From September 26^th to 30^th  I had a chance to be in a observership program at Thomas Jefferson University. My purpose of joining in this program was to learn the systems of hospital and learn the differences of medical education in America. Though it was a short-term visit, I was able to observe several departments. We were able to join in some of the free clinic run by the students. It was a meaningful experience for me. I would like to write down some of the thing I felt and experienced through this program.

Internal medicine

I joined in the Green1 team where there were one attending, three residents and two medical students. In the Green team they were responsible for the General medicine. There were other teams that was responsible for Cardio and GI and so on. I joined them with the morning rounds. They first discussed what they thought about the patients through the pre-rounds. Each medical students had few patients and did their presentation on how they should treat the patients. It was so impressive for me seeing medical students working as one of the team members. In my clinical clerkship I just mainly observe doctors treating so it was a big difference for me. Residents and attending taught the students nicely so I thought they were more supportive to medical students compared to my university. The patients I saw during the rounds were different from the patients I saw during my clinical rotations, for example alcoholism, sepsis, homeless patient with decubitus. During the rounds, doctors were listening closely to the patients and were considerate to the patient feelings. The chart they used were different from the one that is normally used in Japan. We were able to see the basic information of the patients with one page and I was surprised to see that there was a chat that every medical staff could use. They were talking about the treatment of the patient and I thought that it was an effective system since they do not need to call to other staff members every single time. The charts they carried though the rounds were easy to understand and had information on what to do even on night shifts.

Family medicine

In Japan family medicine is not so common compared to America so it was very interesting for me to observe the outpatient. In the department of family medicine, they examine about 12patients from children to adult in the afternoon. I was able to observe patients with hypertension, chronic kidney disease, smoking cessation, regular check-up and mastitis. During the examination Dr.Cymring was offering vaccination for the COVID and flu. I was surprised to see the system that they were able to get the shots without a reservation since we had to have a reservation to get the shot in advance. For the elderly patients some of the patients were also taking a vaccination for herpes zoster. Dr.Cymring started the conversation like “How’s life?” to ask about their daily lives. She was bringing back the memories with the patients who had not come to the hospital for few years. I thought that from these kinds of conversation we would be able to understand the lifestyle of the patients which will lead to better treatment. When I asked Dr.Cymring what family medicine was she told me that the best part is being able to see the whole family. She also told me that it is also important to work together well with the social workers.

Pediatrics

I was able to observe outpatients at NEMOURS Children’s Health. I was able to observe six moth check-ups, one year check-up and examination of siblings. During the check-up they were also doing blood test and checking if they were able to walk well. Dr.Berman was asking what the baby was eating and drinking and also teaching parents on what kind of things the baby should take. The siblings came because of obesity but at the same time there was a questionnaire on their mental. If there was something suspicious, the doctors suggest the patients to talk with the counselor. Dr.Berman talked theses things without her mother in order for the patient to feel relaxed and talk freely. One of the things I though impressive was that since in America there are many people from different races there were educating from small ages. They were giving out free books to the babies and children who came to the hospital. The characters in the book were from different races so that they could learn that there are various races. They would improve the education in pediatrics by taking opinions from the children. Also, I saw many documents about LGBTQs and thought that it is important for children to learn diverse background of each people. I noticed that many doctors were presenting their pronouns close to their name tag. This is something I noticed in another department as well. I thought that by doing this, patient could easily tell their pronouns to the medical team as well.

JeffHOPE、China town Clinic

I was able to join in two of the free clinics run by the students, JeffHOPE and China town clinic. I joined Eliza Shirley in JeffHOPE. It was a shelter mainly for women and children which provided not only medicine but also dippers and other daily stuffs. There were also kids committee and also provided counselor as well. In the medical team, M3and4 worked together with M1and2 to examine the patients. Students did patient interview and physical examination and diagnosed the patients. They also prescribed medication after getting checked by the resident. I helped prepare for the medications. Seeing each students doing different work I thought the clinic was run effectively.

In the China town clinic, M3and 4 students were taking patient history and physical examination. Students made the decision on whether to take ECG and judged the result. Dr.Lau checked for the decision and I felt that he was relying on the student. There were patients who had been coming to the clinic for years and also patients without health insurance. I was impressed to see students not only doing examination but also considering about social background of the patient. There were many members who were able to speak Chinese and there was student from nursing who helped with the translation. When there were no students who could speak Chinese, they used phone translation. I was able to talk with students in JeffHOPE on the online program this Spring but seeing two clinics I felt more strongly that I should also do something for the community.

Lecture

In the lecture of Dr.Majdan, we had ECG lecture in the beginning and then patient interview with standardized patient. During the patient interview Dr.Majdan pointed out to us if we were thinking about the patient and if we were asking thinking with differential diagnosis. He pointed out our behavior during the interview and also the medical words we used when asking the patients. By experiencing patient interview in America, I learned that how we call our patients and consideration to the patient is really important. In his lecture I realized the importance of history taking and structured interview skill.

Summary

Through the program I was able to learn that the hospital was organized for the community and for the patients with different social backgrounds. The systems of outpatients were different from Japan but I thought it as effective and thought that the way the meetings were held were also effective. On the other hand, I was able to realize the good point of the Japanese medical insurance system where everyone can get the treatment easily. Seeing the presentation of medical students in their rotations, I felt that I should participate in my clinical clerkship more actively. I had interest in working in America but by this program I thought that I should make more future plans and what I want to learn more clearly. I would like to make good use of what I had learned in this program as a doctor.

Acknowledgements

I am grateful to participate in this program thanks to Dr.Sato, Dr.Asano and members of Noguchi medical research institute, Dr.Pohl, Dr.Chantel Venkataraman, Dr.Christopher Adkins, Dr.Wayne Bond Lau, Dr.Barbara Cymring, Dr.Tara Berman, Dr.Joseph Majdan, Dr.Jessica Most, JeffHOPE, China town Clinic and members of Thomas Jefferson University, Ms.Yumiko Radi, Ms.Rieko Nakamura and members of Japan center, Dr.Makoto, Dr.Shuji, Tammy, Scott and Japanese students who participated in the program with me. I am thankful to every person who was involved in this program. Thank you very much.