Report of Oversea Clerkship Program in Osaka City University

My name is Chokchai Prajongporn and I am 5th year medical student of Thammasat university. For me, It isn’t first time in Japan because in last 2 years I went to Tokyo for conference (Disaster medicine) and I saw and learned about health system and management in Tokyo. So this time I choose OSAKA CITY UNIVERSITY because I think about management, treatment ,and health system are different from my country and Tokyo and the second cause is Osaka is bigger city in Japan.
I split my elective period for 2 weeks in Traumatology and Critical care medicine and another 2 weeks in Hepato-biliary-pancreatic surgery in faculty of medicine, Osaka City University and Osaka City University Hospital.

Traumatology and Critical Care Medicine (3/2-3/13)

I am a little nervous in this department because in emergency situation I must to understand and correct about management in each patients but I can listen and speak little Japanese language. Fortunately, my professors and my residents in this department so very kind and take me to understand in every situation and management by English, a little Japanese and sometimes body languages.

In this period, In this department has 2 professors from PUSAN NATIONAL UNIVERSITY HOSPITSAL to see about working and management in this hospital. They are so kind and teach me like my teacher.

In Emergency room has so many cases in every times such as trauma(car accidents, drowning) , medicine (suicide, medication overdose) ,and CPA(cardio-pulmonary arrest). In management every patients, It’s quick to management and judge how to do in this patient. In this period I try to on duty overnight because my professor tell me in nighttime is so many cases than daytime and it’s real! It’s so many cases in this time but tiredness has not impact for everyone and management flow like the system. In sometime has to operation my professors and my residents can do very well.

In our ward, it separates in 4 wards (ICU , ECU , High care unit ,and 11th floor) it’s so many cases in this ward. My professors and my residents has conferences in morning and evening for how to management in next steps and sometimes has inter-department conference such as radiography. In management it’s so vary from patients-Echocardiogram , central line insertion , arterial blood gas , intubation ,or minor operation(Trachostomy ,Thoracotomy ,ICD insertion).

In this department, It’s make me a good impression for many cases such as the case is young man went to ER because cardiac arrest. In hospital, Everyone help him to come back and he was come back but unfortunately, he arrested again in our ward. Everyone help him again and next time his family told us for no resuscitation his son. From this case I see about living will of this patient and how to management in this family in psychologic and others problems

Hepato-Biliary-Pancreatic Surgery (3/16-3/27)

I choose this department because in Thailand it’s so many cases of hepato-biliary-pancreatic diseases such as hepatocarcinoma , cholecystitis , cholangiocarcinoma and In Japan has many new technologies and treatments for each patients than Thailand.

In this department shows about many cases of this diseases but sometimes it’s so complicated for understand cases. Fortunately, my professors and my residents are so kind and funny. They tell me to understand about this case and the next management to operation.

In first day, I’m nervous again because my professor want me to help his operation(Case Hepatocarcinoma and this operation is hepatectomy) but my professors so kind and tell me everything in this operation. And the next day, I went to ultrasonography to follow up cases(most are hepatocarcinoma and hepatectomy before). In some case, we follow up more than 10 years so I think difference from Thailand because we follow up 3-5 years and then as annual.

Sometimes if I’m free, my professors and my residents bring me to operation rooms for see another operations in other departments so I choose Cardiovascular surgery. About CVT surgery it’s so many cases of mitral valve regurgitation , aortic dissection and dilatation and my professors tell me to understand the cases and operations too. I think every operations which I saw my professors select the best management for this patient if this management, it’s so many hard and use many times in operations. And other department I see in operation room is Anesthesia, in some cases are more than 1 blockage and some techniques such as ultrasound-guided rectus sheath blockage it’s the first time for see this technique and make the new my knowledge.

In some cases about hepatocarcinoma I see about laparoscopic hepatectomy. It’s the new my experience because in Thailand most selected to open hepatectomy. And this case, I has homework from my residents for write operation note in this cases. I try to write it because it’s my first time and sent to my residents. They check my operation note and tell steps of this case operation to more understand.

Another activities in this department such as

- Ward round (grand round) : This activities it make everyone to understand cases and managements. For about patients are so happy and co-operation to check and tell medical information.
- In some case, He or she has drainage so we must to check about drainage everyday and check about position of drainage by fluorescent every weeks.

This department make me a good impression in one case. This case admits in hospital so long time (around 4 month) and her symptom is improve. My professors and my residents choose bring her on vacation at outside hospital for relax and release her stress. This situation shows me to not help patient for symptoms only but must to see and help everything of each patient.
I am very glad to choose faculty of medicine, Osaka city university and Osaka city university hospital for this elective and exchange program. Finally, I would like to thank you everyone in OCU to help ,make me to the new knowledge and experience ,and make many steps to me for a good doctor.
Thank you again!
ありがとうございます。

Best Regards,
Chokchai Prajongporn
5th year medical student,Thammasat University, Thailand
04/02/2015