Leaving for the US tomorrow!

What a great month I had in Japan. I wrapped my visit today with a good friend Kazu and his family to tour around Nagoya. He brought us to a very nice restaurant for lunch; we had shabu shabu (Japanese hot pot) and blowfish sashimi! I will post photos when they're uploaded later.

I have to say I feel very bittersweet that I am leaving. Although I'm eager to go back to NOLA, I feel so indebted to these great friends in Japan because they have been incredibly nice to me. I hope these friendships can last for a long time and I will get to be a host for them someday.

Last Day at work!

Today marks the last day at work in Nagoya! I know I have been lazy updating my blog but it doesn't mean I did not have a great time. The friendships I made here are incredible and I am sure I will get to keep in touch with them for a long time to come. Here are some photos I took on my last day at work:

The cardiac department staff. They're all super nice to me and took care of me during my stay there.

Aki and I. She is the secretary of the int'l exchange program. We went out one night and had lots of fun at a Japanese bar (Izakaya)!

Dr Kasuya and I. Dr Kasuya is the director of the int'l student exchange program. Also took care of me very well.

Like my Uganda traveling blog, a lot of my entries from now on will be not real-time, meaning I will type it up in work document and post here.

Difference in Education continued – Hierarchy

As I alluded in the previous entry, there seems to be a lot of defined roles in the Japanese medical system and there is very little fluidity. I understand hierarchy in medical system is often necessary to ensure efficiency and patient safety, but I feel that the Japanese hierarchy is often time-wasting, un-educational, and hopeless. For example, we US students and residents often complain about the scutwork (blood draws, transport, etc) being un-educational and decrease the work efficiency. In Japan, scutwork is all they do, with the exception of professors. From what I have heard, the internship and residency training in Japan is pretty much all scutwork. There is very little emphasis on education. Interns/residents learn important management skills by watching, and there is very little time for organized lectures and teaching because it is so busy in the hospital.

In terms of surgical cases, the attendings cannot operate on their own; they must wait for the professors to arrive to begin the vital part of the operation. For a CABG, attendings can cut open the chest and start harvesting internal mammary artery, but the actual CABG must be done by the professors in most cases. Therefore, I often see some attendings hold retractors and suctioning for a few hours in a case (just like what med students do in the US) until the professors finished the vital part of the case. It is therefore not difficult to understand that Japanese doctors often have lots of gripes about their work condition and want the autonomy that they think they deserve.

Differences between the US and Japan - Education system:

I will attempt to do a brief analysis from the top down: “professors” à attendings à residents à medical students. The first day that I started working in the cardiac surgery department, I noticed a big difference from the US: there was no resident! The cardiac surgery department has about 10 staff surgeons, but only 3 of these 10 have the “professor” ranks. The professors usually are much older (at least 50) and have more experiences in operations. The other 7 are just attendings. How this works is that the “professors” are the real first operator in the OR, and the other attendings were merely assisting them during the case. Occasionally, the attendings will get to be the first operator, and the professors will assist, but these are only in straight-forward cases. Therefore, the attending surgeons actually act like the residents in the US in my opinion.

So where are all the residents? Apparently, most residents work in community/county hospitals where the standard of care and complexity of cases are lower than an academic hospital like Nagoya. It is interesting to note that in Japan, medical students graduating from med school will go do a 2-year internship year (very similar to the transitional year in the US, where they do rotations in all disciplines), and then go into specific residency of their choice. To specialize in some disciplines like CT surgery, there’s technically no “fellowship” like in the US; the residents that are finished with their residency will get hired by the specific department and start their training there (it’s more like an apprentice, in my opinion.)

Finally, onto med students. The medical education in Japan is like everywhere else in the world (except for the US). High school graduates enter medical school at the age of 18 years old. It takes 6 years to get an M.D. degree. Therefore, most med students earn their MD at 24 years old, which is A LOT younger than their counterparts in the US (around 28 years old, I think.) When the Japanese med students do their clinical clerkships, they are mainly just observing. In the OR, med students really just stand around and can’t touch anything. They are allowed to scrub in, however. But scrubbing in usually makes things a lot worse for med students, because they cannot really move much to get a better view of the surgical field.

In summary, I feel that the med students in the US are really acting like interns in Japan in terms of what we can do (writing notes, assisting in surgeries, etc). The Japanese system seems to be more fixed and it definitely takes longer to gain autonomy amongst doctors.

Nagoya hospital pictures

Here are some photos of the hospital that I work in!

Main entrance - under some construction on the left. This building is a brand-new gorgeous-looking outpatient clinic center.

Patient ward - the hospital has over 1000 beds!

Another angle

Differences between the US and Japan – Hospital medicine

In Japan (and like most places in Asia), patients stay in hospital MUCH longer than in the US for similar condition. For example, average hospital stay for a woman with a regular vaginal delivery without complication is 6-7 days, compared with 36-48 hrs in the US! Another example: I was told that a patient with an elective lap chole (laproscopic cholecystectomy) in Japan has an average stay of 3 days. In the US, the same type of patient can go home the same day! I feel that in Japan, the hospital really baby sits patients well and will not discharge patients until they feel 100% physically. In the US, on the other hand, as long as the patients are stable and show some early sign of improvement, they are discharged right away. I’m no public health expert, but I am pretty sure the skyrocketing health care cost in the US has something to do with it; the longer the patients stay in the hospital, the more money it costs BOTH the patients AND the hospital.

There are definitely more differences than I described above. I just put up something that was very obvious to me. I shall discuss it further later.

Cardiac Surgery

For my first two weeks of rotation in Nagoya, I worked in Cardiac surgery dept. I mainly worked with two main surgeons, Dr Usui and Dr Ueda. Both spoke good English, and they were extremely nice to me. They were really interested in my experiences in the US as a med student. As far as the cases go, I was lucky enough that every day during the two weeks there is a different operative case every day. They range from CABG (coronary artery bypass graft), valve replacement, aortic dissection, and thoracic aortic aneurysm repair. Unlike my two weeks of CT surgery in the US, where most cases were just CABG, it’s really an equal mixture of aortic arch/artery repair and CABG. I found aortic repair much more interesting (but also more challenging) than CABG. It definitely requires fine operative skills from a cardiac surgeon. There was one case where the entire surgery went for 19 hrs (!!) until 5am the next day because the whole descending thoracic aorta was reconstructed. Fortunately, they let me go home early at 4pm in the afternoon J

First post - Intro

Hello!

Welcome to my blog! This is a long-awaited first post in my Japan clerkship blog. I am in Japan for the month of February, doing two weeks of cardiac surgery and two weeks of surgical oncology. I have been in Nagoya for about 9 days, working in the Cardiac surgery department here. So far the experience has been great. It's very interesting to see how the US and Japan medical education systems differ. I will definitely talk more about it later.

Thanks for reading my blog! I will start posting more often and will put some pictures on here soon!

Phil