Aimi Fumino (6th grade)

I would like to report that I completed my clinical training at the University of Wurzburg in Germany for four weeks from April 2 to April 26, 2024. There are two reasons why I wanted to study abroad in Germany. First, I was inspired by the fact that a senior in my club had studied abroad the previous year. I was very interested in hearing about the differences between clinical training in Germany and Japan, and I thought that taking on the challenge would definitely be useful in my future medical career. Secondly, in the summer of my fifth year, I participated in a medical ethics program at the University of Washington in the United States, where I had the opportunity to discuss with doctors practicing in the United States. I felt that my perspective had broadened and I wanted to learn more about global medicine. Here, I would like to share what I learned and felt based on the experiences I had during my clinical training.
First of all, Wurzburg is a city on the Main River in southern Germany, surrounded by wine fields, and walking around the town you can feel the European atmosphere with churches and castles. Wurzburg University has a long history of over 600 years, and hospital buildings are scattered throughout the town, which still remain today. The university is very proud of Dr. Roentgen's discovery of X-rays and his Nobel Prize, and all students learn about Dr. Roentgen's achievements in their first class. The university is known for having produced 14 Nobel Prize winners.
I trained in the Department of Anesthesiology for the first two weeks. The reason I chose the Department of Anesthesiology is that in Japan, I only have one week to observe anesthesiology, and I wanted to study hard if I was going to be in surgery, and I heard that Dr. Geire, an anesthesiologist, is very welcoming to Japanese students and will provide thorough support. There are buildings for each medical department on the university campus, and each building has an operating room. I trained in the operating rooms of Ophthalmology, Head and Neck Surgery, Plastic Surgery, and Obstetrics and Gynecology. The first thing that surprised me about my training in the Department of Anesthesiology was that there was an induction room and a recovery room. In Japan, patients enter the operating room while awake, and induction and awakening are done in the operating room, but in Germany, there is an induction room next to the operating room, and anesthesia for the next patient begins when the previous operation is about to end, and as soon as the operation is over and cleaning is finished, the anesthetized patient is taken to the operating room and the operation is completed. After the operation is over, the patient is woken up from anesthesia outside the operating room under the supervision of an anesthesiologist, and is taken to the recovery room. In the recovery room, anesthesiologists and nurses constantly monitor the patient's condition, and when they judge that the patient's pain has disappeared and that their mental state has stabilized, they send them to the general ward. Personally, I felt that this system had the disadvantage of not doing everything in the operating room, but by moving the patient, there were moments when the monitor was off for a few seconds even though the patient was asleep, but I felt that it had the advantage of efficiently progressing the operation. Another big difference from Japan was the way they interacted with the patient. Perioperative management is the role of the anesthesiologist, so the anesthesiologist was responsible for picking up the patient before surgery, talking to the patient's family just before the operation, calling out to the patient who woke up, and explaining the operation to the patient and their family immediately after the operation. I was able to observe all of these scenes from close up, and in between, I was taught about anesthesiology, and I was able to experience many things that are difficult to experience in Japanese training, such as securing a peripheral route, administering oxygen before anesthesia, and inserting a laryngeal mask. I was also allowed to accompany the induction of anesthesia for electroconvulsive therapy for depressed patients in the psychiatric ward, and was in charge of ventilation before and after the procedure for all patients. At first, I was looking at the numbers on the machine, but the doctor taught me that it was important to look at the patient and feel, not the machine, so I was able to observe the patient's chest and abdomen and feel their breathing myself. It all comes down to practice, and all the doctors, nurses, and patients accepted it, so I was able to spend a very meaningful two weeks.
In the third and fourth weeks, I did my practical training in the Department of Radiation Oncology. There are not many opportunities to do practical training in radiation oncology in Japan, so I chose to study in the place where X-rays were discovered. Every day, the radiology department starts at 8am with a conference where doctors and physicists discuss the patient's radiation treatment plan for about an hour and a half. It was all in German, so it was difficult to understand, but the teachers and the students who accompanied me translated it into English each time, which was very helpful. As for the contents of the practical training, I was able to observe the explanations the teachers give to patients before radiation therapy and the follow-up after radiation therapy, and I actually observed radiation planning CT, external radiation beam irradiation, and brachytherapy. Patients who can live their daily lives are not hospitalized and receive treatment while visiting the hospital every day, but there is a radiation oncology ward for patients who need to be hospitalized, and I accompanied them on the rounds there and performed physical examinations. The treatment that left the biggest impression on me was total body irradiation (TBI) for a 6-year-old boy with leukemia. This treatment is only available at a limited number of hospitals in Germany, and many patients come to Wurzburg, Germany from other countries for treatment. It is also performed in Japan before hematopoietic stem cell transplantation, but I have never studied it in detail or seen the treatment in person. The lungs and brain are protected by a protector made with a 3D printer, and treatment is performed with a small amount of radiation per treatment, so I was able to imagine the treatment from a physical perspective. During the two-week practical training, I was able to learn a lot about various malignant tumors such as breast cancer, prostate cancer, cervical cancer, rectal cancer, lung cancer, nerve tumors, and brain and bone metastases of other cancers, as well as about radiation therapy and chemotherapy, and the subsequent progress. Since I want to treat tumors in the surgical field in the future, this was a good opportunity to study radiation therapy, which is an inseparable part of that.
After the training, I cooked with ingredients I bought at the supermarket, went out to eat with international students from Nagasaki University and German students who came to Hyogo Medical University Medicine recently and will come next year, and had a home party with them. It was a very fulfilling experience and I was able to enjoy a lot of international exchange. On the weekend, I took the train to Frankfurt, Munich, Rothenburg, and other places for sightseeing, and enjoyed a month of life in Germany. Before going, I had a lot of worries, such as whether I could live abroad, whether I would be okay if I couldn't speak German, and whether I would be able to get along with the local doctors and students, but thanks to everyone, I had a lot of fun and was able to have a very valuable experience that I will never forget. Finally, I would like to express my gratitude to the professors at Hyogo Medical University, the professors and students at Wurzburg University, and everyone else who was involved in giving me this wonderful opportunity. Thank you very much.