Clinical Exchange in Japan

Choosing an elective destination was initially challenging. I had travelled to several countries in Asia, however, Japan had managed to elude me. It was a country which greatly intrigued me, with its completely unique culture and way of living. Therefore, I knew where I wanted to go.

I contacted Nagoya University’s Office of International Affairs and one of the secretaries; Kumiko Shimohata, responded very quickly and helped me immensely with organising this elective. Ms. Shimohata provided me with thorough directions which made it a smooth transition from Nagoya’s Chubu airport to our residence on campus. When we arrived at the office, Ms. Shimohata briefed us completely, and organised for a member of staff to take us to our relevant departments. This was especially important as Nagoya University Hospital is very large and not all signs have English translations.

I had previously not had any experience on an Infectious Disease ward or in Anaesthesiology. These were two specialities I was enthusiastic to gain further experience, so chose to carry out my clerkship in these fields.

What did I do in ICT?

The Infectious Diseases Control team were very welcoming, and Professor Yagi took time out to give me a comprehensive explained tour of the laboratory, explaining the general weekly routine and how the multidisciplinary team there worked together. In addition, he talked through the core principles of the practical techniques and results seen as he ran through several case studies. This was very useful as I did not have much practical knowledge of microbiology lab work. Hence, with Professor Yagi’s tutorial, it helped complement my clinical knowledge of Infectious Disease as well as aid my comprehension of the case studies ran through by the different doctors during meetings.

I got the chance to attend a variety of sessions including a pharmaceutical drug talk (the bento boxes provided were a class above the free food from drug talks in the UK!), Surgical ICU meetings, Therapeutic Drug monitoring discussions, case meetings and even an Infection control measure check round for each ward in the hospital. I also got the chance to attend several consultations with a doctor. These were in Japanese, however, the doctor would kindly translate after for me. This was something of note which I was very grateful for during my elective in Nagoya.

What did I learn?

The best part of my time at the department was when the doctor talked through cases and quizzed me on them. This really tested and pushed me to apply what I had learnt during my Microbiology teaching from my clinical year. I filled in gaps in my knowledge, using the textbooks in the department. This was helpful for example when a doctor would ask me to read up about toxicity for Vancomycin, Rifampicin and Teicoplanin. After doing so, I would be asked questions on them relevant to the patient case or the therapeutic drug monitoring meeting.

I learnt about the different drug toxicities, the types of hypersensitivies, how to analyse blood culture results and different empirical therapy regimens amongst other things.

What did I do in Anaesthesiology?

My last two weeks of my elective was in the Anaesthesiology department. Here, I got the chance to experience a breadth of surgical operations. Initially, we were given the chance to attend a Sim-Man session with the Japanese medical students. This was very useful for learning the effect of different anaesthetic drugs. In addition, the doctor in charge got us to describe what we observed over time as the drug was administered. This made us understand the importance of being astute to the fine changes in a patients vital life signs over the course of seconds. I got the chance to sit in on a pain clinic with helpful explanations after by the professor.

Highlights included me witnessing childbirth for the first time during a Caesarean section. Straight after, I got the chance to witness an emergency C-section. The surgeons were ultimately calm in the normal C-section. However, I observed how the surgeons effortlessly stepped up a gear and worked in double time during the emergency operation, when intubating such a small patient; a difficult challenge.

What did I learn?

The professor who was the head of the department, talked us through a complex case of anaesthetising a young girl with Down Syndrome. He explained the differences in intubation, and specialised equipment they use for more challenging patients such as intubation tubes with embedded cameras for additional guidance.

Differences in healthcare observed between Scotland and Japan

This clinical clerkship has given me the opportunity to, for the first time, compare differing healthcare systems. The UK is covered by the NHS which provides free healthcare to every citizen. To allow for this, tax rates are higher to cover costs. On the other hand, Japan’s government pays for the majority of healthcare but patients are still required to pay a %, with vulnerable groups such as the homeless having to pay less. Several of the Japanese doctors were surprised by this difference.

From my time in ICT I learnt about the differences in antibiotic resistance.

How was it doing it in Japan?

Nagoya was a great location in Japan. It was in between Kyoto and Tokyo (closer to Kyoto). This enabled me and my colleague to go on a weekend trip to Kyoto. The location also enabled us to visit Osaka, Hiroshima and then to Tokyo with the Japan Rail Pass. Many of the doctors gave me very useful advice on what to do in those cities which was helpful.

Summary.

In summary, I had a very enjoyable clinical clerkship at Nagoya University. I gained an insight into new specialities, which will be very helpful in guiding my future specialist career path within medicine. Even though there is a language barrier, it is still possible to do a clerkship in Nagoya despite not being able to speak Japanese. This was made possible by the staff there who took time out of their schedule to translate meetings, consultations and tutorials, for my benefit.

Thanks goes to:

I would like to thank Professor Yagi, Dr Matsumoto, the rest of the Infectious Disease team, Professor Nishiwaki, and the rest of the Anaesthesiology department for allowing me the opportunity to carry out my clerkship in their respective departments.