Clinical Exchange in Japan

Departments: Emergency & Critical Care Medicine, First Department of Surgery,
                         Neurosurgery, Geriatrics
Period: 2013.02.04 – 2013.03.29

To me, studying in Japan just like a dream come true. Although it was only two months, I learned a lot as if I had stayed for a very long time. Thank to everyone I met in Nagoya University Hospital, thank you for offering me such a good memory!

I must say, the ER&ICU here are totally different from our hospital. To tell the truth, I like how things work here better. Let's talk about ER department first. ER in NUH is always quiet and tidy. Quiet means that ER in NUH is not a noisy place, people may talk louder but never shout, there are no one yelling at each other, either. And tidy is that the family just stay outside the working zone waiting, doctors and nurses do things in order, ER will never be in a mess even a second. Sadly, It's just the opposite in our hospital. I think the decisive reason may be that we receive too many patients back in Taiwan, it is hard to maintain the treatment quality when shorting of manpower. Hope we can have the same medical environment as NUH!

Secondly, the ICU. What impressed me most is the morning meeting and evening meeting every day. All the available doctors gather to discuss the patient. When it comes to pediatric patient, doctors might even be over 20 totally! I think this is great, every one in the ICU knows exactly each patient's condition, it's easier to react when emergency happens. Another thing catch my eyes is that there are TVs for patient in ICU! I've asked the doctor on duty, he told me that the TV may have benefit to patient's rehabilitation, it can offer some stimulations to unconscious patients. Maybe not evidence-based, it's still a good try.

I run the course with three 5th grade students, it was a very interesting experience to me, I must thank Prof. Nagino, who gave the chance to rotate this way. Three students with me are Arafuka, Imaoka, and Uno (left to right). Thank you all! At first I thought it would be difficult to communicate with them, since my Japanese is not so well. I worried too much. One of them can speak English fluently, the others used easy Japanese in order to let me understand (or through writing), most important is that they are all very kind! We had a good time together, and learned a lot from each other.

I was once asked if the curriculum for 5th grade students would be too easy for me, my answer is not. Besides the teaching language, the way how they arranged the surgical course was also different from which in Taiwan, thus I could get some new information from a different point of view! For example, we had a lot of lectures and group discussion in our hospital, the merits are that we can get plenty of basic knowledge, yet this makes us have no time to see surgery, which may be the soul of surgical department. In NUH, we had lots of chance to see surgery, and before the operation time there are some little lectures to remind us about important things. There is no definite way to teach students, and I am lucky to experience different ways!

During this course, I went to two sub-departments: Surgical Oncology and Vascular Surgery. Besides mini-lectures and operation, there was a speech given by a Canadian vascular surgeon. Perhaps it was the only moment I could understand most (laugh)

Before the course began, Prof. Wakabayashi asked me: “What do you want to learn?”, “Surgery.” I said. Then I got a free license to see every single surgery of Neurosurgery department. I saw 12 operations, spent over 50 hours in the operation room in two weeks. Very impressive! Feeling exhausted physically but energetically psychologically! I never thought I could see so many kinds of surgery in Japan! Some surgical technique I even never saw in our hospital. Which was more exciting was that I was allowed to be first assistant for a while! Although it was no more than three minutes, and what I did was just giving some water under the microscope or adjusting the setting, it still made me very happy, thanks Dr. Fujii! Frankly speaking, I feel to be a neurosurgeon after this course! Dr. Fujii said that he wants to meet again when I become a neurosurgeon, I must study much more harder or it will be impossible (laugh)

Besides the surgical technique, the high technology here also surprised me. The most impressive one was intra-operative MRI. Dr. Fujii told me that there are about 10 intra-operative MRI in Japan, and there are two in Nagoya! There is only one in Taiwan, and not in our hospital, my teacher often talks about the machine, but it never shows up in NTUH. So you can imagine how astonished I was when I first saw intra-operative MRI worked! After the surgery, there was a mini-speech given by neurosurgeon from other hospital (the one that has another machine in Nagoya) I am glad to learn more about it! Hope there will also be one in our hospital one day!

Geriatric department was my last stop in NUH, and here I met most patients, making connection with many lives. It was a very good experience! Doctors here were all nice to me, thank you all! Before I came, I thought geriatrics might be popular in Japan, because Japan has already been an elder society. Yet to my astonishment, Dr. Hirose told me that not only doctors but also citizen in Japan barely knows or interested in geriatrics, the field still yield to be discovered. This made me be more respectful to geriatrists in Japan, they are pioneers who walk lonely for the whole society! In Taiwan, we also have same problems: aging people, decreasing birth rate, and unpopular geriatrics. I think Japan is the best country we should learn, and we can fight together!

Home service was an impressive experience to me. I only saw this at psychiatry department in Taiwan. Through this, I saw the real aspect of aging society of Japan, there are still more out there, waiting for help. I remember a case: An old lady who had many underlying chronic diseases and was also diagnosed of major depression, her daughter also suffered from depression. I don`t know why her daughter developed depression. Maybe it was because of genetic problem, maybe it was to much for her to care her mother. What can we do for them? It seemed that the situation has improved after home service started, but will things get worse when we stop visit them? Everything happens again? Should we help them forever? It`s hard to tell the answer.

Finally, I want to offer special thanks to Prof. Kasuya and Ms. Iizuka, without your coordinating and helping, my exchange course couldn`t be so smooth, You did a lot for me, thank you very much! I wish I have chance to visit Nagoya University Hospital again!