Shino Tokai (6th grade)

For four weeks from April 1st to April 26th, I did my clinical training at Rutgers Robert Wood Johnson Medical School in New Jersey, USA. Since I enrolled, I had wanted to study abroad during my early years, but the COVID-19 pandemic made it difficult. It was a very difficult decision to apply for this program in April of my sixth year, but I thought that if I didn't take on the challenge now, I would regret it for the rest of my life, so I decided to study abroad. I haven't decided what field I want to go into in the future, but there were many similarities between the image of the doctor I want to be and the idea of Family Medicine in the United States, so I applied to this program because I wanted to experience the real thing. This month has been very stimulating and unforgettable.

During the first two weeks, I worked with Dr. Lin, a Family Medicine doctor, and not only did I see patients in the hospital or attend outpatient clinics, but also attended university classes. The university hospital and office are about an hour away from New York by train, and I walked to school from the apartment where I was staying. Patients with a variety of complaints visit the Family Medicine outpatient clinic. The age range of patients is wide, from newborns to people in their 90s, and Family Medicine doctors see them. Not only are they of different ages, but they also speak a variety of languages. There were patients who only spoke English, some who only spoke Spanish, and some who only spoke Chinese, so there was a lot of diversity, as is typical of America. At times, we used a tablet to conduct interviews through an interpreter. In Japan, if you have abdominal pain, you would see a gastroenterologist, and if you have a stuffy nose, you would see an otolaryngologist, but the doctors at Family Medicine see all patients, whether they have abdominal pain, dizziness, or stuffy nose. I was surprised at the overwhelming amount of knowledge they had. In addition, because there is no system like the Japanese universal health insurance system in the United States, it was impressive to see doctors and patients discussing what insurance would cover what extent of treatment when considering a treatment plan. They discussed not only illness but also prevention for the future, and I felt the difference in awareness of medical care compared to Japan. At university, I received a lecture on acupuncture, which is Professor Lin's specialty. If there was anything that the students themselves were unsure about, they asked the professor on the spot, and by asking questions, the students' own understanding deepened, and I realized how important it is to be proactive. I was also able to visit Promise Clinic. Promise Clinic is a student-run clinic where medical students provide free primary care to patients who are uninsured, including consultations, tests, and medication. Medical students form teams of four, one from each year, from 1st to 4th year, and examine patients. The system is that 1st and 2nd year students mainly examine patients, and 3rd and 4th year students teach while providing team medical care, and when I visited the clinic, they didn't look like students at all. For patients who could not speak English, students were assigned as interpreters, and students studying social support followed up on social support, so everything was student-led. The students would take their own medical history, make their own diagnosis, think about future plans and medication, and give a simple presentation in front of the doctor. They made their decisions taking into account not only the diagnosis, but also various background factors such as the dosage of medication and cost issues. A single patient was examined by the same team on an ongoing basis, making it easier for patients to continue their treatment. Seeing how the students were taking the lead in everything, I was overwhelmed by the high level of awareness and knowledge of American medical students, and it was very inspiring.

In the last two weeks, I visited the Neurosurgery, Clinical Pathology, Basic Research, and General Surgery departments where Japanese doctors work, with Dr. Ikegami from the Cardiothoracic Surgery Department as the center. I had had the opportunity to read about Japanese doctors working overseas in articles, but I thought it was a story from a faraway place. However, by actually meeting them, I was able to hear a lot about how difficult it was and what Japanese people can do to work overseas, and it was an encounter that had a big impact on my future. In the Cardiothoracic Surgery Department, approximately 1,700 surgeries are performed annually, and at times, one doctor can perform four surgeries a day. I think that the presence of nurses who have passed special exams such as Physician Assistant/PA and Nurse Practitioner/NP is a major factor in making it possible to perform so many surgeries. In Japan, it is common for doctors to assist surgeons, but in the United States, PAs and NPs are responsible. Therefore, the surgeon is the only doctor performing the surgery, which makes it possible to perform many cases. In addition, in the General Surgery Department, a resident doctor was in charge of the robotic surgery. In this way, I realized that it is possible to gain surgical experience from a young age. In addition to observing surgery, we were also able to visit the lab of a professor conducting basic research, and in the clinical pathology class we were also able to observe a pathological autopsy.

I had many experiences this month. Actually, I was very anxious before I left for the US because it was my first time living alone and going abroad. I had a hard time getting used to it for a few days after I arrived. However, I was supported by Dr. Lin, the medical staff, and the students, and I was able to spend a fulfilling, fun, and exciting month. Dr. Lin helped me a lot when I had trouble at the apartment. The students took me to the supermarket because I didn't have a car, went sightseeing in New York and Princeton on the weekends, and played pickleball together (a sport similar to tennis that is apparently popular in the US these days). Also, on a personal note, the students prepared a cake for me as a surprise on my birthday. There were times when I struggled to communicate in English, but thanks to the kindness of many people, I was able to spend a very fulfilling month.

There were many difficulties in going to America alone, but every day was a new experience and a challenge, and it was an exciting month. I feel that participating in this program had a big impact on my life. I am really glad that I decided to take a step forward and challenge this program at that time. I would like to express my gratitude to the professors at Hyogo Medical University of Medicine and the International Exchange Center, the students and professors at Rutgers Robert Wood Johnson Medical School including Professor Lin, the staff at Robert Wood Johnson University Hospital including Professor Ikegami, and my family and friends who supported me. I would like to continue to challenge myself in various things with this experience in mind.