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Clinical Clerk Ship at The Children’s hospital, Zhejiang University School of Medicine Experience Report

 By Ai Niida, Medical student from University of Yamanashi, Japan

Study Period: 2019.5.13--2019.6.07

Rotation Departments:  Neonatology, Endocrinology, General Pediatric Surgery, Cardiology Surgery
Thanks to the relationship between Zhejiang University and my university, I could have this wonderful opportunity and privilege to rotate in Neonatology and Endocrinology Department at Children’s Hospital, Zhejiang University School of Medicine. During my stay for 4 weeks in China, I experienced much more than what I had expected, which were not only medicine but also Chinese culture, personality, history and so on. The reasons why I applied to this program were to learn how the Chinese medical educational system differs from those of others, to study how doctors in China treat patients and to consider my career as a doctor in Japan.
Neonatology
I spent the first 2 weeks in the Department of Neonatology. On the first day of my rotation, I got to know that the NICU in this children’s hospital is extremely competitive in China. One of the impressive characteristics in NICU in ZUCH is that the trans-provincial ground ambulance transport, which covers abroad range of hospitals in whole China, had started since 2004. Therefore, as long as there is a newborn baby who needs intensive care, it takes 8 hours at most one way to bring him/her to ZUCH. Luckily, I could have the chance to accompany one of the doctors who were asked for ambulance transportation from other hospital. It would be a part of my unique experience.
Otherwise, I attended both the morning report and rounding in the afternoon on each day and I observed what the doctors did for newborn babies, such like lumber puncture, umbilical catheterization and ventilation. Besides, I was given department specific lectures and simulation training. One thing impressed me a lot was the different workload from Japan to China nurses in China should do a lot of procedures which meant that one nurse needed to handle several beds by oneself, while one bed needed several nurses in the NICU in Japan.
Thanks to my respectable tutorDr. Chen Ming Yan, who took a lot of time to explain patients and disease to me, was always glad to address any questions I had, hence, I was able to learn a lot about Neonatology, with my limited knowledge of Chinese and Neonatology. In addition, it was the first time that I had ever observed such large number of new born babies. I was truly appreciated seeing that numerous doctors would warmly take care of me and teach specific disease of neonates to me. 
Endocrinology
After Neonatology, then I rotated in the Endocrinology Department for 2 weeks as well. I found that this department was very different from NICU, for example, communication between doctors with patients or their parents and the morning report and rounding which I took part in every day. Also, I was able to compare the general medical system in China and that of Japan. Most impressively, the attending physician took enough time to explain about the diagnosis or treatment in detail during the rounding, so both patients and their parents and doctors who are on the same team could understand totally about the disease. I thought it was important for both to build up a team covering patient. However, doctors in Japan would never talk so much about disease during the rounding. When I rotated in the Internal Medicine Department in my university, I noticed that doctors had seldom discussed about treatment facing patients. Maybe that was because of Japanese personality, which was characterized by foreigners, like bashfulness, politeness and respect.
Finally, I would like to thank all the doctors in the Endocrinology Department and all the medical students who supported me to catch up on what was going on during the rounding and outpatients.
Surgery
Luckily, I had the opportunity to observe surgeries in two departments for two days, one day for General Pediatric Surgery and the other day for Cardiology Surgery. On the one hand, Dr. Gao Zhigang in the Department of General Pediatric Surgery performed several laparoscopy surgeries and it was exciting for me to observe such sophisticated procedures. On the other hand, Dr. Shi Zhuo in the Department of Cardiology Surgery showed me one of the most unique devices for VSD (Ventricular Septal Defect), which was called Ventricular Septal Defect Occlusion Device. I was impressed by this noninvasive procedure, in which there were many advantages, such as shorter time for operation and smaller wound compared to open-procedure. Moreover, this was produced improved device for less occurrence of complication like Atrioventricular Block in China, so a number of surgeries for VSD were introduced to China, and 200 surgeries were conducted per year in this children’s hospital, while 1300 cardiovascular surgeries were did in total. At the same time, I so fortunately to be in a position to experience one of the surgeries with this device, which ended only within surprisingly 30 min.

In fact, Open-thoracic surgery still was commonly suggested for VSD in Japan because it was said that more serious complications could be happened by using the device.

After clinical work, I spent an incredible time in traveling in Hangzhou and Shanghai with other two medical students — Ms. Zhu Heng and Ms. You Bingbing, who were exchange students in the University of Yamanashi. It was so nice for them to bring me to so many places, make multiple arrangements to fulfill my desire and tell me a lot about Chinese food, history and medical educational system. I was honestly pleased to be able to have a relationship with valuable friends whose thoughts influenced me as a medical student.
Overall, although I had a language barrier and limited knowledge of each department, my experience in China was exceedingly positive. I found a lot of differences as explained above and I noticed cultural background which had influence on these differences. Furthermore, I learned about the importance of English knowledge and communication skills.
Finally, I’d like to thank all the doctors in those four departments as well as all the staffs in International Affairs Office for supporting me and for giving me such a memorable time. I had a meaningful learning environment here and hope that the relationship between Zhejiang University and the University of Yamanashi would be more enriched. In addition, I would strongly encourage students to pursue a clinical experience in other countries because it made my insight into career as a doctor more mature.

 


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