Why not pursue a global career path?

Why not pursue a global career path?

The International Exchange Program Committee

On the first day of ACP Japan Chapter annual meeting 2018 in Kyoto, the International Exchange Program Committee (IEPC) held a panel discussion-style luncheon seminar entitled “Why not pursue a global career path?” Although it was a nice and sunny Saturday noon, ideal weather for outing with friends or families, the venue was packed and filled with the energies of the audience. Most of them were seemingly clinical residents or medical students, but some senior clinicians were also attended. After introducing themselves and their career path briefly, five speakers told their story on why they recommend a global career path.

Dr. Yamada

First speaker was Dr. Yamada, who is currently serving for his clinical residency in New York. He explains the difference in educational system for clinical residents between Japan and the United States. Dr. Yamada also mentioned how exciting it is to work with people with various backgrounds in the world’s most vibrant city, also known as a melting pot of races.

Dr. Ohara and Dr. Kinjo

The second speaker was Dr. Mamiko Ohara from Kameda Medical Hospital. As reflecting back the days she was struggling to survive as a researcher from Japan among many talented scientists at a top-ranked research institution in the United States, she introduced the “Planned happened theory” by John D. Krumbolts. According to the theory, there are five things to keep in mind to make your dream come true; those are curiosity, persistency, flexibility, optimism, and risk taking. Dr. Ohara closed her remarks by quoting the following phrase, “You can accomplish more than eighty percent of what you cannot achieve with your earnest effort.” Next speaker was Dr. Mitsuyo Kinjo from Okinawa chubu Hospital. As a mother of three children, she told her experience on pregnancy, childbirth, and raising children while working as a clinical fellow at a hospital in New York. In addition, she stated that earning a master degree of public health during her stay in New York was a significant event not just because it was awesome to study at an academic graduate school abroad with people from many countries, but because the network she created at the school has been affecting her career since then. Dr. Yuko Takeda, from Juntendo University, took over the talk. Dr. Takeda, who spent about a half of her career abroad, focused her story on adult learning. She emphasized that studying abroad is not a privilege limited to young people because adult people can learn effectively about problems they face and they have experience that would be precious resource for them. Dr. Takeda also suggested that studying abroad with a child/children would definitely add more value than staying alone, in that you can encounter unique experience in parenting in foreign countries. The last speaker was Dr. Tsutsumi from Takatsuki Hospital. He provided detailed information on how to succeed in matching clinical residency programs in the United States based on his experience as a mentor for four Japanese young physicians, all of them are currently working as a clinical resident or a fellow in the United States. “All too often, they rush to apply to the programs as soon as they are eligible to apply and ended up failing. They have no clear strategy to success. I’ve been seeing so many cases like that.” He ended his speech by stating that getting into the United States residency program is still possible, and that potential applicants need to have a well-crafted strategy as well as passion.

In the discussion, one attendee asked panelists about their way to improve English speaking ability. Some panelists introduced their tips, and they all agreed that there is no end to learning English and that we do not need to pay too much attention to speak “correct” English. There was also a discussion on the scope of “global career path”. Dr. Takeda indicated, “Some people from foreign countries who are now living in Japan are in desperate need of medical care. Providing medical care to them or doing what we can do for them is another way to pursue a global career path.

At the end of the session, Dr. Kiyoshi Kurokawa, the founding Governor of ACP Japan Chapter, gave us a message that it is vitally important for all of us to see and feel the world outside Japan whenever we can, in order to lead a fulfilling career path in this ever changing world.

We hope that this seminar has provided each participant some insight into a globally oriented career path and would help them pursue it.

Acknowledgement: We really appreciate Dr. Yuko Takeda for her participation as a panelist and also for her thoughtful talk. We are also grateful to Dr. Kiyoshi Kurokawa and Dr. Shotai Kobayashi, the former Governor, for their attendance and their fabulous comments.

 

 

 

 

グローバルキャリアのすヽめ

国際交流プログラム委員会 (IEPC)より、“グローバルキャリアのすヽめ−Why not pursue a global career path?”と題したパネルディスカッション形式のランチョンセミナーの報告を頂きましたので、PRC委員会からも広報いたします。(PRC 前田正彦)

・・・・・・・・・・・・・・・・・・・・・・・・・・・・・

グローバルキャリアのすヽめ

The International Exchange Program Committee

International Exchange Program Committee (IEPC)では、“グローバルキャリアのすヽめ−Why not pursue a global career path?”と題したパネルディスカッション形式のランチョンセミナーを開催しました。パネリストとしてご登壇頂いた5名の先生方には、お一人ずつ簡単な自己紹介とご自身のキャリアパスをご提示頂いた後、それぞれの視点で「なぜグローバルなキャリアを勧めるのか」について語って頂きました。

山田先生

現役米国レジデントの山田先生からは日米間での臨床研修システムの違いについて、また人種の多様なニューヨークで働くことにより得られる刺激や、医師以外のニューヨーク在住日本人との交流についても言及がありました。

小原先生、金城先生

小原先生からは、世界トップクラスの米国の研究室でもがき苦しみながらも最終的に周囲やボスの信頼を得るに至った経過を振り返りながら、偶然が支配するように見える人生のキャリアパスにおいても、実は好奇心や粘り強さ、柔軟性、楽観性、リスクテイクといったことがとても大切だということ(「計画された偶然理論」というのだそうです)などをお話頂きました。金城先生からは、米国でフェローとしてご活躍中の間のご出産や子育てのご経験や、米国でMPHを取得された際に築かれたメンターや周囲との人的繋がりがその後のご自身の活動にも大きな影響を与え続けていることなどを語って頂きました。武田先生からは、成人の学びはそれぞれが抱える課題や問題に基づいて導かれること、過去の経験は学習のための貴重な資源であるとの指摘した上で、卒後年数がある程度たってからの留学も学ぶ意義が大きいことをご自身の経験を振り返りながらお話頂きました。また、子ども連れの留学ならでは経験できる貴重な体験についても興味深いエピソードを交えながらお話を頂きました。筒泉先生からは、米国へ臨床留学するために必要なことを具体的に提示頂きました。USMLEの高スコアや説得力のあるPersonal Statementといったハード面のみならず、絶対にやり通す強い意志、また臨床留学に通じた外部のサポートなども必要であることなどを語って頂きました。また、米国臨床留学は厳しいが不可能ではないこと、成功するためには情熱と冷静な戦略を併せ持つことが必要とのメッセージも頂きました。

質疑応答では英語の学習法、特にスピーキングの上達法に話題が及びました。英語学習には終わりがないということがパネリストの先生方の多数の意見でしたが、一方で必ずしも“正しい英語”を話すことを意識し過ぎる必要はないとのコメントも頂きました。また、パネリストのお一人から、医療を必要としているのに受けられない外国人の方々が日本には少なくないこと、そのような方に手を差し伸べることも “グローバルな活動”だとのご意見を頂きました。

質疑応答の最後には、黒川清初代ACP日本支部長から、たとえ短期間であっても若い間に海外を自分の目で見てくることの大切さについて強いメッセージを頂きました。1時間のランチョンセッションでしたが、参加者の皆さんがグローバルキャリアの道へ一歩足を踏み出すきっかけなれたとしたら、本セッションを企画したIEPCとして非常に嬉しく思います。

謝辞:武田裕子先生にはIEPCメンバーではないにも関わらずパネリストの一人としてご参加頂き、そして素晴らしいお話を頂き有難うございました。また初代支部長の黒川清先生、前支部長の小林祥泰先生には本セミナーに足をお運び頂きまた貴重なメッセージを頂き感謝申し上げます。

ACP’s International Fellowship Exchange Program (IFEP)のお知らせ

IEPCの牧石徹也先生から、IFEPのお知らせを頂きましたので、PRC委員会からも広報いたします。是非、ご応募をご検討ください。
(PRC 前田正彦)
・・・・・・・・・・・・・・・・・・・・・・・・・・
ACP会員の皆様方
ACP米国本部より、北米を除くACP支部会員を対象とした奨学金付きの4週間の臨床見学プログラムについて、参加者募集の連絡がありました。
ACP日本支部WebsiteのWhat’s Newのコーナーにも掲載されましたが、改めてMLにてご連絡致します。非常に魅力的なプログラムですので、是非、ご応募をご検討頂ければと存じます。
ACP’s International Fellowship Exchange Program (IFEP):
・参加者は、米国またはカナダのアカデミックな病院で、1ヶ月間、内科または専門内科を4週間、臨床見学をすることができます。
・ご自身の関心のある疾患や領域について、その予防や診断、管理が米国のアカデミックな病院でどのように行われているかを直に体験することができます。
・どの病院で見学を行うかについては、ACP本部が参加者の関心のある領域などを考慮して決定します。
・臨床見学の時期は、2019年3月か4月が望ましいとされています。
・参加者は、2019年4月にPhiladelphiaで開催されるACP年次総会への参加費用がACP本部から支給されます。
応募締め切り:2018年8月1日
プログラムの詳細は、米国本部websiteをご参照ください。
応募される場合には、日本支部にもご連絡をください。
日本支部連絡先
ACP日本支部国際交流プログラム委員会事務局
書類は、米国本部の指定のemailへ直接ご提出ください。
これまで、日本からも1名、2012-13年にご参加されています。
(米国本部websiteのIFEPのwebsiteに過去の参加者が掲載されています)
ACP日本支部国際交流プログラム委員会
委員長 矢野晴美
副委員長 牧石徹也

My pride as a doctor was born from my experience in Hawaii

My pride as a doctor was born from my experience in Hawaii

Tokyo Women’s Medical University, Department of Nephrology

Yusuke Ushio, MD

In February 2018, I was trained at the Kuakini Medical Center and Queen’s Medical Center (QMC) in the state of Hawaii, U.S., through the ACP Japan International Exchange Program.

The main reason I applied to this program was that I wanted to learn more about medicine overseas and gain an objective view of medical practice in Japan. I had an opportunity to work with a physician who was trained in the U.S. during my residency and many colleagues were hoping to work abroad in the future. As a doctor, I wondered why they wanted to work abroad. At the time, my teacher said to me, “Not everything is always clear, at first,” and I decided to apply.

The first half of the training was held at Kuakini Medical Center. The institution was founded as Japan Charity Hospital for Japanese Immigrants. Following WWII, the name was changed to Kuakini Hospital and then its current name, Kuakini Medical Center.

I was trained in Family Medicine at Kuakini Medical Center. I shadowed the clinical professor of Family Medicine, Dr. Tokeshi, who was a student of the first graduating class of the John A. Burns School of Medicine at the University of Hawaii, established in 1973.

He said, “I like not only physiology but also surgery and all of the others, and I couldn’t decide on a department.”

In recent years, the concept of Family Medicine has been more acknowledged in Japan. The family physician is a doctor who provides wide-ranging, comprehensive medical care for the young and old, regardless of the affected organ. In U.K., there is a phrase “from the cradle to the grave.” The family physician is called a GP (General Practitioner) and provides primary care before patients see an organ specialist. Dr. Tokeshi has been providing this model of care for 40 years.

A wide range of medical students, residents, fellows, and even attending physicians from all over the world come to study under Dr. Tokeshi. The training provided by Dr. Tokeshi is called Tokeshi Dojo, and the doctors who study in Tokeshi Dojo are called Monkasei. A Monkasei’s day begins early in the morning; we attend a morning lecture at 6:30 and start working at 8:30. The most impressive aspect was the fact that Dr. Tokeshi asks us to take the details of patients’ social history. Questions include: “Where were you born? How did you grow up? How have you lived your life?” It is also important to remember his words, “It is not enough to only treat illnesses—doctors must be able to recognize all aspects of patients.” I took a look back on my own medical practice and reflected in my heart. “To always treat patients with respect is the most important thing of all” is a phrase I constantly repeated to myself. I learned from Tokeshi Dojo how to behave and live as a physician.

The second half of the training was held at QMC. At QMC, I shadowed Dr. Nogi, a hospitalist who is responsible for inpatient service at QMC. In recent years, the number of hospitalists has increased in the U.S. because of advantages such as a reduction in days of hospitalization. Because there is no outpatient duty, hospitalists can concentrate on inpatient care throughout the day. A shift system of seven days on duty and seven days off is common. Even in Japan, where voices calling for a revolution of work-life balance have become louder, there is a possibility that the number of hospitalists will increase if there is a major reform in the future and the need for hospitalists increases.

There are several small islands around Oahu Island where QMC is located, such as Hawaii Island and Maui Island. There was a case of consultation from a hospital in a small island via a video phone. Hospitalists at QMC provided appropriate instructions to the doctors at a hospital in Hawaii island, and the patient was taken to QMC by a medical helicopter on the next day. I think that such medical care can be applied to Japan, especially underpopulated areas, as a doctor on an isolated island can consult specialists in an urban area, using a video phone and can provide the best medical care.

I was also impressed by the medical education. I appreciated the idea of actively participating in a lecture rather than just listening to it. In resident conferences held twice a week, there was always an active discussion. In addition, I thought that this was a great opportunity to improve presentation skills. History and physical findings were considered more important to narrow down differential diagnoses than test results. I want to cultivate more this way of thinking.

Finally, since the time I studied in Hawaii until now, I have been reflecting on the days I spent there, wondering, “” When I look objectively at myself now, I think the days I spent were marvelous. I appreciate this wonderful experience and the support from all the committee members in ACP Japan, Dr. Tokeshi, and Dr. Nogi.

Thank you from my heart.

May 2018

Yusuke Ushio, MD

UshioHawaii1

Chapter Business Report 2017-2018: IEPC

International Exchange Program Committee

Chair: Harumi Gomi MD, MPH, FACP

Report:

What We Accomplished

  • Clinical observership at Olive View Medical Center, University of California, Los Angeles (UCLA) was initiated in 2012, and ended as of August 2017. Since 2012 until the end of the program, there had been a total of sixteen observers through this program.
  • Masayuki Nogi and Jinichi Tokeshi, and other supportive local physicians at Department of Medicine, University of Hawaii kindly offered clinical observership for our two members in November 2017 and February 2018, respectively.
  • The committee has created evaluation criteria (evaluation sheet) for the candidates’ CVs and personal statement.
  • Mentorship has been introduced for each observer before, during, and after the observership.
  • An Email list serve for the alumni members of this program, committee members, and the ACP council members has been launched for a weekly report from the Olive View Medical Center by observers.

What We Were Already Working On

  • Revision of credential evaluation/support for the candidates

 

What We Initiated

  • More strategic recruitment for the candidates of the observership.
  • New members who are still early in their career (such as Drs. Yuji Yamada, Emily Muranaka) joined this committee to support the members to obtain international medical experiences.
  • After the obsevership at Olive View Medical Center, University of California, Los Angeles ended, our committee tried to find any new programs for clinical observership and Dr. Takahiko Tsutsumi has significantly contributed to explore and support the clinical observership program at University of Hawaii.
  • The committee will organize a seminar to help early career physicians understand clinical and research experiences they could have in international settings for physicians in early career at the annual meeting of ACP Japan Chapter in June 2018.

Plan:

What We Plan To Work On

  • discussion on how this committee could explore or continue any exchange programs or international exchange activities after the UCLA program ended. This includes accepting students/residents/fellows from other countries.
  • How to disseminate the experience report to the younger ACP members and non-members, and those who are interested in the clinical observership in the United States.
  • More comprehensive recruitment and support systems for the program applicants.
  • Creating alumni members activities and leadership to share and sustain learning experiences after the observership.

Seminar Notice

International Exchange Program Committee

ACP Japan Chapter Annual Meeting

Luncheon seminar

Time: 11:40-12:40, Saturday, June 2, 2018

“Why not pursue a global career path?”

Held by International Exchange Program Committee

from International Exchange Program Committee

International Exchange Program Committee

1. What we Accomplished

a. Clinical observership at Olive View Medical Center, University of California, Los Angeles was initiated in 2012, and ended as of August 2017. Since 2012 until the end of the program, there had been a total of sixteen observers through this program.

b. Drs. Masayuki Nogi and Jinichi Tokeshi, and other supportive local physicians at Department of Medicine, University of Hawaii kindly offered clinical observership for our two members in November 2017 and February 2018, respectively.

c. The committee has created evaluation criteria (evaluation sheet) for the candidates’ CVs and personal statement.

d. Mentorship has been introduced for each observer before, during, and after the observership.

e. An Email list serve for the alumni members of this program, committee members, and the ACP council members has been launched for a weekly report from the Olive View Medical Center by observers.

 

2. What We Were Already Working On

a. Revision of credential evaluation/support for the candidates

 

3. What We Initiated

a. More strategic recruitment for the candidates of the observership.

b. New members who are still early in their career (such as Drs. Yuji Yamada, Emily Muranaka) joined this committee to support the members to obtain international medical experiences.

c. After the obsevership at Olive View Medical Center, University of California, Los Angeles ended, our committee tried to find any new programs for clinical observership and Dr. Takahiko Tsutsumi significantly has contributed to explore and support the clinical observership program at University of Hawaii.

d. The committee will organize a seminar to help early career physicians understand clinical and research experiences they could have in international settings for physicians in early career at the annual meeting of ACP Japan Chapter in June 2018.

 

Seminar Notice

International Exchange Program Committee

ACP Japan Chapter Annual Meeting

Luncheon seminar

Time: 11:40-12:40, Saturday, June 2, 2018

“Why not pursue a global career path?”

Held by International Exchange Program Committee

2017-18 国際交流プログラム委員会・活動中間報告

2017-18 国際交流プログラム委員会・活動中間報告

 

委員長 筑波大学医学医療系教授・水戸協同病院

矢野(五味)晴美

 

国際交流プログラム委員会では、2012年に発足し、前支部長の小林祥泰先生、およびカリフォルニア支部長のDr. Soma Waliのご尽力により、カリフォルニア大学ロサンゼルス校(UCLA)の教育病院であるオリーブビューメディカルセンターにて総合内科を中心とする臨床見学プログラムを中心とする活動を行ってまいりました。これまで通算16名の派遣者を輩出しました。残念ながら2017年8月を持ちまして、この臨床見学プログラムは終了いたしました。2017年8月以降、ハワイ大学に2名派遣することが決まり、活動しております。

 

以下で2017-18年の当委員会の活動の中間報告をさせていただきます。

 

1. これまで達成したこと

a. 国際交流委員会では、2012年より活動開始し、同年よりカリフォルニア大学ロサンゼルス校(UCLA)の教育病院であるオリーブビューメディカルセンターにて総合内科を中心とする臨床見学プログラムが開始されました。2017年8月に本プログラムが終了するまでに合計16名が渡航し本プログラムに参加しました。

b. 委員会では、渡航候補者の英文の履歴書や志望書の作成などをサポートしてきました。

c. 各渡航者には、委員がメンターとして担当してサポートしました。

d. ACP日本支部幹部、委員、派遣者、派遣修了者が登録された同窓会メーリングリストを発足しました。派遣者は、臨床見学中、毎週1回、臨床見学の振り返り・学び・経験などを投稿してもらいました。振り返りを関係者で共有できとてもよい機会になりました。

2. 現在、取り組み中のこと

提出予定の英文の履歴書および志望書を委員会でレビューし建設的なフィードバックを行っております。

3. 取り組み始めたこと

a. 昨年度から、派遣者を戦略的にリクルートしております(2017年8月以降、一時、中断しております)。

b. 2017年11月のNews Letterで委員が自己紹介文が掲載されました。

c. 2017年8月にUCLAのプログラムが終了後、ハワイ大学での臨床見学プログラムで渡航者が2名います。

4. 今後、計画中のこと

a. ACP日本支部の若手会員、非会員および米国での臨床見学希望者にどのように臨床見学に関する情報を届けるかを検討しております。

b. UCLAでの臨床見学プログラムが終了したため、ACP会員向けの適切な臨床見学プログラムが必要な状況になっております。

c. 臨床見学目的の渡航に関する助成について議論をしております。

Report of International Exchange Program Participant – Dr. Fujisaki

ACP Japan Chapter IEP

Exchange period: 2017/10/31-2017/11/21

Through the ACP Japan Chapter International Exchange Program, I was privileged to observe Hospital Medicine and Family Medicine in Hawaii. I would like to thank Dr. Nogi, Dr. Tokeshi, and everyone else involved in the Program, for helping me to gain invaluable insight into the significant differences between the way health care systems are organized from country to country.

<Hospital Medicine>

I performed the observation of Hospital Medicine by shadowing a hospitalist Dr. Nogi at the Queen’s Medical Center (QMC) in Honolulu.

Firstly, I learned that Hawaii’s population is quite diverse. Almost 40% of the state’s 13.6 million residents have Asian roots, including 15% Japanese; a quarter of the population is White; Native Hawaiian and other Pacific Islanders account for 10%; and finally, African Americans about 2 %. Of the above, 10% also count themselves Hispanic, and 25% overall identify as two or more races. In view of the Compact of Free Association between the United States and the three Pacific island nations: the Federated States of Micronesia, the Marshall islands, and Palau, as the biggest hospital in the region, QMC accepts a variety of transferred patients reflecting a diversity of race, creed, and other characteristics. In this way, severely ill patients in the vast area will converge at QMC, and hospitalists at QMC, together with numerous consultants, must deal with a wide range of diseases. For example, I witnessed a hospitalist consulting oncologists for a chemotherapy regimen, a palliative care team for management of side effects, infectious doctors for febrile neutropenia, and specialists in the main land about the Car-T therapy to treat a patient diagnosed with B-cell lymphoma. Throughout the observation, I also learned that hospitalists are required to show leadership like an orchestral conductor to convey harmonic medical care with many specialists. Especially because of Hawaii’s great diversity, the local hospitalist’s competency as a team leader required both familiarity with the medical resources in the hospital and the skill to operate as a communication hub for directing the best multidisciplinary care.

More broadly, I learned that the number of “hospitalists” in the United States has grown from a few hundred to more than 50,000 over the last decade?larger than any other subspecialty in internal medicine. I also learned that hospitalists bring reductions in hospital costs, lengths of admissions, and rates of readmission. It is for these reasons that approximately 75% of U.S. hospitals now hire hospitalists. Some specialists predict that the number of hospitalists will further increase, although this new type of specialty has its disadvantages, such as discontinuity of care from outpatient to inpatient care or medical field overlap with other specialists.

Meanwhile, the number of hospitalists in Japan is as few and far between as they were a decade ago in the United States. Because of Japan’s rapidly growing aging population, the myriad diseases and intense need for acute hospital care common to this group will require new strategies. I anticipate the number of Japanese hospitalists who play a leadership role in those settings may increase over the next decade, following the footsteps of the United States.

<Family Medicine>

I performed Family Medicine observation by shadowing Dr. Tokeshi who is a clinical professor of Family Medicine at John A. Burns School of Medicine at the University of Hawaii. Dr. Tokeshi has been serving his male and female patients of all ages from the cradle to the grave for almost 40 years. As a matter of fact, he is the primary care physician for 5 generations of one family. Shadowing him was truly inspiring and I learned that the family doctors’ approach to health problems is through longitudinal continuity of the patient/doctor relationship?one seldom established in the relatively short-term clinical relationships within other specialties. Furthermore, personal life histories were meticulously taken. For example, I learned that Japanese descendants in Hawaii often have unique life histories influenced by migration or world war. Those factors proved indispensable in interpreting health problems in the physical, psychological, social, cultural, and spiritual dimensions. These problem-solving strategies appeared to be core elements to a professional primary care physician’s repertoire in Hawaii.

From a wider perspective, family doctors are the first gates in primary care and have important roles as coordinators and advocates for the health of the community. When it comes to the health care system in the United States, I learned that it is difficult for ill or poor people to purchase insurance contracts and gain easy access to primary care. I understand that in 2010 the Affordable Care Act (“Obamacare”) was made to improve the situation, and as a result, the number of people who have insurance is expected to increase by 2020 and bring more fairness in primary care.

Japan, by contrast, offers medical insurance for the whole nation and people there have ease of access to medical care. On the other hand, Japan does not yet have qualified training programs for primary care physicians; and although the Japanese Medical Specialty Board has been preparing for establishing a new training system in each medical field by April 2018, there remains a shortage of family doctors. Consequently, Japanese patients are rarely seen by their officially trained primary care doctors, but are seen instead by providers whose specialty is on the boundaries of medical fields divided by anatomical and physiological systems.

With the number of Japanese elderly, multi-morbid patients skyrocketing, I imagine the number of Japanese trained as primary care physicians like the family doctors in Hawaii?who approach and can manage any health problems from holistic perspective, will increase, once global standard primary care training programs are established here in Japan, in the near future.

Tomohiro Fujisaki, MD 2018 January