Clinical Exchange in Japan

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Experience Report

Katharina Sies from Germany
period: March 1st 2015 – April 3rd 2015
department:Department of Pathology and Biological Responses

I planned my clinical clerkship almost a year ahead of time. In retrospect, I think that about a six month time span would suffice to secure the clerkship with all its details. Already during the time of planning the internship I was positively reinforced about the prospects of coming to the University of Nagoya. The contact with the international office was always very quick, the organization was highly professional and thought through and I always felt taken care of – there was always a person I could approach concerning any questions that came to mind. Be it a concrete question regarding the clerkship or a general one concerning the housing. This “backbone” of communication with the international office would continue also during my stay in Nagoya, laying the grounds for a great experience.

On arrival to Nagoya, within a couple of hours after getting off the plane from Germany I had been introduced to most of the laboratory members – on a Sunday. I had learnt my first lesson concerning Japanese researchers: They are very hard working. The second lesson I learnt was, that although communication using the English language was not always completely flawless, it would suffice. Just seeing how much effort my Japanese colleagues put in to be able to communicate with me made me feel certain, that I would be able to make some great friends in the laboratory. The Japanese course that I took during the semester did not show the results that I was hoping for. I am extremely grateful to my colleagues and friends who would not only help me whenever I needed assistance (in the hospital, the train station or the restaurant) but also would continue to teach me phrases and words throughout the stay.

My day in the laboratory started at 9 AM and ended at around 18.00 PM. The daily schedule differed from day to day. A constant throughout the entire clerkship was clinical diagnosis of histological specimens from patients. Prof. Dr. Toyokuni took a lot of time, energy and patience to explain and teach me on the basis of the slides before us. Not only did he explain the pathomorphological aspects of the specimens, but also about pathophysiology and epidemiology. Especially the differences between German versus Japanese epidemiology were quite interesting to me. Further, the classifications used in Germany sometimes vary from the ones used in Japan. During my stay I studied the most important Kanji considering the diagnosis sheets, enabling me to understand the most important data (even though Prof. Toyokuni’s translations of the accompanying comments on the side would give much more valuable information). As I had more theoretical knowledge than practical about pathology starting this clerkship, I am extremely grateful to Prof. Toyokuni for teaching me hands on knowledge and making it possible for me to feel more confident in the assessing of histopathological changes in diseases.

On my first day in the laboratory, Prof. Toyokuni presented me with the age and gender of a patient, about 100 histology slides, about 100 photographs taken during the patients’ autopsy and the question: “Why did this patient die?”. This was quite a challenge – and a lot of fun! At first I went through the slides and photographs and came up with a rough concept. After discussing the histology with Prof. Toyokuni he gave me further information about the disease history of the patient, as well as the clinical chemistry of the blood work. I then wrote a report in form of a “clinical pathological case study”, including important photographs and slides. During the course of my clerkship I conducted two of these studies. I am very thankful to have gotten the opportunity to study these cases. At first I was a bit overwhelmed, as I had never done such complex pathological work in University before, but I learnt so much by working my way through the slides, reading up in textbooks and papers and discussing the case with Prof. Toyokuni.

I also had the chance to observe an autopsy conducted by Prof. Dr. Ishii in the department of Legal Medicine. This was definitely one of my highlights during the stay. Prof. Ishii took a lot of time to explain the procedure to me, making the connections between macroscopic findings and possible meaning to the death of the patient. It was highly interesting to see the truly detective like work that was done here.

Further I got to partake in a clinical pathological conference. Here clinicians and pathologists discussed cases together, giving each other input and laying the ground for further discussion. It was very interesting for me to see how the pathologists worked very closely with the other clinicians. New research findings where also included within this conference, making it a generally very informative act.

Every Wednesday the Toyokuni Laboratory holds their weekly Lab-meeting. First, as in a journal club, an article was presented by a member of the lab. The article was sent around beforehand and discussed after the presentation. Even though some of these presentations were held in Japanese, having read the article beforehand and viewing the figures discussed, it was a quite impressive example as how the language of science is a world wide one. I enjoyed these lab meetings, as they gave insight to topics I would not have been exposed to in my lab/University in Germany.

The unique thing about the department I chose to do my clerkship in, is the intermixture between the clinic and science. The department for pathology and biological responses lay the every day focus on research, which gave me the opportunity to gain insight into topics I was completely new to. On the other hand, as the research is done by a mixture of PhD students, medical students and examined pathologists there is always a clinical background. This is shown through the discussions and outlook over the experiments, as well as through the daily work of the pathologists in diagnosis, autopsy and clinical pathological conferences.

At last I want to stress how welcome I felt at all times in the University of Nagoya. What made this clerkship so special was the people who I met during my stay. I feel very fortunate to have been given the opportunity to be a part of a Laboratory which such a good environment as the Toyokuni Laboratory. That we had lunch together every day, did weekend outings to the Ise Shrine, dinners and parties with Karaoke at the end, met up to wander the city on the weekends and enjoyed the cherry blossoms together I will never forget. I am very grateful to all members of the lab who made my stay what it was – sugoi (amazing)!

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