Office of International Affairs Graduate School of Medcine Nagoya University

I had a clinical clerkship at Division of Infectious Diseases at Johns Hopkins University in Baltimore, U.S.A. for a total of four weeks from March 2023. Although it was only one month, it was a valuable and irreplaceable experience. I would like to introduce my life during my clerkship.

Before clerkship

This clerkship was the first time in four years after pandemic of COVID-19, and preparation for this program was very difficult. Although it had been decided within Nagoya University that I would be able to study abroad at Johns Hopkins, I had not actually received an acceptance letter from the visiting medical students office at Johns Hopkins. Even one month before I was scheduled to study abroad, I was still undecided as to whether I would actually be able to go. I called the person in charge directly and managed to get an acceptance, but after that I was in a big hurry to get ready for life in the United States. I managed to find a monthly apartment near the university and contacted the landlord to secure a place to live, which I shared with a classmate who was going to study abroad with me.

Division of Infectious Disease at Johns Hopkins University

I spent my clerkship at Bayview Medical Center, a branch hospital of Johns Hopkins University. This hospital is located 20 minutes by bus from the main hospital, and compared to the main hospital, which has many complex surgeries and diseases, this hospital is like a fortress that accepts a wide range of patients from mild to serious diseases.
Division of Infectious Diseases provides consultation services for complicated infectious diseases, such as infectious diseases with many complications, severe sepsis, and bacteremia. A fellow and an attending doctor work as a team and perform an average of four consultations every day. In addition, this division takes over as a sub-department for patients whose condition has not yet calmed down or who need more time before a treatment plan can be established.
Here is a daily flow in the department. A fellow goes around to see patients in the morning, and discusses with an attending and a professional pharmacist dedicated to infectious diseases in the afternoon, and then the whole team will make rounds again in the afternoon. Patients are admitted to the general ward, ICU, CCU, and sometimes to the emergency department, and it was very cool to see the doctors walking around the hospital, communicating with the doctors and nurses in each department and giving them precise advice.

About clinical clerkship

The first part of the clinical clerkship was to follow behind the fellow and observe a consultation and a conference. On the first day, I was given a list of patients who were in the fellow's charge and told to follow his round, but his explanations were too fast and complicated to understand and I didn't even think up of what to ask. I clearly remember feeling a strong sense of crisis that my training would end without any growth.
I decided to increase what I could do little by little. I arrived at the hospital before the doctors, gathered information on patients from medical records, researched guidelines on Up-To-Date while eating lunch, looked for questions to ask the doctors, and kept asking questions during conferences and rounds. In the U.S., hospitals using the same electronic medical record system can view the same patient's hospitalization records and test results from other hospitals, which is convenient, but at the same time, information was complicated, and it took me a long time to find even a single history of antimicrobial use or past medical history necessary for a conference.
From the second week, I actually started to be in charge of patients. At first, I watched doctors examining patients, and presented information about patient information at the conference. I gradually began to interview patients in front of the fellow, but I was often interrupted by doctors in the middle of the interview, and I continued to feel powerless. As I took notes on how doctors talked to the patient, what they asked, and the points they focused, I quickly imitated them, and gradually doctors began to entrust me to interview patients on my own. Eventually, I was able to do almost everything by myself, from examining the patient, making an assessment and plan, presenting at the conference, which gave me a sense of growth and, to a small extent, confidence.
In addition to practical training in the hospital, I had the opportunity to talk directly with world-renowned infectious disease doctors, infectious control staff (unlike in Japan, this team was formed by nurses and public health graduates), a professor at Johns Hopkins University who graduated from Nagoya University, and to attend lectures with medical students of Johns Hopkins. It was not very often that I was spoken to by other people, but when I went to talk to them and asked questions, they kindly welcomed me and taught me about their precious experiences. While practicing in an unfamiliar hospital overseas, I realized the importance of thinking of what I want to do and actually taking action on my own.

Breaking time during clerkship

Although it was only a month, I found time to travel to neighboring cities on weekends with my classmate Ran. I especially enjoyed watching watching MBA games in Baltimore. One Friday, the attending doctor who taught me a lot took me out for a happy hour drink, and we had a lot of fun talking about his past research experience. I also went dinner with a new friend of medical students in Johns Hopkins, and we promised to meet again in Japan.

At last

I would like to take this opportunity to thank Dr. Kasuya, Dr. Hasegawa, and all staff at Office of International Affairs in Nagoya University, Dr. Itzel, who has taught me medical English since I entered university, the teachers and staff at Johns Hopkins University, my classmate Ran, and my parents for supporting me through this very valuable experience.

My rotation in Johns Hopkins Hospital (JHH) was with the department of pediatric hematology. This report will focus on a typical day in JHH.

My morning started at 7 am with a cup of coffee and the detail from the night doctors. There were usually 5-6 patients in the ward, and I was in charge of one of them. After the morning report of my patient, I spent some moments with my patient to wake him/her up and check up on him/her to get the vitals and physicals. Those are for my presentation and the chart.

The morning round was with 1 attending, 1 fellow, 2 residents and me. First, the residents or me gave the presentation about the patients including basic information and updates. One thing I was surprised was even me was asked to provide a treatment plan for the patient and the attending actually listened and always gave advice. After the presentation, the team went to see the patient at bed side.

In the room, the doctor in charge was always the resident or me. Other doctors stood at the back and only gave advice and added information when needed. There were tons of moments that I wasn’t able to explain everything and that was the time the attending and fellow came up to help me. Most of the time, our patients were young kids and adolescents. So obviously, talking to mom and dad was a huge job in my rotation. It was challenging, but with the advice for the residents, I learned a lot from it. After leaving the ward, the team get together, and we all received feedbacks and mini lectures from the attending.

The rounds finished near noon and the out-patient session started after lunch break. Amazingly, residents and I were the ones who talk to the patients first. With the information we got, we gave presentations to the attendings, and we chatted about the plans for the patient. After the discussion, the attendings took lead and went back to the examination room and finished the out-patient encounter. After each patient, the attendings taught us new things according to the last patient we saw. For me, the patient-based lectures were the highlights of the day.

Above all, this was the normal day I spent in JHH. And I believe everyone could felt the same as me that the team was so sweet and kind, and the attendings were very warmhearted in teaching. There were very huge gaps in pediatric hematology between the US and Japan. It took me a while to learn and adjust the new environment, but the process was so satisfying. The experience and knowledge from JHH was priceless and I firmly believe it will help me in the future. I couldn’t thank much to everyone who made the international exchange available. Both Nagoya side and JHH side, who gave me so much help will be greatly appreciated, and I hope the communication between us will never ends. Thank you!

Blue sky and historic buildings. Cherry blossoms bloomed in many places, and people enjoyed beer and music on the terrace.
This is Munich, where I spent 5 weeks.

Ludwig-Maximilians-Universität München (LMU) is the biggest university in Munich, and famous as the university where Roentgen conducted his research. The medical school has two campuses, one near the central station and the other in Großhadern, where I participated in the Neurology Winter School. About 30 students attended the Neurology and Oncology Winter School, half of whom were LMU students and the rest were students from all over the world. Each international student was paired with an LMU student for practical training in the same ward. My study buddy was a fifth-year female student who was kind and responsible.
Morning at Neurology started at 8:00. The LMU students were allowed to take blood and perform lumbar punctures like Japanese residents. Patients were cooperative, and no one refused to allow the students to perform medical procedures. When I made a mistake in drawing blood, the patient allowed me to redo the procedure, saying "Learning by doing!" Those warm words remain with me to this day. After the blood collection, we made ward rounds with the residents. In the ward, there were more than 10 patients with brain tumors, infectious diseases, and neuroimmune diseases. The rounds were conducted in German, but my study buddy explained the main points in English, so it was not so difficult to talk with the residents about the cases and ask questions. After the rounds, we interviewed new inpatients, conducted the neurological examination, and reported the results to the residents. In addition, the neurology department held case report meetings twice a week, and the chief professor made rounds once a week.
After having lunch in the cafeteria, I attended radiologic conferences and chatted with friends over coffee at a café. In the afternoons, we had lectures. The content included lectures about neurological diseases, such as stroke, neurodegenerative diseases, and epilepsy, a visit to a pediatric neurological hospital, and case discussions. In the lectures, we learned about a wide range of topics, such as diagnosis in clinical practice, basic research, and the mechanism of fMRI. We also visited a rehabilitation hospital, where we experienced an exoskeleton robot and a treadmill in a game format.
After the Winter School, I had the opportunity to join the outpatient clinic team for neurodegenerative diseases. During the internship of two weeks, I saw patients with Parkinson's disease, Alzheimer’s disease, multiple system atrophy, progressive supranuclear palsy, corticobasal syndrome, and so on. I also observed botulinum therapy for cervical dystonia and neuropsychological test. Outpatient care was of course conducted in German, and I sometimes felt frustrated that I had to ask for explanations in English every time, or that I could not say anything to patients who cried. However, the language barrier was not necessarily bad when learning about neurological disease cases. Not being able to understand the language allowed me to concentrate on physical findings and patients' emotional movements. I can proudly say that I am now able to observe patients better thanks to this study abroad experience.

During my stay in Munich, I didn't want to waste even a single day. So, I went out to dinner with friends, went to museums and the ballet, and compared beers and sausages after weekday classes. On weekends, I participated in recreational activities with Winter School members and took day trips to the suburbs on my own. I also met LMU students who participated in the LMU-NU Collaborative Online USMLE Review Classes together. They helped me before my departure and showed me around the city when I was there.

During my five weeks of study abroad, I kept in mind the words of Dr. Banno at the pre-training: "Do the best you can. At first, I interpreted this as referring to my ability in practical training. And sure enough, I realized how poor my English skills were. At that time, my study buddy said to me,
You are always positive. You always say "Yes! I want to do it!”
What can I do? I can do the practical training diligently every day. I can be on time. I always can be a positive Yes man. Ability is certainly necessary. But more than that, I believe that my attitude makes my reputation.
Finally, I would like to thank all those who supported me.

This report describes my experiences during the eight weeks of clinical rotation in the general hospital of Vienna Medical University (AKH.) The rotation included Pediatrics, Radiology, Obstetrics/Gynecology, and Anesthesiology departments. In every department, I was able to work and learn with experienced doctors, students, nurses, and other healthcare professionals but in this report, I’d like to highlight my experiences in the Pediatrics and Anesthesiology departments.

The Pediatric rotation was my first two weeks in AKH and I was able to divide it into two terms; the 1st week in NICU, and the 2nd week in Pediatric Cardiology. Because I couldn’t get any chance to see patients with congenital heart diseases during my Pediatric rotation in Nagoya University, the 2nd week in AKH was an especially precious chance. Every day in the ward, I joined a conference and a ward round to follow up patients. I also had chances to join some catheter interventions, which were very interesting not only from a Cardiologic aspect but also from an Anesthesiologic aspect, which has been my major interest. What I enjoyed the best during the week, however, was that I was allowed to visit each patient to do physical examinations by myself. Although of course some patients and patients’ families only spoke German, senior doctors encouraged me to try by myself with another Erasmus student. We, as a pair of students, tried thorough physical examinations to all the patients with very rare and complicated congenital heart diseases, discussed findings together and presented them to senior doctors, receiving feedback and additional information. We were also responsible to interpret patients’ ECG and had chances to report findings to the senior doctors. Many patients in the ward had quite complicated conditions, in which often several congenital heart diseases existed at the same time. Yet it was a wonderful chance that I could improve my skills for physical examinations and could practice discussing pathological abnormalities of each patient with other students and the senior doctors.

During the two weeks of Anesthesiology rotation, I was able to join an Anesthesia team in a Trauma Surgery department. Because AKH is the largest hospital covering the Vienna area, its emergency department is large enough to be separated into two, a general one and the one special for trauma patients. The station has one shock room, outpatient clinic rooms, and a surgical area with three operation rooms. In addition to joining the anesthesia for scheduled trauma surgeries, when we had emergency trauma patients carried in, I could also visit the shock room and join the first touch by the Trauma Anesthesiology team. Knowing that I was trying to become an Anesthesiologist in my future, one resident invited me to his nightshift in the general Anesthesiology team as well, where all the rest of adult surgeries were held. Together with my prior experiences during the rotation in the Anesthesiology team in my home university, I was able to try some interventions, compare methods of anesthesia in Vienna with the ones in Nagoya, and discuss all those differences and following pros and cons with the Anesthesiologists there, using some scientific papers.

The rotations in Radiology and Obstetrics/Gynecology were of course very educative and because they were relatively longer, I acquired so many more knowledge and practical skills than I had done in my home university. Outside the rotations did I get chances to meet some Japanese doctors working in Vienna, Viennese students I met the previous year, when they did international clerkship in my home university, and many of my European friends. It was thanks to all the doctors, secretaries, and the friends in Vienna Medical University, and to all the professors in our International Office that I could enjoy every single minute during this program.And I’m sure that I will continue to build upon the invaluable experiences gained during these 8 weeks, not only in terms of my skills and knowledge in anesthesiology for my future career but also in fostering an international career. I would like to take this opportunity to express my heartfelt gratitude to Professor Kasuya and Dr. Hasegawa from the International Affairs Office at Nagoya University School of Medicine for their support and efforts in implementing this study abroad program, as well as to all the professors and students at the Medical University of Vienna's International Exchange Department. Thank you all very much.

小児科ローテで参加させていただいた
小児の緊急対応シミュレーションセミナー

When I was 16 years old, before entering university, I attended an information session about Nagoya University. At that session, a sixth-grade senior student was talking about his experience in an overseas clinical clerkship. His interesting story made me feel that someday I want to have an internship abroad like him. After a long while, this year, my long-cherished wish has finally come true. From March 6th to April 28th, I could have a clinical clerkship at Medical University of Vienna and had a great time there.

The hospital of Medical University of Vienna locally called AKH (Allgemeines Krankenhaus) is more than twice the size of Nagoya University’s hospital. When I first saw the hospital’s main building, I was astonished by the size of it and the number of rooms it has. In addition, the number of engaged people is far more than Nagoya University. Many doctors, not only from Austria but also from other countries such as Italy, Spain, Hungary, etc., work there. Also, AKH accepts many international incoming students and residents, so the hospital is bustled with people from around the world.

During the two months at the hospital, I rotated three different departments: cardiac surgery, thoracic surgery, and radiology. In each department, I had a good time and learned a lot from a variety of cases.

In cardiac surgery, about five operation rooms were working, and various operations were going on at the same time every day, so that I could take part in many surgeries during two short weeks. When I saw a thoracotomy performed on a young child, I was impressed by how carefully and quickly the suture was completed. Also, I was inspired by the local sixth-grade students. The last year at Medical University of Vienna is called a practical year, and they worked more like junior residents in Japan rather than students. This curriculum is quite different from that of Japanese medical schools. While they were busy assisting operations and interviewing newly admitted patients, they were highly supportive of international students and taught me many things.

Following two weeks after cardiac surgery, I rotated to the Department of Thoracic Surgery, which annually conducts more than 100 lung transplantations. Even before leaving Japan, I was looking forward to participating in transplant surgery at this department of Medical University of Vienna, where several doctors from Nagoya University often come to learn the technique of them. Eventually, I could watch two lung transplants starting at night. The bronchus, left atrium, and pulmonary artery were carefully connected, and the white donor lung, which had lost blood, turned pink inside the recipient's chest cavity. That was one of the most amazing surgeries that I have ever watched. Besides the transplant surgeries, I could see cases I had not encountered in Japan, such as extended resection of lung cancer and closure of a broncho-esophageal fistula.

My last rotation was in the Department of Radiology for four weeks. The department is divided into small groups. For example, the CT imaging diagnosis group is separated into several divisions: surgical, internal, emergency, neurological, etc. I was able to see a lot of cases in different rooms with different doctors every day. There were also some opportunities to discuss the location of the lesion with the doctor. In addition, I had some chances to have leisurely conversations with doctors. I was delighted to find that more people than I expected were interested in our country and had a positive impression of Japan.

The clinical elective at the hospital was fulfilling, and on top of that, I enjoyed my free time outside the hospital. After work on weekdays, I often had opportunities to interact with local people or other incoming students. Talking with those with different cultural backgrounds has broadened my horizons and made me realize once again how vast the world is. I really appreciate their hospitality and kindness.

The city of Vienna was a wonderful city full of attractions. Statues of famous composers such as Beethoven and Mozart were built all around the city, and it was an excellent experience for me to listen to fantastic music at a low cost in the standing area of Wiener Staatsoper and Musikverein Wien. Also, I enjoyed a beautiful museum with paintings by Austrian artists such as Klimt and Egon Schiele, tasty coffee, and a wide variety of wines. During two months in Vienna, one of the changes was that I came to like drinking wine more than before. Taking advantage of the location surrounded by many countries, we had a trip to another country on the weekend.

All in all, my two months in Vienna were definitely one of the best periods in my entire medical school life. This experience will be an invaluable asset and will strongly influence my thinking. I hope this close relationship between Nagoya University and Medical University of Vienna will last long. I want to tell what I have experienced in Vienna to younger students interested in having clinical clerkship abroad, and I would surely recommend going to Medical University of Vienna.

Finally, I would like to express my sincere gratitude to Dr. Human Salemi, Ms. Sarah Seider, and all other people of Medical University of Vienna. Also, I can’t thank the Office of International Affairs staff enough for coordinating this fantastic program in such a problematic situation with the coronavirus. I look forward to seeing people who I met in Vienna again someday.

Vielen Dank. Thank you very much.

Hello, I am Juri Hakamada. I had the opportunity to study as an exchange student for 8 weeks at the Medical University of Gdansk in Poland. I was at first not only excited but also worried about living in a dormitory and experiencing new things in an unfamiliar country. However, many people supported me e, and I was able to spend a very meaningful time. I would like to introduce some of what I studied and experienced.

Life in Gdansk
Gdansk is a major port city in Poland facing the Baltic Sea. It was very safe, that I could even go out alone at night, and the daily supplies are cheap, so it was a really convenient place to live. The city is rich in nature, but it is also well-developed. For example the transportation system (there were many trams and taxis running, which were very cheap) was very useful, and I could find lots of shopping malls, and other facilities, so there were no problems in daily life.
We lived in the university dormitory. It is located about 15 minutes by foot from the hospital. We were given a single room, which was furnished with basic furniture so I did not need anything extra to buy. There was a washstand in the room, but the kitchen, shower, toilet, and washing machine are shared with the floormates. There were many other international students living in the dormitory besides us, and we were able to spend time with other students in the dormitory. My Italian neighbor made pasta for us, and in return, we cooked okonomiyaki and had it together.

School Life
The greatest feature of Gdansk Medical University that it is very international: there are two courses, Polish Division and English Division (ED), and students from various countries study in the ED. There were also a large number of international students sent by ERASMUS, an exchange study program among the EU. Although we were in Europe, there were also Indian, African and Asian students, and we were able to experience many cultural differences. We studied in the ED course, so we were able to study in English. The official language is Polish, so there were times when the doctor translated for us in the outpatient setting, but the younger patients could speak English, so we also had the opportunity to directly take their medical history. The clinical training system was similar to Nagoya University. The fourth and fifth year students are divided into small groups and rotate all departments for one week to one month, and then the sixth year students select a few departments and practice in them for a longer period.
I joined the 4th and 5th year students’ groups and rotated through five departments: obstetrics and gynecology, pediatrics, pediatric surgery, urology, and family medicine. Each subject had a exam on the last day. The exam was either multiple-choice questions or oral exams. The oral exams were not one-question-and-one-answer, but rather kind of like PBL in our studies in Japan, in which the group members and the director teacher discussed and confirmed their knowledge using case examples, and that was very new to me. There were also many lectures, and lectures on obesity were regarded as important, so I felt the difference from Japan. In the pediatrics department, I was able to take medical history from parents and actually perform physical examinations to the children. In the urology department, I had a chance to perform cystoscopic examinations on patients.

The People I Met
We received huge support from the people there, especially from Professor Wozniak of the Department of Biochemistry, and Pawel, the attending student. They welcomed us so warmly as if we were their family. On the day we arrived, professor picked us up at the airport even though it was late at night and brought daily necessities and food to our dormitory. He invited us for dinner few times, and we did ohanami together, too. He always asked us how we’re doing. Pawel invited us to parties at his home, gave us opportunities to have fun with local students, and even rushed to our dormitory to buy medicine for us when I got sick. Also, we gave a presentation about tea to local students and had a discussion about school life at an event called "Nagoya Day" organized by the professor. It was a very valuable experience.

Conclusion
I had wanted to join this program since I entered university, so I was genuinely happy that this program resumed. I was very anxious about living in an unfamiliar place, but many people helped me, so I had a really great time through the whole of my stay. I learned and grew a lot, not only academically but also as a person. I was greatly helped by the openness of the people I met there to accept new people. Now that I have been back home for a few months, I can feel that my own behavior has changed compared to before my study abroad.
Last but not least, I would like to thank all the people who were involved in this study abroad program. Thank you very much.

Even though it was about one month ago that we left Gdansk, I remember all the people we met there and all the experiences we had there as if it were yesterday, and the memory would stay in my mind forever.

Before going to Gdansk, we had no idea about how to live the life there, even didn’t know how to get to our dorm from Gdansk Lech Walesa airport. However, our first experience in Gdansk was so lovely and unforgettable. Professor Wozniak, who is responsible for our exchange, surprised us by picking us up in the airport without informing us in advance. We were so impressed because we didn’t say nothing to him but information that our flight from Frankfurt would arrive the airport at night on March 4th, and from that information he searched the time we came and ordered taxi for us. I was nervous to live in the country actually, but that anxiety was flowed away at that time. He also invited us to dinner with his wife and his friend, which was the best in Polish dinner I had ever had. He always took care of us trying to make our exchange the best, which impressed us. Without him, our exchange was not like this definitely.

In Medical University of Gdansk, which is called GUMed, I was looking forward to watching lung transplantation, which is not operated in our university hospital in Japan. Students there have easy access to attending to operations of transplantation, just texting to the websites of the department that they would like to join the transplantation, which surprised me, but I expected that it was a little bit difficult to attend to the operations because there were sometimes many people who wanted to attend and the number of those who could go was limited. However, contrary to my expectation, I could attend to an operation of lung transplantation so easily. The reason was so simple because they do transplantation almost every day, which is enough to manage a number of students. In terms of lung transplantation, they do about 100 every year in only one university even though the number of lung transplantation in Japan so far was only 234 in whole Japan. Literally, doctors there experienced more lung transplantation than all the doctors working in Japan, which surprised me. If I had never been to GUMed, I might never watch operation of transplantation forever.

We also had a great time with a variety of students from all over the world. In English division of GUMed, there are students from a lot of countries, Norway, Sweden, India, Iran and etc. Although we were in Poland, we could learn medicine in English, and it is also attractive for medical students in Europe who want to study as exchange students. That’s why there were so many exchange students from other countries in EU. There were many students from almost all the countries in EU, and we sometimes hanged out with them and we learned cultural differences of each other, which were great opportunity not only for us but also for them. We made friends with quite nice students and we sometimes text about our life in Japan after Gdansk.

I also realized that how good people in Europe were in speaking English. Students there speak English by far more fluently than me of course, but almost all the people in Gdansk could speak English so fluently, especially young people. We didn’t have a trouble to communicate in restaurant or shopping mall. When I got lost there, they didn’t hesitate to speak to us in English. I was so impressed, and at the same time, I fully understand how difficult it is for non-Japanese speaker to travel or live in Japan because a lot of Japanese people are not as good as Polish people in English, so after Gdansk I decided to be as nice as possible for people from other countries in Japan, as people in Poland did for us.

I had great experiences in Gdansk thanks to people in Japan as well as people in Poland. I would like to say thank you to them and I would utilize these experiences not only as a doctor but also as a Japanese.

I went to Lund University, Sweden as an exchange student and did a clinical placement at Skåne University Hospital in Malmö, affiliated with Lund University. I would like to make a report on my experience below.

I studied in the Infectious Diseases ward for the first four weeks. They have an infectious diseases department as one specialized field in Sweden because of their experience with pandemics in the 20th century. In this hospital, physicians in each department treat most infectious diseases, and doctors in this department address complicated cases with comorbidities or specific problems, such as tuberculosis.
In the ward, I followed residents and went for rounds with them. Although they talked with patients in Swedish, they explained to me a lot about the cases afterward, so I learned a lot of practical things. Also, I had time to talk with my mentor once a week. In the discussion, I increased my fundamental knowledge and found the differences in preventing or treating several infectious diseases.
In addition, I visited the outpatient clinic and saw consultations several times. A doctor let me perform elastography, in which you can measure the level of liver fibrosis, and it was a valuable experience for me.

The following placement was at Vascular Center. The department consists of vascular surgeons, a few physicians, and radiologists. I saw many operations and endovascular treatments performed by vascular surgeons, and especially, endovascular aneurysm repair (EVAR) was impressive. This procedure is indicated mainly for aneurysms below renal arteries in Japan. However, doctors at Skåne University Hospital also treat upper lesions using stent grafts with fenestration. This fenestrated EVAR (FEVAR) looked like a delicate procedure, but experience surgeons performed it in a short time, and it was astonishing.
As for other treatments, I saw surgery for thoracic outlet syndrome for the first time. In this disease, there are often thrombi in the subclavian vein, so thrombolysis, removal of the first rib, and placement of a stent are required. I saw these procedures and understood the series of treatments.

I also learned such things as differences in work styles or medical systems through this exchange program and had quality time in Sweden. I would like to thank the doctors and staff at Lund University and Skåne University Hospital for their cordial support and guidance.

I joined clinical placements at the School of Medicine at Lund University for 8 weeks; 3 weeks in Hand Surgery, 1 week in Emergency Department, and 4 weeks in Oncology. During this period, I learned medical knowledge and the pros and cons of the medical system in Sweden and Japan.

First, I write about my experience with Hand Surgery. In Skåne region, which is about 11,000 km2 and has a 1.4 million population, there is only one hand surgery department. Accordingly, that department is very big and specialized. It has 15 hand surgeons, 4 operation rooms, 5 outpatient-clinic rooms, and a rehabilitation ward. This department covers special trauma, like hand neuron damage, degeneration diseases, tumor, and rare malformations. Every day, it has about 10 surgeries and 50 outpatients. The working hours are 8 a.m. to 4 p.m. Of course, they had emergency operations after that. The contents of the placement were to join operations, observe outpatient clinics and join conferences. One of what I am surprised about was that surgeons do not have to be in the operation rooms during an introduction of anesthesia. Also, the roles of nurses were more varied than in Japan. I suppose it is a much more efficient way than the Japanese system. At outpatient clinics, patients and doctors talked in Swedish, but every time, doctors described to me what they talked about, checked, and cared about. Also, they let me conduct physical examinations of the patients. The most memorable thing during this placement was an on-call night. Every night, a junior hand surgeon and a senior one stand by for urgent consults from the emergency department or other hospitals. On that night, there were several accidents and an incident in which people got injuries to their hand, One of them had stab wounds on his hip and wrist, so on-call doctors from Orthopedics, Vascular unit, and Hand Surgery got together to stop bleeding and suture the wounds. It was shocking for me that he was assaulted at the nearest station to the hospital, which I use every day. Apart from that hectic night, this department had a homely atmosphere and everyone communicated with almost no hierarchy, like age or profession. I liked such a lively atmosphere.

Second, I had a placement at Emergency Department for one week. At this department, students talked to patients and had medical interviews and physical examinations, thought of differential diagnoses, discuss necessary tests, and consult with emergency doctors eagerly. For me, such an active way to learn was very attractive, and tried to do those things, too. Patients were supportive of students and they kindly let us ask a lot of questions and examine them. Of course, I cannot speak Swedish, so I chose young patients, who are likely to be able to speak English or asked local students to translate the conversations. The situations of each real patient were much more complicated and unspecific compared to the cases in textbooks. So I was often taught about the cause of symptoms only after I consult senior doctors.

Third, I spent four weeks in Oncology. There were several teams which are in charge of each organ’s cancer. The main work were outpatient clinics, ward, and emergency call. Every day, doctors had a conference at 8:00. Then, they worked on the main tasks from 9:00-16:00. On the ward, some patients had acute deterioration of the symptom or severe side effects of the treatment. Sometimes, it was tough for me to face patients who had incurable diseases, but I learned how doctors and other staffs communicate with such patients and their families during this placement. At on-call, young oncologists received phone calls from cancer patients with any symptoms which may have been related to cancer or treatment. At outpatient clinics, each patient had a 30-60 minutes slot. Therefore, they could talk about their cancer and anxiety with doctors fully. I was assigned to outpatient clinics of several teams, so I learned the test and treatment of each malignancy and compare the treatments in Sweden and Japan. The doctors were all kind and they answered my question thoroughly. Also, the new clinical trials Lund University was working on were interesting to learn. On the last day, I presented a breast-cancer case to my supervisor, which was the perfect finish to my clinical rotation at Lund University.

Through this experience, I found that Swedish medical staffs embrace work-life balance much more than in Japan. Accordingly, women work the samely as men in hospitals.
There were a lot of female administrators in the hospital who had children. I suppose this is because the supportive system and kind atmosphere for parents have been established in Sweden. Doctors told me that this trend had been made in these 30 years. Also, personal identification number was used fully in the medical system. Patients are identified and medical records are resisted with the number. What is more, this number system is used in clinical research, such as collecting patients’ information anonymously. These systems are one of what Japan aims to establish. Therefore, it was so fruitful that I could see how they work in real society. Of course, I re-appreciate several beautiful points of Japan. For example, we have very quick access to doctors in an emergency, and we can have surgery soon after diagnosis. Each medical system has merits and demerits, and these two months were my first time seeing a foreign country’s society with my own eyes.

What I learned this time was only a part of the Swedish system. Therefore, I will sustain my interest in this issue and continue thinking about a better medical system and working atmosphere, as well as polish my medical skill.
Lastly, I would like to thank the all staff of the Office of International Affairs at Nagoya University and Lund University for this brilliant experience.

Norway has nothing. There is almost nothing except the harsh terrain and climate and the North Sea oil fields. There are no people. There is no Uniqlo or Muji. Trondheim, the third largest city in the country, has nothing but a university. But there is charm. Norwegians are independent-minded and love their country. People come from all over the world for tourism and immigration. Understanding this gap may lead to understanding Norway itself and its medical care.

The university hospital is called St. Olav's Hospital, named after a local historical saint. The area served by the hospital is called Trondelag. The area served by the hospital is called Trondelag County, which covers about one-fourth of the country. I was chosen to go alone from Nagoya University for this study abroad program. I spent one month each in neurology and orthopedics department.

At the neurology department, I learned about works in the wards and outpatient clinics. The first thing that surprised me was the short length of stay for patients. In Norway, hospital stays are short anyway, with most patients staying less than a week. I felt like I was being baptized into the concept of medical care where all medical expenses are paid by the government.
What was particularly impressive in the ward was the scene of a patient with suspected multiple sclerosis (MS) being informed of her condition. The patient, a biologist, must have known the gravity of the situation. She was in tears. The doctor kept repeating, "I understand...”. The importance of an attitude of understanding and empathy was universal. The doctor then decided to perform a lumbar puncture, which was performed without anesthesia. The doctor later told me that this was the norm in Norway. He also told that he had never used local anesthesia and did not even know why it was necessary. In Japan, we are sometimes told that "A patient is a customer," but I almost never felt this during my training at the university hospital. Here, however, I keenly felt the meaning of that phrase.
In the outpatient clinic, I observed Huntington's disease and MS, which is common in Europe and the United States. Huntington's disease is known as its dance-like movement, but in the early stages of the disease, it is said to be marked by easy rage and constructional apraxia. In Norway, it is rather popular to carry a hunting rifle, but if a patient is found to have rage disorder, the doctor has to suspend his or her license to carry hunting rifles. In addition to drawing, a test for constructional apraxia. It is called Luria's test, which has never been seen before in Japan. For multiple sclerosis, clinical trials using anti-CD20 antibodies are underway throughout Scandinavia. I was also able to attend a drug presentation. Through the lumbar puncture and Luria’s test, I realized that the treatment outline of what are examined and what treatment is given to patients is the same in Japan and Norway. However, I learned that there are differences between countries in how this is done.
Another thing I noticed is the progress in gender equality. Take, for example, the emergency medical team. I assumed that it is a tough job that requires not only knowledge, but also physical and mental strength. In Japan, I have the impression that there are more men in this field. However, in Norway there are so many women that there are rather more women than men. The neurology department also has a slightly higher number of women than men.

The next month, I was assigned to the orthopedics department. The first week, I was assigned to the trauma group, the second week to the joint replacement group, and the third week to the hand surgery group.
First, I staked out the waiting room of the operating room and succeeded in getting to know the operating room management nurses and the operating room nurses. There is a reason why I decided to communicate with the nurses instead of the doctors. This is because surgeons do not enter the room until after the induction of anesthesia and immobilization of the limb. On the contrary, as soon as the primary surgeon entered the room, he checked the status of anesthesia, preparation of instruments, antibiotics, etc. with the surrounding medical staff, and started performing the surgery three minutes after entering the room. This is a very efficient way of working. There is usually only one primary surgeon.
The anesthesiologist injects the anesthesia, but the anesthesia nurse maintains and awakens the patient. The anesthesia nurse system is unique in Scandinavia and requires one and a half years of training after obtaining a nursing license. The anesthesiologist is remotely monitoring multiple operating rooms after the introduction of the system. Personnel costs are also 100% government funded, so they need to be reduced. As for the anesthesiology department, they are reducing labor costs in this way.
For joint replacement surgeries, there is an anterior room, where anesthesia nurses perform spinal cord block, sedation, route securing, and insertion of urinary catheters. He said this is how they increase the turnover rate in the operating room. I thought that the beds were transferred from one room to another. Then I realized that the bed in the front room was also a mobile operating table. The patient was moved directly to the operating room, the primary surgeon entered the room at the same time, and three minutes later, the primary surgeon began performing the operation. I felt that efficiency had reached such a level that it was even considered an art form.

I summarized what I learned in the following three points.
First, the content of medical care is the same in Japan and Norway, but how it is performed is very different. If a patient comes to the hospital, the examination items to be performed and the treatment to be given are generally the same, regardless of the country. This is the result of the development of global guidelines and papers published in English and their publication and search systems. I realized the importance of updating medical knowledge. Conversely, there were major differences in how tests and treatments were performed. This is largely dependent on regional characteristics, culture, and customs, as well as on the healthcare system and ways of working, which will be discussed below.
Second, Norwegians value the working environment, and this depends on the fundamental and latent strategies of the country's people. This is because Norway has only 1/25th the population of Japan while the area roughly the same as Japan. Furthermore, the country is full of elements that make people depressed, such as polar nights and cold weather. Therefore, as a labor force, there is a sense of mutual respect among the people. This means that they should live healthy lives and contribute to society by moderating their working hours and enriching their lives. Hence, people seek efficiency.
Third, the health care system changes the purpose of a doctor's work dramatically. Specialists in Norway's hospitals, as specialists, focus all their efforts on diagnosis and building a treatment plan, or surgery. And for chronic treatment and maintenance, patients are immediately transferred to GPs, rehabilitation hospitals, or elderly care facilities for follow-up. Although Norwegian doctors say that this is a treatment that puts pressure on the national treasury, they do not care about income and expenditures and do not hesitate to provide the best medical care to patients who need it. Also, patients who do not need treatment are returned home immediately. I got the sense that this is close to the original form of acute care medicine.

I thought that people generally think that history, culture, and achievements lead to authority. All of these are wonderful things, but authority, when taken too far, can lead to fixed hierarchies and depressed communication. In Norway, people are not obsessed with authority, but are confident and proud of their work. I also had a good impression of this.

I was fortunate to meet Dr. M, a Japanese PhD student there, who is working as a PhD student in the Epidemiology Department at NTNU after completing his initial training at Nagoya University Hospital. He gave me advice on life in Norway by phone before my trip. He invited me to his office, home, and even a bouldering rink after my arrival in Trondheim. I was also indebted to Dr. H, a Japanese doctor in the field of neurosurgery. He specializes in functional neurosurgery, specifically spinal cord stimulation therapy (SCS) for chronic pain and deep brain stimulation therapy (DBS) for Parkinson's disease and other tremors, using electrode insertion. I was invited to attend one of these surgeries.

I would like to express my heartfelt thanks to everyone at NTNU and St. Olav's Hospital, Dr. H and Dr. M at Trondheim, and Dr. Kasuya, Dr. Hasegawa, and many other doctors at the International Relations Office of Nagoya University for giving me this opportunity to study abroad. Thank you very much.

From March 18th to April 16th, 2023, I studied abroad at Korea University in Seoul, South Korea. I spent my first two weeks in the emergency department and the next two weeks in the neurology department. Today, South Korea is one of the most popular countries all over the world, and I had a wide variety of experiences there thanks to many people’s help. Below is what I have learned from this study abroad.

First, I would like to talk about my life in Seoul. Prices are cheap and public order is as good as in Japan, so I was able to go out alone without anxiety. I stayed at a hotel in a town called Jongno 3-ga, which is about 15 minutes away from the university by subway.

Living alone was my first challenge, but the hotel staff did everything except laundry, so I was able to spend a very comfortable time. The access to the university was very good, and I had no trouble commuting. In addition, this town was very close to popular spots in Korea such as Myeong-dong and Itaewon, so I thought it was a perfect place to enjoy sightseeing. Just as there are many people in Japan who like Korea, there are also many people in Korea who like Japan. Most of the people I spoke with had been to Japan before, and they talked about their memories of their time in Japan. Fukuoka and Okinawa were especially popular places among them. I was often greeted with Japanese words, which made me feel happy. I could hardly speak Korean, but I used the Google Translation app, so I had no trouble communicating. However, to enjoy Korean culture more, I thought it would have been good to learn Korean. Perhaps because of their national character, Koreans were very generous. At my favorite restaurant, the store clerk always talked to me cheerfully, and I had good memories of serving refills of kimchi every time.

Next, I will write about the study. I had an internship at Korea University Anam Hospital. In each department, the teachers were in charge of me and supported me kindly. All the rounds and conferences were held in Korean, so there were some parts I didn't understand, but the doctor explained it in English later. Another major difference from hospitals in Japan was that the names of diseases and symptoms were expressed in English. English was used for both medical records and verbal communication, and I got the impression that English was more familiar with medical care than in Japan.

In the emergency department, I was able to observe the workflow of the teachers. I will start working as an intern doctor next year so I thought it was important to have an image of emergency work. Therefore, the practice was very meaningful for me. The conference started at 8:00 every morning, with case reports and abstract readings. In the internship, I learned especially about the importance of triage. Triage refers to prioritizing the treatment of the disabled according to the degree of urgency and severity in order to provide effective medical care within limited resources. Korea University Anam Hospital is one of the largest hospitals in Korea, and a large number of patients are brought to the emergency department every day. I was taught that it was essential to maintain the quality of emergency care by prioritizing, especially in such a large hospital. This also applies to emergency services in Japan, and I was reminded that I needed to practice triage by myself. In the neurology department, I was able to deepen my understanding of diseases such as cerebral infarction and Moyamoya disease. To be honest, I didn't find many points that were different from neurology departments in Japan, but I thought it was good to learn about neurological diseases from a different angle. Cerebral infarction is a common disease all over the world, requiring prompt treatment and response in the acute phase. Furthermore, constant monitoring is also essential because symptoms may fluctuate even when the condition stabilizes. Regarding Moyamoya disease, I actually examined patients in the ward and made a case report. This disease is common in Asia, especially in Japan, South Korea, and China. The teachers asked me the meaning of the Japanese word “Moyamoya”. It was my pleasure that I was able to explain the meaning of this word to them in English like this; "It's about getting in trouble and having a bad feeling." In addition, I gave presentations on the differences in the careers of doctors in Japan and Korea. This was not only requested by my professors, but it was also a field that I had been interested in for a long time, so it was a good opportunity to output. Both of them are the same in that students have to attend medical school for 6 years, and that it takes more than 10 years from entering university to become a specialist, but I found that there were two major differences between Korea and Japan. The first is the career right after graduating from university. In Japan, you work for two years as an initial training, while in South Korea, you move on to a one-year period called an "internship." The significance is almost the same, and in both cases, it is important to visit various departments and decide which major you want to pursue. Secondly, Korean doctors have to work as public health doctors (PHD). PHD refers to Korean male doctors who work for three years instead of military service in areas without doctors or airport quarantine. You can choose how long you want to work in PHD according to your career path, but most of them go through it in their 20s and 30s. Under the COVID-19 pandemic, PHD played a major role in collecting samples for PCR tests on the front lines of Korean medical care. Furthermore, at the end of the practical training, we went to a Korean BBQ restaurant. I was able to feel the spirit of "hospitality" from the teachers to much extent. The authentic Korean BBQ was so delicious that I will never forget it. In the university campus, there were students from various countries other than Korea, such as Mongolia and Germany, and I had many opportunities to talk with them. I was able to feel the difference in values with Japanese people, and it broadened my horizons. Many students liked Japanese animation culture, and I enjoyed talking about works such as "ONE PIECE" with them.

Until this study abroad trip, I had never lived alone or traveled abroad alone. However, I was able to have a fruitful study abroad in a comfortable environment thanks to the kindness of the university professors, administrative staff, students, and local people outside the university. In the future, when I meet people from overseas in Japan, I will definitely do my best to contribute to them. Furthermore, I really appreciate my parents for their financial support. Finally, I would like to express my gratitude to Professor Kasuya, Professor Hasegawa, and other teachers in the International Affairs Office, as well as people at Korea University, who supported me throughout the entire process of studying abroad. Thank you very much.

I spent a month at Korea University in Seoul, South Korea, for my internship. I had a truly invaluable experience during this study abroad program. Every day was so special.

Korea University is one of the three main universities in Korea. It has three major hospitals in Korea, one of which, Asan Medical Center, is ranked 30th in the world and 1st in Korea. The campus consists of picturesque buildings surrounded by trees and is so spacious. It is hard to believe that it is in the center of Seoul. The hospital was also huge and beautiful. New wards are still under construction. The students’ academic level was also very high compared to Japan, and their wealth of knowledge and experience inspired me.

As for the internship, I spent the first two weeks in Breast & Endocrine Surgery and the last two weeks in Pulmonary Medicine. On my first day, I was very nervous and wondered what it would be like. However, while waiting for the doctor, I met Lara (an exchange student from the University of Munich), who would rotate in the same department as me. She was very friendly, and we hit it off. The doctors in the Breast & Endocrine Surgery were also cheerful and friendly. The professor, Dr. Kim, is a world-renowned thyroid surgeon, and I was overwhelmed by his excellent skills and personality. He was a professor at Johns Hopkins University, and TV cameras were filming him throughout his surgery. Patients and doctors from all over the world came to see him. I was particularly impressed to observe a procedure he had developed, Transoral Robotic Thyroidectomy (TORT), a revolutionary way to approach tumors and leave no scars after surgery. In Korea, robotic surgery is becoming more common due to insurance coverage, and there are many cases of TORT, so it was very exciting. In this unit, I went to the operating room many times to assist in surgery. I was often told, "You can do it," and I did a lot of suturing and ligation. I was also taken to a facility where I could practice with the da Vinci and experience everything from installation and activation to simulated surgery. I feel very fortunate to have met and been mentored by such a wonderful doctor as Prof. Kim.
The pulmonology doctors were also very nice. Korea University Hospital is one of the largest hospitals in Korea, so there were a lot of bronchoscopies, about ten a day. It was a good experience for me actually to perform pulmonary function tests and prick tests. I also fondly remember following the doctors during their breaks, having coffee and lunch together in a cafe, and chatting with them a lot.

After the internship, I was with Lara every day. There was not a day that we were not together for three and a half weeks until she went back to Germany. She was also active, so we had the same things to do and talk about. I was sad the day we said goodbye and talked a lot. During my respiratory training, I met and practiced with medical students from KU. I met one of the girls and went out with her in Hanbok. I had many plans daily, so I had little time to be alone.

As for where to live, I stayed with my host family. The university provided no dormitories, and since it was the first dispatch to Korea University from Nagoya University, I needed help figuring out where to live. But I happened to get in touch with a girl who was a student at Korea University, and we became good friends. When we discussed places to live, she suggested I stay at her house. It was my first homestay experience and her family's first, so we were both unfamiliar with the situation. However, I thought it would be a great opportunity and immediately decided. I was a little nervous before meeting them, but they were a very nice family when I met them in person, and I immediately felt that I could handle it. I spent most of my time with my host mom. She was a nurse at the hospital where I did my internship, and we saw each other every day. I looked forward to the breakfast she always made for me. My host mother knew that I liked to exercise, so she often took me for walks. I liked her personality, and we went hiking on the weekends, but more often, we walked together for a few hours on weekday evenings. She was hardworking and had a beautiful heart, so listening to her story made me feel positive about myself.
My best memory with the host family is that on the Saturday of the last week of my homestay, I went with my family to climb a mountain about 1,100 meters high and eat Korean food at a mountain hut. My host family treated me like a real family member, making me feel comfortable. There are too many memories to write here, but every day was so special, and I feel like I have a new family.

I have met wonderful teachers, university, friends, and family and gained much more than I could have imagined before going abroad.

I want to thank all the people I have met who supported me during this study abroad experience.

I studied abroad at National Taiwan University in Taiwan for a total of two months in three departments: ophthalmology, endocrinology, and family medicine. I was the only exchange student from Nagoya University to National Taiwan University, and although I was filled with anxiety, I gained many valuable experiences through this study abroad program. I would like to report on some of my experiences during my study abroad.

National Taiwan University is located in Taipei, the largest city in Taiwan, in an urban area within walking distance of Taipei Station. The hospital is larger than Nagoya University Hospital, with three buildings (one for obstetrics, gynecology, and pediatrics, one for outpatient services, and one for hospital wards) and over 2300 beds. As for life in Taiwan, eating out was cheap and I ate out most of the time. As for transportation, Taipei has a well-developed subway system and bicycle rentals are widespread, so I often used them. If you want to go to other cities from Taipei, you can take the train, bullet train, or bus. The language is basically Chinese, but many people can speak English, so I did not have much trouble without Chinese knowledge. In addition, when I communicated with them in Chinese, they seemed pleased.

I first studied ophthalmology for two weeks. In the ophthalmology department, I spent the first week with fifth-year students in their training spots, and the second week with sixth-year students, with time in between to observe surgeries. During the practical training, we observed outpatient clinics, watched video lectures, and experienced examinations using actual examination equipment. In the outpatient clinic, we not only observed but also interviewed patients and performed slit-lamp microscopic examinations with other students. The lectures at the outpatient clinic and video lectures were basically in Chinese, but local students translated them into English, so I was able to understand them. Moreover, I saw surgeries such as cataracts, glaucoma, vitrectomy for retinal detachment and pre-macular membrane, strabismus surgery, and surgery for nasolacrimal duct obstruction, which are also common in Japan. All surgeries were almost the same as in Japan, and I felt that medical care is standardized internationally.

Next, I spent four weeks in the Department of Endocrinology. In endocrinology, I participated in twice-weekly case conferences, made rounds, and observed thyroid echocardiography. I mainly did rounds with other students and residents. There happened to be an elderly woman who could speak a little Japanese in the endocrinology ward, and I mainly made rounds for this patient. This patient was in her 90s and had learned Japanese during the Japanese occupation of Taiwan, and I remember that she looked very happy when I used Japanese. About 50 thyroid echoes were performed every day, and I learned how to use the echo and how to read the images.

The last class, family medicine, lasted two weeks with other students from Japan. In family medicine, we observed an outpatient clinic, a palliative ward, and a home-visit clinic. Family medicine outpatient clinics are divided into various types, such as lifestyle-related disease outpatient clinics, diabetes outpatient clinics, and travel medicine outpatient clinics. The travel medicine outpatient clinic was particularly new to me because I had never seen such a clinic in Japan. I also had the opportunity to observe a travel medicine conference in Taiwan. At that conference, Taiwanese government officials and others discussed national quarantine, which was a valuable experience for me. I had never seen a palliative ward in Japan, and it was very interesting. There were many volunteers in the ward, and they were providing aromatherapy and giving patients baths with their beds. I actually joined in the aromatherapy with the volunteers. During the home visit, I was able to actually see Taiwanese housing. In Taiwan, families are able to perform many more procedures than in Japan, and I felt that home medical care has developed.

I think a major event other than the practical training was my participation in the university-wide Taiwan-Japan language exchange club. Many Taiwanese and Japanese students belonged to the club, and we had language exchange meetings several times a month. I was able to learn and use Chinese there. We also had many other events and I made many friends and went to many places and had fun with them, so I am glad that I took the plunge and joined the program.

Last but not least, I would like to express my gratitude to the Office of International Relations for giving me this opportunity, to the professors who gave lectures, and to National Taiwan University. Thank you so much.