Report of Oversea Clerkship Program in Osaka City University
13th April 2015～1st May2015
I did my elective posting in Osaka City University (OCU) in the Department of Dermatology under the supervision of Professor Daisuke Tsuruta. The reason I chose OCU for my elective study was because my friends who have been to OCU for their elective study told me that OCU provided an excellent atmosphere for studying and that the Sensei were very supportive, friendly, and were willing to provide time for us.
On my first day, I was accepted by Professor Tsuruta, who is also the head of Dermatology department. He welcomed me warmly and explained the activities and facilities I could join and use in my 3-week period. He told me that I could join the Outpatient Clinic (OPC), surgery, and that He would introduce me to the research projects the Department was working on. One student, Ozaki, was also assigned to accompany me and informed me the schedule they would do.
On that first day, I joined the OPC together with Ozaki and observed the Sensei examining the patients. I was very impressed with the advanced technology in which all information was directly stored in the hospital's database and thus it would be very convenient and effective in case the patient comes back to do control. Besides that, the residents also took the picture of every patient's skin lesion as a comparison to know the progress of the disease and how effective the treatment is. Most cases I observed were autoimmune and malignancy cases, which were quite new for me since most cases I found in my home country were infections. Thus, I learned a lot from the cases I observed and also the approach used for those diseases.
Another interesting thing was that right beside the Sensei's table, there was a microscope which can be used in case additional examination was needed. Thus, the specimen taking (scraping) can be taken and directly examined under the microscope. In my opinion, this is a very effective and efficient way so the patients do not need to go to another room for this procedure to be done.
Besides the OPC, there was also a room called the procedure room located just across the OPC. In this room, various procedures such as skin biopsy, narrow band UVB treatment, and drip intravenous injection were done.
Another activity I did was ward round and bedside teaching which was done every Tuesday from 1 pm until 2.30-3 pm. In this session, the residents reported cases in the ward, especially interesting cases. The Sensei would then give feedback and comments on the treatment and also suggestions for the next steps needed to be done. After the ward round, Professor Tsuruta would choose several interesting cases and gave us bedside teaching. Following it was the Pathology conference in which the residents present some histopathological specimens from both the inpatient and outpatient clinics. In the conference, the pathology specimens was shown directly in the TV screen in front of the room which was connected to the electronic microscope. In my opinion, this is a very good approach for both the students and residents to learn more about histopathology specimens, which is an essential skill need to be mastered in the field of Dermatology.
Operations were done twice a week, on Monday and Thursday. I had the opportunity to observe some operations done by Kamo Sensei, a plastic surgeon who focuses himself in Dermatology. Most of his patients were patients with malignancy such as SCC and BCC in which several procedures were done, such as skin flap and skin graft, tumor resection, and even amputation. Besides that, in some cases, the invaded lymph nodes were also taken using a photoemission approach in which a contrast was injected intravenously so that the target lymph nodes could be visualized clearly. Besides done by a plastic surgeon, Kusutani Sensei, who is a dermatologist, also does operation in here. It is quite different from my country in which surgeries are always done by a surgeon. Kusutani Sensei was also the person who explained every surgery procedure done and why such approach was taken instead of other approaches. In addition, she also translated many things for me so that I could understand the operation better.
In addition, I also got to take one case and made a case report out of it. The case was about pyoderma gangrenosum, which is a rare type of neutrophilic dermatosis commonly happens especially in patients with malignancy. I felt so fortunate to be able to do this case report, aside from the fact that this is a rare case, because my supervisor for this case report, Imanishi Sensei, is a very supportive and friendly person. He was willing to spend 2-3 sessions in a week each about one hour to explain me about the case and helped me to understand the laboratory results and the disease progression of the patient. He also showed and explained me the histopathological specimen of the patient under the microscope.
All in all, I felt so blessed and fortunate to be able to do a 3-week elective posting in OCU. I would like to express my gratitude to Professor Tsuruta as the head of Dermatology Department for accepting me in OCU for 3 weeks, Sugawara Sensei for explaining about hair loss and allopecia, Kusutani Sensei for her effort and time in translating the operation, spending much time in the OPC and ward to explain about the patients we encountered, and also Imanishi Sensei for being a great case discussion supervisor. I wish the best for all of you and really hoping to come back someday to OCU to do a collaborative research. Arigatou gozaimasu!