Introduction

Background

Researchers have long sought higher-quality information regarding the state of medical institutions and public health in North Korea [1]. One important data source has been the accounts of refugees, some of whom practiced as physicians in North Korea. In one study, North Korean refugee physicians seeking licensure in South Korea were administered an examination resembling the Korean Medical Licensure Exam [2]. The results indicated that they were well prepared in surgery and obstetrics, but had little knowledge of psychiatry.

Other studies have analyzed domestic North Korean medical journals. North Korea publishes at least nine journals, eight of which are held by the US National Library of Medicine, although they are not available online [3]. These journals have been criticized for failing to meet international standards; articles often contain few international citations, minimal statistical analysis, and frequent praise of the Kim regime [4]. North Korean researchers also display a particular interest in traditional Korean medicine, with many articles investigating natural cures for various illnesses [3].

Researchers have examined these journals to better understand public health priorities and challenges in North Korea. For example, a review of articles on cardiovascular health revealed that interventional therapy was being used as a substitute for cardiovascular surgery, although the study participants were predominantly male [5]. Choi et al. [6] reviewed surgical publications and noted limitations such as the likely absence of computed tomography and magnetic resonance imaging and limited access to medical devices, particularly for laparoscopic surgery. Another study of mental health articles suggested that while psychotherapy and mental health care appear to be available in North Korea, discussions of suicidality and bipolar disorder are notably absent [7]. Furthermore, analyses have been conducted on the treatment of infectious diseases [8], with a particular focus on tuberculosis [9].

Three previous studies examined international general science publications and found that partnerships with Chinese institutions were common and that many research topics had military applications [10–12]. Another study, which focused on PubMed results through 2017, identified 16 publications, including two authored solely by North Korean researchers [13].

Medical education in North Korea is provided at various types of institutions. University-level medical colleges grant “senior” medical degrees, while medical junior colleges produce graduates who must undergo further training before practicing independently. Additionally, technical institutes exist, and one military institution is responsible for training physicians [14]. The extent of access that North Korean academics have to external research remains unclear, although accounts from defectors suggest that significant restrictions exist even for scientists [15]. Nevertheless, some academic exchange is evident, as over 1,000 North Korean students were reported to be studying abroad in 2012 [16]. Table 1 presents a list of North Korean medical education institutions, with their names in both Korean and English, categorized by type.

Objectives

Reliable information on healthcare delivery in North Korea remains scarce. As described above, bibliometric analysis of the medical literature provides insight into both healthcare delivery and educational institutions in North Korea. Specifically, the aims of the present study were as follows: (1) to assess whether previous bibliometric analyses have accurately captured North Korea’s contributions to internationally indexed medical journals; (2) to identify the areas of the medical literature in which North Korean authors publish and quantify the relative frequency of these contributions; and (3) to evaluate and compare the contributions of North Korea’s medical education institutions to the international literature, including their partnerships with non-North Korean entities.

Methods

Ethics statement

This study did not involve human subjects and was based solely on literature databases. Therefore, institutional review board approval and informed consent were not required.

Study design

This investigation is a bibliometric study based on a literature database.

Data collection

We conducted PubMed searches using the strategy outlined below. Articles were manually screened for relevance to human health; studies related solely to agricultural science or pure microbiology were excluded. Author affiliations were examined, and any articles in which at least one author was affiliated with a North Korean educational institution (Table 1) were flagged for further review. Articles were reviewed to determine the relevant medical specialty, research type, publication date, journal of publication, number of citations listed in PubMed, and any non-North Korean institutional affiliations among the authors. We also recorded whether the study involved primary data collected from North Korean patients. Journal Impact Factors (JIFs) were obtained from Clarivate.

Search strategy

The following search strategy was designed to capture articles authored by researchers affiliated with the institutions listed in Table 1: Kanggye[Affiliation]; Kim Il Sung[Affiliation]; Pyongyang Medical University[Affiliation]; Nampo[Affiliation]; Wonsan[Affiliation]; Pyongan[Affiliation]; Chongjin[Affiliation]; Hamhung[Affiliation]; Hwanghae[Affiliation]; Kang Gon [Affiliation]; Haeju[Affiliation]; Hyesan[Affiliation]; Kaesong [Affiliation]; Sinuiju[Affiliation]; Pyongyang[Affiliation]; Hyong Jik[Affiliation].

Statistical analysis

Descriptive statistics were computed.

Results

Our search yielded 331 records (Dataset 1), of which 79 met the inclusion criteria for this study. Of these, 11 publications were produced solely by North Korean researchers without international coauthors; these publications had an average JIF of 1.5 and received an average of 1.5 citations per publication. Seven studies reported data collected from North Korean patients.

Table 2 presents publications categorized by subject area, along with the average JIF and the number of cross-citations. Table 3 details the international partners involved in the research, while Table 4 organizes these partners by country. Table 5 lists publications by North Korean institutions, and Table 6 categorizes them by research method.

Discussion

Key results

Our findings on the distribution of research interests largely corroborate previous studies [2] indicating that North Korean medical institutions have a strong focus on surgery. Additionally, we observed a notably productive dermatology research partnership between a Kim Il Sung University (Pyongyang, North Korea) researcher and colleagues at Charité – Berlin University of Medicine in Berlin, Germany; all dermatology publications originated from this team.

Traditional Korean and Chinese medicine were also prominent areas of interest, consistent with previous reviews of North Korean domestic literature, as discussed further below. Infectious disease research was another leading area, with much of the activity focused on COVID-19.

Interpretation

Impact

Despite the strong focus on surgery, researchers faced challenges in publishing surgical studies in high-impact journals and in attracting citations. Notably, four of the seven articles involving North Korean patients were surgical studies. We suspect that the lower impact of these publications may be due to limited access to advanced surgical technology. In contrast, the dermatology research conducted in collaboration with Charité – Berlin University of Medicine in Germany, demonstrated high impact, with one study receiving 22 citations.

We suggest that the relatively high impact of research on Korean and Chinese traditional medicine—evidenced by moderately high JIFs and average citation counts—is an important finding. Previous authors have proposed that North Korean physicians’ interest in traditional medicine aligns with the regime’s emphasis on self-reliance and anti-colonialist nationalism. One analysis also suggests that this focus may reflect responses to resource limitations imposed by international sanctions and economic conditions [17]. Our research indicates that, in addition to these factors, North Korean researchers place significant importance on conducting traditional medicine studies that meet international research standards, and they may be emerging as leaders in this field.

International partnership

A majority of the research (86%) identified involved collaborations with international institutions. In many instances, North Korean researchers listed dual affiliations with their international partners. Our findings suggest that some North Korean medical researchers have access to foreign academic exchange. Nonetheless, the existence of unpartnered research indicates that certain researchers within North Korea possess the resources to produce and submit articles that meet the standards of moderately competitive international journals.

Research methods

Although studies involving North Korean patients were infrequent, the available studies demonstrate a willingness on the part of both researchers and domestic authorities to publish data from within the country. Three studies that included North Korean patient data resulted from a dentistry partnership with the University of Eastern Finland (Kuopio, Finland), involving an outreach program published in 2016 and 2017. The remaining studies were conducted solely by North Korean institutions. Among these, three were randomized prospective trials: one examined artery-only clamping during nephrectomy [18], another investigated acupuncture as a modifier of cerebral blood flow (which received 11 citations) [19], and the third focused on vascular surgery [20].

In each case, the articles included an ethics statement confirming that ethical approval had been obtained from the relevant institution. However, we note that the political conditions in North Korea make it difficult to assess the extent to which informed consent is actually obtained from study participants.

Limitations

A key limitation of our study design is that we examined only those articles in which the author affiliations matched the list of known North Korean medical colleges provided in Table 1. Our search did not retrieve records clearly associated with any other North Korean medical colleges, although we did note records linked to the university life science departments of institutions not included in our study. We chose to include records from Kim Il Sung University, given its historical affiliation with Pyongyang Medical University (Pyongyang, North Korea; discussed below) and its relatively high volume of medical research, but we did not analyze studies produced by other institutions.

Additionally, North Korean authors were inconsistent in transliterating place names in institutional affiliations and in the styling of English institution names (for example, “Pyongyang Medical College” and “Pyongyang University of Medicine” appeared to refer to the same institution). This inconsistency created some uncertainty in attribution.

Kim Il Sung University housed Pyongyang Medical University until 1948, and after a period of independence, reabsorbed the institution in 2010 [14]. The institution became independent again in 2019. Consequently, our study included both institutions and evaluated their contributions separately.

Conclusions

Our review largely confirms previous assessments of North Korean domestic research, highlighting that surgery and traditional Korean medicine are key areas of focus. Unlike earlier studies—which critiqued the low quality of domestic publications—our review demonstrates that North Korean researchers actively collaborate with international partners and are capable of producing work that meets international standards. While it is important to acknowledge the severe human rights abuses committed by the North Korean regime, our findings may contribute to a more nuanced understanding of North Korean realities for international observers.

Notes

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Funding

The authors received no financial support for this work.

Data Availability

Dataset file is available from the Harvard Dataverse at https://doi.org/10.7910/DVN/FPTYRH.

Dataset 1. Research data for evaluating North Korean academic medicine’s contributions to the international medical literature.

kcse-365-dataset-1.xlsx

Supplementary Materials

References

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Figure & Data

References

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