Experience Reports (for Nagoya University Students) | 2016

Clinical Clerkship at the oldest medical school in the U.S., University of Pennsylvania

Yosuke Hamada

I still remember the day when I left the Centrair for Philadelphia as if it were yesterday. Although I had flown to many countries before, this was indeed my first trip to the States, and I just couldn’t wait to start the thrilling journey. I could not have made the clerkship at U Penn so fruitful without the support of Dr. Kasuya, Dr. Hasegawa, and Ms. Nishio, to whom I would like to express my heartiest gratitude. I completed a one-month rotation in Paediatric Pulmonology at the Children’s Hospital of Philadelphia, and another in Haematology and Oncology at Pennsylvania Hospital. Here, I briefly summarised those experiences and the life in Philadelphia.

Perelman School of Medicine at the University of Pennsylvania - U Penn has the oldest medical school in America. It was founded in 1765 and is now widely regarded as one of the top medical schools in the world. The school has put so much effort in education, and the facilities across the campus are just amazing. Hospitals affiliated with Penn Med are Hospital of University of Pennsylvania (HUP – the first university hospital in the U.S.), Pennsylvania Hospital (Pennsy – the first hospital in the U.S.), and Children’s Hospital of Philadelphia (CHOP – the first children’s hospital in the U.S.). As you can see, U Penn is the origin of the clinical medicine in the States.

Children’s Hospital of Philadelphia (CHOP) - My first rotation was paediatric pulmonology at CHOP. The buildings of CHOP are larger than those of Meidai hospital, and I often got lost at the beginning. All the departments are exclusively for children, therefore many people across the world come to CHOP to seek the best children’s care. My rotation was divided into consults, inpatients and outpatients, each of which I did for more than a week. I started with consults and followed an intelligent and kind attending and course director, and a talented fellow. On the first day, I could seldom do anything but getting accustomed to the rotation. Owing to my personality, from the next day, I sort of got used to it and was able to ask many questions. They also asked me a number of questions for each patient, and even asked me for advice of treatments, which I did not expect. I did not find the relationship between the staff so hierarchical, and I felt very comfortable when asking questions. Even when they were busy, they seemed to be happy and enjoy their work. I often saw patients with cystic fibrosis, asthma, and tracheomalacia, and learned so much throughout the rotation.
 Besides the bed-side learning, I also joined grand rounds, every day noon conferences (lunch was free, which was very helpful for a student like me), and pulmonary conferences for the department. I especially found the noon conferences helpful as I could learn a lot about general paediatrics through presented cases and I made many friends with the Penn students and the residents. I also contacted some medical staff and got an opportunity to observe Dr. Campbell’s VEPTR surgery for scoliosis. I reassured the importance of taking an initiative through this experience.

Pennsylvania Hospital (Pennsy) - The second rotation was Haematology and Oncology at Pennsy, the very first hospital in the States. Pennsy also has the oldest surgical theatre in the U.S., and I was deeply impressed with the historical room.
 I mainly did consults for the whole month, and in the spare time, I saw some outpatients. I initially thought that I would follow the doctors and carry out some parts of physical exams if there was a chance. In fact, I got all the consult calls, and had to talk to the patients, take their histories, do physical exams, and present the cases to an attending all by myself. I did not know what to do with the first one who was an HIV positive patient in a psychiatric ward. My colleague, Shin was rotating Haem/Onc at the same time, so we worked together to solve the problem. It was very challenging but so rewarding that I really got into clinical oncology. Through many cancer cases, I made an effort to read a lot of related papers, and got the best grade (honors) from the department, which I was very happy with. I would definitely recommend that anyone who will do the clerkship at U Penn choose Haem/Onc at Pennsy.

Life in Philadelphia - I stayed in a student accommodation called Sansom Place East, which was a good environment to make friends with people from different departments. Moreover, I really liked the atmosphere on campus. As it was getting warmer, people lie down on a grass, and chill out, talking to friends. I was able to enjoy the “campus life.”
 Philadelphia being such a historical city and having many famous touristic places such as the Liberty Bell, my favorite touristic spot was the Philadelphia Museum of Art. This place was also used to film-shoot the Rocky series. Whenever I had time to do some exercise, I ran to the museum and chilled out there. The scenery from the top of the stairs in front of the museum was incredibly beautiful.
 Philadelphia is really close to NY and DC, so I made the most of the weekends to visit those cities. I cannot unfortunately describe all of my experiences, however, everything I did in the States was so precious that I will never forget this two months.

Night Nation Run

The Oldest Surgical Theatre

Clinical Clerkship at U-Penn

Shin Nagai

My clinical clerkship experience at Pennsylvania University started at the end of March till the last day of May. Although two month is a short time, it was a great experience - studying in the Ivy League University is not a thing that everyone can do.

The first four weeks starting from March 28th, I did my clerkship in Pediatric Cardiology division at CHOP (Children’s Hospital of Philadelphia). The four weeks were divided into two weeks of inpatient service, one week of outpatient service, and a week of consult service. On the first day of my clerkship, I went to the clerk desk as the e-mail told me to, and after talking a few words with the clerk, I was taken to the ward by her and was thrown into the morning round. Soon as I arrived, the attending physician asked me, “Tell me what you know about the coarctation of the aorta”, and I was dazzled. Struggling with all the unfamiliar medical terms, the morning round was over and everyone started doing their own jobs. I was alone there, not knowing what next to do. The environment was totally different from that in Japan, where the entire schedule is already in order and we always know what to do next. Also the all English environment was making me nervous too. I regret my lack of preparation. The students must be aggressive or they will be left alone in the US. Only the people who prepare a lot and participate aggressively are welcome. This is an important factor I learned through the days in the US. The day after this, I asked everything I didn’t know to someone near me at the morning rounds and caught and followed a fellow after it. I also continued my attitude through the outpatient service and consult service. It was a very nice experience to see rare congenital heart disease such as tetralogy of Fallot, TAPVR, coarctation of the aorta, and so on, which I didn’t have the chance to see at Meidai Hospital. There was a duty to make a 30 to 40 minute presentation of a pediatric cardiology disease in the division. I had a hard time finding the correct literature and putting it together, but when I finished my presentation, the attending gave me a good job and I was very satisfied about it.

The second month I did my clerkship at the hematology/oncology division in Pennsylvania hospital. This time I got many chances of hands-on compared to the first month. I rotated this division with Yosuke, who is a classmate of mine at Nagoya University. The duty of this division was to do the first touch of the consult. We give our cell numbers to the clerk desk and watch outpatients until we get a call. After we get a call, we head to the wards read the charts and get the information. We examine the patient, make an assessment and a plan and present it to the attending. Afterwards, we go see the patient with the attending. At first we had a difficult time finding the correct information, but as we get used to doing the consults, it felt like we were in the cycle of the practice and this was very satisfying. Pennsylvania hospital is the oldest hospital in the US and we could feel the history of the place too, which was interesting.

Outside the hospital experience was fulfilling too. I stayed at IHP (International House of Philadelphia), where students from all over the world come to study at Philadelphia. The house threw parties and it was very easy to make friends there. I went drinking with them, went to New York, and so on. It was a very nice experience and they are friends that I want to treasure for life.

I am very happy to have gone studying abroad. I learned how small a world I was living in, and how recessive I was about studying. All the things I saw in the US, such as the medical system, atmosphere in the hospital, the motivation of the students widened my view of life. The environment of recessive students left alone was a good medicine to me. I’m going to be a resident in a year. I think this was a very good timing to change my attitude.

I would like to thank everyone who was concerned in my clinical clerkship to the US. Dr.Kasuya, Dr.Hasegawa, Ms.Nishio, thank you for making my program come real. And all the financial helps were essential. I would like to say thank you to my parents. At last, I’d like to thank all my friends especially Yosuke for supporting me mentally.

Feedback of my study abroad in Johns Hopkins University

R. Y.

I had the pleasure to do my clinical electives in Johns Hopkins University in the department of Medical Oncology and Ophthalmology from 04/20/2016 to 06/17/2016. I chose Medical Oncology because it is still a rare department in Japan and I also wanted to see how the clinics or clinical trials are going on. Ophthalmology is one of the most popular departments among American medical students and I wanted to know the reason why it makes so. I am really grateful for being accepted to both departments and having chances to do my rotation.

I would like to mention two cases that really made me think and left a big impression on me. The most memorable shock through my study abroad is that how the bone marrow transplantation (BMT) was different from what I had learnt in Japan. This is not the case with all over America but only in some area including Baltimore. Johns Hopkins University has been doing HLA haploidentical BMT for years and is making good results with the leading doctors. I had many chances to follow patients going through BMT and to listen to lectures by famous professors, which was amazing. I am sure that I would never see or hear about them without studying abroad. Moreover and very importantly, this regimen makes a huge difference on how patients go through BMT. They can stay home and do BMT in clinic, and even if they have some complications they don’t have to stay in a small room or talk through the glass window, which is the standard in Japan. They can meet their kids or family or even their pets, which was really surprising to me and reinvented my image of hematology.

The other impact for me was to know how people hesitate to come to hospitals due to their money issues. I had the chance to see the emergency ophthalmology clinic and I felt sad to see many African American people coming to the hospital after they had lost their both vision and couldn’t help to think if only they had come a week or a day earlier. On the other hand, I also met some patients who didn’t need any urgent care or didn’t understand why they thought of coming here, such as a woman who was afraid of cataract just because she heard that her friend had underwent a cataract surgery. These were not only few cases but I could actually see the tendency and when I asked the doctor she said, “this is what is happening in America.” Baltimore has one of the highest averages of salary in the U.S., but at the same time there are a lot of poor people, which means there is a huge gap of income. I couldn’t imagine how related the patients hesitation and health insurance was until I came to the U.S., but the reality was that people who live very close to Johns Hopkins are far from accessing to Johns Hopkins.

Through this study abroad, I didn’t realize much difference in medicine itself except BMT, but I have seen how differently the medicine is served as a service. In the U.S., they provide the best medicine and care for the affordable people, while they don’t necessary provide a good medicine for the unaffordable. This is the impression I got from my two months and I know that I have only seen a side of America, but I am glad to experience and gain my own opinion rather than hearing someone’s. What is more, I had chances to think about the medical systems while meeting people from all over the world and sharing information of their country. Appreciating and rethinking about your own country is often said to be one of the achievements of studying abroad, comparing and giving a second thought about Japanese medical system and medicine gave me a new sight.

I would like to thank the medical oncology and ophthalmology department and the people involved for accepting me as a visiting elective student. At least but not least, I also appreciate the support from Nagoya University and my family, friends who made my study abroad happen and to be successful.

Johns Hopkins hospital report

Yuika Kureyama

To begin with…
 The first time I knew this exchange program was when I was in junior high or high school. I’m very happy that I could my dream came true, and at the same time, I feel that I have to make use of this great experience for my next dream.
 I studied in Hopkins from April 20th to June 17th. I rotated in pediatric oncology and then moved to medical oncology. At first, I was a little disappointed that I was not accepted to the other department which I wanted to go to, but then I found the oncology department so much more exciting and interesting. I am quite satisfied with what I experienced in these departments.

Pediatric oncology
 My rotation started with a sign out from the nightshift, and then I participated in sit down rounds, walk rounds, noon conferences, and teaching in the afternoon. When I have free time, I checked charts in a resident room and asked questions to residents. They were very helpful and have a lot of knowledge. I could learn a lot of things by reading charts. We treated a lot of patients with leukemia, brain tumor, and osteosarcoma.
 Especially, I was so impressed that doctors, nurses, pharmacists, and dietitians discussed the plan for the patient together actively. However, I had a difficulty too. Before going to Hopkins, I had expected that they would provide a lot of homework or job. On the contrary, I actually had nothing to do in the afternoon on the first day. I felt I needed to take an initiative by myself. On the next day, I asked the attending if I could take care of a patient and also tried to increase the number of asking question by myself. Other difficulties are that there are lots of abbreviations to remember. Because we use tons of medicine for chemotherapy, it took a long time to read a chart at first. By using the information, I made a presentation about patients in charge in the sit down rounds. I strongly remember that I was very intense before the rounds not to disturb the rounds. Therefore, I will never forget that my attending told me that my presentation was excellent.
 Attendings were changed a couple of times during my rotation. The idea of treatment or how to teach were different from person to person, so I was also intense every time on the first day of the new attending. I cannot forget that one of them told me to make a presentation about High-dose methotrexate/Leucovorin rescue. I was a bit nervous but it was a great experience because he gave me a feedback.
 I also observed the outpatient clinic. I met a boy who completed a three-year-course chemotherapy for osteogenic sarcoma. Nurses celebrated him and held a party named “chemo party”, where they sang a song and gave him a huge “American” cake. Seeing him and his family, Tears brought up naturally. By contrast, I met a teenage girl who was admitted with recurrent osteogenic sarcoma. She already knew that the prognosis was terrible and cried every day. Her family was also disappointed and upset about that. I didn’t know how to get along with that kind of patients. I felt I needed to know how to deal with them if I was in charge of them in the future and want to get a communication skill before becoming a full-fledged doctor.

Medical oncology
 My team is usually in charge of patients with solid tumor. Most of the patients had metastatic cancer. I often saw my attending telling patients that there is no way to do with that cancer. I re-realized that how horrible cancer is, and would like to deal with better treatment for cancer in the future career. In this way, each patient had a critical problem, so it often took 4 hours to do walk rounds. Many patients admitted to Hopkins expect higher quality of medicine, because they came to HOPKINS, which means doctors have more responsibility. Actually, residents in Hopkins are so diligent and knowledgeable and I have heard it is so hard to match to Hopkins.
 I always had a patient in charge, and made a presentation every morning. I was gradually used to the system in Hopkins in the second month, which made it easy to understand what doctors were talking. Still, it was hard for me to answer quickly when nurses asked me some questions about administration of drugs, which made me so frustrated.
 Besides me, one student from Dominican Republic also came to Hopkins as an exchange. She will graduate from medical school in her country this summer, and then will spend one year for USMLE to get a job in the United States. She is so motivated and can speak English completely. She motivated me in many ways. I thought that if I plan to work in the United States, it would be very hard and competitive because there are lot of foreign students like her.
 In general, medical oncology department had more teaching that pediatric oncology. The theme varied from palliative therapy for end-stage cancer to immunotherapy. They were all interesting and exciting.

 Before I went to Hopkins, I thought it would be almost impossible to communicate with other students. However, it was not true. If I am a little more courageous than usual, I can make a lot of friends. I tried to be as active as possible. For example, I asked for the participation in the ER teaching, and sneaked into the party for local students. I did many things that I had hesitated to do when I was in Japan. Many friends I met there were all very kind, and some of them showed me around by car. I don’t deny some of the area in Baltimore is still sketchy, but I am definitely happy that I could came to Hopkins. I really recommend studying in Hopkins! I met many fabulous people there, and had a great experience. I would like to say thank you to all the people who supported me. From now on, I will try my best to live for all the people who helped me in my life.

My days at the University of North Carolina (UNC)

Tomoki Hattori

Dream of many years; this would be the most appropriate word to describe how desperately I wanted to study abroad. After finishing all my 3-month rotations at UNC, I would like to say all I really wanted was there in North Carolina: delight, struggle, and invaluable friends I made there.

During the first month I did my rotations on pathology and covered frozen section, GI, GU, and cytology.  Frozen section, for example, was my first rotation there and it was really enjoyable because I myself actually did numerous stains and observed many slides, such cases as meningioma, Crohn’s disease, and endothelial cancer. Since frozen section deals with a variety of fields, I grasped the general picture of pathology during my first week. In addition, I observed many cases in GI, GU, and cytology and discussed each case with residents and attendings, although I often had difficulty understanding what was going on because of my lack of knowledge. The only thing I disliked in there was gross section. It is a process to make an excision into a fixed sample, so we have to cut and fix real gross organs like stomach and colon. I am pretty sure that no one loves it, but it was so grotesque. The most impressive case I saw there was leg amputation. The patient developed massive metastatic melanoma and, for the sake of palliative care, left leg amputation was performed. I did not see the patient but saw the leg. It was so GROSS with numerous black dots everywhere around. But it is also a good memory in pathology.

Second month was really focused on old people. I was on geriatrics and took care of outpatients for the first 2 weeks and inpatients for the rest. Since I really like interacting with old patients, it was my great pleasure having this rotation. In Japan, a general image of geriatrics would be aspiration pneumonia and heart failure, but this was not the case in UNC. Of course, there were many patients with those common diseases but this department was also in charge of patients with acute pancreatitis, GAVE, and interstitial pneumonia. Attendings also gave us short lectures about problems typically in geriatrics, including polypharmacy and delirium. Just as in Japan, America is in short of places for old patients who couldn’t live independently any more. All doctors in geriatrics worked in harmony with social workers and care-managers to achieve the best possible care for patients. Throughout this rotation, I had a lot of time to interact with old patients; I liked them a lot and seemingly they also liked me. It was my pleasure to establish good relationship with them.

My last rotation was for cardiology which I really wanted to do. I belonged to Cardiac ICU and took care of inpatients and, at the same time, observed many procedures in Cath Lab. I had a coworker in this rotation; she was a visiting student from China and was really desperate to start residency in the U.S. She had already finished all the STEPs and had an extensive knowledge of a variety of medical fields. Her English was also very good and I sometimes felt inferior to her. However, I believed in myself and struggled to find whatever I could do; for example, I always sneaked into Cath lab to learn catheterization procedures alone, got close to doctors and cardio technicians, and asked them a ton of questions. They taught me how to interpret X-ray images and decision-making processes during procedures. Also, in the CICU, I learned how to understand each lab result or Swan number. Residents and fellows were really good at grasping patient’s condition with those testings, and by following patients every day for a month, I got used to their way of thinking in acute management in cardiology.

Finally, I would like to share my memory with my best roommate ever. His name is Albert Chang, who is also a medical student at UNC. We knew each other because the head of

Nagoya University’s branch in North Carolina helped me to find a room. We spent a great amount of time together; we went eat out every night and talked over a variety of topics, like politics and religion and Japanese Anime, and laughed over trivial things together. Since he is also a med student, we discussed every interesting case we saw and he taught me a lot about the reality of U.S. medical system. Our common dream is to be a cardiologist and it would be superb if we could discuss heart diseases 10 or 20 years from now.

My studying abroad could not be achieved without all your help: great teachers and professors in Nagoya who taught me a lot of information about UNC and medical system in the states, my friends who struggled together to study abroad, and all my new friends in the United States. Hereby, I would like to express my great gratitude to all of you. Thank you very much. I would definitely come back to the U.S. to visit UNC again.

My challenge in Duke University

Erina Hosono

I’d like to express my deepest gratitude to everyone who supported my three-months challenge. Without their help, the life would have been totally different and I couldn’t have fulfilled my ambition. As a representative of Nagoya University, I went to study in Duke University. In addition, I got chances to observe MD Anderson Cancer Center, do some research in Duke University and participate in clinical electives in McGill University. Through these experiences, I could learn the different ways of thinking and attitude, be highly motivated by various people with the diverse backgrounds and broaden my horizons beyond this country.

As a visiting student in Duke University, I participated in the pediatric hematology and oncology team for 4 weeks. At first, I was so disappointed because the only thing I could do was “observe” the doctors. I was not good at speaking my mind, but this frustration encouraged me to negotiate with the attending. I couldn’t stop crying when I expressed my feeling, but this difficulty truly made me break out of my shell. I had really great time in the hospital after this embarrassment. I started to study with the impatient team and took charge of one patient. In the first week, I made a presentation about the patient by reading the manuscript I had carefully prepared. Next week, I could give a presentation by reading just a note. Moreover, I could ask some questions and do the physical exams by myself. I could even write a medical record and talk about the latest knowledge of ITP to the resident physicians. In the third week, I asked the resident to give me more patients and I was in charge of two patients. I tried giving my opinion about the treatment as well. The resident doctors often asked me to check the physical condition and feeling of the patients. Through the conversation with doctors, I felt I was gradually recognized as a member of the team. In the last week, thanks to the consideration of the attending, I got a chance to see the patients in the general pediatric clinic. In addition, I could get an appointment to see the brain surgery by Dr. Fukushima. I was so impressed by him and made a firm resolution to be a doctor who will be able to provide a good influence on someone.

These are my experience in Duke University. For me, Duke is the place that I could learn a lot as a medical student and mature emotionally and mentally. I’m a greedy person who wanted to do many things, but Duke always made my wishes come true. The world I’ve never seen is so large, and myself I’ve never noticed is much bigger. This is the message for promoting students to go and study abroad and I totally agree with the content. I really appreciate such a precious and valuable experience, and I’d like to try not to stop here and seek another chance to lead to the next step.

My challenge at Tulane University School of Medicine

Maho Taguchi

This time, I had a chance to participate in the clinical clerkship at Tulane University School of Medicine, New Orleans, Louisiana. New Orleans is famous for Jazz, peculiar food culture and festivals. It has southern cheerful atmosphere and people in New Orleans are very jolly and light hearted. I liked New Orleans the moment I arrived there. My stay there was the hardest but most exciting experience in my life.

My rotation started in pulmonary medicine. I rotated with pulmonary consulting team. Every morning, I rounded with my fellow, taking medical histories and doing physical exams together. After finishing all of my duty, I often went to see bronchoscopy or went to clinic. At first I felt nervous and sad because I couldn’t say even simple things in English and I couldn’t do anything smoothly like I do in Japan. However, thankfully, my fellow was so kind that he taught me many things and supported me anytime. Additionally, the pulmonary consulting team was markedly international in character. The members came from various countries, for example, Dominica, India, China, and so on. I broadened my horizon and general view of the world by communicating with doctors with different cultures and customs.

I rotated in Anesthesiology for next 2weeks. On the first day, I couldn’t get permission to try tracheal intubation because a doctor said “ You are a visiting student, so you can do only observation.” I didn’t get it, so asserted on my rights to do not only observation but also clinical clerkships. Consequently, I was allowed to try intubation many times during my rotation. I realized how important it was to keep on trying and not give up even if I was rejected once. Also, I experienced various types of intubation because many patients in the US have difficult airways to intubate. I tried intubation using LMA, bronchoscope and video-assisted laryngoscope that I never tried in Japan.

Finally, I rotated in Stroke Service in Neurology for next 2weeks. In this department, I often required to express my assessments about patients and opinions about neurological themes in front of many doctors and students. It was the first time for me to rotate with other students, so my low English skills and insufficient medical knowledge were exposed and I had a sense of inferiority. I shed tears in my mortification almost every day. However, I never gave up and made every effort so that I could feel I’m growing. Finally, doctors and students regarded me as a member of the team. This rotation was the hardest ever, but at the same time, made me grow up a lot.

All in all, my stay in New Orleans was beyond description. I had a precious and never forgettable experience. I believe that these experiences will make a big influence on my future. I would like to express my gratitude to all the people who supported me and let me have such a great experience. Thank you very much.

Clinical Clerkship at Tulane University

Katsuya Sakashita

I experienced clinical clerkship for six weeks at Tulane University, located in New Orleans, Louisiana. During this term, I rotated SICU (Surgical ICU), ER, and PM&R (Physical Medicine and Rehabilitation). I learned a lot of interesting things on each rotation.

In SICU rotation, my job was to take overnight history of my patients, do brief examinations, and present my patients to senior doctors. A female student who rotated SICU with me was amazing for me. During a morning round, she didn’t hesitate to state her opinion. That means not only she positively joined the round but also she had enough knowledge and memorized significant laboratory data. That was totally different from a round in Japan. She was a good sample of clinical clerkship and made my subsequent rotations much better.

My next rotation was ER. In SICU rotation, I saw a few patients in a day and had enough time to take history. On the other hand, in ER, we had many patients waiting and need to see them quickly. In this term, I tried to take focused history and examination quickly and then present them to senior doctors. At first, my job was so bad. Especially, my presentation was terrible. I took a long time to prepare, wasn’t able to speak fluently, and stated poor assessment & plan. So I practiced again and again on both on-shift day and off-shift day. Finally I think I made my job much better than before.

In PM&R, my last rotation, I saw patients who are suffered from chronic pain such as shoulder pain, back pain, and knee pain. I took history of their pain since last visit and presented to my boss. In addition, I learned actual situation of opioid use in the United States and experienced joint injections. The most impressive thing was education system in the United States. My boss in this department was a very nice educator. He kindly explained how to take history, write a chart, and talk to patients. Furthermore, he introduced some interesting cases he has seen before. Then I noticed that doctors in the United States are generally eager to educate medical students or their subordinates.

This experience in New Orleans was really exciting to me and positively changed me in many different ways. I’m profoundly grateful to everyone who supported me in both Nagoya University and Tulane University.

"The biggest challenge in my life"

Mayuko Yamamura

I had been to Tulane University School of Medicine for clinical clerkships for 2 months. It locates in New Orleans, which is famous for sightseeing, jazz music, delicious seafood and cocktails. The reasons I chose Tulane University was not only because I wanted to practice my English in New Orleans, but also because I really hoped to know and talk with many people from all over the world. Of couarse I was eager to learn, see the differences between Japanese and American medicine, and also eager to know how medical students in the US work during their clerkships.

MICU (pulmonary department)
 My first rotation started at MICU team for 2 weeks. MICU team consists of 1 attending doctor, 1 fellow, 3 residents and 3 interns. They looked very busy but they were so kind to me. MICU round starts at 8am every day, so before that, they had to see their patients and prepare for presentations. Cases there were very severe and difficult to understand for me so I had to ask many questions and study home a lot. However, at 2nd week I followed one patient, who had brain attack. I went to see her every morning and evening, had some presentation and discussed with other doctors how to treat her.

Obstetrics and Gynecology
 The 2nd rotation was at ob/gyn department for 2 weeks. I am going to be obstetrician in the future so I was very excited about the rotation in ob/gyn at Tulane. I found some differences compared to ob/gyn in Japan. In the US, almost all delivery is done with anesthesia. And all patients’ room is private room so they can stay with their baby all the time in their own room. These were what I found different, but happy and joyful feeling that we all have when a baby was born was as precious as Japan.

 The final rotation was in Cardiology department for 2 weeks. I belonged to consult team, so when we got a consult from other departments, I went to see the patient, had some physical exams, check the chart and had presentation to the fellow. For example there were cases of heart failure, acute coronary diseases, arrhythmia and so on. Seeing, discussing, and treating patients with other doctors was really good experience for me.

During the rotation for 6 weeks, I met some medical students at Tulane University. I think they study harder, work harder, and are much better at discussing things than Japanese students. Talking with them was really interesting and I had a lot of stimulants from then. They also took me to many good places in New Orleans so I could fully enjoy the city. Everything was so exciting.
 All these experience broadened my horizon and made me more motivated about learning. I really appreciate all the help from officers at Nagoya University officers at Tulane University, my friends, and my family. Thank you so much.

Studying at Tulane University School of Medicine

Kota Hiraga

From March to May 2016, I studied at Tulane University School of Medicine. The reason why I chose this university was that I hope to see the US medicine and want to develop my English ability. Before going to Tulane university, I studied English medical examination and presentation with my colleagues. I felt excited and anxiety because I would test what I learned.

I rotated cardiology for the first two weeks. Since I was a foreign student, I was going this way and that. I couldn’t find what to do. Doctors scarcely taught me of their own accord. So, I needed to ask them. In Japan, I hardly ask doctors, therefore it was hard for me to ask. However, when I asked them, they willingly taught me. After asking them again and again, I got accustomed, and I thought asking is better and effective for learning. I strikingly felt I was ever passive in Japan. I thought I had to be active especially in the US. Otherwise, I would not be able to learn anything. They finally recognized me and after few days, they assigned some patients to me. Then I could learn more and more things, for example the case of the chest pain caused by drugs, which I wasn’t able to learn in Japan.

For the next two weeks, I rotated neurology. On this department, I was in the consult team with three students. They pre-rounded on their own patients. They could accurately do medical interview, examination and assessment. I felt them as if residents in Japan. Although sometimes I was able to use what I learned in Japan, I couldn’t do like other students many times. I strongly made up mind to study harder to catch up them. During my rotation, I tried to examine as many patients as possible. That experiences developed both my medical and English abilities.

I rotated MICU for the last two weeks. Since I got used to ask and discuss with doctors, I could be more active than I were. So, I could learn the intensive care little by little. I felt that my English ability was developed during my stay in the US. That made me so delighted. However, the intensive care was of course hard for me. I thought that I should have learned at ICU in Japan. Although it was common with three departments I rotated, I should have learned about those departments more in Japan. If I did, I could have learned more and more.

During my stay in the US, I was always wondering what is the difference between the US medicine and Japanese medicine. I felt the US patients are more interested in medication than Japanese patients. The US patients was able to tell their precise history of present illness. They remembered the name and amount of medicine which they used. It was so surprising because I had never met such patients in Japan. I thought they were interested in medication because they had to pay more money than Japanese patients did. I thought the fact that Japanese medicine is so generous had both merit and demerit. This is because I believe that the more enthusiastic patients are for medication, the more chance they could get to take treatments. I also felt the American education was more practical. It was impressed that American students were more active and worked as if residents in Japan. I thought I should have been more active during my clerkship in Japan. I felt I had lost chance to learn more things during my clerkship in Japan.

In New Orleans, there were many black people living. So many patients were black although there were doctors of various races. Because black people had their own accent, it was hard to communicate with them. Therefore, I was so glad when I was able to communicate with and do medical interview to them. I was able to broaden my horizon by contacting people of various races.

I think one of the good points of studying abroad is that you have to overcome the new environment. On the way of overcoming, you probably can feel your development. On studying in the US, I had a lot of precious experiences. I felt my development many times. Making use of these wonderful experiences, I will study hard in the future.

I couldn’t go to the US for studying alone. There were many people who helped me. I deeply appreciate their help. I would like to show my gratitude for their supporting.

My precious experience of studying in Tulane University. USA

Koji Ao

I had never been abroad to study and I had lived with my family until that time, so I wanted to challenge to live alone in a foreign country. And medicine in America is really advanced, and I can talk with doctors patients , and others there in English. That`s why I want to study in USA and I studied in Tulane University in USA for 2 months.
 Tulane University is located in New Orleans , which is the main hospital of south part of America. About 70% of people in New Orleans are blacks. And its culture is effected by French one, so food in New Orleans is very delicious. People there also eat clowfish, which is called “ZARIGANI” in Japanese. Jazz music was born there. We hear many kinds of jazz around the city. On April, jazz festival is held there and we enjoyed the concert of famous groups. On the other hand, New Orleans is a dangerous city ; we find the tracks of gunshot. Hurricane often attacks the city.

[ About the rotation in Tulane University school of medicine]
 I rotated OBGYN for 2 weeks and Orthopedics for 4 weeks.
 I studied in OBGYN clinics in University Medical Center for a week and birth center in Lakeside Hospital for a week. In the clinic, I checked pregnant women of early phase, and GYN patients with 3 rd year students and residents; such as echo, vaginal examination, On Friday, I joined the OBGYN lecture with 3 rd year students. I had a very good experience to meet many patients in New Orleans and make friends with many students there.
 The next week, I studied in birth center in Lakeside hospital. I had to go to the hospital until 5AM, so sometimes I had to get up at 3:30AM! The student rotating OBGYN picked me up to the hospital because no bus goes there. There, pregnant women who will give a birth very soon and women after birth are hospitalized. I observed childbirth and joined C-section. In America, almost all cases are painless childbirth. That is why childbirth is very quiet and calm in America, unlike in Japan. I also joined C-section. In the first one, I met a huge patient. Soon I met huge baby which weighs more than 4 kilogram , and normal baby who weighs about 3 kilogram, they were big twin!! I realized “American Size” and I was really surprised!! I was very happy to see the childbirth and I thought that Both Japanese babies and American ones are very cute! I could rotate American OBGYN and understand the difference of American and Japanese OBGYN and the universal charm point of OBGYN.
 I rotated Orthopedics for 4 weeks. Tulane Orthopedics is divided into 5 units ; Trauma , Reconstruction , Rheumatoid , Sports ,and Pediatrics. I rotated 4 units except Pediatrics. In Trauma unit, I scrubbed in traumatic surgery. Most cases were ankle fracture. Next, in Reconstruction unit, I scrubbed in Total Hip Replacement and Total Knee Replacement. These surgeries were really aggressive and I was thrilled. I was also impressed to see the real hip joint because I also damaged my own one. Third, no surgery was done in Rheumatoid unit, so I joined Reconstruction unit that week. The final week, I rotated the sports unit. I scrubbed in hamstrings decompression surgery, and Total Shoulder Replacement. I was impressed by these ones because I rarely saw these ones in Japan. After work, the resident Dr. D. Johnson took me to beer garden! I enjoyed orthopedics rotation very much!

 I broke my leg last November, and I was hospitalized. I was not sure if I could go to study abroad. Fortunately, I could . During preparation period and in America, many people helped me. Mr. Kasuya , Mr. Hasegawa , Ms. Nishio, negotiated with Tulane university many times and advised for me. Orthopedic doctors, and Rehabilitation staffs treated me and advised for me. My parents paid hospital charges and expense of studying abroad. My friends who joined Tulane rotation from Nagoya University helped me in many situations. I appreciate for all of them. I could experience precious time for the future. I was really happy I could study abroad! I want to make the most of these experiences for the future job. If I have a chance, I want to go to study abroad again (America or other countries)!

My experience at Lunds Universitet and UPMC

Tomomi Seki

I had an opportunity to do clinical clerkships both in Sweden and the U.S. this spring.

I arrived at Lund, Sweden at the end of March. It was still really cold there around that time. I had to take a MRSA screening at first. After that, 4 weeks of my clinical clerkship at Lund University had started. No one has been to Lund University from Nagoya University as an exchange student. It was the first time. I had some hard time to prepare for it, but everyone was kind and helped me a lot. I want to say thank you to whom all I met during this program.

I chose General surgery there. They have many teams such as upper gastrointestinal, hepato-pancreatic and colorectal surgery. I joined colorectal surgery. They offered me to join operation, rounds, out-patient clinic and many other things. I was able to suture during rounds, assist the operations. They gave me so much chances to learn about surgery, medical system in Sweden and even Swedish culture. People in Sweden are really good at speaking English and I didn’t have difficulty in communicating with doctors and people in town. At the same time, I started feel like I want to learn how to speak Swedish strongly. I bought a small English-Svensk dictionary and medical book for youth, and tried to increase the vocabulary. I was sharing a room with two Swedish students at Lund University, so they also helped me learn Swedish.

I remember one doctor in colorectal surgery team. She is very very cheerful woman, and she makes everyone smile all the time. One day, the patient who had gone through an operation lost her motivation and she just stayed in her bed, not moving, not eating much food. Staff were worrying her and the doctor went to her room and had a conversation. After some time later, the doctor succeeded to change her mind! She started to take nutrition and even more, she came out from her room and went to cafeteria in the ward! Within a few days, there was a full of smile on her face. I felt that I want to be like this doctor, and I want to make people happier like her.

In June, I went to University of Pittsburgh. Dr. Doi, who is working at department of Infectious Disease there, and doing research at the same time. I wanted to learn what it is like to work in the U.S. and I wanted to study about ID. I had many chances to have lectures from attendings and fellows. There were some IDs which is unique in North America. It was very interesting to learn such things and know how doctors think when they decide patient’s treatment plan. Furthermore, I luckily got an opportunity to join academic conference, ASM Microbe. It was fun to know the world’s interest and latest research.

I had wonderful time during these clinical clerkships. I really want to say thank you to everyone who helped me and supported me.

Clinical clerkship at Medical University of Vienna

Eitaro Funada

This year, I went to Medical University of Vienna in Austria, country located at central of Europe. I studied at the department of Thoracic surgery for four weeks, General practice for four weeks, and Emergency for three weeks. I am going to tell you what I did and what I learned at each department.

【Thoracic surgery】
 The reason why I chose this department was simple. Student from Vienna told me that lung transplant is very famous (more than 200cases per year). I was eager to experience the operation of lung transplant which seldom watches in Japan. First of all, I will explain the difference between Austria and Japan. In Japan donors need to express their will to donate organs with donor cards. However, in Austria people who don`t want to be donors needs to express with cards. That is why the number of recipients after brain death is much more than Japan. Furthermore, I could find the department of transplantation internal medicine at university hospital. They take care of patients after transplant operations. I think this is another reason of difference between two countries.
 My clinical clerkship start from conference at 7:30. There are a lot of students and clinical fellows from different countries to learn transplant, so the conference is usually held in English. Though, discussion heats up and once someone start to state in German, they start to discuss in German and it was a big problem for me. After conference, my job was to checkup our new inpatients like blood test, ECG and spirometry. At first I could not do well at taking blood, and felt inferior to native student, but I practice many times and make progress.

【General Practice】
 This program is made for foreign students and I visited many medical facilities in Vienna with Nao and two women doctors from Kyrgyzstan and Uzbekistan. For example, we went to school physician, HIV care facility, sanatorium medical facility, and house for homeless people. We got some explanation and observed inside the building. Then we introduced medical system or law of our own countries and discussed the difference. It was great opportunities to know the medical system of other countries. I also went to a general practitioner`s office and stayed at his house for four days. His home was so comfortable and family treated me as real family, so I really miss them.

 At this department, I observed first medical examination of walk-in patients, then support for some medical treatment like infusion, blood gas, ECG. We took intravenous line of almost every patients, so I had many opportunities to try and improved a lot. Of course I failed many times but patients was nice to me and I thought they have good understanding to education. I also took part in nighttime and weekend emergency. I was so surprised that there was many student observing or training at off hours, and stimulated from them.

 Special thanks to Dr.Kasuya, Dr.Hasegawa, Ms.Nishio, Dr,Selemi, Dr.Hanisch, and all people who support me to study abroad. I could not have such a nice and precious time in Vienna without your help. DANKE!

Experience report -The Medical University of Vienna (4/4/2016~6/17/2016)

Nao Hatashita

I studied at the Medical University of Vienna for three months. I chose this university because I was interested in public health and general practice. I did my clinical clerkship in pediatric, general practice and emergency department.

In April I studied in the pediatric department. First, I went to the neuro-oncology department. In that department, I spoke with English speaking patients or their parents. The second half of the month, I did my clinical clerkship in NICU. In NICU, I helped doctors and participated in the conference every day. I was so surprised because patients came from various countries and many doctors can use several languages.

Next, I studied in General Practice (GP) department for 1 month. This GP program was for foreigners and all lectures were done in English. Doctors from Kazakhstan and Uzbekistan also took part in this program. We visited many places, for example, AIDS help house, school physician’s office, nursing home and so on. I really enjoyed studying in this department because I’m interested in general practice and public health. I learned a lot about Vienna’s medical system. And this program was a good opportunity for me to know about Japanese medical system.

I did my clinical clerkship in an ER department in June. Students had to take blood every day. This job was too hard for me in the beginning because I did not have much experience of taking blood in Japan. But, thanks to some medical students’ kind help, my skill improved every day. I felt very happy when patients said “Danke” to me after drawing their blood. Student in Medical University of Vienna were excellent. They had a lot of knowledge and took on things actively. I should learn from them. Other than studying in the hospital, I tried many activities like volunteer in Mcdonald house in Wien, Teddy Bear Hospital activity, a volleyball team, homestay, language exchange and so on. I learned a lot and made many good memories during my stay in Vienna. I met many wonderful people. Traveling other countries in Europe and experience various cultures were also fun. I think I will never forget about three months in Vienna.

Before I came to Vienna, I felt really nervous because it was the first time for me to stay in a foreign country for such a long time. But the life in Vienna was much more exciting than I had expected. I was lucky to have the opportunity to spend three months in Vienna and I would highly recommend the experience to any medical student looking to studying abroad.

I’m grateful to everyone who had helped or taken care of me. Thank you so much.

My experience at Medical University of Gdansk

Junki Kobayashi

Dzien dobry! Hello! My name is Junki Kobayashi. I am a medical student from Nagoya university in Japan and have studied in Gdansk Medical University for three months.

First of all, I must write about the biochemistry class. As you know, Mr. Michal Wozniak is the professor in this department and also our coordinator. Soon after coming to Poland, I and my roommate Yuki were worried and felt lonely. But he helped us to adapt to the new environment, so we could have a great time soon. For example, Professor Wozniak invited us to his house, and then introduced his family and served nice lunch. In addition, he introduced me to the professional rugby team, called Ogniwo Sopot. So, I could play rugby in Poland and improved myself as a rugby player. I really appreciate him for taking his time. I want to reward him someday.

Secondly, I would like to explain what it was like to take medical training in Poland. I was impressed by a lot of things. First, I was so surprised that other medical students of English Division and Erasmus could speak not only their mother tongue but also other language like English fluently. At first, I couldn’t listen to what they said even in English and so hesitated to speak to them. However, all of them kindly accepted me and became friends with me. I felt they were much more motivated and ambitious than students in Japan. Second, doctors were also intellectual and kind. I took medical training at departments of Dermatology, Tropical medicine, Clinical Allergology, Geriatrics, and Family medicine, and I was amazed by the componence of doctors. When I ask doctors questions, they kindly answered and eagerly taught me about other things that were related to them. And they always took care of me and asked me many questions. Thanks to them, I got many knowledges about medicine. Third, I realized differences between doctors in Poland and those in Japan. Many Japanese doctors work in order to earn money and win honor, on the other hand, doctors in Poland work due to make their lives, and they have to get knowledge and experience in order to compensate for the lack of medical instruments. I felt doctors in Poland were working more diligently than those in Japan, and I strongly think that we Japanese need to emulate them. I learned not only medicine but also what we should be as doctors. I surely make good use of these experiences for my future.

Thirdly, I would like to introduce my daily life in Poland. On weekdays, I often went to the training gym near the dormitory in order to train myself after classes. After that, I practiced rugby in the professional team, Ogniwo Sopot. Although I wasn’t a good player, they allowed me to participate in practice, and gave me the chance to play rugby matches. Moreover, I could make many friends in this team. At night, I and Yuki often drank with friends in the dormitory and they taught us how tasty wodka was. And, needless to say, I studied for the exams! On weekends, I did many kinds of things such as going on trips to other cities in Poland, playing rugby matches, and drinking with friends…etc. All of them are good memories.

Finally, I would like to introduce Poland. The most impressive things in Poland were the beauty of the country and the warmth of people. There was lots of nature and beautiful townscapes in many parts of Poland, so I could enjoy walking around the towns and feel relaxed in forests. And I could make much more friends than I had expected. We drank and played games through the night, went on a trip to the old town in Gdansk and Poznan, and had a heart-to-heart talk about our dreams. Now I miss all of people I met in Poland very much and hope to see them again.

If I hadn’t come to Poland and had spent three months in Japan, I couldn’t have had such a great experience. I strongly encourage my junior students in Nagoya university to study in Poland. I wish I could go back in time and have a dream like time in Poland.

My experience at Medical University of Gdansk

Yuki Sunohara

This time, making use of the student exchange program, I’ve been to the Medical University of Gdansk with Junki Kobayashi. I myself was on the first trip abroad, so I was mixed with excitement and anxiety. Now we’ve finished our practice and been back home safely, and my mind is full of achievement, satisfaction, and gratitude toward many people who supported me. During this 3 months, I rotated Biochemistry(2w), Psychiatry(1w),Neurology(2w),Haematology(2w),Surgery(3w),VascularSurgery(1w),Clinical Allergology.

We were sharing an old room in the Student dormitory No.2, located in the Campus site. The first thing we did in that dormitory was greeting around and giving them a souvenir. It was very effective, and after that we got to know many students. We were given much care and attention by them, and that felt my heart.

I studied Psychiatry at first. The class was held at the special hospital, 5km away from our dormitory. Its appearance reminded me of Shiroyama Hospital, in Nagoya. Basically the style of classes here was comprised of 1~2-hours lecture and medical interview by assigned group, through doctors’ translation. My first patient was with schizophrenia. It was really hard to catch his history, because of my unfamiliarity with Polish English(They sometimes clearly pronounce R) and complicated context of his story. With the help of my group member, I was barely successful of making me through. Here in Poland, it appeared they have many alcoholic patients, thereby we performed medical examination of these symptoms, including Wernicke-Korsakoff syndrome.

My second rotation was Neurology. I studied a lot about Neurodegenerative disease like Huntington’s disease, corticobasal syndrome; cerebellar atrophy degeneration, demyelinating disease like multiple sclerosis; and infantile epilepsy. I luckily got good individual lessons about neurological examination. Among them was some English speakers, I finally could take easy medical interviews by myself after 3 weeks. That was the most impressive and fruitful practice during this 3months.

Another impressive department was Surgery. Cases there were really new to me; they were hepatic echinococcal cyst, and huge splenomegaly. However, their ideology about hygiene was laxer than Japanese’s one; we had to push down the nozzle of disinfectant by hand, and the paper to wipe our hands was the same thing as the one in the bathroom. At the end of the week we had presentation about something what we were interested in. I was so nervous, but I made it.

One more thing to note in our practice, there was an instruction of Biochemistry from Professor Wozniak. The theme was the substances which protect nerves, and promote memory amelioration. We had a chance to demonstrate it on the international symposium with Italy and Japan, out there we welcomed Prof. Wakabayashi, ex-professor of GUMed, Dr.Kasuya, Dr.Kondo, and Dr. Gerry, graduate student of Nagoya Univ. They seemed to miss the old days there, over some stories about their life in Gdansk.

Outside school, I played futsal with Surgery’s professors twice a week; I also ran the full-length marathon. Sometimes it is inconvenient in rural area, with no English guides or speakers. On the other hand, in the town we can easily find English-fluent people, so I didn’t felt much inconvenience on its all process to run.

We also communicated with student there. In GUMed there are many students mainly from Europe. (Some of them are in the English Devision, others are making use of Erasmus program.) They taught me a lot about the difference of value between countries to countries. They tend to put more weight on the balance between job and life. They also had stronger desire to be rich. One thing I’ve got beaten was their extraordinary English skills, on the different level compared with Japanese’s one. They humbly said that’s because the order of sentences are the same, or the origin of the words are common and so on, however I thought we Japanese, even usually poor English speakers, have to switch on the practical conversation-style education and gain the skills.

Last but not least, Polish students are really kind to us. They often invited us to their room and offered us a bunch of vodka glass. Outside the dormitory we played the game to win the beer can, I remember. I hear that they tend to work outside because of the low price of Poland, but I’d really like to meet them again when I visit there next time.

Looking back on this 3months, we were followed with series of events. Many of them are awesome. But sometimes I felt much stress from the difference of lifestyle, awkwardness of my English, and some unnecessary issues from outside. However, we could get over cooperating with each other. Like this way, sharing special experience with Japanese students is the one of the great elements in this 3month in Poland, I guess.

I’d like to give best regards to prof. Wozniak and teachers in Biochemistry department(Adam),Dr.Kasuya doctors of the Office of International Affairs, lots of friends we got to know during this stay (especially Yanusz, Piotr, Fillippo, Armando, Maciej, Szymon, Karolina, Duane, Dinal, Alvaro, Izabel), aunties in the dormitory, and Junki Kobayashi. Thank you all!

My experience in Freiburg (Germany)

Ryota Kiriyama

I was allowed to do clinical clerkship in Freiburg University to study from 4th April to 24th June, which is in South West of Germany.

I rotated Neurosurgery, General Surgery and Plastic&Hand Surgery, so I can rotate three departments in three months.
 At first, I visited Neurosurgery for four weeks. Neurosurgery in Freiburg University is in a Neurocenter, which is a special ward for neurogical disease, and this department is very huge because they has six private operation rooms and operates more than three thousand cases. The main practice was to observe the operation, but fortunately Thai Neurosurgeon also came to study at same time. He has undergone a lot of cases as a Neurosurgeon, so he told me about operation and disease. I could observe many cases of epilepsy and Brain tumor because Neurosurgery in Freiburg University is famous for epilepsy surgery. I experienced a lot of cases, which contain from a major disease to a rare disease.

The next month, I rotated General Surgery in the city hospital not in the University hospital. At first, I was told that I cannot rotate General Surgery. Therefore, I asked Freiburg University foreign office that General Surgery was my most interesting department, so I wanted to rotate. Then I was allowed to rotate General Surgery! After this, I felt it was important to claim my own idea. The practice in the city hospital was different from that in he University hospital. I was able to practice as a member of team and I could participate in a lot of cases (2~3 cases/day). There were a lot of Gallstone, Colorectal cancer and Hernia operation because German foods have many meal dishes. In addition, I was able experience almost all common diseases such as appendix and ileus.

In my last term, I rotated Plastic&Hand Surgery for four weeks. The doctor of Plastic&Hand Surgery told me that the technique required for Plastic Surgery was very similar to Hand Surgery, so they were same department. They did many kinds of operations. For example, facial nerve paralysis, soft tissue tumor, skin defect, carpal tunnel syndrome, bone fracture, breast enlargement and rhinoplasty. I could also observe outpatient clinic and the doctors explained about patients through Xp, CT and MRI.

A life in Freiburg enriched my heart and I learned a lot of important things through this program. I've felt strongly the support and warm hospitality of many people. Although doctors were very busy, they listened my poor English question and answered them carefully. Furthermore, people in the town and in the resident tried to understand me not to desert me, who cannot speak German. I’m very happy because I could do clinical clerkship in such a good environment, so I should make use of this experience to my future.

At the end, I really appreciate Dr.Kasuya, Dr.Hasegawa and other staffs of Office of International Affairs, and all people who supported me. Moreover, I would like to thank a lot of people in Freiburg.

Studying abroad in Freiburg

Genki Nakamura

In 2016, I could join this clinical training program and studied abroad for about 3 months in Freiburg University in southwest area of Germany. At first, I was so interested in studying abroad in Germany because Japanese style of medicine had been introduced from that of Germany. For this reason, I started to think that I wanted to go there and finally I could get the chance to take part in this program. I knew this program before entering Nagoya University in the first place, so I was so happy that I could study there.

In this program, I rotated cardio surgery and trauma surgery in Freiburg University hospital, and general surgery and Anesthesiology in Diakoniekrankenhaus, one of the private hospitals near the University. In addition, Germany has similar and different points in education for medical students. Germany has 6-year education for them like Japan, but 6th-year students in Germany work and get a little money in hospitals like Doctors. Japanese style of medicine was introduced from that of Germany, but each country has different style in some terms. Then I will write about each clinical training in Freiburg.

Firstly, I rotated the general surgery for 4 weeks from 04.04.2016. Roughly we did short rounding, conference, rounding and operation or ER. The rounding was German so it was very hard to understand this. These cases were mainly inguinal hernia, GERD, cholecystitis, colon cancer, and thyroid tumor and so on. I could often wash my hand and go to the table, and help such operations. In ER, I could help many kinds of cases such as bone fracture, some disease in psychiatry, and appendicitis.

Moreover the doctors in general surgery was so friendly that we went diner and enjoyed beer together some times in 3 months.

Next, I went to trauma surgery for 4 weeks, and there we did rounding and conference and after that I went to operation or ambulatory practice room. In operation room, I helped some operation with my hand washed such as radial bone fracture, pelvic bone fracture, spinal surgery and so on. In ambulatory practice room, I could learn neurological examination with the professor in spinal surgery.

In cardio surgery I stayed for only a week, but it was so incentive for me. I joined conference, lecture by the professor and some operations. The operation of artificial heart was so interesting for me. In this department, I was always with the professor and I could get the chance to go to the heart center in Freiburg University with him. He told me that this center was biggest in Europe. And there I could help or see some heart operations.

Finally, I studied Anesthesiology in the private hospital for 3 weeks and there I joined the conference and after that I helped and see the anesthesia in operation room.

In this department, I was trained for diagnosing ECG and did some procedures such as intubation, V-line, NG tube, and setting respirator. These cases were about general surgery, orthopedics, obstetrics and gynecology and so on.

Through my clinical training in Freiburg, I could not only learn many things about medicine but also become more assertive and more confident. I will draw on this exciting experience, and I am going to get ‘gold medal’ in the field of medicine for saving many people in the world.

Now, I would like to express my gratitude to Dr. Kasuya and Dr. Hasegawa and other staffs of International Affairs, and all people who supported me. Thank you so much.

My Intern in BUMC and SJTU

Yasushi Aoyagi

Visiting and studying abroad has opened my eyes to new insights that I would not have otherwise gotten in Japan. During my time in the States, I realized just how much I could learn from other cultures. However, when I started reading papers and using advanced medical devices, I found that much of it was in English. From these experiences, I realized the importance of mastering my English. Thus one of my primary motivations for applying to this program is to have a chance to be surrounded in an English speaking environment. I found that when I was in the States, I could practice and improve my English, particularly my medical English, dramatically. In Japan, I live in an international resident house, so I could practice conversational English. But, it was a completely different experience when I shadowed in Stanford Hospitals. I felt like I had to get accustomed to native medical English.

I would like to come to the States to continue practicing my English. I was fortunate enough to shadow Professor Michael Federle at the Stanford Hospital, who introduced me to many insightful views. Radiology continues to be my passion. From my summer experiences and interests in 2015, I would like to apply to a study abroad program in the States.

In East Coast, Toronto, New York, and Harvard medical school are famous in a radiological field. However, BUMC I visited is class 1 trauma center in New England so there are tons of cases. To read these, I came to Boston.

Actually, this is my first time to join the radiological intern as a full rotation. But, the lectures residents did are basic one : chest, abdominal, MSK, pediatric, neurological and nuclear medicine. I could learn the systematic approach to image interpretation. During stay in Stanford, I could observe only GI reading. Thus, this opportunity was impacted on my memory.

Secondary, I could talk with physicist working on Rads-on. That was also impressive because there are much MD in Japan. But, here in Boston (maybe States) physicists work and give a lecture fortunately.

When I lived in Nagoya, I interacted with many of the Chinese locals and believe that speaking Mandarin is an important skill in today’s world. During my summer program at Stanford, I made friends with my roommate from China. I’d love to go visit him back in China someday.

China is also interesting because of its large population. With With over 1.3 billion people, China has higher chances to encounter rare disease like Gaucher disease or Albino, and it has brought us important insights into uncommon diseases. In addition, I’m interested in international medicine – where hospitals accommodate out-of-country patients. If possible, I would like to visit both Shanghai and Beijing. From this reason, I came to SJTN in this summer 2016. This is first time to come to Shanghai.

My first clerkship is department of Radiology I’d love to. This was 3 weeks rotation. I could stay from 7:45 to 19:00. The attending is high caliber in language as well as radiology. I was impressed with that. However, I tried to join the clerkship as much as possible. For example, I joined holiday as Emergency Radiology. I studied KUB, chest radiograph, ab radiograph, MSK. The amount was someday up to 147 images. So tough work.

Then, next is TCM department, mainly TCM oncology. This was 2 weeks rotation. I joined clerkship with Serena from Rochester, New York. We joined table round, and see patients. The medical interview and physical exam are different from WM. In TCM area, tongue and blood pulse are important. I checked them when taking physical. In addition, we could see massage department we could do hands-on, moxibustion. There are other department like acupuncture. We can see how to stink the needles to meridian point. Totally, I could study a lot like the basic theory of TCM, 5000 year history of TCM, and taking medical history of TCM. Everything is authentic.

Then, neurosurgery.This was only 1 week rotation. I did finally stitch up overseas. It reminds me of the days in Japan. Something new and interesting. Practice and make my hands smooth were as important as language. I cannot forget this good memory forever.

Then, respiratory. This was 2 weeks rotation. I joined this with 4 students. Rotation is table round, walking round. And students take EKG with nurses. I could see the case report in Japan. I interpreted it for my attending. That was my great job in this department.

The last one, hypertension department and Shanghai Institution of Hypertension. This was 3 weeks rotation. The rotation is table round, walking round in the morning and follow the attending. In the afternoon, I joined outpatient clinic someday or went to Shanghai Institution of Hypertension to learn about some etiology and techniques and procedures for research.

My experience in Taiwan

Katsuya Yamaguchi

I went to National Taiwan University to study medicine for 12weeks. Taiwan is closely related with Japan, and NTU was founded by Japanese government in Japanese colonial period. I wanted to go to NTU from before, because I heard that medical education in English is popular in Taiwan and I wanted to improve my English skill. In NTU Hospital, I studied about radiology, Obstetrics, Gynecology and Anesthesiology.

In radiology department, I attended morning conference, took lectures and saw catheter treatments. I had good chances to see cerebral blood vessel’s catheter treatments and TACE.

In ObGyn, I took lectures with NTU’s students, and took part in the cases of c-sec and vaginal delivery. After that, I saw many cases of amniocentesis at the clinic in Taipei city. In Taiwan, amniocentesis is more popular than Japan. I heard that some Japanese patients come this clinic to take amniocentesis. I think Taiwanese obstetricians have a great skill of amniocentesis.

The last department was anesthesiology. There were various cases in NTUH’s operation rooms. I saw many types of anesthesia; open chest surgery, c-sec, pediatric anesthesia, heart surgery with heart-lung machine. They were great experiences for me. I saw that NTU’s anesthesiologist took part in some operations at the same time. It was so surprising for me. On last day, I got a chance to present about Japanese anesthesiologist and Japanese medical school life. I introduced about Japanese medical office system, part time job for university’s students and club activity in our school.

On the whole time, I had so exciting experiences in Taiwan. Local doctors and students can speak English fluently and very kind to me. I will make use of this experience in my future.

In the end, I want to say thank you very much to stuff of international affairs office, educational affairs section and scholarships office. I’m grateful to all of your help.

My experience in Taiwan

Yuki Karasawa

Hi! I’m Yuki KARASAWA, a 6th grade medical student in Nagoya University. I had a great experience to take part in the student exchange program between National Taiwan University and Nagoya University (NTU) from 14th March to 4th June. Especially thanks to Ms. I-Wen Chang, a Teaching Assistant from NTU, College of Medicine, she had contacted me through E-mail and kindly helped me to decide the schedule in NTU and staying at the Jing-Fu Alumni hall.

I arrived at Taiwan on 28th April and I planned to study speaking in Chinese at TLI (Taiwan Language Institute) for two weeks before the NTU exchange program starts. It was very helpful for me to acquire Chinese speaking and listening ability and I totally used not English but Chinese during staying in Taiwan.

My first four weeks of rotation was at the Department of Emergency Medicine(急診部). Assistant Professor Rui-Sheng Yan enthusiastically welcomed and assigned me to the lecture program of 6th grade, practical training at Emergency department, getting on an ambulance with ambulance service at night time, and so on. They all kindly showed and told me about the Taiwan Emergency system, which is different from Japan to some extent. For example, their ambulance service has three grades, EMT-1 (Emergency Medical Technician - 1), EMT-2, and EMT-P. They say what they can do is limited according to the grades and also which team to take a patient to the hospital. For example, if a emergency patient is considered to be triaged as very severe, EMT-2 and EMT-P will go to the site and they decide which team is appropriate to take the patient to the hospital at there, and the team which is not assigned to transport will go to the next site. Another thing I’m surprised is that there are too many walk-in and emergency transported patients at the NTU hospital that there are many beds and stretchers even on the isle of Emergency department!! Which looks as if there are disasters everyday! Of course, it is usual for them but it was one piece of my eye-opening experience.

My second four weeks of rotation was at the Department of Family Medicine (家庭醫學部). Dr. Shin-Yu kindly assigned my schedule to participate in the lectures at outside hospitals and have opportunities to see outpatient interview. At the outpatient section, there are some interesting special departments, for example, obesity clinic, smoking cessation clinic, travel medicine clinic, and so on. What I’m interested in was that at the travel medicine clinic Dr. Shao-Yi Cheng showed me how to find what kind of treatment is needed for the patient who would go abroad, and this knowledge would also be helpful for me in future.

My third four weeks of rotation was at the Department of Pediatric Medicine (小兒部, two weeks) and at the Department of Obstetrics and Gynecology (婦產部, two weeks). Dr. Chin-Der Chen kindly welcomed me and arranged me to see OBGYN department and Dr. Hsin-Hui Yu to Pediatrics. What I was surprised about Taiwanese OBGYN was that they conduct the amniotic diagnosis to almost all pregnant patients! In Japan, there is ethical problem about amniotic diagnosis, and it is prohibited to choose the abortion for the reason of genetic defects. But Taiwan allows them to choose abortion.

Last but not least, I’d like to show my best gratitude to the school members of National Taiwan University, all the Taiwanese people who kindly helped me, roommates at Jing-Fu alumni hall, and exchange students from Japan and other countries. I was very happy to have such an once-in-a-lifetime experience!

My precious experience at The Chinese University of Hong Kong

Kota Hiraga

I studied at The Chinese University of Hong Kong in June 2016. I was a little nervous because no one who is a student of Nagoya University school of Medicine has never been there for study. Although I stayed in Hong Kong for only one month, I deeply feel I had precious experience there.

Medical system of Hong Kong was interesting. There are roughly two types of hospitals in Hong Kong. One is public hospital and another is private hospital. When you visit a public hospital, you will pay only about HK$100. Even when you took big surgery, you will pay almost the same price. However, you have to wait for long time in public hospitals while the price is cheap. You have to wait for more than half a year to visit outpatient clinic of Prince of Wales Hospital which I practiced at. It was strikingly impressing that a patient told us that he recognized his tumor before but he had to be wait for more than six months to visit the hospital. If you want to go to the hospital without waiting, you can choose private hospitals. However, you have to pay much more money in private hospitals than public hospitals. Therefore, you have no choice but to wait unless you have much money. A patient who had choledocholithiasis said that she had to wait for more than nine months to take the operation because she didn’t have enough money for visiting a private hospital. I keenly felt how generous Japanese medical system’s support is.

Hong Kong was a British colony. Therefore, Hong Kong medicine is strongly influenced by British medicine. A teacher told me that British medicine puts an emphasis on physical examination. Teachers actually taught students about physical examination enthusiastically. They had students do inspection, auscultation, palpation and percussion to outpatient. Then, they ask students about differential diagnosis and what to do next. I thought what Hong Kong teachers taught was so practical.

It was impressive that all of the teachers and students could speak English. This is because they couldn’t enter universities unless they could speak English. They can speak Cantonese, English and Mandarin Chinese. I sometimes felt ashamed not to speak even English fluently. After knowing that they can speak at least three languages including English, I came to think it is natural that you can speak English.

During my stay in Hong Kong, I tried to learn as Hong Kong students did. However, I could learn less than they did because I couldn’t understand Cantonese. Teachers sometimes used Cantonese for teaching. I regretted that I didn’t learn Cantonese before going to Hong Kong. I strongly felt that the preparation is the most important for studying abroad.

I rotated Upper GI & Metabolic Surgery. What made me impressed was that there were many Japanese technologies. I was also surprised when teachers told me that they learned many surgery or endoscopy skills in Japan. I had never thought Japanese medicine was high-level. I could look at Japanese medicine while I came to know some foreign people thought Japanese medicine was better than their medicine.

Although teachers and students could speak English, almost all patients could speak only Cantonese. I couldn’t learn anything without Hong Kong students. There were many Hong Kong people who like Japan. They supported me many times. Many people were interested in Japan, and had been to Japan several times. I felt pleased and proud of being Japanese. On the other hand, I keenly felt how little things I know about Japan when I talk with them about Japan. I sometimes could answer their question about Japan. I thought that I should have learned Japanese culture more.

I got chance to think back about Japanese medicine and culture while I learned medicine of another part of Asia and interacted native people. It was precious experience that I could look at my country objectively. I got to think studying abroad is just not for leaning a language. During my stay in Hong Kong, I feel I could broaden my horizon. I will surely make use of these experiences.

I couldn’t go to Hong Kong for studying alone. There were many people who help me. I deeply appreciate their help. I would like to show my gratitude for their support.

Flinders Medical Centre

Koki Morita

I went to Adelaide, capital of South Australia, and I did the clinical placement at Flinders Medical Centre (FMC), which is associated with Flinders University. I’m going to talk about Adelaide, FMC, my clinical placement and my life in Adelaide.

First of all, I’m going to talk about Adelaide. The population is about 1 million people. There is beautiful beaches in the west, and nice hills in the east of the city. Many people from different countries live in Adelaide, people are nice and Adelaide is a very safe city. So it’s very easy to live there.

FMC is located in the south of Adelaide, one of the biggest hospital there. It has 580 beds, co-located with Flinders University and the 130 bed Flinders Private Hospital. Approximately 74,000 people attend the ED each year. Its equipment is big and There are many doctors, so I felt ED there is more developed than Japanese ED. There are about 60 doctors working in ED and they work 10 hours time-shift. Teaching seminar is often held every week, doctors present interesting cases each other or do simulation training using a model. I felt ED in FMC is developed and has good system about teaching.

As for my clinical placement, for the first 3 weeks, I did shadowing which means I followed one of the doctors and see patients together. After that, I started to see patients alone. I took medical history, did physical examination and presented the case to one of the doctors. Then, I saw the patient with the doctor together and got feedback. In addition to that, the range medical student can do to patients in Australia is wider. So I tried the new thing for me, for example establishing an intravenous line, suture and so on.

Doctors are very kind, although my English is not so good, doctors tried to understand me and tell me with plain English till I could understand. In addition to that, doctors always said hi to me, and every time after working, they always said to me “Thanks for your help”. They treated me like as one of the doctor, so I got the confidence to work there.

Also I met the doctor I should aim to be like. He is always nice to not only patients but also staffs. He always tries to think about what is the best for patients. He told me what is important when I work as a doctor.

I enjoyed the life in Adelaide very much. I shared a house with two guys born there. They are very kind to me, spoke to me a lot of times, invited me to some parties and events and took me around in Adelaide. Thanks to them, my English improved and I could know well about Adelaide. In addition to that, I touched their way of thinking and that made my world wider. It is unforgettable.

Actually I felt nervous before I left Japan for Adelaide because I thought my English was not so good and my knowledge of medicine was not good enough. But many people helped me, and thanks to that, I learned a lot. This experience will absolutely have a good effect on my future.

I cannot thank everyone I met in Adelaide and the staff of the International Office enough for their support. I hope I can go back and study there again.