Kentaro Shimizu (6th grade)

I would like to report that I completed a one-month elective internship in the Department of Anesthesiology and Nuclear Medicine at the University of Würzburg from April 1st to April 28th, 2019. The University of Würzburg is located in Bavaria, Federal Republic of Germany, and its official name is Julius-Maximilians-Universität Würzburg. In this article, I would like to talk about the differences in the medical systems and clinical settings between Japan and Germany, as well as my personal impressions.


The University of Würzburg has a history of about 600 years, and is the university where Philipp Franz von Siebold, the famous doctor of Dejima, graduated, and where Dr. Roentgen, the discoverer of X-rays, taught. It was a great experience to be able to do my practical training at a university with such a long history.

First, the first two weeks were my anesthesiology training. The anesthesiology department started early, with a morning meeting time of 6am every day, and we exchanged information at a general conference, and then anesthesiologists were seconded to each department, such as orthopedics, ophthalmology, obstetrics, pain clinic, psychiatry, and surgery. This time, I experienced psychiatry, ophthalmology, and orthopedics. I wondered what anesthesiologists do in psychiatry, but I understood when I was told about the difference between treatment in Japan and Germany. It is not a major treatment in Japan, but in Germany, they often use something called electrotherapy for depression. This therapy is exactly what it sounds like: electricity is applied from electrodes attached to the head, which causes the muscles in the whole body to contract as a side effect, inducing considerable muscle destruction, so muscle relaxants are used in the short term to prevent muscle destruction. That is why anesthesiologists are needed. The basic bag valve mask technique I learned here is essential to becoming an anesthesiologist, and I practiced it repeatedly many times. What I felt and learned here was that Germans have large faces, so it is impossible to create a tight seal with one hand and stable ventilation is not possible; however, this is not simply because their faces are large or because Germans all have large hands; rather, perfect ventilation can be achieved by adjusting the direction of the back valve, the amount of pressure applied, the position of your fingers, etc.

Besides psychiatry, I also went to ophthalmology and orthopedics for anesthesiology training. There was a crucial difference between Japan and Germany. That was the presence of an invasion room. In Japan, anesthesia is administered in an operating room, but in Germany, anesthesia is administered in this invasion room. However, only anesthesiologists and the nurses who work under them are allowed to enter this room. The purpose of this is to ensure that surgeons cannot be rushed, and to prevent medical errors by providing time and mental space. The background to the creation of such rooms is deeply connected to the German education system, and I would like to briefly mention this.

In Germany, when teaching students or interns, senior doctors teach them one-on-one. In that case, students are not mainly observed, but are actively made to perform invasive procedures. This inevitably takes time for instruction and procedures. If anesthesia is administered in the operating room, the surgeon will be pressured to start the operation quickly, which may result in mistakes and sometimes even threaten the patient's life. For this reason, it is said that the invasion room was created to create an area that is inviolable by anyone other than anesthesiologists, and to ensure both education and safety. And like many others, I was also able to actively secure the line, intubate the trachea, and intubate the laryngeal mask, which was a valuable experience.

In the last two weeks, I had practical training in nuclear medicine. Unlike Japan, radiation therapy is performed almost every day in Germany, and Germany is at the forefront of nuclear medicine treatment. Patients with Graves' disease were treated by having them swallow radioactive capsules, and patients with pheochromocytoma were treated by intravenously administering radioactive liquid medicine. I also received lectures on ultrasound techniques and the key points of reading CT and MRI images. Unfortunately, it wasn't during my practical period, but on the day of the regular inspection of the MRI, I was able to have the rare experience of seeing the inside of the MRI.

I have always been very interested in going abroad, and I applied for every opportunity to study abroad at my university. However, this time, the program was longer than my previous ones, at one month, and I was doing the training alone, so I was very anxious and felt more like it was a challenge than something I was looking forward to. However, now that I have finished this program, I truly feel that I am glad I went, and it has become an invaluable asset for my future life.

I would like to take this opportunity to express my deep gratitude to Dr. G, who enthusiastically guided me during this study abroad, B, who consulted with me during my stay, Mr. Torii from the International Exchange Center, and everyone else who helped me with this study abroad. Thank you very much.