Clinical Exchange in Japan

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Experience Stories in Nagoya Univ. School of Medicine

Mr. Liu from Taiwan

Departments: Infection Control Team (ICT), Geriatrics, Emergency & Intensive care unit
Period: 2012.03.09 – 2012.04.12

It was my pleasure to have a chance visiting Nagoya University, school of Medicine, as a short-term exchange student from National Taiwan University. During the 6 weeks, I have visited the Infection Control Team(ICT), the Department of Geriatrics, and the Department of Emergency and Intensive Care Unit. Studying and discussing with the doctors were really nice experience. We talked about not only the medical knowledge but also the difference of medical system. Every member of Nagoya University was friendly and patient to me. I think I will miss this 6-week journey in Nagoya after I return to Taiwan.

The job of infectious disease doctors is quite different between Japan and Taiwan. In Japan, infectious disease doctors play the role of supporting and consulting, instead of working in the ward. Besides, due to the fact that infectious disease department is a newly independent department from chest internal medicine, we had quite a few lessons of chest internal medicine during the two weeks.

Dr. Yagi and Dr. Iguchi had some brilliant lessons in the ICT(Infection Control Team) department. They introduced the examination process and lab facility on the first day, and established the basic concept about how to approach a patient with infectious disease, which was emphasized again and again in the two weeks lesson. We had several classes of case discussion of Nagoya University Hospital’s M&M conference, which was challenging and interesting. Another interesting experience is that Dr. Yagi invited us to the NICU, and told us he wanted to modify the redundant infection control rule of this room.

I really enjoyed the lesson in the ICT. Although we had some language problem in the very beginning; however, the challenging case discussion inspired us to establish the thinking process of infectious disease, along with the knowledge of antibiotics use.

We had some other lessons except infectious disease during the two weeks. Doctors of chest internal medicine gave us more lessons about lung cancer and pneumonia. Although we had some similar lesson in Taiwan, it was still a good review and quite interesting to know the research what the teachers was doing. We need to attend the morning meeting of case run every morning, too. I like the rule that every morning we are applied to read one journal essay. However, my Japanese ability was not good enough to understand what the situation was during the case run, which seemed to be a little frustrating.

However, I still had a fulfilling two-week lesson in ICT and chest internal medicine. The kindness of the doctors really gave me a warm welcome. It was also inspiring to share the difference of the medical environment between Japan and Taiwan. Thanks to all the doctors and I think I will miss the first two weeks in Japan as an exchange student.

Department of geriatrics was the only bedside course I chose in Nagoya University Hospital. Upon the orientation, Dr. Umenagi assigned me to follow Dr. Yanagawa, who was a kind female teacher, during the following two-week course. Dr. Yanagawa soon printed a newly-admitted patient’s medical record and asked me to build the future plan for this patient.Thrilling, but challenging!

A female patient who had underlying diseases of depression and iron deficiency type anemia, was admitted to the hospital due to decreasing consciousness level. Elevated serum ammonia and low hemoglobin was noted via blood examination. Therefore, our task was to search for the reason why this abnormal lab data occurred.

Usually, Dr. Yanagawa does not give the answer directly. She gave me a hint and hoped me to search for the related information first. After I gained some knowledge of the topic, we discussed the issue the next day. I think it’s time to gain back the logical thinking of independence, instead of simply memorizing the knowledge.

We needed to report the daily status of the patient in the morning meeting. I never present in a foreign language before. I tried to use Japanese to explain my plan and thinking process. Thanks to all the doctors withstanding and Japanese education, I think it was the most exciting memory during the two weeks.

During the weekly conference, we are asked to give a brief presentation of the geriatric medicine and impaired swallowing of elders in Taiwan. Although we did rehearsal, I still felt quite nervous in front of all the senior doctors. Surprisingly, although Taiwan is an aging country, the impaired swallowing of the elders’ status was quite different.

Dr. Suzuki gave us several small lectures during these days. The most impressive one is the medical team sent by Nagoya University Hospital for the refugees of the earthquake in 2011.

I still felt appreciate to all the members in this department, for their warm welcome. I felt I was a member of the big team, and a maturing doctor here.

I was astonished when I saw the emergency department of Nagoya University hospital for the first sight. No more patients lied on the sidewalk, and no more crying relatives shouted at the nurses. Due to the poor medical classification system, the emergency room in Taiwan is always like a battlefield.

The weather was changing during the beginning of April, and the strong wind caused several accidents of children and the elders. Besides, cardiovascular disease was the main reason for patients’ admission these days. We met several patients with aortic dissection and acute myocardial infarction. Thanks to Dr. Tsuzuki and Dr. Hinoshita, who expressed extreme patience discussing with us even though we sometimes had language troubles. Besides, Dr.Murase introduced us to the emergency and internal medical ICU. Surgical ICU and NICU were visited in the same day. Since we did not have chance visit ICU in the first six years in Taiwan’s medical education, I thought this experience was quite a good preview for our internship.

Professor Matsuda invited us to a lecture held for junior residents about basic emergency concept. The handout was very friendly to foreign students. Even though sometimes I lost follow of professor’s lecture, I could always trace back to the correct information by reading the handout.

The conference on Thursday was quite interesting. The journal sounded complex in the beginning. Because there were no detail handout, it was difficult to catch the point. However, after looking up in the Internet, those essays were very useful and inspiring for us in clinical work. I really enjoyed the introduction of new antibiotics drugs. Although it was held by a pharmaceutical propaganda, both the slide and film were still interesting and useful.

We were lucky to follow Professor Matsuda to Nagoya Central Hospital in order to perform anesthesia of a cystectomy surgery. Before devoting himself into emergency medicine, Professor Matsuda was originally an anesthesiologist in the hospital. We talked about some useful knowledge about anesthesia and watched the process of the surgery at the same time.

I really enjoyed the course in the emergency department. The well-organized medical classification system built a friendly medical environment, both for the patient and medical student. To study case by case with a senior doctor formed the thinking process of how to approach a new patient, which was the best treasure in this course.

Thanks to Dr. Kasuya, who arranged the brilliant course schedule and take care of our living during these days. Thanks to Ms. Hiramitsu, who help us from the very beginning of application and all the stuff for the exchange programs.

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