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Exit Questionnaire

Please describe the actual training you have received here.

Training started at 8:15 with the morning conference where all the department staff discuss progress and changes of cases. I learned how to present cases properly and how to discuss them with other team members accepting their generous and educational remarks. I also observed how the whole staff can function as one mind completing each other's' shortcomings and pitfalls.
After that the morning rounds (kaishin); a firsthand observation of doctor/patient communication, and its hidden value in gaining the patients' trust and cooperation.
Ward duties come after where each doctor attends to their assigned patients. This is a great chance to observe many and diverse medical maneuvers, techniques and therapeutic regimes. Also it was a chance to get involved with cases on a deeper and more individual level.
After lunch time I mainly stayed near the ER where various emergency cases were carried by ambulances and the hospital helicopter. This was the most fun part of the day where there were countless new things to learn every time. From how to evaluate a new case, taking proper history and performing primary survey and all the way to watching ACLS in action being performed according to the latest and most advanced international guidelines.
This section taught me the importance of team work and qualities of leadership in the most stressful conditions such as cardiac arrest and multi trauma patients as well as the importance of proper organization and cooperation between different departments and specialties. The advantages of the fully computerized data system were most obvious in such situations where the presenting patient's entire medical history was sent within a matter of minutes. As my university hospital still uses a paper system; it was truly a marvelous experience for me.

Was that what you expected? If not, in what way was it different from your expectation?

Yes, I believe it was. However, I usually prefer to experience first rather than to expect something so it's hard to tell.

(Good/ better points)
I consider myself lucky to have chosen Shinshu University's emergency department! The emergency system there was top notch in organization, coordination and up to date with almost all aspects of medical advances. I believe Dr. Okamoto -with the help of everyone's powers- has built a masterpiece in the lovely town of Matsumoto.
On the personal side; Dr. Okamoto and the rest of the staff went out of their way to make me feel more than welcome and a part of their team by inviting me to department staff related events and outings. This gesture somehow took away the natural feeling of estrangement in a new place and made me feel more involved and also improved my learning capacity and the urge to get involved. Everyone was very cooperative and they patiently answered all my questions and always made sure to explain what was going on.
The training time 8:15 ~ 17:00 was appropriate. So I had time for extra activities and proper rest every day.
I was provided with student account ID and gained access to the computerized data system; this was a great way to keep up with the patients' data and progress.

(Dis-satisfying points)
Although the training schedule clearly stated the doctors I was appointed to; most of them had no idea about this assignment and some were -understandably- too busy to disturb them. Sometimes I would randomly walk to a physician working on their case and introduce myself then ask about the case. This process would repeat a few times daily.
It would be more beneficial and organized if the student was introduced and assigned to one willing physician for a set period of time (a few days or one week for example). The student would follow the assigned physician most of the day following up on the same cases and experiencing a physician's day in the hospital. This will increase familiarity between the two and save time and effort on both sides.

Please comment on the items below.
  good points dissatisfying points
Housing The rent was relatively affordable and of clear amount; I knew exactly how much I was paying
Very close to the hospital.
Had a good sense of security and privacy.
The cleaning services and TV were a good extra.
Although cooking wasn't allowed; personally I don't consider it a negative point. Between training, extra events and exploring the city there was hardly anytime left for cooking. It also provided a good chance to experience Japanese cuisine.
Japanese Language Course NA NA
Livelihood in general Matsumoto is a very nice place to live in my opinion; where life is relaxed yet one can accomplish many things in one day.

The city website is very useful and provides many valuable information about sightseeing, events, transportation and life in matsumoto. I wish every Japanese city had such a website!

There are many shopping areas and historical places to visit which means a magnitude of extra activities and exploring.to satisfy all interests

The cellphone and university internet access generously provided were very useful and made life a lot easier.
The lack of internet connection outside campus was somewhat inconvenient especially for lack of active maps while roaming the city.

There's a system here in Tsukuba university where every international student is assigned to a Japanese student "tutor" who would help them understand how to "get around" such as using public transportation, city tours and answering questions about daily life and any small problems they might face. In light of the previous problem; my tutor here helped me rent a portable wifi device which allows me to stay connected to the internet all time. Many foreigners use this rental service for convenience and I think many students would want to be introduced to this service as well.
I believe such a tutor system is beneficial to both students as Japanese students would also get the chance to experience new and diverse cultures and the foreign students would get a companion for sightseeing and a chance to participate in student activities and events.

I was lucky to meet such nice students who were by pure chance rotating in the ER however this meeting was a good coincidence that doesn't always happen. It would be a lot better if there was an organized system to allow foreign students and Japanese students to freely communicate with one another such as a tutor system or perhaps allowing the visiting student to join a club of choice as a temporary guest member and engage in club activities with other students.
Please list as many things you think you have gained from this experience of living and studying in Shinshu.

I wouldn't do this experience right no matter how many items I try to list however just to state the hallmarks;

* By living on my own in a foreign country and becoming fully responsible for my life style, training and education it made me realize that a person is truly responsible for how much they achieve in life. That as long as you have willpower you can do anything, become anyone or go anywhere. This is the complete opposite from the Egyptian and many other societies' practice where parents and society decide almost everything for you in life even after you start your own family! And you comply to such practice falsely believing that "it is the easy way out"

* After being exposed to so many people from various cultures and backgrounds I learnt never to assume or stereotype. If you don't get ask or get involved then you'd end up living in a fantasy world of your creation. There's always a story behind the scene and more than meets the eye. As quoted by Nietzsche "And those who were seen dancing were thought to be insane by those who could not hear the music". This is a crucial corner stone for plausible scientific research as well as critical thinking. Even for planning your future; a plan based on false assumptions will never work.

* Too often we unconsciously focus on trivial matters so hard that we end up missing out on the most important details or even forget our main purpose. This happens when someone 'gets stuck' at a certain point and stops moving forward unaware that time waits for no one. When someone realizes they're at this stage forcing yourself into new experiences and gaining new input from the environment around you will make you realize how trivial your original problem was and how big and wonderful the world truly is.

* Almost never say new to a new encounter or experience for it is always worth the trouble even if it somehow caused negative emotions. You'll definitely end up learning something new about life.

* Familiarized myself with the Japanese EM system and recognized the main differences between it and the American EM system.

* Got a very short introduction into the world of research and realized how not-boring and crucial it is to the current world we live in.

* Learned how to show respect for colleagues, patients and even strangers we meet on the street.

* Observed and admired how dedicated the Japanese people are in almost every aspect of their lives.

* Japanese convenient stores are indeed very convenient! Even if you get lost; just head to the nearest conbini and you'd find very nice employees who would help you!

* Everything occurs in its right time, not one second earlier or one second later so move at your own pace and as long as you're doing your best then you'll receive only the best for you.

How are you going to utilize what you have learned here?

While some of the things I learnt at Shinshu are lifelong lessons; concerning the current near future I think I achieved my main purpose of inspecting the Japanese EM system and now have enough premises to utilize in the following;
* What to expect from different stages of EM physician career in a Japanese hospital.
* What sets a good EM system from an unorganized one. How to compare the criteria that will help me choose the program best befitting my purposes.
* While using all of these real world data; I'm currently weighing my options of pursuing a residency in a Japanese university hospital as an EM resident.

Would you recommend Shinshu University School of Medicine to other students?

I would recommend it to myself! I believe if I decide on rejoining the Japanese medical system for research or residency; Shinshu university will be on the top of my list of choices. So yes I would also recommend it to many other students.as well!

NAME: Rana Elkhanany
Home Institution: Alexandria School of Medicine
Dept. of Acceptance: Emergency and Intensive Care Medicine
Training Period: Sept. 6th ~ Oct. 4th 2013