Isabel Trenholmさん

I arrived in Japan on June 24, 2023, where I was warmly greeted by Madoka, my program coordinator and contact person during my stay. She kindly helped me move into my accommodations and become acquainted with the hospital and surrounding city of Nishinomiya. My rotations ran for a total of 3 weeks, from June 26 to July 14. My first week, I rotated in the Department of Respiratory Medicine, followed by the Department of Cardiovascular Medicine, and lastly the Department of Emergency, Disaster and Critical Care. During these visits, I had the opportunity to sit in on patient encounters, observe various procedures, and ask questions and learn from HMU attendings, residents, and medical students. Below I have included brief summaries as well as some of the highlights of each of these rotations.

Department of Respiratory Medicine: HMU specifically specializes in research and treatment of Mesothelioma. I learned this was in part because the surrounding city of Nishinomiya at one point had a factory that exposed many of its workers to asbestos, and so the hospital sees a disproportionate number of Mesothelioma patients. The overwhelming majority of inpatient stays are for lung cancer and pulmonary complications caused by cancer. One such case I observed was a chest tube placement and drainage of a bilateral malignant pleural effusion second to cervical carcinoma. I learned how various lung cancers were treated using monoclonal Abs and immune checkpoint inhibitors as well as some of the complications that can occur. I also had the opportunity to observe several bronchoscopy procedures and later practiced using a bronchoscope simulator owned by the department. During my rotation I met and spoke to an English-speaking patient. We chatted about some of the cultural differences, his experience living in Japan as an American, and his favorite cities, attractions, and foods that Japan had to offer.

Department of Cardiovascular Medicine: During my rotations, I observed various procedures and even had the opportunity to scrub in for a couple of them. I was struck by the both the technology and teamwork I observed among surgeons, residents, nurses, technicians, and engineers, all with their own vital role. Some of the procedures I saw included TAVI (transcatheter aortic valve implantation), catheter ablation, transesophageal ultrasound, CT angiography, PCI, and echocardiography. One specific case I observed was a patient undergoing TAVI to correct an aortic stenosis due to severe calcification. I was struck by how a clinical intervention as major as valve replacement could be accomplished through such minimally invasive measures – a single incision into an artery. I was shown the two different types of replacement valves available and learned about the clinical indications for using one over the other. Following the operation, I had the opportunity to touch and handle the different catheters and balloon used during the procedure.

Department of Emergency Medicine: Each day began with a meeting discussing any overnight events or new admissions. This was followed by rounding in which each resident oversaw checking in with several patients and then monitoring them throughout the day. Later, the team would round as a bigger group seeing each patient to pass off to the night staff. The number of new patients each day was variable, and so every day was slightly different depending on how many patients were admitted and what exactly they were admitted for. Some cases I saw while rotating included a woman with Wernicke Korsakoff and a patient with a crush injury of the distal phalanx. My rotation in Emergency Medicine also prompted many interesting discussions about the differences in emergency care and healthcare in general between the US and Japan. For example, I learned that in Japan, there are fewer organs to harvest and use for transplant patients because of the lack of gunshot victims. One issue in Japan I learned is that ambulances are used very frequently for non-emergency and non-necessity cases because they are free. During a conversation with one of the attending, she shared that she also spent time studying in the US and told me how they found doctor patient encounters in the US less formal and more conversational. Furthermore, in most outpatient visits in the US, the patient will sit on an exam table, while in Japan, the patient will sit in a chair next to the doctor in an office. Lastly, and one of my fondest memories, was making and eating takoyaki with the ER attendings and residents one night after my rotation. It was absolutely delicious!

Outside of my hospital rotations, I was excited to find that I had ample time to explore all Japan had to offer! From cuisine, to shrines, to historical sites, shops, and museums, I took advantage of all that I could to immerse myself and connect with the country’s rich culture and traditions. And I am so grateful to the people that I met while there – doctors, residents, students – who helped me to do so! While in Japan I reconnected with Mayuko, a 6th year HMU medical student whom I had previously met in the United States while she was rotating as an exchange student in our RWJ hospital. She introduced me to some of her friends as well as students in the English-speaking club. Many days I was able to eat lunch with them during my break and go out to dinner / explore the surrounding area with them after my day in the hospital. Some of my favorite memories include watching a baseball game at Koshien Stadium – Hanshin Tigers vs. Chunichi Dragons, shopping in Osaka station, playing with hedgehogs and baby pigs at Japan’s animal cafés, and visiting Osaka’s National Museum of Art. The food was definitely one of my favorite aspects of my visit. I have always loved Japanese food and had a blast trying everything.

My abroad experience at Hyogo Medical University was truly unforgettable, and I am so grateful to everyone that helped to make this program possible. I will forever cherish the lessons learned and memories made both in and outside of the hospital.