タイ・マヒドン大学附属シリラート病院より選択臨床実習

学生研修レポート

Pornkamol Tiranaprakijさん （マヒドン大学附属シリラート病院4年生）

〈抄訳〉

Day1 解剖学教室では、指先くらいの大きさしかない生まれたてのネズミの内耳解剖をしました。生き物の解剖は初めてだったのですが、組織をとりのぞいて骨を割り、蝸牛管を取り、そして毛細胞を見つけるというそれぞれのステップを先生方は丁寧に教えてくださいました。そのあとコンピュータ制御のとても新しい蛍光顕微鏡で毛細胞を見ました。とてもはっきりと見えました。

Day2 宮武伸一教授のBNCT （ホウ素中性子捕獲療法）の特別講義を受けました。原子反応の仕組みやどういう利点があるか、脳腫瘍の患者さん治療への応用、そして将来性などについて学びました。転移性のがんの治療について質問しました。

Day 4 小児整形外科では、藤原憲太先生の医師と患者の関係についていい勉強になりました。まず先生はやさしく子供の患者さんに挨拶し、穏やかな感じで話しかけるのです。子供の患者を注意深く見て、異常性を見逃すことがないようにと教わりました。先生の子供たちへの温かさに感動し、子供の患者さんには自分もこのように接しようと思いました。

Day 5 CT画像診断についてくわしく放射線科で学びました。タイでは盲腸にはCTスキャン検査が含まれていないのでCT画像で盲腸を見るのは初めてでした。膵炎の膵臓や、大腿ヘルニア、その他たくさんのCT画像を見ました。鳴海善文教授が日本のガイドラインを各疾患ごとに説明して下ったので、タイの場合と比べることができました。

Day 12 病理学ではスライドの見方を習ったり、ホルマリンを注入してスライドを作る作業をしました。先生は、自分の仕事が好きで、表舞台に立つことはなくても患者さんの疾患の回復の助けになることが自分の幸せだと語ってくださり、とても感動しました。手術中の病理報告は15分以内にしないといけないのですが、手術室に直接連絡できるシステムがあり、実際にその場面を見ることができました。

Day 16 口腔外科では、植野高章教授にがん患者のオーラルケアについて教えていただきました。オーラルケアについて気をつけて患者さんに接しようと思います。その他、下あご骨折修復、親知らずの抜歯、舌の切除などの見学をしました。

Day 17 三島救急医療センターに行きました。脳内出血による心拍停止の患者さんに対する心肺蘇生（CPR）、胸部の痛みを訴える患者さん、そして階段から落ちた患者さんへの対応と、３つのケースを見学することができました。救急患者さんの為に多くの進んだ機器がそろっており、マネジメントも含めて詳しく説明を受けました。救急センターを見学する機会があってよかったです。タイにも将来このようなセンターができればいいと思いました。

Day 18 消化器内科で午前中は上部消化管内視鏡検査を見学しました。私たちの病院とプロセスは大体同じでした。そのあと、シミュレーションセンターで、内視鏡の使い方の練習をしました。内視鏡の先が見えるので正しい方向へ動かすことができ、とても素晴らしいと思いました。午後は大腸内視鏡検査を見学しました。

ありがとうございました。

CLINICAL ELECTIVE PROGRAM

OSAKA MEDICAL COLLEGE

14th March 2016-8th April 2016

4th year medical student, Siriraj Hospital,

Mahidol University

Pornkamol Tiranaprakij

Day 1 Department of anatomy

Today,We had a chance to learn about Inner

ear Hair cell. Sensei taught us how to dissect the

newborn mice which were so little just as small as

our fingertip. This was actually our first time doing a

dissection with live animals. Therefore, this

experiment was very exciting for us. Sensei taught

us from the beginning about how to remove tissue,

crack open the bone, separate the cochlear and lastly

identify the inner hair cell. Senseis are very kind to

us. They taught us about everything and gently

explain all the instruction for us.

After we finished the dissection, we continued

with the experiment and we had an opportunity to

see the inner hair cell of newborn mice under newly-

invented fluorescent microscope which was very

advanced and convenient. The microscope was

controlled solely by computer and the picture could

be seen clearly on the computer’s screen.

Thank you so much Sensei, for teaching us a

lot for everything and also for treating us such a

wonderful Sushi lunch. Arigato Gozaimasu

Day 2 BNCT

We had such a special opportunity to have a

lecture about Boron Neutron Capture Therapy from

Professor.Miyatake. The lecture was very fantastic

and interesting. We have learnt a lot of things about

BNCT starting from the mechanism of reaction,

advantage of BNCT, management and adaptation for

treatment of Brain tumor patients and development

for future research. Professor.Miyatake explained to

us that this method can be used for treatment for

many malignant brain tumors and also kindly answer

to our question for an adaptation of BNCT for the

use of Metastatic cancerTreatment,

We have been inspired by this wonderful

lecture kindly explained to us by

Professor.Miyatake. Arigatou Gozaimasu

Suntory Brewery

In the afternoon, OMC had arranged the

program for us to go to Suntory Brewery, one of the

most famous beer factory in this area. We had a

great chance to observe the production of Beer from

the beginning until the end. Thank you OMC for

arranging this program for us

Day3 Department of Microbiology and

infectious control

We had an opportunity to join Ward round with

the infectious team. We observed management for

antibiotics and infectious control and can compare with

the system in our country. The picture next to this

paragraph is the picture of Japanese microbiology

textbook. I’m really impressed by this book because it’s

well prepared with explainable cartoons and it looks

very understandable for students.

Department of Blood transfusion

At transfusion center. Sensei explain us about

system of blood donation and transfusion guidelines

which are a little bit different from ours. I'm impressed

by one video from donation cable. It's very interesting.

Mishima Emergency critical care

Another exciting rotation, today was their yearly

training day as a preparation for upcoming disasters. As

you can see from the picture, this is all just a simulation.

I’m really impressed by well-prepared training for

unpredictable disaster we have seen today. Japan always

delicately prepares for every events and situations.

Day 4 Pediatric Orthopedic

Our rotation today was Pediatric Orthopedic Out Patient

Department with Prof Fujiwara He treated his children patients

really well. Though we could not understand Japanese, he had tried

to explain to us. He gave us a very good example of doctor-patient

relationship. We had seen he greeted his small patients gently and

talked to them kindly. He also taught us to examine our future

children patients carefully so that we would not miss any

abnormalities.

I was inspired by Professor.Fujiwara kindness and care for

his young patients. I hope that in future, I can treat my own young

patient as well as him. Arigatou gozaimasu

Day 5 Radiology

In the morning, we had a discussion about CT

image cases. It was a very fun and informative

radiodiagnosis lesson. We had a chance to see CT of

appendicitis (It was very interesting for us because

in Thailand we have different guideline which

doesn’t include CT scan. Therefore, this was our

first time seeing appendicitis as CT image.) ,

pancreatitis, femoral hernia and many more. Sensei

was very kind to us. He taught us a lot about how to

read CT image and also explain us about a role of

radiology in japan guideline for each disease so that

we can compare to our country’s guidelines.

During the lunch time Professor.Narumi treated

us a wonderful lunch and after that we stayed at

outpatient clinic where we had observed many

interesting cases. Sensei also let us do physical

examination with his patient and kindly explained to

us all about radiation interventions in this hospital.

We have learnt a lot of things today. Arigato

Gozaimasu

Day 6 Cardiology Medicine

In the morning, Professor.Ito gave us a lesson

all about basic cardiology. He explained every

mechanism of heart murmurs by giving us a picture

of graph that can explain heart sounds and murmurs.

This lesson was very interesting and understandable.

After the lesson, Professor let us examine cardiac

simulator for heart murmur which we can hear every

heart murmurs at the exactly right location as the

real body. We used our own stethoscope with this

simulator together with kind guidance from

Professor Ito.

In the afternoon, we continued our rotation

with observation of Transesophageal

echocardiogram and cardiac catheterization.

Professor explained all along the process and also

explained to us about cardiac diseases in Japan. So

that we can understand more about the difference

between Thailand and Japan

Day 7 Urology

Today Wahn and I went to different

departments. For me, I went to Urology department

where I had learnt a lot of wonderful things.

I was arranged to stay at Urology outpatient

clinic. Sensei was very kind to me. He let me do

many urology procedure such as cystoscopy, double

J insertion, and penile drug injection. Sensei

supervised me in every process. In spite of language

barrier, sensei had tried very hard to translate

patients’ information and diseases to me

In the afternoon, I had a chance to observe an

operation in newly opened OR. The operation room

is very well equipped along with high-technology

program. I’m very impressed .Thank you very much

for today rotation.

Day 8 Emergency Medicine, Takatsuki

Fire headquarter and Doctor Helicopter

Today rotation was one of the most exciting

rotation for me. In the morning, we had lecture about

Emergency system at OMC and in Japan. I had just

known about the emergency care in Japan which are

divided into steps so that patients can be well-

treated. After that we went to Takatsuki fire

headquarter where we learnt a lot more about

emergency system in Japan. They showed us the

center room which receive emergency call from all

responsible area. They gave me a chance to make a

simulation emergency call. The system can

understand many language such as Japanese, English

and Korean. We could see whole picture the

emergency system by this.

In the afternoon, we went to Osaka university

to learn about Doctor Helicopter. After I had a

lecture and saw the real doctor Heli. I was very

impressed. This emergency system is exactly the

same as in the movie “Code Blue” which I had seen

before I went to Japan.

Day 9 Department of Neurology

Today we were arranged for Neurology

Department. We were allowed to be in Neurology

ward round. We had a chance to observed many

interesting cases. We had found that there were

many rare-cased patients at OMC. Although the

ward round was in Japanese. All neurology doctors

kindly translated all information into English for us

and also explained patients’ pathology to us. From

this ward round, we can understand more about

Neurology management at OMC.

We observed many interesting diseases such

as Anti-NMDA encephalitis, Parkinson’s disease,

Stiffman’s syndrome, Multiple sclerosis etc.

Thank you very much for today rotation.

Day 10 Gastrointestinal Surgery

Today we had a great chance to observe

many interesting Gastrointestinal surgery in newly

opened operation rooms. The cases were quite

interesting and they were all done under

laparoscopy. Some of the operation used new 3D-

technology. We both had to wear 3D glasses during

the operation. After we wore the glasses, we had

found that the real-time video of the operation was

increased in dimension and quality as well. We

asked professor about the benefit of this technology.

He told us that it helps increase accuracy of the

operation, reduce length of the operation and the

field of the operation seen from the monitor will be

better and easier for surgeon to operate.

We had an opportunity to observe many

interesting cases such as Low anterior resection for

colorectal cancer, pancreatic tumor dissection, HCC

tumor dissection and esophageal cancer operation.

I was very impressed by today rotation. This

rotation was very exciting and informative. Thank

you so much for today rotation. And also Thank you

Prof Hayashi so much for treating us a wonderful

sushi dinner and desserts.

Day 11 Department of Pharmacology

Today we were arranged for Pharmacology

rotation where we had a great chance to do an

experiment about reactive oxygen species (ROS).

Sensei taught us about this mechanism which is a

very important process happening inside our body

and all living organism.

We had seen many advanced machine and

also observed an analyzing machine which can

analyze substance and show all data as graph in the

computer in few seconds.

Today rotation is very interesting. We were

really glad we had this opportunity to learn more

about Pharmacology experiment. Arigatou

Gozaimasu

Day 12 Department of Pathology

Today we went to pathology department

where we had learnt a lot of interesting and

impressive things. Sensei was very nice. He taught

us how to read the slide and also let us prepare the

slide by injecting formalin into the specimen. Sensei

told us that he is always happy with this work. He

said that although he is just a backseat doctor that

nobody knows, he is still happy that he can help his

patients to get better. He said he can have happiness

by his own style. All this expressions were very

impressive for us.

Moreover we also had special chance to

observe real-time intra-operative pathology report

announcement to the operation room. The report had

to be announced within 15 minutes. In this pictures,

sensei showed us how to use this broadcast system

that can connect directly to the operation room. This

was so amazing.

Thank you so much for today rotation.

Day 13 Department of Neurosurgery

For Neurosurgery rotation, in the morning

profressor Tucker brought us to the operation room

to observe neurosurgery cases. He not only

explained all the operative information to us, he also

challenged us by many interesting questions that

gave us an opportunity to think and analyze our

knowledge for the answer. He also gave us many

researches and journal print-out so that we could

understand more about every case. We were very

impressed by professor’s kindness to us. Arigatou

gozaimasu

In the afternoon, we observed aneurysm

treatment intervention by the use of stent. The

procedure was very interesting. Thank you very

much for today rotation

Day 14 Neuropsychiatry

Today we observed psychiatry outpatient

clinic. Although it was all in Japanese. Professor

kindly translated it all into English for us. He also

taught us about each disease and management so that

we can understand more about this rotation.

Professor also let us understand more about

psychi-patients feelings and how to cope with their

problems. This will be essential for our future

patients.

Thank you very much for today. We had learnt

a lot from today rotation

Day 15 Department of Physiology

Our rotation today was at Physiology

department. In the morning, we first met

Professor.Ono. We were very impressed by all his

stories about research in Zebrafish and also about his

working stories in NIH. He also showed us a robotic

fish tank which was very amazing. Arigatou

gozaimasu

We were also taught and explained a lot about

physiology experiment in this department by

generous professor and doctor in this department.

We had learnt about cardiac receptor experiment,

tubular cell function in frog and also zebrafish

experiment. We had an opportunity to try hatching

zebrafish eggs and also try to use micropipette-

making machine.

We had a lot of interesting experience today.

Arigatou gozaimasu

Day 16 Department of Dentistry and

Oral Surgery

Thank you Prof.Ueno for explaining us about oral

care in cancer patient. The lecture was very good

and informative. We will remember your guidance

in caring about our patients’ oral care.

Moreover, in this picture prof. gave me this

wonderful Conan poster with all main character

narrators’ signatures. I could not be more delighted.

In the afternoon, we had a chance to observe

many operations such as mandible fracture

repairmen, wisdom teeth extraction and tongue mass

removal. Thank you so much for today rotation. We

had learnt a lot of things.

Day 17 Mishima Emergency Critical

care center

Today we were arranged to visit emergency

center in Osaka. We had got a chance to observe real

emergency management in japan. We had seen 3

emergency cases today (CPR (actually my first time

observation) to patient with cardiac arrest from

cerebral hemorrhage, chest pain , falling from stairs

patient) This center is fully equipped with many

advanced and essential machines for treating

emergency patients. We were very appreciated by

Prof.Kobata's kindness in explaining us all about

emergency management in this center and also about

patients' condition. This was a very good

opportunity for us to observe this emergency center.

We really hope that in the future our country will

have a center like this one.

Day 18 Department of Gastrointestinal

Medicine

In the morning we observed upper

gastrointestinal endoscopy. The process was quite

similar to our hospital. After that sensei brought us

to simulation room to teach us how to use

endoscopy. The simulation machine was very good.

As you can see from the second picture. This

simulated stomach can help us identify the location

of the tip of endoscopy. This is very good for

practicing how to orientate an endoscope to the right

direction.

In the afternoon we had a chance to observe

interesting cases undergone by colonoscopy. Today

rotation was very interesting. Arigatou gozaimasu

Day 19 Department of Perinatology,

National Cerebral and cardiovascular

center

Today was our last day rotation at OMC. We

went to national cerebral and cardiovascular center.

We were told that this center is the only one center

specialized in the field of congenital heart disease

and related complication in Japan.

All doctors in this hospital are spacialists who

can definitely take care of many advanced and rare

conditions as well.

I had a chance to observe in outpatient clinic.

Sensei told me that this hospital is very special.

Every patient who wants to be treated here has to

undergo a screening. They have to be in serious

condition or specific for criteria selected by the

hospital.

For going to this special hospital was such a

good experience for us. Thank you very much for

today experience.

At simulation center, we had learnt many

skills. This center is well equipped with

many interesting simulation machine

such as laparoscopy training, simulator

and program for physical examination

and gastrointestinal endoscopy simulator.

This activities were very fun and

interesting .Thank you very much for this

wonderful experience.

CULTURAL ACTIVITIES

We went to Ibaraki city hall for this wonderful

cultural day with many generous people.

Before lunch we had a great chance to learn

how to make our own Onigiri and te-maki.

This cooking activity was very fun. After that

we had our lunch with many Japanese people.

We had talked about many interesting topics

about Japanese and Thai culture.

In the afternoon we had such a

wonderful opportunity to wear kimono. I was

very impressed for all your kindness to us. It

was such a wonderful experience. After that

we were divided into smaller group to talk

about our culture. We had prepared Thai snack

and PowerPoint presentation so that everyone

can enjoy our talks.

Thank you very much for today

TEA CEREMONY

We had such a wonderful opportunity

to participate in Tea ceremony kindly

prepared by tea ceremony club members at

OMC.

We were very impressed with

everything. We had realized that tea

ceremony is not easy. It has many

processes and manners that everyone who

is interested in has to practice many years.

Thank you very much for the help

from tea ceremony club members in

teaching us how to accurately make one

cup of traditional Japanese tea. It was very

impressive. Arigatou gozaimasu.

After tea ceremony we also had a

chance to enjoy shabu-shabu dinner with

tea ceremony club members and

international club members generously

treated by OMC.

Memorable moments

Thank you Ms.Matsumoto so much

for taking such a great care to us

before we go to Japan, preparing all

best rotations for us, picking us up on

the first day, showing us around ,

treating great dinner for us and

helping us all along this elective

program. We were both very

impressed by your kindness to us.

Arigatou gozaimasu

Apart from academic program, there is one best thing that impresses me

very much. It is people here at OMC. They were very kind to us

especially OMC students. We were welcomed by their gentleness and

hospitality on the very first day. We had been to many wonderful places

and activities such as Kobe ,Kyoto, around Osaka, Koyasan, HANAMI

party, Sukiyaki party and other impressive places because of their

preparation for us. They also helped us and made sure that we have the

best stay here at OMC. Thank you very much for making one of my

best memories here at OMC. We could never thank you more.

Memorable moments