EHC Shadowing Reflection: UCSF

Takahiro Akimoto

Hello!

My name is Takahiro. This is my first article. So nice to meet you!

It was March 18th. Thanks to VIA program, we could go to hospital of UCSF: University of California San Francisco.

We gathered around 7:30 and went to UCSF by BART.

8:25 – We waited at ICU patients’ waiting room to wait until my team arrive.

8:30 – I met my team member. Six people make one team, and there are one student and one resident doctor. Five people are women and man is just one person. A doctor has MBA and another doctor has MPH.

8:35 – A meeting named “Sign up” was started. One doctor explained her patients and we heard her presentation with breakfast. And one doctor came and present his patient of last night. The presentation finished only 10 min. It is very natural and professional, so it is very surprising to me. One superior doctor hit upon to introduce us the important point of the disease which the patient had. The lecture is rich in content. And it seems that the student could understand very much. But it took only 2-5 min, so it was also surprising and exciting me!

8:55 – The round was started. Doctors presented their patients in front of the patients’ room. They talked about CC, HPI, PMH, Meds, All, SH, FH, ROS, VS, etc. And they used SOAP style so it is easy to understand, however, the speaking speed is a little bit fast. The patient rooms are only single or double room. It is one of the different point from my university.

11:00 – Our team discuss with many co-medical workers, for example, social workers, nurses, pharmacists, and psychiatrist. I heard this conference is used to be held everyday. But that finished only 6min.

11:10 – They finished morning round already, so I attached the student and watched how to work as third grade. She is so kind to tell me about her patients closely.

12:00 – Lunch session was started. It seems that everyone could join and it held every noon. Then I can learn about C.difficile and how UCSF cope with any other the infection in the hospital. Presentation is very interesting and the presenter used a question system.

13:00 – Todays’ special shadowing was ended.

Thank you for reading this article. And I appreciate my team and VIA stuffs.


Anna Nakai

I’m Anna Nakai, 4th year student of Tokyo Women’s Medical University. Now, I want to write about my shadowing in this EHC program

It was March 17th, I could go to UCSF : University of California San Francisco, internal medicine for shadowing. I was assigned to ICU department and its department divided into two floors. There are cardiovascular floor and general one.

First, when I was join the following group, they talked with their patient about therapeutic strategy. That discussion consists not only doctors and patients, but also patients’ family. They took long time to discuss until they were convinced of what to do next. At that time, the doctor asked the patient, “what questions do you have?” not “do you have any questions?” . I was impressed by their consideration towards the patients in all respects.

After taking to their patient, I could identify all team members, their own works and relationship each other. Dr. Kahn MD. is an attending doctor of my group, and that group consists two medical doctors, nurse practitioners, a pharmacist and two student doctors. In their conference, both of that student doctors take charge of their own patients and explain the situation by themselves. I see its training will improve their doctor’s skill.

In the same way, we went the rounds of their patients. Next patients had serious disease : he had liver cancer and it spread throughout the body. His disease progressed as he couldn’t live much time. This time, discussion between the doctors and the patients focused on what to treat from now on and where to go after being out of the hospital. I could see that patients trust their doctors, and also the doctor help his decision by holding patients’ hand. That situation made a deep impression on me and it made me think more about relationship between doctors and patients.

It was interesting and there were a lot of things we all need to learn. It was a great opportunity to learn difference or benefits compared with Japan.

Thank you.


Chikako Naoe

I went to the UCSF for shadowing on March 18th. It was my first time to visit the hospital in America so I was little nervous about participation to the shadowing.

First, we were introduced to the doctors who work at the UCSF and then we followed them individually so as to know how the doctors in the U.S. treat patients in the hospital.

I could be able to see several patients and know the process of treatment.

The most impressive things was that in America, there are a few specific departments and most of the doctors see various kinds of diseases in the hospital. They have some specific departments like Emergency or NICU but besides these, they don’t have any specific distinctions. That’s means we have to gain ability of treating many kinds of patients if we want to work at the United States as a doctor.

Next, I would like to write about some process which the DCs did on that day.

First, they gathered at the meeting room on the morning and some DCs told other team members about their patients’ symptoms and how they are going to treat them. And others asked some questions or gave some advices about the way of treatments. I was very surprised that so many young doctors convey their opinions even if when they talk to the elderly one. I would like to gain such great courage and have ability of telling others my opinions directly in the future.

I could only follow them and see how the doctors work at the hospital this time, but I would like to come again and become one of the medical team members.


Shota Ike

Hi, I’m Shota Ike. I shadowed at UCSF on March 17, 2016. Shadowing had been the most interesting part of the program for me from when I decided to participate in EHC program.

First, we participants were separated individually and I attended the internal medicine team. The attending physician was Dr. Bradley and the team is composed of other two resident doctors and two UCSF medical students who were third and fourth grade medical students. By shadowing physicians, I learned what it is really like working in the field, assisting patients, and learning the process of diagnosis. In order to introduce their team members, they gave their name cards to the patient and the way of assisting patient was so attentive.

There were many differences in shadowing between Japan and the U.S., such as system of grand rounds, physical examination and conferences. Especially, I was surprised that there was the environment that even medical students can easily share the opinion with doctors and how fast things are going in the hospital.

Finally, I became a friend with one of medical students in the team and we discussed each other’s education system during the break. It was very good experience for me to learn the differences between the medical students in Japan and America by discussing with local medical student. I want to put these experiences to explore the challenges for medical education development in Japan.

Thank you!!

Screen Shot 2016-03-25 at 17.11.42


Mayu Yamakita

Hello, I’m Mayu Yamakita. I’m a 4th year student of Osaka Medical College.Let me talk about my UCSF shadowing!

On March 17th, I visited UCSF medical center. I took part in one medical team.The team had an attending doctor, a resident doctor, a intern doctor, and two medical students.

First, I joined a meeting that they hold every morning. In the meeting, the team shared the information about new patients. The doctors talked about their patients’ situations, and asked the students what diseases they have. I was so surprised that the meeting was so heated. Everyone in the team discussed actively. And I think I should follow their attitude.

Second, I followed the team and went to a emergency department. In the departmet, I could see 3 patients, taking histories, and some physical examinations. In the examination, medical students worked hard and played a larger role than I had expected. They took histories, and did some physical examinations. Also I noticed that their way to take histories were so similar to Japan. They set their eyes at the same height as patients, speak slowly, and showed a sympathy.

Third,I attended to the meeting named intern report. That was like a PBL class in Japan, and people guessed the disease of the scenario. I think these meeting is very useful to practice making diagnosis.

Last, I took a look at conference. The team members and coworkers like nutritionists and social workers shared the information of patients. And since they share the information, they can support their patients deeply, I guess.

Thank you for giving me such a precious opportunity. And thank you for reading!


Mari Miyajima

Hi. I’m Mari Miyajima. Today, I’d like to talk about my shadowing experience with the UCSF internal medicine teams on March 17th.

Firstly, we were introduced to the team individually at8:30. In my team, there are 2 doctors, 2 residents and the 4th & 3rd medical students. After the quick introduction, the team had a meeting. That was mainly about patients’ conditions. They take care of 10 patients, each of the members are in charge of 2 or 3 patients each. Each of the members talked about family history, the lab, how the patient was like and what kind of treatment they can do. I was so shocked at how fast the doctors talked. It was difficult to catch up with what they were talking about. Then we had a group lunch discussion afterwards. Dr. Arvind, a resident of my team, had a presentation about his case. It was a case about a man who traveled to Guatemala and Mexico. Since he had a high fever, other residents had to find out what kind of disease he might have from the information. Considering his family history, lab, HPI (History of Present Illness), they came up some possible diseases such Malaria, Zika or hepatitis. In this group meeting, I found some differences between Japan and America. I was so surprised that the meeting had such a nice atmosphere so that even medical students can discuss with their opinions while eating lunch together. Also, when they talked about the case, so many people shared their opinions with chatting and laughing.

After that, we moved on to the rotating. It was literally the first time to go around the hospital as a medical student, so everything there was so new and fresh to me. First, we had a short meeting with social workers. After that, we went to see some patients. One interesting thing that I saw was how to treat patients who don’t speak English. Since the patient speak only Chinese, they used the interpreter phone. As America has such huge diversity, the interpreter phone must be useful for both doctors and patients. Also I had a chance to see how doctors talk to the patients. The way they talked was so kind and clear that even I could totally understand what they said. And they didn’t use any difficult medical terms to the patients and their family.

In conclusion, it was definitely the best experience I’ve ever had as a medical student. Since I don’t have a lot of chances to shadow until 4th year, I found it so difficult to have motivation for my study. However, I saw that a 3rd student took a lot of part in a group. The environment and atmosphere in the hospital were so nice that even students can share opinions with doctors. This experience motivated me to study hard for the rest of 4 years at university. Also I’m sure this shadowing will be a huge step toward my future.


Mariko Watanabe

Hello, my name is Mariko Watanabe. I’m a second year student of Kyoto university.

Today I’d like to share my experience at UCSF Medical center on March 18th. In my shadowing, I could join the medical team of Transitional Care Unit.

The team was comprised of four doctors and one medical student and one pharmacist.They had the first meeting to share information about patients who they would see in the morning. After that, they went around some departments to examine the patients.

They had an after-meeting every time they examine a patient, and discussed the treatment plan or the treatment effect actively. In those meetings, there was the meeting to talk about the patient’s discharge plan with social workers.

In my shadowing, the most impressive thing was about nurses in the US. In US, there is a occupation, “Nurse Practitioner”, besides Registered Nurse.

Nurse Practitioners are nurses who were more educated and had more advanced training , they can care patients more widely and take more responsibility to medication. For example, they can diagnose, they can prescribe medication.

Mostly Japanese nurses correspond register nurses. Actually Japan also has the system of Specialized nurse, however  it is not still common.

Most Nurses and Nurse Practitioners in the US were working with advanced-skills, responsibility, respect from other providers.

The working style was  interesting for me, I was so impressed!

Moreover, I found a  Japanese nurse in ICU by chance and I could talk with her fortunately. She worked as a nurse for eight years in Japan, and moved to the US. It was the first time for me to talk with nurses working abroad, so I could learn the difference of nursing between Japan and the US, it was a valuable experience.

Through this shadowing, I could learn the difference of medical and nursing between Japan and the US. Thus I want to share this in Japan.

Thank you for reading this article. And I appreciate my team and VIA staff.

Leave a Reply

Your email address will not be published. Required fields are marked *