The student program at the Faculty of Medicine, the University of Calgary, Canada

5th year students*, School of Medicine, Medicine major

　From August to October in 2007, eight 5th year students attended the 5th annual medical program of studying at the University of Calgary which started in 2001.
　In spite of the fact that there were more applicants than ever, eight of us were accepted into the university thanks to the great effort of Dr. Jadavji at International Health, the University of Calgary, our Dean Dr. Takayanagi, Dr. Tsuzuki, Dr. Iwaki and Dr. Yokomizo. Also, the 21st Century Challenges in Studying Abroad Program (CSP) of Kyushu University helped us with financial aid. We would like to express gratitude to all of them.  We would like to express our appreciation for this wonderful opportunity in the report below.

~PartⅠ~
   Our impressions of Calgary city and our lives there in detail:

◆The city of Calgary and the University of Calgary（Hiroko Ikeuchi）
　Calgary is a quieter city than I expected. And it is a society in which everyone has access to a car. Of course, we can take the C-train or a bus and use a bicycle borrowed from our host family. But, if you live there for a long time, I think that a car is an indispensable tool.
　Arriving at Calgary at the end of July, first I thought that it was as cool as autumn of Japan. However, the fact was completely different. In this season, the temperature usually drops down under 10℃ in the morning and rises over 20℃ in the afternoon.  Actually, my host mother said, “It can snow any time of the year.”
　An interesting thing for me was that we could often see some kind of wild animals, such as rabbits and squirrels. Once I heard that ‘kayori’ sometimes appears on the huge hill at the center of the town. I wondered what a ‘kayori’ is, but found out that they were not saying ‘kayori,’ but coyote. Needless to say, I was so surprised when I realized this.
Canada accepts immigrants, so there are various people in Canada, also in the university. They have various ethnic and religious backgrounds.  Students need to graduate from other departments before entering the medical school; therefore each of the students has a different specialty. For these reasons, it is the ideal environment for training to think about one thing from various views.
　The atmosphere of the campus is similar to a Japanese one. But people seem to distinguish the medical department from others more clearly than in Japan. The reason is not only that the hospital is apart from the main campus, but the unique requirements for admission to the medical school.

◆School days with the 1st year students  (Ai Yokoyama)
　In Course I, we had exactly the same school life with the Canadian students from the very first day to the last. Because of that, I felt as if I were a real student at U of C. Not only Japanese students but also the Canadian students have to make friends. All of us were starting fresh from nothing at first. Fortunately,that made people think of me as a fellow, not as a guest. I believe that is what made it so hard for me to say goodbye to these friends with whom I shared wonderful times.
　The students came from all across the country and each of them had various kinds of backgrounds in their undergraduate studies. Also there were students from Malaysia and Brunei. It was so meaningful and impressive talking with those highly motivated people about many interesting things. During break and after school, we got together in front of the lecture room to chat. These are only everyday things, but for me it was such fun that I didn’t want to stop.  Those days have become my precious memories.
　It didn’t take long for everyone to get to know each other as they take good advantage of the internet to get everyone informed of what was going to happen each day. For example, they often made plans for hockey, basketball, soccer, drinking parties, and home parties. I felt they had a positive attitude toward everything. I didn’t know what those events would be like, but everyone was kind enough to take us out and gradually I learned how to enjoy them.
　Even though I adjusted to the new place and new people, I still had some problems.
However, there was always someone who lent me a hand. I believed that they kindly knew that I, who came all the way from Japan, was in need of help. Even if they didn’t, I was really glad and grateful when they helped me to do something. One thing for sure is that they were very kind. I don’t know how many times I said thank you when I was in Calgary. Seven weeks is not long enough, but those days I shared with them were beyond description.

◆O-week（Tomotsugu Takano）
　We reached Canada at the end of July, and the term start early in August.
　The first week was the week called “O-week”, and there were many events during the week. The most impressive event was “Med Olympic”. We reserved a park near the hospital. From ten to fifteen members made up one team and we had about ten teams in total.  Each team tried hard to win.
　We played many interesting games. For example, we played tug-of-war. The losers of tug-of-war were supposed to jump into a pool of water and noodles. In another game we had to plunge our faces into water mixed with pickles, marshmallows, and mayonnaise in order to get them and points. I’ve watched games like that on TV programs in Japan, but have never experienced them myself. Another thing that surprised me was the active character of the students.
　We had many other events that week like a scavenger-hunt and a naming ceremony. All of them were very impressive to me, but what impressed me most was the fact that senior students hosted most of these events for us.  These events made it very easy for us not only to get to know our classmates but to get used to the culture. We also had special orientation only for us. Thanks to it we could get into our classes smoothly.

◆Lecture contents and an examination of Course I  (Kenji Okumura)
　I attended Course 1. The schedule included statistics and a class about ethics as well as Course Ⅰ.There was not a lecture on the Monday morning or Friday afternoon, but serious lectures and small group discussions took place from 8:30 a.m. to 5 p.m. otherwise. Practice or the bedside training of physicals with real Doctor to place in our spare time so I was quite busy. Teachers did not take attendance in class at all and everyone could get PowerPoint that they used.  Most people brought in laptops and participated and took all the notes on their laptops. Every time there were questions from students in class and I was surprised at the positive attitudes of the students. 
　The contents taught were anatomy, biochemistry, physiology, pathology, pharmacology about fever/sore throat, hematology, and gastrointestinal.  It was very tough.  Epidemiology was different than my class in Japan.  We had lectures about sickle cell disease, thalassemia, hemophilia and Celiac disease that were very interesting. 
　Professionalism awareness in all the students of Calgary was high.  They eagerly absorbed the contents taught about professionalism in the ethics class.  They purchased books such as Robbins or Harrison after entrance to school to study.  There were small group discussions 2 or 3 times a week.  I could prepare beforehand and join the discussion in our small group of 8 to 10 people.  For each class there was a cas and a questions related to it.  Each time, a student leader presided over the group and talked about the case.  The cases represented basic diseases and it was not so difficult.  But the discussions proceeded to more in depth contents.  Since I am not used to rap sessions like the Canadian students seemed to be, it was difficult for me.  But I was able to participate in the small group discussion somehow because I had studied somewhat more in medicine than them.  When a discussion became heated, the students spoke so fast that it was hard for me to follow and grasp it.  After getting used to it, however, I could enjoy it all and it was a good chance to learn. 
　In addition, there was “small small group,” and the exercise of an interview with a simulated patient.  This training of how to do physical examinations was performed once or twice a week, and sometimes we went to the real medical scene and practiced.  I think that it was efficient to study and then practice immediately concerning what we had just learned in lectures. 
　I also took an examination for the mid-term of course I.  The form was to answer in writing while looking at a specimen of dissection.  The contents are made up of questions from the lecture contents.  I was impressed that even if asked, students would not talk about the contents of the exam because that would go against professionalism.

◆With the 2nd year students  (Marie Kubota)
　Calgary is a multiracial city.  Immigrants from China account for a great part of its population. I took part in the 2nd year class, where I found that the students were divided into groups of close friends, groups roughly composed of the same ethnic persons.
　We exchange students had a ‘class buddy’ each, who voluntary helped our school life. My buddy Tom was of Swiss origin and was a very international person. He had some experience working in Kenya and traveling around Asian countries.  He was also interested in Asian culture and art such as statues of Buddha. Tom often took us Japanese students along with his high school friends to his home, his relative’s home and neighboring famous spots for natural beauty. In Calgary, I got to know not only my classmates but many other people one after another.
　Medical schools in Western Canada have ice hockey teams, and every year, just as ‘Western Japan Medical Athletic Meeting’, ‘Ice Bowl’ or hockey tournaments are held. I went to this year’s game to cheer U of C teams. That night there was a costume party, where well-disguised medical students from various areas gathered all in one place.
　During my eight weeks staying, I came into contact with the culture and the social affairs of the region through attending events and experiencing the daily life of Calgary students.

◆Course Ⅴ（Yasuhiro Abe）
　The neurology course consists of neuroanatomy, clinical neurology, and neuropathology.  Firstly, we learned neuroanatomy, mainly CNS from cerebrum, spinal cord to cerebellum by lecture, and after that we were challenged to answer the names of the anatomical regions in the laboratory, using real specimens.  Secondly, in the lecture of clinical neurology, faculties emphasized the typical clinical manifestations or symptoms of each neurological disease. They used many diagrams to facilitate understanding of diseases. And besides there were small group workshops in which we discussed many cases from diagnosis to treatment we learned in the lecture. From these two approaches to each disease, it was possible for us students to imagine the way we should do different diagnoses and choose basic treatments inclusively when we see patients showing typical symptoms.
　In the patient presentation, real patients were invited and told students about their diseases; about the onset, the symptoms, treatment, and so on.  The patients spoke without using medical terms, and students had discussion with the patients. So students could learn that there were no patients who had a typical medical history or symptoms, understand patients’ physical and mental agony, and acquire the skills of how to explain diseases without medical terms. In the clinical core, students were supposed to visit a hospital once a week, take a history of the present illness other medical history, do physical examination, and make a presentation to a doctor. The doctor gave feedback to students, had a small discussion with students and prescribed medicine or explained to patients about their treatment strategy in front of the students. I felt this was the typical North American way of medical education that exposed students to clinical situations in early years.
　Thirdly, students learned neuropathology without using microscopy, just used slides. In the lecture pathophysiology of main diseases were included.
　There were four tests. They were mostly case style tests, and using specimens in the neuroanatomy and neuropathology tests.
              
◆The climate, food, residence (Takashi Imai)
・Climate of Calgary
　In August, it’s very cold and chilly especially in the morning and at night. You may not be able to go out without your jacket or coat. In September, it’s getting much colder so you can’t do without your outwear.
・Food of Calgary
　Canada is a multi-cultural country so you can eat many kinds of traditional food. For example, Canadian, Sri Lankan, Chinese, Vietnamese, Ethiopian and Japanese foods are available there. Above all, Canadian special products, maple syrup and ice wine are really delicious. The price of food there is bit higher than that of Japan.
・Home of Calgary
　Calgary is now expanding rapidly because business is very good due to oil. Many houses are now under construction. You can get public transport of bus and C-train in downtown but service is still not available in the suburbs so transport is a bit inconvenient. As for town, there are so many public parks that I could feel relaxed and have good time. I stayed at a Canadian family’s house in the suburbs where there are many new houses. It is a quiet residential area so it was really comfortable for me. In addition to that, there was a son and a daughter in the family. They are about the same age as me so they often took me out and we had a nice time. For me, it was a precious experience to spend a good time with my Canadian family.     

◆How to spend Weekends（Yukimitsu  Kuwabara）
　On weekdays, we were busy studying at university and didn’t have much time to enjoy sightseeing. So we spent most of our weekends going sightseeing. But there were so nice many places to see that we couldn’t see all of them, in spite of spending all our weekends out.
　Around Calgary, we enjoyed the vast Canadian nature in places like the Canadian Rockies, Banff, Drumheller, going rafting, etc.  For me, the most impressive place was the Canadian Rockies, where we went camping with my classmates. After enjoying a great view and hiking to a literally “rocky” summit, we were surprised to find a glacier. At night, we slept under a sparkling meteor shower. That was really unforgettable.
　Other points of interest included famous places such as Calgary tower, Olympic park, and Heritage Park.  Not only that, we could enjoy watching sports, for instance, American football, ice hockey, and baseball.  American football, which is not so popular in Japan, was especially exciting. In the stadium, we cheered Calgary’s local team with thousands of enthusiastic fans.

~PartⅡ~
　Each of us felt differently during and after the days at U of C. But one thing for sure is that we had an extremely meaningful time and what we learned there is going to be useful for the rest of our lives.

◆My impression  (Yasuhiro Abe)
　This is my impression about the environment surrounding Canadian medical students. It is very different from that of Japanese medical students. I’ll give three examples here.
　Firstly, students are given a chance to make a presentation in the medical general meeting of the province. My friends did it. One friend presented about the history of cataract surgery, the other one about the history of drug therapy.    
　Secondly, even students have a chance to work at Eye Bank. Fortunately, I was allowed to join one of my friends and see how the donation of cornea was done. It was impressive to me that he told me he had learned how to write a chart, do office work of doctors, and understand various kinds of diseases and their treatments through his job.
　Thirdly, students who want to do research have a chance to join a research team as a student and it’s possible for their name to appear on a thesis if they do a good job.
　Why is the environment so different between Japan and Canada? I know Canadian students have a bachelor’s degree, a master’s degree, or a PhD. But the biggest difference is that they have enough time to spare for extra work, because they aren’t locked in the lecture room from the morning to late in the evening like in Japan, and Canadian medical society welcomes medical students and gives them a lot of opportunities to get in touch with many medical affairs. 

◆ What I Considered from the Exchanging Program  (Marie Kubota)
　On this exchanging program at the University of Calgary (U of C), I participated in the 2nd year to take CourseⅤ. The‘Neuroscience & Aging’ course started on August 13th with a span of eight weeks. During that period, I realized some differences between U of C and universities in Japan in the way students are taught materials. Since Faculty of Medicine, U of C is a three-year medical school; there is no learning term to be especially focused on basic science. Instead, basic and clinical medicine, and even practical medicine are all included in one course.
　The best constructed unit in courseⅤ was neuroanatomy, I felt. We dissect a whole body by ourselves in Japan, but Calgary students learn with the specimens dissected in pieces beforehand by the experts. Both learning styles may have advantages and disadvantages. In U of C style, the specimens were so clearly displayed that I could easily know the concise structures of the nervous system. In the Bacs Center, we could access plenty of specimens for self-learning. The same theme was covered in each lecture and the following laboratory session, which helped our understanding as well.
　In all U of C lectures, sessions seemed to be made so the students acquire the ability to differentiate diseases from clinical symptoms. In other word, every disease was taught from the viewpoint of symptomatology. In the course, much time was spared to ‘small group discussion’, or a case study session. In some classes, we had patients in the lecture theatre to have them talk and show the symptoms of their diseases. Most classes covered clinical medicine rather than basic areas such as physiology or biochemistry. In medical faculties in Japan, by contrast, the first two and a half years are spent to learn only basic medicine, making experiments in the laboratory or sketching a great amount of microscopically observed prepared specimens. Japanese undergraduate curriculum seems to aim at educating students to be ‘physician scientists’. The different ways of medical education may reflect the difference in the health service systems in each country, in what is required of doctors in each society. I, myself, am pleased to go to six-years of university in Japan. Recently, the government has been considering introducing Western style medical schools in Japan, but I feel it would be prudent to keep the present style.  In this framework we can make improvements step by step, using examples from foreign systems.
 
◆Seven weeks with my wonderful friends  (Ai Yokoyama)
　The seven weeks I had in Calgary was so wonderful that I don’t know how to describe it well. I long wanted to study abroad as a medical student, but when I was in the 2nd year I almost gave up the dream, not believing that there was such a program for studying at University of Calgary. Since I first heard about it, I tried my best studying English.
　However, I realized in Calgary that studying medicine abroad as a student was much harder than I’d expected. Many times I felt miserable at case discussions and that made me regret that I hadn’t studied medical English enough and that I’d been too optimistic about it.
　But still now I can’t help feeling that living in a foreign country attracts me very much. I believe it’s because there are more fun and positive impressions than difficulties. Above all things, I’m sure that meeting with people there made me feel this way.
　To tell the truth, I was suffering from homesickness at first. Though I saw many beautiful sights in the suburbs of Calgary, everything was spread out in the city itself and I couldn’t get used to that size. But people’s kindness helped me out of it so I got over it. Fortunately, there were people who often came to me asking me to tell them Japanese. Some people asked me to sing together Japanese songs. Some people worried about me having a cold every day until I recovered. Some people even gave me gifts of the things they had held dear. People called my name waving their hand even from a distance.  They spent time with me, and took time explaining things to me until I fully understood. They were so warm and nice and that touched me. Many of my friends were Asian, so I felt that recognizing each other as Asian formed a bond between us.
　Those were the days in which I realized what I’d dreamed about before going there was shallow and superficial. I mean, just thinking of being a med-student at U of C made me excited, and I was looking forward to the life in English itself and presumptuously I even thought it would be a good chance to improve my English. But in Calgary, I found that there were more profound things. When I was talking with my friends, I never thought it was a chance to train my English. Nor did I want to. That’s because they were my “friends” and I enjoyed talking with them. There were no barriers of language or nation between us who want to reach the same goal.
　For the last week, just thinking of having to say goodbye to them soon made me so sad. To my happiness, it seemed to me that they were feeling the same way. I was grateful. Tears didn’t stop on the last day. I will never forget the words they gave to me. I hope to be able to see them again one day just as we promised.

　In closing, we would like to thank again all the people concerned with this program for giving us this great opportunity. We sincerely hope for this wonderful program to be continued in the expectation of our juniors getting to have a chance to have similar precious experiences.  We thank Ms. Christine Kuramoto for her comments on this manuscript.

Footnote: *: Each name of students is indicated in parentheses at the corresponding section.

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