The One-and-a-Half Syndrome of Korean Clinical Training: 1.5 Years of Fracturing.

Years of Fracturing"All resident physicians and healthcare workers who are striking or have left the medical fields must return to work within 48 hours, and any disobedience will be subject to punishment according to martial law."This chilling sentence was one of the five articles in the martial-law proclamation issued on December 3, 2024 by former President Yoon. 1 The subsequent events were widely reported in international news sources: the National Assembly's termination of martial law, the president's impeachment, the opening of sedition trials for the president and his aides, and finally the election of a new president.However, the explicit mention of "residents" in the five articles of that proclamation remains puzzling, and has not been fully explained.This is not merely a political or legal question, since it reveals a deeper public misunderstanding of the structure of Korea's faculty-resident training system.This unprecedented situation began in mid-February 2024, when Yoon abruptly announced the expansion of the national medical-school quota by 2,000 students. 2This drastic unilateral proposal would instantly increase the existing quota by about 65%, far exceeding what medical experts had anticipated. 2The medical community immediately raised concerns about the lack of scientific basis, potential deterioration of education quality, and further imbalance in the regional distribution of healthcare. 2,3he administration's uncompromising push for changes in Korean clinical training triggered mass resignations among both young resident physicians and medical students, who left their posts or took leaves of absence, and to everyone's surprise this situation lasted for 1.5 years.During this period, Korea's healthcare system-often regarded as one of the best in the world-entered a severe crisis: emergency care deteriorated, surgeries were delayed, and hospitals focused solely on the provision of essential services. 2This was an inevitable consequence of losing 12,000 residents-92% of the resident workforce, accounting for about 40% of training-hospital manpower-almost overnight. 2,4he operation of Korean training hospitals has long been based on two major pillars: faculty (physicians who serve both as hospital specialists and as medical-school professors), and their trainees, the residents. 5Faculty members divide their time between providing clinical services and education/research, while the role of residents has been split between providing clinical labor and being trainees.From February 2024 to August 2025, hospitals responsible for emergency and critical care experienced what may be called a "one-and-a-half syndrome" ("1+ defect").The collective departure of residents eliminated their two essential halves-clinical duty ( defect) and training ( defect)-to create a full "1 defect." At the same time, the absence of trainees deprived faculty of their educator/researcher role ( defect), leaving them functioning almost exclusively as physicians.Professors were forced to fill this clinical void for 1.5 years, with this structural breakdown constituting a "1+ defect." As expected, faculty experienced overwhelming clinical workload, burnout, and a steep decline in academic productivity.