Office of International Affairs Graduate School of Medcine Nagoya University

I rotated in the Oncology Department and Endocrinology Department of Johns Hopkins University Hospital for a clinical elective for 4.5 weeks each. I then visited the Ophthalmology Department of Massachusetts Eye and Ear Infirmary, which is a teaching hospital affiliated with Harvard University Medical School, for 3 weeks as an observer. Just before the departure at the end of March this year, I felt nervous about many things, which turned into a good memory now. I am very grateful to the faculty members and administrators at the Office of International Affairs of Nagoya University Medical School, doctors and students of Johns Hopkins University Hospital and Massachusetts Eye and Ear Infirmary, host family, and my parents for their strong support. I am also grateful to the Tobitate Ryugaku Japan for their generous financial support.

In the Oncology Department of Johns Hopkins University Hospital, I first rotated in the Solid Tumor Team for the first 3 weeks and then switched to the Leukemia Team for the following 1.5 weeks. I mainly participated in the inward service where I was assigned to two or three patients all the time. I checked all data and notes, saw the patients, presented the cases at the Morning Round every day. The works at the Oncology Department were very tough for me because there were so many patients who were in very severe medical conditions. One patient received Cisplatin for his esophageal cancer which made him throw up 20-30 times one night. Another patient had a chronic pancreatitis caused by PD1 inhibitor, Pembrolizumab. She had a very severe pain on scale of 10 out of 10 for many days because small amount of opiates were not effective anymore.

The second department in which I rotated was the Endocrine Department. In the Outpatient Clinic, I saw patients and presented the cases to the attendings before their examination. The examination and note writing of new patients were difficult because I had to pick up important information from the documents provided by their primary care physicians, talk with patients, and write notes. On the previous day, I checked the medical conditions of all the patients of the attending who worked with me on the next day. In some cases, that enabled me to do good history taking and physical examination, however in other cases, I struggled with getting important information and writing organized notes in such short time. In the consult service, I saw patients consulted by other departments with a fellow, helped writing consult notes, and had presentations in front of an attending. The cases which I saw include follow-up of post pituitary surgery, hypercalcemia, and adrenal insufficiency induced by PD1 inhibitors. When I wrote consult notes. I felt that not only my knowledge about medicine but also my writing skill in English was not sufficient to make perfect notes. What attendings pointed out during the fellows’ and my presentations was based on decent evidences and very beneficial for my studying.

During the last 3 weeks of my stay in the U. S., I visited the Retina Team of Massachusetts Eye and Ear Infirmary as an observer. In the Outpatient Clinic, I saw age-related macular degeneration, retinal detachment, Von-Hippel-Lindau disease, Vogt-Koyanagi-Harada disease, retinopathy of prematurity, and so on. As for surgery, I saw scleral buckling and vitrectomy. During my visit, the Harvard Ophthalmology Annual Meeting was held, and I could listen to many exciting lectures which cover latest surgical techniques, cornea donor program in Syria, development of enterococci, gene therapy for retinal disorders, possible etiology of Nonarteritic Anterior Ischemic Optic Neuropathy, and retinal prosthesis system, etc.

The differences between U.S. and Japan that I noticed are as follows. First, in America, the separation of each duty among doctors, nurses, and other workers is prominent. In every Morning Round, social workers were suggesting to the doctors which rehab or hospice patients should be delivered to. There were nurse practitioners who did bone marrow biopsy. What doctors do is examining patients, getting information by checking data, ordering necessary procedures and drugs. Taking lines and injecting drugs were done by nurses. This separation of each duty among doctors, nurses and other workers gives doctors more time for research and family life.

Second, many painkillers were used in the U.S. Especially, oxycodone was even used just for suspected arthritis. In bone marrow puncture and biopsy, fentanyl was injected as well as lidocaine.

Third, patients were different. Of course, patients’ personality depends on the individual. However, if we generalize it, Japanese patients tend to be submissive to doctors. In the outpatient of oncology, patients’ family examined many options in advance and asked doctors many questions.

Fourth, outpatient and inward services were also different. As for the inward service, the duration of stay was much shorter in America. In the round, doctors always discussed when patients should be discharged. There was a service called IPOP which gave bone marrow transplant in outpatient service. Conversely, in the outpatient, doctors spent a lot of time, often 1 hour, for each patient. Because students and fellows see patients as well, the total duration of examination was much longer than in Japan.

The fifth point is about education. After graduation of medical school, there are organized residency and fellowship programs in the U.S. The quality of each residency and fellowship program is monitored by an independent organization. In Japan, education for doctors really depends on each hospital, so there is a significant difference in the quality of education among hospitals. In the U.S. it is more uniform and systematic.

As for medical research, there are some merits in the U.S. The equipment and devices are cheaper in America. There are many collaborations between doctors and researchers in other fields like IT and pharmaceutical industry. One doctor said that Japanese doctors should collaborate more, because Japanese engineering is advanced. In addition, researchers can use a lot of money because of donation funds like chair of research.

Finally, this experience was one of the biggest events in my life. I could learn many things, which was only possible by visiting the two hospitals in the U.S. It was rewarding for thinking about my future career. Before going to the U.S., I vaguely felt that medicine in America is much more advanced than in Japan. However, I felt that the level of medical care and the diligence of doctors and other workers in Japan are not far behind the U.S. I am now proud of being Japanese. In the future, in addition to working as a doctor, I want to improve the system of Japanese medicine.

I would like to thank all the people who made my visit to the U.S. possible.

One of my biggest dreams is to become a great research-minded doctor. To achieve this goal, I joined this exchange program and clinical clerkship in Johns Hopkins, from two perspectives: problem-solving capability and career planning.

My main reason for this exchanging program was to put myself in the challenging environment at a foreign university and to make myself more active. Compared to the system of medical school in Japan where students only digest scheduled curricula in the syllabus tamely and passively, medical schools in the U.S. let students coordinate their clinical clerkship more autonomously. Students worked as an individual who can assess the patient’s condition and map out essential clinical tests and remedies. Aside from this, students also honed technique on how to give an effective presentation to their team, hopefully leading to better discussion regarding their patients in charge and advanced medical treatment among multiple specialized professionals. Through this observation, I got to be more confident in solving problems in any environment.

The other purpose was to take my career choices to higher level. Having graduated from a university and received education in different fields, I have dwelled on how I can maximally utilize my academic background and past experience for my future career. As opposed to the case in Japan, such backgrounds and experiences were not only naturally accepted but considered as a favorable precursor to gain better outcome in the U.S. Medical students and doctors in the U.S. were embodiments of the highly designed profession reflecting their backgrounds and experiences. Through communication with the foreign students and doctors, I learned factors affecting their careers.

Though I had many precious experiences in Johns Hopkins, the most unforgettable one was seeing the young female patient with fibrolamellar hepatocellular carcinoma, a disease specific to American people. Her cancer was unresponsive to any therapies and metastasized to her lung, letting her live on a ventilator. Moreover, her limbs got so swollen (due to anasarca) that she could not walk. She and her family chose terminal hospice care in her early 20’s. I could not forbear weeping every time I would visit her room in the morning round.

One day, I was hailed by her mother. She squeezed my hand tightly and said to me, “I really appreciate your warm heart…”
This experience made me realize how important it is for doctors to build a strong relationship with their patients and their patient's family.

Overall, my rotation in Johns Hopkins was fruitful for me. The whole system regarding the inpatient and outpatient service was totally different from that of Japan. American people including doctors, students and even patients are more independent and incentive in order to make their lives productive. Also, they are opinionated people, as they would insist on what they want to do with their medical conditions.

All in all, this exchange program further enhanced my motivation and resolve in becoming a better doctor. I am grateful for all the people I worked with in this experience. I'm sure that all the knowledge and experience I gained will pave way to a brighter future ahead.

I am very honored to have an opportunity to visit Duke University and McGill University, which are both world-renowned for their excellent clinical practice and research. In this report, I will talk about what I experienced during the whole program in five sections: “Clinical Elective at Duke”, “Life in Durham”, “Clinical Elective at McGill”, “Life in Montreal” and “What I learned through the electives.”

1. Clinical Elective at Duke

At Duke University Hospital, I spent one month at Hematology and Oncology Department. Before I start talking about what I did as a visiting medical student, I think it is better to explain what oncology is like in the U.S. in advance to facilitate the understanding of what I will cover in this section.

Firstly, in the U.S., all cancer patients see an oncologist to get a treatment, and an oncology department gives their patients not only outpatient care but also inpatient care. Usually, an oncology department consists of several divisions according to organ systems or diseases, such as pulmonary oncology and malignant hematology, thus making it possible for each specialist to see patients with a cancer of their field. When it comes to Japan, each department sees patients with organ-specific diseases but there is no distinction between benign and malignant diseases. In the U.S., on the other hand, malignancy is clearly distinguished from benign diseases and oncologists see only cancer patients; other specialists benign illnesses. For example, Duke University Hospital has Duke Cancer Center, a facility just for oncology department, where all oncology clinics are located and patients get ambulatory treatments.

Since it was a clinical elective in an outpatient setting, I went to five different clinics depending on the weekday: GYN, GI, Malignant Hematology, Malignant Hematology and Benign Hematology respectively from Monday to Friday. What I actually did each day was like the following. When I visited a clinic in the morning, an attending assigned me several patients from his/her schedule. The next thing I do was collect information about a coming patient via medical records beforehand and independently saw the patient by taking medical history and doing physical examinations. Then, when I finished a presentation about the patient to the attending, we went back together to the examination room and here was the attending’s turn to see the patient. After the whole patient visit, writing a progress note is the last thing I did. Then I started preparing for the next patient and repeated the whole process. Since most of the patients came for a return visit, I, naturally, got to see a lot of return patients. However, I sometimes had a chance to see a new patient. It was a bit tough because I had to read but, at the same time, it was an experience full of excitement. Attendings there were working really hard but always friendly and instructive enough to give me feedbacks after my presentation or a patient visit. The fact that there was no other student in the same rotation is the only thing I feel sad about, but, overall, I am quite satisfied with this elective because I was able to see a lot of patients with different types of cancer and get a picture of what cancer patients are like in terms of symptoms due to cancer itself or side effects. Another thing that was satisfactory to me is that I had a chance to visit Sickle Cell Disease Clinic due to absence of an attending I saw every week that day. As you know, sickle cell disease is quite rare in Japan, so it was a really precious opportunity.

As a visiting medical student from Japan, all the things I saw and learned at Duke were literally full of surprise, but among them I have three things I found especially surprising and worth sharing with you.

The first thing I want to tell you is that there is a healthcare professional called a physician assistant (PA), who works closely to a doctor. According to Merriam-Webster, “physician assistant” is defined as “a person certified to provide basic medical services usually under the supervision of a licensed physician.” As it looks, PA’s could have a wide variety of roles and actually I have no idea what they do in other hospitals, but in Duke Cancer Center, a PA works with an attending and not only manages his/her schedule and does paper work but also even sees some return patients independently. In this way, splitting tasks and lessening each burden enables things to go smoothly and efficiently.

Secondly, there were a lot of clinical trials going on very actively. When I walked through a hallway of a clinic, I found numerous bulletins on the wall that called for enrollment in a trial. What was more surprising is that there were offices only for clinical trials on each floor and people working there were involved with management of enrollment and requirements of each trials and collection of data from participants. It is almost impossible for doctors to remember all complicated requirements of each trials, do more frequent evaluations than usual and deal with a lot of documents necessary for trials, while doing everyday clinical practice. Here you can see that splitting tasks now leads to maintaining the momentum of numerous clinical trials going on at the same time.

The last surprising fact is about complex health insurance system in the U.S. People in the U.S. usually get a private health insurance to cover expensive medical costs, although there are some public health insurances like Medicare, which is for elderly people aged 65 or more and Medicaid, which is for those who have a low income. What is more, each state has different insurance companies that are offering different insurance plans, so this means what kind of medical service you can expect to get totally depends on which plan of which company you are enrolled in. Here is a story. As I mentioned above, every Tuesday I went to GI Oncology Clinic, where one of the attendings I worked with often saw patients with neuroendocrine tumor (NET). As a new third-line treatment for NET, Lutathera®, a radiolabeled somatostatin analog, was approved by FDA on Jan 29, 2018. However, as of April 2018, when I was at Duke, no insurance companies in North Carolina had made a decision about whether they would cover the cost of Lutathera® or not, so no patient in North Carolina was able to get the treatment unless they pay all the cost. It was a great pity that I saw not a few patients with NET who had to leave the examination room in disappointment for this reason. Among them was a patient with his family who spent more than five hours driving all the way from the suburbs to seek for a second opinion. In the U.S., even if approved by the country (FDA), a drug cannot necessarily be used to help those who need it. This is quite harsh reality for patients who keep their hopes up to new treatments. Talking about Lutathera®, I strongly hope insurance companies will decide to cover the cost as soon as possible.

2. Life in Durham

Just like the predecessors, I also got to stay with a host family, Jenny and Fred, who are both kind and friendly and working in a microbiology lab at Duke. I had a really great time with them doing lots of things together like going out to eat a pork BBQ and a pecan pie, both of which are southern specialties, and celebrating Easter by crafting egg decorations. I remember they once took me to a beautiful park full of nature along Eno River, where they do volunteer work on weekends. They are helping constructing and restoring trails so people can enjoy hiking safely.

Durham is an academic city greatly supported by Duke University. I myself believe that “D” of “Durham” is “D” of “Duke.” The city has a quiet and academic atmosphere, and, even outside the campus, you will find many students and people working at college who wear a hoodie or a T-shirt with a big logo of “DUKE” in front. When you step into University Library or a café near the campus, you will invariably see “Blue Devils” working hard on MacBook with excessive Duke stickers on its back, which was always a great motivator to me. Honestly, I think it is very difficult to find a better environment for studying even if you look around the world.

3. Clinical Elective at McGill

At McGill, I took an outpatient oncology program again. I learned as a visiting medical student for one month at Jewish General Hospital, which is the second teaching hospital for McGill University and is located just five or six subway stations away from downtown Montreal. Now you might wonder, like I did, how you could get training in a French-speaking region without speaking French, but the truth is that there is no worry. McGill University was originally established by an English man, as the name “McGill” suggests, so doctors talk with each other in English and all the conferences I attended were also in English. What is more, almost all patients are bilingual, which makes sense because you cannot do without English when you go out of Quebec, where Montreal is, and step into Ontario. After all, I had no trouble communicating in English with anyone in the hospital.

In terms of how oncology works, I think there is no significant difference between Canada and the U.S. Jewish General Hospital has Segal Cancer Center, a facility specializing in oncology just like Duke Cancer Center. As far as I experienced, cancer treatment and activity of clinical trials in Canada also seems to me quite similar to those in the U.S. Luckily, I had a chance to talk to a resident, who graduated from a US medical school and worked as a resident for two years in the U.S before coming back to her hometown, Montreal, and she agreed to me at least in a field of oncology. However, although it may be not a matter of Canada vs the U.S. but a matter of the size of a hospital, Segal Cancer Center seems to put more emphasis on general oncology than Duke Cancer Center. I feel this way because a doctor in Segal Cancer Center usually belongs to several divisions at the same time and sees patients with different types of cancer. For example, one of the attendings I worked with breast cancer and GI cancer on Mondays and Fridays and lung cancer on Wednesdays. It was really impressive to me because you cannot find a doctor working like this in Japan.

What I did at oncology clinic is exactly the same as I did at Duke Cancer Center; I see assigned patients by taking history and doing physical exams before an attending and I go back to examination room. I was glad to have an opportunity here again to see patients with various kinds of cancers including breast cancer, GI cancer, lung cancer, GU cancer and malignant melanoma, some of which I could not see at Duke.

Reading on this report so far, you might have an idea that there is nothing particular that distinguishes medical practice in Canada from that in the U.S., but it is not the case. The biggest difference is probably health insurance system. The truth is that medical costs in Canada are free of charge, and all of them are covered by tax. However, you are supposed to pay a full price for medication, so people usually get an insurance just for drugs. When I went to Jewish General Hospital for the first time, I was surprised to see patients leaving the hospital right after they finished their visit. Of course, there is no cashier in the hospital. Universal access to medical care is apparently an amazing thing, but it is also the case that it has adverse aspects. One of the biggest problems is a long waiting time at a hospital, especially at an emergency department, due to a lowered threshold of seeing a doctor. Actually, I saw a patient with postoperative colorectal cancer, who told me in disappointment that she had to wait more than 12 hours when she once developed lower back pain and went to an ED. The only part she and I were happy about was that the lower back pain had not been involved with bone metastases.

4. Life in Montreal

Often dubbed “Paris in North America”, Montreal is a beautiful city with a European ambience. When you step into an old district in downtown, streets filled with cobble stones and lanterns will make you feel as if you really came to Europe. People are enjoying a sunny day talking with friends and drinking coffee or beer at a terrace table facing a bustling square.

While you are fascinated by a street sax player, you may be surprised by a carriage passing by in front of you. In the center of the old town lies Notre Dame Cathedral, which is the most famous church in Montreal for its magnificent blue interior which reminds you of Saint Chapel in Paris.

In Montreal, I stayed at a house I had reserved via Airbnb, which was located just five-minute walk away from Jewish General Hospital. At that time, three students except me were staying in the same house; a German girl who also came to McGill as a visiting medical student, an Italian boy who came to Engineering Faculty of Montreal University to finish his doctor degree, a French girl majoring in physics who also came to Montreal University. Every night around dinner time, we spontaneously got together at the dining table and had a great time eating dinner and talking about each country’s culture and many other things. Germany, Italy, France and Japan. It is more like an international conference. I guess we could call it “G4.”

5. What I learned through the electives

In this last section, I am going to tell you two main things I learned during two months of clinical electives in the U.S. and Canada.

The first thing is that clinical clerkships in Japan are just one form of medical education, not a universal way of teaching medicine. For medical students in Japan, unless they go abroad to learn medicine like I did, it is only natural to assume that the present system of clinical clerkships is the only and definite way to learn clinical practice, but that is clearly not the case. Medical education in the U.S. and Canada puts a great emphasis on “exposure.” It never allows students to just observe what doctors are clinically doing and finish all the programs as an outsider; it requires students to go into the center of clinical practice and think for themselves about how to evaluate the present status of this patient and what treatment is now recommended according to the evaluation they make. In this way, you can learn clinical practice through your own experiences. Also, as this way of education demands a high level of knowledge and skills, it becomes clearer what you can do now and what you cannot, which spontaneously leads you to what is the next thing to overcome.

Another thing is about a real meaning of EBM. To be honest, before this program, I had thought EBM means strictly carrying out standard therapies stipulated by guidelines. However, I learned many times that a growing accumulation of evidence one after another reveals standard therapies do not necessarily yield the best outcome for a certain patient when you consider his/her clinical characteristics and prognostic factors. Of course, these features should be included in guidelines in future to achieve individualized standard treatments, though. When I was at Segal Cancer Center, I clearly remember that doctors were actively discussing about treatment plans citing recently published papers at Tumor Board, which I attended every week. Through all these experiences, now I have come to believe that EBM means appropriately interpreting evidence which is emerging day by day and giving a patient the most suitable treatment imaginable in accordance with their clinical characteristics and preferences.

Lastly, I would like to express my best gratitude to all the people who kindly supported my overseas electives: Dr. Hasegawa, Dr. Kasuya and other staff in Office of International Affairs; doctors at Duke and McGill; Jenny and Fred; and my parents.

Duke West Campus
With Doctors at Duke Hematology Oncology
Jenny, Fred and Me
at an Italian Restaurant
With Dr. Panasci
at Segal Cancer Center

"Looking at the high sky blue, I go along the street where old-fashion trams come and go. When I turn the second alley from Bourbon Street, the first thing that jumps into my ear is the sounds of the trombone and saxophone. It is not easy to reach a cold brew because they stop my foot unintentionally in the live jazz music heard here and there, although I have got sweaty and thirst, after walking for long in the strong sunlight. I finish listening to the three bands in the street, go crazy, say to myself "Bravo!!", and I throw a dollar bill in a bucket. It is at this moment that I notice the appearance of the sky changes. That is cloudy like grey and black paints stirred. It doesn't take me long to get wet through from the heavy rain, so I immediately escape to a café nearby. Again, I am absorbed in the piano jazz and after a time I realise that the orange sunshine has already grown to the feet of the piano that. I decide to take a walk to the Great River in the south. When I walk along the bank, the wind hits my body, which is already completely dry. The steamboat Natchez that is anchored at the edge of the brown murky rapids plays the masterpiece of the Master of this town, which is very, very wonderful- What a Wonderful world!

Like this, I spent a lot of time going out in New Orleans on the weekends. I participated in clinical clerkships at Tulane University in "the City of Music". During preparing for the internship as well as during my days at Tulane University, I was faced with a lot of difficulties, which includes my hard time with the southern strong accent spoken by the patients and doctors. This was so stressful that I got the urge to give up following their conversations. When I returned to my bedroom, I was so tired and fell into my bed. However, I was able to overcome these difficulties thanks to the 'power' of the cheerful jazz music.

This experience at Tulane has become more fulfilling and satisfying than the one I ever got. I was able to deepen my friendships with Japanese doctors and researchers, who have been struggling and working at Tulane, as well as local medical students. I felt anew that various people are working together to support each other and strive for their goals every day. This experience has been a great foundation and motivation for my new future goals. I sincerely thank all the teachers, friends and my family members who fervently supported me.

This spring I had been studying in Tulane University for 3 months. Exactly it was my first opportunity to visit a hospital in the US as a medical student. I had supposed that I could not prepare too much before I went there. But once I started doing my clinical clerkship, I could feel gradually getting accustomed the environment. I came to be able to listen more, join discussion, and enjoy the whole stay in New Orleans. Here I would like to show several experiences in my study.

One of my best memory is having joined American College of Physicians Internal Medicine Meeting. It was so lucky for me that the annual meeting of ACP was held in New Orleans. Doctors from everywhere gathered in New Orleans, not only from the US but also from all over the world, and the atmosphere of the city dramatically changed during the period of the conference. I was really impressed by the large convention center and the number of presentations. Each speaker had prominent technique of giving speech, so it was really interesting for me to listen.

Moreover I participated in the reception and I could talk with great doctors like Dr. Centor, who is famous for Centor Score for group A streptococcal pharyngitis, Dr. Amir, vice president of Clinical Policy and the Center for Evidence Reviews at the ACP. There were also some doctors from Japan; some of them were young doctors graduated 2 to 3 years ago and they were representatives of Doctor’s dilemma, which was quiz competition of medical knowledge. I was shocked that they were competing against native speakers in English. Also another doctor, he was from hospital in suburban of Nagoya, was just PGY1 doctor but he won a prize for his research and he got the chance to give a presentation in the US. I recognized that my motivation could change the quality of my residency any way. Many doctors performance in that congress stimulated me very much.

In the clinical clerkship in Tulane University I studied in Hospice. In hospice rotation I visited patients’ houses an d nursing homes. I deeply remember an elderly lady who passed away during my rotation. She was suffering from Parkinson disease. Furthermore she lost her house when Hurricane Katrina hit New Orleans and she moved to her mother’s friend’s house. However, both of her mother and mother’s friend had already gone and she was living her mother’s friend’s daughters. It was really complex condition. The lady seemed to like daughters and she liked to be said “you look like mother and daughters,” but on the other hand daughters looked like tired about caring the lady. At the first time I met her, her condition was not so bad and she told me those story about Hurricane Katrina and her family, and about Vietnam War. Also she was petting her dog. However after two days when I visited her again she had got dyspnea, and that day was the last time for me to see her. When I say goodbye at the second time I saw the lady, I said “I will come back next week again certainly, so please let’s see again.” She nodded saying yes, but we couldn’t see each other again.

Hospice does not offer treatment for prolonging life. They are aiming at relieving patients’ pain and support them and their family. Hospice sends letter to deceased family for one year, so daughters will also receive letters for a while. This woman and staffs of hospice showed me how it is to die at home, and how we face death.

These two stories are just a few of my experiences in Tulane. I really appreciate everyone who helped me make my exchange program successful.

I had studied in National Taiwan University (NTU) for 12 weeks from March. At first, I had not thought that I would go to study abroad at all because I’m not good at English, but as the grade went up, I came to want to do something that I can do only in my university life. In addition, the story of my seniors, who had studied abroad, made this propose stronger. This is the reason why I decided to study abroad.

I heard that Taiwan is pro-Japanese and many Taiwanese come to Japan every year, and vice versa. This is why I wanted to go there once. And I also heard that in Taiwan, English is mainly used in medicine, so I chose this university because I thought that I could learn a lot and I wanted to know how the medical education with English in Non-English-speaking countries was studied.

NTU Hospital (NTUH) has more than 2300 beds, and more than 6500 foreign patients visit NTUH every year. In fact, I had many chances to see them, and every time I saw, the doctors in NTUH looked being used to see them. In this hospital, I rotated OBGYN, Dermatology, Family Medicine, Endocrinology, and General Surgery for 2 or 3 weeks.

In the first department, OBGYN, I rotated in Obstetrics, Gynecology, and Infertility for every one week. In Obstetrics, I saw many special deliveries, such as painless deliveries, those of children with congenital heart diseases, which is rare cases in Japan, and so on. In Gynecology, after operations, I could join surgical training programs of local students. In infertility department, there were so many patients with infertility, and the fact, which many Japanese patients visit NTUH, made me surprised.

Dermatology is the most popular department in Taiwan and covers cosmetic dermatology. Not only with rare diseases, I was surprised that the number of patients with acne or rough skin was quite a lot in spite of University Hospital. I also saw the clinic of a very famous dermatologist in Taiwan, who has own cosmetic brand.

In Family medicine, I saw general ward, palliative ward, and outpatient clinic for each one week as well. Because in ward, patients could not speak English, I could not ask them by myself, but with residents, I took some tests every day. In addition, in palliative ward, I learned emotional care of patients and families, and pain relief, both of which I had not learned in Japan. In outpatient clinic, there were many unusual clinics in Japan, such as palliative, non-smoking, weight-loss, and travel clinic.

In endocrinology, doctors made my schedule, in which I could learn ward, outpatient clinic, thyroid echo in well balance. Taiwan has many DM patients, so the nation recommends DM screening actively, and I could see many examinations. But in Taiwan, not only the number of DM, also that of endocrine patients is a lot. Therefore, I saw many patients and I had a great time to study endocrinology in this department.

In the last department, general surgery, I could see some operations which I’m interested in every day. In this department, Robot surgery is common as well as in Gynecology. I often talk with doctors and local students about many patients. That was also very nice experience for me.

I want to write about life out of hospital as well. I stayed NTU dormitory for 3 months. It has only double rooms. I lived there with another foreign student, whom I hadn’t known, because I went there without my friends from Nagoya University. At first, I didn’t want to do so, but it turned out that I had a greater time with my roommates to talk a lot or to go out together on weekend. There were many foreign students and I went to eat dinner or to drink almost every day. Thanks to that, I never felt lonely.

At last, I’m very grateful to many people, who helped me a lot. Thank you.

I’m Satoshi Shinoda, 6th grade of Nagoya University faculty of medicine. I studied medicine abroad to the Chinese University of Hong Kong (CUHK) for 2 months. Hong Kong had been governed by United Kingdom until 1997. For this reason, vestiges of that time still exist. For example, the name of the CUHK’s hospital is “Prince of Wales hospital. If you are familiar with world history, you may notice the name of it is same as the battleship which took an active in the past UK navy.

I stayed at the dormitory which was near the hospital. It was natural that I must stay at the double room since I was an elective student and the dorm was for the local students. I shared room with Yuki Kondo who was also from the same university. At first, I felt little bit anxiety because I had never lived with other people for such a long time. Fortunately, it was utterly groundless. It was true we needed to concern with each other , we were able to live comfortably. Now, he is my best friend.

I rotated in Ear, Nose, Throat (ENT) and Obstetrics and Gynecology (O&G) for 1 month, respectably. ENT had 9 staffs and dealt with nasal disease, hearing loss, head and neck carcinoma. They were all very educational. They posed me many questions. The most impressive question was about NPC. Do you know NPC? It stands for nasopharyngeal carcinoma. I had no idea about it. I asked them about the detail about it. They taught me NPC is very common in Hong Kong. Later, I studied about NPC and textbook said that that is very common in South China and Southeast Asia. Moreover, doctors in Hong Kong always checked the infection of EB virus because EB virus is the risk of NPC. The best part of studying abroad is learning regional-specific diseases and treatments.

Many local students learned in ENT. There are only two medical universities in Hong Kong, the university of Hong Kong and Chinese University of Hong Kong. In addition to that, high popular density in Hong Kong and Hong Kong people are all earnest about children’s education. As a result, the number of students who can enter the medical schools are very limited and medical students are all elite. Their knowledge were awesome and their English was very fluent. But they were kind and friendly to me. This was very lucky for me who felt lonely in a foreign country. Interaction with other medical students was precious experience. The clinical clerkship in ENT passed in the blink of an eye.

I rotated in Obstetrics & Gynecology in the next month. The OG in CUHK has many departments like oncology, perinatal care, which are also common in Japan, and female urology, infertility treatment and prenatal diagnosis, which are rare in Japan. All departments are very active, but it is complete deferent that they are very active and they are eager to teach medical students. Unfortunately, doctors in oncology, female urology and perinatal treatment were very busy and they didn’t have time to take care of elective students like me. It happened very frequently that they don’t talk back to me even when I said “good morning”. What will you do if you are me? In my care, I ignored all my schedule and observed operation what I was interested in and visited outpatient departments of infertility treatment which was not in my schedule. By the way, infertility treatments in Hong Kong were very progressive and doctors liked to teach me everything. It was unmixed blessing. Time passed by and last rotation was in prenatal diagnosis clinic. Their works were to find congenital malformation and chromosome aberration before the delivery. By the way, all Japanese have ever seen the Down syndrome patients. Looking back, I had never seen them in Hong Kong. One of the reasons was prenatal diagnosis in Hong Kong. Doctors measured all fetal posterior neck edema, which is so called Nuchal Translucency, (NT), as a screening for Down syndrome. The fetus who were suspicious of Down syndrome would undergo amniotic diagnosis and got the define diagnosis of Down syndrome. As a result, almost all pregnant choose artificial abortion and Down syndrome in Hong Kong weeded out. The ethical perspective in Hong Kong was clearly different with that of Japan. How do you think about this? They wondered why Japanese didn’t check the Down syndrome. They asked me this question. I couldn’t answer but “it is ethically unacceptable”. I can still remember their reactions. In Hong Kong, it is very common to spend a lot of money for children’s education and they do not afford to raise a child who cannot expect anything in return. I think this is one of the reasons for this difference. To realize the difference of treatment which comes from ethical perspective is precious experience that can get through studying abroad.

This time, I have studied at the Chinese University of Hong Kong for two months. In Hong Kong, despite the same population as Aichi prefecture, there are only two medical schools. So the students are really excellent and they do not do club activities or part-time jobs. In Hong Kong, all medical lessons are given in English. Therefore, medical staff and students can speak English fluently. However, some elder doctors had a strong Cantonese accent and it made me difficult to understand.

Everyone in Hong Kong was basically pro-Japanese and there were many people who have been to Japan many times, including teachers. The nurses also greeted me in Japanese ”Konnichiwa”, and I was able to spend a comfortable time with topics such as "I went to Osaka before!", "I know Gundam” and so on.

The major difference between medical system of Hong Kong and that of Japan is that there are Public Hospital and Private Hospital in Hong Kong.

 Public Hospital: Only HK $ 100 per day is required for hospitalization, but the waiting time to get medical treatment is very long.

 Private Hospital: There is no assistance from the government for medical expenses, so the medical expenses paid by patients is huge. But you can see a doctor right away.

These are the differences. The hospital where I were is Public. I heard that, for example, it is necessary to wait for about three years for artificial knee joint replacement, and I was shocked to hear that.

[Clinical Clerkship]

Since the official language of Hong Kong is Cantonese, I was not able to conduct a medical interview etc. by myself. However, in outpatients and wards, students and doctors translated the patient's story into English and made a physical examination together. Conferences and rounds are also in English. It was very helpful and educational for me.

Throughout the clinical clerkship, I acted relatively freely thanks for doctors words “Everything is up to you”. If local students were present, I was able to participate in the discussion with them and if it’s not so, I was able to observe surgery or outpatient and so on.

Upper GI & Metabolic Surgery : I entered the operative fields with almost all the operations, and I could experience some simple procedures. There were less patients with gastric cancer compared with Japanese, and the number of patients with esophageal cancer was relatively large. Operations using Da Vinci and operations to remove a part of stomach of obese patients deliberately were also performed. In addition, the surgeons also performed an endoscope of the upper part (esophagus ~ duodenum). I could see the procedure like EMR and ESD, which are within the range of gastrointestinal internal medicine in Japan. When it comes to the technic of endoscope, Japan seems to be ahead of Hong Kong. There were several doctors who said "I’ve been to Japan for endoscope training". Every teacher was so kind and friendly that the atmosphere was very good. The reputation seemed to be good also among local students. Prof. Teoh, my supervisor, was especially friendly. He played Japanese music in the endoscope room for me and taught me a lot of thing enthusiastically.

Orthopedics and Trauma : Although I had refused my acceptance before a flight, I negotiated directly at the hospital. I don’t know why, but I was easily accepted. I spent 2 weeks in the sports team, 2 weeks in the trauma team. Prof. Yung, a professor of the sports team, is a very famous orthopedic surgeon who has been engaged as a sports doctor for 15 years. Many professional athletes came to the outpatient of the professor. Also, I perform a simple physical examination. In the trauma team, I stayed mainly in the operation room. Every doctor there kindly explained the operation and I learned many things.

[Life in Hong Kong]

Because of the cost of living in Hong Kong is high (especially land price), Hong Kong seemed not to be much different from Japan in terms of living cost. If you hear Hong Kong, you may image a metropolis as represented by million-dollar night view. However, if you go out a little far, there are also seas and mountains and you could also enjoy nature by hiking and kayaking. In addition, badminton is popular in Hong Kong, so I joined some clubs and played badminton with local people during my study abroad. I was able to interact with many citizens regardless of age and sex, and it was a very good memory.

[Conclusion]

I would like to express my gratitude to everyone who supported me. Satoshi Shinoda, a roommate who shared good times and bad times for two months, thank you very much.

Fortunately, I had the opportunity to join a clinical clerkship in University of Freiburg in Germany from 3rd in April to 22nd in June. Freiburg is a beautiful city surrounded by “Schwarzwald” in South-West of Germany. Because of its scenic beauty, safety, and sunny climate, it is one of the popular cities in Germany. The experience there has become a precious memory for me.

As for the clerkship, I rotated in neurosurgery in university hospital in April, in anesthesiology in Loretto Krankenhaus, a city hospital in Freiburg in May and in neuroradiology in university hospital in June.

The first month was in neurosurgery in Neurocenter. Its department has their own 6 operation rooms, where 3000 operations are conducted in a year. This is why many doctors come and learn there not only from Germany but also from other countries in Europe such as Italy, Sweden and Slovenia. My day started at am every morning. I joined a morning conference and then saw some operations, IVR and the management in ICU. Because various kinds of operations were done every day, I was able to experience many cases I was interested in as I wanted. I sometimes had difficulty in understanding the topics discussed in the conference, as all of them were naturally in German. But some kind doctors taught me in English after that if I asked them spontaneously. I realized the importance of taking actions positively. One of the doctors said, “The language barrier makes it difficult for you to learn, but don’t be too careful. You only have to consider what you should learn as a student and try step by step.” I was also helped by the kindness.

The next month was in anesthesiology in Loretto Hospital. I heard it is one of the teaching hospitals in Freiburg, so some German students visit there. Every doctor and staff was very kind and welcomed me, because I was the first Japanese student to visit there. I was mainly in an operation room with the doctors, where I learned how to use the machine, to administer medication, to interpret ECG, and examine patients physically. The study only in textbooks was not enough especially for anesthesiology, so it was a good chance for me. Moreover, I was able to practice many skills which I couldn’t try in Japan such as tracheal intubation, venous injection, and so on. Other students from other parts of Germany came there in the same period as me. I spent enjoyable time in a rock bar and a music festival with them after clerkship.

I went back to university hospital in June and rotated in neuroradiology. Usually, I got some cases from my superior doctor in the morning and then practiced to interpret the images, summarize, and give the presentation. I got in touch with various cases such as brain stroke and many degenerative diseases. Aside from that, I also spent plentiful time in seeing IVR and taking lectures about neurology. In this department, Dr.Wuertemberger, one of the doctors there, really helped me. In spite of his business, he not only gave me a lot of meaningful lectures but also told about various medical systems in the world. It was so useful and gave me a global perspective because he saw the many hospitals in Canada, America and Japan. I appreciate his kindness.

Finally, the 3 months have become a great experience which I can’t forget forever. Of course, I was often troubled because of my poor medical and English skills, but I went over it by my own efforts and the kindness of the people I met. I believe I gained a lot from having struggled in a foreign environment. I am very grateful to all the support by the people in Nagoya University and Freiburg University.

I have studied at the University of Freiburg in Germany for three months. The motivation for going to study abroad was somewhat cool or somewhat vague at first. For example, I would like to see medicine in Europe, to find the goal of my doctor’s career, and so on. However, after I finished, I could obtain more than what I had expected and became satisfied with studying in Germany.

About department which I rotated

I have rotated pediatric surgery, anesthesia department and radiology department for one month each. Especially I had a great time in the rotation of pediatric surgery. The operations that could be seen were the operation for inguinal hernia, orchidopexy, the reduction of the intestinal tract, such as abdominal wall rupture and meconium ileus, and so on. A young doctor who became a pediatric surgeon in the 2nd year taught me a lot of things which included the technique of surgical suture. She was nice to teach me carefully in English. On the day of operation, I could participate in every operation and somedays the doctors allowed me to do closing a surgical incision. In particular, since I saw the operations of inguinal hernia more than 10 times during the first three weeks and since there were only a few doctors because of their vacation, I could have more than three times for challenging to participate in the surgery as a first assistant. I borrowed the suture kit to practice at free time every day and I experienced a lot in many operations, so I could do the surgical suture better than when I was in Japan. I remembered that I felt very happy because I felt my own growth and had the time to be a member of the team as the day passed when I rotated in the department of pediatric surgery.

Summary

For three months in Germany, I met with various students and doctors. I learned a lot of things and I got the goal for my career as a doctor in the future. I am certain that for young doctor the ability to take action before thinking is very important through what I learned from studying medicine and living a life in Germany. I felt anxious about studying and living in a foreign country before I went to Germany, but now I am confident that I manage to live anywhere in the world. In the future, If I have a chance, I would like to try to study abroad as a researcher or as a clinical doctor. Finally, I am thankful to the people who supported me to study abroad, including Office International Affairs Nagoya University Graduate School of Medicine, the foreign office of Freiburg University and the persons concerned in pediatric surgery, anesthesiology and radiology department in Freiburg University Hospital.

My time in Adelaide has been one of constant discovery and cultural exchange. I have loved the opportunity to engage in dialog with both faculty and students throughout the Pediatrics and Family Medicine department. I am extremely grateful for the open and honest answers and spirited discussions we have had, comparing the Japanese and Australian healthcare systems, customs, and cultures.

As a future rural family physician, I found it particularly interesting to see how the clinics operated in Whyalla. I felt welcome in Bunyarra clinic from the minute I arrived, and truly had a wonderful experience meeting the doctors, nurses, and assistants. It was great to see how similar the clinics between two countries were, and yet how different the dynamic between the patient, nurse, and doctor are in Australia compared to Japan. In Japan it is very common for the practice of medicine to feel very sterile and impersonal, which is almost never the case in Australia. The appreciation and level of respect from patient to doctor, and from doctor to patient, was inspiring to witness. (They sometimes cry with patients!) The clinic visits felt friendly and efficient, with no wasted time. I hope to run my own clinic as efficiently one day!

It was also very interesting to discuss the advantages and disadvantages of our respective health insurance systems. While I have a great deal of respect for certain aspects of Japanese healthcare, our insurance system is huge and sometimes oppressing the hole budget of our country, and I was very curious as to how Australia was managing to insure such a large population. I was impressed by the coverage options and relatively affordable patient payments, the Australian system is truly set up to allow for anyone to access quality healthcare only if they truly need it. And it must be a good system for doctors. If only Japan could adopt a similar system!

My rotation was truly highlighted by the daily lunches with different students in Adelaide University. I loved being able to discuss their careers, dreams, and frustrations over delicious Kangaroo meats (and other great food). And the most impressive thing in Australia was the face of doctors and nurses, they were smiling every day, every time! I find the life of a Japanese doctor to be one of joy and hardship, joy in the completion of a hard days work and hardship in the necessity to hold multiple jobs in order to make a reasonable salary. But Australian doctors looked enjoying their “own life”, enjoying sports, music and activity with their families. I was shocked to hear how hard the average Japanese physician has to work to make half of what Australian physicians can make in salary. Work – life balance is a very important part of being a happy and successful physician and to prevent physician burnout. It was good for me to have a chance for me to think the balance.

I hope I was able to provide some useful insights into Japanese healthcare and culture to the physicians and students I worked with. I am greatly looking forward to beginning residency in a few months, and feel that this experience was an extremely useful and interesting cultural exchange that will help me to bring an international perspective to my future training. Thank you so much for the opportunity to work with so many different wonderful physicians!

I was fortunate to be able to study at The University of Adelaide in South Australia for 3 months- the first 2 months at the Women’s and Children’s Hospital in Adelaide and the last month at Bunyarra Medical Clinic in Whyalla, a rural town in South Australia.

Adelaide is not a large city, but a lot of facilities, and consequently people too, are concentrated in a small area, and it is known as the “20 minute city” because any major point in the city can be reached within 20 minutes. Thus the main streets are crowded even on weekdays, and in the crowd you can spot people of various ethnicities (European, Asian, African, Aboriginal etc.). The multicultural atmosphere made it easy for me to adapt to life there. For the same reason, there are restaurants and shops run by people from various countries in Adelaide, so I had no problems locating food and daily necessities, although I felt that the cost of living there was high. The home countries of the medical students at the University were also diverse. For instance, a student who was on rotation at Allergy and Immunology with me was from Ireland, and had lived in France when she was a child. Another student, who was on rotation with me in Gastroenterology was a Malaysian and had studied in a medical school in Malaysia for 3 years, and then transferred to The University of Adelaide. She said she had come to Adelaide to start working early because if you graduate from medical school in Malaysia, you have to wait for a year after graduation until starting to work as a doctor due to there being an excess of doctors there. Because the students came from diverse backgrounds, they had totally different ways of thinking to me, so I learnt a lot of different viewpoints through conversations with them. This diversity made learning English more enjoyable for me as well. You can hear English spoken in lot of different accents in Adelaide because accents vary among the people there, depending on their background.

In Adelaide, I was placed in the Pediatric Allergy, Immunology, Genetics, Gastroenterology, Cardiology, and Renal Departments over a period of two months. The methods of training differed depending on the department or the doctors I followed. Sometimes I took history and examined patients, and sometimes I sat behind a doctor and just watched what he or she did. I was placed in the biggest Children’s Hospital in South Australia, so I often saw patients with rare genetic diseases. I learnt much about diseases common in both Japan and Australia, such as Inflammatory Bowel Disease and Kawasaki disease, and also about diseases common in Australia but not in Japan, such as Celiac disease and Cystic Fibrosis.

In Whyalla, I was placed in a general clinic. The training started with taking blood from patients at 8:30 in the morning every day and I saw a lot of patients throughout the day until the clinic closed at 5 p.m.. Sometimes I could take patient history, examine patients, and make clinical records by myself. In Australia, skin lesions due to ultraviolet rays are very common and I had the chance to try cryotherapy using liquid nitrogen, as well as doing excisions and sutures, under a doctor’s supervision.

I believe I have really learnt a lot through this exchange program, from improving my grasp of the English language and increasing my medical knowledge to life lessons such as how to negotiate with staff, and how to build good relationships with both staff and patients.

I sincerely appreciate the support I received regarding my participation in this program from the staff of Nagoya University.

Thanks of the partnership between Nagoya University and the University of Western Australia, I was pleased to have the opportunity to visit Sir Charles Gardner Hospital and Rural Clinical school in Albany.

The first two weeks, I rotated rheumatology. Because we don’t have rheumatology department in Nagoya University Hospital, the time was very meaningful for me. Mainly I observed outpatient clinic. In the clinic, I could see lots of types of collagen diseases such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, polymyositis/dermatomyositis, and vasculitis. With some cases, I could exam patients. They were all cooperative and helped me with understanding the features of diseases.

Then, I rotated clinical immunology another two weeks. In the clinic, I saw many cases of allergies. In some cases, I could observe how to diagnose and identify the allergen. I didn’t have a chance to see skin prick test or allergy challenge test before going to Australia. In Japan, patients consult different department depends on what type of allergic symptom they have. So “immunology department” is lucid for patients. In addition to clinical work, I experienced laboratory work as well. With doctors help, I saw immunofluorescence samples of skin and kidney. I really enjoyed the process of investing pathological specimen. It reminded me that medicine is based on science.

For the latter half, I studied at Albany rural clinical school which is located the Southern part of Western Australia. It is the school which is established for the education of med students in rural environments. The students were from not only UWA but also University of Notre Dame Australia. They are all 3rd-year students = Japanese 5th-year students but have a wide variety of knowledge. They motivated me very much.

In this period, I experienced training both in general practice and regional core hospital. My biggest aim of this elective was to understand the relationship between GPs and hospitals. So they arranged my course to achieve my goal. GP is a system that can offer primary care for all people. In Australia, patients cannot consult specialists without referrals from GP. Basically, all patients see GP at first and some patients are introduced to specialists. The range of GP’s work was wider than I thought. At first, I imagined GPs treat just mild cases. During this period, however, I noticed that GPs play a big role in preventive medicine.

On the first and last week in Albany, I studied at two GP clinics in Albany. Patients came to GP for various reasons. The most impressive patient was 18yrs girl who came to get contraception pill with her friends. In Japan, it is prescribed by mainly gynecologist. I think there is a high hurdle for Japanese women to think about their sexual health. In contrast, in Australia, they can ask about their sexual health at GP where they always go. This feature plays a big role to prevent STI and unwanted pregnancy. In another case, a patient came to GP to take skin check against skin cancer. For Japanese, skin cancer is an uncommon type of cancer but Australian understand much about their risk. I saw some patients who had some pre-cancerous regions and got them removed by liquid nitrogen. And I could cut regions of skin cancer for some cases as well. These cases taught me the importance of GP in terms of preventive medicine.

On the middle two weeks, I studied at Albany health campus which is regional core hospital of Albany. I was with general medicine team there. The patients they treat are so diverse. For example, someone has primary sclerosis cholangitis and the other has stroke. The doctors gave me many chances to exam patients by myself.

The program I really want in Nagoya University is teaching round. They have it twice a week and students who are rotating internal medicine join the program. It is consisted with history taking, physical examination, data and image interpreting, and presentation. From this sequence, students can learn how doctors think and decide their management plan and get feedback directly from supervisors. I joined them a few times and they were always interesting for me. Teaching round can offer students very meaningful and conserved chances.

In addition to that, I could observe their clinical exams. In Australia, they have OSCE every year. The OSCE for 3rd-year students is made based on GP setting. For me, they looked like real doctors. They are better than Japanese students in terms of clinical knowledge and communication skill. I think Japanese students concentrate too much on the national exam.

Through these two months, I could learn not only clinical knowledge but also medical system and education. Every single day taught me new things. I could find my role model and good friends. I really appreciate this precious opportunity. I’m pretty sure that this exchange was the biggest and best choice in my university life and can change my life. I’m grateful to all people who supported me for this elective.

I had practiced for 3 months in AKH, which is the hospital of Medical University of Vienna in Austria. AKH is the largest hospital in EU and because it has enough departments, doctors and facilities, many patients from the west countries of EU to the east visit it. In AKH, I had clinical practice in Otorhinolaryngology, Transplantation and Orthopedics for each one month.

At first, I studied in Otorhinolaryngology. In this department, the system is completely different from Japanese one. Doctors are split to a ward group and an operation group. Of course, doctors in the ward group sometimes have operation and vice versa, but they usually share information through conferences and rounds all together. In my case, a doctor in the ward group had taken care of me. So I usually followed him and learned how he managed the ward. Otherwise, I took medical examination or blood from patients and consider cases with students who were rotating. Otherwise, He allowed me to go to ambulatory or operation, but it was hard to learn because in ambulatory they communicate with German and operations are usually micro one.

In Transplantation, because it share a ward with General Surgery Departments I can see any operation I wanted to learn, but this meant I had to consider and join by myself.

In this department, there are one or two kidney transplantations a week and one or two liver transplantations a month, and what is different from Japanese is that most kidneys taken from dead bodies are used. In every morning conference, I saw what operations are planned on that day, and I asked doctors to let me join operations. They never denied my requests so I can learn what I wanted. Moreover, students who rotated the department are so friendly and kind that I could follow them and see admissions.

In Orthopedics, the system is similar to one in Nagoya University; they are devided to some groups. I belonged to hip-knee group. The group has operation 3 days a week and ambulatory 2 days a week. Most of operations I joined are artificial head bone replacement operations. Anyway, doctors are so energetic and fun that I enjoyed the practice a lot.

This program must improve not only medical knowledge and English skills but also my personality. I got confidence and proactive attitude through such a hard environment where mother tongue is not spoken or no one care me without doing actively. Moreover, because students there have much more medical knowledge and clinical skills than me it stimulated my motivation a lot. I believe that these experience must be useful for my life as a doctor.

In the end, I really appreciate all persons who support me for this exchange program; Prof. Kasuya, Dr. Hasegawa and stuffs in the office of international affairs, members of Frontier, doctors in AKH, stuffs in student offices and other who have helped me.

I was studying at Medical University of Gdańsk for 2 months with Mr. Somiya for 3 months. For me who originally was not good at English, this study was a kind of challenge. Since the seniors of club activities were studying abroad somewhere every year, I wanted to study abroad from the beginning of the university. The reason why I chose Poland was that the seniors who went to Medical University of Gdańsk last year also seemed to be very enjoyable and I felt that practical training in English was substantial. Thanks for the help of the relationships between seniors every year, I was able to have a good studying life to the end. I would like to introduce such life of studying abroad.

First of all, I’d like to show about content about studying, I took a different department every 1 or 2 weeks. In concrete, I took the department of neonatal department, obstetrics and gynecology, hypertension and diabetology department, hematology department, pediatrics department, ophthalmology department, pediatric surgery department. As a daily schedule, we had lectures at various departments, and then practiced at the bedside. Although the lecture was not much different from that of Japan, the ratio of diseases described emphatically are different because epidemiology is greatly different from Japan. Also, I felt that the medical treatment in Japan is progressing more than I assumed in the neonatal department, obstetrics and gynecology department, pediatrics department, and pediatric surgery. Even a disease with low mortality rate in Japan has died nearly half in Poland. The fact which I surprised was that a disease I had thought as rarely killed so far would be easy to kill if the situation changed. I think that such an experience which cannot be had in Japan will be a future prospect.

Because many patients cannot speak English, the teacher interpreted them to us. Thanks for their help, we could examine them. Medical interview is regarded as one of the most important skills in Poland, and I often was asked what should be taken from patient by the teacher. I received the impression that they aimed to diagnose and treat as cheap as possible because eastern Europe country is not affluent so far. Drug prices were talked about as well as effect time and side effects in the selection of medications. I think that having felt the difference with many medical conditions with Japan in such a point has great value. There was a test at the end of each department, so I studied towards it every week. They were good stimulation to keep my motivation high. This is also one of the points that I realized that the choice of this university was good.

In my daily life, I was trying to live as a local person as much as possible. We cooked by ourselves as much as possible and participated in various events without refusing when invited. Thanks to the everyday items my seniors left behind, I was able to comfortably live three months. Professor Wozniak who made the exchange relationship with our university and his supporting professor, Adam took care of us in many situation like that I needed to use Polish. Also, they gave us a chance to make a presentation to polish students about efficiency of green tea, which was very interesting experience. Professor sometimes invite us to have a meal with his wife and Adam to show us what a Polish dish is.

In addition, many local students invited me to play and drink, which let us have a fulfilling life every day. To have more chance to communicate with local people, I contacted to the local badminton organization and joined it for practice weekly. Although the barrier of language was big, I think that it was good to participate positively with it because I had an opportunity to go to meal and drink together with those who can speak English. On weekends and consecutive holidays I went to travel to other countries, and I was able to communicate with local people and other travelers.

I was surprised that the world I can participate could be enlarge just because I could speak English a English, and at the same time I made sense that almost all the important information could only be obtained in English. I experienced various things in three months that I could not write all here, that I sincerely glad that I could study abroad for such a long days. Thank you very much for those who supported this study abroad.

First, I would like to say how thankful I am of Professor Wozniak, Adam, doctors and students I met at Medical University of Gdansk. From the first day I arrived, Adam was so welcoming and greeted me in his laboratory. Also, one of my friend, Janusz, showed me around the university and invited us a welcome party. Everyone I met was so friendly and the experience I had is irreplaceable and precious to me.

Medical University of Gdansk

I was in Medical University of Gdansk from March to June. This is the largest medical university in northern Poland and located in one of the most beautiful cities in Europe with an old town and beautiful beaches. In this university, there are 2 courses, Polish Division course and English Division course. The latter course is international course and students are from Sweden, India, The kingdom of Saudi Arabia, Spain, Italy, USA and so on. In this course, all of the lectures are in English. I had studied as a member of this course.

Practical training

During this stay, I rotated Hypertension and Diabetology, Cardiology, Cardiac surgery, Allergology, Pneumology, OBGYN and Pediatrics. Usually I had lectures in the morning and after that I had practical training in the afternoon. Patients could not speak English so doctors asked them what wanted to know in Polish. In this practical training, the hardest thing was tests in the last day. In order to pass these tests, I had to study every day after the practical training. For example, in the cardiology class, I had to learn about 100 ECGs in 1 week. It was really hard but these tests were great learning opportunity for me.

Daily life

Prices are twice or three times cheaper than Japan so I did not have to spend a lot of money on living expenses. Also, Gdansk is safe and I could walk alone at night. For these reasons, Gdansk is easy to live.

In this university, there were many parties so I could meet a lot of people easily. It was really interesting to meet people who had different cultures and thinking.

Lastly

This 3 month was the greatest time in my life. All of the students I met were excellent and I got motivation from them. If I have a chance, I would like to meet them again someday.

First, I went to Lund University in Sweden. In the first month, I observed surgery, mainly cancer of the pancreas and the esophagus. I was interested in difference from Japan, for example, doctors had tea time during surgery in Sweden. It was impressive that hospital was put together and secured manpower, and doctors maintained a work-life balance. Actually, a half of doctors were woman in spite of surgery.

Next month, I studied pediatrics by observation. Standard weight of new-born infants there is 3,500g, I felt a physical gap between Japanese and Sweden. In practice, I spent many times to only visit outpatient and so on by rotation, but a doctor of cardiovascular pediatric surgery department taught me enthusiastically. I improve this field well.

I think that we may learn about handwork better in Japan than Sweden, but there are many students who come from various countries. We can be exposed to culture, thinking, and idea. No other place is better than Lund in broadening one’s knowledges. In fact, experiences of Sweden motivate me to study hard in Japan.

I went to Dalhousie University in Canada after Lund. This university isn’t a partner university, but I wanted to study in the English-speaking world, so I looked for desperately and applied for the university. I also observed surgery in Canada. A policy there was that lecture student work using hand. I joined almost operations as a main assistant, and I learned handwork like a suture a lot. I think that may English have got better in a situation that I managed to speak English among native speakers.

Canada has wealthy nature. Although I am usually not moved by nature, there were many moving tourist spots. I want you to share this feeling.

Finally, you may be told demerits when you think studying abroad, but most my classmates and senior students who went studying abroad said that going to study was a good experience. I am sure of usefulness of studying abroad. If you want to study abroad, I want you not to care about other people’s opinion and to go abroad. You will think that studying abroad is helpful and exciting experience.

I had studied medicine at Lund University for 2 months. I took clinical rotation in ICU department and Internal Medicine department. I spent precious time there.

First, I am going to write about ICU department. It was in Lund University. The morning conference started at 7:30. The doctor who was in charge of teaching me assigned two patients every day. I researched their medical history and expressed the summary on the lunch meeting. After eating lunch with doctors and other students, I observed emergency room, took part in ward round or enjoyed Fica. Fica is the most important event in Sweden. It is like coffee break. The doctors in Lund value that very much. I was impressed that average people in Sweden have 5 cups of coffee per day. Every work was usually over at 16:00.

Second, Internal Medicine. It took 1 hour by train to go from the dormitory where I lived to Ystad hospital. Commuting to the hospital was a little bit tough for me. Morning conference started at 8:00. It was all Swedish, I could not understand that. I had the chance to take medical pre-examination for out-patients. It was very nervous but really good experience. I was surprised that there were a lot of patients with diabetes type1 because it is not so common disease in Japan. And also, in Ystad hospital, there were a lot of young doctors and medical students, so I could make many friends. After finishing works, I played tennis with them every day.

The important thing that I think after coming back to Japan, I appreciate that I tried to apply to this exchange program. It is true that it was time-consuming and there were many preparations to do but I grew up physically and mentally. I could get new perspectives through talking with doctors and medical students in Lund.

This year, I spent about 2 months studying abroad at Shanghai Jiao Tong University. My study began with 2 weeks of practical training at the Chinese traditional medicine department of Ruijin Clinic. In traditional Chinese medicine (TCM), acupuncture and moxibustion are widely used. But to tell the truth, I don't think many people in Japan understand the basics of medicine practice and handling. So, I selected this department for my study abroad in order to help fill that gap. The medical professionals I worked with carefully explained the methods of diagnosis and treatment. I also asked students from local hospitals to participate in actual acupuncture and moxibustion treatment.

Next, I continued my practice and study at the department of nephrology at Renji Clinic. Here, I attended lectures with other students, and had opportunities to observe the operations of PD and HD. The dialysis room was very large, and it was very overwhelming that more than 60 dialysis instruments worked at the same time.

Finally, I moved onto practicing at the department of gastroenterology at Renji Clinic. This department is known to be one of the most highly regarded departments in China. It is roughly divided into three sections: digestive tract disease, hepatitis, and endoscopy. I worked in each section for a week at a time. Although we learned very quickly on each team, I was most impressed by the speed of the endoscope testing. Doctors were performing endoscopic examinations at an extremely high rate not often achieved in Japan. Even now it is hard to believe that they were treating nearly 40 patients in only a single room during the morning.

So far, I have discussed my impressions of practical training, but the weekends and life after practice were also very fulfilling. I was able to deepen my friendships by exploring new places with Jiao Tong University students. I was also very happy to share the experience of life abroad with other students from foreign countries. I feel that engaging in religious and political discussions has expanded my values. The city of Shanghai is now experiencing an economic bubble, and the character of the city is revealed to people walking in its streets. Moreover, I was able to sense the difference in national policies from Japan, and their effects on the citizens of China. I also traveled to many cities and mountain areas apart from Shanghai.

In general, I feel that my experience studying abroad was very valuable. Due to the difference in the social and political climate, I believe it is a reality that hospitals providing advanced medical care are in short supply in China. However, I'm convinced that my experience with traditional Chinese medicine and the unique sense of medical care in China will give breadth to my life as a future doctor. I was stimulated by my unfamiliar life in China, the reality of socialism, and my exchange with local and international students. It has given me an opportunity to look back on my own life. And even though I encountered many challenging and dangerous situations, all of them have been good experiences. I am very grateful.