A Report of Elective Module in Kobe University
Davrina Rianda
5th Year Student of Universitas Indonesia“Experience is the best teacher.”I always believe that the best way to learn is by doing it. Before I start myessay, let me inform you that this is my first time to study aboard, even for a shortperiod of time. I felt honoured to have this opportunity. The first thing that popped up
in my mind was a mission of learning not only about the academic things, but also theJapanese culture. Honestly, I was so curious to know more about how Japan candevelop many improvements in science and technology.

A.

Dermatology Rotation
My first two weeks were spent in theDermatology Department of Kobe University.
Hiroshi Nagai, MD, PhD was my supervisor forthe dermatology rotation. On the first day, heintroduced us to many staffs in Dermatology
Department. We were glad because they reallygave us a warm welcome. Nagai Sensei also introduced us to Nishigori Sensei, thechief of Dermatology Department. Nishigori Sensei told us that last year, there wasalso an Indonesian student having her PhD program in Dermatology Department ofKobe University. Nishigori Sensei also said that she hoped that we can enjoy our timein this dermatology rotation.
Basically, our dermatology rotation was divided into several kinds of activities:
outpatient clinics, operation room, tutorial, an introduction to laboratory activities,
conference, and professor round. In every activity, we were supervised by a seniordoctor, either it is Nagai Sensei, Kunisada Sensei, or Fukunaga Sensei.
Our activities in outpatient clinics varied from observing outpatient
examination, seeing a fungal inspection through KOH examination, and having thespecial clinics session. For the special clinics, we had the allergy immunology andtumor clinics. During our rotation, I observed that the most common diseases in here
are atopic dermatitis, psoriasis, and allergic dermatitis. Contrast to Indonesia, werarely found any skin infection in Japan. The
one and only infection that we found wasinfection of M. chelonae, which is related tothe use of tap water in Japan.
For the operation room, we observed
manykindsofoperations,suchaspigmentectomy for nevus pigmentosus,
Bowen’s

carcinoma,andextrammary

Paget’s disease. Nagai Sensei also showed
us the dermatome. This tool is used toseparate the epidermis and upper dermis
from lower dermis in the skin graft. We
were surprised that skin grafting is done by
the dermatologist here, not by the plastic
surgeon. Another interesting activities in ourrotation is tutorial session. All of the tutorial sessions were supervised by Nagai
Sensei. The topics ranged from dermoscope, phototherapy, graft versus host disease,dermatomyositis, allopecia, etc. Before the tutorial started, Nagai Sensei had told us
about the topic in order to make us more well prepared for the tutorial.
Eventhough we didn’t have any researchsession here, Nagai Sensei took us to thelaboratoryofdermatology

orientation

about

research

fora

brief

activities

indermatology department. He also showed us
theculture

melanocytes,

ofmelanoma

thentaughtcells
ushowandtodifferentiate one to another. We also joined
the clinical and pathological conferences ofDermatology Department. Both conferences
took a long time because there were a lot of
patients (as I counted, it reached about 45patients). Surprisingly, we didn’t feel boredbecause there were always a senior doctorwho kept telling us in English about the patients’ conditions. Before the conference
begun, we were given a chance to introduce ourselves to all of the senior doctor,
residents, and interns. Again, I felt so grateful that this department welcomed us very
well. Last but not least, I also joined the professor round. The round was held in thedermatology ward. Led by Nishigori Sensei, the round was attended by the seniordoctors, residents, interns, and medical students.

B.

Gastroenterology Medicine Rotation
Moved to the third and fourthweeks of my elective module, I joined
the gastroenterology medicine rotation.
Here, I was supervised by Prof. Takeshi
Azuma, MD, PhD. Azuma Sensei is thechief of Gastroenterology Department ofKobe University. Firstly, Azuma Sensei
gave me an introduction about the Gastroenterology Department. He also said that
one of the main developments in here is on the endoscopy center. I was not reallysurprised because I have read about how Japan developed the screening program ofgastric tumor using endoscopy. Hence, almost all of my activities in thegastroenterology rotation were spent in the endoscopy center.
BeforeI

startedmyactivities

intheGastroenterology Medicine Department, Azuma
Sensei introduced me to Yoshizaki Sensei, a 3rd year
resident of this department. Yoshizaki Sensei thentook me to the doctor office, a place where otherresidents spend their time to work on some reports
here. I was introduced to Ohara Sensei. I was toldthat both of Yoshizaki Sensei and Ohara Sensei
would be my supervisors. They also asked me about
what do I want to learn here. I felt so lucky that mytwo supervisors were really friendly and helpful.
There

arefivekindsofactivities

thatI

followed

here:

Esophagogastroduodenoscopy (EGD) and Colonoscopy division, Endosocopic
Retrograde Cholangiopancreatography (ERCP) divison, hepatic division, professor

round, small conference, and case presentations from medical students. In a week, I
spent three days in the EGD and ERCP division, then two days for the hepaticdivision. At first, I felt strange to learn such an advanced knowledge like this. But as I
learnt more and more in the divisions, I really enjoyed learning many things as I couldin this rotation.
On the first day, I went to the endoscopy
center.

Here,I

learntabout

theEGD,colonoscopy, and ERCP. In the EGD andcolonoscopy

divisions,

I

saw

many

examinations for the diagnosis and screening. Iwas told by Morita Sensei, a senior doctor ofEGD, that in Japan, people above 60 years oldmust having a screening of gastric tumor using endoscopy. There are also manytechniques to visualize the lesions in EGD such as Indigocarmine, iodine, narrow
band imaging (NBI), and magnifying NBI. All of the techniques are used to get moresensitive screening program and more reliable diagnosis. Not only for screening anddiagnosis, the endoscopy could also be used for the nonsurgical treatment using
resection of the tumor. For the ERCP, I just observed only one case about the tumorof head of pancreas which osbtruct the billiary tract. Also, I was allowed to join thesmall conference for the EGD intervention. This was a discussion between seniordoctors and residents in the EGD division about the patients who will undergo
resection using EGD on that week.
Another activities in the gastroenterology
medicine rotation is the Hepatic Division. I
observed the echo abdomen examination. Saito
Sensei, one of the residents in the divison,
explained to me about how to read an echo
abdomen, such as assessing the hepatomegaly,
defining the fatty liver, finding stones in the kidney, etc. This is completely a newthing for me, since I have never been learnt much detail about echo abdomen.
My favourite session in gastroenterology department is the Professor Round.
This round was led by Azuma Sensei and attended by the senior doctors, residents,interns, and medical students. Interestingly, since each medical student had to follow
up two patients, every student had to do the physical examination of abdomen in front

of Azuma Sensei. After that, Azuma Sensei would give a short comment about thepatient and repeated the examination the patient to confirm the findings.
In this department, I was invited to the case presentation session from the Kobe
University medical students who had the gastroenterology rotation that week. I was soenthusiast about this, because many cases would be explained more detail and I could
compare the treatment between here and in Indonesia. On that day, some of thepresented cases were IPMN, hepatocellular carcinoma, and Behcet syndrome. In thiscase presentation, the main focuses were history taking, reading CT-Scan/MRIresults, and nonsurgical advanced treatment, such as PTGBD, EST, and ENBD. I wasa bit surprised that medical students in Kobe University have learnt in detail about theadvanced treatment which is not really common for me.

To be honest, my elective module in Kobe University is beyond my expectation.
I learnt many new things, not only for the academic things but also the cultural one. In
my opinion, screening is the most developed program in here. For example, forpatient above 60 years old, they must undergo gastric cancer screening using theEGD. This examination is covered by the national insurance. I also learnt about
profesionalism. When I was in the dermatology department, I learnt that whileobserving the examination, we have to keep sitting on a chair until the doctor asks us
to take a look at the lesion. It is considered as “not polite” to observe the patient fromabove (we often do this if if we were standing while observing). From a small
conversation with the medical students in Kobe University, I also learnt about
hardwork. They told me that if they haven’t finished their tasks or study time, they
will not spend their time to have any leisure activity. Finally, I really hope that one
day I can go abroad again. Since experience is still my best teacher, it is such a golden
opportunity to learn about many new things, share them to the Indonesian people, andmake a change for better Indonesia in the future. Thank you very much, Professor
Kuno, Kato Sensei, Kimi-San, Terao Sensei, Yun Sensei, and all of the student tutors
for taking care of us very well. This will be one of the most precious experiences thatI will never forget.