Clinical Exchange in Japan

I undertook my junior elective for a period of four weeks in Nagoya University Hospital, Japan. Organising the elective was straightforward with the help of the Office of International Affairs, as they were rapidly responsive to my emails and enquiries. On my first day, I was warmly welcomed by the whole cardiology team after having introduced myself at the cardiology conference held every Monday. My supervisor, Dr. Morimoto Ryota, was very attentive as he made sure to give me a briefing every morning about my schedule for the day and would contact me if there were any changes.

During my stay, I acquired an invaluable clinical experience and knowledge related to a variety of cardiac conditions, diagnostic techniques and management options. Since Japanese is the primary language used in the hospital, the doctors were more than happy to translate cases and procedures to me in English. Furthermore, I was fortunate to have one-to-one teaching and discussions with the doctors as I was the only medical student in the department at the time.

The majority of my time was spent in the cardiac catheterisation lab. Prior to any procedure, one of the doctors would talk me through the history of the patient and then look at any ECGs and echocardiograms available to interpret. By the end of my placement, I was more familiar with the orientation of the coronary artery tree in coronary angiograms and identifying areas of stenosis. In addition to translating in English, the doctors sometimes drew simple diagrams to aid their explanation. This facilitated my understanding and interpretation of figures from procedures such as fractional flow reserve (FFR), haemodynamic circulation figures obtained from right heart catheterisation and Qp/Qs values to determine the severity of a shunt in septal defects. PCI was another procedure I saw on a daily basis. I learnt that the choice of preference between PCI and CABG is determined by factors such as the patient’s age, number of vessels involved, LAD artery involvement and presence of other co-morbidities such as diabetes.

I attended the professor ward round every Tuesday where I was able to practice my cardiovascular examination skills and listen to different types of murmurs. The ward round extended to the ICU, where I saw Impella– a ventricular assist device– for the first time. Furthermore, I was able to attend theatres where I watched the Impella device being replaced while the patient is temporarily supported by ECMO. I also attended a TAVI procedure where the efforts of the cardiologist and cardiothoracic surgeons are combined to complete the procedure.

For the remaining time, I attended various MDTs, conferences, lectures and simulations. My supervisor was very keen on teaching me and sharing his research findings and interesting cases, as I accompanied him to a few conferences where he presented alongside other international speakers. I also participated in an echo simulation session. The senior doctor ran through the basics of echocardiography first and how to hold the probe in different positions for different heart views. We then applied those techniques on volunteers before attempting different simulated cases on the SimMan. I was able to correctly identify different cases of myxoma, ischaemic walls and right ventricular hypertrophy– which proved this session useful and enjoyable.

Aside from obtaining medical knowledge, I enjoyed being immersed in the Japanese culture. The Japanese doctors were very welcoming and kind. I was always treated to lunch and they were curious about Scotland (where I live) and my home country, Oman. It was an opportunity for us to exchange information about our cultures. I also had some time to explore Nagoya and its food specialities. My personal favourites were unagi and tebasaki chicken wings. I also travelled to nearby towns and cities as Nagoya is in close proximity to popular destinations like Kyoto, Nara, Shizuoka and Osaka. I would recommend doing an elective in Japan as this entire experience was immensely rewarding and of a great educational value.