Sophia Tumsudenさん

As a rising second-year medical student at my university in the United States, embarking on my first trip to Asia, I was both excited and apprehensive to participate in the international medical student program at Hyogo Medical University. I was not sure what to expect from the large language, cultural, and social differences, however I was looking forward to experiencing healthcare in such a distinct setting. I arrived in Japan on June 20, 2024, accompanied by my friend and fellow Rutgers medical student, Kavya Atluri. Experiencing the program with a companion was invaluable, allowing us to share and reflect on our experiences along the way.

Madoka, our contact at the Center for International Programs, helped us get settled and guided us through our preparations for the four-week rotation at Hyogo Medical University. We had the opportunity to request specialties for observation, and as someone interested in anesthesia and surgery, I was thrilled to be assigned two weeks in each the Anesthesiology and Lower Gastrointestinal Surgery departments. Over the course of the program, I engaged in numerous meaningful interactions with doctors, residents, medical students, and patients alike. I am profoundly grateful to all who shared their knowledge and kindness with me during the program. I would like to share a few of the highlights from each rotation.

During my rotation with the Anesthesiology Department, I was paired with a different attending or resident each day, providing me with exposure to a diverse range of cases. For example, one day I observed a cesarean section procedure with subarachnoid spinal anesthesia, allowing the patient to remain conscious during the procedure, and the next day, I observed a heart valve repair procedure involving one-lung ventilation for the surgeon to access the heart. In addition to the diversity of cases, I was intrigued by the intricacies of the general anesthesia procedure, although different for each unique patient, and the use of data points from the anesthesia monitors for induction, management, and emergence. For example, I learned about the use of rocuronium, a muscle relaxant, and the Train of Four (TOF) monitor used during induction to ensure the patient’s muscles are relaxed enough to attempt intubation. I also spent time in the Intensive Care Unit and the Pain Clinic, where I observed various procedures including a bronchoscopy, numerous ultrasound-guided anesthetic injections, and a spinal cord stimulator placement. I truly gained an appreciation for the depth of knowledge and skill required for a career in anesthesia and the wide variety of career paths available to anesthesiologists.

My subsequent rotation was with the Lower Gastrointestinal Surgery Department. During this rotation, I was paired with Dr. Kimura and observed other members of the Colorectal Surgery department as well. I observed morning rounds, surgeries and outpatient clinic visits at a nearby hospital. I witnessed several colorectal cancer surgeries involving the removal of a portion of the colon and/or rectum. I learned about different aspects of cancer staging and saw a variety of different colorectal cancers in the excised specimens. For instance, I learned that while T1a staged disease can usually be removed using an endoscopic procedure, a T1b staged disease typically requires resection surgery due to infiltration of the submucosa. In addition, I learned about some differences between the United States and Japan in colorectal surgery procedures. For example, the United States uses the low-tie technique for resection of the inferior mesenteric artery and Japan uses the high-tie technique. One of the reasons for this difference in technique is that in Japanese patients, there tends to be less peri-aortic fat, allowing for better visualization and avoidance of the autonomic nerves when isolating the inferior mesenteric artery with the high-tie technique. These nerves would be more difficult to preserve in a typical American patient using the high-tie technique, so the low tie technique is preferred. I found it very interesting to learn how these differences in patient populations can lead to the use of distinct techniques. Finally, a particularly memorable experience was participating in a laparoscopic suturing simulation with Hyogo Medical University students, guided by Dr. Matsubara. I am very grateful to Dr. Kimura and the rest of the Lower Gastrointestinal surgery department for the wonderful experience!

These rotations were invaluable as a rising second-year medical student, especially as I had not yet studied Anesthesiology/Pain Management or the Gastrointestinal system in depth. The opportunity to learn about these new topics in a clinical setting was enriching. In addition, I really appreciated the opportunity to talk with Hyogo Medical University medical students and doctors about the differences in culture, education, and healthcare between the United States and Japan. My clinical experiences throughout the summer internship program were incredibly valuable in expanding my knowledge of medicine and healthcare systems and in developing cultural awareness as a future physician. My heartfelt thanks to Hyogo Medical University for this incredible experience!