Experience Reports (for Nagoya University Students) | 2019

Days in Baltimore and Beijing

Ming Jin

I had clinical clerkships at Departments of Neurosurgery and Plastic Surgery at Johns Hopkins University in Baltimore, USA for a total of nine weeks, and at Peking University in Beijing, China for three weeks in neurosurgery. Each clerkship was a great experience which was meaningful and irreplaceable.

・Neurosurgery at Johns Hopkins University

Department of Neurosurgery consists of four services: Brem, Cushing, Dandy and Pediatric. These services are named in memory of Dr. Cushing and Dr. Dandy establishing the Study of Neurosurgery at Johns Hopkins University for the first time in the world. I rotated each service for one week.

Each morning, I had to go to the hospital at 5 am. I heard doctors of department of surgery in the United States have to go to work very early in the morning, and in fact, it was a fight with myself to wake up at 4 o'clock every day. When I arrived at the hospital, residents were confirming the conditions of patients. I went the rounds with them at 5:30. Most of the patients were sleeping because it was completely dark outside, but the residents mercilessly woke them up and started neurological examinations to them. After that, I participated in the resident seminar from 6:30, joined NCCU (Neurosciences Critical Care Unit) conference from 7:00, and began to observe operations from 7:30. Basically, I was allowed to scrub in, while some residents allowed me to irrigate while looking through a microscope and do the tying. Of course, I would not be allowed to do any surgical procedure unless I say I want to do.

In US, spines and peripheral nerves are also treated by neurosurgeons, so there are around 5,000 operations a year at two hospitals. At Neurosurgery of Johns Hopkins Hospital alone there were at least seven operation rooms working from 7 am. The finishing time of me was from 5 to 7pm, which means as I go home and eat supper, I had to sleep as soon as possible, or enough sleep cannot be guaranteed. Therefore, it was a unique experience in United States to feel happy even when I ended with 12 hours of clerkship, which I cannot imagine in Japan.

At the beginning, the residents and nurses were so busy, so they didn’t take care of me very much. Therefore, I actively greeted to them "How are you?", showed an attitude to help them even the smallest things, trying to prove that I was a useful existence for them. Then, their attitudes gradually changed - greetings came from them, and I was able to assist in preparations for ward treatment and pre-operation.
There were many types of surgeries at Johns Hopkins Hospital. Brain surgeries and decompression surgeries were of huge numbers, but the surgery itself was not so different from Japan. What impressed me was that there were as many as 3 cases of craniotomies for glioblastoma on one day which are extremely rare in Japan. Besides, I was able to see Minimally Invasive Spinal Stabilization using a robot that has not been introduced in Japan yet. However, I thought the wound might be a little larger than the equivalent operation of a cerebellar tumor in Japan. When I talked about that with a neurosurgeon from China, the same opinion was given by him. Maybe Asians are better at delicate hand movements.

Even patients undergoing craniotomy came to the hospital on the operation day morning, and the hospitalization period was only 2 days. In the US where there was no universal medical insurance, it was common sense to shorten the hospitalization. One surgeon told me, "Staying in the hospital will make patients’ conditions worse." In addition, there are health care providers qualified as Physician Assists who perform ward management and miscellaneous tasks while surgeons were performing surgeries. Nurse Anesthetists, who were anesthetizing during the stable period after the anesthesiologist introduced it, were also existent. There were co-medical staffs that cannot be found in Japan, which is to improve the efficiency of medical care.

I used my free time to ask a resident at Consultation Service, and I went on to examine patients in other departments. There is no universal intern program in the United States, so medical students have to select their specialties immediately after graduation. The intern in the US varies depending on the specialization. Therefore, there was always a resident in charge of consulting, and a system in which doctors would consult as soon as cases deviating even a little bit from their specialties.
When I was at Pediatric Service, I said I wanted a patient to be assigned to. Then I was asked to perform neurological exams to a patient who had part of his brain removed. With no medical examination tool, tendon reflex was examined using my middle finger, thermal nociception with tuning, and I used the vibration function of iPhone to check the deep sensation. I remember I was very happy to know the exact location of sensory disorder more than I expected.

One day when I went to the hospital, a patient whose brain was penetrated by bullet was in my service. The patient at NCCU was unconscious with Pinpoint Pupil. He was barely dying with a respirator. When I asked the resident what the next step is, they answered they planned to have a brain death judgment when his body temperature recovered. I thought I could never forgive the weapon that would harm a life which is the most important in the world in a flash.

・Plastic Surgery at Johns Hopkins University

Plastic Surgery is one of the most competitive specialties in the United States. It is a pass to advance to cosmetic surgery and is on top of high income in relation to medical insurance, while there are very limited hospitals that have resident program of plastic surgery. Johns Hopkins Plastic Surgery Team consists of three services: Hoopes, Edgerton at Johns Hopkins Hospital, and service of Johns Hopkins Bayview Hospital. Hoopes was mainly responsible for breast reconstruction, micro-reconstruction and general reconstructive surgery. Craniofacial, pediatric and transgender surgeries are done by Edgerton. And Bayview Hospital is in charge of hand surgery and burn injuries. I rotated 2.5 weeks at Hoppes and remaining service for one week each. The meeting time in the morning was 5:30, and operation from 7:30 after residents’ “ruthless” rounds - I had a clerkship more than 13 hours every day (the latest experience was until 1:30am). It was definitely tougher schedule than Neurosurgery. Plastic Surgery was unbelievably busy than that in Japan, with over 20 operations performed every day and approximately 30 operations a week for breast-related operations. Besides, plastic surgery was characterized by treating students as a team member.

During the operation, I imitated the medical students at Johns Hopkins University, grabbed the electric knife and burned the bleeding site. But attendings and residents said nothing to me. Since then, I did more and more hemostasis, washing and suction by myself. The wounds were often huge. So, when I was given a needle holder and tweezers from surgeons saying, "I left the half to you", I was so excited. In a month, I did a lot of fat, dermal and subcutaneous sutures. In addition to scheduled surgeries, there were also sudden surgeries when a flap is needed, so there were always days when there were remained surgeries even at midnight.

One day when I participated in an operation which continued after 9pm, my cell phone in my chest pocket vibrated suddenly. And after that, the operation nurses were talking loudly because there was a shooting incident between the hospital and my dormitory. I felt my spine was freezing, worrying about how to go back home. Luckily, I returned home safely with the free dispatch service of Johns Hopkins University that day. It was an unforgettable experience. Also, when I had a week of clerkship at Johns Hopkins Bayview Hospital, I chose the Baltimore city bus for my morning commute, because the free shuttle bus started from 6:30. I got on the bus only with African Americans during the dim, but on the last day I felt sick with a very strong smell of cannabis from the next side and the back side passengers. The public peace of Baltimore is not good at all. When I exposed myself to a dangerous environment, I was able to recognize again how valuable Japan's safe environment is.

At Bayview Hospital, according to the policy of the chief, students were required to check the medical records of all patients, go a round by themselves, and report the contents to the residents each morning. In fact, even on the final day, since I didn’t know what medical procedures to do, I could not achieve the goal to go the rounds alone. If I had the chance of clerkship at this hospital for a longer period, I felt I could also manage patients alone like a student at Johns Hopkins University. I was a little frustrated. At Bayview Hospital, in addition to scrubbing in the surgeries, I prepared the operation agreement letter before surgeries, hand over to PACU (Pre and Post Anesthesia Care Unit) after operation, did pre-examination for outpatients, and had a chance to review the papers with a 20-minute presentation. One day a gunshot emergency operation came in at midnight, thus I was not able to go home that day. There is no 24-hour convenience store like in Japan, while it's dangerous to go out. So, it was an interesting experience to have food, water and bedding procured from the surroundings on my own and sleep overnight.

On the last week of the clerkship, I had a Skin Grafting of foot as a first assistant. When closing the wound, the attending said, “You did very well today. Remaining is for you.” and suddenly took off the operation gown and went somewhere. I looked around and found that anesthesia was performed by Nurse Anesthetist. There was no doctor in the OR just with a foreign student performing the surgery! I calmed myself, completed the sutures, rolled 3 types of gauze, and then handed over to nurses at ward. When I told this to a resident later, she just said "Good job." It seems quite different depending on the department, but I think plastic surgery is one that most treats a student as a team CONTRIBUTOR.

In addition, I experienced many cases in plastic surgery that cannot be easily seen in Japan. Charles Procedure (peeling the skin of the lower leg, cutting off the layer of fibrous tissue inside with scissors and sticking back the skin), Lefort III Osteotomy (Peeling off the skin of the face from the scalp to the eye, cutting zygomatic bones, pulling out the lower zygomatic bones, and returning the skin), Metoidioplasty (transgender surgery from female to male), Penile Inversion Vaginoplasty (transgender surgery from male to female) etc. In fact, it was a series of shocks when I saw these operations, but it was also the moments when I thought it was so fantastic to have clinical clerkship in America.

In the United States, popular specialties can only be selected by top graders. I’m very fortunate to rotate in highly competitive Neurosurgery and Plastic Surgery in America. The clerkship in the United States looks hard, but if you participate actively, you will experience wonderful clerkship that you cannot imagine in Japan. It is up to you to make your clerkship meaningful.

・Neurosurgery at Peking University

Before the beginning of the clerkship, the replies from Office of International Affairs of Peking University were very quick - they took care of me so well. For each international student, an instructor as soon as an undergraduate student mentor are assigned. I asked the mentor for help when meeting with problems about my study and life during the clerkship. Peking University is the only one that has this kind of system in the affiliated schools of Nagoya University.

I had a clerkship for three weeks at Beijing Hospital, which is a city hospital. It belongs to the highest level “Sanjia Hospital” in China’s hospital ranking. The Neurosurgery Team, led by nationally famous neurosurgeon Dr. Wang, introduced catheter technology earliest in China and is still the top of the country in cerebrovascular field. In China, the leading cause of death is cerebrovascular disease, so many patients were introduced there from all over the country. I was a member of the vascular group and experienced a lot of difficult endarterectomies, stent implantations, aneurysm coiling surgeries and so on. In a surgery, such as an endarterectomy, I had the chance of doing subcutaneous and skin suture.

Each morning, I went to the hospital at around 7:30. I checked the conditions of patients who had operations the day before and participated in the morning conference from 8 o'clock. All the communications were in Chinese, but there were also several doctors who had had observations at Johns Hopkins University or the University of Chicago in the United States. So, they were able to explain me the medical terms in English. Doctors of master’s degrees and doctor’s degrees were also very good at English. Moreover, the doctors were very enthusiastic about education. If there was a medical treatment or an emergency case, they would give me a phone call if I was not in that place.

Since I can speak Chinese, I had the chance to chat with patients and their families when checking the conditions. However, one patient who I had a good conversation until the day before had a sudden change of condition at midnight. He had already passed away when I went to the hospital the next morning, which made me so sad. In addition, patients with subarachnoid hemorrhage were often carried to ER. When I explained the seriousness of the illness and the risks of treatments, I saw a lot of families who collapsed crying. It was the first time for me to be soon before life and death, so I could not help feeling the responsibility as a doctor and sometimes powerlessness.

One day, when I was observing a Carotid Stenosis Stent Implantation, an embolus flew, and obstruction of the basilar artery occurred. The atmosphere of the operation room changed at once, but the surgeon calmed down and suck the embolus immediately. The chief surgeon told me that it was the first time in his 10 years’ career as a surgeon, but I thought anything can happen in a real clinal situation so being able to make judgments at such situation is also a necessary ability for a doctor.

Doctor’s office is always in the ward at most hospitals in China, including Beijing Hospital. The interesting thing was that patients and their families always visit the doctor's office directly rather than asking the nurses if there were any doubts. Although many patients can be relieved by the closeness between doctors and patients, doctors were forced to deal with the patients who came in every five minutes even during the work. When a doctor was walking in the hallway or visiting other patients, the family looked attentively at doctors and asked various questions the moment doctors came out. As for the contents of the question, something like “why MRI examination has not started yet?”, or “I want you to look at the patient because he has his back itching” were there. Most of them can be easily solved if they just ask a nurse. In addition, those who asked for a second opinion with CT and MRI taken from other hospitals were waiting in the corridor frequently. And there were always patients who called the doctors’ mobile phone directly.

At the root of those unfamiliar behaviors was the patients’ distrust to doctor. It seems there is still a perception that doctors do not see the patient first or look at their full attention without connections or money. Indeed, for patients coming from far away from Beijing, shortening the time also leads to a reduction in financial burden given the hotel fees and other factors. So, why they have to come to Beijing from far away? Behind that, there was a social problem of uneven medical resources in China. “Oneline cities” such as Beijing and Shanghai actively adopt guidelines of WHO and communicate with foreign countries frequently, so medical care is the same level as developed countries. On the other hand, the other regions had not reached its development yet, so patients had to go to a large city to receive good medical treatment. Therefore, difficult cases were gathered in Beijing, and the level of doctors in Beijing was getting higher and higher, which means it would take time for regional differences to disappear.

Aside from the clerkship, there was a culture that values food very much in China. There was always free lunch box for each operation room, and I was always offered lunch and fruits at catheter room. Even in late evening, dinner was also prepared. I never bought meals with my own money during the clerkship. They always asked, "Have you had meal?". And if I answered, "I haven’t", the technicians and nurses prepared rice and a large amount of side dishes with fruits and sweets. The warmth and humanity were as if I was in my parents' house.

In terms of daily life, the transportation network such as buses and subways, was very developed. And the shared bicycles were quite cheap, which I think is even more convenient than Nagoya. I was surprised that smartphone payment is so developed in this country. I never used cash for three weeks in China. There were vending machines that could be paid by face, and there were so many barcodes in and outside the hospital. With the rapid development, I can expect further progress of medical care and social welfare in this country.

Doctors, no matter which specialty they choose, should read papers and attend academic meetings to get up-to-date information. Unfortunately, the current language of medicine is English and will not be changed for a while. It is easy to read an English paper or have a presentation at medical conference by looking up on a smartphone dictionary or Google. However, at information society, medicine is developing rapidly, and now there is a need for an ability to discuss medicine with doctors from all over the world. Even from the perspective of history, countries that refuse to interact were left behind in the world's rally.

I think a doctor should stay abroad for a short period of time clinically or for research. It does not have to be an English-speaking country. The moment one leaves Japan, people outside cannot speak Japanese, so the communication tool will eventually be English. There is possibility where people we speak to cannot speak English well. Therefore, I think it is the real English ability to be able to communicate well with simple words and grammar. It is not expected for an exchange student to improve his English skills in just 3-month clinical clerkship, but I’m sure he can develop his ability to DISCUSS and NEGOTIATE with foreign people using his limited English skills. Of course, medicine in Japan also leads the world, which always incorporating cuttingedge knowledge and technology, and people's morals are the best in the world. Working in Japan as a doctor is a great choice. So, I hope even the juniors who want to work in Japan should not miss the wonderful opportunity of clinical clerkship in foreign countries, which can make them stay abroad and improve themselves.

Finally, I would like to express my greatest gratitude for offering me one of the best events in my life to Dr. Hasegawa, Dr. Kasuya and Dr. Itzel at Office of International Affairs, all the doctors at Johns Hopkins University and Peking University, as well as my parents.

Elective Report

Takeshi Sasaki

Earlier this year I had a precious chance to have an elective clerkship trip to the US and the UK from Feb. 22nd to Jun. 23rd. The schedule was as follows: first of all, thanks to the JMEF (Japan Medical Education Foundation) program I stayed in Glasgow, Scotland for 4 weeks for an elective at Neurology department of the University of Glasgow. Then I moved to the US and spent 4 weeks for another elective at Pulmonary Medicine of Duke University, and 2 weeks for an observership at its ID service. Finally, I went back to Cambridge, England and experienced 6-week stay for my last elective at OBGYN of the University of Cambridge. Actually I didn’t expect to visit 3 different places at all when I started planning this trip and thus the application process was quite complicated, but thanks to all the generous support I was able to finish the trip without any problems. I’d like to give the details of each placement below.

I was mainly based on the Queen Elizabeth University Hospital during the Neurology placement in Glasgow. It was such a pleasure for me to study at the place where GCS (Glasgow Coma Scale) originated. 3 medical students were also coming from other universities in Japan so we would encourage each other every day by talking about what we did in the rotation. What was particularly impressive was there were so many MS patients, which can hardly be seen in Japan, and even MS clinics.

The next destination, Duke University, was located at a small city called Durham in North Carolina and Nagoya has had affiliation with Duke for years. Fortunately I was able to follow some CF patients, which is another rare disease in my country. At first I wasn’t supposed to observe the ID service but my host mother Jenny kindly made efforts that eventually made the observership possible. Also, I had a short trip to Greensboro, which is another city in North Carolina, to observe Dr. Longphre’s workplace. She is one of the alumni of this program and works as an anesthesiologist there. She also let me experience a lot of things which are special to the US.

My final destination was Addenbrooke’s hospital in Cambridge. I applied for this elective program as I spent 2 weeks at St. John’s College, which is one of the colleges in Cambridge, for an exchange program in 2016 and really wanted to join its Harry Potter-like formal dinner again. My supervisor’s specialization was Gynecology and because of that I was rather attached to Gynecology than to Obstetrics. As for extracurricular activities, one of my friends from the college enabled me to enjoy the formal dinner twice in total and also I got a chance to attend one of the May Balls, which are balls that take place at the end of the academic year of Cambridge. On weekends, I walked around Cambridge city center and also extended the journey to France to watch the Fench Open quarter-finals, taking advantage of being in the UK in the season.

Unfortunately, I didn’t feel that my English improved or my medical knowledge increased dramatically after all. I believe, however, this trip was meaningful in a sense that I was able to understand the difference of healthcare, medical education, and even medical English between the two countries and know the existence of Japanese people who are supporting/will soon support the international position of Japan as one of the countries in the world. Overall, everything was new to me during my stay in the US but I was so pleased to have reunions with some of my old friends in the UK. Lastly I’d like to conclude this report with deepest gratitude to all the doctors/professors who helped me out with organizing this trip.

The Chinese University of Hong Kong

Takumi Ebina

I studied abroad at The Chinese University of Hong Kong for two months. Hong Kong is one of the safest cities in the world and there are many people who like Japan, so I was able to spend a very comfortable time.

I was attached to the Department of Gastroenterology & Hepatology. I observed endoscopic procedures, outpatient clinics, and word rounds. Patients spoke Cantonese, but medical records were written in English and word rounds are held in English. Therefore, there was no language barrier during my clinical attachment.

I was very surprised when I watched an Oesophagogastroduodenoscopy (OGD) for the first time in Hong Kong. In Japan, endoscopists take dozens of photos during an OGD and often use NBI. However, in Hong Kong, endoscopists take only a few photos during an OGD and rarely use NBI. Moreover, another unique feature of the endoscopies in Hong Kong is that surgeons also perform any kinds of endoscopic procedures.

Many Gastroenterologists were very friendly to me. They often gave me lectures and took me to local restaurants. In addition, an assistant professor came to Nagoya and we went sightseeing after I came back to Nagoya.

There were many foreign Gastroenterologists from Europe and Asia. I often talked and had lunch with them. It was very meaningful that I was able to talk with doctors from various countries.
The medical care system of Hong Kong is very different from Japan. If you are a Hong Kong resident, you can go to a public hospital more cheaply than in Japan. However, the wards are heavily crowded and outpatients have to wait for a very long time. I cannot forget the sight the beds in the passage outside the cubicles being also full. However, I never saw any inpatients or outpatients complaining to doctors.

Actually, I had never lived alone, traveled abroad alone, or studied abroad until this studying abroad. I was very anxious about whether I could live alone before departure. However, doctors, local students, other exchange students, and local people were very kind to me. I came to think that I would try to talk with foreigners as much as possible when I meet them in Japan from now on.

I would like to thank the Office of International Affairs and everyone I met in Hong Kong.

Experience report (University of Glasgow)

Takuma Hirano

For nine weeks (3/25-5/24), I stayed at Glasgow and did my work as a medical elective. The first 6 weeks were completed in the Neurological department at QEUH (Queen Elizabeth University Hospital), and the last three weeks were at GPs all over Scotland. Both of them were really fantastic and wonderful.

My typical day at QEUH was started with OSCE section, studying basic neurological examinations and interview. After that, we were divided into groups of five students and each group observed outpatient clinics, a ward round and neurophysiological examinations. As I had expected, the local students were so good at proceeding interview and neurological examinations. In addition, they are confident about themselves. At first, I found myself really inferior to them in terms of those clinical skill but I was gradually inspired by them and tried hard to catch up with them. I really enjoyed group works because I could learn a lot from local students by watching them proceeding examination and interview. As I spoke English with patients every day, my interview and clinical skill was gradually improved and I got more confident.

After I studied at QEUH, I had an opportunity to undertake a three-week clerkship with the GPs. The time I spent with them was absolutely amazing. Since this was not included in the medical elective program, I contacted a local GP and asked him whether he could host me as an observer. Despite his tight schedule, he kindly accepted me and arranged everything needed during my clerkship. I really appreciate it because studying primary care in Scotland was what I was really keen on. I visited many surgeries around Glasgow and observed outpatient clinic, house calls and call centre. I sometimes had an opportunity to see patients by myself in a consultant room given for me. It was a good experience. All the GP I met were very enthusiastic to teach me the primary care system and the history of General Practice. They also showed me their professionalism as a GP throughout their work , which is “ continuous, accessible, patient-centered . And I was really impressed by how deeply patients respect and trust GPs while watching patient clinic.

On weekends, I enjoyed sightseeing as well. I explored Glasgow city with local students. I thought Glasgow was an industrial city but my cognition was completely changed after I visit many places. I would say that Glasgow is a City of Art and Music. Walking around the city centre, you can see lots of buildings whose walls are painted by local artists. Also, there were variety of pubs where we can enjoy Scottish music performance by local musicians. People enjoy listening to the music with a glass of Scotch whisky. Sometimes, I took a short trip to local area such as Lake district. The scenery was so wonderful that I got into nature in Scotland.

Nine weeks were really short for me to get used to the student life in Scotland but I am pretty sure that this experience had definitely influenced my view of studying and working in Scotland. I have not completely decided what profession I chose in the future but whatever I become, I really wish to have an opportunity to come back to Scotland again, hopefully as a clinical resident doctor.

Finally, I would like to express my gratitude to all the doctors and GPs who took care of me in Scotland, as well as the staff of office of international affairs in Japan. I would never forget all their continuous support and hard work.

Clinical Clerkship in Freiburg

Hikari Kondo

I’m Hikari Kondo, a sixth-year student at Nagoya University. I had studied at the University of Freiburg for three months. Now, I'm on a plane heading to Hong Kong. Actually, I was going to sleep during the flight, but the cup nudle provided on the plane was so delicious that I got a lot of refills. I woke up with full stomach, so I’ll try to spell out my experiences while remembering what I experienced while studying abroad.

I rotated in the Neurosurgery Department and Neuroradiology Department, Epilepsy Center of Freiburg University Hospital for a clinical elective for total 12 weeks. I was interested in neuroscience, and I decided to absorb a lot of knowledge about neuroanatomy from the teachers. On the first day of the memorable practice, however, I had no chance to learn anything. It just ended as a visit. I was shocked and depressed that I didn’t want to go to the next day's training. Though Ms. Yoshikawa who was practicing together with the first department was take part in the team, I was encouraged by her attitude and tried to asked questions to the surgeons. In addition, in order to raise the level of questions, I reviewed the neuroanatomy textbook that I used when I was in the second grade. After a few days, I was able to understand the contents of the surgery, and studied about rare cases such as Focal Cortical Dysplasia, trigeminal neuralgia, and cavernous hemangioma. I also had a chance to give a presentation in front of preceptors.

Practical training at the Department of Neuroradiology was the most enjoyable part of my three-month study abroad. There is no particular schedule, so I was able to participate freely in endovascular treatment team and diagnosis team in the MRI and CT room. Endovascular treatment team focuses on treatment for patients who have been urgently taken in by ambulance, such as stent placement for cerebral infarction and coil embolization for subarachnoid hemorrhage. Diagnosis team included MS and von Hippel Lindau disease follow-up to diagnosis of stroke. I also compiled the findings from the study of images and gave a presentation. When I was able to report correctly, my findings were included in the report, which was very rewarding.

During the last two weeks of my stay in Freiburg, I visited the Epilepsy Center. In this department, pediatricians and specialists in epilepsy worked together making a diagnosis and treating patients who complained of convulsions and tremors. I was able to study techniques for predicting cerebral dysfunction, how to read brain waves, differentiation between epileptic convulsions and Psychogenic convulsions, and classification of epilepsy. Plus, the preceptors had experience studying abroad during the postdoc period, and it was a good opportunity to hear about it.

In summary, unlike the practice at other universities, there is no schedule in clinical elective in Freiburg University. If you want to create your ideal practice on your own, I highly recommend studying abroad at the University of Freiburg. I would like to thank all the people who made my visit to Freiburg possible. I'm sure that all the experience and knowledge I gained will pave way to a brighter future ahead.

Clinical Clerkships in National Taiwan University and Freiburg University

Marina Yoshikawa

I am incredibly grateful to have had an opportunity to do clinical clerkships in two universities: two weeks at National Taiwan University(NTUH) and twelve weeks at Freiburg University. Both universities had their own culture and were quite interesting to compare.

In NTUH I was placed in department of obstetrics and gynecology(OBGYN): first week at obstetric and infertility center, and second in gynecology. Here, I was able to observe plenty of surgeries including cesarean section and many other interesting techniques like level II ultrasound examination and urodynamic study. Some of these are rarely done in Japan(e.g. single-incision laparoscopic surgery, level II ultrasound etc.), so I really enjoyed observing them and wished I could stay longer(two weeks were too short!). Throughout the electives, I have never felt any difficulty based on the language barrier. The doctors were kind enough to explain me every procedures they were doing and answered to all of my questions in fluent English or even in Japanese. It was extremely helpful and I could get the most out of the experience.

In Freiburg I rotated three departments(neurosurgery, anesthesiology, OBGYN), each four weeks. My first rotation at neurosurgery always started with the morning round at 7:00. Doctors and nurses took part in the round and discussed the patients‘ condition before they meet the patients. After that we had the routine morning conference, where post-operative patients and emergency patients were reported. Most of the time during my clerkship I observed surgeries. I was astonished to see all of the microscopic surgeries were done with highly sophisticated technical skills and it was really awesome that doctors were welcome to explain procedures throughout the operations. The following month I went to the Loretto-Hospital to rotate in the anesthesiology department. The hospital was small, but experience here was unforgettable. There were only two surgical departments(urology and orthopedics), but there were big operation as well as small one, so a variety of anesthesia were done. Doctors were kind enough to let me do almost every procedures: mask ventilation, intubation, spinal anesthesia, arterial line placement etc. Also, they were quite willing to answer to my questions, which was helpful to understand complicated usage of medications. They sometimes used medicaments which are not admitted in Japan, which was totally interesting.

The last month of my elective was in OBGYN department at St. Josefs-Hospital. Here I observed many gynecologic surgeries, outpatient clinic, vaginal delivery and cesarean section. Although most of the clinical process and surgical procedures were similar to those of Japan, the total care for the pregnant women was outstanding. Delivery rooms were incredibly big and equipped with comfortable bed, and women could take best postures they wanted during the delivery, which is rare in Japan. Another surprising part was that fathers were allowed to stand by their partner during the cesarean section and he also attended the first basic investigation of the newborns, which helped to relax mothers.

Overall, I enjoyed my clerkships in both universities very much. I am extremely grateful for the support of my home institution, NTUH and Freiburg University, which gave me the opportunity to see another healthcare system and to learn from international colleagues. I will always remember and cherish this experience.

Experience Report

Kenju Ando

I had had my clinical placement at the University of Adelaide in South Australia. I would like to report what I have experienced and learned in Adelaide.
Adelaide is the capital city of South Australia, which was originally founded as a freely-settled British province. There are many immigrants and their descendants; therefore you will meet people of various origin if you walk around the central city. It is a very ideal place for international students to study and live. In addition, Adelaide is surrounded by remarkable beautiful nature. There are many colorful birds flying around the city and you can find wild animals including koalas and kangaroos at national parks.

Since the university does not have a university hospital like the Nagoya University Hospital, all medical students are having their clinical placement at affiliated hospitals. I had my rotation for 12 weeks at the new Royal Adelaide Hospital (RAH), the largest hospital in South Australia relocated two years ago.
The first 6weeks I had studied medical oncology, and the latter 6 weeks I had rotated gastroenterology and hepatology. At both departments I was allocated supervisors to organize my placement and they were really helpful and always tried to improve my rotation. Usually I went to the ward at 8 o’clock in the morning and participated in inpatient care such as interview, recording medical charts and blood collection with other students and doctors. Sometimes I had a chance to observe outpatient clinic and endoscopy several times a week. While most of the indications and regimens for treatment are similar to those in Japan, some medications such as antibiotics and anticoagulants are used different from Japan.

At the beginning of my placement, I was very confused and it took almost one month to get used to the new hospital because there are many differences between the placements at RAH and our university hospital. However, thanks to medical students and other members at wards, I was able to study a lot of things. For example, they kindly taught me how to take blood or how to write medical records on paper which I hadn’t had enough chance to practice before I visited there. The students always assisted me whenever I had to interview with patients or their family which are sometimes very difficult for me due to language barriers.

Almost every day we had a coffee break which was very impressive for me. They love to have a break even they are very busy. During the break, everyone had relaxed with their favorite drinks, and I chatted a lot with students and doctors who usually did not have enough time to talk at wards. It was very precious for me to have a chance to talk with them every day. Against my expectation, everyone knew a lot about Japanese culture, and I felt happy when they talked about a trip to Japan on vacation or Japanese food for me.

After returning to Nagoya and started a new rotation at a hospita, I once again noticed a lot of differences in clinics, education and values between Australia and Japan. The most remarkable difference in a ward for me is that patients in Adelaide are young compared to patients in Japan. While almost all the patients are older than 65 in Japan, at RAH, surprisingly only 30% of patients are older than 65 which means they usually do not have severe complications, and discharge hospitals earlier than patients in Japan. At conferences, the doctors discussed the details of origin and lifestyle of their patient’s more than Japanese doctors usually do when they decide the diagnosis or treatment, since Adelaide has a multicultural society. The goal of medical education in Australia seems to become a general doctor after the graduation rather than to acquire knowledge and to become a specialist as in Japan.

I would like to appreciate all of the members in the Office of International Affairs of Nagoya University who supported negotiations and preparations, as well as the members of the University of Adelaide and the Royal Adelaide Hospital who accepted my clinical placement.

My experience in the University of Adelaide

Akiyo Mase

Since this spring, I had studied at Adelaide University in Australia for three months and rotated in Women’s and Children’s Hospital (WCH), located in North Adelaide. Adelaide is the capital city of South Australia, cozy city, and surrounded by beautiful nature.

WCH is a specialized hospital for children and women. I rotated in some pediatric departments for three months. I rotated one department every two weeks, Allergy / Immunology, Genetics, Infectious Disease, Respiratory, Neurology. I spent the first two weeks and the last two weeks in Allergy / Immunology. The student's job was to do medical interview and physical examinations at the Medical Day Unit and report to the register. I was surprised that she told me to write a prescription and she would make a signature later. I struggled in the first two weeks and was quite depressed, but in the last two weeks, I was able to do interviews and presentations. At Genetics Department, I was able to see patients with rare genetic diseases and attend counseling. It was a shame that I was absent for about 3 days because of flu. In the Infectious Disease Unit, I could learn some rare disease, such as osteomyelitis, strongyloidiasis and so on. In addition, I could get some chances to write medical records, conducted physical examinations, and gave presentations. In Respiratory Unit, there is quite many patients of Cystic Fibrosis that are rare in Japan. In Neurology Department, we were able to see a wide range of cases including cerebral palsy, epilepsy, and MELAS. Surprisingly, patients had to wait their appointments for to month at least. In Australia, there are private medical care and public medical care. The public medical care is free although patients have to wait such a long time. It was interesting to know and discuss about the difference in medical system between Australia and Japan.

I also participated in various teaching sessions with 5th grade students from the University of Adelaide. During the teaching session, a group of several students practice interviews, physical examinations, and presentations and a senior doctor gives us a feedback. In addition, there were many opportunities to learn with students. I am glad that I could know the curriculum for medical students in Australia. It is also a good memory that some students invited me to dinner and having fun together with mahjong.

To be honest, I was very anxious before departure, and I was not confident that I could finish the training. However, with the warm support, I was able to finish. It was a precious experience for me to stay and do clinical clerkship in a very different environment from Japan, in terms of the medical system, cultural background, and racial diversity.

I'm grateful to all people who supported me for this elective.

My Clinical Elective Experience at University of Western Australia

Nao Adachi

I had the privilege to participate in a 8 week elective rotation at University of Western Australia. For the first 4 weeks, I rotated Rehabilitation and Aged Care at Sir Charles Gardner Hospital in Perth. Then I moved to Karratha and spent another 4 weeks studying Rural Medicine at Karratha Health Campus.

In Geriatrics, I mostly spent my time in the GEM unit. I went on rounds, participated in meetings and teachings, observed the clinics and took history from the patients. After taking history, I usually presented the case and discussed the patient’s problems with my supervisor. Geriatrics patients had multiple comorbidities, which made them interesting but also difficult to understand their condition. Also, I had the opportunity to go with the PTs for home visits. I was able to see what their house looked like and how they were living at home. During my rotation, I talked to as many patients as possible to practice my history taking and presentation skill. On the last day, my supervisor told me that my case presentation has gotten much better.

At Karratha Health Campus, I rotated the Ward for 2 weeks and Maternity for 2 weeks. They only had CT, ultrasound, and no MRI. Most of the doctors fly in from other cities, stay for a few weeks and then go back. There, I met Aboriginal people for the first time. Until then, I didn’t know about all the Aboriginal problems that Australia was going through. The indigenous have shorter life expectancy, lower standards in education and employment, and serious problems with drug/alcohol abuse. I realized the importance of healthcare education. I went to Roebourne (a town next to Karratha) to educate the Aboriginals with the Population Health team. We taught them physical therapy in the park and also held an event called “Health Hair Day” at an elementary school to prevent lice. I had a valuable experience interacting with the locals.

Everyone I’ve met in Australia was really kind and helped me get through those 2months. It was an honor for me to meet such wonderful people. I learned the importance of being honest and to ask for help if necessary. After completing my clinical elective, I feel a little more confident than before. I hope I could make use of this great experience in the future.

I am deeply grateful to the members of the Office of International Affairs at Nagoya University. They supported me throughout the whole experience. I would also like to thank whoever associates with this exchange program in both universities. Finally, I could not thank my family enough for letting me participate in this program. Thank you for giving me such a great opportunity to learn.

Clinical clerkship report

Yoshinobu Iwaki

I have finished 2 month- clinical clerkship at University of Western Australia (UWA). First and foremost, I am grateful to those who helped me.

In the first month, I was enrolled in the neurosurgery department of Sir Charles Gairdner Hospital (SCGH) in Perth, the largest city in the state of WA. Quite a few patients are referred to SCGH of around 600 beds. The neurosurgery department was brisk with 14 registrars and 7 consultants working vigorously.

The schedule was basically as follows: morning round at 7am following 3 operations in 2 theaters respectively till 6pm. In addition, conferences, short lectures for intern, outpatient clinic, seminars for registrars and ad hoc operations at night or on the weekend are available to join. What to attend or not was totally up to me.
The number of surgery I watched amounted to 51, 60% of which was brain, and the rest of which was spine. I scrubbed in 31 of them, where I could develop my hand technique little by little as it was. I would feel tested when checking the wound I had closed in the next morning round.

Although I was in a theater most of the times, I sometimes observed a clinic, where consultants asked me stimulating but hard questions to answer, or went to ward to flip through medical records of academically intriguing cases.

What remained regrettably undone was ward administration, the main task for residents. It seems, however, difficult to contribute, given that I had limited access to lab data, and even UWA students did nothing about it, whereas residents looked too busy to take time to teach me. Anyway, it was the best decision to absorb myself in theaters. When observing carefully, I realized consultants performed the technique more sophisticatedly than registrars; even registrars looked bright to me, nevertheless consultants showcased their class with exquisiteness as to the tiniest aspect. I figured out what ‘beauty’ was all about in surgery I had not been able to.

Doctors in this department were exemplary dedicating themselves to jobs without grumbling over the environment, while making it through tough exams. I sincerely respect them, and have recognized what it meant to be a neurosurgeon, and the distance to cover in the next several years.

There are 3 medical students who concurrently rotated the department; one is a visiting student from Italy, and short as the time we shared was, he relieved my anxiety soon after my arrival. Another is a UWA student, who invited me to a dinner at the Japanese restaurant she worked at. She told me some funny Australian idioms, which was really helpful afterward. The last but not least was a UWA student as well, who kindly gave me a lift almost every day while enlightening me backed up by broad knowledge. Were it not for these mates, I might have had harder time.

In the second month, I flied from Perth to Karratha, a small northwest coastal town surrounded by vast wilderness.

Karratha Health Campus is a brand new hospital established half a year ago, at the center of the town of 15000 people. Not highly equipped though, it is responsible for many patients referred from adjacent communities. I chose to study at ED.

In contrast to ED in Japan generally full of the elderly, here I saw relatively young patients. Karratha is known for mine, whose workers are naturally young. Besides, merchant seamen and indigenous people granted variety. My job was as follows: First, bring the patient after triage, take the history doing physical exams, filling in nursing records, and consult a senior doctor. After he or she saw the patient, order the test, prescribe medicine as discussed, and write the summary. Since the whole process took so long even in the simplest case, I could see only several patients although staying 730am- 6pm. It was such great environment that I studied even on the weekends. Despite some horrible faults such as miscalculation of dosage of medicine, consecutive failures in cannula, and overlooking appendicitis, staff helped me out whenever at a loss, kindly instructed, and trusted on me even more firmly. I cannot appreciate their mindset more.

Gradually, I grasped all procedures by myself in some cases similar to what I saw previously. The role here is what to do as a junior resident in Japan next year, thus I believe I will be able to carry it out with confidence.

Finally, I would like to share a story that was most impressive. As was often the case with the indigenous, they would present with gunky abscess in lower limbs, arm pit, or buttocks. The abscess reached the soft tissue, which obviously should have been intervened earlier. Poignant smell was well enough to torment me during dressing change. We asked them to come again on the following day to keep it sanitized, but they did not usually show up. In addition, poor adherence to prescription have produced resistance to antibiotics resulting in limited alternatives of medicine and unfavorable prognosis. Why don’t they come earlier? With the scene beating me, I thought it was simply owing to lack of education. One day, when I casually chatted over snack with a friend of mine in the next cabin complaining that they came too late, his atmosphere changed, asking me ‘‘do you know the history?’’ Here is the story: his wife is indigenous who earned master’s degree, a very rare academic background among those. Highly educated as she is, she would not bring her son to the clinic when he got sick, so it has been always husband who did it. Why does it happen when she understands the importance of medicine? Much to your dismay, a hospital, until the Aboriginal Land Rights Act was proclaimed in 1977, was taboo for the indigenous. To visit facilities owned by the government with children allowed the government to kidnap them with an unreasonable excuse that they had been nurtured improperly. The government in those days enrolled indigenous children into White family to assimilate them. This is called ‘lost generation.’ The tragedy has still been dissuading them from going to hospitals. Things have changed by and large, as I saw many indigenous adults willing to bring her kids as soon as they noticed if any. However, the time has yet to come when this imprinted idea inherited goes extinct.

What embarrassed me is I was reluctant to get to know their background; I interpreted the situation into my context instead. Since this thumping experience in the middle of the itinerary, I tried to be caring on patients with a step higher ‘acceptance of diversity,’ which I wrote as my virtue in the motivation letter of this program.

Ignorance is NOT bliss. I will embrace the lesson that you have to know the history to judge someone.

Experience in Vienna

Takashi Naka

From April 1st 2019 to June 21st 2019, I studied in Medical University of Vienna. Since it has been one of the most important cities in entire Europe for a long time, Vienna is a lovely city with historical atmosphere everywhere. At the central part of the city, we can find two huge cube buildings. They are the wards of the hospital where I studied for twelve weeks. Allgemeines Krankenhaus (AKH) is Europe’s fifth largest hospital with more than 2,000 sickbeds and people all over Europe come here to get high-level medical cares. There I was able to learn and experience lots of things.

My clerkship started from the department of Radiology. This department is divided into many subspecialties. I was so surprised at division of labor. In one subspecialty, for example chest X-ray, radiologists read only chest X-ray images and other subspecialties do others. After conferences and meetings in the morning, I followed radiologist in various subspecialties. Although sometimes I felt my English and knowledge was not enough, staffs there gave me kind educational supports, so I could learn a lot during and after the clerkship.

My second department was the division of Transplantation. Since this division shares the ward and operation rooms with General Surgery, I could join kinds of general surgery operation as well as transplant operation. This system enabled me to experience much more cases than I expected. In AKH, most transplant cases are deceased-donor transplantation, which is so different from our style in Japan. I knew this fact before, but it was important for me to learn that from clinical practice.

For the last four weeks, I visited the department of Ophthalmology. Just like Radiology, this department also has many subspecialties. I spent much time in macular division. Of course they have a lot of patients, especially patients with age-related macular degeneration, but it is not very busy there, so ophthalmologists taught me about diseases from the basics. I had English discussions with ophthalmologists and patients. It was challenging, but really rewarding experience.

Local students in AKH stimulated me a lot both in study and daily living. I had some opportunities to learn ultrasonography from local students and I was so surprised at how high-level they are. In some home parties, they introduced me many interesting things in Vienna which I could never find as a tourist.

I spend meaningful three months in Vienna. I believe this experience can be obtained only in this period and this place. Everything was wonderful. I am grateful to Professor Kasuya and Dr. Hasegawa in Office of International Affairs, Dr. Salemi in International Office of Vienna medical university, and all persons who supported me.

Experience in Vienna

Kana Nakayama

Recently, I did a clinical clerkship for three months at the Medical University of Vienna, which has one of the biggest hospitals in Europe. This university is located in the middle of Europe, so it’s very international and there are so many students from other countries of Europe. Vienna is the number one city in the 2018 Ranking of Towns where people want to live, so it’s easy to live there.

Since the official language in Austria is German, the biggest concern was having to learn the language, but once I went to the university, almost all people spoke to me in English, which made me feel better. I was so surprised how much effort they put into English education after I heard small kids speaking English so fluently.

Whenever I introduced myself, many people showed interest in Japan and I was able to spend a comfortable time with topics such as “Where are you from in Japan?”, “I know Nagoya!”, “I’m thinking of visiting Japan soon!” and so on. Many teachers asked me about medical systems in Japan and we could discuss them, so I could spend a really fruitful time with them.

〇clinical clerkship

I was very worried about language, but every doctor gave me lectures in English. They were so eager to teach the students, so it was very helpful and good for me. Some students in their sixth year were working at the hospital, so they had stunning practical techniques. This stimulated me and kept me motivated a lot. When I was with them, I could make a physical examination together. This helped me so much. I really appreciate them.

OB&GYN: There was no fixed schedule, so I could choose what to do every day. However, this was hard for me because I was not used to deciding what to study by myself. I really struggled with this, but this experience taught me the importance of being active. Some doctors let me do some simple procedures and I learned many things from them.

Pediatric Cardiology: Pediatrics were divided into several sections, so there were only five doctors. They were kind enough to take care of me all the time. I could spend precious time thanks to them. Besides, since there happened to be some sixth-year students, I could gain much more experience than I would gain by myself. I also joined ward round and saw the children who were hospitalized every day, so it was hard to say goodbye to them.

Radiology: In this department, they gave me many choices, such as MRI, CT, X-ray and so on. This meant I had to consider what to do and join by myself. Every doctor I followed gave me useful lectures in English. The most impressive thing was fetal MRI, which is not so familiar to us. This hospital is putting so much effort into this section compared to Japan that I could gain much more experiences about this than I could in Japan.

〇Conclusion

I would like to express my gratitude to every people who supported me, including Office International Affairs Nagoya University Graduate School of Medicine, the foreign office of Medical University of Vienna.

My special experience in Medical University of Gdańsk

Eriko Sumi

I studied at Medical University of Gdańsk in Poland for 3 months. Everything which includes getting a visa and living alone in a foreign country was my first experience, but I was able to live a fulfilling life thanks to a lot of support. The main reason I chose Medical University of Gdańsk was my senior studying there before told me various wonderful experiences which I cannot get in Japan and it attracted me.

In the downtown, of course, people speak Polish, but the university has a course called English Division, where all conversations and classes are conducted in English. About 300 students are enrolled in the first grade, and surprisingly women occupied about 70% of all. Students came from all over the world, including India, Iraq, Italy, Canada, Sweden, Spain, Saudi Arabia, Germany, and Norway. By interacting with students who have completely different backgrounds, I was so inspired by their attitude to face medicine and clear visions for the future. I realized that I studied in a truly comfortable environment in Japan.

I joined the different groups in 4th or 5th grade every 1 or 2 weeks and studied anesthesiology, heart surgery, oncology, orthopedics and traumatology, pediatrics and surgery. The staff sent me a schedule in advance, so I was able to choose some departments I am interested in. As in Japan, I had lectures, ward training, outpatient visits, surgery visits, and ICU visits. At Medical University of Gdańsk, students start studying medicine from the first grade, and it is quite difficult to pass to the next grade, so the amount of knowledge of the students was amazing. And, unlike in Japan, even if in surgery and orthopedics, more than half of all doctors were female and those who raise children or who are over 60 years old worked hard and energetically, so I was impressed as a fellow woman.

I had so many surgery visits and they were very enjoyable every time. A new operating building was constructed last year, and there are 30 operating theaters. I feel that the surgical instruments used are not much different from Japan. At this university, they can do a lot of things with doctors during practice, for example, a urinary catheter, intubation, and laryngeal mask insertion. I also tried intubation for the first time in the operation of pancreatic cancer. At first, it was not easy to insert the tube, but finally I was able to manage to succeed. Like this, on weekdays, study was always tense, but on weekends and Easter holidays, with Ms. Nakamura, I went to other cities in Poland or other European countries, so I was able to balance study and leisure.

I really appreciate that Prof. Wozniak, a professor of biochemistry, and Adam, his secretary helped me a lot. From the first day I arrived in Gdańsk, not only by office procedures, but also by cycling and shopping together on the weekend, Adam supported me greatly. During the Easter holidays, I was invited to the home of the professor and enjoyed the Polish traditional cuisine by his wife and I also had the opportunity to eat sushi with his son’s family. The professor welcomed me like a real daughter and always paid much attention to me, so I never felt lonely. And he also gave me an opportunity of a presentation about the relationship between green tea and longevity for Polish high school students at the university. It became a valuable experience.

For a few days after I arrived in Gdańsk, I was not confident, but I was able to get over that with Ms. Nakamura. We were helped by so many people and I feel that I could learn a lot of important things not only in medicine but also for my future life and then grow up. What I learned for 3 months will be useful in the future to be a good doctor.

In the end, I would like to express my deepest gratitude to all persons who support me for this exchange program; Prof. Kasuya, Dr. Hasegawa and stuffs in the Office of International Affairs, members of Frontier, Prof. Wozniak, Adam and Ms.Nakamura.

Precious experience in Gdansk

Rika Nakamura

I went to Gdansk Medical University in Poland for two months. I experienced many wonderful things for the first time and expand my viewpoints. It was my dream to study abroad from entering Nagoya University.

I chose this university for two reasons. First, we can learn medicine here in English. There are two courses of Polish Division and English Division. Second, this university is specialized for foreign students from all over the world. So I met many students from Sweden, Saudi Arabia, Iraq, India, Spain and Italy, which I have not known a lot. I entered their group and talked a lot about many things of not only medicine but also everyday life. Especially I was surprised by seeing many sick Islam friends during the Ramadan season and began to feel familiar about Islam. In addition to it, I was surprised about the fact that most students know a lot about their own culture and history and some of them know more about Japan than me.

I took Pulmonology, Ophthalmology, Tropical infectious medicine, Oncology. We had to take each test at the end of the course and passing it was very difficult. So I always took electric dictionary to practices and asked many questions to teachers and friends seriously. In particular, in Pulmonology practice it is a good memory that we had to answer by reading X-ray one by one up to 100 pictures. In Tropical infectious medicine, I met patients of Malaria and Echinox which is very rare in Japan.

It was very comfortable to stay in Gdansk because it was very cheap to buy any things. I bought a lot of food in supermarkets and gained weight. It was also really safe there and we were able to walk alone at night. However it was so cold even in May. There were a lot of snow and we could see cherry blossoms at the end of May.

Professor Wozniak who loves Japan supported us very much. He said "I am your father in Poland so please contact us anytime." He welcomed us and we were able to release our anxiety about our new life. It was precious experience that we did a presentation to high school students about green tea wearing a kimono that his friends lent us. And Maria, his wife and his grandchildren took us to a delicious sushi restaurant and welcomed us to their homemade Easter party. Their hospitality was wonderful that I can know deeply about 一期一会, his most favorite word. Adam, Professor Wozniak’s secretary helped us a lot. We went cycling to the park ate a lot of Polish foods and so on. He also supported our mental stress. He is so gentle that he sent us a lot of souvenirs from Poland.

There were many parties like BBQ among friends. I was so impressed by the party for learning and teaching our own languages to one another and making more friends. And I recognized that Japanese is very difficult for foreigners.

The life in Poland was so amazing and stimulating. It was a little difficult for me because it was the first time to stay alone and in foreign countries. For example, I was surprised at their wide knowledge of medicine. It was impressing that they learn medicine in English, which is not their original language and study hard in foreign countries. The most impressive thing is their kindness of helping us even though we stay only for two weeks. I reflect on my behavior that I did not give enough hospitality to foreign students. I decided to change my mind and am grateful to think about it during the stay.

Thank you very much for helping me a lot to the teachers of international collaboration room and all of the people who supported for my studying abroad.

Clinical Clerkship in Lund University

Takanao Omi

Last spring, I got a chance to study at Lund University for 2 months. The experiences I had there was simply amazing, and I strongly believe it will have a huge impact on my life. Here I report the days I spent in Lund.

Before explaining the rotation, I would like to introduce Lund University and the town of Lund briefly. Lund University is one of northern Europe’s oldest universities and is consistently ranked as world’s top 100 universities. It is located in Skåne, the southernmost prefecture of Sweden. Lund is known for its beautiful streetscape, good security and calm climate. Since students account for about half of the population of Lund and there are many international students, I could say Lund is one of the most comfortable cities for foreign exchangees like us. Although prices in Lund were high compared to that in Nagoya, I didn’t have any complaints during my visit regarding to the living environment.

Now, I would like to move on to the main topic. I rotated Neurology Department and Vascular Unit for 4 weeks each. Both departments are in Malmö, which is the third most populated city in Sweden. Since the dormitory was in Lund, it took 40 minutes to commute to the hospital by bus. Malmö is very different from Lund in that there are many immigrants from the Middle East. Due to the characteristic of Malmö, it was a little difficult to communicate with patients in English.

During the first month in Neurology Department, I saw outpatient clinic, Neuro Observatory and consultation from the other departments in well balance. At outpatient clinic, doctors take an hour for each patient. As I mentioned, not many patients speak English. In addition, even when patients are Swedish and speak English fluently, they tended use Swedish to tell their symptoms more precisely. Therefore, I could not understand what they are saying, but the doctors were very kind to me that they explained about the patient before and after the examination. When the patients were English speakers, I was allowed to perform interview and neurological examination. Compared to outpatient clinic, there were less events at Neuro Observatory and consultation, so I was able to ask questions about patients, diseases and the medical system of Sweden.

The second month was at Vascular Unit. I participated in ward round, operations and catheter. I see a lot of operation and procedures, and what I was most excited was to take part in CEA and embolization of pulmonary arteriovenous fistula. Since there are many doctors watching the operations, I was able to ask questions to them.

Overall my experience in Lund was so meaningful by not only learning clinical knowledge but also realizing the differences between Japanese doctors and Swedish doctors. The doctors in the hospital went home much earlier and take a long summer vacation. It was very impressive that I had to lock up the office when I stayed there until 5 p.m. Although the salary is lower than that in Japan, most of them seemed to be satisfied with their lives.

Finally, the days in Sweden surely broadened my horizon. I sincerely appreciate the kind support I have received from everyone, especially Dr. Kasuya, Dr. Hasegawa and all staffs of international affairs. Thank you very much.

Clinical clerkship in Lund University

Ayaho Fujita

I experienced two months clinical clerkship in Lund University. These two months were beyond my expectation and most in my college life. I was so inspired by all experiences that this challenge was fruitful. I knew that healthcare delivery differ from countries especially those with high welfare and heavy burden (Sweden) versus those with middle welfare and moderate burden (Japan).I learnt not only medical differences but also new values such as equality and open society.

I did clinical clerkship in Oncology department and NICU. Both department gave me different treatments or diseases from my country. Among them, observing brachytherapy for cervical cancer was especially impressed me. I had never seen this treatment in Japan and the only brachytherapy I had observed in Japan was one for prostate cancer. I could see the effectiveness of this treatment in reality. In addition, in NICU, I was astonished by the way to take care babies. In Japan, mainly nurses take care of the patients like adult patients but in Sweden, parents were responsible for their children. I thought that the reason why this system is conducted in Sweden was because both of parents take child care leaves.

Sweden is one of the most equality between men and women in the world. As I said, in Sweden, most fathers obtained child care leave as well as mothers. In NICU or GCU, fathers took care of their children because mothers were exhausted by delivery. Not only mothers but also fathers value the time they spend with their family. Male doctors leave offices at three o’clock in order to pick up their children. I have never seen male doctors like them in Japan, so I was really influenced by gender equality in Sweden.
Upon arriving at Lund, I felt immediately welcomed. Whenever I was at a loss, all passers-by helped me. In clinical clerkship, not only doctors but also patients welcomed me. In medical interview, most patients told me that they hoped my study would be fruit and my stay would be wonderful. Outside the hospital, I had the chance to hang out with students of other departments. Lund University has a lot of faculties, such as law, physics and even art. At first, I didn’t have any friends in Lund because my dorm doesn’t contain any space to share with other students. Nevertheless, Lund University offered all medical students in medical departments “buddy system”. Through this system, I got contact with my buddy students, who is born and grew up in Lund and majored in radiography. Thanks to her, I made a lot of friends from all over the world and they welcomed me even though I joined them lately. Sweden is well known for one of the countries which accept refugees positively. I could understand from my experiences both in hospital and outside the hospital.

I appreciate all supports from the staff at the International Student Office, my friends, doctors who taught me in Lund University Hospital and mostly my family.

Norwegian University of Science and Technology

Erika Tange

I did clinical rotations for three months from April at St.Olavs Hospital attached to Norwegian University of Science and Technology. This university has become a partner school with Nagoya University from this year. I decided to go to Norway without hesitation because I wanted to go to a place that no one had ever visited and was attracted by beautiful photos of Trondheim. I would like to introduce my experience in Norway.

St.Olavs Hospital has 1,366 beds and is responsible for medical care in Trondelag County, whose population is 280,000. A Each department has a ward, so it was impressive that doctors used a scoter to move around the hospital.

I rotated at vascular surgery, orthopedic surgery, and digestive surgery for one month each. The official language of Norway is Norwegian, but most people can speak English. The conferences, interviews, and medical records are all in Norwegian, but the doctors are very kind in all departments, and they explained a lot in English before outpatient and during surgery.

Unlike in Japan, there are no student training schedules, so I was asked "How is your plan today?" every day. I decided by myself whether I went to see outpatient, surgery, or other departments. I was able observe many cases such as artificial blood vessel replacement, limb venous bypass, and dialysis shunt formation in surgical fields. Because this hospital has a doctor helicopter, I was excited to experience emergency surgery for ruptured aortic aneurysms.

In addition, I was able to interview patients who could speak English because kind doctors took an appointment. I was able to make use of the practice at the preparatory training at Nagoya University. Also, I experienced a lot of techniques that I could do, such as blood pressure measurement, rectal examination, and simple operation of the endoscope.

When I finished studying abroad, I thought that living abroad is not so hard as I expected. I think anyone can do it as long as there is a determination. The hard part was that I had to think and decide what I would do in “It’s up to you” environment. I was worried many times because I didn’t know whether Norwegian meetings that I couldn’t understand were worthful or I may have got more knowledge in Japan.

However, at the end of the month, the doctors said, “You were doing your best without knowing the language,” and I felt the value of studying in Norway for the first time.

Finally, I would like to thank Dr. Kasuya, Dr. Hasegawa and other international collaboration offices and frontiers for giving me such a valuable opportunity.