Reflection of the medical elective in Osaka City University

My name is Anyon Chan, and I am from the medical school of the Chinese University of Hong Kong. Before entering the final (fifth) year, I spent two weeks in cardiovascular medicine from early April, and then another two weeks in cardiovascular surgery.
The cardiovascular system attracted me because of the beauty of its anatomy and physiology, and also of its diversity in pathologies and interventions. The combination that I chose provided me insight into how cardiovascular conditions were managed by the collaboration of internal medicine and surgery. As medical schools in Japan teach in Japanese, this proposed a brand new challenge to me as I had no knowledge in Japanese medical terms.

Before talking about what I have done in the first two weeks in cardiovascular medicine, I would like to express my heartfelt gratitude to all the doctors that I have met. Even on the first day, I already felt much welcome as Professor Yoshiyama greeted me after the case conference. In the following two weeks, the Professor reminded me in his out-patient sessions and the grand rounds of the importance of basic clinical skills, that was history taking and clinical examination. Thanks should also be given to Doctor Iwada, who discussed with me how the schedule should be arranged and coordinated all the activities in the attachment in internal medicine. I spent most of my time observing various procedures like cardiac catherisation and pacemaker inplantation, among which I would like to make a special note on echocardiography. It was one of my favorite procedures in the attachment in cardiovascular medicine, as it integrated both the knowledge of anatomy and physiology. Moreover, it bore much importance in clinical management because of the variety of information it provided. In the echo laboratory, doctor Iwada and his colleagues were very patient with me and were more than willing to explain every detail regarding the procedure. Even when there were times when the language barrier set in, bilingual communication still proved useful. Along with the ablation session in which doctor Takagi taught me in English about electrophysiological study and its application, this attachment served as revision of what I have learnt in cardiovascular medicine.

Cardiovascular surgery was a completely new subject to me as I will only be doing this in the final year. In this attachment I spent most of the time in the operation theatre watching common surgeries like mitral valve repair and aortic valve replacement, along with joining case conference and following grand round. It was not easy to start another attachment at first, probably because the teaching style was different. I was trained to think critically, to raise questions actively and to read different materials in order to gain some understanding on the management of cases. Fortunately, surgeons were generally helpful as they were willing to solve my queries, with some of them having a good command of English. Moreover, the local student was very helpful as he translated the Japanese medical terms for me. In these two weeks, I was amazed by the meticulous planning in the pre-operative stage, the perfect coolness in facing difficult situations and the pursuit of perfection in surgical techniques and outcomes. It was my pleasure to have observed one of the top surgeons in Japan performing mitral valve repair by loop technique.

Last but not least, thanks must be given to the university for the overall arrangement of this elective. The university was very flexible and tried to suit my needs throughout the attachment, which made learning a very enjoyable and efficient process. To conclude, this medical elective session has provided me much insight not only in a specific specialty but also inter-disciplinarily and culturally. Most importantly, it helped me further develop an interest in working with the cardiovascular system.