Naoko Masutani (6th grade)

I studied abroad at the University of Wurzburg from April 2nd to April 26th, 2024. It was a 17-hour flight from Kansai Airport to Frankfurt Airport, with a transfer in Dubai. The flight that was scheduled to depart was delayed due to equipment trouble, and it started with an unexpected incident where we arrived one day late. From there, I took a train to Wurzburg, where my coordinator Katrin greeted me warmly. After that, I left my luggage at the dormitory and was shown around the hospital and the center of Wurzburg. My head was still fuzzy, but I couldn't forget the taste of the wine I drank while listening to the music playing around me on the bridge over the Main River, and I was able to enjoy the atmosphere of the wonderful city.

The training was originally scheduled to start on Monday, but since April 1st was a national holiday for Easter, it started on Tuesday. Initially, I was scheduled to rotate in the cardiology department for two weeks, but due to a conference, the first week was suddenly changed to training in the ICU. In the ICU, rounds began at 7:30 in the morning. After that, each patient is treated individually as needed. What surprised me the most was that a sixth-year student was inserting a central venous catheter (CV catheter) into a patient by himself. In Japan, I had the impression that CV procedures are quick and are done by interns, so seeing a student calmly doing it himself made me realize the high level of the students. Also, when an emergency patient was brought in, the sixth-year student took appropriate measures such as securing a route without any hesitation, and reported possible diseases to a senior doctor, which was impressive. I also assisted with ultrasound and CV there, but I felt a little frustrated at my lack of knowledge and experience. At first, I was confused because the doctors were running around the ICU looking busy, but I was told, "For now, just shadow the doctors. If you don't understand, feel free to ask me anything." From then on, whenever I entered the room, I put on gloves and tried to be proactive by asking, "Is there anything I can do?" and "Can I try?" At around 4:30 p.m., the night shift staff took over, and I went home.

In the Department of Cardiology, morning rounds began at 7:30. I was part of a team consisting of students, residents, and senior doctors. Together, we visited the patients' rooms, took physical examinations, and reported to the senior doctors. The rounds were all conducted in German, but the students and residents translated into English for me, so I was able to understand to some extent what was being said. After that, the morning blood collection was the students' job, so I pushed the blood collection cart around to each patient's room and took blood. After collecting blood with the students two or three times, I was surprised when they said, "I'll do this, so you take care of the patient over there," but after that, I was able to draw blood by myself. There was also a patient with valvular disease, so I listened to their stethoscope, and if there was a patient who could speak English, I was able to take everything from a general interview to taking physical examinations. I also did simple things like intravenous drip injections and securing a route.

For the next 1.5 weeks, I rotated around the anesthesiology department. The anesthesiology training at my university was only one week, so at first I was a little worried about whether I could keep up. However, Dr. Geier, who was in charge of me, carefully instructed me, and at first I received a simple explanation of how to use the bag valve mask and the machine, and I was able to enjoy the training very much, as I was able to secure a peripheral route, administer oxygen before anesthesia, insert a laryngeal mask, and intubate the trachea with a laryngoscope almost every time I had an operation. Of course, I had never had such an experience in Japan, and this was my first time. Even so, the doctors around me said, "Don't worry, we'll change if necessary!" and it seemed like all we had to do was practice. Also, during the anesthesiology rotation, I never got bored because I rotated around various wards such as psychiatry, obstetrics and gynecology, thoracic and cardiac surgery, and ophthalmology every day. In addition, after the morning conference, it is a daily routine to take a coffee break once the morning work has calmed down a little, and Dr. Geier served me his own coffee, which was one of the daily pleasures.

The last three days were spent in nuclear medicine. The opportunity to visit was my meeting with Professor Higuchi from the Department of Radiology. Professor Higuchi is also a doctor at the Heart Failure Center, where he is involved in the treatment and research of nuclear medicine. I was interested in him after hearing about his research and clinical practice. Furthermore, the University of Würzburg is actually the place where the famous Roentgen discovered X-rays, and it is also a place where nuclear medicine research is active. So I changed my plans a little and decided to visit the Department of Nuclear Medicine. I think one of the good things about this university is that you can schedule your training flexibly to a certain extent. In nuclear medicine, outpatient care starts around 9:00, and when the opportunity arises, I perform thyroid ultrasounds on patients. In addition, I read images in the image reading room, wrote reports together with the doctor while looking at CT and MRI images, and was taught the key points of reading images. There is also a ward for radioactive treatment for Graves' disease and thyroid cancer, and I had the opportunity to make rounds with students and senior doctors.

What I felt throughout the month was that compared to clinical training in Japan, which is mainly observation, Germany places more emphasis on hands-on training. Medical education in Germany is also six years long, just like in Japan, but sixth-year students spend one year as interns in internal medicine, surgery, and three medical departments of their choice, and also receive a salary during their training. Perhaps due to this influence, I thought there was a big difference in clinical experience at the time of graduation School of Medicine in Japan and abroad. Furthermore, during that time, there is no need to train at the university hospital you are affiliated with, and some students train at the hospital they want to work at in the future or overseas. When I talked to students, some said they wanted to work in Spain or Switzerland in the future, and one female student said she wanted to be a trauma surgeon in Africa. In addition, in Germany, there is a clear on-off system where you work when you work and rest when you rest, making it easy to work as a doctor, and in fact, more than half of School of Medicine students are women.

Living in Germany was a little expensive due to the weak yen, so I cooked for myself once a week. Every meal I ate out was so delicious that I ended up overeating every time. On holidays, local students invited me to their homes, I went sightseeing with students from Nagasaki University who were doing their training at the same time, my university professors took me out to eat, and we went to Munich, Heidelberg, and Frankfurt by ourselves, so I was able to spend a very fulfilling time.

This short-term study abroad program was a big challenge for me. Due to the language barrier and the fact that it was my first time studying abroad, I was unsure whether to apply until the deadline, but I knew that if I missed this opportunity I would regret it, so I mustered up the courage to apply. This month was an invaluable experience for me, and now I'm truly glad that I went.

Lastly, I would like to take this opportunity to thank all the people who helped me during this internship, including the professors at Hyogo Medical University, the professors at the University of Wurzburg, the coordinator Katrin, the students, the International Exchange Center staff, and Fumino-san, who spent a month with me. Thank you so much.