American Physician in Japan: Teaching Out of Context

• DOI: 10.4300/jgme-d-12-00170.1
• Publication Date: 2013-09-06T18:09:26Z
• Authors: Brian Sanjay Heist
• Keywords: Whiteboard; Bedroom; Stairs

I stepped inside kaigishitsu ichi (conference room 1) and froze. had just completed a teaching session hustled up down numerous flights of stairs through the hospital complex. With labored breathing dilated pupils, stared at whiteboard on far wall, 30 feet away, which displayed scientific poster titled, “Thrombotic Thrombocytopenic Purpura with Myocardial Infarction.” At that moment, was slowly sliding board. The been empty in morning when left this poster, along 2 others. Presently, front were 10 carpet, followed by 4 rows tables chairs. On table each chair catered bentou box, medical student munching bentou.The resident who prepared dressed suit, note cards hand, anxiously looking to me for guidance. hospital's pathologist, participated case being presented, leaned passively near doorway. Not single other or attending physician there. It certainly neither arrangement requested nor audience envisioned inaugural session.“12:05 pm, Saturday, March 7, 2009,” read my cell phone screen. about halfway 3-year stretch as American faculty-in-residence general residency program Sapporo, Japan. taken post immediately after completing own hoping introduce Japanese residents various facets US training experience.Although aware sessions not popular Japan, required 18 third-year complete scholarly project indicated preparing presenting would fulfill requirement. Because cared large number rare pathophysiologically intriguing cases, but limited tradition encouraging pursue work, thought introducing clinical vignettes be surefire success.The less enthusiastic. That year, heard great including Campylobacter mycotic aneurysm, classic tetanus, Lemierre's syndrome. Whenever encouraged develop their cases into posters, reply uniformly “I'll think it,” Japan is unequivocal euphemism “I'm interested.” Ultimately, able persuade only 3 project, them chose present poster. remained optimistic, denial, rationalizing reaction hesitance embrace new ideas from teacher.Near end academic hosted weekend students, scheduled lunch hour first day. designed flyer urged all attend. Needless say, eagerly anticipating moment.Now, shoulders low, went room. ceased. In English introduced concept asked if anyone ever experienced one. replied quizzical stares. commenced her presentation. She diligently and, clear pronunciation, recited background H&P case. Then she paused. members, many whom replaced chopsticks pens, her, consternation. share questions thoughts. More silence followed. concluded presentation summarized it Japanese, audience's faces unchanged.After presentation, continued deteriorate. second called away emergency. As began case, third arrived said he few minutes between procedures his We quickly tacked whiteboard, short span took eat pieces norimaki, raced dashed back operating room.After presentations, again solicited comments audience. “What wrong head MRI case?” asked. “I could see someone finally responded softly. sole remaining wheeled review cases. we moved around point out findings imaging studies, half rose get better view, jostling form huddle secretary announced 1 everyone suddenly rush next activity.My failure provided motivation reflect cultural differences Western education importance understanding one's audience.Among features noteworthy physicians, are particularly relevant experience. First, comes didactics, more accustomed intense listening furious note-taking than discussion, perhaps because self-discipline group harmony culturally valued individual expression opinion. Second, reminiscent United States several decades ago. characterized bedside procedures, ranging phlebotomy intubation, ancillary support, consistent oversight, an absence work-hour restrictions. context, residents' attending's images what means may have sync. did view extremely foreign they also considered another unwelcome task overloaded schedule.In consideration international omnipresence determined educational experience trainees. time, however, described within appropriate highlighting opportunity afforded—namely participation conference. Most importantly, brought our chief Society General Internal Medicine (SGIM) annual meeting, reported rave conference slide show. (The shots Miami Beach backdrop might helped.)Fast forward years 2012 SGIM Annual Meeting: am perusing aisles lunch-hour find seeking. He has visitor observe him explaining answering enthusiastically. accompanied classmates, makes total 11 former meetings. Consistently, describe feeling empowered success giving forum motivated attempt bigger challenges—just like current