National Taiwan University
I was astonished when I saw the emergency department of Nagoya University hospital for the first sight. No more patients lied on the sidewalk, and no more crying relatives shouted at the nurses. Due to the poor medical classification system, the emergency room in Taiwan is always like a battlefield.
The weather was changing during the beginning of April, and the strong wind caused several accidents of children and the elders. Besides, cardiovascular disease was the main reason for patients’ admission these days. We met several patients with aortic dissection and acute myocardial infarction. Thanks to Dr. Tsuzuki and Dr. Hinoshita, who expressed extreme patience discussing with us even though we sometimes had language troubles. Besides, Dr.Murase introduced us to the emergency and internal medical ICU. Surgical ICU and NICU were visited in the same day. Since we did not have chance visit ICU in the first six years in Taiwan’s medical education, I thought this experience was quite a good preview for our internship.
Professor Matsuda invited us to a lecture held for junior residents about basic emergency concept. The handout was very friendly to foreign students. Even though sometimes I lost follow of professor’s lecture, I could always trace back to the correct information by reading the handout.
The conference on Thursday was quite interesting. The journal sounded complex in the beginning. Because there were no detail handout, it was difficult to catch the point. However, after looking up in the Internet, those essays were very useful and inspiring for us in clinical work. I really enjoyed the introduction of new antibiotics drugs. Although it was held by a pharmaceutical propaganda, both the slide and film were still interesting and useful.
We were lucky to follow Professor Matsuda to Nagoya Central Hospital in order to perform anesthesia of a cystectomy surgery. Before devoting himself into emergency medicine, Professor Matsuda was originally a famous anesthesiologist editing some journals in the world. We talked about some useful knowledge about anesthesia and surgery and watched the process of them at the same time.
I really enjoyed the course in the emergency department. The well-organized medical classification system 'Meidai Triage and Acuity Scale System board (MTASS)' built a friendly medical environment, both for the patient and medical student. To study case by case with a senior doctor formed the thinking process of how to approach a new patient, which was the best treasure in this course.
National Taiwan University
I’ve always wished to receive emergency course training since my fifth grade. The most important reason is that emergency course let medical students practice clinical knowledge in a limited time. In other words, you have to react reflectively. In such way, you correct your first impression and organize your thinking process immediately. This process would also play a special role no matter which course you choose in the future.
To my surprise, the emergency department in Nagoya University is quite different from Taiwan. The hierarchy of medical service structure is much organized in this place. Thus, the patient number 12,000/year seems less than average emergency department in Taiwan. It was also a good news for us beginner, for we can take more time to think about the case thoroughly. The doctors here including professor Matsuda were all very willing to teach us or guide us through the whole case. The most impressive case was an adolescent girl with dissociative disorder lost her consciousness all of a sudden. Upon her arrival, her consciousness level was E1M1V1. However, we saw that her muscle tone was kind of preserved when the doctor dropped her arm. The conclusion of mine met with professor Zhang, a doctor from Peiking. However, there were still some investigations needed to unveil the mystery.
Emergency ICU is also a fundamental region to emergency department. The cases here were more complicated and delicate. Thanks for the hard working doctors here. They had to not only care about their duty, but also us bothersome students. Tacotsubo cardiomyopathy was one of the interesting cases we encountered. I’ve heard it once in the CSI series, but never thought about seeing a real case. You can imagine how excited I was. Like other department, emergency ICU also had some conflicts in dealing with patients. An elderly female who suffered from aortic stenosis was too old for surgical treatment. However, according to the ACC/AHA guidelines, surgery is the only way efficient for treating the AS-induced heart failure. There was no “right or wrong” no matter which treatment was given. Sometimes the will of patients were more important than everything.
Although it was quite happy time learning in this kind of environment, there are still some suggestions I wanted to offer. If it could be, dispatching us to one of the doctors separately would be better for learning and discussing. I know it would be kind of difficult because the doctors have different shifts every day.
The last but not the least, thanks for the professors and doctors here not only for your lessons, but also for your hospitality. We really had a great time and got plenty of knowledge here.
to be continued