Clinical Exchange in Japan

Study report Nagoya University Hospital Clinical Clerkship
Period: February - May 2009

Lena-Alexandra Beume, 6th year medical student
Albert-Ludwigs-University of Freiburg, Germany

After having spent six months as a NUPACE-exchange student at Nagoya University with excellent Japanese courses, research work at the Centre of Brain Life Science and many interesting experiences in my free time, I decided at the end of January 2009 to extend my stay in Nagoya for another three months and to start my clinical clerkship at Nagoya University hospital.
Thanks to the valuable help of the NUPACE-Office, Nagoya University and Prof. Kasuya, I could realize this wish and accomplish my clinical training in the Department of Pulmonary Medicine and the Department of Cardiology.

During the semester I had spent in basic research at the "Department of Brain Life Science", I had become familiar with the excellent teaching system within Nagoya University Hospital and learned to appreciate the extraordinary support of the University's professors during my medical studies. Whenever my schedule for my research project allowed it, Prof. Kasuya, in cooperation with Prof. Natsume from the Department of Neurosurgery, had made it possible for me to attend some selected and always highly interesting neurosurgical operations at the University Hospital and to pursue the follow-up of these patients. The experiences of my stay at Nagoya University Hospital allowed me to feel already familiar with the surrounding of a Japanese Hospital and the fact that I recognized some of the students, physicians or doctors amongst my new colleagues made the commencement of my clinical training very comfortable.

I spent the first seven weeks in the Department of Pulmonary Medicine under Prof. Hasegawa, where my daily schedule started at 7:45 with the presentation of newly arrived patients and the planning of bronchioscopic interventions. It was always followed by the summary of an English paper the junior doctors had chosen from renowned journals on the subject of pulmonary medicine. This was subsequently followed by an interdisciplinary discussion with professors, doctors and researchers, focusing on the journal club's topic or the department's own research.

Since the majority of the departments patients were hospitalised for lung cancer, both, the paper and the department's own research often concerned the bio-pathological or genetic mechanism of evolution of lung caner, studies on treatment schemes of different lung cancer subtypes or new categories of lung carcinoma. This helped me a lot to strengthen my knowledge about TNM classification, adjuvant and neo-adjuvant therapy options and the possibilities of lung operations.

I was very lucky in this time to work together with two extraordinarily nice female assistant doctors who were never tired to discuss patients´ cases with me, to help me with the Japanese language and to let me know about interesting bronchioscopic procedures or emergency interventions. They were naturally extremely busy but still managed to have some free minutes so we could enjoy every day our lunch time in the top floor restaurant of the hospital with a wonderful view over Tsurumai Park and the whole city. Sometimes, Prof. Hasegawa would also join us and together we had very interesting chats about the Japanese and German culture, about differences in the medical education system, German sausages and Japanese beer, famous German writers and Japanese poets, beautiful tourist spots in the two countries and our own experiences during travel and study.
The end of my seven weeks coincided with my birthday, which I spent together with the two doctors at a wonderful restaurant in Nagoya City Centre over a delicious Japanese dinner they had organized as surprise for me.

The subsequent period of clinical training was in the Department of Cardiology. Here I could widely benefit form the broad knowledge of Prof. Murohara who was always very willing to explain to me the different patients´ histories during the professor's rounds and to discuss the often very complicated treatment of cardiac disease. Following my interest in the surgical field, I was happy that he made it also possible for me to spend a lot of time in the catheter laboratory, where I could attend different interventions for coronary angiographies, stent placement and laser ablation for arrhythmic heart failures.

At the end of April began the biggest in event in the whole of Japan, the cherry blossom season -I was very happy I could sometimes join small groups of patients, nurses and doctors, leaving the hospital for wonderful Tsurumai Park next to the clinic and spend some time with them under the cherry trees. I will never forget the picture of the three old lady patients in their wheelchairs in full admiration of the handsome Dr. Ono who was singing their favourite Hanami-song for them one afternoon while slowly floating cherry blossom leaves were falling on his white coat and hair.

In addition to my work at the hospital during weekdays, Prof. Kasuya also made it possible for me to join problem-based-learning (PBL) groups on Saturdays. These PBL study groups were originally designed for Japanese “outgoing students" and thus were held primarily in English. During every session, two different “patient" cases were presented by one 6th year medical student, who were acting as the patient, while other students had to perform history taking and physical examination using the English language. The experiences of these study groups helped me a lot to expand my vocabulary concerning medical English and to get more practice in history taking and examination for patient's cases ranging from dermatological to neuro-psychiatric to urgent cardiac matters.
Thanks to these groups, I could also get in closer contact with the Japanese medical students and develop some warm friendships, namely with two undergraduates who had qualified for a three-month clerkship at the University Hospital in Freiburg and whom I was to meet again in late summer in Germany.

As a conclusion, the extension of my stay in Nagoya and my clinical clerkship at Nagoya University Hospital was a wonderful opportunity for me in several regards. It allowed me to improve my Japanese language skills, to get to know the Japanese culture better and to deepen my professional acquaintances. Also, these additional three months allowed me to deepen my friendship with other exchange students and with some of my working colleagues.

In the last days of my stay in Nagoya, I realized how much I had started to feel at home in this city, how much I had grown fond of the daily bicycle ride to the hospital, my cosy apartment in the southern part and how much I would miss my colleagues as well as my friends here in Japan. With my work at the University's Hospital I had developed a daily routine but still, every day held special experiences for me that made it unique. Every day I was happy I had extended my stay and thus taken the opportunity to deepen my professional medical knowledge and widen my horizon for the understanding of this country.
With regards to technical and personal experience I would highly recommend a stay in Japan, especially at Nagoya University Hospital for medical students from all countries.

I would like to thank you and the staff at Nagoya University Hospital for providing me with the opportunity to study abroad in Japan. My expectations for this experience were very high and your program has managed to not only meet, but exceed my expectations. I learned a lot during my time at Nagoya University and was truly impressed by the learning opportunities available to international students. I wish my schedule would have allowed for me to study in Nagoya longer; after one month in Japan I was only beginning to scratch the surface of the opportunities available to learn about culture, social issues, language, universal healthcare and of course medicine.