Clinical Exchange in Japan

Japan is one of the most developed countries in the East Asia and has a mature medical system which holds the field for both high-graded medical care and important researches contributing to the medical society. I am privileged to have my 5-week elective attachment in Nagoya University Hospital, which provides tertiary medical care in the Aichi prefecture where it is located and also in other nearby areas, so there are plenty of sophisticated cases which are less common in everyday practice. In the past 5 weeks, I have attached in two contrasting specialties, namely geriatrics and paediatric surgery, for 2 and 3 weeks respectively. Through these 5 weeks of attachment, I have observed the similarities and differences in patient care between Hong Kong and Japan in different aspects, such as medical approaches and care arrangements, while also obtaining some insights of the healthcare system in Japan. For example, Nagoya University Hospital are much less crowded and better staffed than most of the public hospitals in Hong Kong, ensuring a better patient care quality and making fewer compromises in terms of clinical resources.

As Japan is one of the countries most affected by aging population, I have learnt much in the geriatrics department of the hospital, which is supporting my further studies and career back in Hong Kong, where the increasing medical burden from the aging population is also an important issue, especially in the public medical system which most Hong Kong doctors will be spending, at least, our initial years of the career. In my 2 weeks of attachment in the geriatrics department, I obtained a general grasp of the specific features in geriatric care, while observing the everyday care practices in the hospital, keeping it in my memory and cross-referencing with local practice when in the geriatric rotation in the coming year, to further my understanding to the subject and appreciate the differences arising from other aspects, such as living conditions and everyday routine of the elderly. For example, I have observed that walking stairs is an important aspect of physiotherapy in geriatric patients who are planning to be discharged home back there, as many of them are living in detached houses where stairs are commonly present inside their homes; contrasting with that in Hong Kong where stairs are relatively less important (unless the patient is living in an apartment without lifts). With this in mind, I followed the daily routine of the team of geriatric doctors, paying attention to the conditions of patients in the ward and the corresponding medical approaches and the pathway towards further long-term care; the turnover rate in Nagoya University Hospital is relatively lower than that in Hong Kong, thanks for the relatively abundant beds, so I had more chance to observe the progress of the patients there. In the two weeks of attachment, the most unforgettable patient to me was a patient with a past history of Parkinson disease and cardiac arrest causing widespread brain damage, developing bedsore due to inability of conscious movement; the condition was further complicated with undernutrition due to inadequate intake, rendering the bedsore hard to heal in the short-term.

Apart from following the clinical activities, I also received tutorials specific to the subject, such as dementia, nutrition and refeeding, which deepened my understanding to their approaches in caring the patients; they also gave me an introduction to geriatrics itself which let me understand more on the general background and situation. In one occasion I have also observed one of their research works in action, which was to study the effect of chemotherapy to the cognitive function in the elderly, and I observed one of the doctors doing various cognitive tests to a patient.

In paediatric surgery, I aimed to understand problems and diseases commonly appearing in the specialty and the general approaches tackling them. During the 3 weeks of attachment, I was lucky to observe a wide range of different surgeries as Nagoya University Hospital has a wide catchment area for paediatric surgery, similar or even wider than the entire Hong Kong, for patients needing tertiary specialist care. In the attachment period, I followed the team’s daily routine, attending the morning rounds, research paper sharing sessions, evening conferences etc. The case load for surgery is relatively high but there were few emergency surgeries in the specialty, therefor I had the chance to prepare for what I would be seeing and found the surgery sessions quite fruitful, having chance to witness different cases such as biliary tree resection for congenital biliary dilatation, colon resection for Hirschsprung’s disease, inguinal hernia repair and resection of a relapsing liposarcoma.

In addition, the team arranged tutorials with the fifth-year local medical students on introducing the common diseases appearing in the specialty, also skills sessions on suturing and even a taster on laparoscopic operations, which is very commonly done in the specialty to minimize trauma towards children. It was stimulating to me and let me become more interested to surgery. The tutorial on common diseases in the specialty linked and complemented my previous exposure in paediatrics back in my home university, which made me understand more on both paediatrics and paediatric surgery.

The doctors here are very friendly and willing to answer my questions, and they are quite welcoming towards international elective students in general.

In my free time during my attachment, I also made use of the hospital library to read up related materials in both specialties in order to enrich my clinical exposure there and to improve my medical Japanese for better understanding towards the clinical scene. Another unexpected gain from that was that I found some Japanese materials describe medical knowledge from a different angle from the usual English materials which improved my understanding in some areas of previous knowledge.

On the other hand, Nagoya University itself also provided some opportunities for international students to communicate with the local students, with various activities organized by the local students, such as dinners and day trips, into which I spent some of my free time in Nagoya.

Lastly, there are a few points that I want to share for prospective international students who plan to have clinical attachment in NU.

Firstly, your journey would be more fruitful if you manage to learn some Japanese before you come. Nagoya itself is not quite a tourist-oriented city and not many places, such as restaurants, would have English menus or explanations. Life would be smoother if you know some basic Japanese. Also, some doctors might not be very good at speaking English (but they would try).

Secondly, choose your attachment time wisely, especially if you are planning to do it on April/May. There are a few days of national holiday in the end of April/beginning of May (called the Golden Week) so you might want to adjust your plan of attachment according to this.

Overall, the 5-week attachment was very fruitful to me and I enjoyed the elective attachment very much. I would like to thank the Office of International Affairs and the two departments for the smooth arrangement and bringing me a delightful experience.