Stanford 25 in Okinawa: 10 things learned about this beautiful island

February 6, 2014

This week, I have been given the opportunity to visit Okinawa and teach the Stanford 25 bedside exam. The residency program (called the Muribushi Okinawa Project) consists of 8 hospitals throughout Okinawa. I get to visit each hospital and conduct a 3 hour Stanford 25 session covering multiple topics. This Stanford-Japan exchange program is organized by Dr. Haruko Akatsu (Stanford Department of Endocrinology)

Here’s the top 10 things I’ve learned about Okinawa and their medical education:

1) Their medical education system is very different from ours:
After high school, they enter into a combined undergraduate college/medical school for 6 years. Next they go straight into residency. Residency is the same for everyone. Like a US medical student, they rotate through various field but take full care of their patients. After two years, they either go into general practice or specialize. Their general practice is similar to a family doctor. If specializing, their continued residency can take many more years depending on what they choose. For example. general internal medicine is 3 years, general surgery is 5 years and many of our medical sub-specialties are three years. If they do a medicine sub-specialty, they do not need to do a general internal medicine residency.

2) There are no work hour regulations:
The typical day for a Japanese resident starts at 6am and ends as late anywhere from 7-10pm. There is no clear on-call schedule. They admit as needed, often daily. They get, at most, 1 day off each month. They also must be available for pages all the time (although pages at night on infrequent and never urgent so they don’t worry too much about missing a page or call).

3) Most residency programs are 1 hospital:
This program is unique, consisting of 8 hospitals. Most residency programs in Japan are associated with 1 hospital. However, since they don’t have great variation in the hospital type (no private, VA and county hospitals), the experiences in various hospitals are similar. Even at this residency program, residents don’t have to rotate to other hospitals.
Here’s Dr. Miyagi, the residency Program Director:

4) Average patient stay ranges 10-30 days:
In Japan, everyone has health insurance. They also don’t have pressures for discharges to open more beds or address cost issues. Patients often stay longer. While patients do have co-pays for their hospital stay, it does not vary with how long they are admitted. As you wound imagine, there are less social issues.

5) They all use bedside ultrasound:
Almost all the residents I worked with had some experience in using the ultrasound. They use older and very large ultrasounds and there is no formal training. One resident told me that they simply train themselves. Despite not having a formal training curriculum, they share an enthusiasm for this skill very much like our residents.

6) They love technology, especially Google Glass!
Here’s a video of one hospital’s residents seeing Google Glass for the first time:

7) Slots and pachinko are extremely popular:
While gambling is technically illegal, there a large number of slot & pachinko parlors. Pachinko is basically like a slot machine where balls fall down into various slots. Depending on where they fall, you collect more of these balls and turn them in for prizes. Its illegal to directly win cash from these places but there is usually a place nearby where you can exchange your prizes for money.
(Below is a Google Photo Sphere. You can scroll around in 360 degrees. It may not work on your phone.)

8) Awamori… the ultimate sake:
Made in Okinawa, Awamori is unlike other sake in that is is usually 60-80 proof. Most sake is usually 30-40 proof. Even more surprising is that it doesn’t taste strong at all. 

9) Karate was born here:
I must admit, part of what I only knew of Okinawa came from Karate Kid 2. What I learned was Mr. Miyagi’s character was based on a actual karate teacher from Okinawa: Chōjun Miyagi. He was one of the first teachers of Chinese hand combat fighting in Okinawa that would later become karate. Karate is still a big part of Okinawa. Other activities include fishing and surfing. Okinawa is a popular vacation destination from mainland Japan. Some people have called it the Hawaii of Japan. One last thing is baseball. A big part of Japan culture, they also have Spring training in Okinawa!

10) They are wonderful people!
The people of Okinawa are truly some of the most kind, welcoming and respectful people I have ever met. I am very thankful the for the opportunity to come here and experience their hospitality.

Errol Ozdalga, MD

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