Clinical Exchange in Japan

Report on an elective in Pediatric Cardiology/Cardiosurgery in Nagoya Japan

Maykel Michiels, i269573

Both pediatric cardiology and pediatric cardiosurgery are two subjects hardly touched by the Maastricht program up to the fourth year. During the second year, in our 10 weeks studying gynaecology and obstetrics we have been introduced to congenital anomalies, including cardiac anomalies among others. It was at the time of our anatomy class, studying neonatal cardiac anatamy that I became interested in pediatric cardiology. Save for that short period, the only preparation I have had were my internship surgery (teaching my how to 'scrub'/prep for surgery) and medical subjects in general: cardiac physiology in Block 1.3 and the internship Internal medicine, and pediatric (cardiac) physiology in 2.2. Though most of my physiology skills were a bit 'rusty', I feel as though they were easy to pick back up. Even though I feel my knowledge was on par, I know I would have performed better if I had had my internship in pediatrics before my elective.

I spent my time in Nagoya in two different hospitals. My overall supervisors were Dr. Kasuya and his assistant Aki Naganawa.

My time in Nagoya has been a great experience for me. On one hand, Japan, along with its medical system, is completely different from the Netherlands and the Dutch system. Students spend their first two years studying basic subjects, touching their first stethoscope not until the fourth year. Japanese doctors work more hours than their Dutch colleagues, but are payed a lot less (especially in the University Hospital, where some cardiac surgeons are forced to work two, three jobs just to make ends meet). Also, in contrast to the Netherlands where a student has had a 'bad' internship if at the end the doctors don't know his/her name, in Japan silence is appreciated very much, and along with their hands-off training, Japanese students are always standing in the back, mostly just listening and writing down whatever they hear. They are generally disciplined, hard working students. Getting into medical school (especially the fabled Tokyo University) is a great privilege in Japan. Becoming a doctor in Japan means dedicating your life to your job, which seems like a confirmation of the typical stereotype of hard working Japanese.

Fundamentally, medicine remains the same wherever you go. Both hospitals I spent time in had a meeting to discuss new research at least once a week, and we've discussed articles by Dutch authors at least twice. The Japanese, while proud of their system, look (up) to the European and American systems and learn what they can. The Japanese system has implemented a lot of principles from the German system in the past, and sometimes when I had a discussion with a doctor and he didn't know the English word he was looking for, his 'Japanese term' usually did get across because it was a derivative of the German language. What I'm trying to say is, studying in Japan didn't feel so alien from studying at home. There are more similarities than I had expected at first. Not to mention I could use both the Nagoya University and the UB Unimaas database to access PubMed or UpToDate.

I was surprised to see how many Dutch doctors the Japanese doctors could name, what places they had visited and especially how famous Maastricht is. I had expected the Japanese to not know Maastricht. But while they all knew Leiden, and Sometimes Erasmus, Maastricht was always high on the list. Nagoya University had recently adopted the PBL system which really surprised me, but not as much as the surprise I got when I ran into a cardiologist whom I had already met in Maastricht at the internatonal PBL-days for which I volunteered two years ago. So, while Maastricht is looked down upon in our own country, it's in high regard in foreign countries.

Well, next to my time spent in the hospitals, getting to know the Japanese way of life was one of my 'personal' learning goals. I lived with a Japanese roommate, and with him as my connection to the Japanese world I really got to know the Japanese life. I was very happy to have a roommate. I think that if I had to live alone, I would've been bored quite often: communication with the average Japanese person is quite difficult making the country and city not as inviting as you'd hope, especially since Japanese are by nature quite inhibited and held back, though I have to say this is also one of the more exaggerated stereotypes. Having a roommate speaking both languages really helped here.

One final thing I wanted to talk about is the language-barrier. To cut to the point, communication is doable. I had been warned to study the Japanese language because English is a no-go, but that's simply not true. Even though I had studied a couple of words Japanese, my skills in Japanese were basically 0. All the doctors speak English, my roommate speaks English. Patients rarely spoke English and only a few nurses spoke English. So communication with the doctors was my main route for information gathering during my days. Admittedly, not as fluent as speaking English with my friends back at home, with some patience I could get any answer I wanted. They biggest problems were meetings, morning and evening meetings. Luckily, one of the doctors would usually translate the patient information for me. If you want to go to Japan, knowing the language is a definite advantage, but don't let it stop you if you don't.