To become a doctor in South Korea, one must complete an educational curriculum at a medical school and pass the Korean National Licensing Examination for Physicians. The medical school education follows a competency-based curriculum that is grounded in the competencies society expects from doctors and is designed to equip graduates with the professional competencies necessary to treat patients from day one after graduation. Today’s society requires a higher level of competencies from doctors than in the past and places a strong emphasis on continuous competency development. This approach ensures that competencies are developed and expanded sequentially [1].

A doctor’s competencies refer to what the doctor is able to do, how the doctor approaches his/her practice, and the doctor’s role as a professional, and include knowledge, skills, and attitudes [2,3]. Competency-based education is typically structured in four steps: identifying the appropriate competencies, designing a training program, establishing suitable assessment methods, and setting minimum passing standards [4]. Because the competencies required of doctors can vary significantly depending on the clinical, cultural, and geographic context [5], determining core competencies is a critical step in planning competency-based education. In Canada, the CanMEDS (Canadian Medical Education Directions for Specialists) 2000 project outlined the general competencies needed by healthcare professionals [6], and in the United States, the Accreditation Council for Graduate Medical Education's six core competencies refer to a doctor’s role as a medical expert, communicator, collaborator, health advocate, manager, scholar, and professional [7]. In the United Kingdom, common competencies for medical students are detailed in Tomorrow’s Doctors, and for specialties in Good Medical Practice [8].

In Korea, research on competency development has been ongoing since 2007, initiated by a study on the common curriculum for medical specialties conducted by the Planning, Research, and Development Committee of the Korean Institute of Medical Education and Evaluation [1]. The virtues and competencies required of doctors in Korea were recently updated in “Korean Doctor’s Role 2022,” which delineated 54 roles and regulations across five domains: patient care, communication and cooperation, social accountability, professionalism, and education and research [9]. Patient care encompasses medical knowledge, medical care competency, and patient safety competency. Communication and collaboration involve interactions with patients and their families (guardians), as well as with health workers and the broader society. Social accountability covers public and international health activities, along with participation in healthcare policy. Professionalism is characterized by ethical practice and autonomy, patient-doctor relationships, self-regulation led by professionals, and competencies in professionalism and self-management. Education and research are defined by their respective competencies. The framework of the Korean Medical Competencies serves as a guideline for both basic medical education programs and postgraduate training. Therefore, it is essential that these guidelines continue to be updated to reflect the evolving context of Korean society and to align with future developments [10]. Analyzing research trends is one method of identifying issues related to medical competencies in Korea.

Research trend analysis is a method used to identify societal needs, and to date, it has primarily been conducted through systematic reviews [11-13]. However, systematic reviews involve categorizing and analyzing past studies based on the knowledge and insights of a limited number of experts. The diversity of concepts and contexts in the literature can make it challenging to set criteria without introducing subjectivity, which in turn narrows the scope of the analysis [14,15]. To address these limitations and derive more cohesive and structured outcomes, text network analysis on the basis of text mining has increasingly been employed.

Text network analysis offers the advantage of not being constrained by specific tools, allowing for the systematic organization and explanation of knowledge structures through the derivation of features in the form of a connection network [16]. It also facilitates an intuitive understanding of context by identifying influential keywords within a large corpus of text and examining the relationships between these keywords [17]. In addition, topic modeling yields comprehensive insights by uncovering latent topics within the text and analyzing the associations and distributions of each topic. This enables the identification of key topics and their interrelationships at a micro level, as well as the discernment of the evolution and context of key topics and the trends of topics over time at a macro level [18,19]. Analyzing research trends through text network analysis can aid in comprehending the progression of research over time, future issues, and the interconnectedness of concepts, which can help organize the context of the knowledge structure.

Therefore, this study aimed to extract keywords from research on doctors’ job competencies in Korea over the past decade using text network analysis and to analyze the interconnections among these keywords. Furthermore, we examine the primary topics addressed in the research on doctors’ job competencies in Korea and explore research trends by tracking how each topic has evolved over time. This analysis will assist in proposing future research topics and directions for the advancement of doctors’ job competencies in Korea.

Using text network analysis and topic modeling, we analyzed research trends related to doctors’ job competency in studies published in Korea from 2011 to 2020.

The most frequently occurring words in studies of doctors’ job competencies published in Korea from 2011 to 2021 were “family,” “revision,” “denial,” and “health.” These terms were prevalent across multiple studies. The word “family” appeared most often in discussions about disclosing medical errors to patients and their families, the doctor’s duty to provide explanations to patients and their families, obtaining consent, and the treatment of individuals without family ties. “Revision” was commonly associated with changes to healthcare legislation, while “denial” frequently arose in the context of doctors’ refusal to provide treatment and patients’ legal right to refuse treatment. The term “health” was used in various contexts, including community and patient health, the right to health, health-related issues, and the National Health Insurance Act. These findings indicate that legal considerations regarding the rights of patients and doctors in medical contexts are a dominant theme. The results align with those from the centrality analysis.

The terms that exhibited significant centrality in both connection and proximal centrality analyses included “life,” “nation,” “informed,” “restriction,” and “right.” Additionally, the words that served as key mediators in the relationships between other terms were “life,” “level,” “nation,” “informed,” and “ethics.” When examining the terms with high connection and proximity centrality, “life” was predominantly associated with discussions on the protection of patient life, legal regulations concerning life, and bioethical principles. The term “nation” was frequently used in the context of national health and welfare, philosophical considerations at the national level, laws, and policies, as well as to highlight the variances among different countries. The word “informed” was primarily used in reference to the obligation of physicians to provide clear explanations of their medical practices.

In other words, the keyword network analysis showed that discussions about national policies concerning the principle of respect for life and the legal obligations of physicians in medical contexts are prevalent. This finding aligns with the “Korean Doctor’s Role, 2022” which highlights the importance of patient safety competencies and social responsibilities, including effective communication and collaboration with society, engagement in public and international health initiatives, and involvement in healthcare policy [9]. This trend may be due to the focus of the Korean journals examined in this study, which predominantly address healthcare-related laws and policies, such as those found in ‘The Korean Society of Law and Medicine,’ ‘The Korean Journal of Medical Ethics,’ ‘The Korea Consumer Law,’ ‘The Asia Pacific Journal of Health Law & Ethics.’ Furthermore, the exploration of doctors' legal responsibilities is not unique to Korea. International studies, such as those on a national palliative care competency framework [23] and the ethical and legal considerations surrounding end-of-life care in intensive care units [24], also address these issues.

Second, topic modeling identified a total of five distinct topics. Topic 1’s primary keywords included “life,” “death,” “rights,” “human,” and “diagnosis.” This topic predominantly comprised studies that sought to delineate and educate individuals about the varying perceptions and concepts encountered in medical contexts. Topic 2 featured terms such as “remote,” “medical law,” “judgment,” “restriction,” and “license.” It focused on discussions regarding the criteria for limiting physicians’ liability, the restriction of medical care, and the competition arising from legal judgments within the realm of medical law, as well as the legitimacy of doctor-patient interactions via telemedicine under existing telemedicine regulations. Topic 3 encompassed keywords like “life-sustaining,” “informed,” “damages,” and “compensation.” It revolved around legal precedents and cases involving the withdrawal of life-sustaining treatment as stipulated by the Act on Decisions on Life-Sustaining Treatment for Patients enacted in February 2018, in addition to liability issues related to damages for failing to provide adequate explanations or for medical malpractice. Topic 4 addressed the professional self-regulation of physicians, as well as the variations in national policies and principles. Lastly, Topic 5 examined the outcomes of various educational programs for university students at medical schools and hospitals.

After identifying keywords and original articles, the topics were organized as follows: life and death in medical situations, medical practice under the Medical Act, medical malpractice and litigation, medical professionalism, and competency development education for medical students. It is apparent that topics 1, 2, and 3 primarily involve discussions about medical law, while topics 4 and 5 pertain to medical education. Concurrent with this study, there were 745 international studies indexed in PubMed that shared themes with Topic 1, focusing predominantly on the quality of life of patients with chronic diseases or cancer [25] and end-of-life care [26]. Regarding Topic 2, 194 articles were retrieved on topics such as medical liability and related topics [27], medical malpractice under criminal law [28], and doctor’s liability in artificial intelligence-enabled healthcare [29]. Themes similar to Topic 3 were found in 2,646 studies retrieved from PubMed in the last decade: medical malpractice [30,31], medical litigation [32], and medical malpractice [30,31]. There were 6,106 international studies similar to Topic 4, of which 1,343 involved medical students and 1,780 involved physicians. There were studies on the concept of medical professionalism [33] and the relationship between medical professionalism and doctor’s well-being [34]. Topic 5 focused on the outcomes of healthcare professional development education, and 36,729 related articles were retrieved. There were also studies on competency education methods for medical students [35] or education for specific competencies of residents or doctors [36,37]. Thus, the five major themes of doctor’s competencies identified in this study have been similarly studied abroad.

Third, we analyzed changes in research topics over time and found that the most frequently studied topic in Korea was Topic 5 (“competency development education for medical students”), followed by Topic 3 (“medical malpractice and litigation”) and Topic 1 (“life and death in medical situations”). However, there was no significant difference in the proportion of studies by topic over time. When comparing this study with international research, it is noteworthy that there were 36,729 studies related to medical personnel competency development education in PubMed during the same period, which represents a substantial volume of research compared to other topics. In the analysis of research trends by period, from 2011 to 2016, which corresponds to the first and second periods, Topic 5 (“competency development education for medical students”) was the most researched. This surge in interest likely occurred due to the shift to the medical graduate school system in 2009, prompting numerous studies related to identifying the characteristics of medical graduate students [38], curriculum development and evaluation [39], and school adaptation [40]. In addition, between 2017 and 2021 (i.e., in the third and fourth periods), Topic 3 (“medical malpractice and litigation”) was extensively studied. This increased focus can be attributed to the full implementation of the end-of-life decision-making system in Korea in February 2018, leading to a significant rise in discussions on this topic before and after its introduction. Of the 280 articles retrieved using the keyword “end-of-life decision-making,” 218 were published in 2017 or later, covering topics such as a review of the end-of-life decision-making system [41], comparisons with overseas end-of-life decision-making laws [42], and differences in perceptions of end-of-life decision-making [43].

According to the linear regression analysis, all the topics were considered “cool,” with regression coefficients displaying negative signs that were not statistically significant, as they exceeded a significance level of 0.05. Consequently, it can be inferred that research on doctors’ professional competence has been on the decline over the past decade, shifting focus toward specific competency development education, such as professional performance. Despite the lack of statistically significant differences in this study’s findings, the proportion of research on Topic 5 (“competency development education for medical students”) has seen a gradual decrease from period 1 to period 4. In contrast, research on Topic 4 (“medical professionalism”) has seen an increase. This trend suggests a growing emphasis on professionalism within the common competencies of doctors. This shift aligns with the crisis in traditional medical professionalism and the societal call for a new form of professionalism that moves away from exclusive elitism [44]. The concept of medical professionalism [45], the emphasis on its importance [46], and the growing number of discussions on professionalism education methods [47] can be considered a response to the needs of the times.

As shown above, studies related to physicians’ professional competencies have been conducted on various topics, with a particular focus on medical activities as defined by the Medical Act and the development of medical personnel’s competencies. This emphasis is largely in response to current issues such as the creation of medical specialty graduate schools and the implementation of the End-of-Life Decision Act. These developments indicate a shift in research topics concerning physicians’ competencies to better align with societal changes. Thus, there is a need for ongoing refinement of competencies, taking into account societal needs and contexts. Over the past decade, research has primarily concentrated on the foundational concepts of physicians’ competencies and educational methodologies. In the future, it will be necessary for research to evaluate the effectiveness of a systematic approach to developing and educating physicians on “entrustable professional activities” that incorporate these competencies.

The limitations of this study are as follows: The analysis of research trends was segmented into four periods, with first to thirds periods spanning 3 years each, whereas fourth periods encompasses only the 2 years of 2020 and 2021. This discrepancy complicates statistical comparisons with the other periods. Furthermore, although it was anticipated that a significant number of studies would address the educational shifts prompted by coronavirus disease 2019 (COVID-19), which instigated innovative changes in medical education, only published studies were included in the fourth periods. Consequently, this does not represent the full scope of research on physician competencies related to COVID-19. Future research should focus on analyzing the ongoing trends, particularly during this critical period of transformation in medical education.