Clinical Exchange in Japan

For five weeks, I undertook an observational junior elective, shadowing surgeons in the Nagoya University Hospital in Nagoya, Japan. The first three weeks were completed in the paediatric surgical department, and the last two weeks were in the thoracic surgical department. Teaching was conducted in both Japanese and English in both departments, as I was often in lectures and seminars with final year Japanese students. I was placed with final year students because students in Japan rarely have any practical experience of wards or surgeries before this time, so I had a similar level of clinical experience due to the differences in curriculum. A typical day included an hour commute each way with a ten-hour working day five days a week with Japanese being the primary language used. Largely, my clinical experience was in surgical procedures, both minor in the ward setting and in operating theatres. The main challenges were acquiring in-depth knowledge to keep up in my specialist settings and overcoming the language barrier.

Between June and August, I completed my junior elective at Nagoya Teaching Hospital in Japan. I spent three weeks in the paediatric surgical department and two weeks in the thoracic surgical department. I had chosen surgical specialties because I was interested in minor procedures and was aware of the language barrier when communicating with patients in a medical speciality. The language barrier still existed, but I was able to understand surgical procedures performed and brief communications between patients and doctors by the end of my elective.

The paediatric surgical department gave me invaluable knowledge into paediatric medicine, surgery and care. Morning ward rounds in the neonatal unit helped me learn about developmental diseases and treatments. I assisted in the morning routines of the neonates and with minor procedures, such as stretching of the oesophagus in oesophageal atresia. My professionalism was challenged in caring for younger patients because they did not understand what was going on and they became upset. I reminded myself often about the necessity of these procedures and took my cues from the nurses when comforting the children. I also learnt that most patients are highly superstitious and will not take organs from deceased donors, therefore transplants are rarer; I saw one transplant in five weeks. It is a general superstition rather than wide medical opinion, so it was interesting to see the difference in attitudes.

My teachers in the thoracic department were very keen for me to learn the language and communicate with their patients, so most of my medical Japanese was from this team. I was fortunately allowed to scrub-up for most surgeries performed in my two weeks there and saw robotic surgery performed for the first time. I found out that this department does not perform transplants and that cardiac surgery is a separate speciality with only occasional overlap. I was originally disappointed, but I gained invaluable experience in managing thoracic cancers that I may not have gained otherwise. While I was very grateful for the opportunity to scrub up with the surgeons and learn procedures such as stitching and camera use, the additional layers that are used in Japanese theatres, e.g. two masks, meant that the setting was warm. It was initially challenging to remain focused and it was made worse by following surgeons’ schedules with little time for eating and drinking. I managed to resolve this by keeping snacks on my person during the day between surgeries and drinking most of my water at mealtimes. I think I found this aspect difficult because I had only scrubbed up once in Glasgow and only three times in paediatrics beforehand.

While I view my elective as a positive experience, both professionally and personally, I do feel that it is challenging. The work schedule is intense, and the surgeons expect students to have knowledge beyond third year level. However, the experience is immensely rewarding, and the surgeons and students are kind and helpful. I would recommend learning the basics of the language and customs to prepare for an immersive experience in Japanese culture.