enrolled. For the control group, 31 patients who were planning to undergo AF ablation and who had no abnormalities at TEE were enrolled. All patients underwent dual-energy cardiac CT that was not electrocardiographically gated. For quantitative analysis, iodine concentration was measured on CT images. The statistical significance of differences in mean iodine concentration between thrombus and SEC as measured at CT was assessed by using the Student t test. RESULTS: Among the 63 patients, a total of 13 thrombi and 19 instances of SEC were detected at TEE. Using TEE as the reference standard, the overall sensitivity, specificity, positive predictive value, and negative predictive value of dual-energy cardiac CT in the detection of thrombi and SEC in the LAA were 97% (95% confidence interval [CI]: 82%, 100%), 100% (95% CI: 86%, 100%), 100%, and 97%, respectively. At CT, the mean iodine concentration was 1.23 mg/mL ± 0.34 (standard deviation) for thrombus and 3.61 mg/mL ± 1.01 for SEC (P = .001). CONCLUSION: Dual-energy cardiac CT is a highly sensitive modality for detecting LAA thrombus and for differentiating thrombus from SEC in patients with stroke.ope

Analysis of tumor markers in cytological fluid obtained from computed tomography–guided needle aspiration biopsies for the diagnosis of ground-glass opacity pulmonary lesions

BACKGROUND: The purpose of this study was to assess whether analyses of tumor markers in cytological fluid can improve the performance of computed tomography (CT)-guided needle aspiration biopsy (NAB) for the diagnosis of ground-glass opacity (GGO) pulmonary lesions. METHODS: Forty-two patients were prospectively enrolled for CT-guided NAB. Levels of cytokeratin 19 fragments (CYFRA 21-1) and carcinoembryonic antigen (CEA) from serum and cytological fluid were measured. The cutoff values of 3.3 ng/mL for CYFRA 21-1 and 5.0 ng/mL for CEA (threshold A) or thresholds by adding 2 standard deviations to the mean levels of markers found in patients without malignancy (threshold B) were used to identify malignancy. The sensitivity and area under the curve (AUC) of NAB alone were compared with those of NAB combined with serum or cytological tumor markers. RESULTS: Among the 42 patients, 30 (71.4%) had malignant and 12 (28.6%) had benign lesions. For NAB alone, the sensitivity, specificity, and AUC for diagnosing GGO were 70.0%, 100%, and 0.850, respectively. The sensitivity and AUC increased significantly for NAB with cytological CYFRA 21-1 compared with NAB alone, using both thresholds (threshold A: 86.7%, P=.026 and .933, P=.016; threshold B: 93.3%, P=.008 and .925, P=.046). CONCLUSIONS: Cytological fluid measurements of CYFRA 21-1 can improve the diagnostic performance of CT-guided NAB for GGO pulmonary lesions.ope

Cardiac computed tomographic angiography for detection of cardiac sources of embolism in stroke patients

BACKGROUND AND PURPOSE: We assessed the diagnostic performance of 2-phase 64-slice cardiac computed tomographic angiography (CCTA) for the detection of a cardiac source of embolism in stroke patients using transesophageal echocardiography (TEE) as the reference standard. METHODS: We selected 137 patients who had experienced a recent episode of stroke and had undergone both 2-phase 64-slice CCTA and TEE within a period of 5 days. A potential cardiac source of embolism detected at both CCTA and TEE was recorded, and echocardiographic findings were categorized into high- and medium-risk sources based on the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification. RESULTS: Of 137 patients, 100 abnormal findings in 91 patients were found on TEE, and 46 patients had no abnormal finding on TEE. The overall sensitivity, specificity, positive predictive value, and negative predictive value of the 64-slice CCTA for detecting cardiac sources of embolism were 89% (95% CI, 82%, 95%), 100% (95% CI, 90%, 100%), 100% (95% CI, 95%, 100%), and 81% (95% CI, 70%, 92%), respectively. TEE detected a total of 47 high-risk sources of embolism, whereas CT detected 44 lesions. For medium-risk sources of cardiac embolic stroke, TEE detected a total of 53 abnormal findings, whereas CT detected 44 abnormal findings. Of 53 lesions, there were 8 false-negative results on CT (5 patent foramen ovale and 3 atrial septal aneurysm). CONCLUSIONS: Two-phase 64-slice CCTA is a noninvasive and useful modality for detecting high-risk cardiac sources of embolism in stroke patients.ope

Additional diagnostic value of tumor markers in cytological fluid for diagnosis of non-small-cell lung cancer

BACKGROUND: Cytological fluid from a needle aspiration biopsy (NAB) is obtained directly from tumor tissue, therefore many biomarker candidates will be present in high concentrations. The aim of this study was to prospectively assess and validate the tumor markers CYFRA 21-1, CEA, and SCC in cytological fluid obtained from NAB samples to determine if they improved the performance of NAB for diagnosing non-small cell lung cancer (NSCLC). METHODS: A total of 194 patients (M:F = 128:66, mean age 63.7 years) with suspected malignant pulmonary lesions were prospectively enrolled and underwent percutaneous NAB. Levels of CYFRA 21-1, CEA, and SCC were measured by immunoassay in serum and cytological fluid obtained during aspiration biopsy. Cut-off values to determined malignancy were 3.3 ng/mL in serum and 15.7 ng/mL in cytological fluid for CYFRA 21-1, 5 ng/mL and 0.6 ng/mL for CEA, and 2 ng/mL and 0.86 ng/mL for SCC. RESULTS: Of 194 patients, 139 patients (71.6%) had NSCLC and 55 (28.4%) had benign lesions. Sensitivity increased significantly for NAB combined with cytological tumor markers compared with NAB alone (CYFRA 21-1: 95% versus 83.5%, p < 0.001, CEA: 92.1% versus 83.5%, p = 0.002, SCC: 91.4% versus 83.5%, p = 0.003). Accuracy improved significantly for NAB combined with cytological CYFRA 21-1 compared with NAB alone (95.9% versus 88.1%, p < 0.001). The area under curve (AUC) of NAB with cytological CYFRA 21-1 was significantly larger than for NAB alone (0.966 versus 0.917, p = 0.009). CONCLUSION: Of the tested tumor markers, cytological fluid measurements of CYFRA 21-1 improved the diagnostic performance of NAB for NSCLC.ope

Dual-enhanced cardiac CT for detection of left atrial appendage thrombus in patients with stroke: a prospective comparison study with transesophageal echocardiography

BACKGROUND AND PURPOSE: A noninvasive method with high reliability and accuracy comparable to transesophageal echocardiography for identification of left atrial appendage thrombus would be of significant clinical value. The aim of this study was to assess the diagnostic performance of a dual-enhanced cardiac CT protocol for detection of left atrial appendage thrombi and for differentiation between thrombus and circulatory stasis in patients with stroke. METHODS: We studied 83 consecutive patients with stroke (56 men and 27 women; mean age, 62.6 years) who had high risk factors for thrombus formation and had undergone both dual-source CT and transesophageal echocardiography within a 3-day period. CT was performed with prospective electrocardiographic gating, and scanning began 180 seconds after the test bolus. RESULTS: Among the 83 patients, a total of 13 thrombi combined with spontaneous echo contrast and 14 spontaneous echo contrasts were detected by transesophageal echocardiography. All 13 thrombi combined with spontaneous echo contrast were correctly diagnosed on CT. Using transesophageal echocardiography as the reference standard, the overall sensitivity and specificity of CT for the detection of thrombi and circulatory stasis in the left atrial appendage were 96% (95% CI, 78% to 99%), and 100% (95% CI, 92% to 100%), respectively. On CT, the mean left atrial appendage/ascending aorta Hounsfield unit ratios were significantly different between thrombus and circulatory stasis (0.15 Hounsfield unit versus 0.27 Hounsfield unit, P=0.001). The mean effective radiation dose was 3.11 mSv. CONCLUSIONS: Dual-enhanced cardiac CT with prospective electrocardiographic gating is a noninvasive and sensitive modality for detecting left atrial appendage thrombus with an acceptable radiation dose.ope