Clinical Exchange in Japan

Picking Japan was definitely the right choice for my Junior Elective. At first I was on the fence about the idea, when my colleague first suggested it, however after spending 5 weeks there it was definitely worthwhile. I had travelled to parts of Asia previously, and I was very interested in the vastly different culture in comparison to the West.

Organising the elective was fairly straightforward following regular correspondence from Kumiko Shimohata who assisted us greatly in sorting everything out. She led us through the whole application step by step and was happy to answer any queries that we had.

When the time finally came, 3 flights and a train ride later, we arrived at the student residence that was provided by the university. We were given detailed instructions in English on how to get there, which made our arrival very straightforward. On our first day we navigated our way to the Office of International Affairs where we met Ms Shimohata. We were given a brief introduction then escorted to our relevant departments.

Orthopaedics/Rheumatology

I spent my first 2 weeks in the Department of Orthopaedics/Rheumatology. At Glasgow University, Orthopaedic Surgery is briefly covered in 1st year and 3rd year and is not revisited again until 5th year. I had shown a keen interest in Orthopaedic Surgery, and wanted further exposure to it.

As I was escorted to the department I was pleasantly welcomed by Prof.Naoki Ishiguro, who introduced me to the various doctors. He also presented me with a timetable where I would be spending time with each of the following teams:
• Rheumatologists
• Hip Surgeons
• Knee & Shoulder Surgeons
• Tumour Surgeons
• Hand Surgeons
• Spinal Surgeons
• Paediatric Orthopaedics

Each day I would report to the department at 9am except for Tuesdays and Thursdays where I would have to report at 7:45am. This was because the Orthopaedic team would have a conference on these days to discuss and review interesting patient cases, review scientific literature and give doctors the opportunity to ask any questions about practices that had been carried out. It was interesting to attend these conferences as some of the cases would be presented in English, however I had some difficulty with the ones that weren't as they were given in Japanese. Some of the doctors would help to translate what was being said however often it was hard to keep up. Following the conference, I would be greeted by the respective doctor that I would be with for that day.

These doctors would then take me down to theatre. On the first day I was given a tour of all the facilities available, including where to get changed into scrubs, what was in each operating room and how to easily navigate my way around. What I found interesting, was that there are cameras in all the of the operating rooms to record the surgical procedure taking place. These cameras could then be streamed to allow students to observe what was going on.

With each of the teams I was able to gain exposure to a variety of clinical conditions. The doctors were very helpful in explaining the case to me, and were happy to answer any questions that I had. They would also quiz me on my anatomical knowledge, which kept me on my toes. I was even given the opportunity to perform a surgical scrub in with the hip surgeons and get involved which was thoroughly enjoyable.

Anaesthesiology

Following my two weeks in Orthopaedics, my last two weeks were spent in the Department of Anaesthesiology. I am very interested in anaesthesiology as I did a special 5-week module in this field and thoroughly enjoyed it. As anaesthesia is not covered much in the undergraduate curriculum I decided that I wanted more experience in it as part of my elective.

On the first day we were given a tour of the department and introduced to the various doctors there. Following this we attended a practical session with other Japanese students. It was a simman session, going through airway management and discussing the different effects that pharmacological agents can have on the body. One of the professors was very helpful in translating, as the session was being delivered in Japanese.

Aside from the simman session, most of the time spent in Anaesthesiology was in theatre where were able to get some hands on experience with airway management. This is an excellent skill to have, and being able to practice it was very helpful as it is important in any emergency situation. We also received teaching on the importance of monitoring a patient when they have been anaesthetised, and the various drugs that are given to the patient. Many patients received local nerve blocks to help with pain management, one of the professors noted that this was a popular procedure to be carried out in Nagoya University Hospital.

Aside from regular anaesthesia, we also had the opportunity to observe Paediatric anaesthesia, obstetric anaesthesia and spent some time in a pain clinic.

Nagoya and Beyond

Following our elective in Nagoya, my friend and I bought a JR rail pass and travelled all around Japan. We visited: Kyoto, Osaka, Nara, Hiroshima, Tokyo and the Fuji area, travelling around 2 weeks in total. This was very enjoyable as we got to see different areas in Japan and experience travel in the Shinkansen. A personal favourite moment of mine was climbing Mt Fuji, as the views at the top were absolutely breathtaking.

In summary, I had an enjoyable time carrying out my elective in Nagoya University hospital and would encourage everyone to come and do it. Initially I thought I would struggle not knowing any Japanese, however it is was not an issue as the doctors all spoke English and were very accommodating. I definitely recommend buying the JR Rail Pass if you are planning on travelling around Japan, it will save you a lot of money!

Special Thanks To:
Prof.Naoki Ishiguro and the rest of the Orthopaedic Team.
Professor Nishiwaki and the rest of the Anaesthesiology Department
Ms Kumiko Shimohata and the Office of International Affairs