Ivan Ševeljevićさん（リエカ大学第5学年次）

I was really happy and honored to be one of three students that got the opportunity to experience exchange in Japan and do clinical clerkship at Hyogo College of Medicine. It turned out to be the best month in my life!

In the middle of August, after big preparations (buying plane tickets, packing our big luggages etc.) we were on a flight (Zagreb-Dubai-Tokyo) to Japan. After 20 hours of flying we were finally there and although tired because of the jet-lag, we tried our best to visit as much as possible. Immidiately, we were surprised by how big Tokyo is. Completely different from anything seen before in Croatia or Europe; high-tech city that is huge, crowded, has lots of tall buildings and commercials. Spending time in the capital of Japan was excellent experience as we managed to visit some of the cities top attractions (Meiji shrine, Asakusa, Akihabara, Shinjuku, Ueno park etc.). I hope we will return to visit the Olympics 2020 because we really loved it!

However, our exchange was taking place in Nishinomiya, so after 5 days in Tokyo we had to take the night bus to Osaka. When we got there, we were taken to Guest House of Hyogo College of Medicine which turned out to be great accommodation; little beautiful house really close to the hospital that has everything you need. After unpacking our things and introducing ourselves to Anna, an exchange student from Germany, we went to welcome dinner with really nice Japanese students (they came to Croatia after our exchange in Japan ended). Next day we made a small daytrip to Osaka and on Monday our clinical clerkship started. Andrej was doing his clerkship in Endocrinology, while Luka and me had similar schedule, rotating each day between these departments: Anesthesiology, Intensive Care Unit, Emergency Medicine and Pain Clinic. Hyogo College of Medicine hospital is very big and it has lots of buildings, so it took us couple of days to learn how to get around. It was very interesting for us to see how very modern, new, clean and beautiful this hospital is. Equipment is the highest quality (we have seen some things that we do not have yet in Croatia, for example DaVinci machine for robotic assisted surgery), as we expected before coming to Japan, because we knew that Japan is one of the most developed countries of the world. First day, we made a quick tour around hospital to introduce ourselves to our mentors on each department, and we got schedule for following weeks. Everyone was very nice and kind, so we instantly knew that the next few weeks in hospital were going to be great.

Usual day was different in each department. At Anesthesiology, each day we got the opportunity to visit different operations, to observe or even help our mentors. We learned how to intubate patients and ventilate during induction of general anesthesia. We discussed different drugs and methods used in preoperative preparation of the patients and also the parameters that are important in monitoring during surgery. In my opinion, the most interesting were cardiac surgery procedures and the use of TEE (transesophageal echocardiography). I was extremely happy when I found out that we were going to learn it and try it. In the hospital, there is a room with different kinds of simulators for learning. For me, this was one of the highlights of our clerkship as I think this is the best way for students to learn practical skills. Some of the simulators we practiced on are really advanced and those types of simulators are what we do not have in Croatia. As I mentioned before, we were promised to learn echocardiography, so we did it in this room; from learning basic projections of both TEE and TTE (transthoracic echocardiography) to solving different „cases“ and learning the possible pathologies of the heart (all of that with the help of our mentor, of course). We had great time and many interesting lectures in this department, but I have to mention that doctors also learned something from us. During last week, we made a powerpoint presentation about Croatia and everyone looked interested and liked it very much.

In Intensive Care Unit, we discussed different aspects of Intensive Care Medicine. Each day, we had conferences with both Intensive Care Unit and the Infection Control Unit. During these meetings, we discussed patients that are currently in the department and after that we would go on a round to see the patients ourselves. One of the most interesting things for me was learning about ECMO (extracorporeal membrane oxygenation), invasive and noninvasive ventilation (we even got to try noninvasive ventilation ourselves!). Both Luka and me got our own themes to do a little research on, and we presented those themes to other doctors during one of the meetings. Emergical medicine day would start with a simmilar meeting where we would learn about different serious health conditions and how to treat them. It was interesting to find out about Burn center and treating the burned patients. We observed and even helped during the treatment of one unlucky old lady who got her chest seriously burned. Pain clinic was also very interesting and useful for us, although we stayed there for only 2 days. This part of medicine is still being developed in our country so it was great to see something new.

To conclude, all of the clinical pratices were very useful and we learned quite a lot. After staying in Japan my interest in Anesthesiology and Intensive Care medicine grew bigger, so I can say this exchange was very successful for me!

Learning in the hospital was not the only thing we did in Japan, as we made sure to get the best out of our free time. During weekends, we had so much fun as we visited nearby places and cities. First weekend, we visited Nara (we really liked feeding the deers) and Himeji castle. Second week, we made a two day trip to Tokushima with our friends from Intensive Care Unit; there we went on an exciting rafting tour on Yoshino river. Last weekend, we stayed whole weekend in Kyoto where we were astonished by its cultural and historical meaning. On our way back, we stopped at Ibaraki to have a wonderful dinner with Prof. Okamura, one of the most important scientists in Hyogo College of Medicine, at his 200-years old traditional Japanese house. During weekdays, we also tried our best to sightsee places after our practices; on several occasions we went to Kobe and Osaka, and also to Koshien to see the baseball match for the first time in our life. Although our schedule was busy, we did not miss the opportunity to experience Osaka and Kobe's nightlife and we were not dissapointed at all (special thanks to Yosif, great guy from Bulgaria who is doing scientific researches in Hyogo College of Medicine hospital). All in all, Japan is a really interesting country with lots of historical and cultural attractions, and we managed to see only a little part of it.

After describing a bit how our days looked like in Japan I would like to highlight two things that surprised us the most and that were best in Japan; people and food. In my opinion, Japanese are one of the kindest and nicest nations in the world. Everyone tried their best to make us feel welcomed and to make our stay in Japan as good as possible. They were very interested in learning about Croatian country, culture and people (and to know how tall we are). Although English is a big problem in Japan (which also very surprised us) we managed to find our way of communicating with everyone, we made quite a lot new friends and met many interesting people. Friends we made are the best thing about our stay in Japan and we really enjoyed spending time with them, in the hospital or out of it (for example we had a really good night out last week with the doctors from our department). I really liked the working atmosphere in all of the departments; relationships between coworkers are really good and friendly. There were a lot of „team building“occasions (lots of dinners and the Tokushima-rafting trip) on which we were invited, like the rest of the department. I think this is very important and I hope that someday I will work in an atmosphere like this, where everyone is friendly and kind to each other. Also, we felt really safe during our whole stay, we did not have any uncomfortable situations and in my opinion, Japan is probably the safest country in the world. Food was another great thing that blew our mind. It was very delicious and we tried quite a lot new things-for example Okonomiyaki (our favorite), Kobe beef (best meat in the world), Takoyaki, Sushi, Yakitori, etc. We are already starting to miss Japanese cuisine.

5 weeks in Japan flew by very fast as we experienced a lot of new things (and took thousands of photos) and we were very sad to leave. However, there are many, many things we did not see or try (for example climbing Mt. Fuji, skiing in Nagano, swimming in Okinawa, going to Onsen...) so I am sure I will come back in Japan some day in the future. Also, I hope to meet wonderful people that we met during our stay again; maybe in Japan, Croatia or somewhere else in the world if we meet on some medical congresses.