Building Bridges through Medical Education 医学教育で世界に橋を架ける | Haruko Akatsu | TEDxFulbrightTokyo



we're having sukiyaki for dinner tonight what kind of beef would you like do you want American beef does anybody want Australian beef how about Kobe beef well I guess it depends on who is paying how about find a new car just because we live in Japan we're not limited to buying only cars made in Japan let's flip this if I'm a car manufacturer my model needs to compete with automobiles from Germany Italy France Japan Korea the United States and more by the end of the 20th century nearly all sectors of modern society had undergone globalization globalization introduced international competition but more importantly international collaboration established global standards and promoted growth and innovation in this highly globalized world even today only a select few sectors of modern society remain mostly domestic can you think of any one of those fields is clinical medicine for the most part patients are not given international choices when selecting doctors physicians in any given country do not need to compete for patients with physicians abroad you may wonder why we need even question such a well-established domestic scheme of clinical medicine however I believe clinical medicine is no different from our sukiyaki or other sectors of our society globalization will improve the overall product and service quality in this case by quality I mean patient care I came to this realization when I became an international medical student in the United States I'm basically made in Japan but a unique sequence of events led to this extremely fortunate opportunity it is rare for American medical schools to accept international students who didn't attend us high school or college not even a month since I entered medical school I found myself wearing a white coat introducing myself as student doctor and interviewing patients in a hospital this was part of the first year medical interview course at the beginning of the course we were taught that about 80% of all medical diagnosis can be made just by obtaining a comprehensive history from our patients this surprised me based on my previous experiences in Japan I thought medical diagnoses are made through blood tests x-rays CT scans and MRIs I quickly learned that that was not necessarily the case in the United States this course met once a week in the hospital we first-year medical students learned how to conduct a comprehensive medical interview including this small section of an interview called the review of systems review of systems is where physicians systematically ask a set of predetermined questions about different organ systems regardless of what the patient's chief complaint is chief complaint is the main reason why a patient seeing a doctor for let me give you an example one day I was seeing this elderly gentleman who was complaining of a heart palpitation a cardiovascular symptom so my interview started by asking more about his heart palpitation and about the cardiovascular system then I moved to ask more questions about other organ systems such as have you noticed any blood in your stool which is a gastrointestinal symptom unexpectedly he answered yes so I continued to ask more questions about his gastrointestinal system and then I moved to ask questions about other organ systems after I finished my medical interview and physical examination as usual I came up with my differential diagnosis which is essentially a list of possible diagnosis we physicians make after evaluating each individual patient and at the top of my list for this patient was colon cancer you might wonder how I came up with colon cancer when he was seeing me for a heart palpitation well colon cancer can cause slow and subtle bleeding from the colon manifesting as blood in the stool ongoing bleeding can cause a condition called anemia an anemia can cause heart palpitation indeed this patient had an undiagnosed colon cancer when I first met him if I didn't use the review of systems I probably would have missed the fact that he was occasionally having blood in his stool which didn't bother him so he didn't volunteer to tell me about it until I specifically asked about it if I didn't use the review of systems I probably would have ordered a heart scan and not the abdominal scan it is easy to ask questions about the obvious it takes more effort and practice to be able to ask questions about something that is not so obvious and review of systems health clinicians not be blinded by or biased by the chief complaint I was fascinated when I first learned about this review of systems as a first-year medical students since I never had been asked such a broad range of comprehensive questions by Japanese physicians as my time in medical school progressed I was becoming more aware of just how differently medicine was taught and practiced between the United States and Japan to such medically advanced countries it is not that one way of practicing medicine is better than the other rather by introducing international perspectives in clinical medicine and by evaluating how each individual country practices medicine I thought we could further improve our patient care since we can learn so much from each other to me this was no different from how globalization has been steadily improving other sectors of our society for decades aware of this I graduate from medical school completed my postgraduate training and became a faculty member all in the United States while I practiced and taught medicine I established a US Japan clinical exchange program there I invited over a hundred Japanese medical students residents fellows attending physicians to US hospitals I also sent more than 30 American clinical educators to different Japanese not schools and to teaching hospitals through these exchanges I deepened my appreciation that neither Japanese nor American medical educators and clinicians are fully aware of what their peers across the Pacific do this further convinced me of the great untapped potential for improving patient care by building bridges across country borders in clinical medicine this is all very good however globalizing clinical medicine is easier said than done to start patients are too sick to travel abroad even if they're well enough to travel it is very difficult for patients to see physicians abroad due to financial medical insurance and language barriers no matter how great an international physician may be a lot of patients will not feel comfortable being examined by or cared for by a physician who doesn't speak their language and who's not familiar with their culture and custom there are barriers from the physician side to there's no global or universal medical license unlike in medical research clinicians usually do not have any reasons or resources to connect with clinicians abroad to overcome these difficulties and barriers one solution is to bring international perspectives into medical education by affecting the training process of future physicians the new doctors can bring a global lens to patient's bedside and back home to their local community after all local medical culture is passed down through generations of local physicians two years ago I made a decision after living in United States for over 25 years to return to Japan and to take the position as dean of medical education at a brand-new Medical School which opened in April 2017 near Narita International Airport the goal of this new medical school is to bring international perspectives into Japanese medical education at this school medicine is taught in English which has never happened in Japan before one in seven students are international students from countries such as Mongolia Myanmar Indonesia Vietnam Cambodia Laos and more at this new school and I now direct and teach the first-year medical interview course together with my colleagues from Japan and England some non Japanese clinical custom we introduced through this class have already stirred up some surprises like American medical students our students learn to ask all patients about illegal drug use and whether the patient is sexually active if so whether the patient's partners are men women or both medically these are important questions even if the chief complaint seems to be completely unrelated to illegal drug use or sexually transmitted infections these deliberate questions allow US clinicians to obtain comprehensive medical information from our patients of course our students learned and practice the review of systems when the first two medical students conducted a comprehensive medical interview – our standardized patients who are community volunteers trained act as patients they were stunned a lot of these Japanese volunteers had never been asked these questions by Japanese physicians equally Japanese practicing clinicians who came to observe and evaluate our students medical interview performance was punished to some of them what they witnessed was literally foreign to them me I secretly smiled knowing that these awkward cultural educational experiences are exactly what I envisioned these small eye openers to the differences will shed a new light to how we practice medicine and I believe will globalize clinical medicine three decades ago when I became an international medical student I established a small personal new path between Japan and the United States now I'm helping my students build bridges between Japan and so many different countries and tonight I'm gonna enjoy sukiyaki as I celebrate the power of globalization we still have a long way to go towards globalizing clinical medicine but I believe the health and welfare of patients worldwide will be better because of it and I'm so grateful I'm able to advance this new path in my own small way thank you [Applause]

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