William Hassett (Supervisor)

1.教員総括

2016 Overseas Training Program to U.C. San Diego, Moores Cancer Center

William Hassett (Supervisor)

The Overseas Training Program Committee at Dokkyo Medical University (DMU) chose nine 5th year students to take part in an observation annually hosted by the University of California, San Diego (UCSD). This year's group consisted of Megumi Kaku (Leader), Tomoki Hasegawa (sub- leader), Satsuki Mikoshiba, AinaNinomiya, Mizuki Takahashi, MizukiWatanabe, Masatoshi Sato, Tasumi Yamazaki and Yuya Yokoyama with snr. Asst. Prof. William Hassett acting as their Supervisor. This Overseas Training Program (OTP) group departed Japan on Saturday 20th of August and returned to Japan on Saturday September 3rd. Our destination, UCSD, is recognized as one of the top 15 research universities worldwide and Moores Cancer Center, the hub for this trip, is located within a section of the campus dedicated to the research of thesciences.

Established by John and Rebecca Moores in 1978, Moores Cancer Center (MCC) is one of the 45 National Cancer Institutes (NCI) designated Comprehensive Cancer Centers in the United States. These institutions are dedicated to scientific innovation and clinical excellence. This designation is only reserved for centers with the highest achievements in cancer research, clinical care, education and community contributions. MCC unites cancer-related research laboratories with clinical trials, offers prevention and outreach programs, and provides clinical care within its facility. It was designed to promote interaction and intellectual communication between clinicians and researchers with an aim to develop the innovations made in the laboratory directly to patients thus providing a "bench-to-bedside" approach to cancer. Moores Cancer Center's mission is to 'Save Lives by Transforming Cancer Prevention, Detection and Care'. MCC provides patient care that features a multidisciplinary team approach. These teams include specialists such as medical, surgical and radiation oncology, pathology, diagnostic radiology, working with professionals within the fields of psychology, genetic counseling, nursing, social work, and more. Also, we saw an army of dedicated volunteers, along with those mentioned previously, working together to provide the best course of cancer treatment and support in an excellent environment for patients and their families, who are embarked on a journey through the cancerexperience.

Dr. Maria Tiamson - Kassab, who is a board-certified psychiatrist and the Director of Moores Cancer Center's Patient & Family Support Services (PFSS), organized this year's 'Observation Program' that mainly focused on the PFSS at MCC and lectures were presented by clinical psychiatrists, psychologists and counselors. The PFSS is a specialized service that is dedicated to supporting cancer patients. Its aim is to provide or renewing a patient's resilience, restoring a sense

of value to their lives and by helping them transcend what they are going through, but most of all the PFSS are there to improve the 'quality of life' (QOL) of both the patients and their families. Addressing a patient's wellbeing during treatment has been shown to improve both cancer care and outcomes. The observation also included visits to Thornton Hospital, UCSD Maternal, Fetal Care and Genetics Center, Hillcrest Hospital, Rady Children's Clinic, the Exercise and Physical Activity Resource Center (EPARC) along with tours of the beautiful SALK Institute for Biological Studies, Triton Campus (UCSD), and The Birch Aquarium, located near Scripps Institute of Oceanography. At MCC we also attended various classes on Oncology, a look at Bioarchaeology with Adriana Tamayo, who herself is a cancer survivor, and a class by Fred Liu, who is currently a 4th year med. student at UCSD and for the first time an introduction to Patient Simulation Training. The program gave our students, not only the chance to compare and contrast treatments, services and facilities offered both in the U.S. and Japan, to talk directly to students realizing the education systems offered to med. students both at DMU and UCSD, but more importantly to communicate with those professionals and survivors of cancer who daily offer support to cancer patients and theirfamilies.

The OTP began with a welcome breakfast hosted by Dr. Kassab with various members of the PFSS team dropping in and out. The breakfast acted as an icebreaker where we all had an opportunity to meet for the first time. Included were Liliana Cardenas and Sandra Pilgrim, Ms. Cardenas (Lilly) was my main contact throughout the trip. Everyone wanted to know about us and the students had to introduce and speak about themselves, while being asked follow up questions. Then Ms. Kaku gave a presentation introducing DMU for the very first time to the doctors and members of MCC's PFSS. The presentation allowed the team to discover a little about us and gave them a chance to ask the students many questions regarding DMU, its educational structure and more about them and their dreams for the future. After breakfast, Ms. Clea Shannon, who is a cancer survivor and now volunteers at MCC, gave us an informative tour of the facilities. We were then taken to Thornton Hospital, where Dr. Hirst took us around the Cardiovascular Center's ORs and Emergency units of the hospital. The students found the tour of both centers interesting and it allowed them to compare and contrast those facilities and equipment employed in both DMU's hospital and MCC / Thornton. We were then taken to the SALK institute to enjoy a tour of its facilities. Jonas Salk was the developer of the polio vaccine and he founded the institute in 1960 with his friend the architect Louis Kahn. The original buildings of the Salk Institute were designated a historical landmark in 1991. In 2006 the California Historical Resources Commission deemed the entire site suitable for listing on the National Register of Historic Places. Today, SALK ranks among the top institutions in the USA for research output in the life sciences. Thanks to Lilly the OTP was scheduled for learning in the classroom in the mornings, with afternoons, when possible, learning about cultural and important educational sites located in and aroundUCSD.

This year, for the first time, we attended classes in Palliative Care conducted by Dr. William Mitchell, who is a board certified medical oncologist, and Dr. Jeremy Hirst, who is a board certified psychiatrist. As preparation for these classes, students were allowed to engage in a Patient Simulation class that examined interviewing techniques with a professional actor taking the role of a patient with severe depression. This was achieved with guidance directed by Dr. Iglewisc, who is a psychiatrist. Coupled to this was Dr. Brent Mausbach's class into his research into depression in cancer. He showed us that there is so much to be learned about addressing problems with depression, which is shown to cause shorter outcomes as well as burdening the medical system with increased costs that tries to provide added care and treatments. We learned about bringing a sense of legacy to patients nearing end of life with a class by Dr. Lori Montross and Dr. Emiley Meier, who are both clinical psychologists. This lesson gave the students a window into new ways of dealing with end of life care in a different culture and as a result there was much discussion on the ideas of dignity and legacy and how they are managed in Japan compared with what we learned in this course in the USA. Along with this theme, Dr. Hsu, who is also a certified psychiatrist, spoke frankly to us of his experiences in hospices and other hospitals providing care to terminalpatients.

At MCC through the PFSS there are many non-medical programs offered to patients to help them attain a better QOL. Many of these classes, which usually start with meditation, center on the arts and crafts. Alessandra Colfi, who has a background in design and fine art, gave the students a class that demonstrated art's therapeutic effects. Also, Alessandra allowed some students to participate in a class along with cancer patients to see how such classes are beneficial. During the class our students were given every opportunity to communicate directly with those going through treatment. Dr. Sharon Bray, who is known for her innovative work with 'transforming writing' or 'writing as a way of healing', talked about her work and her classes that are aimed at those whose voices have been silenced by serious illness, pain, loss or trauma and how being able to write and voice our thoughts and experiences can be remedial. In a special class that she gave us in our 2ndweek, Dr. Bray persuaded the students to write honestly about their own feelings and experiences, moreover about what they hoped their legacy should be as doctors, all with interestingoutcomes.

As mentioned, meditation techniques are used by many in the support services and we were introduced to them by Dr. LaviniaFiorentino, who focused on the problems of insomnia and Michelle Lemarie-Simkin, who gave a class centered on Hypnotherapy and Healing Touch. Both classes gave the students their first opportunity to experience a method of treatment that is practiced without the need for medications. Those who learn these skills have the ability to conquer insomnia, anxiety, panic, depression, trauma, pain, constipation, diarrhea, shortness of breath and nausea. Possessing these tools helps patients to achieve an improved QOL by themselves. The classes by Alessandra, Sharon, Lavinia and Michelle allowed the students to consider the emotional as well as the psychological aspects of treating cancerpatients.

An important part of this observation focuses on the research currently under way at MCC to improve cancer treatment and therapies. We looked at how studies to further understand genetics is having an impact on medicine with Dr. Kimberly Forbes and Dr. Lauren Korty. Dr. Forbes gave a class on the developing area of Genetic Counseling, where doctors help assess the risk of cancer based on personnel and family history. Later we were taken for a tour of UCSD's new Fetal Care and Genetic Dept. in Sorrento Valley. Here we met Dr. Korty who is a specialist providing prenatal and genetic counseling regarding amniocentesis, chorionic villus sampling (CVS) and ultrasound findings to parents. The students were treated to lectures on Neuro Oncology by Dr. David Piccioni, Hematology by Dr. Michael Choi, and Renal Cell Carcinoma with Dr. Michael Randall. Each told us of their ongoing research and the clinical trials in their particular fields that attempt to offer better practices in treating those with certain types of brain tumors, blood diseases causing cancer and patients with prostrate, kidney and bladder cancer. These lessons reminded the students ofthe valuable work that is done at MCC in research and reinforced the MCC's message of having programs where research teams seek to translate basic scientific findings into therapeutic interventions for patients and to increase understanding of important diseaseprocesses.

We were also introduced to those members of the PFSS that included Ms. Yuko Abbot, who introduced us to the importance of the Oncology Social Work Services. She taught us how she and her colleagues offer a wide range of support to cancer patients from diagnosis. Dr. Lauren Hermas, who is an occupational therapist, shared with us her experiences in orthopedics, utilizing evidence- based practices and manual therapy techniques. Dr. Veronica Cardenas talked to us about the Psychology Trainee Program and Dr. Bilge Pakiz gave us a class that centered on obtaining funding for research and clinical trials. David Wing, who is the coordinator of the Exercise and Physical Activity Resource Center (EPARC) gave us an extensive tour of his facilities and demonstrated, with the help of our students, some of the devices used to measure and manage a patient's physical activities. He also showed us some new equipment that EPARC was currently developing to measure such physical performance. For all the students these lessons acted as an introduction to a new area of consideration and they became more inquisitive as regards to learning more about what similar systems are currently in place inJapan.

The observation also consisted of a visit to UC San Diego Medical Center, Hillcrest. With around 380 beds it is a primary hospital for the UCSD's School of Medicine. Here we saw a 'care team' meeting first hand. These teams are a feature of the manner of how care is provided in the States. We learned that this team was made up of health professionals from many backgrounds that included nurses, pharmacists and social workers, which was a revelation for our students. Furthermore, in attendance that day were Fellowship Students and 3rd and 4th year UCSD med. students, this offered our DMU students a chance to see on-site training in practice. Dr. Kim, a geriatric psychiatric specialist, chaired the meeting and students were able to see interaction at his

rounds that centered on assessing and treating older patients with depression and anxiety, as well as patients who are experiencing severe aggressive behavioral disturbances as a complication of dementia. The students, for the first time, saw a care team in action and were able to observe how students in the U.S. gain clinical training. After, we were shown around the Psychiatric-Geriatric unit located in the hospital by Dr. Beverly Chang. This unit was designed by Dr. Daniel Sewell, putting into effect his vision of a proper venue to host residents and is unique in its use of fashion and design.

At the end of the first week the OTP participates in an observation at Rady Children's Hospital, which is the largest children's hospital in California. It has about 500-beds and is a dedicated pediatric care facility and a designated trauma center that provides the largest source of pediatric medical services in San Diego. Sara Loughead, who is an engineer and was involved in the planning and overseeing of the hospital's newer wing's construction, provided us with a thorough and excellent intensive tour of the hospital that included a visit to the emergency rooms, a look at the incubation units and ICU. What impressed the students was the child friendliness of the hospital and they appreciated the effort taken there to make children feel, as much as possible, welcomed with warmth and affection. The design of Rose Pavilion and the hospital's new wing, which was opened on the 10th of October 2010, was impressive. The gardens were of particular interest with specialized facilities in place to handle medical emergencies should theyoccur.

Towards the end of the observation Dr. Christine Zoumas led a class on nutrition awareness and Anne Cleveland's last class was on Meditation and Yoga for Health: "Fighting Cancer with Food and Physical Activity". The students were invited to prepare a healthy pizza lunch at the Host Heeling Foods Kitchen located in MCC. Dr. Kassab came along and together we enjoyed a quick lunch together during which there was a small ceremony held to acknowledge the signing and exchanging of the new MOU between our institutions. After that, Dr. Kassab presented the students with a Certificate of Completion of this year's Program. I am certain that these certifications were most appreciated and will be treasured by all of ourstudents.

There were notable improvements in the 2016 OTP, when compared with previous observations. All the students were provided with a schedule with information of all the lessons to be attended before the group left Japan and on arrival, MCC provided the students with further information and updates to their schedules. A flash drive was then presented to each student containing all the presentation slides for their further reference. The first day's breakfast introduction/presentation along with thorough organization resulted in students that were better prepared for the OTP. All of the lectures that were presented were given by professionals dedicated in their fields of medicine. The lectures were clear and well organized; moreover the presenters encouraged questions, comments and discussion in a friendly and relaxed manner and at the end of a class emails were swapped with students with the insistence that they should keep in touch withthem

in the future. Dr. Kassab understood that our students would have difficulties in English, so she emphasized the importance of an approach to learning that was much more interactive and student centered while offering our students topics that were new, challenging and motivating for them; this was helped when classes included UCSD fellowship and med. students.

Regarding those lecturer's who taught the classes, because of their interest in patient care and possessing excellent clinical acumen, they acted as excellent role models for our students. Also, to further improve the quality of learning for future OTPs at MCC, a post observation evaluation form has been sent to each student. It is hoped their feedback and comments will help this program to be further developed providing a more interesting OTP for future students. On behalf of DMU, but especially our UCSD OTP students, I would like to thank everyone most sincerely at MCC especially Dr. Kassab for being a wonderful and welcoming host (on many occasions) and Liliana (Lilly), who thought about us everyday and looked after us with warmth and kindness. We ought to remember with gratitude all of those, who either organized or gave our students lectures, for taking valuable time out of their busy schedules and made efforts to afford us with an educational experience that is unique. We should not forget that no other institution has access to Moores Cancer Center as is offered to Dokkyo Medical University and that the bonds of friendship and trust that have been established between our two institutions over the years continue to be strengthened. Next year's OTP brings the prospect of further development of this OTP and perhaps we should consider here at DMU the introduction of an observation allowing UCSD med. students to visit Japan. As educators we should try to ensure benefits to all our students, all of who will be doctors in the future. Finally, I would like to thank Dr. Chigusa, Chair of the Overseas Committee, for his support and advice and thank all the staff of our division who work so tremendously to make these Overseas Training Programs a reality.