Clinical Exchange in Japan

My name is Jaris Gerup, I’m a 26 year old medical student from University of Copenhagen, currently in my 4th grade (out of six) of medical school. During the spring semester 2016 I was lucky to do a 2 month clinical clerkship at Nagoya University Hospital. I visited the following departments: Department of Hematology, Department of Anesthesiology, Department of Endocrinology and Diabetes, Department of Breast and Endocrine Surgery and Department of Pediatric Surgery.

Hematology

I spent my first two weeks under the guidance of Prof. Hitoshi Kiyoi and his colleagues. I was glad to be put into a schedule telling me which person to follow from day 1. During my stay I took part in ward rounds as well as overlooking clinical procedures such as bone marrow aspiration. I was also introduced to the facilities of microscopy and flowcytometri which are crucial in the work of diagnosing the group of patients.

I participated in one of the weekly conferences Monday evening. The conference was held in Japanese but I was lucky to have Dr. Iriyama(-sensei) translating the matter to me. One day I was invited by Dr. Iriyama to join her class with other Japanese students in which she gave a lecture about the pathology and characteristic of different hematologic diseases such as AML, ITP and APL.

I felt the department took their time to explain me many things about the patients, procedures and options of treatment. When not discussing medical matters with my superiors I was recommended many good places to go inside and outside Nagoya.

Anesthesiology

During two weeks at department of Anesthesiology I spent my time observing many operations and how to ready different patients for surgical procedure. This included ultra sound-guided neural blocks, intubation and monitoring of the patient in anesthesia. Prof. Kimitoshi Nishiwaki showed me the department's SimMan simulation room of where I could train to administer the drugs involved and improve my technical skills on a mannequin while providing anesthesia.

One thing I found interesting was that the anesthesiological work between Denmark and Japan differs in the usage of gas anesthesia. In many Danish hospitals the procedure are relying almost solely on the use of intravenous anesthesia. I look forward to discuss the subject within Danish hospitals.

Endocrinology and Diabetes

Of my three weeks stay at Prof. Hiroshi Arima's department the first workdays clashed with the 'Golden week', the Japanese national holidays held every year in the beginning of May. To my surprise this included that almost 50% of the in-ward patients could be send home to their families to return the next week.

When following the work of my superiors in the out-patient clinic I participated in different procedures from taking thyroid biopsies to administering somatostatin analogue to one patient suffering from acromegaly. Even though the patient communication was only held in Japanese the routinal consultation and health check were giving me an insight in the assesment of the diabetic patient in general. I was pleased to find out that the department had a partnership with Danish colleagues and the Company of NovoNordisk which meant that one of the doctors would leave for Denmark while I was staying at the department

Breast and Endocrine Surgery

Under the guidance of Ass. Prof. Kikumori I was invited to participate in the surgical procedure of mastectomy. This included assisting with biopsy-taking of the sentinel nodes before suturing together the skin folds. Later I had the chance to see a thyroid lobectomy involving the isolation of n. Laryngeus recurrens, preserving the blood supply while not damaging any other vital structures in the exposed area.

One evening I participated in a conference held with members from different departments to discuss the surgical options for the scheduled operations. In between the walkthrough of the patients my superior gave me the necessary details to understand the complexity of treating the specific patient.

Pediatric Surgery

My last week in the hospital I was enrolled at the department of Prof. Hiroo Uchida where I had a broad introduction to the pediatric field. I was invited to participate in the morning rounds in the neonatal ICU and my superiors really found the time to explain me quite a lot about surgical techniques and typical surgeries when treating for instance akalasia or a stricture in the oesophagus of a newborn. One late afternoon I even witnessed the acute work done to young girl entering the hospital on the suspicion of appendicitis which were later confirmed and send to the operation room.

In the office there was a machine on which I could train with scope and sutur when not spending whole days with my superiors who were curious to involve me in their daily work. Two times a week the whole department came together to summarize the current patients and challenges for next week in english for the sake of mine. Before ending my elective almost the whole department joined me for a farewell dinner on a restaurant close to my residence inside Nagoya city.

Final thoughts

I was lucky to establish an agreement directly with the Medical School of Nagoya University which meant that I could not take use of all the favors included when exchanging through the NUPACE programme. With that said I received all the help I could wish for from officials within the Office of International Affairs, fellow students and superiors.

My stay gave me a great opportunity to experience Japan, the unique culture, the language, the health-care system and hospital environment which I have found heart warming, hard working and high leveled in taking care of the Japanese population.

I hope that my trip and these words will open up for future exchange of medical students and strengthen the bonds between the University of Copenhagen and Nagoya University.

Sayōnara - Mata ne