JADECOM Trip October 2013

Japan Trip:  Oct. 10-16, 2013

OHSU Family Medicine headed to Japan as part of our JADECOM Exchange Program. John Saultz, MD, department chair; Roger Garvin, MD, residence director, Daisuke Yamashita, MD, South Waterfront Clinic medical director; Eric Chen, MD, MPH, third-year resident at Richmond clinic, Wes Fuhrman, fourth-year medical student, and Stacy Brungardt, STFM executive director.  The team will be making presentations throughout their stay in Japan, including several at the JADECOM Generalist Forum:  People Need Real Generalists.

Wes Fuhrman, OHSU medical studentMeet Blogger Wes Fuhrman

Wes will be blogging throughout the trip

I am Oregon born but was raised all over the place. Some of my other homes include Tokyo, Chicago and the verdant state of New Jersey. In a fit of teenage rebellion, I shipped myself off to boarding school in New England. I stayed out in the Nor'east to spend my collegiate years at Wesleyan University where I ran competitively and received my BA and MA in neuroscience. After a year in the AmeriCorps and some inspirational international medical experiences I decided to take the plunge and apply to medical school. Now, as a fourth year medical student, I am pursuing for a career in family medicine with a particular interest in serving rural areas.

Taking off   

All set!Day 1 Oct. 10, 2013

The flight was delayed, but we're finally taking off. 

Pictured: (right) I'm all set.  (far right) Dr. Eric Chen and Dr. John Saultz.


Day 2, Oct. 11, 2013

Sunrise over Mt. Fuji

We touched down in Tokyo a little after 5pm (1am Portland time). As we descended you could spot the profile of Mt. Fuji on the setting horizon.

A gracious welcoming party from JADECOM met us at the airport and provided transportation into the city. There, we met up with Dr. Yamashita and grabbed a light dinner while going over tomorrow's schedule. Now, we are all tucked away in the Palace Hotel, ready to recharge before our first full day in Tokyo!

Photos:  Sunrise over Mt. Fuji from as the plane begins its descent into Tokyo.  At right, John Saultz, MD, (far left) and Stacy Brungardt chat with Daisuke Yamashita (right).  In the background, Eric Chen, MD.

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 The team of residents I joined for morning roundsTokyo train stationDay 3, Oct. 12, 2013

Jet lag helped me get an early start to the day with a run around the Tokyo Imperial Palace. The 5K Palace loop is one of the most popular running paths in Tokyo.  So even at 6 in the morning there were plenty of other joggers to fall in stride with.  

We were on our own for breakfast so I hit the streets in search of a cafe or bakery. I soon found myself wandering in the maze-like subterranean shopping area under the central Tokyo train station. One of the few eateries that was open happened to be a ramen shop. Ever since living in Japan as a child, I have Lunch timehad a soft spot for good ramen. This is not the instant ramen that most Americans associate with this realm of cuisine. I'm talking hearty bowls of vegetables, noodles and meat set in meticulously crafted broth. It's the unofficial national comfort food and, as they do with many things, the Japanese take great pride in crafting great ramen.  So despite the unconventional hour, I bellied up to the counter and enjoyed a bowl of ramen for breakfast.

Our JADECOM hosts/caretakers picked us up at 9 to depart for the North Tokyo Social Insurance Hospital. There, Dr. Chen and I joined small teams of residents for morning rounds while the rest of our group met with their physician counterparts.  The routine of rounding on patients was comfortably familiar. Despite not knowing much Japanese medical terminology, I could follow most interactions by observing the residents Japanese medical students interested in Family Medicineposition, tone and use of physical exam. It was fun to realize how much I could glean from the common process of a patient workup. 

At noon we broke from rounds to have lunch and listen to several presentations on family medicine training and practice in Japan.  Our OHSU contingent provided the presentations for the second half of the afternoon including talks by Dr. Chen and Dr. Yamashita. 

We ended our day with a welcoming dinner and party complete with a kampai speech and group "banzai!" chant. I had the chance to meet several medical students at the party who are interested in Family Medicine.  Family Medicine is still relatively new to Japan, so many medical students have little to no exposure to it. In many ways, the students who joined us today are the early pioneers of what will hopefully become a thriving Family Medicine culture in Japan.

After many a friendly handshake and group photos we returned to The Palace Hotel to submit to our displaced sleep cycles and hit the hay. 

Pictured, from top:  Tokyo train station, the team of residents I joined for morning rounds, lunch time, and Japanese medical students interested in Family Medicine.

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Eric Chen, MD; Roger Garvin, MD; Daisuke Yamashita, MDDr. Saultz receiving an awardDay 4, Oct. 13, 2013

Today we took part in the JADECOM Generalist Forum. This gathering consisted of a morning CME-like session on developing core competencies as a means of shaping and evaluating resident education. The second half of the day included several presentation from various prestigious primary care related physicians discussing the definition, role and importance of Family Medicine in Japan.

Family Medicine has only been an official medical specialty in Japan for the last several years. In Japan the realm of primary care is  provided for by variety of overlapping and not necessarily cooperative specialties. Today's discussions were in large part focused on reiterating the need for comprehensively trained primary care physicians and discussing how Family Medicine can adapt meet this need.

As it currently stands, Japanese Family Medicine lacks a discrete identity.  There is a small and growing group of Family Medicine physicians in Japan but their practice philosophy and scope remain highly variable. Training at medical schools is primarily provided by specialists and consequently even those students who are interested in primary care have a hard time finding adequate mentors and training. Furthermore, those students who are interested in Family Medicine are apprehensive about the specialties lack of a clear role. Understandably, it's hard to commit your life to a profession that has yet to mature into its final form.

After-dinner celebration

As I mentioned in my last post, these students and their predecessors are very much the pioneers of Family Medicine in Japan. They are motivated to improve patient health by providing comprehensive primary care but the pathway to due so is not clear. In many ways they are stepping into the confrontational unknown as they pursue what they believe is best for healthcare in Japan.  Many students credited their exchange experience at the OHSU department of Family Medicine for providing them with an exemplary image of Family Medicine that will help guide their future pursuits.

It was clear from today's discussions that the pathway for change will not be an easy one. But with the patient's needs at heart this courageous group of physicians and students are creating a system and culture that will benefit the people of Japan for generations to come.

Pictured (Top left) John Saultz, MD. receives an award of appreciation from JADECOM Chairman Dr. Yoshiara. (Top right) Eric Chen, MD; Roger Garvin, MD; and Daisuke Yamashita, MD, at the Generalist's Forum. (Bottom) Group photo at the after-dinner celebration.

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Kyoto bamboo groveDay 5, Oct. 14, 2013

Today we traded the urban megapolis of Tokyo for the more traditional city of Kyoto. No presentations today, just sightseeing and good food. Eric and I had a great time exploring Kyoto with several young doctors and residents. I'll let the pictures do the rest of the talking.

Street snacksCrafty mobile






Oni, a Japanese evil spirit




Pictured: (Top, left) Street snacks.  (Top, middle) Crafty mobile. (Top, right) Kyoto bamboo grove.  (Left) Myself and medical students with Oni, a Japanese evil spirit.  (Below, left) Roger Garvin, MD; Eric Chen, MD; and blogger Wes Fuhrman ride the Bullet Train. (Below, right) Enjoying the outdoors around Arashiyama. (Bottom left) Azusa and Eric Chen, MD.


Garvin, Chen and FuhrmanArashiyama







Azusa and Dr. Chen





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Group shot before departing NaraDay 6, Oct. 15, 2013

Our final full day in Japan! Sad but true. It has been a wonderful whirlwind of learning and partnership. 

Dr. Chen and I kicked the day off with morning rounds at JADECOM's Nara Community Hospital. We were joined by Dr. Nishimura, who gave us a run down of the hospital's General Medicine residency education. Morning rounds at Nara HospitalIn this case, General Medicine is analogous to Family Medicine. As I mentioned before, these terms are in the process of being defined so for the moment they are more or less interchangeable.

We were reunited with Dr. Saultz, Dr. Garvin and Stacy at lunch for a set of presentations including several from our group about the evolving role of US Family Medicine and Family Medicine residency education at OHSU. We also got to hear from Dr. Yoshimura about the structure of his Family Medicine residency program.

Dr. Saultz giving his presentation

We wrapped up the forum with a group photo and some hurried goodbyes as we hustled to make our bullet train back to Tokyo. We were greeted by a downpour at Tokyo Station that was all too reminiscent of home. Fortunately, there are extensive underground passageways that link the nearby subway stations and buildings. With a little navigating, it was possible to avoid an ill-timed shower by making the three-block trek to our hotel completely underground. 

Once back in the plush confines of the Palace Hotel, we Farewell dinnerwere joined by several members of JADECOM, including Dr. Yamada, for a farewell bash. We ate amazing food and shared stories from the past six days. We also received many thoughtful gifts from our gracious hosts including intricate glassware made by Dr. Yamada's wife. It was a celebration worthy of the strong bond between OHSU and JADECOM. 

During his afternoon talk, Dr. Saultz mentioned that it is the duty of the family physician to constantly improve. I feel that partnerships, like the one between OHSU and JADECOM, provide us with the motivation, inspiration and support to continue to improve so that we may better serve our patients. Family Medicine is truly about family, both in the community and inter-professionally. We are very fortunate to have JADECOM as part of our professional family!


Pictured, from top:  Group shot before departing Nara, morning rounds at Nara Hospital, Dr. Saultz giving his presentation and our farewell dinner.

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