Report my experience in the externship at the Department of Hospital Medicine in Shands Hospital, UF Health

Tokyo Bay Urayasu Ichikawa Medical Center General Internal Medicine Resident

Shuhei Uchiyama

I am honored to report my experience in the externship at the Department of Hospital Medicine in Shands Hospital, UF Health, a program by the International Exchange Program Committee of ACP Japan Chapter.

I applied to this program because I would like to be a resident in the U.S., and to become a specialist in hospital medicine in the future. Since the field is not yet common in Japan, I thought that I would be able to gain a lot of experience that could not be obtained in my country. Consequently, my guess was correct.

I observed two branches of the division; the floor team and the consultation team. The floor team basically takes care of inpatients who have multiple health problems not limited to one organ. In my hospital, I usually work as a general internal medicine doctor, and I noticed that there is not such a big difference in terms of work content and treatment strategy between U.S. and Japan. I was pleased to know that the clinical skills that I have gained in my workplace are as good as the ones residents of one of the best teaching hospitals in the U.S. can learn.

The consultation team consists of a resident and an attending doctor. They accept consultations from other departments and procedures including thoracentesis, paracentesis, lumbar puncture, and so on. The main cases of referrals are co-management of patients in surgery divisions. For example, we get many patients from orthopedics with comorbidities such as hypertension, diabetes, and heart failure. The cooperation between each department to treat patients was quite impressive.

Since this unique consultation system is the biggest reason for me to become a hospitalist in the U.S., I was happy to have the chance to observe their work. Though the system is not prevalent in my country, I am convinced that it is beneficial to both patients and doctors in other departments because surgeons do not have to take care of those problems and can concentrate on their specialties, and patients are treated by specialists of internal medicine. In the future, I would like to learn about this culture and bring it back to my country to make the Japanese healthcare system better.

Not only was it an excellent chance to learn about medicine in America, but it was also such a great opportunity for me in terms of my future carrier as a resident. Doctor Kattan, the attending doctor, was so generous that he allowed me to see patients and make presentations on each round. Although it was a short externship, I felt that I made a significant improvement in my clinical skills through this experience. I believe that it was achieved by reflecting on the attending doctor’s evaluation and advice about my assessments, plans, and presentations every day. He also asked me a lot of clinical questions related to patients during rounds, which revealed that I need to be more familiar with a wide variety of diseases, treatments, etc. I also realized that it was vital for me to acquire his ability to educate residents and medical students in the future.

Through this externship, my determination of becoming a hospitalist has only gotten deeper. I strongly recommend this program to those who wish to work in the United States.

Finally, I would like to express my heartfelt gratitude to the attending doctors who gave us the chance to join the externship, doctors in IECP of ACP Japan Chapter including Dr. Maliishi, and Dr. Stein who kindly and wholly helped me before and during my stay in Gainesville, Florida.

University of Florida Department of Hospital Medicineでのエクスターンシップ

東京ベイ・浦安市川医療センター 総合内科専攻医

内山 秀平

このたび、アメリカ内科学会日本支部国際交流委員会のプログラムにより、University of Florida Department of Hospital Medicineに3週間のエクスターンシップの機会を頂きました。学んだことはあまりに多く、書ききれない事柄も多々ありますが、できるだけ詳細にご報告させていただきます。

はじめに、今回ローテーションさせていただきましたDepartment of Hospital Medicineとその志望理由について説明いたします。この診療科はいわゆるHospitalistが勤務している診療科であり、入院中の患者のうち複数科にわたるプロブレムを持つ患者を中心に担当を行っています。また、他科(主に整形外科、泌尿器科、産婦人科などの非内科系診療科)からの内科的コンサルトも引き受けています。私は将来米国にてHospital Medicineを専攻したいと考えており、今回のエクスターンシップは本場のHospital Medicineを学ぶまたとない好機と考えたため、応募をさせていただきました。

Hospitalistの勤務体系はseven days on, seven days offと呼ばれており、7日間の連続勤務ののちに7日間の休暇があります。休暇に入ってしまう関係上、単独の医師をShadowしつづけることができないため、7日間をFloorでshadowしたのち、次の7日間をConsultation serviceで過ごすという方法を採らせていただきました。正確には週の中盤でseven daysの交替が行われるため、バランスよくいずれも1週間半ずつ滞在することができました。



入院患者の疾患は多岐にわたり、心不全、肺炎、COPD急性増悪、蜂窩織炎などの日本でも比較的よくみられる疾患から、cystic fibrosis、sickle cell diseaseによるacute chest syndrome、cocaine-induced ACSなどの米国ならでは(?)の症例まで見学をすることができました。日本でも見られる疾患の診療内容に関しては普段から私が総合内科医として行っているものと大きな差はないと感じられましたが、コストの意識が強い影響か退院のスピードは非常に早く、case managerが各患者のdispositionについて毎日確認を行っている場面が非常に印象的でした。

②Consultation service



もともと私がhospital medicineに興味を持ち始めたのは総合内科としての病棟担当もさることながら、このような他科からのcomanagementのシステムが素晴らしいと考えたことが契機でした。例としては、大腿骨頸部骨折で手術を控えている患者の併存疾患である高血圧、糖尿病、心不全のマネジメントを受け持つ、というような内容です。コンサルテーションのみを受け持つ部門は日本の病院には一般的でないと思われますが、非常にやりがいのある仕事だと感じられました。

さらに、attendingであるDr. Kattanは私がECFMG certificate holder(=USMLE STEP1/2 CK/2 CSをクリア済)であること、米国でresidencyを行おうと考えていることを汲んでくださり、患者のプレラウンドから回診におけるプレゼンテーション、さらには処置まで許可をいただくことができました。加えて短時間ではありますが新規のコンサルテーションがあると最初に通知が来るPager(ポケベル)も渡していただき、実に多くのことを経験させていただきました。これらの経験は私の将来のキャリアにおいてかけがえのないものになると確信しています。


最後に、このような貴重な機会を頂きました牧石先生をはじめ国際交流委員会の先生方、滞在前だけでなく現地にて多くのアドバイス、日常の手助けを頂きましたDr. Steinに心からの感謝を申し上げ、ご報告とさせていただきます。


小尾佳嗣, MD, PhD, FJIM, FASN小尾クリニック 顧問


写真1South towerから望むNorth tower


日本との大きな違いのひとつは、患者さんの社会的背景です。比較的若年でアルコール性肝硬変から肝腎症候群を発症している症例や、違法な静注麻薬の使用から感染性心内膜炎を来たし二次的にAKIを合併している症例が多く、また ERには金曜日の透析を種々の理由でスキップされ、溢水で運ばれて来る方も少なくありませんでした。また、長年オーランドの救急で定期的に透析を受けていた保険のない不法移民の方が、車を数時間運転して飛び込みでやってきて、ここで腎移植を受けさせてほしいと訴えてきたこともありました。確かにカリフォルニアやイリノイなどアメリカの一部の州では、こういった不法移民の患者にも腎移植を実施しているプログラムがあります(腎移植の方が透析よりコストが低いため)。しかし他の多くの病院と同様、Shands病院でもCKDや心不全など慢性疾患を抱えた保険のない不法移民患者へ十分なケアを提供するのは困難な状況でした。このように多様な社会的背景を持った患者さんを見ましたが、時に対応が難しい状況に対しても、Attendingはプロフェッショナリズムを保ちながら、常に患者さんに寄り添いつつ、個人として心から尊重して接していたのが非常に印象的でした。

写真2Dr. Tantravahi(上)とDr. Ali(下)

実は、このExternshipを始める直前にECFMG certificateを取得し、いよいよアメリカで臨床医と働く準備ができたばかりでした。そのような中、自分が実際にフェローとして働く前に実際の現場をフロリダ大学Shands病院で垣間見る機会を得ることができたのは大変貴重な経験でした。学習機会に対する私の求めに柔軟に対応しつつ、様々なDiscussionを通じてアメリカの医療を教えていただいたAttendingのDr. TantravahiとDr. Ali、見ず知らずの日本人を快く受け入れていただいた腎臓内科のチーフであるDr. Mark Segal、およびKaylaを含めたスタッフの皆様、このような特別な場を提供していただき、現地での生活をサポートしてくださったDr. Gerald Steinに心より感謝申し上げます。ACP日本支部の会員であったからこそ得ることが出来た今回の経験を糧に、今後もアメリカでPhysician-Scientistになるという目標へ向けて邁進してまいります。

My externship experience at Division of Nephrology, University of Florida

Yoshitsugu Obi, MD, PhD, FJIM, FASN

Advisor, Obi Clinic

I am a PGY-16 board-certified nephrologist and have done my clinical and epidemiological research at University of California Irvine between 2014-2018. While studying there, I have become intrigued with the US clinical practice, which I was not able to get familiar with just reading articles or analyzing data. I do need to do clinical practice by myself for this purpose, and I started preparing to become a US-certified physician even though it may seem ridiculous to start over my career at the age of 40’s. Therefore, it was very fortunate for me to obtain an opportunity for the 3-week externship at Division of Nephrology, University of Florida (UF). I learned a lot there, but here I would like to briefly summarize some of the most impressive experience.

Figure 1. South tower view from North tower

UF Shands hospital is a huge hospital with more than 800 beds (Figure 1), and health care is provided across four buildings including its associated Veterans Affairs medical center. The nephrology team divides into several groups into those physicians who cover the general wards and ICU, those who cover ER and the chronic care hospital, and those who cover kidney transplantation. Nephrology fellows rotate these locations throughout their training period. At Shands hospital, the primary care providers for inpatients are hospitalists and/or surgeons, and the main role of the nephrology team is consultation where they suggest treatment advice and provide dialysis treatments. They take care mainly of dialysis patients admitted for complications and those inpatients suffering from acute kidney injury and/or electrolyte abnormalities. Fellows see patients early in the morning and then meet the attending physicians to discuss treatment options. They start ward round after electric medical record review, which is very similar to what I have done in Japan.

One of the biggest differences to Japan was the socioeconomic backgrounds of patients. There were quite a few young patients with alcoholic cirrhosis complicated by hepatorenal syndrome and those IV drug users with infectious endocarditis complicated by acute kidney injury. I often encountered hemodialysis patients coming into ER for fluid overload after skipping their last treatment session for a variety of reasons. Also, I recall meeting an undocumented and uninsured immigrant patient with ESRD who presented to the ER in the middle of the night after driving all the way from Orlando, where he had been receiving regular hemodialysis care for many years, in the hopes of receiving a kidney transplant. Shands hospital, like most hospitals in the US, face challenges of taking care of uninsured and undocumented patients with chronic comorbidities such as CKD and heart failure. Some states, such as California and Illinois, are able to offer kidney transplantation to select undocumented ESRD patients, mainly because it is less costly than continuing regular hemodialysis. Nevertheless, I was deeply impressed to see that the nephrology physicians always made every effort to listen to patients, feel for them, and respect their will regardless of their social backgrounds.

Dr. Tantravahi

Dr. Ali

Figure 2.  


I had been just certified by ECFMG when I started this externship, and now I am preparing to start my career as a physician in the US. Therefore, it was a highly valuable opportunity for me to observe real clinical practice at UF Shands hospital before I work as a nephrology fellow. I greatly thank the nephrology attendings Dr. Tantravahi and Dr. Ali (Figure 2) who gave me flexible learning opportunities and taught me US medicine through discussions during their busy working time. I also thank Dr. Mark Segal, the Chief of Nephrology, and all the staff including Kayla; they welcomed me with warm hospitality although I was a total stranger to them. My special thanks go to Dr. Gerald Stein and ACP Japan Chapter for providing such a unique program. My experience at UF Shands hospital will definitely help me pursue my ambition to become a physician-scientist in the US, and I will strive to make my best effort to achieve my goal.

The road to an FACP – Why do we aim for it? –

The road to an FACP – Why do we aim for it? –

(Health and Public Policy Committee (HPPC) project)

Kichijoji Asahi Hospital, Internal Medicine

Yuhta Oyama, MD, FJSIM, FACP

On the second day of ACP Japan Branch Annual Meeting 2019, the afternoon of June 9, we held a session with the above title as a project of HPPC. There are 337 FACPs, 6 MACPs and 1 Honorary Fellow as of December 18, 2018 in the ACP Japan branch. By listening to the reason why they aimed at Fellow, how they changed their daily work by becoming Fellow, and how they would like to act as Fellow in the future, we hope more member aim to FACP.

We had conducted a similar session at the annual meeting last year, and in this project, we also conducted a preliminary questionnaire on acp-exchange etc. We ask FACP and MACP about the process of becoming FACP/MACP and the change after that, etc., we ask Members about the image of FACP and whether or not they are aiming, and how they think they would change by becoming a FACP.

In the session, after explaining the purpose first, we presented the results of the preliminary questionnaire. Based on the results, valuable comments were received from Dr. Kenji Maeda, the current Governor of the Japan Chapter, Dr. Fumiaki Ueno, the former Governor of the Japan Chapter, and Dr. Noriko Yamamoto, chair of the Women’s Committee. As a result, a more meaningful message was delivered to everyone who participated, as well as to HPPC members. We would like to deeply thanks to the three commentators for taking part in this session despite the busy period. There are various motives when becoming a Member or Fellow, but being a Fellow gives them a mental motivation such as pride, confidence, and a sense of responsibility that seems important to continue the profession of a doctor.

After that, participants, commentators, and HPPC members joined to form three small groups, and group discussion were conducted along the theme. Participants exchanged their opinions easily, and active conversations were held in all groups. Finally, we made a summary and ended this session.

Members who participated in the session could hear the story from Fellow in the group discussion, so they would have thought of becoming a Fellow. Thank you very much for all the participants who have been listening diligently. It is hoped that more people aim for Fellow with this project as opportunity, but eventually it is the hope of us that ACP Japan chapter members will be more by repeated such projects.

FACPへの道 - なぜ,それを目指すのか –

Health and Public Policy Committee(HPPC)企画

「FACPへの道 - なぜ,それを目指すのか – 」

吉祥寺あさひ病院 内科 小山雄太

ACP日本支部年次総会2019の2日目,6月9日の午後,HPPC企画として上記タイトルでセッションを開催した.ACP日本支部には2018年12月18日現在で337名のFACP,6名のMACP,1名のHonorary Fellowがおられるが,その方々はどのような思いでFellowを目指されたのか,Fellowになることでどのような違いが日常業務に生まれたのか,今後どのように活動していきたいか,といったことを聴くことで,より多くの方がFellowを目指しFACPになってもらいたいという意図があったからである.


セッションでは,まず趣旨説明のあと,事前アンケートの集計結果をセッション中に発表した.結果をもとに,コメンテーターとして御登壇いただいた前田賢司・現支部長と上野文昭・前支部長,Women’s Committeeの山本典子委員長のお三方から貴重なコメントを頂戴した.これにより参加された皆さんにもHPPC委員にもより意義深いメッセージが伝えられることになった(3人の先生には会期中ご多忙にも関わらず本セッションにご登壇いただきありがとうございました.心より感謝申し上げます).MemberやFellowになった時の動機は様々であるが,Fellowになることで誇りや自信,責任感など,医師という職業を継続するうえで重要だと思われる精神的な動機付けが付与されることが多い,ということが昨年同様に認識される結果であった.



Contemplate the Healthcare Reform

Report from Women’s Committee 2019 June、2019

Chair; Noriko Yamamoto, MD FACP(President of Yamamoto Clinic)

Contemplate the Healthcare Reform.     9 June,2019 AM11:55-14:00

Women’s Committee;

Chair; Noriko Yamamoto, MD FACP

Co-Chair; Noriko Kawashima, MD FACP

Member; Keiko Arai, MD FACP, Yuko Morishima, MD FACP, Eri Matsumoto, MD Ayako Miki, MD


1, Become the best hospital many doctors would like to work at.

NPO Corporation Director Dr.Toshiko Takino, MD

2, How the maternity leave system works in the US and how to keep work-life Balance?

Sapporo Tokusyuukai Hospital Dr. Shadia Constantine, MD FACP

3, Diversity management of the Palliative care Division at Iizuka Hospital.

Iizuka Hospital Palliative care Division Director Dr. Hideyuki Kashiwagi MD

4, The approach at Tokyo Women’s Medical School, Now and then, in future. From medical education to re-training as physician after any leave.

Tokyo Women’s Medical School Center of the Adult Diseases. Professor Dr. Noako Iwasaki, MD

5, Career Support multiply Patients Safety equal Work style Reform to have approached For 12 years at Okayama University medical school.

Okayama University medical school Professor Dr. Hitomi Kataoka.MD


First speaker Dr. Takino has the corporation E-J net to measure the functions to work comfortably in the hospitals for female physicians. That is called HOPIRATE by Dr. Takino. She told why she has begun this program, she was a physician of gastroenterology and almost got burn-out when she was working the hospital by fulltime back in her days.  She said recently young doctors has been changing to make much of work-life balance and female doctors make things of their personal life , they don’t take care of the patients around time of their return. Other male doctors compensate the patients care after female doctors left and they must work till late hour. The male doctors feel nuisance for that and think female doctors make trouble but are not useful. So HOPIRATE has changed the marks for measurement about working with high motivation not only the conditions of work place with childcare facilities, short time working. The hospital where female doctors are working cheerfully will gather good nurses and office workers and they get more fixed at the hospital, increase the number of patients, they will get more incomes and be happy.

Next speaker is Dr. Shadia Constantine. She was graduated from medical school of Panama and got her residency at US. She has come to Japan as the teaching stuff of the medical education and has three young kids. She told about the maternity leave system in the US. Most of all female physicians can take the maternity leave for about 8weeks. She is working as a teaching physician in Japan and learning at Oxford University.

Third speaker Dr. Hideyuki Kashiwagi has a certified MBA and qualification of social welfare. He affirmed not to admit the stereotype for previous winner. He declare the vision and mission of their division and he and his subordinates pursue to achieve them. He always try to get his subordinates engagement, stimulate their mindsets, share their Why thing. He gave the example the Mikoshi model, Mikoshi is portable shrine. 5 people keep to shoulder the Mikoshi and 2 people come to join, 7 people carry the Mikoshi comfortably but then they feel heavy strangely, 2 person hang the Mikoshi and load them. He told to start conducting easy issues he could do although they have many tough issues.

Fourth speaker Dr. Naoko Iwasaki is Professor of the Tokyo women’s medical school. Tokyo women’s medical school is very unique because the only female students study to become doctors and they perform to educate to become good female doctors and live their lives as doctors. They continue to educate their students why they want to become doctors, they must keep working as physicians. They have had some surveys for alumni association what you are doing. They especially told young female students must have the motivations to become good doctors. Also they perform the work-style reform to go back home at 18 o’clock.

Last speaker is Professor Dr. Hitomi Kataoka. She has a 2 years old baby. She has been working the MUSCAT career center at Okayama University medical school for 12 years. In rural area in Japan the numbers of doctors is running short, in city area especially Tokyo area the numbers of doctors is too much.  She think the working doctors now in Okayama don’t quit and keep working with any personal conditions. Most of all doctors think they must work for their local patients because local medical care will collapse if they would quit to work. She told we have to balance between doctor’s well-being and local medical care continuity. They need the supports from their family, comprehension from co-workers. She told when female doctors is increasing in the hospital the female doctors got to have more motivation for upper titles of academic societies.

We held this long time symposium for about 130 minutes, but I didn’t feel too long. 5 doctors talked different issue from various viewpoints. I felt they all talked we need to change our perception for our well-being and social rules. Generation X and young generations have different wishes and lifestyles. But we will avoid to collapse the local medical care, Dr. Iwasaki and Dr. Kataoka have been working for medical education and making mediating center for re-job placement for long time. It would be most difficult and important that we must have been working for long time to change people’s mindset for equity in gender. But now we must take action for this issue with our colleagues and families.

I felt their each efforts are very venerable they have been working on their own identities. But I felt sorry the participants were very small this day. I think young doctors want to go to the educational sessions. They seem to think the work-life reform is not their issues, older peoples like directors and professors must think and perform that for young doctors. I don’t think young doctors don’t need to involve this issue I rather think they must involve this issue for themselves. And work-style reform is not only for female physicians. I think all the physicians must involve and think of this matter and take actions for it. The hospital that female physicians work comfortably and actively will gather good nurses and co-medical staffs and increase the numbers of patients and incomes. And I think the critical point about work-life reform is Patients First. I think we don’t forget we are working for the patients, not only to increase our medical knowledges and practices for ourselves. We must have the balance between personal life and work. But that will not always keep same balance. Sometimes doctors will make a thing of the work as physician but another time they will make a thing of the personal life. This seems long time challenges. But I think at this matter the important thing is physician’s Professionalism. I think we physicians must keep going upon the Professionalism. And we have to keep up with fast pace of daily life and receive the diversity, I think we have to change the mindset and stereotype about gender .That would be much more challenges.

Finally I would like to thank you for the 5 speakers. And I appreciate to Dr. Noriko Kawashima she designed this symposium and I admire her intelligence and networks. The members of our committee had meetings for respective charge and conducted their own ideas. I am very proud of them and appreciated.

Healthcare Reformを考える。

2019年 ACP日本支部講演会 Women’s Committee企画報告

Women’s Committee委員長 山本典子 やまもとクリニック院長 FACP

Women’s Committee 委員長;山本典子 副委員長;川嶋乃里子

メンバー;新井桂子 森島祐子 松本衣里 三木綾子

「Healthcare Reformを考える。」2019年6月9日 日曜日 11時55分より14時 京都大学 時計台百周年記念講堂 国際交流ホール2


  • Opening Remarks :川嶋乃里子先生
  • 働きたくなる病院へ:イージェイネット代表 瀧野敏子先生
  • How the maternity leave system works in the US and how to keep work-life balance?:Sapporo Tokusyuukai Hospital Dr.Shadia Constantine
  • 飯塚病院緩和ケア科のダイバーシティマネージメント:飯塚病院緩和ケア科部長 柏木秀行先生
  • 東京女子医大の取り組み、これまでとこれから。学生から再教育、再就職まで生涯にわたる人材育成と働き方改革:東京女子医大成人病センター教授 岩崎直子先生
  • キャリア支援×患者安全=働き方改革 岡山大学の12年の取り組み:岡山大学大学院医歯薬総合研究科 地域医療人材育成講座 片岡仁美先生

まず瀧野先生は NPO法人をつくりホスピレートという病院評価を行うことをなさっています。これを始めたきっかけなどのお話があり、女性医師が働きやすい病院の評価ということで始めたということですが、若い医師たちのワークライフバランスを重視する人が多くなったという変化や女性医師が時短などの条件で入職し働いても、患者さん重視でなく帰るころには患者をみないとか、自分の生活重視に偏り男性医師に迷惑がかかったりするようなことも出てきて、最近は保育所や時短などの条件面だけではなく、医師がモチベーションを高く持って輝けるようにするということを評価にいれていくよう考えているとのことでした。 また女性医師が働きやすいと、女性ナースやスタッフの定着率もよく、良い人材が集まりやすいということです。またそのために患者さんも増え、収入もあがり、病院としても個人としても豊かになる、という効果があるというお話でした。

次にパナマで医学部を卒業されUSで研修を受けられたDr.Shadia Constantineです。3人のお子さんがおられて ご主人が主夫をなさっているということでした。アメリカには法律としての産休はありませんが、大学や大きな病院ネットワークには規定があり、給与をもらいながら平均8週間くらいは産休を取ることが多いということです。ただし産休をとるのは5分の2くらいということでした。USでの比較検討などのペーパーを示していただきました。



最後は岡山大学の片岡仁美先生でした。12年にわたり岡山大学で医療人キャリアセンターMuskatセンターでの活動をなさっておられます。働き方改革を行おうとすると地方だと人がどんどん増やせない現状なので、今働いている人をこれ以上やめないで、事情があっても働けるというようにすることが必要と考えられたそうです。ですから現在は女性医師だけではなく、男性や子育てだけでなく介護で時間が必要な人も対象にしているそうです。過労や働く時間が長いと診断エラーも増えるので、医師自身もうつや自殺企図など健康を損なわれることもある、でも目の前に患者さんがいれば やらなければいけない、自分たちがやらなければ医療が崩壊する、若手の研修も十分にできないなどの状況の中で、患者安全と地域医療の継続性、医療人の健康とバランスをとることが必要とお話されています。プロジェクトは、家族のサポート、上下の理解、同僚の理解、適切な労働力が大事とのことでした。色々な具体例をお示しいただきましたが、6人目の立場での復帰という言葉が印象的でした。5人の定員でその枠内で復職すると自分ができないことやわからないことが多かったり、時間的に早く帰ったりすると周りに迷惑をかけるということで心苦しくなり続かない。定員の増員ということでの6人目なら、本人も周りも受け入れやすいということです。このような活動で 女性医師も増えると女性医師の専門医志向も上がったということでした。


素晴らしい内容だったのですが、参加者が少なかったのがとても残念です。ACPでは教育的なセッションが多いので、若い先生方はそちらの方が興味を引くと思われますし、働き方改革は上の人のやることと思っていたりするのかもしれません。ですが社会性を持って働くことは大切ですし、自分さえよければよいという立場ではないはずですので、こういう分野にも興味を持ってもらいたいと思いました。働き方改革は女性だけの問題ではありません。瀧野先生がおっしゃっていたように、女性医師が気持ちよく元気よく働ければ、病院内に良い循環が生まれると思います。しかし女性医師自身もプロフェッショナリズムの意識をきちんともち、患者さんのためということを一番に考えて、時短でも週3回でも、高い医療レベルを提供するべく努力するべきだと思います。私たちの仕事は有難いことに、働きながら学ぶことができます。色々な患者さんを診察し、治療して 症例の経験として、自分のものにすることができます。毎日が勉強です。一つでも多くの知識を得て、早く立派に尊敬される医師になろうとするならば、多くの患者さんをみて経験することです。医師としての自分と家庭での親としての役割など、どちらを重視したいかは各人違うと思いますし、特に女性は自分の意志とは別に、子育て中で子供が小さいと時間的にも家庭に多くの時間を取られることになるでしょう。ワークライフバランスは個別的でもあり、また時間的な要素もあり、難しい課題だと思います。でも男性も女性も、より高いレベルの医療を行える医師であるために、研鑽を積むことは常に必要ですし、幸福感を感じる日々を過ごすことも、人間として不可欠なことだと思います。いつも完璧に過ごすことは不可能だと思いますし、我慢する時期もあるかと思いますが、自分で選んで 自分で道を見据えて日々を歩んでいけるように、男女ともに方策を考えて続けることが必要だと感じました。またその根底には、患者さんを第一に考えること、地域医療を守ることなどProfessionalismがそれぞれの医師の心にしっかり根付いていることが必要とも思われました。


最後に、素晴らしいご講演をいただいた5人の先生方に心よりお礼を述べたいと思います。企画を立ててくれた副委員長の川嶋乃里子先生の行動力と情報ネットワークに感服しましたし、WC委員のメンバーは、各担当を決めて打ち合わせに連絡にと特に指示することなく 各自で考えて行動してくれました。委員会のメンバーにも感謝したいと思います。

「”Is there a doctor on board?” 高度3万フィートのオンコールに自信を持って手を挙げられる医師になるために」

米国内科学会日本支部年次総会 講演開催報告

埼玉医科大学病院 総合心療内科 山田悠史

米国内科学会日本支部年次総会におきまして、「”Is there a doctor on board?” 高度3万フィートのオンコールに自信を持って手を挙げられる医師になるために」というタイトルで講演を行いました。我々国際交流プログラム委員会では、国際交流にとって最も大切なツールの一つ、医学英語の教育を行うことを念頭に、今回の講演を企画しました。医学英語を使う状況を思い浮かべる中で、委員から、日本における航空機内救急に関する知識、教育の乏しさの指摘があり、ここに焦点を当てることになりました。

IATA(国際航空運送協会)によれば、世界の航空旅客数は2018年に40億人を突破し、さらに増加の一途をたどっています。常時5,000機以上の旅客機が高度30,000 フィートの上空を飛行し、1日あたり1,000万人が機内という閉鎖空間で数時間から十数時間を過ごします。そこで問題となるのが航空機内救急(In-flight medical emergencies; IME)です。過去の統計によればIMEは平均約600便に1件発生するとされ、毎日約1,000件のIMEが世界のどこかの上空で起こっている計算になります。このようなIMEに対して自信を持って対処できる術を身につけていただくことを目標に講演を行いました。

当日は、朝一番の企画にもかかわらず50名を超える聴講者が集まりました。講演は、短時間のアイスブレークのあと、元演劇部の牧石委員長扮する医師の乗客が、筒泉副委員長扮するシンガポール人の乗客リチャードの失神に対応するという寸劇で始まりました。元客室乗務員 の駒崎クララさんにもご協力いただき、本物の客室乗務員さながらの演技をしていただきました。寸劇での3名の迫真の演技は、すぐに聴講者の心を掴み、笑いも交えながら航空機内救急の理解にお役立ていただけたのではないかと思います。また、寸劇の合間にレクチャーを挟む形式で進め、山田より最新の文献に基づくIMEの基礎知識や対応方法についての講義、IMEで想定される英語表現の講義を行いました。また寸劇のあとには、元客室乗務員の星山芳実さんから、IMEにおける客室乗務員の役割、メディカルキットについて、航空機内の医療支援体制、医師登録制度についての解説が行われました。医師だけによる講演とせず、お二人の客室乗務員経験者にもご参加いただくことで、より深みのある内容になったのではないかと思います。


A report of the seminar; “Is there a doctor on board?”

A report of the seminar; “Is there a doctor on board?” at the annual conference of American College of Physicians, Japan Chapter

GIM, Saitama Medical University Hospital

Yuji Yamada, M.D.

We held a seminar, the title of which was “Is there a doctor on board? -to be a physician who can confidently raise a hand to help in-flight medical emergencies” at the annual conference of American College of Physicians, Japan Chapter, Kyoto, Japan. Our initial plan was to create a seminar which can help participants improve their English communication skills. Through our discussion we found in-flight medical emergencies are not well recognized in Japan and decided to focus on this in our seminar.

The number of annual commercial airline passengers exceeded 4 billion for the first time in 2017 according to the report from International Air Transport Association (IATA) and it is expected to increase further. More than 5,000 aircrafts fly at an altitude of 30,000 feet at any given time and ten million people spend several hours daily on the plane. Here comes the problem: In-Flight Medical Emergencies (IMEs).

The estimated prevalence of IMEs is approximately 1 in 600 flights, meaning 1,000 IMEs occur somewhere in the sky every day. As a result, it is becoming inevitable to encounter some kind of IMEs when we take a flight. Therefore, learning and preparing for IMEs are essential for us physicians. The main purpose of this seminar was to provide basic knowledge and important skills to better cope with them.

On the day of this seminar more than 50 participants gathered early in the morning. After quick icebreaking activities, we started the session with a short play. Dr. Makiishi, who belonged to a drama club, played a role of a physician passenger. Dr. Tsutsumi became a passenger from Singapore, who developed syncope in the aircraft. Ms. Komazaki, who is a former cabin attendant, played a cabin attendant role very naturally. Their impressive performance instantly grabbed audience’s heart and greatly helped them understand the concept of IMEs. Lectures were also given in-between the performance, regarding 1) common presentations and proper management of IMEs based on up-to-date medical literatures, 2) tips of history taking in English, and 3) introduction of cabin attendants’ role in IMEs and emergency medical kits available on airplanes. I believe the lectures given not only by a physician but also by a cabin attendant made the understanding of audience even deeper.

It is essential to learn and prepare for IMEs in advance to care sick passengers efficiently since the condition in airplanes is quite unusual. However, in reality, there are not many workshops or seminars available in Japan. We hope this seminar was a great opportunity for audience to recognize the importance of preparation for IMEs and also a great start to expand this type of activities in the future.