Office of International Affairs Graduate School of Medcine Nagoya University

In the spring of 2025, I had the opportunity to participate in clinical electives at the University of Bologna in Italy. I appreciate each and every of you who made this to possible.

A Familiar Yet New City: Bologna

Bologna, located in northern Italy, is the capital of the Emilia-Romagna region, famous for its rich food culture. Many may think of “Bolognese,” but locals call it tagliatelle al ragù, a flat pasta dish with meat sauce.
The city is known for its medieval gates (porte), long arcades, and a historic atmosphere that has earned it UNESCO World Heritage status. With campuses and libraries scattered throughout, the whole city feels like one large university. At the center stands Piazza Maggiore with the Neptune fountain, the model for Maserati’s emblem. Local markets are filled with seafood, cheese, ham, and fresh vegetables, while shops range from casual brands to luxury boutiques.
Nearby are Venice, Ferrara (the home of Ferrari), and Modena with its F1 circuit. Bologna also has an international airport and a well-developed railway network, which makes travel convenient. For me, as a student from Nagoya, a city known for its noodles, car industry, and useful transport connections, Bologna felt somehow nostalgic.

Orthopedics at Ospedale Rizzoli

The Rizzoli Orthopedic Institute is one of the largest in Italy and ranks ninth worldwide in orthopedics. Since I am highly interested in adolescent spinal deformities, I was above excited to train here. I was able to observe a wide range of procedures, especially involving the knee and shoulder.
The hospital, once a 16th-century monastery, sits on a hill and has beautiful chapels and a library. There I saw an enormous globe said to be “too big to be taken away” during Napoleon’s invasion, detailed botanical and anatomical sketches, early instruments for measuring spinal deformities, and finely crafted braces.

Surgeries started at 7 a.m. every day. Many procedures were new to me, including allograft transplantation using a cadaver center, customized high tibial osteotomies, and trochleoplasty for congenital knee dislocation. One technique unique to Rizzoli was ACL reconstruction where the graft is left partially attached, an approach potentially suited for young athletes. Even in routine surgeries like total knee arthloplasty, the steps and reasoning differed from Japan, teaching me the importance of lifestyle differences, such as sitting habits, in surgical choices.
I was really happy that I could stand very close to the operating table—something unimaginable in Japan—and as my Italian improved, I was able to help a little, for example, passing them what they needed, and it made me feel like I belonged there. At first, I often struggled to follow the procedures, but kind and experienced residents from Europe and the Middle East, as well as device specialists and radiation technologists kindly explained. The operating rooms were multilingual, with English, Italian, Arabic, and sometimes Turkish spoken. Watching the speed and skill of the surgeons inspired me to pursue such mastery myself in the future.
Postoperative care was also different: patients were discharged early, continuing rehabilitation at home or in rehab hospitals. Doctors often mentioned Japanese “perfectionism,” saying they found it rare that surgeons in Japan manage rehabilitation themselves to such detail.
The surgeons at Rizzoli wrote papers constantly alongside surgery, saying, “We are exhausted, but proud and passionate about our work.” Their dedication left a strong impression on me. Everyone was warm and friendly—daily winks in the OR (since masks covered our mouths) and the Italian custom of cheek-kissing soon became normal. Thanks to their openness, I never felt lonely despite being abroad.

Cardiology and Pediatric Surgery at Sant’Orsola-Malpighi Hospital

At the renowned department of Cardiology at Bologna, I spent my first two weeks were in the high-care unit, observing emergency cases and postoperative management. Italian medical terms were challenging at first. For example, coronary artery names are differenr from English—but through quizzes on auscultation, ECGs, and echocardiography from the kindest doctors, I gradually adapted.

I then joined the pulmonary hypertension (PH) unit, working with some of the sweetest people imaginable until the end of my stay. There, I observed the long-term management and follow-up of patients with PH; idiopathic, post-thromboembolic, with COPE, congenital heart disease, connective tissue disorders, and even thalassemia, which is quite rare in Japan. A lady from Eastern Europe have stayed in my heart. She developed PH because congenital defects had not been corrected early, reminding me of the importance of screening and early intervention.
I also had the chance to witness clinical trials by Dr. Giorgia for new therapies and saw patients improving, which was a powerful experience. Once, Prof. Palazzini picked up my Japanese book I had brought and, despite in Japanese, read through it pointing out images and values, comparing cases and explaining them. This reminded me that medicine truly crosses borders, and that mastering the science itself is more important than the language barrier. I also read decades-old medical records preserved, which showed me the progress of treatment of PH over time.
In April, I also joined pediatric surgery, which I had been interested in and found challenging. Since it is compulsory for students, more than 20 students gathered on one floor, and I had a great time talking with them. Some actively tried to join surgeries, while others sneakily drifted toward the snack room. Majority operations were laparoscopic hernia repairs, and young doctors had a lot of chance to operate. In outpatient clinics, I saw creative ways to comfort children—cartoons, soap bubbles, and friendly and playful interactions during exams. I was impressed by how experienced doctors and nurses skillfully supported both little patients and families. I also found that the moms were truly great at comforting their children and teaching me some Italian.
I really enjoyed life in Bologna, no doubt: attending an opera with a lovely roommate Catherine, visiting Venice, walking F1 circuit with Giada, joining home parties at Dr. Alberto & Dr. Laura’s (who inspired me to visit Sardinia someday), and at Ema & Filipe’s (who made me want to visit Brasil someday) and traveling around Italy and beyond. The city was charming, clean, safe, affordable (similar to Tsurumai in Nagoya), and full of delicious food—so much so that I rarely used the Japanese ingredients I had brought. With its excellent connections, Bologna is a perfect base for students who also want to travel. Personally, I visited Turkey, Norway, the Czech Republic, Morocco, Switzerland, Belgium, Poland, Luxembourg, Ireland, and more, taking full advantage of the 90-day Schengen allowance.

What I learned about Healthcare and Medical Education in Italy

Italy has an amazing public healthcare system, free of charge, but long waiting times mean that many combine it with private care. For non-urgent cases, waiting over a month is not uncommon. While this made me appreciate Japan’s universal health coverage, I also noticed areas where Japan could improve and learn from Italy, such as overlapping hospital functions, multiple examinations, and frequent admissions.
Some people say that Italian medical students often have a relaxed schedule with shorter clinical hours, but I’ve seen they studied really hard. In their final year, they must balance their thesis with national exams. Since residency programs and specialties are assigned solely based on exam scores, competition is especially tough for popular fields in big cities like cardiology/orthopedics in Bologna. I realized how different this is from Japan, where students usually choose their desired working place and specialty more freely. Japan might be the most relaxed country in the world for med students.

Reflections

Everyone I met during these three months was kind and supportive, and I am deeply grateful. While I could have gained some knowledge in Japan as well, the unique encounters and experiences abroad were irreplaceable. Every rotation ended with things I wished I had understood better or had spoken up about more, which made I swear I’ll never stop learning.
I have long been interested in medicine outside the English-speaking world, and my three months in Italy far exceeded my expectations. The lessons I learned and the people I met will remain a source of strength as I shape my future as a physician.
This precious opportunity was only possible thanks to the guidance and support of Prof. Kasuya and Dr. Hasegawa, Dr. Itzel and the International Office team, senior alumni, my teachers at Nagoya University, and above all, my parents. To all of them, I extend my heartfelt gratitude.

This report describes my experiences during the three months of clinical rotation at the University Medical Center Freiburg, one of the largest hospitals in the country. It was a valuable and irreplaceable experience.

Clinical Training

#Month 1: Thoracic Surgery
I participated in morning rounds and conferences, performed blood draws with local students, and took part in surgeries. Since I had limited opportunities to practice venipuncture in Japan, I initially felt anxious. However, with the careful guidance of Practical Year (PJ) students—German sixth-year medical students undergoing practical training—and the warm encouragement from patients even when I made mistakes, I eventually performed blood draws independently. In the operating room, I observed thoracoscopic and robot-assisted surgeries, and I also served as a second assistant in open thoracic surgeries. Sometimes I felt frustrated due to a lack of explanations, but by asking questions, I received detailed explanations about anatomy and surgical techniques. I was even allowed to perform plate fixation in a rib fracture surgery. One memorable moment was when I performed a bronchoscopy. The supervising physician told me, “You're so skilled I wouldn’t have guessed it was your first time—you should consider a specialty that involves endoscopy.”

#Month 2: Obstetrics and Gynecology
PJs organized student schedules and task assignments. I was welcomed into their team and observed vaginal deliveries, gynecological surgeries, cesarean sections, and participate in daily rounds. While some of the midwives were strict toward me due to my lack of German proficiency and did not allow me into the delivery room—an experience I found quite frustrating—the majority of the physicians were supportive. They provided explanations in English and gave me opportunities to assist in robot-assisted and laparoscopic surgeries. One significant experience was when I assisted a breast surgery with just one supervising physician. That physician, known among students for being highly educational, treated me as a peer and colleague, which made me feel deeply recognized as a medical student. On the wards, I also noticed that pregnant women were often accompanied by their partners, and some rooms even had beds for them. This highlighted a significant cultural difference from Japan and gave me insight into how childbirth is valued differently in Germany.

#Month 3: Otorhinolaryngology
I joined daily rounds and observed both surgeries and outpatient care. Since I have a particular interest in oncology, I was assigned to the tumor ward and observed the pre- and postoperative management of patients with oral, pharyngeal, and laryngeal cancers. I observed head and neck surgeries and found the microsurgeries and large-scale reconstructive surgeries especially fascinating. In the outpatient care, I observed a wide range of cases involving patients from children to the elderly. I learned the entire process—from medical interviews to ultrasound and audiometric testing—and how treatment plans were decided. I followed different residents every day and observed various styles of outpatient care.

One of the most significant challenges I faced was the language barrier. Conferences and conversations with patients were conducted in German, so I couldn't fully grasp the context. In German university hospitals, even exchange students are expected to have a certain level of German proficiency, and many Erasmus students from other countries were able to speak the language. Of course, I can communicate with doctors in English, but being the only one who could not understand German often made me feel isolated.

What I learned

I learned about the differences between the medical systems in Japan and Germany. Disease patterns varied greatly, which I realized were closely tied to differences in healthcare systems, national contexts, and cultural attitudes toward medicine. I was impressed that a single department handles a wide range of treatments. For example, in thoracic surgery, physicians were responsible for everything from bronchoscopy and surgery to chemotherapy. In ENT, the department handled large-scale reconstructive surgeries internally. I also noticed that surgeries and anesthesia were conducted in separate rooms to maximize efficiency, and cost-awareness influenced medical equipment usage and hospital stays. Through these experiences, I strongly felt that understanding the international background and healthcare systems is essential for practicing evidence-based medicine and conducting clinical research in the future.

Interacting with German medical students was also highly inspiring. They possessed deep knowledge and continually refined their clinical reasoning skills through hands-on training. I was impressed by how precise and logical their answers were when I asked them questions. I was able to engage in practical medical tasks, including blood draws, ultrasound examinations, and assisting as a second operator during surgery. These experiences taught me the importance of understanding the rationale behind medical tasks. Moreover, I learned that German students often did internships at various hospitals and departments. It plays a key role in their career development, and I found their proactive mindset extremely motivating.

Daily Life

This was my first time living abroad alone for an extended period. As the University of Freiburg did not offer student housing, I found accommodations through Airbnb. Fortunately, my host was helpful, so I faced no significant issues in daily life. I had to navigate public transportation, daily shopping, and all administrative procedures related to my stay independently without Japanese. Through trial and error—and with the help of many local residents—I gradually adapted myself to a new environment. Freiburg is a student-friendly city with a lively and safe atmosphere, charming independent shops, and abundant nature. It was a very comfortable place to live. On weekends, I explored various parts of the city and its surroundings, gaining firsthand experience of the region’s unique culture and history.

Conclusion

Participating in this study abroad program has been my goal since the open campus event back in high school. Over these three months, I had a fulfilling rotation with a wide range of clinical experiences. I prefer stable environments, but this opportunity pushed me out of my comfort zone, which led to significant personal growth. I would like to express my sincere gratitude to everyone who made this incredible opportunity possible.

Overview of the Clinical Rotation

In the first month, I was assigned to the Department of Pediatric Cardiology in Lund. I primarily observed outpatient consultations and occasionally had the opportunity to observe catheter procedures and pediatric cardiac surgeries. As Lund University Hospital covers a wide medical area in southern Sweden, I encountered many complex cases that I had never seen before at my home university.
In the second month, I joined the emergency department in Malmö. During the first week, I observed physicians conducting history taking and physical examinations. From the second week onward, I was allowed to take charge of my patients. I took patient histories, performed physical examinations, and presented my findings to senior doctors. This hands-on experience was extremely valuable for my clinical learning.

Clinical rotation in Sweden (overall)

Before I came to Lund to start my clinical rotation, I was a bit anxious about the language, as Swedish is the working language there.
Nevertheless, it turned out that the doctors were very proficient in English, and I had no difficulty communicating with them. I also had the opportunity to meet residents and interns at the hospital, and we often discussed clinical cases together.
Although conferences were sometimes held in Swedish, the doctors kindly took the time to explain the key points to me afterward, which was very helpful.
Regarding communication with patients, there were times when I couldn’t understand what was happening, especially when the patients were young children or elderly individuals who did not speak English. Even in those situations, the doctors kindly explained what had occurred, which helped me a lot. On the other hand, some patients spoke English fluently, allowing me to conduct history taking and physical examinations smoothly.
Additionally, many doctors, patients, and medical students showed interest in Japanese medical practices and culture. We had several discussions on these topics—discussions I had not often considered in Japan—which provided me with valuable new perspectives.

Clinical rotation in Sweden (each department)

In pediatric cardiology, I mainly attended outpatient consultations and learned the basics of pediatric echocardiography, how to interpret echo views, and details about the patient's conditions. I also had the opportunity to observe inpatient duties, catheter treatments, and surgeries in pediatric cardiac surgery.
When discussing patients' conditions with the doctors, I made sure to compare the treatment guidelines of Japan and Europe, always being mindful of “why this particular treatment plan was chosen for this patient.” I feel that this helped me build a fundamental understanding of pediatric cardiology.
Additionally, in Sweden, I frequently observed cases where genetic testing was actively sent to research institutions in cases where a family history was suspected. This practice is facilitated by the national ID system, which manages medical information and makes it easier to track hereditary diseases and introduce family history-based testing. Also, the national initiative called Genomics Medicine Sweden has been advancing genome analysis, and the public insurance coverage has lowered the barriers to genetic testing. These factors contribute to the unique healthcare culture in Sweden.
In the emergency department, during the first week, I observed the doctors as they conducted history taking and physical exams. Starting from the second week, I was allowed to take a patient's history and perform a physical exam as the first touch with English-speaking patients, followed by presenting the case to the senior doctor. I was able to experience the entire process of emergency care firsthand, from interacting with the patients to the communication involved. Additionally, I observed that some patients, referred by general practitioners or those who walked into the emergency department, first called the hotline to determine whether they should visit the emergency department or not. This aspect of the Swedish healthcare system, especially the initial triage and selection for emergency care, was very different from Japan's medical system, and I gained a lot of valuable learning from it.

Difference Between Japanese and Swedish Medical Systems and Culture

First, I was impressed by how many female doctors and medical students there were. It seemed to me that the well-established employee benefits and parental leave systems in Sweden play a big role in creating an environment where women can work comfortably in medicine.
Second, Sweden has a General Practitioner (GP) system, and I got the impression that large hospitals like the one where I did my rotation don’t usually handle long-term follow-up care. Instead, they focus more on acute cases, while the patient’s assigned GP takes care of the chronic treatment. I felt that this division of roles is clearer and more structured than in Japan.
Third, in the emergency department, I found it interesting that they used a team-based approach. After triage, patients were assigned to different teams based on their condition, and each team included doctors who specialized in that area. I thought this was a unique system compared to what I’ve seen in Japan.
Lastly, from a cultural point of view, I enjoyed the custom of "Fika." Even during work hours, staff would often gather for a short break with coffee and pastries, and during that time, they would casually discuss patient cases or chat about everyday topics. It felt like a light, informal conference. I got the sense that they value the idea that relaxed conversations can lead to better ideas than working under constant stress.

Life in Sweden

We rented houses in both Lund and Malmö and had no problems at all—the houses were fully equipped with everything we needed for daily life.
We usually cooked at home using ingredients bought at nearby supermarkets. Although rice and Japanese seasonings were a bit more expensive than in Japan, we were still able to find them. By combining them with the Japanese food we had brought with us, we were able to enjoy Japanese meals and didn’t feel homesick.
While living in Lund, we felt very safe. The city had a peaceful atmosphere, and we enjoyed visiting its beautiful spots, such as the Lund Cathedral.
In Malmö, we were told that some areas could be a bit unsafe at night, but we never felt in danger in the area where we stayed.
When we first arrived in February, the weather was mostly cloudy and the days were quite short. However, as March came, the temperature began to rise and the days grew longer. By April, the city was full of spring colors and beautiful scenery. One of the most unforgettable moments was visiting a garden on Lund University’s campus on our final day—it was truly stunning.

My name is Atsuna Kamei, a sixth-year medical student at Nagoya University School of Medicine. In 2025, through a clinical exchange program, I had the invaluable opportunity to undertake eight weeks of clinical training in the United Kingdom.

During this period, I spent four weeks in February at the University of Glasgow’s oncology department, a partner institution, followed by another four weeks in March at St George’s, University of London’s pediatrics department, a non-partner institution. The experiences gained at both universities were exceptionally enriching and have been profoundly meaningful to me. Given that I trained at two institutions, this report is somewhat extensive; however, I will detail my learnings below.

Why the UK?

I entered medical school amid the chaos of the COVID-19 pandemic. During the orientation, I overheard that there was a medical English class, and though I was only a first-year student who barely knew how to write an email properly, I gathered the courage to send a message to Dr. Itzel expressing my interest. She replied with surprise, saying, “The class is currently paused, but how did you even hear about it? I’ll let you know once it resumes.” I still remember that exchange as if it were yesterday.

That moment marked the beginning of my journey. Under the guidance of Dr. Itzel and many inspiring mentors, I actively participated in medical English classes and Clinical Case Discussions. Through short-term exchange programs and summer schools, I had opportunities to interact with medical students from different countries. These experiences allowed me to witness firsthand the diligence and excellence of medical professionals and students worldwide. Regardless of their origin, they consistently demonstrated remarkable dedication and pride in their work. Over time, my desire to expand my learning and personal growth beyond national boundaries became stronger.

This international perspective also heightened my interest in the societal and systemic factors that influence medicine and healthcare. I aspired not only to acquire knowledge but to immerse myself in real-world settings where I could critically analyze and explore ways to improve healthcare delivery. This aspiration led me to pursue the exchange program.

Among many options, I was particularly drawn to the United Kingdom due to its distinctive National Health Service (NHS), a publicly funded healthcare system guided by the principles of equity, accessibility, and free care at the point of use. The NHS holds a special place in British society—it was celebrated during the opening ceremony of the 2012 London Olympics, and consistently ranks among the top sources of national pride in public opinion surveys. However, no healthcare system is perfect. The NHS faces financial instability and recurrent strikes, underscoring the challenges that accompany even a widely cherished system. Studying within such a framework was especially valuable to me, as I aimed to understand the influence of healthcare policies on clinical practice.

Additionally, I had previously attended a two-week summer program at the University of Cambridge at the end of my third year, marking my first visit to Europe. The UK’s deep historical roots, coupled with its role as a cultural hub, left a lasting impression on me. The prospect of spending two months learning and living there was exciting, even before I embarked on my journey.

February: Oncology at the University of Glasgow

My four-week clinical training at the Beatson West of Scotland Cancer Centre was an incredibly unique and enriching experience. As Scotland's largest cancer center and the second largest in the UK, Beatson provides specialized oncology care, and it is rare for international students to train there. Prof. Jeff Evans, who leads Phase I clinical trials in Scotland, kindly arranged my training schedule so that I could learn one-on-one with a supervising doctor every day.

Established in 1451, the University of Glasgow is the fourth oldest English-speaking university, following Oxford, Cambridge, and St Andrews. Located in Scotland’s largest city, Glasgow blends its industrial heritage with a vibrant cultural and artistic scene. It is home to a large student population, and its safe and welcoming atmosphere makes it a wonderful place to live.

At Beatson, I had the invaluable opportunity to shadow oncologists specializing in a wide range of cancers, including colorectal, upper gastrointestinal, hepatocellular, metastatic breast, germ cell tumors, ovarian, lung, sarcoma, melanoma, etc. Consultations were thorough, often lasting up to an hour, and I observed complex discussions involving prognosis, treatment options, and breaking bad news. Initially, understanding Scotland’s distinct accent and responding to spontaneous questions were challenges, but over time, I gained confidence in engaging in meaningful conversations with both doctors and patients.

One key observation during outpatient consultations was the way patients first received their diagnosis. Many arrived at Beatson without a clear understanding of their condition, despite being referred for advanced-stage cancer, resulting in their first experience of being formally diagnosed as "Stage 4" at Beatson itself. Physicians often expressed frustration that prior discussions had not sufficiently prepared patients for this moment, as it hindered their ability to engage in treatment planning. Yet, despite the severity of their illnesses, many patients maintained remarkably high quality of life due to tailored treatment approaches. I witnessed doctors adjusting medication schedules to accommodate patients' holiday plans, engaging in warm conversations during consultations, and reinforcing a sense of optimism through phrases like, "We cannot cure your cancer, but we can treat it." These moments underscored the profound impact of compassionate patient communication and the need for continued innovation in oncology treatments.

Beyond outpatient clinics, my training extended to the Acute Oncology Assessment Unit (AOAU), where I assisted in assessing urgent cancer-related cases via the hospital’s helpline service. At the pharmacy, I learned about clinical trials management, discovering that Beatson oversees 400–600 protocols at any given time, with 150 actively running trials. I also gained insights into primary care through a general practice rotation thanks to Dr. Alec Logan.

I encountered several distinct aspects of British healthcare. For example, imaging reports took about a week, and it took six weeks to book a PET scan. Therefore, scheduling constraints often led to alternative approaches such as telephone consultations. The presence of a dedicated Nurse Practitioner for patients aged 16–26 highlighted a unique specialization within oncology nursing. Additionally, Beatson Cancer Charity managed the hospital’s café and mobile coffee service, demonstrating the role of philanthropic contributions in healthcare. Interestingly, in Scotland, known for its cultural affinity for whisky and deep-fried foods, liver-related diseases linked to lifestyle factors were more prevalent than those caused by viral infections. For example, hepatocellular carcinoma (HCC) was more commonly associated with alcohol use and obesity, rather than viral hepatitis, which is a more dominant cause in many parts of Asia. In addition, I encountered several patients with genetic hemochromatosis, a condition more frequently observed in people of Celtic descent."

Meaningful personal interactions also enriched my time in Glasgow. I reconnected with two students I had met during their exchange visit to Nagoya University, and a Student Buddy kept in touch, ensuring my experience was smooth. Glasgow medical students introduced me to the structure of medical training in the UK, including its randomized allocation system for junior doctors and the longer pathway to specialization compared to Japan. Outside of clinical training, I joined student clubs and explored the university’s magnificent Hogwarts-like campus, finding respite in its historical charm. Dr. Alec Logan generously introduced me to local cultural experiences, taking me to the opera, orchestra performances, and the Glasgow Film Festival—moments that became cherished memories.

March: Pediatrics at St George’s, University of London

My four-week training at St George’s, University of London, deepened my understanding of pediatric care within the UK’s diverse healthcare system. As London’s second oldest public medical school, founded in 1733, St George’s is affiliated with a major acute-care hospital, seamlessly integrating medical education with clinical practice. Located in Tooting, an area known for its vibrant, multicultural community, the hospital served a highly diverse patient population, making cross-cultural medical communication an essential skill.

My supervisor, Dr. Jane Runnacles, arranged a well-structured rotation. The first week focused on inpatient care, the second week on outpatient clinics, the third on neonatal medicine, and the fourth on infectious diseases. Additionally, I gained exposure to the hospital’s specialized 'Blue Sky Unit,' which is designed to streamline pediatric consultations and reduce wait times, as well as the Pediatric Intensive Care Unit (PICU).

One of the most striking lessons from ward rounds was the structured team approach: consultants always accompanied new patient assessments to ensure comprehensive discussions. One consultant remarked, "Parents often seek a definitive diagnosis—a label. But instead of rushing to provide one, we must carefully rule out possibilities." This perspective reinforced the importance of thorough clinical reasoning in pediatric practice.

During outpatient consultations, I observed a communication approach distinctly different from what I had seen in Japan. Physicians prioritized speaking with the child first, adjusting their questions according to the child's developmental stage while maintaining direct engagement. A typical interaction began with confirming the child’s age, followed by informal questions like, "Who did you come with today?" and "How’s school?" to build rapport. Eventually, the discussion transitioned into clinical inquiries, such as, "Why do you think you came to the hospital today?" I was surprised to see a five-year-old confidently explaining their allergies—something I had rarely witnessed in pediatric consultations back home.

One particularly memorable case involved a three-year-old Somali boy referred for recurrent vomiting, diarrhea, and abdominal pain occurring several times a month. As the patient’s family had limited English proficiency, telephone interpretation services were used during the consultation. Despite the additional time required, persistent and thorough questioning revealed that consuming excessive junk food at home was the root cause. The attending physician pointed out systemic issues within the NHS, explaining, "GPs have very little time for consultations. Ideally, 90% of pediatric diagnoses should be made through history-taking and physical examination. Yet, many cases are unnecessarily referred to specialists due to time constraints." She described the current structure as a "broken system," reflecting broader challenges in healthcare access.

My time in neonatal medicine underscored the global reputation of Japan’s advanced neonatal care. Some physicians prefaced discussions with, "I think Japan is ahead in this area," and even asked if I was familiar with specific neonatal techniques they had learned from Japanese specialists. Meanwhile, the infectious diseases team provided insight into their specialized role within the hospital, offering consultations across various departments to optimize infection control and antibiotic therapy.

One of the most valuable aspects of my rotation was the emphasis on teaching. Pediatric emergency simulation training was particularly impressive: medical students, residents, and attending physicians assumed different roles in SBAR-format handovers and simulated crisis responses. The session concluded with a reflective discussion on communication strategies, demonstrating a highly interactive and engaging learning environment.

Additionally, cultural communication styles emerged as a topic in pediatric education. One seminar discussed how patients from different ethnic backgrounds interact with healthcare providers. White patients, for instance, often express concerns openly and challenge medical recommendations. In contrast, non-white patients may hesitate to voice uncertainty, sometimes agreeing with doctors even when they do not fully understand. This cultural dynamic added an important layer to clinical communication.

A hospital-wide weekly lecture series, “Grand Round,” provided further interdisciplinary learning opportunities. One session I attended featured discussions on World Kidney Day, clinical ethics regarding emergency transfusions for pregnant patients with religious restrictions, and research presentations by fellows. These sessions fostered collaborative learning and a broader perspective on medical practice.

Beyond clinical training, my time at St George’s was enriched by meaningful interactions with students. Living in university-provided housing allowed me to bond with flatmates, sharing experiences and supporting each other through our respective studies. One Saturday morning, we visited an art museum, where I was encouraged to try sketching for the first time since anatomy class—a moment of creative escape from the rigorous medical environment.

Medical care in London also highlighted key systemic challenges. Discussions with local students highlighted real-life examples of healthcare accessibility challenges, including a case in which a patient endured severe pain from a urinary tract infection but faced difficulties obtaining treatment, ultimately returning to India for medical care. Another student described the staggering two-year wait time for hemorrhoid surgery. These discussions deepened my understanding of the NHS’s structural limitations.

My closest peer during the rotation was an Italian medical student participating in an Erasmus exchange program. We not only studied together but also spent weekends exploring London. Our discussions on pediatrics, national healthcare systems, and cultural differences enriched my learning experience beyond clinical practice.

Key Takeaways and Acknowledgments

Experiencing two distinct cities—Glasgow and London—allowed me to observe stark contrasts in healthcare environments. Glasgow, with its predominantly Scottish patient population, presented challenges related to strong regional accents and cultural norms, whereas London required proficiency in cross-cultural medical communication and multilingual patient interactions. Additionally, rotating through primary care (GP surgery), secondary care (St George’s Hospital), and tertiary care (Beatson Cancer Centre) provided me with a holistic understanding of the UK’s healthcare system and its influence on clinical practice.

Moreover, I was fortunate to visit two internationally renowned institutions beyond my formal rotations: Francis House, a children’s hospice in Manchester, and the Princess Máxima Center, a leading pediatric cancer research institute in Utrecht, the Netherlands. These experiences provided profound insights into holistic patient care and the pivotal role of medical research in shaping the future of healthcare.

Outside of medicine, the exchange program encouraged me to embrace challenges beyond my comfort zone. Despite a demanding clinical schedule, I was determined to maintain my ballet training in preparation for an upcoming summer performance. Finding local studios and continuing lessons abroad required initiative, but I was ultimately able to sustain almost the same training intensity as in Japan. Dancing alongside performers from diverse backgrounds was both inspiring and rewarding, further strengthening my confidence in my technical development.

Finally, I extend my deepest gratitude to the many individuals who made this exchange possible. I sincerely appreciate the guidance and support of Prof. Kasuya and Prof. Branko, the invaluable scholarship assistance from Dr. Shibahara, the unwavering mentorship of Dr. Itzel, and the administrative coordination provided by Prof. Hasegawa and Ms. Miyagawa. My heartfelt thanks also go to the Frontier Committee, my supervisors—Prof. Jeff Evans at the University of Glasgow, Dr. Alec Logan in general practice, and Dr. Jane Runnacles at St George’s, University of London—and the pediatric, obstetrics, and gynecology teams at Nagoya University. Above all, I am forever grateful to my parents, who have supported me throughout every step of this journey.

This exchange program has been a transformative experience, one that will undoubtedly shape my future career in medicine.

Purpose and Background of the Study Abroad

The reason I chose Germany as my study abroad destination is because I have long held a deep interest in the country. I had heard that Germans share a similar national character with the Japanese, and I was also intrigued by how Germany, like Japan, experienced defeat in war yet achieved significant economic growth to become the leading economy in the EU. I was particularly interested in how post-war Germany has addressed its history, including the Nazi era, and how it educates future generations about these issues. Therefore, through studying abroad, I wanted not only to learn about medicine but also to experience German culture, people, and history firsthand.

For clinical training abroad through Nagoya University, students could choose between two German universities: Ludwig Maximilian University of Munich (LMU) and the University of Freiburg. I chose LMU because it offered electives in both neurology and oncology, which are the fields I am most interested in. Additionally, the structure of the program encouraged active interaction among students, which I found very appealing. Looking back, I am filled with gratitude, as the six weeks I spent in Munich were immensely fulfilling and provided an ideal environment that exceeded my expectations.

Academic Achievements

LMU offers a short-term clinical course every year called the “Winter School,” which brings together LMU students and international students from countries such as Brazil, Colombia, Georgia, Italy, and Japan (including students from Nagoya University, Yokohama National University, and Jikei University School of Medicine). The Winter School consists of two concurrent programs: Oncology and Neurology. Each has its own weekday curriculum, while joint weekend programs include group excursions to nearby areas.

I participated in the Oncology Winter School from March 3 to March 27. Ten LMU students and ten international students joined this program, and we built close relationships through lectures, weekend trips, and dormitory life.

On weekday mornings, we were involved in clinical practice, such as ward rounds, blood sampling, and ECG measurements. In the afternoons, we attended one to three lectures per day, each lasting 60 to 90 minutes. For clinical training, each participant was paired with an LMU "buddy" (a 3rd–5th year medical student). Since conversations with patients and handovers during rounds were conducted in German, our buddies translated for us and also taught us clinical techniques. I am immensely grateful for their hands-on support. I enjoyed the opportunity to perform procedures not typically done by medical students in Japan, and I was also impressed by the high level of LMU students. It was notable that all patients were willing to talk during rounds. While the treatments were largely similar to those in Japan, I noticed some differences—for example, bone marrow transplants were performed even in patients in their 80s, and transfusion protocols differed. Afternoon lectures covered systematic learning about different types of cancer by organ, as well as topics such as psycho-oncology and palliative care, which I had little exposure to in Japan.

From March 31 to April 11, two Nagoya University students, including myself, participated in a neurology rotation arranged through the support of Dr. Bustos from the International Affairs Office and Dr. Katsuno from the Department of Neurology.

In German university hospitals, departments are typically divided by disease, such as stroke units, epilepsy units, and neurodegenerative disease units. We were able to rotate through each and observe clinical practice. The physicians were very committed to teaching and allowed us to perform neurological examinations on patients. They also provided detailed explanations in English regarding various conditions, disease mechanisms, and the latest research. We observed procedures like EEG and EMG and visited inpatient neurology wards when time allowed, giving us a broad exposure to a range of neurological conditions. What struck me was the frequent use of biological tests. In addition to cerebrospinal fluid tests for amyloid and tau in diagnosing dementia, amyloid PET and tau PET imaging were also routinely performed, which surprised me.

Experiences from Living Abroad

This study abroad experience allowed me to interact with students from around the world—including those from South America and Central Europe—which left a lasting impression on me. In many countries, including Germany, medical students play an active role in the healthcare system, and I felt that they were more advanced than us in both clinical skills and medical knowledge, which was very inspiring. The Winter School also organized weekend day trips by bus, where we visited famous sites like Neuschwanstein Castle and also participated in meaningful excursions such as a guided tour of the Dachau Concentration Camp. Munich offered an enriching cultural environment. For example, people under 30 could enjoy front-row seats at the Munich Philharmonic and opera performances for only €14, and admission to state art museums was just €1 on Sundays. I shared these cultural experiences with friends. As someone with a deep interest in German and European history, I also took solo trips to Berlin and neighboring countries on weekends to visit museums, which became unforgettable memories.

Reflections and Future Goals

Thanks to the people and opportunities I encountered, this study abroad experience was truly incredible. However, I also faced a major challenge: a strong sense of helplessness in not being able to contribute to the people who hosted me at the hospital. While I learned a great deal thanks to the support of others, I was frustrated and ashamed that I could not give back due to my lack of experience, knowledge, and language skills.

Despite knowing that speaking German was essential to communicate with patients during an internal medicine rotation, I naively assumed I could manage with English alone. In Germany, English proficiency is generally high—especially among doctors and students—so I had no problem receiving instruction or making friends. However, if one wants to live in Germany and contribute on the hospital ward or communicate with patients, speaking German is clearly a necessity. I never imagined language barriers would feel so insurmountable, and I was quite discouraged at times. Particularly in Germany, where immigration is a significant social issue, a high level of German proficiency is required to work in healthcare. One of the doctors in my ward, originally from Bosnia, said that she had studied so much German that she forgot English.

That said, I must emphasize that most people understood my lack of German and helped me with simple English and other means. As I mentioned, the average German’s English proficiency is much higher than that of Japanese people. I even had casual conversations over beer with strangers at restaurants. So, there’s no need for future students to be overly fearful of going to non-English-speaking countries. What I want to emphasize is that learning a language is a form of showing respect. I regret not learning a few greetings or useful words that might have helped me build stronger relationships. I believe learning even a little of the local language can make your study abroad experience more enjoyable.

Going forward, my goal is to repay the kindness I received during this program by paying it forward to those I meet in the future. This includes acquiring specialized medical knowledge, explaining it clearly to patients and students in fluent English, learning even a bit of someone’s native language when communicating across cultures, and taking initiative to reach out to those in need. As someone aspiring to be a hematologist, I was especially struck by something a leading leukemia expert said during a lecture: “Anticancer drugs are poisons. Therefore, the use of such drugs must always be evidence-based.” This message has stayed with me. To provide the best possible care for my future patients, I want to continue learning relentlessly as a scientist and contribute to medical progress through both basic and clinical research. I aim to be a physician who maintains a global perspective, embraces challenges, and is capable of making a meaningful impact in any environment.

Acknowledgments

Finally, I would like to express my heartfelt gratitude to all those who made this study abroad opportunity possible. To Dr. Kasuya, Dr. Hasegawa, and Dr. Bustos of the Nagoya University International Affairs Office, to the many professors and my buddy Andrea at LMU, to the seniors who helped me prepare, to the classmates who studied with me during the program, and to my family who supported me throughout—I offer my sincerest thanks. Thank you for making these irreplaceable six weeks a reality.

I had the pleasure of visiting the Medical University of Vienna and doing my clinical clerkship at the Vienna General Hospital (AKH) for two and a half months from mid-February to the end of April. I had a lot to learn from every stage of this whole experience including preparing for the application, organizing my clerkship with coordinators at AKH, getting everything settled for a long-term stay abroad, lectures held on Saturdays, and the clerkship itself.

Pediatrics

I rotated at pediatric cardiology for the first two weeks and at pediatric nephrology/gastroenterology/rheumatology for another two weeks.
At pediatric cardiology, I saw many cases of congenital heart diseases including severe ones, very rare ones that I never see in Japan, or ones that are indications for heart transplantation. I remember hearing heart murmers. The doctors were truly kind and took their time to give me feedback when I reported them what I saw in the patient and my thinking process. One of the doctors taught me how to interpret electrocardiogram results which was one of the biggest obstacles I had to overcome.
At pediatric nephrology, I observed dialysis and abdominal ultrasound examination. When doing examinations using the ultrasound, there was a doctor with a lot of creative ideas to calm down pediatric patients as it becomes difficult to obtain proper results if the patients move. At pediatric gastroenterology and rheumatology, I studied at the outpatient clinic and saw a lot of referrals from other hospitals, follow-up visits for chronic diseases, and liver biopsy.

Radiology

As soon as I started my rotation at radiology, I noticed that the department was divided into multiple groups such as chest X-ray, CT, MRI, interventional radiology, trauma, ultrasonography, breast imaging (including both mammography and breast biopsy). The radiologists first taught me their ways of interpreting images, and based on what I learned from them, I tried making an interpretation report on my own and asked for feedback, which I thought was very educative. I also remember hearing stories about how radiologists have the healthiest work-life balance.

Obstetrics and Gynecology

I rotated one week at obstetrics and another week at gynecology. I had the chance to scrub in during a rare operation and observe the outpatient clinic that was highly specialized and divided into multiple groups. For example, at the obstetrics outpatient clinic, I visited the multiple birth group, the fetal risk group, and the maternal risk group.

Visceral (General) Surgery

This was the last rotation for me at AKH and became the chance to see and study a wide variety of operations. This was also a good opportunity for me to meet other international students who came from outside Austria to study at AKH. I found out that Austria is a highly preferred country to work in as I met a lot of students and doctors who visit AKH in pursuit of chances to come back.

Language

I did not have trouble living in a non-English speaking country as much as I had expected as a great part of the population, especially medical professionals, speak English without any problem. Nevertheless, being surrounded by a German-speaking environment sometimes felt stressful in the beginning. However, as time passed by, I realized that learning simple German phrases and trying to use them make a good impression and gradually became used to finding doctors who can give me explanations in English.

Living in Vienna

Vienna is known to have a good public transportation system which connects almost everywhere within the city. There were many places to do grocery shopping or pharmacies in the city and I thought Vienna is certainly one of the most livable cities in the world, also showing its beautiful colors especially in the spring. I often saw people who were enjoying their times after work or spending time on the terrace. I was also entertained by the rich culture and history, which became a good opportunity for me to do some research on the city and European history.

Closure

This overseas clerkship could not have been this much of a success without the support of professors at the international affairs office, Frontier members, my parents, friends, and people who I met in Vienna. I was able to safely come back after creating unforgettable memories of both exciting moments and unexpected moments. I would like to show my biggest gratitude for this special privilege of being involved in such a wonderful experience during this time of life and I am grateful for all the help I received during this overseas program which resulted in huge growth in my studies, the ability to live abroad, and interpersonal communication.

March 3 – April 25, 2025, at St. Olavs Hospital, NTNU

In the spring of 2025, I completed a two-month clinical internship at St. Olavs Hospital affiliated with the Norwegian University of Science and Technology (NTNU). NTNU is located in Trondheim, Norway's third-largest city. Other medical schools in Norway are located in the capital city of Oslo, the second-largest city of Bergen, and Tromsø in the north. NTNU is a comprehensive university with a wide range of academic disciplines. Living in the dormitory allowed me to interact with students from various departments and international students, enriching my study abroad experience. At the hospital, medical records and patient examinations were conducted in Norwegian, but many staff members and patients spoke English fluently, which made for a fulfilling internship experience. During my stay, the Nordic World Ski Championships were held in Trondheim, and the city was filled with a festive atmosphere, which was also memorable. In this region where cross-country skiing is deeply rooted in the culture, I had many opportunities to bond with doctors and students through conversations about skiing, and it was a pleasant experience that skiing, which I had started at university, became a topic of conversation.

Learning in Orthopedics

During the first four weeks, I was assigned to the orthopedic department, starting each day with a 7:30 a.m. X-ray conference. I was initially overwhelmed by the lively discussions involving 40 to 50 doctors. After sharing my interests with the study abroad coordinator, I rotated through several teams, gaining exposure to a wide range of cases and diverse medical perspectives. In the first week, I observed and assisted in the initial treatment of patients with fractures and other injuries in the orthopedic emergency department. Although I was anxious about training in English, I gradually adapted to the clinical setting thanks to my previous studies in Japan, UpToDate, and the kindness of patients. From the second week onward, I joined the trauma team and participated in approximately 30 surgeries of varying complexity. When given the opportunity to perform dermal suturing, I felt frustrated by my lack of skill and practiced every night using borrowed instruments. A unique custom in the operating room was that, during long procedures, nurses would offer juice and help us drink it through a straw. Each day brought new surgical experiences, which made the learning demanding yet exciting and enjoyable. I also came to appreciate the value of interdepartmental collaboration, such as working with geriatricians to manage postoperative delirium in patients with proximal femur fractures. In the final week, I visited various outpatient clinics—pediatric orthopedics, spine, knee, diabetic foot care, and more—and felt genuinely reluctant to leave. The doctors generously took time between examinations to teach me in English with enthusiasm.

Learning in Gastrointestinal Surgery

For the final four weeks, I was assigned to the upper gastrointestinal surgery department. Each day began at 7:45 a.m. with an image review session, followed by ICU and ward rounds, and then surgery or outpatient clinics. During the Whipple procedures, which I observed multiple times, I was given the opportunity to assist—a role that made me feel both nervous and excited. I also observed PEG procedures, which were performed differently from those I had seen in Japan. This allowed me to deepen my understanding by comparing techniques between the two countries. Outpatient care primarily focused on inguinal hernia cases, which I also found fascinating. Additionally, I had the chance to observe gastroenterologists teaching endoscopy to junior surgeons—an unexpected pleasure, especially since I was already interested in gastroenterology. One of the most memorable experiences of the internship was the “Surgeons’ Meeting” held on Friday mornings. Before the regular image review, all the surgeons in the hospital would gather in the cafeteria, enjoying breakfast together and chatting cheerfully. Although the main purpose was to foster professional relationships, I couldn’t help but think it might be a more efficient alternative to staying out late drinking. On one such morning, a female surgeon I hadn’t previously spoken with offered me Norwegian waffles and coffee, leaving me with a warm and lasting memory. As the internship progressed, I began asking the front desk staff during my free time, “Are there any interesting outpatient cases today?” I also visited the emergency department between surgeries or in the evenings with a kind resident who mentored me. I was impressed by how proficient the younger generation in Norway is in English—it even allowed me to conduct a medical interview in English with a 10-year-old patient experiencing abdominal pain. I encountered several emergency-specific cases, such as testicular torsion and appendicitis, making for an enriching experience. In the final week, as I began to feel the sadness of leaving Norway, I asked one of the specialist doctors in detail how he managed to balance family, clinical duties, and research. That conversation left a lasting impression on me. His sincere enjoyment of daily learning and his attentiveness to detail deeply inspired me, prompting reflection on the kind of doctor I aspire to become.

Differences in Medical Culture

In Norwegian medical settings, it is not uncommon for doctors to finish work by 3 p.m., and there is a strong emphasis on improving work efficiency through measures such as using robots in hospitals and voice input for medical records. Online consultations are also common in outpatient care. Doctors and nurses maintain a flat hierarchy, and in the operating room, they exchange greetings and introductions every time. Many nurses kindly explained the surgical procedures and showed me where to stand during the operations for the best view. Approximately 70% of medical students are women, and I felt that the concept of gender equality is deeply ingrained in the workplace. Additionally, many doctors from other countries who came seeking better working conditions are employed there, making the diversity in the medical field particularly notable. Furthermore, students begin obtaining limited licenses to examine patients starting in the winter of their fifth year, which makes Norway’s clinical internships more practical.

International Exchange and Daily Life

In the dormitory where 15 people lived together, lively interactions took place every day. On my birthday, I was treated to a homemade dinner and cake, making it one of the happiest birthdays I have ever had. On the final day of the internship, we enjoyed a farewell dinner at an Italian restaurant. Additionally, reuniting with Norwegian students who had previously come to Nagoya University and being shown around the city and campus was a memorable experience that truly highlighted the appeal of exchange programs. Activities such as bowling, home parties, and casual conversations at cafes with them made me realize that medical students’ perspectives are surprisingly similar despite differences in nationality. Life in Norway was generally comfortable, but when I felt my health deteriorating due to a wheat-based diet, I made adjustments such as switching to jasmine rice and gluten-free foods. Due to the high cost of living, my cooking skills naturally improved. On the final day of my stay in Trondheim, I visited the fjords with my dormitory friend, and the breathtaking fjords I saw under the clear blue sky left a lasting impression. Despite being a small city, the harmony between nature and urban life was charming, and I understood why Norwegian students say, “This is the best place to raise children.” I encountered more children there than in Nagoya, and those words left a deep impression on me. Additionally, being told, “You’re good at making friends,” that day gave me great confidence, as I had previously lacked confidence in my English communication skills.

Perspectives Gained Through Study Abroad

Through this study abroad program, I gained a perspective that allowed me to compare the healthcare systems of Japan and Norway. For example, I was able to reaffirm the high level of Japanese technology in gastroenterology, which motivated me to deepen my studies in this field. At the same time, experiencing the Norwegian healthcare system gave me a more flexible view of work styles and team dynamics. During the internship, I proactively introduced myself at appropriate times, asked to be taught in English, and requested to participate in surgeries and outpatient clinics. This active approach to creating learning opportunities was crucial, and one day, the words of my kendo mentor—who always emphasized the importance of “cultivating the character to take initiative”—suddenly resonated with me. The realization that mastering Norwegian would allow me to work locally, combined with the frequent use of English as a common language, broadened my perspective on healthcare and work. This has been one of the major achievements of my study abroad experience.

Acknowledgments

One of the reasons I was inspired to pursue this study abroad opportunity was Dr. Itzel’s medical English class, which I continued attending thanks to her bright and engaging personality. Additionally, the lectures offered by the Frontier Association—a network of study abroad alumni—provided valuable preparation before my departure. The experience I gained through hospital training at our university and prior to this program greatly supported my learning during the internship. I sincerely thank everyone who taught, guided, or supported me—both in Japan and in Norway—throughout this journey. I am committed to continuing my studies and becoming a doctor who contributes meaningfully to society. I am truly grateful to everyone who helped make this opportunity possible.

Preparation

When I first attended the orientation for the Clinical Clerkship Abroad Program in the fall, I realized I lacked everything—language skills, medical knowledge, and confidence. Still, I was determined to participate in the program. From that day on, I began studying English. During clinical rotations in Nagoya, I actively engaged in conversations with international students. Through these interactions, I learned about differences in healthcare systems and gained insight into living abroad, which helped me prepare mentally and linguistically.

After being accepted to the program, International Affairs provided me with lectures to enhance our motivation and medical knowledge. The stories shared by doctors about their experiences back in those days, regardless of age or specialty, were truly inspiring and made me even more excited for the journey ahead.

The Medical System in Hong Kong

Hong Kong does not have a national health insurance system like Japan. There is no fixed medical fee schedule; instead, all treatment is private medical care. There are three main types of medical facilities: public hospitals, private hospitals, and clinics. Public hospitals offer at a lower cost but have long waiting times. Private hospitals accept any patient but at a higher cost.

In Hong Kong, doctors are not employed by hospitals, instead, they earn a portion of the fees paid by patients. This system leads to relatively low salaries for public hospital doctors. The Prince of Wales Hospital, where I trained, is the teaching hospital of the Chinese University of Hong Kong (CUHK), and staff shortages were evident. Often, doctors from mainland China or overseas, who often struggled with English or Cantonese, were seen to support one another while working together on clinical care, research, and education.

Practical Training – Ward and Outpatient Experience

All medical records and lectures are in English, so I had few problems other than outpatient consultations and surgery, where Cantonese was sometimes spoken.

In the first half of my training, I joined the surgical rotation of local year-6 students. Since students must take an OSCE at the end of each rotation, which is for actual inpatients, they were highly motivated and proactive. The lectures were interactive, and students frequently practiced outside class with real patients. By following them, I got a more practical learning experience compared to Japan. Fortunately, for a patient speaking fluent English, I could take medical histories and conduct physical examinations using the skills I had prepared in Nagoya.

Practical Training – Surgical Observation

During the latter half of the training, I was engaged in on surgical observation. There, the doctors and nurses were welcoming and supportive.

One memorable experience was a discussion on the use of the NanoKnife procedure for pancreatic cancer—an approach not yet available in Japan. I also had the chance to share my experience from Nagoya University’s Department of Surgical Oncology, especially regarding perihilar cholangiocarcinoma. This exchange made me appreciate the world-class training environment at Nagoya University and inspired me to contribute to its continued development in the future.

Another difference from Japan is that gastrointestinal surgeons in Hong Kong perform endoscopic diagnosis and treatment. Professor Philip, the President of CUHK and a pioneer in GI endoscopy, performed the first ESD in Hong Kong in 2004. He now works on the development of surgical robots and endoscopic systems. As I had a personal interest in robotics, I was honored to meet Professor Philip and be invited to his company in Science Park, the largest technology center in Hong Kong. His colleagues welcomed me and explained to me about cutting-edge machines and devices.

Daily Life in Hong Kong

Hong Kong is a dense urban city with over 7 million residents living in an area half the size of Tokyo. It is extremely convenient, and I quickly adapted to the lifestyle. I stayed in a dormitory for local students, where it was only a five-minute walk to the wards and OTs. Therefore, it was easy for me to develop close friendships with the local students, often joining them for meals. They often mentioned national issues around them using irony, often with a sense of irony. Yet through those conversations, I could clearly sense their pride and strong identity as Hongkongers. I came to deeply respect their culture and the values they hold.

The dorm was a bit old, with shared kitchens and showers. As a side note, I found a gecko with large belly in my room on the first day. Two weeks later, it gave birth, and by the time I left, the baby had grown up. I saw my own growth during the program reflected in the little gecko’s development.

Acknowledgments

Lastly, I would like to express my deepest gratitude to Dr. Kasuya, Dr. Hasegawa, and Dr. Itzel, as well as the staff at the International Affairs Office, for their support in preparing for this program. I also sincerely thank Professor Chok at CUHK and my mentors in Japan, Dr. Hideki Takami and Professor Yutaka Kondo, for their invaluable guidance.

“LIFE IS COMING BACK”, this line, taken from Ozawa Kenji’s 1994 song “Lovely”—a work I recently performed at our school festival—perfectly captures how I felt during my 11-week stay in Poland. I still don’t fully understand what that “Life” refers to—whether it means vitality, passion, or something else—but whatever it is, I truly got that feeling. Between the stimulating experiences in a foreign country and the quiet, solitary time spent in a dorm room or library, I gradually regained the sense of color and rhythm that I had almost forgotten in my everyday life.

The city of Gdańsk, located on the coast of the Baltic Sea, was historically a major trading port, and it was also the very place where World War II broke out in 1939. Since I have long been interested in early 20th-century history, Gdańsk had been on my list of places to visit. I’m genuinely grateful that Gdańsk was my first encounter with Europe.

After a 20-hour journey from Haneda Airport via Helsinki, I arrived in Gdańsk. When I arrived at a student dormitory, I was initially shocked by the lack of Wi-Fi, the need for a lighter to ignite the gas stove, and the absence of a refrigerator, but I adjusted quickly. A few days later, Professor Michael Wozniak, a biochemistry professor and a key person in the partnership between the Medical University of Gdańsk and Nagoya University, generously provided us with food, dishes, cooking utensils, and even clothespins, which dramatically improved my quality of life. His support, offered every year to students from Nagoya, is truly impressive. I’m deeply thankful for that.

Professor Wozniak played a central role in organizing a major event I became involved in: the “Nagoya Days”. The event was designed to introduce aspects of Japan, particularly in the context of medicine, to local audiences. Topics included “Fumi Matsuzawa, the Japanese nurse who saved Polish orphans left in Siberia after World War I,” and “The health benefits of polyphenols in green tea.” For this project, I collaborated with students from the Young Leaders Program (YLP), who came from a wide variety of backgrounds—from undergraduates in biological sciences at Gdańsk University to high school students, including Professor Wozniak’s own grandson. Since we differed in upbringing and academic focus, our exchanges were genuinely stimulating. Toward the end of my stay, one of the YLP students studying Japanese invited me to his home in the nearby town of Sopot, where we enjoyed traditional Polish dishes, talked about our futures, and played guitar together, which was a truly heartwarming memory.

Now, let me move on to the clinical clerkship itself. One of the Medical University of Gdańsk’s defining features is that it has two divisions, Polish and English. As a student from Nagoya, I was assigned to the latter. While patients and doctors were Polish, the students in my group came from places like Sweden and India. Except for when speaking with older patients who weren’t comfortable in English, the entire program was conducted in English, which greatly lowered the language barrier. What stood out to me most, however, was how proactive and welcoming my colleagues were. Many were fans of anime and were eager to ask me questions about Japan. In the program, we rotated through different departments every week, with written tests in most of them on Fridays. My classmates readily shared old questions or sometimes study materials, and after the tests, we’d often relax and chat over food at a nearby café or food court. I couldn’t have asked for better peers.

Of the departments I rotated through, two gave me a particularly strong impression.

The first was Endocrinology, during my very first week. What stood out was a seminar where actual patients were brought into the classroom. Around 20 to 30 students were free to interview them and try to diagnose their conditions. It was a completely novel experience for me. We met patients with acromegaly, Addison’s disease, Hashimoto’s thyroiditis (which had led to hyperprolactinemia), insulinoma, and MEN1, which helped bring textbook knowledge to life. What struck me was the classroom culture: regardless of whether they were right or wrong, students voiced their opinions freely. I really admired that boldness and I felt I could learn from it.

The second was the Toxicology and emergency states in internal medicine rotation in the 6th week. Held at the Toxicology Center downtown, this session had us conduct patient interviews in small groups. One patient I met was an 18-year-old girl who had overdosed on lamotrigine after struggling with personal relationships. She spoke English and even acted as an interpreter for an interview with a middle-aged patient in the same room. This level of patient cooperation is something I rarely see in Japan. Learning about the personal histories behind these overdoses was delicate and challenging, but also deeply meaningful. It offered insight not just into their conditions, but into the people themselves.

During the Easter holiday, just before I returned home, one of the Indian students in my clinical group said something that struck me:

“You came here by yourself, and you’re going back with us in your mind.”

It was a simple phrase, but it made me realize that my time in Gdańsk was really coming to an end—and that I had truly lived here for 11 weeks. I often asked myself how I had changed during this experience. The answer, I now feel, is that I’ve gathered countless memories and lessons that I carry inside me. And with those, my life has become a little more colorful. I feel I can go for something again with a renewed sense of curiosity and energy. “LIFE IS COMING BACK.”, that phrase still sometimes echoes in my heart.

Finally, I would like to express my deepest gratitude to all those who made this study abroad possible, especially the professors and staff at the International Collaboration Office. Thank you from the bottom of my heart.

I had the opportunity to do a clinical clerkship for three months starting in February 2025 at the University of Bologna, specifically at the Sant'Orsola-Malpighi General Hospital. Surrounded by rich culture, cheerful people, historic architecture, and delicious food, I had an irreplaceable and unforgettable experience in just three months. In this report, I would like to share both my clinical and daily life during the clerkship.

Before Departure

The University of Bologna is known as the oldest university in the world, and I was thrilled to have the opportunity to train at such a historic institution. However, since I was among the first group of students from my university to be sent to Italy, there was limited information available, which made me anxious. To prepare, I reached out to Italian students who had studied at my university and researched online to gather as much information as possible.
Bologna is a student city that attracts students from all over the world. The Faculty of Medicine even offers a six-year program in English. Because of this, housing shortages are a serious issue, and I found it very difficult to secure short-term accommodation for just three months.
In terms of language, I started studying Italian using the app Duolingo about six months before my departure. However, I couldn’t dedicate as much time to it as I had hoped, so I was worried about whether I could complete the training and communicate effectively with those around me without being fluent in Italian.

Clinical Clerkship

Sant'Orsola-Malpighi General Hospital is said to be the largest hospital in Italy, attracting patients from both the north and south of the country. The hospital complex is vast and surrounded by nature, with different buildings for each department. I was struck by how different it was from the hospitals I was used to, and I remember feeling excited about the unknown journey ahead. I rotated through Internal Medicine, Gastroenterology, and Pediatric Cardiac Surgery, spending four weeks in each department.

・February: Internal Medicine (Inflammatory Bowel Disease Ward)
I was assigned to the IBD ward, which I learned was a national center for inflammatory bowel diseases. During the first week, I was the only student, and I joined the doctors on their rounds. Despite the language barrier, the doctors were welcoming and invited me to participate in physical exams and discussions. One doctor told me, "Not everyone might speak a lot of English, but don’t hesitate to ask anything. I’ll answer everything you want to know." This made me more determined to be proactive. I was also invited to attend evening meetings, and although they were conducted in Italian, one doctor kindly explained things to me in English via their smartphone.
From the second week onward, six Italian medical students joined, and we formed a group. After rounds, we discussed patients using provided case files and took part in ECGs, blood pressure measurement, physical exams, and patient interviews. I also had the opportunity to observe abdominal ultrasound exams with English explanations from the doctors. Throughout this rotation, I deepened my understanding of IBD while also practicing basic clinical skills I had learned in Japan.

・March: Gastroenterology
In Sant'Orsola-Malpighi General Hospital, conditions other than IBD are managed by the Gastroenterology department. I spent each week in a different setting: the ward, endoscopy room, outpatient clinic, and ultrasound lab.
In the first week, I joined first-year residents during rounds and was allowed to help with simple tasks such as placing ECGs and IV medications. I was given papers and articles on EUS guidelines and fecal transplants for self-study. The doctors were very friendly—many of them were fans of Japanese culture and even took me out to Japanese and Italian restaurants.
In the second week, I observed various endoscopic procedures, from gastroscopy and colonoscopy to advanced techniques like ESD, EUS-FNA, and ERCP. When I requested to observe more procedures beyond routine exams, the doctors kindly arranged it, allowing me to learn more in-depth.
In the third week, I observed outpatient consultations. Though the conversations were in Italian, a kind student explained things to me in English on their phone, helping me better understand the clinical context.
In the fourth week, I observed ultrasound diagnostics. The supervising doctor was very patient and taught me the basics. By the end, I was even allowed to perform an abdominal ultrasound myself.
This month helped me expand my knowledge beyond what I learned in February and gave me exposure to endoscopy, outpatient care, and imaging.

・April: Pediatric Cardiac Surgery
This rotation was a combined program with pediatric cardiology and pediatric cardiac surgery, which was perfect for me as I wanted to learn both internal and surgical aspects. I observed operations once a week and joined rounds, outpatient clinics, HCU, and the catheterization lab. Among the three departments, this one had the most students, as cardiology is a popular field for medical students in Bologna.
During rounds, I encountered patients with a wide variety of congenital heart defects—from neonates to adolescents and even some adults. Doctors gave detailed explanations, and sometimes even drew diagrams for me after rounds. In HCU, I saw post-op management, and in the catheter lab, I observed an ablation procedure. Though I only managed to visit the catheter lab once, it was a very fulfilling experience.
In surgery, I witnessed various procedures including Glenn operations for single ventricle cases and ECMO removal. Surprisingly, I was allowed to stand very close to the surgical field without needing to be sterile. This allowed me to observe surgeries up close while receiving live explanations from the surgeons. The professor, a female surgeon, was especially impressive—highly skilled, articulate, and kind. It was also heartwarming to see the same babies I saw in surgery later doing well during the rounds.
Overall, I had the chance to observe a wide range of clinical scenarios and interventions, and I gained valuable insights into congenital heart disease management.

・Reflection on the Clerkship
In each of the three departments, I was lucky to be surrounded by kind doctors who tried to teach me in English, and students who helped me along the way. By proactively following doctors and asking questions, I was able to learn things that I would not have encountered in Japan. I’m deeply grateful to all the doctors, students, and friends who supported me. It was a truly enjoyable and eye-opening experience.

Life Outside the Hospital

Since living in Italy for three months is a rare opportunity, I made the most of it by traveling to other Italian cities and countries in Europe and exploring Italian cuisine to my heart’s content. Bologna is well connected to the airport and central station, making it a great hub for travel. Each place I visited had its own unique charm and rich history, and the memories from these trips are treasures I will cherish forever.
In Bologna, I reunited with Italian students who had studied at my university and friends I met through the GAME-TEI program. We enjoyed home parties, city walks, and aperitivos, allowing me to experience local culture and lifestyle. It truly felt like I became one of the local medical students, even if just for a short while.
Being a fan of Italian cuisine, I was in heaven with pasta, pizza, espresso, tiramisu, and gelato. I tried many different pizzerias recommended by local friends, and each one was delicious. The supermarkets also offered fresh and affordable produce, and with easy access to olive oil and balsamic vinegar, I enjoyed cooking and experiencing the local diet firsthand.

Differences Between Japanese and Italian Healthcare

There were several notable differences between the Japanese and Italian healthcare systems. First, while Italy has a system of "free medical care," it comes with conditions—only treatments and tests related to diagnosed illnesses are free. Routine health checkups are not covered, which contrasts with Japan’s preventive approach. Public hospitals offer free care, but the waiting times can be extremely long. For example, patients with non-life-threatening conditions may wait months for surgery. To receive quicker care, many people choose to pay for private hospitals.
Second, every citizen is assigned a family doctor, whom they choose themselves. They must consult this doctor first before being referred to a larger hospital. Some family doctors even share their contact information so patients can reach them easily.
Regarding clinical settings, one major difference is that patient information is shared across all hospitals in a region via electronic records—an impressive system for patient follow-up. However, despite this, digitalization is still in transition. Doctors often transcribe from paper to electronic records, and physical folders are still widely used.
Another significant difference was the higher ratio of female physicians in Italy, particularly in fields like gastroenterology and cardiac surgery, which are still male dominated in Japan. Seeing many women thrive in these specialties inspired me to aim for the same and made me reflect on what needs to change to create a more inclusive medical environment in Japan.

In Closing

Over these three months, I made unforgettable memories and grew in many ways. One of the biggest areas of growth was learning to take initiative and stay positive in unfamiliar, challenging situations, especially when I couldn’t always communicate in the local language. This experience strengthened my confidence that I can overcome future obstacles by being proactive and adaptable.
I also truly fell in love with Italy. The cultural differences were fascinating, and I gained new perspectives I couldn’t have found elsewhere. My world expanded through connections with medical students from a faraway country, and my motivation for the future grew stronger. For anyone who wants to broaden their horizons in medicine and beyond, I can’t recommend the University of Bologna highly enough. Even if you don’t speak Italian, I guarantee your experience will be amazing—and if you do speak the language, it will be even better.
I’m determined to visit Italy again someday, and I’ll continue studying Italian until then.
Finally, I’d like to express my heartfelt gratitude to everyone who made this incredible experience possible: Dr. Kasuya, Dr. Hasegawa, and the staff of the International Office; Itzel-sensei, who taught us medical English since our first year; the professors, staff, and students at the University of Bologna; my host family, roommates, and most importantly, my parents. Thank you so much!

Introduction

I had the opportunity to study at National Taiwan University (NTU) for two months, during which I rotated through four clinical departments: Gastroenterology, Endocrinology, Family Medicine, and Oncology. I was the only student from Nagoya University to study at NTU this academic year. Naturally, I was filled with anxiety before departure, but I was able to spend a very enjoyable and fulfilling two months.

Hospital and Healthcare System

National Taiwan University was established in 1928, and it was one of the former imperial universities founded during the Japanese era. Similar to Nagoya University, the medical campus is separate from other faculties, and it is conveniently located about a 10-minute walk from Taipei Main Station. The first thing that struck me upon arrival was the scale of the hospital. NTU Hospital has four inpatient buildings—A, B, C, and D—each approximately 17 stories tall. Additionally, there is a separate outpatient building, which is a renovated structure dating back to the Japanese colonial era. There is also an independent pediatric building, and a new facility to house minor specialties is scheduled for completion next year. Although I initially wondered whether such a large hospital was necessary—even for Taiwan’s top institution—I came to understand that the reason lies in the healthcare system. Like Japan, Taiwan has a universal healthcare system, but it does not require patients to pay additional fees for visiting university hospitals directly. As a result, patients can consult top-level hospitals like NTU Hospital at a low cost, even for first visits, leading to high patient volume and the need for large-scale facilities. In addition to the hospital’s size, I was also impressed by its electronic medical record system. Taiwan has fully implemented a national health insurance card system, which allows cloud-based centralized management of personal imaging data. This enables seamless sharing of data between hospitals without the need for manual transfers and greatly streamlines the referral process.

Clinical Rotations

I spent two weeks each in the departments of Gastroenterology, Endocrinology, Family Medicine, and Oncology. In Gastroenterology, I found that their clinical approach closely followed Japanese endoscopic guidelines, giving the impression that it was not significantly different from Japan. The rotation took the form of in-person discussions similar to PBL, where professors discussed with students the cases admitted in the week. I had the valuable experience of observing a liver biopsy, which I had not seen in Japan. In Endocrinology, I attended presentations in the morning, and in the afternoons, I observed thyroid echo. A particularly memorable topic was the presentation on metabolic surgery for diabetes. In Taiwan, this surgery is covered by insurance and is actively recommended for patients with a BMI over 37.5.
Since I did not rotate through Oncology at Nagoya University, I could not directly compare, but I was impressed by how busy the physicians were—each doctor saw about 50 to 60 outpatients every morning. I participated in conferences and observed procedures such as central venous port placement. Chemotherapy was administered both in outpatient and inpatient settings, and clinical trials were actively conducted in collaboration with the adjacent research building. Among the four departments, the most memorable experience was in Family Medicine. This rotation offered a wide variety of learning opportunities, from observing outpatient clinics to accompanying hospice home care visits. The outpatient clinics covered a wide range, including a traveler’s clinic operated in shifts by physicians similar to the CCD system, as well as geriatric care. During the hospice home care visit, I accompanied one doctor and two nurses to the house of a woman in her 90s with end-stage renal disease. The team discussed with the family about preparing for a home death, including the issuance of a terminal illness certificate and future medication adjustments.

Life in Taiwan

Regarding food, I found that Taiwanese cuisine is generally mildly seasoned, which suits my preferences. Meals were also quite affordable, typically about 70% of the cost in Japan. As for the climate, I stayed in February and March, so the weather was somewhat chilly but not cold enough to require coats or knitwear. It was quite comfortable overall. In my free time, I enjoyed sightseeing with friends I had met during a language program in the Philippines, an Australian guy who was also studying abroad, and friends from Japan who came to visit me. The most memorable experience was climbing Mount Yangmingshan with the Australian guy. Although it is only about 1,000 meters high, the steep incline made it a challenging hike. However, the sense of accomplishment upon reaching the summit was incredible and left a lasting impression.

Conclusion

I was fortunate to meet outstanding professors, fellow students, and friends, making this a significant and rewarding experience. I want to express my gratitude to Dr. Kasuya, Dr. Hasegawa, and all the staff members at the International Affairs Office and the Academic Affairs Division, as well as the professors at National Taiwan University, for their invaluable support in making this opportunity possible.

I participated in clinical practices in the Medical University of Gdansk (MUG) in Poland for 11 weeks for the Overseas Clinical Rotation Program. Here, I would like to share what I experienced during my stay in Poland in terms of the medical practices and the cultural differences. First of all, let me introduce a little about the city "Gdansk", where I studied in. “Gdansk” may sound unfamiliar to you, but it is a port town in northern Poland and is actually known as the place where World War II began. It is also famous as a tourist destination in Europe for its beautiful scenery, and it is getting more popular among Asian tourists, especially in China and Korea (although it is still unknown in Japan). I spent almost three months in such a place for practical training at the Gdansk Medical University Hospital.

For the medical practices, I joined the course called "English division", in which all the classes and clinical practices are conducted in English. This course is aimed to produce doctors that will contribute to various fields in English-speaking countries in the future, and the students in this group are from many countries of all over the world, including many Asian countries. Therefore, though I participated in the group as an exchange student from Japan, the doctors considered me as a student of MUG who has studied medicine in English under the European guideline for 5 years. In addition, all the classes and practical training were conducted according to the same schedule and rules of the MUG students. The positive side of this system was that I was able to interact so much with the MUG students and came to become close friends with them, but the downside was that the teachers treated me as local students who studied medicine in English for 5 years in the European guideline, and sometimes were quite demanding to us, the Japanese students, in the classes. However, this tough experience also pushed me to another level of understanding medicine in English and how medicine is considered in the European countries in the end. We rotated in different departments every week, just as the fifth-year students in Japan do, so I was able to experience so much practical training in each field. The classes themselves were also different from those in Japan, with the most impressive being the toxicology and emergency class for me. In those classes, we had to interview and do physical examinations on drug addicts and also patients who had just attempted suicide and then reported to the doctor their medical history and physical examination. After reporting the situation, the doctor would discuss the patient's condition and treatment. As these incidents are considered too sensitive for students in Japan, it was something I could only experience in the overseas program. Another shocking class for me was the endocrinology class, where the doctor brought patients in front of the whole class (about with 40 students). Then, the students started asking questions to guess the patients' disease and treatment. As there were so many students in the classroom, questions were flying all over the classroom. I really appreciate the patients who agreed to go in front of motivated students as a model of a certain disease and to undergo continuous questions, to help us understand their condition and the treatment and management. These were just two examples, but there were other differences in other classes too. All of these experiences were unique to me, and I was able to learn a great deal by participating in them. I strongly recommend Gdansk Medical University, especially for those who want to study many fields in English and want to interact with local students.

Next, I would like to highlight the cultural differences. First, I will mention about religion. Though the young in Poland are said to be getting less religious, still most of the population are Christian. What was surprising to me was that Sunday is considered to be the Sabbath in Christianity, and many stores including supermarkets close on Sunday. When I was not used to this, I often faced hunger on Sunday because I was unbale to get food in the stores. In addition, since I belonged to the English division course which consists of students from various countries with various religions, there were people who could only eat halal food and others who could not eat beef and so on. Although not directly related to religion, there were also many vegans and vegetarians who did not eat any meat products due to environmental awareness. I participated in several food parties with students, and every time someone could not eat one of the dishes due to the reasons mentioned above. I came to realize the diversity and found out that there were less dishes that could be enjoyed universally than I had expected. Another shocking thing was the time of meals. In Poland, there is no such thing as lunch. They have breakfast in the morning, and the next meal is dinner at 3pm, and you can also have supper at night if you want. Since the concept of “lunch” did not exist, the practical classes continued from morning to around 3pm continuously, without lunch breaks. My stomach was rumbling the whole afternoon. I also felt the difference in interest in politics. All the teachers and students had their own opinions about politics and the evidence to support them, and the topics of politics were quite common. This may be because there was an active war close to Poland and the country was facing a complicated time, but anyway their attitude of thinking about their country seriously and expressing their passion for it was touching to me. I felt I should become more responsible for my home country, Japan, which is also facing various problems including the rise in prices despite unchanging salaries or the potential crisis of being involved in global conflict. As you can see from these examples, what I took for granted in Japan was different and diverse in other countries.

It was only three months, but it was an irreplaceable time that changed my life. I cannot thank enough the professors at Nagoya University who prepared for my study abroad, the professors at Gdansk Medical University who accepted me, and the students who became my friends there. Thank you very much.

I had the opportunity to participate in clinical electives at Duke University and Stanford University in the USA for about two months. Both universities are world-renowned for both clinical practice and research, and it was an extremely valuable experience for me to be able to learn in such environments.

Motivation for Studying Abroad

I wanted to gain a clearer vision of the kind of physician I aspire to become by experiencing the world-class clinical and research environments of Duke and Stanford. I aim to become a physician-scientist who can contribute to patient care through both clinical practice and basic science research. I believed that the best way to move closer to this ideal was to learn directly from physicians at the forefront of these fields.
I am particularly interested in the field of neurosurgery, especially in the fields of brain tumors such as glioblastoma. Currently, I am involved in brain tumor research at the Department of Tumor Biology at Nagoya University. Given this background, I have been interested in brain tumor research conducted abroad. At Duke, research into immunotherapy and the tumor microenvironment for brain tumors is particularly active. Stanford also has multiple laboratories pursuing similar research, and many internationally recognized physician-scientists are working in the fields of neuro-oncology and stroke. The opportunity to learn in such an environment was highly attractive and meaningful for my future career.
Previously, I had participated in various international programs, including medical English classes and clinical externships. However, most of these experiences occurred prior to my final year, and mainly involved observation.

This time, as a final-year student, I was granted access to patient records and could participate in clinical practice alongside local medical students. This opportunity held great significance for me, as I wished to test how well my previous learning and experience would translate into the U.S. medical setting.

Clinical Experience at Stanford University

At Stanford, I participated in a clinical elective in the Department of Neuroradiology. I presented cases that I had pre-read in the reading room to residents, followed by case reviews under the supervision of attending physicians. In addition to these sessions, I attended neuroradiology lectures, case conferences, and joint meetings with the neurosurgery department, gaining insights into interdisciplinary diagnostic and therapeutic strategies.
On the last day of the internship, I gave a PowerPoint presentation on a case I was interested in, which gave me an opportunity to organize what I learned. During the rotation, I also observed neurointerventional radiology procedures. In addition, I had the opportunity to observe the surgery of a world-renowned physician-scientist who has advanced stem cell therapy for stroke from basic research to clinical application, while also working as a neurosurgeon, including bypass surgery for moyamoya disease.

One of my main interests before the elective was the use of CT perfusion imaging in acute ischemic stroke, which is not widely implemented in Japan. In contrast, it is actively used in the U.S. to guide treatment decisions. Learning about its benefits, limitations, and real-world implementation directly from experts was highly informative. In particular, it was very meaningful that Stanford was the leading institution of the globally recognized clinical trial “DEFUSE 3 trial.” This study, which was published in the NEJM, demonstrated that mechanical thrombectomy is effective even in acute ischemic stroke patients 6 to 16 hours after onset, by quantitatively evaluating the ischemic core and penumbra using CT perfusion imaging. Some of the attending physicians also introduced real cases in which CT perfusion imaging significantly contributed to diagnosis, which I found very interesting.
I was also fascinated to learn about the “W-EB,” a newer embolization device for treating aneurysms. Since it has only recently been introduced in clinical practice in Japan, it was very insightful to hear directly from physicians who already have lots of experience using it.

Throughout the week, I worked with different attending physicians, each offering unique diagnostic approaches and perspectives. Many of them took time to explain clinical concepts thoroughly, even pulling up past cases to illustrate key points. On the final day, during my case presentation, I had the chance to engage in in-depth discussions and clarify unresolved questions, making it a truly meaningful experience.

Clinical Experience at Duke University

At Duke, I joined the Hematology-Oncology team as a Sub-intern and was able to engage in a highly practical and clinical experience. During weeks 1, 2, and 4, I was assigned to the inpatient hematologic malignancy team, and during week 3, I joined the solid tumor consult service. I managed two assigned patients and performed chart reviews, history-taking, physical examinations, presentations, entering orders, and documentation.
I received sign-outs from the night team each morning and reported key events since the previous day’s rounds. I also proposed daily management plans based on remaining problems, conducted physical exams, and explained the day’s plans to patients. Acting as a full team member in such a setting was very valuable.

Many physicians at Duke are actively involved in clinical trials, and I encountered lots of patients enrolled in clinical trials. During rounds, I received thorough instruction on differential diagnosis and treatment strategy, helping to deepen my clinical reasoning skills. Each morning, our team would round on 8 patients, often taking nearly three hours, an approach that was different from Japanese rounds. On the other hand, lectures were usually brief (about 30 minutes) and focused more on interpreting trial data and evidence evolution rather than traditional pathophysiological explanations, reflecting a different educational style.

A particularly memorable experience was shadowing the Neuro-oncology outpatient clinic. Duke places significant emphasis on research in brain tumors, with about 13 ongoing trials for high-grade glioma alone at the time. Among them were innovative studies on a modified polio virus therapy developed at Duke, and combination trials involving IDH inhibitors and immune checkpoint inhibitors. These settings illustrated the strong collaboration between basic science and clinical care.
I also had the opportunity to sit in on a consultation with a patient who had multifocal recurrent glioblastoma. The neuro-oncologist discussed treatment options with the patient and family, despite the patient not qualifying for certain clinical trials, such as CAR-T (due to lack of target mutations) or the polio virus trial (due to multiple lesion sites). The way the physician communicated these complex decisions was deeply impactful. This encounter made me aware of the current limitations in glioblastoma treatment and the importance of research and clinical trials to provide better treatment options, and it was also an event that made me strongly think that I would like to work for such patients in the future, through research and therapeutic development.

Overall, I learned how U.S. medical students actively participate in team-based care. For assigned patients, students are expected to analyze results and suggest treatment plans, allowing them to apply theoretical knowledge in real-life settings. Many faculty members also balance clinical work with research, some dedicating only a few weeks annually to clinical duties and spending the rest on research, highlighting the diverse ways professionals shape their careers.

Differences in Medical Culture and Education Systems

At Stanford, I was particularly impressed by how actively medical students engage in research. Lectures are primarily offered in an on-demand format, allowing students to view them at home and spend their days conducting research in labs or participating in extracurricular activities. I was truly inspired by how students could shape their learning to match their own goals in such a flexible environment.
In the U.S., experience in basic research is often required before applying to medical school, especially for those aiming to enter academic institutions. Many students begin their research during high school or undergraduate studies. I believe this background contributes to the strong research mindset of medical students in the U.S.

Clinical roles for students are also very different from those in Japan. In the U.S., students are expected to participate at a high level from early on, since they enter residency in their chosen specialty immediately after graduating from medical school. Medical students are typically responsible for one to three patients and are actively involved in daily rounds, presentations, ordering tests and medications, and communicating with patients, roles that closely resemble those of junior residents in Japan.

What impressed me the most was that even as students, we were expected to propose treatment plans, and those suggestions were often discussed and adopted by the team. The culture values input from everyone, including students, and education is highly interactive and participatory rather than one-directional.

Additionally, all departments hold weekly “Grand Rounds,” where leading experts from outside the institution are invited to present cutting-edge research and clinical insights. This system of continuous learning further enhances the professional development of healthcare providers.

Daily Life, Networking, and Memorable Encounters

While at Stanford, I had the chance to meet many Japanese physicians working in the U.S. and learn about their experiences with the healthcare system, career development, and lifestyle. I connected with faculty members and researchers in the neurosurgery field, learning about their individual paths and future aspirations. In addition, a Japanese transplant surgeon kindly allowed me to attend lectures and rounds for the surgery faculty and residents. I also had the opportunity to have dinner with several other people, and I am very grateful for the warm welcome I received.

I also visited Dr. Okada’s lab at UCSF, where research on brain tumor immunology is being conducted. There, I was able to meet Japanese researchers currently studying abroad, alumni from my university’s neurosurgery department, German neurosurgery residents, and U.S. students aspiring to enter medical school, each with diverse backgrounds and goals. I also connected with other medical students, research lab members, and visiting trainees from around the world.

During my stay at Duke, I visited the University of North Carolina (UNC). I was kindly given a tour of the hospital, departments, and simulation center by Dr. Larson, who had visited Nagoya University for a program last summer. I was able to learn about the differences between UNC and Duke, the focus areas of each university, and the working styles of physicians. I also toured the campus with Ray, a UNC student who also came to Nagoya University, as well as with other students. By chance, I also met and spoke with a Japanese medical student at UNC. Furthermore, I had the opportunity to meet Dr. Gordon from Duke, who also visited Nagoya University last summer, and he kindly arranged for me to observe the emergency department on a Sunday.

I stayed with a kind host family, Fred and Jenny, who treated me to dinner and warmly welcomed me into their home. I also had the pleasure of meeting Dr. and Mrs. Hasegawa, who graduated from Nagoya University nearly 20 years ago and had once completed a U.S. clinical elective in their final year, like I was now. I also met Dr. Harada, who graduated from Nagoya University and is also now working in the U.S. At the dinner Dr. Harada hosted, I was able to connect with many Japanese physician-researchers currently conducting basic research at Duke and UNC.

After my rotation at Duke, I attended the American Association of Neurological Surgeons (AANS) Annual Meeting in Boston, the largest neurosurgical conference in the U.S. I had aspired to attend AANS since the application stage of this exchange program, and had submitted an abstract in the fall of the previous year, which was accepted as an e-poster presentation. Fortunately, the conference was held in Boston this year, perfectly after the end of my elective. It was very interesting to listen to lectures by female neurosurgeons whom I admire and who are also active in research, attend sessions that I was interested in, and learn about the latest findings and research in the field of neurosurgery.

While in Boston, I also met Dr. Fuse, a Nagoya University graduate currently pursuing an MPH at Harvard, and through his network, I was also able to meet other Japanese physicians studying public health. I visited David, a neuro-oncologist conducting brain tumor research at Massachusetts General Hospital (MGH), who is originally from the Medical University of Vienna and had studied abroad at Nagoya as a student. I also met a Japanese female neurosurgeon doing research in the same lab. They kindly gave me a tour of their lab and shared insights on building a research career in the U.S.

Looking back, I realize that I was able to meet many faculty members and students connected to Nagoya University during this program. This was made possible by the university’s long-standing international network, and I am deeply grateful. The support and warm welcome I received from so many people made this experience an irreplaceable treasure.

Reflections on These Experiences

This two-month clinical elective in the United States was a very valuable experience that helped shape my future career plans. One of the most memorable moments was from a Duke professor who had long served as an attending physician. He gave me the following words of encouragement:

"Your presentations and treatment plans for your assigned patients have been excellent, which clearly shows you have the ability. I think you can contribute even more by sharing your thoughts during discussions about other patients as well, even when I am talking with the resident about their patients’ cases. Don’t hesitate to suggest plans or differentials. Your input is valuable, and you should be confident in what you bring."

Receiving such words from a respected professor, especially as a medical student, was incredibly uplifting and gave me a great deal of confidence. Being in an environment where students are expected to actively participate in team discussions made me reflect on how I engage in clinical settings. Being asked for my opinion and contributing meaningfully to the team helped me understand the importance of speaking up with confidence and being proactive in clinical care.

Furthermore, meeting so many physician-scientists who balance clinical practice with basic research left a lasting impression on me. In the U.S., after graduating from medical school, physicians typically go through residency and fellowship training before becoming assistant professors, with opportunities to advance to associate and full professor roles. I learned that in some cases, motivated individuals even establish their own labs immediately after completing the fellowship.

I hope to become a physician-scientist who can contribute through both clinical practice and research. This elective gave me the opportunity to speak directly with those people and young professionals who are already on that path. Meeting them clarified my own vision for the future and planted a strong desire to one day follow in their footsteps. That aspiration, more than anything, is the most meaningful takeaway from my time abroad.

Closing

This exchange experience allowed me to see the differences in healthcare systems, education, and culture between Japan and the U.S., and led to many enriching encounters with wonderful people. Through it all, my vision of the kind of physician I want to become has become clearer, and my commitment to contributing to society through both clinical care and research has grown even stronger.

Finally, I would like to express my sincere gratitude to everyone who supported this invaluable opportunity.
First and foremost, thank you to Prof. Kasuya and Mr. Hasegawa, as well as the entire staff of the International Exchange Office, for their great support. I also thank Prof.Itzel for the dedicated education in medical English from my early years, and the teachers involved in the pre-departure training. I would also like to extend my sincere appreciation to the Keiichi Shibahara Foundation for providing generous financial support for this program.
Moreover, I am deeply grateful to the international offices at both Duke and Stanford for welcoming me into their programs, the doctors who guided me throughout the electives, my host family Jenny and Fred for their warm hospitality, and all the physicians, researchers, and students who kindly took time to meet with me during my stay.
This experience would not have been possible without the efforts of all those who have supported Nagoya University’s international partnerships over the years. I would like to take this opportunity to express my deepest gratitude. Thank you very much.

In the spring of 2025, I participated in a two-month clinical elective program at Lund University in Sweden. I had the opportunity to rotate through the Intensive Care Unit (ICU), Anesthesiology, and the Emergency Department. This experience provided not only clinical learning but also valuable exposure to a different healthcare system and culture.

During the first month, I spent two weeks each in the ICU and anesthesiology. In the ICU, I followed an attending physician and observed the care of critically ill patients. Although I did not perform examinations myself, seeing the same patients daily allowed me to understand better how clinicians manage sedation, respiratory support, and nutrition. In anesthesiology, I rotated through both orthopedic and general surgery teams. I observed the induction and maintenance of anesthesia, postoperative pain control, and regional anesthesia techniques. The staff were approachable and open to questions, and I learned a great deal not only about anesthesia but also about Swedish medical training and work-life balance. In the final week, I also reviewed some of my supervisor’s research on post-cardiac arrest brain injury and discussed it with the team, which deepened my understanding of critical care medicine.

In the second month, I joined the Emergency Department, which was divided into four teams: orthopedic, surgical, and two internal medicine units. I shadowed physicians during the first week and then gradually took on more responsibility. From the second week, I was allowed to interview and examine patients independently before presenting them to a physician. I managed two to three patients per day and saw roughly 50 cases over the month. With initiative, I was also given opportunities to assist with procedures like suturing and to explain test results directly to patients. The experience significantly boosted my confidence in applying clinical skills in English.

One of the most memorable aspects of my time in Sweden was the Fika culture—daily coffee breaks shared by staff and students. While it might seem like a simple break, Fika played a key role in team communication. It offered a relaxed atmosphere where it was easier to ask questions, exchange ideas, and build relationships. I believe this culture contributed to the respectful and cooperative working environment I observed throughout the hospital.

There were also notable differences in healthcare delivery. For example, nurse anesthetists in Sweden carry out procedures such as intubation and anesthesia maintenance—tasks often performed by physicians in Japan. Doctors supervise multiple operating rooms and focus more on planning and responding to emergencies. The division of responsibilities between staff was clearly defined and supported by mutual trust.

Outside of the hospital, my life in Lund was comfortable and safe. While the cost of living was high, I saved money by cooking most of my meals. I also joined a student-run surgical workshop where we practiced basic techniques like knot-tying and suturing. I was impressed by the enthusiasm of junior medical students and inspired to consider organizing similar student-led sessions at Nagoya University.

Cultural exchange was another highlight. I visited the home of a Swedish student where we made cinnamon rolls and Japanese okonomiyaki together. Sharing food and traditions allowed us to learn more about each other’s backgrounds. I also met two Japanese doctors pursuing their PhDs at Lund. They generously shared their experiences and even invited me to their home and research lab, which gave me a more concrete picture of international research opportunities.

This elective program broadened my perspective on both medicine and life. It challenged me to communicate in English in clinical settings and adapt to a different cultural environment. I gained not only medical knowledge but also greater independence, cultural understanding, and motivation for future international study. I am deeply grateful for this opportunity.

This spring, I had an opportunity to study abroad for six weeks at Ludwig Maximilian University of Munich (LMU) in Germany. During the first four weeks, I participated in the Neurology Winter School, and in the last two weeks, I joined an additional clinical rotation in the Department of Neurology. It was a valuable six-week program that allowed me to focus on neurology.
It was my first time studying abroad, and I was very nervous at first. I was worried whether I could communicate well enough in English and whether I could adapt to life in a foreign country. However, looking back now, I can say that I had an amazing and fulfilling time, thanks to the support of many people—doctors, my family, friends, and new colleagues I met in Germany. In this report, I would like to reflect on this unforgettable experience in three parts: the Winter School, the additional clinical rotation, and my daily life in Munich.

About the Winter School

The Winter School is a short-term program where international medical students are paired with students from LMU. Together, they participate in ward training and small-group lectures at the LMU University Hospital, Großhadern. I joined the Neurology Winter School with other four international students and five German students.
In the mornings, I was assigned to the neurology ward, where patients were admitted for short stays to determine their treatment plans. There, I had the opportunity to take neurological examinations and perform procedures such as venipuncture and IV-line placement. My buddy, Luisa, supported me in many ways—translating patient’s words from German to English, and teaching me some clinical skills. In addition, the PJ students (6th-year German medical students) were very kind and often helped with translation and procedures. Thanks to their support, I was able to fully engage in the clinical training. One thing that struck me was how much more responsibility German medical students had compared to Japanese students. They wrote referral letters for patients and documented doctor’s findings during ward rounds—tasks typically reserved for junior residents in Japan. It made me realize the significant gap in clinical experience between us, and I was quite shocked. Through this rotation, I was also able to see many cases that I had never experienced in Japan, such as progressive multifocal leukoencephalopathy (PML) associated with immunosuppression after kidney transplantation, HIV-related toxoplasma encephalitis, and primary CNS lymphoma. These rare and complex cases deepened my interest in neurology even further.
Lunch breaks were well-respected, and we always had a full hour to rest. Luisa told me, “Breaks are part of the job, and skipping them is foolish.” The cafeteria in Großhadern was large and offered Bavarian meals, including crispy roasted pork. It was my dairy pleasure to have lunch there.
In the afternoons, we had lectures from specialists in various neurological fields such as dizziness, brain tumors, movement disorders, and epilepsy. I learned many fascinating facts—for example, that epilepsy can have aura symptoms; vertical nystagmus strongly suggests a central lesion; and that deep brain stimulation (DBS) does not stimulate but rather suppresses the targeted area. The program was well-organized and offered a comprehensive view of neurology, which I found extremely valuable. Another thing that inspired me was my fellow Winter School participants. They were highly motivated and demonstrated a deep understanding of neurological diseases. They actively asked questions and engaged in discussions during lectures. Unlike in Japan, where questions are usually asked only at the end of a lecture, the questions were welcome anytime and interactive discussions were encouraged there. That open learning environment was one of the most appealing aspects of the program.
Besides the medical curriculum, the Winter School also offered many opportunities for cultural exchange. We had a group excursion to a nearby town, where I talked about different cultures and learned how people from other countries perceive Japan. Above all, helping each other with peers from diverse backgrounds through the program was an invaluable experience that broadened my perspective.

Additional Clinical Rotation

During the final two weeks of my stay, I participated in an additional rotation, primarily observing outpatient clinics in the Department of Neurology. At the initial orientation, Professor Dimitriadis told me I would be joining the "stroke ambulance" and "dementia ambulance." At first, I was confused—was I going to observe ambulances? What is an emergency in dementia? But I soon learned that in German, Ambulanz refers to outpatient departments, not emergency vehicles. So, I observed follow-up consultations in the stroke outpatient clinic and also spent time in a dementia specialty clinic.
In these clinics, doctors kindly explained the key points of each patient and allowed me to perform parts of the neurological examination. I was especially impressed by how cooperative and welcoming the patients were, even toward a foreign medical student like me.
This two-week rotation was enriching in a different way compared to the Winter School. While the best program was provided in the Winter School, which was well-scheduled, this additional rotation allowed much more autonomy. I was free to stay in the outpatient clinic, join the inpatient ward, observe tests such as EEG and EMG, or visit specialized units like the epilepsy or stroke unit. I was able to visit different areas and learn directly from the medical staff and technicians working there. Visiting the epilepsy unit, which I had not seen much of during the Winter School, left a strong impression on me. It not only helped me overcome my uncertainty about epilepsy, but also sparked a strong interest in the field.

Life in Munich

One thing I constantly felt during my stay in Munich was that I was always facing some kind of unexpected challenge. Whether it was buses departing earlier than scheduled, an Airbnb host who spoke only Arabic, or a washing machine that kept running for more than three hours—there were all kinds of issues that I had never encountered in Japan. At first, I felt overwhelmed and confused, but gradually, I came to accept that such troubles are a natural part of life abroad. Once I dicarded the expectation that everything would go smoothly, I began to enjoy even the unexpected aspects of daily life.
Some of the things I loved most about life in Munich were the beer, pretzels, and lakes. Since Germany is known for its beer, even the ones sold at supermarkets were both cheap and delicious. I didn’t enjoy pretzels very much at first ; I thought they were too hard and salty. But by the end of my stay, I found myself buying and eating them almost every day. I realized that local foods loved by the people usually have their own charm and value. Surprisingly, even though I stayed for six weeks, I hardly missed Japanese food. Instead, I grew fond of local food like bread, potatoes, and pork dishes. The lakes I visited—such as Lake Starnberg and Lake Tegernsee—were about an hour away from the city by train. It amazed me how just a short distance from the urban center, you could find such peaceful, natural environments. Professor Remi had recommended Lake Starnberg to me in a hospital hallway, saying, “You didn’t come to Munich just to stay in the hospital. You must also visit the lakes, mountains, and rivers.” When I visited, I saw swans calmly swimming on the water, and people relaxing after work by the shore. It became clear to me that for the people of Munich, having easy access to nature is a source of peaceful mind.

What I learned through this study abroad experience is that “being silent” and “smiling” is not necessarily seen as a virtue in international settings. Early in my stay, I heard someone say that Japanese people are known for the Three S : Silent, Smiling, and Sleeping. I clearly remember thinking, “That’s me,who am trying to cover up my poor listening comprehension with a polite smile.” In some situations, silence or smiling may be perceived as polite or charming. However, if you want to learn something or andapt to the environment, you need to be more assertive and honest. I used to believe that staying silent was neutral, while saying something incorrect was a minus. But I now understand it differently: silence can be seen as a lack of interest and may even be a minus, while speaking up—regardless of whether it’s perfect—can be a strong positive. I also realized that when I didn’t understand something in English, smiling and pretending didn’t help me grow. What really mattered was the courage to say, “Sorry?” and ask again. From now on, I want to remember that being “silent” and “smiling” might actually take away my chances to grow—and I hope to always hold on to the proactive and brave version of myself that I discovered during this time abroad.

Lastly, I would like to express my heartfelt gratitude to all those who made this invaluable experience possible. I am especially thankful to Professor Kasuya and Dr. Hasegawa, as well as everyone at the International Affairs Office, for their generous support and guidance. I also want to thank Ms. Itzel, whose medical English classes helped me develop the language skills necessary for this experience. I am deeply grateful to Professor Dimitriadis and all the faculty members at LMU who designed such an excellent program and kindly accepted me for an additional clinical rotation. Thanks to all of you, this study abroad experience has become a lifelong treasure for me. Thank you very much from the bottom of my heart.

From March to May 2025, I had the incredible opportunity to take part in a clinical elective in the UK. I spent four weeks in breast surgery at Newcastle University, followed by another four weeks in emergency medicine at the University of Edinburgh. I also had a chance to briefly visit a general practice (GP) clinic in Glasgow. Throughout the two months, I was able to experience a completely different healthcare system and see how doctors, healthcare workers, and patients interact in the UK.

Newcastle University

Newcastle, located in the north of England, is a lively city where industry and academia blend together. In March, there were still some snowy days and the cold winter air lingered. I joined the breast surgery team at the Royal Victoria Infirmary (RVI) for a four-week placement.

In Japan, breast surgeons often manage everything—from diagnosis and surgery to medication and even palliative care. But in the UK, breast care is managed by a well-organized team. Breast surgeons, radiologists, oncologists, pathologists, and GPs all have clearly defined roles, working together to provide specialized care.

One of the most impressive things I saw was how efficient and well-structured the operating theatres were. Patients were put under general anesthesia in the anesthetic room, brought into the theatre for surgery, and then transferred to recovery as soon as the operation ended. The next patient, already asleep, would then be brought in straight away. This smooth process allowed up to five surgeries to be done in a single theatre in one day. Many patients even went home the same day with drains still in place.

I also noticed how common it was for patients to request aesthetic procedures alongside their cancer treatment, like breast reduction on the healthy side or immediate reconstruction. It was eye-opening to see how much emphasis was placed on patients' quality of life.

The team was very welcoming to visiting students. I had hands-on experience with tasks like suturing, drain removal, and even history taking. As someone who hopes to specialize in breast surgery in the future, being part of this multidisciplinary and highly professional team was truly inspiring.

University of Edinburgh

Next, I headed to Edinburgh—a beautiful, historic city often associated with Harry Potter. The rainy and calm atmosphere added to its charm. I was based in the walk-in emergency department at Western General Hospital.

Under the NHS system, emergency departments aim to make a decision—admission or discharge—within four hours of a patient’s arrival. This meant the doctors were always on the move. Still, they took the time to teach me, offering opportunities to take histories, interpret imaging and lab results, and discuss patient management with me. I was touched by their kindness and commitment to teaching.

I also reached out to the breast surgery department nearby and was fortunate to be allowed to observe their work. I'm very grateful to the doctors and nurses who welcomed me. I was able to see many reconstruction surgeries such as fat grafting and immediate reconstruction—procedures I had rarely seen in Japan. It was a rare and valuable learning experience.

General Practice in Glasgow

I also visited a GP clinic in Glasgow, run by Dr. Logan, who has close ties with Nagoya University. In his clinic, I observed care for a wide range of conditions—from children's colds to post-hospital follow-ups. It was fascinating to see how strong doctor-patient relationships are at the community level. The experience helped me appreciate the importance of holistic and personalized care.

Learning from the NHS and UK Work Culture

In the UK, healthcare is funded by taxes and managed by the NHS to ensure everyone receives the same level of care. GPs act as gatekeepers to specialist services, and a referral letter is needed to access hospitals. At first, this system might seem restrictive, but it actually allows for smart resource management. For example, patients diagnosed with cancer are guaranteed to be seen within 35 days.

Another thing that stood out was the use of technology. Patients can access their electronic medical records through the NHS app, and information is shared between hospitals even without a referral letter.

Work-life balance among doctors also left a strong impression on me. Most doctors started their day around 8 a.m. and finished by 5 p.m. It was common to see them taking week-long holidays too. The culture of respecting personal time while working efficiently made me reflect on how Japan might improve its own medical working environment, especially as our population ages.

Since entering medical school, it had been one of my goals to participate in a clinical placement abroad. I’m so happy that I was able to achieve it. The lessons I learned and the perspectives I gained during this elective will surely guide me as I move forward in my medical career.

I am deeply thankful to everyone who made this opportunity possible, and I will continue working hard to become a doctor who provides thoughtful, high-quality care—both in Japan and beyond.

I finished a three-month clinical rotation at St. Olavs Hospital in Trondheim, Norway. In this report, I summarize my experiences from three perspectives: the Norwegian healthcare system, my clinical rotations, and daily life.

Norwegian Healthcare System

I observed two major differences compared to Japan. First, Norway has an efficient healthcare system. In Norway, just five million people live across a land area roughly the same size as Japan. A GP system is in place, and there are only four university hospitals. St. Olavs Hospital—where I completed my clinical rotation—is one of them. The flagship institution among these four is Oslo University Hospital in the capital. Whenever a patient requires advanced care, the government arranges an aircraft to transport them to Oslo. Since patient records are integrated nationwide, notes and test results from other hospitals can be accessed immediately. Using these approaches, Norwegian healthcare system is operated efficiently.
Second, there is no hierarchy in the hospital. During my rotation, I rarely encountered barriers related to gender, age, job, or nationality. Both men and women take parental leave and it is standard to finish work by 16:00. Many doctors are free to choose their specialty or hospital. The doctor–patient relationship is also flat. I observed doctors and patients directly expressing their requests and opinions to one another.

Clinical Rotations

I rotated neurology, pediatrics, and thoracic surgery. Below are highlights from each department.

Neurology (February)
At first, I wasn’t assigned to any group, so I had to approach the doctors myself, which was a bit stressful. However, as I got close to some doctors, I gained hands-on opportunities, like neurological exams, injections, and even lumbar punctures. There are two things that I found interesting. First, the number of Multiple Sclerosis patients is large. I encountered MS patients every day and I learned its typical symptoms and treatments. Second, there were diverse migraine treatments. With one in four Norwegians affected by migraine, extensive research has produced some new therapies. I witnessed dramatic improvements after treatments such as Botox and local anesthetic injections, which I had never seen in Japan

Pediatrics (March)
In pediatrics, I rotated oncology, general medicine, NICU, and emergency. While observation was the main focus, I performed newborn examinations and took histories in English for families from UK. The most impressing feature was the comprehensive support for children and families. All patient rooms were private, equipped with a bed for parents and either a PS5 or Nintendo Switch for entertainment. The rooms in NICU consisted of two area: one area for the newborn and mother, and another for the father, with toilet and shower. Children were encouraged to practice injections or examinations on a mascot named “Gusse,” helping to ease their fear of medical procedures. I found the concept of warmly supporting each child through collaboration between family and staff truly inspiring.

Thoracic Surgery (April)
Because students are not permitted in the sterile field, What I did was observing surgeries. The most interesting thing was the surgeons’ working style. Unlike in Japan, thoracic surgeons perform both cardiac and pulmonary operations; thus, they use minimally necessary interventions such as on-pump CABG. Except for emergencies, surgeries are scheduled only from Monday toThursday and planned to finish by 16:00, allowing every surgeon to leave on time. I was struck by how they maintain work–life balance.

Daily Life

I lived in a dormitory with two students from diverse backgrounds. Talking with them broadened my perspectives on cultural difference. In my free time, I hung out with some Norwegian students who came to Nagoya last year. We experienced Norwegian home cooking and Easter traditions. On weekends, I traveled around Europe with classmates. Speaking Japanese with them during trips helped me refresh.

Conclusion

During my stay, I gained fresh insights that have allowed me to reflect critically on my future career as a physician in Japan. I extend my deepest gratitude to the International Affairs Office and everyone at St. Olavs Hospital who made this program possible.

I spent three months in Gdansk, Poland, one of the most underrated cities in Europe. I joined the English Division class of Gdansk Medical University (GUMed), a modern academic center recognized in the country and in the world.

Practical training

I took part in seminars and practical trainings of English Division alongside students with diverse cultural backgrounds. I selected courses of OBGYN, neurosurgery, transplantology, emergency medicine, gastroenterology, nephrology, and general surgery. Lessons were all conducted in English, so I was able to take part just like other students and had a lot of opportunities to speak up in class. Some patients were fluent in English, which allowed me to take their history and perform physical exams.

What left the strongest impression was the difference between medical education in Japan and Europe. For example, European medical students are expected to memorize not just types of medication and their administration, but also specific dosages and brand names. Also, graduating on time is challenging: they say, on average, it takes about eight years to complete medical school. Furthermore, since it requires excellent GPAs and paper publications to get in competitive departments, many students work really hard in both their coursework and extracurricular activities.

Living

Thankfully, GUMed offerd us free accommodation with a shared kitchen, shower, and bathroom. There were woods right next to the dormitory, so I came across wild animals like boars a couple of times, which was something I had never experienced before. Eating out in Poland was more expensive than in Japan, so I usually cooked for myself. Polish was nothing like English, and it was hard to guess the meaning, so grocery shopping often took me a bit of extra time. Despite the inconveniences, I always enjoyed this experience of living in a different culture.

People

One of the main reasons I applied to GUMed was the great opportunity to interact with fellow students. We studied in groups, and some of them lived in the dormitory as I did, so it didn’t take long for us to become friends. As I mentioned above, they came from a wide range of countries: not only from all over Europe but also from India, Nigeria, Iran, Laos, and many others. We hung out a lot outside of the class-exploring the city, cooking together, or having dinner while traveling. On the day we said goodbye, we all felt very sad that our time together was about to end, but we were also truly grateful to have met each other here in Poland. I am confident that no matter how many years may pass before we meet again, things will be just the same between us.

In conclusion

I had hoped to participate in this program since my first year of university, and I’ve worked constantly to improve both my practical and medical English skills. The experience I had in Gdansk lived up to my expectation, providing me with not only educational opportunities but also challenges and unpredictable situations that helped me mature. I believe these lessons will stay with me and shape the way I work in the future.

I would like to express my gratitude to Professor Kasuya, Professor Hasegawa, Dr.Itzel, and everyone in the Office of International Affairs, as well as all those who supported me during my time in Gdansk.

Introduction

I participated in a four-week clinical clerkship program at Korea University in South Korea, where I was assigned to the Department of Neurology and the Department of Breast and Endocrine Surgery. Prior to the trip, I had concerns about language barriers and cultural differences, but through this experience, I was able to gain valuable insights and learning opportunities. I would like to share the details of this training below.

Hospital and Living Environment

Korea University, one of South Korea’s most prestigious institutions, is located in Seoul, the nation’s capital. Life in Seoul was very convenient, thanks to the highly developed public transportation system, which made commuting to the hospital and traveling within the city smooth and easy. The vibrant dining culture also allowed me to enjoy a wide variety of Korean cuisine.

As I was unable to stay in the university dormitory, I rented an apartment a bit away from the campus. However, there were large supermarkets and convenience stores nearby, so I experienced no difficulties in daily life.
In terms of language, I had studied basic Korean vocabulary prior to my arrival, but I did not have the opportunity to directly communicate with patients during the training. Most of the communication with doctors and students was conducted in English.

Clinical clerkship

In the Department of Neurology, I focused primarily on learning about conditions such as stroke and dementia. The training included not only lectures and ward rounds led by attending physicians but also student-led discussions and presentations, fostering an interactive and engaging learning environment. Activities included watching a film on dementia, followed by a group discussion, as well as attending lectures on interventional treatment for cerebral infarction. These experiences deepened my understanding of the differences between Japanese and Korean medical practices, as well as the social contexts surrounding healthcare in each country.

In the Department of Breast and Endocrine Surgery, I primarily observed various surgical procedures, attended outpatient clinics, and participated in clinical conferences. I had the opportunity to observe a wide range of surgeries, including total and partial mastectomies for breast cancer, open surgeries for thyroid tumors, and robot-assisted operations. Moreover, during conferences and informal gatherings such as dinners with attending physicians, I was able to exchange opinions regarding differences in healthcare and medical training systems between Korea and Japan, which made the experience especially meaningful.

Extracurricular Activities and Cultural Exchange

During the training, I also engaged in cultural exchange by joining local medical students for lunch and participating in a university tennis club. Although I was not fluent in Korean, many of the Korean students were comfortable communicating in English and offered support, which made it easy to build connections and enjoy the experience.

Conclusion

Through this clinical training at Korea University, I gained not only medical knowledge and practical skills but also a deeper appreciation for cross-cultural understanding and the importance of international communication. Though the duration was short, the experience of learning medicine abroad significantly broadened my horizons.
I would like to express my sincere gratitude to all the faculty and staff at both Nagoya University and Korea University for making this valuable opportunity possible. I am committed to applying what I have learned from this experience as I strive to grow into a physician with an international perspective.

Preparation for the Trip

I studied abroad at Korea University. After I was accepted to study at Korea University, I continued to study English, focusing on English conversation. After it was decided that I could practice in the departments of orthopedics and emergency medicine, I also worked hard to study medicine in English and Japanese, focusing on those fields. I had heard from a senior student who had studied at Korea University that there was no problem with practicing in Korea even if I could not speak Korean, so I did not study Korean.
In terms of practical matters, I did not receive a reply to my e-mail two months before my departure, and I could not confirm whether I would be able to do the internship until one month before my departure, so I had to make flight and lodging reservations and complete insurance procedures at the last one month, which was difficult.

Practical Training

During my clinical training in orthopedics, I mainly observed operations. On the first day, two orthopedic surgeons from Japan happened to be there to observe, and I was supplemented not only by the Korea University professors but also by them, which was a great learning experience. As for the differences between Japanese and Korean surgeries, the Japanese doctors told me that the awareness of cleanliness is somewhat lower than in Japan, but the time required for each operation is very short, and they perform 5 or 6 operations in one day, which is unimaginable in Japan. However, it was very cold in the operating room, and I caught a cold and had to miss the next day's operation.
The clinical training in the Department of Emergency Medicine allowed me to see the current state of emergency medicine in Korea. Emergency medicine in Korea seemed to be particularly affected by the current absence of residents from hospitals due to strikes. Although Korea University Hospital has three rooms with about 15 beds each according to triage color, due to staff shortages, only one room was being used, and patients were being gathered in that room regardless of triage color. The doctors also told me that they only accept seriously ill patients. In addition, in Korea, ambulances are charged for minor illnesses to avoid unnecessary use of ambulances, and I felt that a similar system should be introduced in Japan.

[Leisure, Life]

On my day off, I went sightseeing at Seoul Tower and Panmunjom. At Panmunjom, I was able to see North Korea directly and learn about the history of conflict and dialogue with North Korea, which was very interesting.
All the Korean food was very tasty, and I had no trouble eating.

I was able to do a clinical internship at the Medical University of Vienna and Allgemeines Krankenhaus (AKH) for 10 weeks from February to April 2025. When I arrived in Vienna, I was struck by the city’s historical beauty, which made me feel very excited. However, at the same time, I also felt anxious about the cultural differences. My internship began with both high expectations and a sense of uncertainty, but over the course of the 10 weeks, it became an invaluable and unforgettable experience. Here, I would like to share some of my experiences during the internship and my life in Vienna.

Clinical Internship at the Medical University of Vienna

During my 10-week internship at the AKH, I rotated through four departments; cardiac surgery, thoracic surgery, radiology, and neurology. However, I would like to focus on the two most memorable departments—cardiac surgery and thoracic surgery.

A day in cardiac surgery started with a conference at 7:30 AM and after that, each doctor started their operations. Many cases were operated every day, using about five operating rooms. The annual number of cases at the hospital is about 1,200–1,300, and I had the chance to see a wide range of procedures, from basic valve replacements or artificial vascular replacements to more advanced surgeries like the Ross procedure. The Ross procedure is a highly complex and difficult surgery, which is performed by only a few doctors in Japan, so this was an incredibly valuable experience for me. Pediatric cardiac surgery is also actively performed every day, and through observing these surgeries, I was able to get interest in congenital heart diseases. I hadn't realized how fascinating congenital heart surgery is, so this was a life-changing experience.

The department of thoracic surgery was also very active, as the department of cardiac surgery, with two operating rooms in use and approximately 4 to 6 surgeries performed each day. In addition to standard cancer operation, like lobectomy for lung cancer, I was able to see more complex resections and tracheal resections, which are not commonly performed in Japan. One of the impressive features in this department was the number of doctors who came from other countries to learn more advanced knowledge and skills. There were always nearly 10 international fellows, and throughout my internship, I asked many questions to them or received lectures about lung surgeries. They always kindly taught me many things, and their guidance was very helpful for me. When we had a time, we also talked many things about not only the thoracic surgery but also our countries or our daily life. We sometimes went for lunch or dinner, and this was one of the best memories in Vienna.
Lung transplantation was a major feature of this department, and one of the main reasons I chose to come to Vienna was to get the opportunity to observe these procedures. The department of thoracic surgery at the Medical University of Vienna is a very famous lung transplant center in the world, performing approximately 120 lung transplantations annually. Donor lungs were collected from many countries, not only Austria but across Europe, using jets or ambulance cars, and lung transplantations were performed nearly every three days. During my internship, I had the opportunity to join ex-plantation and observe several transplant surgeries. In one case, I was even allowed to scrub in and assist during the operation. The procedure was long and demanding, but participating in it was a deeply inspiring experience.

After the Internship

Through this internship, I was able to realize how sophisticated Japanese medical education and training system is. At the Medical University of Vienna, there were many medical staff, students, and fellows from different countries, so unless I did anything like asking questions, no one realized I was there. As a result, I started to greet doctors and staff in the operating rooms, negotiate to participate in surgeries, and always ask questions by myself. This active approach led to even more chances for hands-on experiences and advanced learning. This experience showed me how important it is to actively pursue the chance for learning by myself, even faced with language barriers.

Thanks to the generous support of the professors at AKH, local students, and fellows, I was able to overcome the language barrier and have a truly fulfilling clinical training experience. I will treasure the time I spent in Vienna as a valuable foundation for my future career—not only as a surgeon involved in transplantation but also as a doctor who can contribute on a global scale. I would like to express my deepest gratitude to Professor Kasuya and Dr. Hasegawa from the International Collaboration Office of Nagoya University School of Medicine, as well as to the faculty members at the Medical University of Vienna and everyone who made this opportunity possible.

University of Glasgow

Study Abroad Experience at the University of Glasgow – February 2025

Clinical Training

In February 2025, I participated in a one-month clinical elective at the University of Glasgow, where I trained in orthopedic surgery at Glasgow Royal Infirmary. My supervising consultant specialized in foot and ankle surgery, so I primarily observed and assisted in surgeries in that area. Each day begins at 8 a.m. with a team meeting to review the surgical schedule and discuss cases. After that, I joined surgeries such as hemi hip replacements and ankle fixations, typically assisting in about three procedures per day. We usually finish around 5 p.m.
My supervisor was originally from Jordan. Although English was his second language, he spoke it fluently and clearly, which motivated me to improve my own skills. He allowed me to scrub into surgeries daily and kindly explained each step, which was extremely educational. One of the biggest advantages of studying in an English-speaking country is that all communication is conducted in English, creating an immersive environment that helped me improve my language ability naturally.
The UK’s healthcare system differs significantly from Japan’s. Most citizens use the NHS (National Health Service), where they first consult a GP (General Practitioner) before being referred to specialists. While NHS services are free at the point of care, long waiting times are a known issue, which can delay access to necessary treatments. Many patients I saw presented with more advanced disease than I would typically see in Japan. Since the NHS is publicly funded through taxation, my supervisor often tried to use less expensive surgical implants, which made a strong impression on me.
Between surgeries, I spent time in the staff room where I had the opportunity to discuss international healthcare systems, working conditions, and physician salaries. My supervisor explained that although doctors in Jordan are relatively well-paid compared to other professions, they earn less than doctors in the UK. However, working as a foreign doctor in the UK comes with its own set of challenges due to strict regulations. Learning about medicine from the perspective of an international physician was incredibly insightful.

Daily Life

Since I’m sensitive to the cold and February in Glasgow is especially chilly, I wore multiple layers, including Uniqlo’s “Ultra Warm” Heattech, a lightweight down jacket, and a heavier down coat. I stayed warm and comfortable throughout my stay.
I rented an Airbnb about a 15-minute walk from the hospital. To keep costs down, I opted for a shared accommodation style with a host and other guests. This turned out to be a great experience—I enjoyed watching football over pizza and sharing meals from different countries. Most essential household items were already available, making it easy to settle in without needing to go shopping immediately. I found that this living arrangement aligned well with my desire to engage with locals and immerse myself in the culture.
Since eating out in the UK is expensive, I usually bought groceries at Lidl and cooked for myself. The hospital didn’t have a cafeteria, so most staff members, like me, brought packed lunches from home.
On the day I arrived in Glasgow, a medical student from the University of Glasgow who had previously studied at Nagoya University kindly invited me to dinner at an Italian restaurant. We met a few more times afterward, and I found it meaningful to exchange perspectives with a fellow medical student from another country.
Dr. Alec Logan, a GP, also took me to various cultural events. The day after my arrival, he invited me to a Celtic FC match where I had the chance to see Japanese national players Daizen Maeda and Reo Hatate up close and experience the lively atmosphere of local football. The stadium was small, bringing the pitch closer and making the experience incredibly immersive. I also attended films and opera performances with Dr. Logan, which helped me appreciate cultural differences more deeply. Additionally, I observed outpatient care at his clinic and learned a lot about the UK’s GP system.
These experiences were incredibly enriching, and I’m deeply grateful for opportunities I could never have arranged on my own.

Final Thoughts

Although I initially applied for this clinical exchange out of curiosity, it quickly turned into a demanding yet rewarding journey. From writing application documents to securing accommodation and preparing supplies, the process required significant time, effort, and financial resources. However, I firmly believe the experience was worth it.
The lessons and encounters I gained through this program are truly irreplaceable, and I feel I’ve grown personally and professionally. I would like to express my heartfelt gratitude to the International Affairs Office and everyone who supported me throughout this journey.

Seoul National University College of Medicine

I studied abroad at Seoul National University College of Medicine for five weeks from March to April 2025.

Transplant Vascular Surgery

The internship was conducted at Seoul National University Hospital. For the first three weeks, I rotated through the Transplant Vascular Surgery Department, and for the final two weeks, I rotated through the Plastic Surgery Department. During the Transplant Vascular Surgery internship, on Mondays and Tuesdays, we performed arteriovenous fistula surgeries for dialysis, and on the remaining days, we observed surgeries such as kidney transplants and varicose vein procedures. Some instructors even allowed us to enter the surgical field. While I had previously observed liver transplant surgeries at Nagoya University Hospital, this was my first opportunity to observe a kidney transplant, making it a valuable experience. While staff conversations were mainly in Korean, both doctors and nurses could speak English, so communication was not an issue. At Seoul National University Hospital, two surgical nurses assisted during surgeries, performing sutures and other procedures. In Japan, it is common for doctors to perform such procedures, so this was an unfamiliar sight. However, the professors explained that this was due to strikes over the increase in medical school enrollment quotas in South Korea. As a result, there was a shortage of working doctors, so the number of surgical nurses was increased as a substitute. When I visited, I was surprised to hear that there were no residents and that professors were on duty. Compared to Japan, the surgery time was shorter, and I felt that Japan might be more meticulous. Other Japanese exchange students mentioned the same thing, so I think that overall, surgeries in Japan take longer.

Plastic Surgery

The head of the plastic surgery department is Professor Chang, who graduated from Keio University School of Medicine and could converse in Japanese, which was very helpful. I had the opportunity to observe surgeries such as breast reconstruction, polydactyly in children, and cleft palate repairs. Since he is a graduate of a Japanese medical school, he was accustomed to the style of asking questions like a medical student during a clinical rotation. When I asked questions, he kindly explained various things, which was very educational. As an international student, there are kind professors who will teach you even if you are passive, but I think the most important thing is to actively ask questions, show your enthusiasm, and make an effort to communicate. During the last week, medical students from Seoul National University returned to their internships, and I had the opportunity to talk with them briefly. From what I heard, they had been advancing in their studies even while they were away from their internships, and their future internship and study plans seemed quite challenging.

Life in South Korea

I was unable to use the dormitory at Seoul National University, so I secured accommodation through Airbnb, located a five-minute walk from the medical school campus. The nearest station is Hapjeong Station, which offers good access to Dongdaemun and Myeongdong. There are about three universities around Hefa Station, so it's a very student-heavy area, and as a result, there are many trendy restaurants. Korean accommodations generally don't have bathtubs, only showers. The place I booked was a room within an apartment building, so the toilet and shower were separate, but the kitchen and washing machine were shared. There were often tourists in the neighboring rooms, and you could hear their voices, so some people might find it cramped. Sometimes it's not clearly stated that the kitchen is shared, which can be confusing. I went to a supermarket called Homeplus to buy meat and vegetables and cooked them myself. Since there was no rice cooker, I used packaged rice or pasta as a substitute for carbohydrates. I mostly cooked for myself except when eating with friends, but there are many delicious Korean restaurants around Hefa Station and Dongdaemun, so if you have the time, I recommend trying them out. Overall, the prices aren't too high, and the flavors suit Japanese tastes. However, dishes like tteokbokki and samgyeopsal are served in portions for two or more people, so you might not be able to order them alone.

On weekends or days when clinical training ended early, I went to eat kanjang gejang with friends who were also doing clinical training at Korea University from Nagoya University, or visited a traditional Korean sauna called a jimjilbang. Additionally, I had the opportunity to dine with pharmacists and plastic surgeons from Seoul National University whom I met locally, and they kindly shared insights into Korean culture and circumstances, making it an invaluable experience.

I spent two months in clinical training at Peking University People’s Hospital in Beijing, China. It was a very different experience from my usual student life. Surrounded by a completely different language and culture, I faced many moments of confusion and discovery while observing daily medical practice and interacting with local medical students and doctors.
Unlike in Japan, I often found myself clearly aware that I was “a student from outside,” and there were many situations where things didn’t go as expected. Even so, there were perspectives and experiences that I could only gain precisely because I was in that unfamiliar environment. Since returning to Japan, I’ve gradually come to realize the value of what I experienced.
In this report, I would like to reflect on the preparation process before departure, what I learned during the training, and my impressions of daily life in Beijing.

Preparation

The most difficult part was, without a doubt, preparing the required documents. There were so many forms and application materials that I felt overwhelmed. As someone who tends to procrastinate, it was honestly very stressful. Writing the study plan and motivation letter was especially tough, as I wasn’t sure what to write.
To pass the internal selection at my university, I had to submit an English test score—either IELTS or TOEFL. I chose IELTS, but I couldn’t reach the required score in the first two attempts. On the third and final try, right before the submission deadline, I finally passed. I still remember the relief I felt at that moment.
I was also anxious about being away for two full months—whether I could still manage hospital visits, national board exam prep, and graduation exam studies. But in the end, I just decided to go for it and committed myself fully.

Clinical Training

I rotated through two surgical departments, spending one month in each. Since I wasn’t allowed to scrub into the surgeries, most of the experience involved watching operations from outside the sterile field. To be honest, it became a bit repetitive in the second month. Personally, I wouldn’t recommend doing only surgery for the entire period. That said, I wasn’t sure what internal medicine rotations would involve either.
Still, I found it interesting to observe differences in surgical techniques, pace, instruments, and medications compared to Japan. I also enjoyed learning about how physicians work in China—their roles, responsibilities, and working styles. These were things I wouldn’t have encountered in Japan.
In my first month, I was assigned to the hepatobiliary-pancreatic surgery department. The supervising doctor there was fluent in Japanese, and his wife also spoke Japanese well, which made communication incredibly smooth. I was grateful to have someone I could easily talk to whenever I needed help. That environment was a major source of emotional support.

Daily Life

Digital payments using QR codes were highly developed in Beijing. However, since I didn’t have a Chinese national ID, I struggled with even small daily payments. Many stores didn’t accept cash, and it was inconvenient to buy food or go shopping.
The local food was completely different from the Chinese cuisine I was used to in Japan. I found that the quality varied greatly depending on the price. Honestly, I had a hard time with the food, and I spent much of the two months thinking about how to avoid eating Chinese food whenever possible.
The language barrier was also a big challenge. I don’t speak Chinese, and very few people around me spoke English. Even within the hospital, I could only communicate with my supervisor—communication with anyone else was almost impossible.
Fortunately, I became friends with a Japanese student enrolled at Peking University’s medical school. That connection made a huge difference. Without that support, I think I would’ve struggled much more.

Conclusion

There were many moments of confusion and difficulty, but all of it became part of a meaningful experience. Beyond the clinical content, I learned about cultural differences and became more aware of my own limitations. This experience may not yield immediate benefits, but I have a feeling that one day, I’ll look back on it and realize just how much it shaped me.