Clinical Exchange
Kateřina Bradáčová
Palacký University, General Medicine, Olomouc, Czech Republic
4. year (2013/2014) of 6 years programme
Clinical Exchange period: 8/4 – 8/29 2014
Department of Neurosurgery, University of Tsukuba Hospital
Introduction
My exchange was provided by IFMSA (International Federation of Medical Students Associations) and I got a chance to choose three research projects from the research project database, including many faculties of medicine in Japan. I am interested in Neurosurgery, so my first choice was a research project "Basic & Clinical research on evaluation and restoration of brain function in Neurosurgery" at the University of Tsukuba Hospital and I am so glad, that my application was accepted. Even my exchange should be research exchange, my tutor Dr. Akutsu, discussed with me the disadvatage of the lenght of my stay (only one month) and changed it for a clinical exchange.
My day in the hospital started at 9 am at the morning round around patients (on Monday and Friday), with doctors from Department of Neurosurgery. During this round we saw patients after surgeries on ICU and HCU, children patients and patients hospitalized at this department. From Tuesday to Thursday my day started at neuroradiological conference, where was presented casuistics of patients and doctors were discussing treatment, radiological images, surgical approach, dates of surgeries, how the last surgeries where successful. After morning round and neuroradiological conference I could see open surgeries or neuro IVR (Monday and Tuesday). Sometimes I could also scrub in and assist at the begining and at the end of surgery. If the surgeries took shorter time, I took a part also in the afternoon round. In the evenings I tried to search for more information about specific diagnosis, treatment, anatomy etc. to understand and remember as much as I could from the day in hospital.
My daily schedule
I would like to present in the report my detailed daily schedule to show what kind of interesting surgeries I could see or assist at and what kind of knowledge or practical skills I have gained through the month I have spent at the University of Tsukuba Hospital.
| Date | Daily Schedule | Learning Experience | Working Hours |
|---|---|---|---|
| 8/4 | Introduction of Tsukuba University, University of Tsukuba Hospital, OPIMA | 10 – 12 | |
| Orientation in hospital Department of Neurosurgery – Neuro IVR – Angiography |
Radiological Techniques in Neurosurgery Diagnosis of metastatic brain tumor (vessels supply), angiography Diagnosis of stenosis in carotic artery, angiography |
13:30 - 17 | |
| 8/5 | Neuroradiological Conference | 7:30 – 13 | |
| Neuro IVR – coiling of intracranial aneurysm Biopsy of the brain tumor Afternoon round around patients |
Coiling with stent placement Stereotactic biopsy | 14 – 17:30 | |
| 8/6 | Neuroradiological Conference | 7:30 – 15 | |
| Resection of meningeoma Afternoon round around patients |
Diagnosis of meningeoma Diagnosis of Moyamoya ilness |
16 - 17 | |
| 8/7 | Neuroradiological Conference | 7:30 – 13 | |
| Resection (partial) of lipoma in spinal cord Afternoon round around patients |
Diagnosis of lipoma in spinal cord | 14 - 17 | |
| 8/8 | Morning around around patients | 9 – 13 | |
| Replacement of VP shunt and lavage of subdural cyst Neurosurgical methods in the pain treatement Afternoon round around patients |
Diagnosis of congenital hydrocephalus VP shunt Extradural stimulator in patient with untreatable pain |
14 - 17 | |
| 8/11 | Morning round around patients | 9 – 13 | |
| Neuro IVR – embolization of AV malformation Endoscopic removal of adenoma of pituitary gland |
AV malformation and its consequences Endoscopic endonasal technique of surgery |
13:30 - 19 | |
| 8/12 | Neuroradiological conference | 7:30 – 13 | |
| Resection of glioma | Diagnosis of glioma Intraoperative MRI | 14 - 17 | |
| 8/13 | Neuroradiological conference | 7:30 – 13 | |
| Resection of craniopharyngeoma Afternoon round around patients |
Diagnosis of craniopharyngeoma | 14 - 17 | |
| 8/14 | Neuroradiological conferenceResection of metastatic tumor in brain, assisting at the surgery |
Diagnosis of metastatic tumor
Neuronavigation at surgeries Working with instruments |
7:30 - 20 |
| 8/15 | Morning round around patients | 9 – 12:30 | |
| Resection (partial) of lipoma in the spinal cord | Monitoring of spinal nerves during surgeries | 13:30 - 17 | |
| 8/18 | Morning round around patients Biopsy of the tumor placed in ventricle's system, assisting at the surgery |
First experience of working with the instruments under microscope Diagnosis of ependymom | 9 - 17 |
| 8/19 | Neuroradiological conference Morning round around patients |
7:30 – 12:30 | |
| Resection of the reccurent glioma, invading intraorbital space and fossa crani ant. | Preserving the important structures in the fossa crani ant. | 13:30 - 17 | |
| 8/20 | Neuroradiological conference | 7:30 – 13 | |
| Resection of the reccurent glioma Afternoon round around patients |
Diagnosis and treatment of the children patient with dumpbell tumor | 14 - 17 | |
| 8/21 | Neuroradiological conference | 7:30 -13:30 | |
| Removal (partial) of the reccurent meningeoma, invading to the intraorbital space, assisting at the end of surgery Afternoon round around patients in english |
Important structures in intraorbital cavity Technique of suturing the scalp | 14 - 17 | |
| 8/22 | Morning round around patients Working on the presentation about Czech Republic |
9 - 10 | |
| 8/25 | Morning round around patients | Emergency case of hydrocephallus in children patient with tumor in 4th ventricle | 9 – 12 |
| Neuro IVR – embolization of the AV malformation Neuro IVR – patient with stenosis of ACM Working on presentation about Czech Republic |
Embolization of AV malformation Symptomatic stenosis of intracranial artery |
13 – 14:30 | |
| 8/26 | Neuroradiological conference | Diagnosis and therapy after | 9 – 13 |
| Resection of meningeoma Presentation about Czech Republic |
removal of the tumor placed close to the brain- stem | 13:30 – 18:30 | |
| 8/27 | Neuroradiological conference | 7:30 – 13 | |
| Resection (partial) of the lipoma in the spinal cord Afternoon round around patients |
Diagnosis and therapy of the dissection of the carotic artery | 13:30 -17 | |
| 8/28 | Neuroradiological conference | 7:30 – 13 | |
| Removal of the reccurent glioma in the temporal lobe, following renoval of whole temporal lobe | Prognosis of the patient withnout whole temporal lobe | 13:30 - 19 | |
| 8/29 | Morning round around patients | Removal of the drain | 9-12 |
| Excursion to the Proton Centre Certificate Cremony |
Proton therapy – indications, mechanism how the proton therapy works, linear accelerator and whole background of the proton centre | 14 - 16 |
At the end of my report I would like to thank all people I have met in the University of Tsukuba Hospital, because without them I could'n spend there one of the best month in my life!
Firstly, I would like to thank all doctors at the Department of Neurosugery for their patient explanations of the matters I did not understand, for involving me into their work, giving me a chance to scrub in and assist at the surgeries, for answering all my questions, translations to english and also kind talks with me and taking care of me whole month. I have appreciated it so much!
I can't forget to send many thanks to OPIMA, the office with so friendly people, who helped me with the orientation in Tsukuba and hospital, with transportation from and to the train station, with my documents, solving all my troubles and having a nice tea breaks with me.
The most important thing I have gained at this exchange, which I appreciate the most is the motivation, motivation to study harder and harder and make my dream to become a neurosurgeon true!
Thank you so much!