About the living,traffic and general impression of Osaka City University and Hospital
Living and Traffic part
Before entering the hospital, I entered the accommodation which provided by the university. And it was really a clear and comfortable place. Most important thing is, it was very near the university and hospital. Although there is a question always in my mind: "why there are so many locks of this accommodation? Two main doors and each have three locks,and two of these locks are the same key??" But it's not a big deal, generally, the accommodation is very good.
They also provide me free Wifi, TV and washing machine. And the fee for this accommodation was extremely low compare to the standard fee in Japan. At the first two weeks, because there weren't many oversea students, I live in my own in this "big house". I was very free in this period though sometimes I felt a little lonely… It is very lucky for me to have a place to live in this kind of price. But since this apartment is mainly for exchange program student, the chances for me to interact with local students here became less. And it was a little pity. But the students here still hold a welcome party for us (although there were only 5 foreign students in this month), and that was so nice and kind for them to do something like this to us.
The hospital is located near the station"Tennoji" for railway and subway. Only about 5~10 minutes walk. So the traffic part was very convenient for me to go for a site seeing in weekend or some free time in workdays. And there was a shopping mall called "Q's mall" nearby. The supermarket in that shopping mall helps me get through these four weeks in Osaka. (The price of food is much more expensive than Taiwan. I need to lower down the expense of food as low as possible, or I will soon spend out all my money…)
General impression and finding about Osaka City University
At the first day when me to go to Osaka City University for oversea exchange program, I noticed that the university and the hospital are very close that there was only a street between them. And there was a bridge connects these two building's third floor. The office of every departments (I guess…) were located in educational building. And also the cafeteria and locker room for students were in that building. The plastic surgery's office was in 7 floor and orthopedics was in 9th floor. In 6th floor, there had student conference room that I can enter for resting or studying. They also gave me the right to enter the library. But the library and training center were in other building's 8th and 9th floors. It was interesting because although that building's most floors were the company or office related to the university, the appearance just like a normal office building. It took me some time to find out that the library was in that building.
The system of operation room, in my opinion, is similar to Taiwan's hospital(at least my college's hospital, Mackay Memorial Hospital).Cloth changing is the same except in our hospital, the operation's shoes are personal stuff and don't need to change every time.
By the way, for distinguishing medical students from doctors, they required the students use the operation cap of white color. At first I didn't know that so the nurses mistook me for doctors many times until they found that I can't speak Japanese……
And before entering the operation room, there is a center which is monitoring every operation's situation(I'm not sure about this part.) After entering the operation, the equipments are seem similar to what we have in Taiwan(of course the type and the brand will be different, but at least the function seems similar.) How the doctors work , how they cooperate with nurses and anesthesiologists all seems the same except I can't know what they were talking about when they were using Japanese. But this is the first day, I think what I saw were only small part of this hospital.
And I was wondering that why always some staffs stand outside the operation, finally I found out that they are who help doctors and nurses who finished washing hands to wear the sterilized clothes. In Taiwan, the nurses in the operation room will take that part. So this is another part different from Taiwan.
Sometimes the operation room will play some classic music. Although I think there weren't too much song(I think I always heard the same song) but it was great to hear that. It can relax the tension in the operation. I wish Taiwan's hospital could do that, too.
education system in Japan
About the medical education system in Japan, they need to study in university for six years. And just like us, after they finish their fourth year, they need to pass the examination for basic medicine knowledge. Then they will enter the hospital. But unlike our college, they only has one year in their university hospital. After fifth year, they will has 6 week to go to other hospital. The rest time of their sixth year will be used for preparing for national examination. Because of this, the course of their clerkship is very limited. they can only chose some department to do their clerkship.
After graduation and get the license, they will be doctors with title"研修医(kensyui)", although they told me that is the title similar to residents, in my observation, I think it is more like our PGY. The training for 研修医 is two years. they can chose the department for training (at least two month for one department.) And how the system work for choosing the department is too complicated for them to explain to me. After the training, they can choose the department and become the resident. Then the system works just like Taiwan. Using some years to finish the specialty training and participate the exam to become the attending doctors.
And the universities in Japan have three semesters in one year. The firs semester will start in April, and depends on the university and the grade of you, you will have summer vacation in July and August. (from1month to two month). The second semester will be from September to 25th, December. The winter vacation will last until about 10th, January. The spring vacation will be about one month. (The period just similar to our winter vacation.) So although I was just start my sixth year in this month, for the students in Osaka City University, they were already get through half of their year of studying.
About the course in Plastic Surgery
On the first day morning, I met one of the medical student who lead me to the office of plastic surgery. And at the same time, there were two intern doctors who also started their internship today. The doctor Hatano gave us a brief introduction of plastic surgery(Because of me, the introduction became English version, the doctors were so nice to me but sometimes I felt sorry that I forced them to use english to do the communication……) Doctor Hatano gave us many cases as example to show what plastic surgeon do. After the introduction, he bring us to the hospital and introduce the floors that relate to plastic surgery(the wards of adult patient, the wards of children, the clinic, and of course, the operation room.) And every Monday ,Thursday, second and forth Friday of the month will have general anesthetic operation, then the Tuesday , first and third Friday will have local anesthetic operation. So today we have a general anesthetic surgery for left side breast reconstruction(mastectomy because of breast cancer).
The operation of left side breast reconstruction took almost 10 hours (sorry for that I didn't see it finished) And the doctors who were not on the table explained what happening and how the surgery works. Sometimes they explain something to the intern doctors in Japanese, the intern doctors will try to explain it to me with English, I am so grateful for that.
About the course in Plastic Surgery
In second day, we had three outpatients for local anesthetic operation: the first was congenital nevus which had received laser therapy before but in vain. It was about 2.5X2.0 centimeters. The second case was adenoma cyst located on left side of parietal part of head. And the last one is keloid on left side ear. All surgeries took about one hour.
And today was my first time to go to the university's cafeteria. Thanks to doctor Uenishi and Kashihara or I think I wouldn't go there by myself. The price I think is a little lower than average but I am not sure. But the food there was good, I am glad I went there today.
And this week I have seen two combined operation with other surgical department. The first one was combined with otorhinolaryngology whose patient had maxillary cancer. After the malignant part was excised and plastic surgeon took over the patient, it was already 3:30pm. And the maxillary reconstruction this time used latissimus dorsi free flap with part of 11th rib bone to replace the removed zygomatic bone. It was my first time toe watch the whole reconstruction operation, and it was amazing and, of course, exhausting. What I learned form textbook was just the mechanism and how to do the surgery. But the textbook won't mention that even just take the flap need a lot of work. You need to carefully separate the muscle you need with other muscles and try not to hurt the vessels and nerves. I didn't remember how long it took to got the flap, I think it almost took 3~4 hours? Especially you still need to get the rib bone with saw. And finally when the surgical area turned to the face part, I was a little shocked by the patient's face. Because of the excision, the left side just lack a large part of things, and other area was screwed because of compression. I have to say, it was hard for me to relate this face to a real lived person. He was just 57 years old and he need to be cut like this just because of cancer. It reminds me how fragile human being is. Let's come back to the operation. The first thing surgeons did is clean the receptive site and make sure potion go the vessel supposed to supply the flap. Then the doctors modified the rib bone to match the removed part. Finally, the reconstruction started. The first step was connect the feb bone with other facial bone with some nails(I don't know the medical term of this…). Second was the most important part(in my opinion….), reconnecting the vessel. In original plan, the facial artery should be connected with the original thoracodorsal artery(the flap's artery). But then the doctors found that the facial artery didn't have much blood flow(maybe because of thrombosis or stenosis). So as substitution, the superior thyroid artery was used. The process of connecting the vessels was under the help of the micrographic equipment. The suture of the vessel was done very carefully, of course, it cost lots of energy and time. But when the suture was finished, the blood flow perfused without any problem, it was really a great moment for me. Then it still a lot of suture, modification…… when the operation eventually over, it was already 2:30 am. Professor Modomura invited me to have "dinner" with them after the surgery. It was a great time to have "dinner" with doctors although when I got back home it was already 4:00am and there was operation on 9:00am that day……., I have to say the surgeons are so amazing that they can do the surgery until so late and still be in hospital so early and keep working. (I don't need to participate the mooring meeting so actually I have more time to rest compared to them.)
About the course in Orthopedics Surgery
Then the last two weeks I was in orthopedic surgery department. Compare to plastic surgery, the orthopedic surgery is a much bigger department. They told me that is because the structure of society of Japan is getting older and older. So the requirement for orthopedic surgeon increased recently. As my rough estimation, there are at least 40 doctors in this department in Osaka City University. During the orientation, doctors Ito said that there are seven group in orthopedic surgery: Spin, Sport medicine, RA, Joint(shoulder, knee and hip), Tumor, hand…….(I am not sure is that exactly the same…). And as a training, we need to do a pre-operation case presentation on Wednesday's morning meeting. After that , we should write a report about this case and read a paper related to this case. Of course, in English~
After the case presentation, we have to read a paper related to the case we presented, and then make a summary to the case and the paper. In the end, do a discussion about these two parts and make a report as an assignment for these two weeks. Although it took me a lot of times, it was really a good training for us to know our patient more deeply and learn how to read a paper and connect them together. And through this report, I knew that I am still so poor at reading the paper…
And in the operation room, I noticed that the orthopedic surgery really required a very high quality of sterile. every surgeon wear at least two layers of sterilized gloves. and besides the surgeon cap, they still need to wear a helmet which will be covered by a sterile cloth to make sure there will be nothing falling from head. Even the students like us, two layer of surgeon caps are required. I haves heard that in surgical area, the orthopedic surgery and neurosurgery are most required for sterile quality because the infection to the bone marrow and nerve will go a very heavy damage. And I was really experienced how strict of their standard.
Because I chose the sport medicine group. Although that there haven't sport operation everyday. But the operations I observed still more were about the joint part. And of course, orthopedics is mainly about the bone. So sometimes in our view, there has some " violence scene" in operation room. But the doctors told us sometimes we should put more power to make sure everything is fixed well. I have to say, the real things happened in operation room are always have some distance from the stereotype image…….
Talking to the team of spine, not only in operation room, the therapy helped by image are also important. On 9/19 we went to see how the myelography works and saw some case treated by selective nerve block. Not only about the bone, in this group you also need to know the function and innervation about spine well. I can understand why the medicine area can be divided into so many subspecialties. Because there are so many knowledge and even a very subspecialty can make you feel helpless when you know how many things you need to learn……that afternoon, the doctor only taught us very basic part of spinal team. I was already feel headache. And I again realized that I still have a long way to go and work to become a "doctor".
And there was a training for us to practice lumbar puncture at there training center. We used the model to practice, and there even had different type like "obesity""elder" for us to feel the difference between these groups. It was really a good experience. When we see doctors do the procedure, it just seems so easy. But when we are asked to try it , we finally know it is really hard……. And I am really thank doctor Toyota , he explain almost everything to me in English and slow the speed to make sure I understand what he want me to know. Although I have mentioned many times, I always feel grateful for the kindness of the staff and students here. Especially they change the morning meeting to English. I think it increase the loading especially for residents, I guess it a least took them twice time to finish the preparation for the case presentation(My case was even had a english version brief typed by a resident because I can't read the past history in Japanese.)
Since we were in orthopedic department, the cast, of course, was one important skill. And they really gave us a training lesson for doing the cast. Although I already have some experience in Taiwan that our training center gave us the similar course, it was really fun to do it in foreign country. The main concepts were same, but the material and steps had some little difference. That was the most interesting part. And that was truly a great time to enjoy it with other Japanese students.
The doctors in sport medicine were all very nice to me, sometimes after the operation; they will bring me to have lunch together. I think the sport medicine, compares to other group in orthopedic department, is not a big group. But in other way, this gave me more chance to interact with the doctors, and it was a very good experience. At the first week, the chief of sport medicine went to German for conference. And some doctors were also in German for training. So for some doctors, I only stay in this department for one week. Besides the routine operation and clinic observation, they also gave us some lectures in these two weeks. And most of them turned the lecture into English version as well. I'm very grateful for that. And because of this, I again recognized that my English ability in medical term and the knowledge still had a lot space to improve.
At the last day in orthopedic surgery, I saw a complicated case of sport medicine. The operation was combined with anterior cruciate ligament reconstruction, medial collateral ligament reconstruction, medial and lateral meniscal repair. It took about 5 and a half hours to finished this operation. And the doctors kindly gave me a chance to wear the sterile cloth to join the operation. It was really a good experience although it was exhausting, too. Because after you wearing sterile cloth, you can't touch anything that wasn't sterile. So you can't sit down or count on wall for relaxing. Your hands can't leave the area around your chest, or it would be polluted. All of these things made me realize how hard work it is of surgeon. But I was really satisfied because the operation that day let me saw a lot important operation of sport area. How to use the graft from semitendinosus muscle and gracilIs muscle, how to create the bone canal for reconstruction, how to do the inside-out meniscal repair. These were all so interesting and new for me. And it surely a perfect ending of the course in orthopedic surgery.
In conclusion, I feel I was very lucky that I can participate the exchange program in Osaka City University. The doctors, staffs and students were all so nice to me and I really learned a lot in these four weeks. And I experience two different atmospheres in plastic surgery and orthopedic surgery. Because the department of plastic surgery was smaller than other department, so the atmosphere there was more casual. And the interaction between doctors was more directly. They even kindly hold a welcome party for me. And orthopedic surgery was a big department, the schedule for me is much more intensive than plastic surgery. But because of this, I saw a lot of different aspects and practiced some procedure during those two weeks, and doctors often bring me to eat lunch together, they also discussed the paper and my report with me and gave me a lot of feedback,I was thankful for that they treat me seriously so I can learn a lot. It is so nice to learn things in these two department. And I really have a best memory in this month. Thanks to everyone who help me in this period so that I can have such a cherish experience.