Clinical Exchange in Japan

My time in the Clinical Exchange Program at the Nagoya University proved to be a highly interesting experience in both academic and cultural terms. My 1-month time at Nagoya provided me with an excellent opportunity to not only learn about doing research in Medicine, but also to observe a wide range of fascinating procedures and appreciate the nuances of the Japanese health system and culture as a whole.

My experience with the Clinical Exchange Program started strong with many thanks to all the staff from the Office of International Affairs. The preparation process of my clinical elective was effortless and they were tremendously helpful throughout the application process. They also provided invaluable help with regard to housing and transport issues and ensured that my stay at Nagoya was a pleasant one.

Throughout the month, I was very fortunate to have been able to attach to both the Department of Neurology and the Department of Gastroenterology & Hepatology. The scope in Internal Medicine is undoubtedly far vaster than one’s imagination, and attaching to the two departments provided a highly contrasting but equally illuminating glimpse to how this may be the case.

My attachment started off with an enlightening two-week experience at the Department of Neurology. The attachment was very well structured with 2 daily lectures and opportunities to observe clinical work in between. Prof. Katsuno greeted me with great kindness and made sure that my interests were well taken care of.

As a tertiary hospital, the neurologists at Nagoya University handle challenging cases day in day out. The doctors were very attentive during clinical examinations and always went into great details in the documentation of their findings. This was undoubtedly also the case during grand rounds, when the senior doctors would all carefully examine and obtain a comprehensive history from each of the patients. Though a time consuming process, this was proven to be an indispensable part to the diagnostic process of a neurologist in many instances.

As a medical student, our daily exposure to Neurology is often directed towards common entities such as stroke, epilepsy and headaches. Throughout my attachment, I was exposed to many new and seemingly “exotic” entities, such as MELAS and Spinal bulbar muscular atrophy, diseases that I previously only had chances to come across while reading textbooks. Through the guidance of the attending neurologists, I had an invaluable opportunity to interact with those patients and invariably learnt a great deal from them.

In addition to the highly rewarding clinical experience, my attachment was further enriched by two daily lectures regarding basic and translational research the Department of Neurology was engaged with.

As advanced as modern medicine is, there is still unfortunately very limited therapeutic agents for many neurological diseases. This is particularly the case of many neurodegenerative disease, such as Amyotrophic lateral sclerosis (ALS) and Spinal and bulbar muscular atrophy (SBMA). Developing disease-modifying agents for these diseases may perhaps be considered by many as one of the holy grails in Neurology.

At Nagoya University, the Department of Neurology has a strong emphasis on understanding the pathogenesis of SBMA, with an ultimate goal of developing a therapeutic agent for the disease. The group led by Prof. Katsuno has made many important findings regarding the pathogenesis of SBMA and has greatly enhanced our understanding regarding the mechanism of the disease. This had led to the development of some very promising therapeutic candidates in clinical trials, and may hopefully become an indispensable addition to the arsenal of medicine doctors may utilize in the future. This has only been made possible through more than a decade of dedicated work, stemming from basic scientific research on carefully constructed models, allowing one to gradually unravel the biological mysteries surrounding the disease. This was the first time I was able to fully appreciate the whole scientific process of developing a therapeutic agent from scratch based on biological mechanisms and it was truly an astonishing narrative.

Following my time at the Department of Neurology, I spent two more fruitful weeks attaching to the Department of Gastroenterology & Hepatology. The department was heavily clinically orientated with a busy schedule every day. My attachment started with a warm welcome from Prof. Goto, Dr. Miyahara and Dr.Nakamura, which all provided me with tremendous help during my stay at the Department. My two-week attachment consisted of a rotation between the four subspecialties in the department, namely the Upper GI, Lower GI, Hepatology and Pancreatic team, which I all owe a debt of gratitude for their teaching and hospitality.

Both the Upper and Lower GI team had a very strong expertise in terms of endoscopic procedures. Both teams routinely carried out technically demanding procedures, such as Endoscopic submucosal dissection (ESD) and Double Balloon Enteroscopy (DBE).

In Japan, gastric cancer represents a significant disease burden and is one of the most prevalent cancers locally. Prior to the invention of the ESD technique, patients would often have to have partial or even their whole stomach removed as definitive treatment to the disease. Even were the disease to be cured, there would still inevitably be irreversible impact to the quality of life of the patients. The mastery of the ESD technique in Japan provided a novel way of en bloc resection of early gastric cancers, allowing countless patients to enjoy a good prognosis as well as retaining their functional capacity. The rise of the use of ESD appealed to me as a very encouraging story of how innovation and continuous improvement of our clinical expertise may ultimately lead to better patient care.

The Hepatology team also consisted of many doctors with expertise in both medical treatments and therapeutic procedures. In addition to core medical treatments, the doctors in the team were also highly skilled in procedures such as Radiofrequency Ablation (RFA) and Transcatheter arterial chemoembolization (TACE). The doctors from the Hepatology team also very kindly gave me tutorials on how they utilized state-of-the-art technology and special techniques to further improve the efficacy and safety of the procedures. My time with the pancreatic team was also a very productive experience, with many opportunities to observe a wide range of procedures such as ERCP, PTBD and PTCD.

Whilst the Department of Neurology allowed me to fully appreciate the importance of careful examination and systematic thinking as a physician, my attachment to the Department of Gastroenterology allowed to me realize that expertise in hands-on skills, or what they may call Tewaza (てわざ) in Japanese, is again another area of mastery a competent physician may possess.

Not only was my attachment enriching in terms of academic aspects, but it was also enlightening in terms of appreciating the unique culture of Japan. Everyone I met was invariably very humble, polite and helpful. This was surely the case in the hospital as well, where both the clinical staff and patients would greet each other with manner and politeness.

I also felt deeply fortunate to have had many chances to engage with inspiring conversations with the locals regarding the cultural differences of Japan and Hong Kong, as well as receiving a lot of travelling advice from them. My visits to Kyoto, Nagoya Castle, Ise Grand Shrine and many other places were all enriching experiences, allowing me to have a glimpse at the cultural and societal roots of Japan. I was also very thankful to have met some good companions from different parts of the globes and had a very memorable time travelling in Japan with them. My stay also provided me with a good opportunity to brush up my rusty Japanese skills, and all the doctors inevitably provided me with encouragement and guidance to improving my Japanese over the course of my attachment.

Overall, my experience at the Nagoya University was truly an unforgettable one. I am grateful and in debt of all the kindness and guidance from all the staff from the Office of International Affairs, Department of Neurology, Department of Gastroenterology & Hepatology, and all the other locals that I am greatly thankful to have met during my stay at Nagoya.