A Rotation in Japan

There's more than clinical learning to be done abroad.



August 2015

After a recent elective rotation in Tokyo, Ivan M. DeQuesada, MD, sat down with Colin M. Segovis, MD, PhD, RFS secretary, to fill us in on daily life as a resident in Japan, setting up an international experience, and the art of break-room picnics.

Colin Segovis: Recently, you completed an elective rotation in Tokyo. What inspired you to travel to Japan and how did you arrange the experience?

Ivan DeQuesada: This was actually the third time I have lived in Japan. In college, I spent a semester studying abroad in Tokyo. I enjoyed it so much that I returned after graduating to teach high school English for a year in Tochigi, north of Tokyo. Naturally, I began looking for a way to integrate my future practice in radiology with my existing interests in Japan. Serendipity at RSNA connected me with the radiology chair of one of the largest hospitals in Tokyo, St. Luke’s International. The department was excited to host me for a month, and Emory (where I was doing my residency) was equally enthusiastic to help me achieve my goal, although the administrative and funding hurdles took more than a year to overcome.

Segovis: Describe a typical day.

DeQuesada: Residents and faculty would arrive around 7:30 a.m. to begin procedures or attend conferences or tumor board. After any morning obligations, everyone would begin reading studies and residents would review their cases with attendings throughout the day, similar to our daily workflow at Emory.

However, the pace was a bit more relaxed than I am used to. For example, although the volume of cases was similar, there was less overall complexity — a balanced mix of normal and abnormal studies. In fairness, St. Luke’s is not a trauma hospital, and radiologists there interpret a lot more preventative and screening studies.

The day would end around 5:30 p.m., with a resident staying in-house to cover any emergency cases in the evening and overnight. Even though the work was done, I found that many residents and even faculty would stay much later to work on academic projects, have meetings, or just study.

I enjoyed a lot of flexibility during my rotation, initially only observing and learning about radiology in Japan. Eventually, I began reading cases on my own but rendered reports in English, because my medical Japanese is very poor. Since St. Luke’s is an international hospital, most physicians there have a working knowledge of English.

Segovis: Can you compare and contrast radiology in Japan versus the United States?

DeQuesada: Many experiences were similar, such as imaging and procedural quality and techniques, software, and hardware platforms, as well as common pathologies. However, some things were starkly different. There was much more emphasis on collaboration and team effort. For example, the reading room is one large room with workstations that double as offices. Attendings do not have private office space.

In addition, although everyone had sub-specialty training, most attendings did some general radiology throughout the day. Camaraderie was emphasized, and the faculty and residents would head to the cafeteria to eat lunch together as a group on most days. The office even averaged about one after-work social event per week.

Segovis: Was there a particular moment or experience that particularly stood out during your time in Japan?

DeQuesada: During the cherry blossom season in the spring, it is very common to have outdoor picnics, or hanami, with family and friends to enjoy the beauty of the season, although many people end up just gorging on food and drink.

On the day of the department’s scheduled hanami, it was raining heavily and the decision was made to have the party in the breakroom. There was a huge spread of food and spirits, mats laid out across the floor like an outdoor picnic, and even a projector playing stock video of cherry blossoms. Faculty, residents, staff, and techs all mingled in what turned out to be a great party.

I think it was a beautiful example of the team spirit and do-your-best attitude that is found throughout Japan.


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