Paul Brown Travelling Fellowship 2010 - Japan: A Report

Dr Robert Mead, Specialist Registrar, Queen Alexandra Hospital, Portsmouth.

Tokyo National Cancer Centre and Okayama University Hospital

Prior to my visit I worked as a clinical and endoscopy fellow in a large DGH for 2 years, developing advanced endoscopic techniques and services. This involved the identification and removal of early gastro-intestinal neoplasia throughout the aero-digestive tract, with techniques brought back to the UK by a consultant who had attended the Tokyo National Cancer Centre (NCCH) 6 years previously.

My visit to the NCCH for 2 weeks and another centre of endoscopic excellence in Okayama, was to further improve my diagnostic, therapeutic and teaching skills, whilst contrasting our current UK practice with the Japanese.

Over my visit I attended a structured experiential programme shadowing Consultants and Senior Residents. The normal working day started just before 8 and rarely finished before 6, with the Japanese doctors often finishing much later. The morning consisted of screening and pre-operative upper endoscopy cases, and the afternoon lower screening cases. Concurrently in the afternoon upper and lower GI therapeutic cases occurred.

Typically 40-50 screening OGD cases were available to view and 10-15 lower screening cases. Typically 2-3 gastric or oesophageal ESD/EMR cases, 1 lower ESD, and several lower EMR's cases were performed each afternoon. EUS was also performed.

A typical week included 4 early morning therapeutic cancer meetings, with Friday being the earliest (07.15 am). The meetings were multi-disciplinary and included presentation and discussion (in good English) of multiple endoscopic, surgical and pathological images. The meetings were lower and upper GI specific, two with educational opportunities and two more formal meetings. Opportunities to attend research and other relevant meetings were also available in the evenings and I attended 3 over my 4 week stay, finishing late in the evenings.

During my stay I was also fortunate to have two teaching sessions from Senior Residents in the rudiments of ESD technique on pig models. This was enormously enjoyable and useful.

Reflecting on my personal experience and I identified over 40 learning points which I believe will impact on my practice. Diagnostically I read 2 departmental morphological and pit pattern textbooks which with other practical teaching consolidated my abilities in lesion recognition with Kudo's and NBI classification. Therapeutically I learnt some extra tips and tricks, and hope to develop a hybrid EMR/ESD skill in the future. Over the 4 week stay I was able to watch training in both basic and advanced endoscopy Japanese style, and in Okayama I made a formal presentation comparing Japanese and UK medical and endoscopic training, with a discussion around common areas of difficulty.

Above and beyond my goals, I began a formal audit comparing Japanese and UK endoscopic practice, and after discussions have the opportunity to develop 3 further research projects. Touristic visits to Mount Fuji, Kyoto, and most of Okayama and Tokyo's touristic sites were also possible (fortunately I attended during the cherry blossom season! – see photos)

Lastly, and perhaps more importantly, I met a lot of distinguished colleagues and made some new friends!