Last update:October 19, 2011

Johns Hopkins Hospital

Taishi Okuno(Johns Hopkins University)

I was allowed to do clinical clerkships at Johns Hopkins Hospital for about three months from March, 2011. Starting to write this report in this returning airplane, it is heartily felt that this fantastic experience that is long and profoundly memorable is about to end at last. Every day when I was trying really hard for this program is recalled, and it makes me feel kind of sadness. To switch my mind firmly toward next another goal when getting off this airplane, I will try to finish writing this report here.

Looking back my days, I recall those days that I was studying English and medicine really hard in Japan, hardships and achievements at Hopkins, many people I met, and wonderful memories with my friends. Now I exactly feel a very big sense of accomplishment and gratitude in being able to spend this wonderful time that I would say was a compilation of my university life.

The clerkship on the 1st month was done at anesthesiology. I was attached under one of the residents at anesthesiology, and I learned many things while helping them. Basically, I was just watching other than doing kind of chores. But in the operation room, I was actually allowed to do various medical procedures such as IV, A-line, intubation, and management of ventilation or blood pressure as students do in Japan. At first it was even difficult for me just to get proper medicine or equipments as residents told me since I couldn't figure out their words precisely. But gradually, I was getting used to the workflow there. And I felt fun since I was feeling that I was being a little function in the operation room. Besides those things, I tried 2 times of overnight shift and also was able to go to see the laboratory twice which is managed by the professor I worked with in the operation room. In this way, I had so many precious experiences at this department. Moreover, it was so nice that I could observe many most advanced operation in various field.

I rotated at Hematology on the 2nd month. At this department, typical day is started from morning rounds, and then we have daytime conference and see some consulted patients. And the day is finished with evening rounds and lectures given by attendings. I had many hardships both in English and medical knowledge especially at this department. So I wasn't assigned patients easily and was mainly just observing at first. At Hematology, I started this rotation with one of the students at Hopkins. He was very excellent and helped me a lot. With his help, I could have inpatients and some consulted cases at last. I actually got many medical knowledge through conferences and lectures and also had many practical experiences in this rotation. But moreover, it was extremely inspiring and great experience to work with this student for a month.

The last rotation on the 3rd month was done at Emergency Department. In this rotation, I got 2-3 patients on an average. I interviewed and did some physical exams on the patient, then quickly made an assessment and a plan, and afterwards I presented about him or her to my supervising resident. Then the resident gave me some feedback and went to see the patient with me again. I could learn both medical knowledges and terms that I should use everyday and usually they are applicable. So I was feeling that I was getting better at my job everyday. Other than those normal shift, I was able to attend lectures or practice s with students at Hopkins and also ride on ambulance. Besides, I was allowed to do a case presentation by Power Point on my last day. I was also experienced some medical procedures such as IV, blood gas, and sutures. So I learned so many things and had great experiences on this last month.

In addition to doing these rotation, I saw many japanese doctors who are working in America, traveled over America with my friends, visited my friends' university, and hung about with other foreign students. Everyday in America was so eventful.

Actually, 3 months wasn't so long. But days were absolutely eventful and challenging. I want sincerely to tell my deep gratitude to all people including my friends, doctors, and stuffs who supported my challenge. And I'm finishing writing this report while praying that many students will try this wonderful experience in the future.

　　

Pennsylvania University

Mio Kanai(Pennsylvania University)

I went to Philadelphia from March to May 2011 in order to do the rotation in Pennsylvania University , Children's Hospital Of Philadelphia.

CHOP is the top pediatric hospital in US and is separated in many specialties such as Pediatric Hematology, Neurology, Cardiology, CICU, NICU, PICU and so on. Also, Pennsylvania University is famous for its reputation for teaching and in fact, there were many doctors who were eager to teach us.

For the first month, I rotated Pediatric Hematology and for the second month, Pediatric Cardiology. In Pediatric Hematology, I was mainly in the consult team. There, I was able to take the patient's history and do the physical exam and then presented to the doctors. Usually, I would give my presentation to the fellow and afterwards to the attending. Even though fellows were busy, they made time to corrected my presentation so that I could give a better presentation to the attendings. During this time, a student from Pennsylvania University was also rotating with me. She was extremely smart and also very motivated so that was very stimulative for me. At the end of the first rotation, I had to do a case presentation in front of about 30 people. The case was very interesting and it was fun to look up and read some articles about it. It made me nervous to give a presentation in front of so many English speaking people, but it was a great experience for me and I learned a lot.

In Pediatric Cardiology, I was in outpatient for the first week, consult for the second week and inpatient for the last two weeks. During the outpatient, the attending gave me lectures about heart murmur, how to read EKG of children and about cyanosis. Also, they taught me how to do the physical exams and let me listen to many kinds of murmurs. The doctors were very eager to teach me, so I wanted to be good enough for them and wanted to understand everything they said. However at the same time, I was getting upset of myself because of my poor knowledge and difficulty in understanding. During the consult, I was taking history and did physical exams and presented to the attending as I was doing in Hematology department. In the last two weeks in the inpatient, I went to see my patients before the morning rounds and presented every morning at the rounds. In the morning rounds, there were 5 to 6 doctors, 2 to 3 nurses and the patient's parents, so I could of course not make a mistake and had to look confident in front of them but this actually made me nervous. While I was presenting, the attending often asked me questions and also gave me homeworks to study about certain things. Other than these, I had to give a talk about a certain cardiologic disease from embryology to management and also explain what is being discussed these days in the articles. I was told that this talk must be about 45 minutes. I've never done a 45 minute presentation even in Japanese, so I was extremely worried and prepared for it almost every day for two and a half weeks. After my presentation, the attending told me that my presentation was excellent so I remember that I was very happy and satisfied.

Other than the rotation, I was partying with the friends from Pennsylvania University and my dormitory. I was surprised one day when I came back to my dormitory and saw many people dancing and partying on the first floor. I really felt like I was in a foreign country and enjoyed it a lot. Also, I went to the home parties of Dr. Nishisaki who is now working at CHOP and of Dr. Kanei who is now working in NY. It was a great experience to talk with the doctors who are now working in America.

Thank you very much for letting me have a great experience as a medical student. I'm sure that the things I felt and learned will all be a great treasure of my life. I would like to say thank you to the doctors and officers of my university , CHOP, my friends, family and all the people who supported me.

My clinical rotations at Tulane University and Medical University of Vienna

Kentaro Mori(Tulane University)

I feel a little bit excited by the foreign atmosphere even though it has already passed several days since coming back to Japan. As a exchange student, I went to Tulane University in U.S.A and Medical University of Vienna and took part in clinical clerkship there. The reasons why I applied to this exchange program are that I longed to experience U.S medicine,which is known as the highest level of it and I am so interested in General Practice in Europe.

The first rotation in Tulane university was Endocrinology. To be more specific, what I did was shadowing of a fellow doctor in outpatient clinic and following up of my patients in university hospital. In addition, it was also my duty to go to another outpatient clinic and taking patient's history, doing physical examination, and present the patient's case including my differential diagnosis to attending doctor. During this rotation, a impressive thing for me was that there was nearly always other specialist who was also following my patient when I went to patient's room.

The second department was Neurology. I belonged to a stroke team, which gave me a role to follow up around 2-3 post-stroke inpatients. In this team, I needed to understand not only a result of neurologic exam but also vital signs, laboratory data, physical exams generally, and sometimes even therapeutic drug monitoring. Therefore, it takes much time for me to get used to the work. Additionally, it was unlucky that I have to pick up important information of the patient from an illegible handwriting. Because it takes much time, I always went to the hospital at 5 am in order to prepare for my presentation of the patient case before a pre-round with resident. After pre-round, we usually took part in a round with attending doctor. And if we get news of new patient, we quickly run into a emergency room. In this rotation, I was pressed for time constantly. However, I have never felt such a strong sense of fulfillment before that I joined the team as a medical student and was taught about such as treatment of the patient case by the resident.

Through these two months in Tulane University, I learned two valuable things as a medical student. First thing is about U.S medicine. To be sure, we can say that it offers high quality medicine if we give a consideration only to a point of view that many kinds of specialists follow up a particular patient together.But actually, advanced specialization and subdivision result in increasing cost of medical care. In turn, it is becoming more and more difficult for those with no insurance to access to medical care.

The system which provide high quality and expensive care for relatively wealthy people and cannot do for those with no insurance was quite surprising to me . The second thing is about medical education in U.S.A. It is worth paying attention to a fact that educational model which resident teaches medical student and attending teaches resident has established. Especially, It was impressive that attending tried to persuade the team by referring to articles when he gives feedback to medical student or resident about our presentation.

My third rotation was General Practice at Medical University of Vienna. Learning field was not at hospital but at GP's office in rural area in Austria. A doctor allowed me to follow him all day and stay his home. The doctor examined approximately 70 patients every day and visited home for patients who were difficult to go to office because of their health problem. To my surprise, the doctor remembered family background and past medical history of all his patients in the village. Honestly speaking, I was overwhelmed by his strong responsibility for people in the village. Through this experience, I came to realize that his ability to deal with many kinds of complaint or health problem quickly derived from this strong responsibility.

The most valuable lesson during these three months is understanding that there is a criterion for a good physician without relation to the difference between medical system in each country. Owing to the exchange program, I could meet so many doctors. For example, I met Japanesedoctorswho works as a clinician abroad, a member of the United Nations or a researcher, as well as those in Tulane University or GP doctors in Austria. Such meeting taught me that a good doctor is a person who has a strong responsibility for people's health. It is quite precious for meto learn it by meeting with doctors abroad.

Lastly, I would like to express my deepest appreciation for people who kindly supported me during this exchange program, especially Dr. Kasuya, Ms. Yamazaki, senior doctors, and friends who studied abroad together.　Thank you very much.

Report of medical elective at Warwick University in UK

Maiko Kurosawa(Warwick University)

Since 1/3 population died of cancer in Japan, I got interested in oncology, especially medical cares to support cancer patients until the very end.In UK, the concept of hospice and palliative care has been well developed, and oncology has more than 50 years of history.In addition, National Health System (NHS) provides almost all medical service for free. Therefore, when I obtained a chance to do my elective at Warwick University Hospitalin UK in this spring, I aimed to learn at least two points through elective, which are "the system of NHS" and "What kinds of cancer treatment and palliative care cancer patients can receive for free."

I did my elective in Oncology and palliative care for 5weeks and hematology for 2 weeks. In UK, an oncologist is in charge of chemotherapy and radiotherapy for cancer treatment. Therefore a surgeon, an internal medicine physician, and an oncologist are always working closely for a cancer patient. In addition, a plan of cancer treatment for each patient is discussed by multidiscipline team which includes a radiologist, a pathologist, and specialized nurses as well.

In oncology, the consultant who I attached to was specialized in palliative care as well as oncology. She was facing to incurable patients every day and often had to tell tough information to a patient and their family. In that difficult situation, her way to approach the patient was very impressive.Even if she had to explain about severe situation,she always tried to give some hope as well as accurate information. I was always moved by her warm words. But, on the other hand, I realized the fact that she was able to spare enough time for each patient because, unlike Japan,sufficient number of doctors and medical staff wereavailable.

Since I told her that I am interested in comprehensive cancer treatment, she introduced me to many different specialists, such as doctors in adult's and children's hospice, complementally therapist, chest surgeon, respiratory physician, medical chaplain, nurses specialized in end of life care, so on. Therefore I had great opportunities to learn their works and how they play roles in cancer treatment. I was impressed that each cancer patient was supported by many kinds of specialists until the very end, and many medical cares, including spiritual care, were provided for free.In addition, I found patients could also receive intensive medical supports from their local medical services. For example, when an end-stage patient wanted to go home, the patient and family discussed with a nurse specialized in end of life care to organize medical careswhich they would need at home, and GPs (local doctor) and district nurses were mainly in charge of medical care at home.It was surprisingthat they could offer a medical staff that stays at home even for 24 hours.

In hematology, I learned hematologist's works in clinic and ward following several doctors, and had opportunities to take medical history and physical examination from a patient, and made a presentation of that case.After my presentation, we had discussion about the patient. Furthermore, I participated in blood study session for junior doctors to learn how to diagnose based on pathological patterns of blood and also attended hematology class for medical students. When I joined hematology conferences which were held in the suburbs, I had chances to discuss about many topics, such as differences of medical system between Japan and UK, with doctors on the way.to and from the venue. Besides clinical study,the consultant who mainly took care of me in hematology invited me to his home party and concert held at church. It was my happy memory to talk with many people who had different background at the party, and went to the church together to listen to the masterpiece, "messiah", composed by Handel.

Exciting 7weeks passed very fast, but I learned a lot of idea and hints which will helpme to think about future Japanese medical system, especially cancer treatment and palliative care. Finally, I would like to express my sincere appreciation for teachers and staff that made great efforts to support this exchanging program. Thank you very much.