Shu Mukai (6th grade)

I will be studying abroad at Julius-Maximilians-Universität Würzburg from April 3rd to April 28th, 2023, and I would like to share the details of my experience. My motivation for applying was that I had wanted to study abroad while I was a student to broaden my horizons, and I was interested in the differences between the modern Japanese and German healthcare systems, as Japan's healthcare system was created and developed based on the German healthcare system. The study abroad program, which was suspended in 2019 due to the COVID-19 pandemic, has resumed for the first time in four years. The recruitment period was only two weeks after the announcement of the resumption of the program, and I was not good at English, had no German language skills, and had little overseas experience other than the opportunity to study abroad in Shantou, China for two weeks in my second year as part of a university program, so I was worried about applying to study abroad. However, through this study abroad experience, I learned that by taking on challenges and dealing with the difficulties that arise, I can broaden my horizons. I also had the opportunity to think about the advantages and disadvantages of Japan's medical care and medical education system through interactions with local students and teachers, and I feel that it was a valuable experience.

I did clinical training in the cardiology department for three weeks and the anesthesiology department for one week. A day in the cardiology department starts with rounds. What was interesting was that two teams visit the rooms of the patients in charge of each department, the head professor's team starting at 7:15 and the mid-career doctor's team starting at 7:30. The difference was that patients with private insurance were visited by the former team, and patients without insurance were visited by the latter team. I participated in both rounds, and although the head professor's team usually finished first, they took about an hour and a half to make the rounds. All the conversations were in German, but the students explained things to me in English, so I was able to understand to some extent. After that, the students' job was to go around the ward and take blood samples from hospitalized patients, and I took blood samples with them. There were about five COVID-19 infected patients in the ward, but they were not treated specially except for being isolated in individual rooms and having to wear gowns when entering the room, and I also had the experience of taking blood samples from them. After the students divided up the work and finished taking blood samples from the ward patients, we looked at the patient's chart, compiled the questions to ask in the interview and the physical examination to be performed based on the electrocardiogram and blood test results, and then headed to the patient. Since many of the patients in the cardiology department are elderly, many of whom cannot speak English, I watched the students take the interview next to me. The German student and I took the physical examination separately, and then we confirmed the findings with each other. Since I did not have many opportunities to take physical examinations during my clinical training in Japan, I was confused when the German student wrote my opinion in the chart, but gradually I became comfortable with auscultation, percussion, and palpation. After that, I had lunch with the students, and in the afternoon, the students explained the pathology of the patients while looking at their charts, and I observed procedures such as CAG and PCI. When I told the doctors that I had never seen TAVI in Japan, I was allowed to enter the TAVI surgical field once.

Würzburg University also has a Fabry Disease Center where Fabry disease patients from all over Germany are examined. As it is a rare disease and I really wanted to meet a Fabry disease patient, I asked a cardiologist to let me visit the Fabry Disease Center for half a day. At the Fabry Disease Center, they follow up and research the cardiac symptoms (heart failure, arrhythmia, and ischemia due to cardiac hypertrophy) of patients who have already been diagnosed, and I was able to observe lectures on Fabry disease and exercise stress electrocardiogram tests. I learned a lot of new information, such as the characteristic waveforms (knotung) that appear during exercise stress.

I spent the last week in the anesthesiology department. The differences between anesthesiology in Japan and Germany are as reported by my seniors who have studied abroad before, so I will not go into details here, but I was able to observe the head and neck surgery, obstetrics and gynecology, dermatology, and plastic surgery operations. Dr. Geier of the anesthesiology department has a deep knowledge of Japanese culture and is familiar with the system of Japanese School of Medicine, so he gave me the opportunity to secure a peripheral route, administer oxygen before anesthesia, intubate the trachea using a laryngoscope, and wear a laryngeal mask, even though he knew that I had little practical experience. Dr. Geier repeatedly told me, "learn, do it, and teach it by yourself," and told me many times that you can only say you understand something if you actually experience it yourself, put it into words, and teach it to others, rather than just watching. Unlike Japanese medical education, which is mainly based on observation, in Germany, where students perform the tests and procedures, the students are certainly able to understand the contents of the test findings more deeply than I was, and I felt that there was a reason for this.

Regarding the differences in medical education and healthcare systems between Japan and Germany, in Germany, medical students performed the tasks that interns do in Japan. Although it is the same 6-year system, in Germany, practical training begins in addition to classroom learning from the third year. Also, I felt that German students had a stronger sense of responsibility because they were entrusted with invasive tasks. On the other hand, compared to Japan, nurses are not allowed to perform invasive procedures such as blood sampling, and as far as I could see, there were no laboratory technicians, so doctors have more work to do than in Japan, and it cannot be denied that this is due to the medical students. There are three national exams during the student's studies (2nd year: Basic Medical Written Exam, 5th year: Written Exam, 6th year: Oral Exam), so it is necessary to study in a planned manner, but I heard that an app called Amboss, which is equivalent to Japan's medlink, automatically creates a study plan for each student, and I thought it was a very rational system. For regular university exams, the university distributes past exam questions and model answers, and students study using Amboss and textbooks while solving them. When I asked for more details, I learned that originally the teachers had not distributed questions or answers, but students would end up reproducing the questions, and the reproduced questions were sometimes incorrect, so the teachers started distributing the questions. As an aside, I was surprised to see that the electronic medical records were almost entirely voice-input using an app called "Dragon Medical Direct." The insurance system is the same as in Japan, with universal health insurance, but some people also subscribe to private insurance, which allows them to receive a higher level of medical care. I thought that economic disparities in Germany may easily lead to disparities in medical care.

Finally, I would like to express my sincere gratitude to the professors at Hyogo Medical University, the professors and students at the University of Würzburg who worked so hard to make this internship possible, and to everyone else who spent a month with me, including Mr. Fukuwatari.