Elective report

School of medicine, Kobe University
8 July‐ 4 August 2013

By
Jutaporn Junwongkaew 5102032
Faculty of medicine Ramathibodi hospital,Mahidol University, Thailand

Elective Report
Introduction
Geographic data
Kansai region includes the cities of Kyoto, Osaka, Kobe, and Nara which are famous forthe rich cultural heritages from ancient times.

Located almost at the center of the Japanesearchipelago on the Seto Inland Sea in Hyogo Prefecture,
Kobe has developed along with the opening of the Port ofKobe in 1868. A Foreign Settlement that formed near theport became the doorway by which foreign cultures
entered Japan. This settlement also played an importantrole in bringing a stylish and modern atmosphere to theentire city. Western clothes, furniture, cakes and shoes aswell as heavy industries such as marine transport,industrial machinery, ship building and the iron and steel
industries appeared one after another, spurring on thelocal economy. The population is 1,544,120 (as of May 1st,2012). The weather is generally mild all year roundwith an average temperature of 16,8 C° and an annual
rainfall of 1,624.5 mm(as of 2011).

Kobe medical school
School of Medicine originally was Hyogo Prefectural
Medical College, which was built together with theestablishment of Hyogo Prefecture. In March 1968, Hyogo
Prefectural Medical College was nationalized and named
Kobe University School of Medicine. After a 138 years of
its history, it has become one of the core school andhospital in Kansai Area.
A mission of medicine is to contribute realization of environment in which the people canlive healthily and safely. Kobe University Graduate School of Medicine is required to generateinnovative knowledge, and accumulate and transmit them to the next generations.
Kobe University has turned out many biomedical scientists who work at the front of thesciences inside and outside the country. Lasker award is the most authoritative award in the field ofbiomedical sciences in USA, and sometimes referred to as "America's Nobel Prize in Physiology orMedicine." Two among 6 Japanese winners of Lasker Prize are concerned with Kobe University
School of Medicine. The late Emeritus Professor, Yasutomi Nishizuka found protein kinase C, andcontributed to elucidation of intracellular signaling transmission through his studies on thefunctional role of this molecule. He was later selected as the president of Kobe University. Dr. Shinya
Yamanaka Professor of Kyoto University, who graduated from Kobe University Medical School, has
found the method how to develop induced pluripotent stem (iPS) cells. He and his colleague issued
remarkable scientific papers which are medical benefits in the fields of regenerative medicine anddrug discovery from Institute for Frontier Medical Sciences, Kyoto University. Kobe University Schoolof Medicine has groundwork to produce such top runners in science.

The elective program
Life in cardiology department

For the first 2 weeks I spend the time in cardiology ward. It was such a right choice
for me since I have learn many crucial practical points of cardiology, seen newer technology
and interventions improving standard of care, and met with incredibly best people.
On the first day I was introduced to Prof. Sasaki then he introduced me to mysupervise doctor, Dr. Mori, and also other doctors in the department such as Dr.Tou,Dr.Nakao.
In a cardiology department, life starts at 10am. We will start the days with morning
round. My supervise doctor, Mori sensei (teacher), will talk to his patient first then he will
describe to our team with including of me, 2 Germans, and a Portuguese. We enjoyedlearning a lot since after a ward rounding we will discuss about the case. Our sensei will ask
and teach us the crucial points of the diseases in many different aspects. I learnt about how
to read the electrocardiogram (EKG), echocardiogram; how is the EKG and blood tests
change during progression of acute Myocardial Ischemia (MI); and knowledge of HOMC,
Atrial septal defect(ASD) and its intervention repair.

I have a chance to visit CATH lab many times to watch interesting interventions withtou sensei or Takao sensei, and also, echocardiogram room with Tanaka sensei.

Here, all the doctors are so kind that they also establish special lectures in English forus. Including CT coronary by Dr.Mori, Trans‐esophageal Echocardiogram by Dr. Tanaka, andMDCT by Assistant professor Tomofumi Takaya, M.D, Ph.D.

On every Tuesday, there is a grand round that both senior doctors and medical
students will join the working team taking care of the patient. Then, after that there will aconference taking about interesting cases on the ward presented by medical students orresidence doctors.

Apart from working together, my impression is to see the well‐bonded relationshipamong the health providers. People talk friendly with respect to another profession whether
he/she is a doctor, a pharmacist, or a nurse. This is a real TEAM WORK!
Here, there is also a soccer night 2 times a month inviting every one interested. Ofcourse, I joined them! And although I already changed the elective department to another,
they still invited me to join their drinking party.

Kobe’s cardiology department was such excellent school and perfect workplace. I
really have a wonderful time. I wish I can visit there again someday.

Life in Orthopedics department
I spent the last 2 weeks in an orthopedics department observing outpatient clinic
and operation, as well as joining ward rounding, grand rounding, and pre‐operativeconference.
Here, I met a world renowned orthopedictrition. From the first day, I was introduced
to Prof. Masahiro Kurosaka, a chief of orthopedics department and inventer of Kurosaka
screw used all around the world to reconstruct posterior cruciate ligament (PCL). I observe
his outpatient clinic for 2 days. He is very kind and joyful. His English is so perfect like anative speaker. Next, I was introduced to Asso.Prof.Ryosuke Kuroda. He is also one of theworld leader’s surgeons in anterior cruciate ligament (ACL) reconstruction. I also visit hisoutpatient clinic and operation room every week. The wall of his clinic is decorated withmany pictures and signatures of famous athletes.

Apart of clinical practices, I was allowed to see and do some basic science researchesof orthopedics department such as doing PCR of meniscus cells, harvesting cell culture ofintervertebral disc cell, and dissecting mouse’s Tibialis Anterior muscle. Sometime it is hard
to explain in English. Drawing diagram and pictures works a lot!

Japanese class
As a medical student in an ASEAN’s exchange program supported by Japan’sgovernment, there was a Japanese class provide by the university every week. They though
me basic greeting dialogue, how to introduce and identify myself, how to ask basic questionin Japanese. It is very nice to have this kind of cultural class in an elective program.

Non‐academic life
My life in these 4 weeks is very fantastic! Since I come to Japan alone, there aremany things exciting. Sometime I feel lonely especially when I go back home. But other thanthat I am very happy staying in Japan. I was warmly welcomed by my friends and teachers,
went to many famous places, and eaten many delicious food and sweet.
My accommodation place is quite far from the city central and very quiet. Still, it is agood place for staying. It is a 1 bed air‐con bedroom with its own toilet. All the necessary
things are provided; internet via LAN cable, TV, soap, shampoo, towel, and yukata. Fridge,washing machine, and iron are also provided in a common room.

For the transportation, I bought a monthly ticket travelling from my place to myhospital which it takes me about 40 minute to reach there. To go out of the usual route, I
have to buy a real ticket. The transportation cost here is quite high but the rail system isquite complete. I can go almost everywhere by train and on foot.

Coming here I can reunion with many of my old friends and also getting to know
many people. They are friends of friends and my teachers. I am impressed in how Japanesepeople treating their friends. So much love and care I received. I feel that I am so lucky inthis part. Almost everywhere I go there will be a friend with me or being at the place that I

am going to go. About my old friends, some are the Kobe’s exchange student who came toBangkok. Others are who I known from conferences I joined.
For the Kobe‐Mahidol exchange student group, we found sometime going outdinning, playing firework, going out sightseeing and also go sailing! I would never have sucha good time in Kansai without them.

Along with Kobe’s exchange students, there were also some of their friends andother foreigner exchange students joined in our Kyoto and Osaka trip.

In that time, one of my Taiwanese friends came to elective in Tokyo. She invited me
to visit her there. At that weekend, we went to Mt. Fuji together and also visited many
places in Tokyo with our old friends.

Last but not least, the food: I enjoyed traditional Japanese food a lot. I have try sushi,sashimi, okanomiyaki, tempura, udon, ramen, zoba, and so on. Thanks to all my friends andmy beloved senseis who treat and advise me very well.