さて、いよいよ日本人組の発表の日です。まずは午前の部に筒泉が”Japanese medicine in super-aged society”という発表を20分、その後各国の重鎮達（なぜか筒泉が紛れ込んでいてかつAKBでいうところのセンター）と１時間のシンポジウム”Challenges & solution of medical practice”に参加しました。前者は超高齢社会日本における医学的問題点および取り組みについて話しました。ワクチンや医療体制などの問題点を各国においてどのように向き合っているかについて議論しました。緊張しましたが大変有意義な時間でした。午後は我らがボス、牧石先生による発表です。”Microalbumuniuria: Is an indication of RAAS blockaed in normal blood puressure?”のタイトルでこれまた20分の発表でした。いわゆる正常血圧、非糖尿病患者における微量アルブミン尿症例においてRAAS阻害剤の適応があるかどうか、と言う議論が必要なトピックについて日本腎臓内科専門医の立場から素晴らしい発表をしてくださいました。
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.
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.
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.
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）
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。
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.
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.
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.