Rethinking Healthcare in Japan from a Global Perspective -Four Medical Students on What They Learned from Their International Clinical Clerkships-

*Student year at the time of the interview

2026/06/30

The Keio University School of Medicine offers a wide range of short-term study abroad programs in which students train at universities and hospitals around the world. A popular program is the Short-Term Overseas Clinical Study Program, a one-month clinical clerkship at a medical institution abroad. In the 2025 academic year, 63 of the 110 fifth-year students took part.

Here, we sit down with four sixth-year medical students to hear about their experiences and how they plan to leverage them in the future.

―― To start, what first drew each of you to medicine?

Matsumura: When I was in elementary school, I got sick while my family was staying in Canada. I was nervous, being in an unfamiliar country, but the doctor there was so kind to me. That was the moment it really hit me: being a doctor means you can put people at ease like that.

Roose: I completely get that. I was a sickly kid, too, and I was always at the doctor's office. I'd be nervous before going into the exam room, but talking with the pediatrician always calmed me down, and it made me want to become someone like that myself. That's what set me on the path to pediatrics.

Sugii: I wasn't dead set on medicine from the start, and there were other career paths that appealed to me as well. But over time, I came to feel that there's something uniquely rewarding about being able to care for people and be directly involved in their health and lives.  Surgery stood out to me in particular because I was fascinated by both the technical skill it requires and the depth of expertise involved.

Fukazawa: My family ran a dental clinic, so medicine was already part of my world. But what actually made me want to become a doctor was a TV show called Doctor G: Unraveling the Medical Mystery. Watching them deduce the diagnosis from the symptoms was fascinating. I remember being surprised that such a job existed, and it really drew me in.

―― And it sounds like you each chose the Keio University School of Medicine for different reasons, too.

Fukazawa: I'm from Gifu, so part of it was just wanting to study in Tokyo. But what drew me most was Keio’s culture of respecting student independence. There's a real sense that you can take initiative and try things for yourself. Not just in your studies, but in extracurriculars, too.

Matsumura: I'm from Kyoto, so I'll admit Tokyo had a real pull for me. Plus, Keio has a reputation for really strong alumni connections. And I felt that network firsthand during this clerkship.

Sugii: Same for me. I really liked how much Keio encourages students to take initiative.

The study-abroad and research opportunities are especially well-established, and there's a whole support system in place to back students who want to take on new challenges.

Roose: I came up through the internal track from Keio Shiki Senior High School, and the open, self-directed culture was a big draw for me as well. There's a culture that really values thinking and acting for yourself.

―― For this clerkship abroad, you each trained in a different country and a different specialty. To start, what drew each of you to your host institution?

Sugii: I did my cardiothoracic surgery rotation at Johns Hopkins University, in the U.S. I've long been interested in cardiac and transplant surgery, and I wanted to see a world-class clinical setting up close. Johns Hopkins also has a special place in the history of medicine as the birthplace of the modern residency system and the site of numerous surgical firsts. Training there had always been a dream of mine.

Matsumura: I did my oncology clerkship at Washington University's Barnes-Jewish Hospital. There are many Japanese doctors on staff, so it felt like a rare chance to watch future role models up close, and I'd heard that even visiting students get to play an active, hands-on role in patient care, which was a big draw for me.

Roose: I rotated through Pediatric Allergy and Immunology at Northwestern University. In the U.S., medical students are trusted with a lot more. I loved that you're not just observing, you're actually part of the patient's care. And with more and more international patients coming to Japan, I wanted to be able to treat people in English down the line.

Fukazawa: I went to the ENT department at the University of Cologne in Germany. Japanese medicine has historically learned a great deal from Germany, and the two countries have a lot in common culturally, too. At the same time, there's been all this talk lately about Germany overtaking Japan in GDP, so I got curious about what the country was really like.

―― Was there anything you found difficult while you were abroad?

Matsumura: The English, for sure (laughs). I'd studied for the USMLE and done plenty of listening practice, but in an actual clinical setting, you have to put things in words the patient can understand. It wasn't just about language ability. It was how you get your message across that was really hard.

Roose: Pediatrics was especially tricky because you're not only talking to the child, you're talking to the parents, too. And in a country as multiethnic as the U.S., the patients I saw really did come from every kind of background.

Fukazawa: For me, every conversation in the hospital was in German, so I really struggled at first (laughs).

Sugii: One thing I noticed in the U.S. was how much students are encouraged to take initiative. At the same time, I realized that if you want to learn something, you have to actively seek out those opportunities yourself. In a busy surgical department, the challenge was figuring out how to show that initiative while being mindful not to interfere with patient care.

―― What kinds of things did you actually get to do during the clerkship itself?

Matsumura: What struck me about the U.S. was that it wasn't "you're a student, so just watch." They treated me as a real member of the team. I was given my own patients. Not just seeing them and writing up the charts myself, but working out the treatment plan on my own and then presenting it to the senior physicians.

―― That sounds remarkably hands-on.

Matsumura: It really was. On top of that, for the cases that stood out, I got to look up the literature myself, pull it together into slides, and present. I gave three presentations in four weeks, so I was really put through my paces (laughs).

Roose: I was given the same kind of role. I'd be the first to take the patient's history, then present it to the senior physicians. At first, I could barely manage one patient a day, but little by little, they trusted me with more. By the end, I was handling several a day and writing charts that needed almost no corrections from the senior physicians. That gave me a real sense of accomplishment.

Sugii: The U.S. really does have a culture of giving opportunities to people who want to learn.

Roose: Definitely. If you take the initiative, people really respond.

Sugii: I joined morning rounds and conferences, and observed surgeries, but I realized that I had to speak up about what I wanted to see and learn. If you put yourself forward, you really do get to experience a huge range of things. More than during my rotations in Japan, it drove home how important it is to be proactive about your own learning.

Fukazawa: Germany was much the same. The sixth-year students there were in a position close to what we'd call a junior resident in Japan, doing a lot of real clinical work, with real independence expected of them. I took part in ward work and scrubbed in on surgeries, too, and it felt like thinking and acting for yourself was just the baseline expectation.

―― What stands out most from the clerkship?

Sugii: Watching heart and lung transplants. Seeing the whole arc was incredibly moving: from procuring the donor organ to the moment it started working again inside the recipient's body. It made me deeply aware of the weight of the gift being passed from one life to another.

Matsumura: The case that has stayed with me most was a young patient who developed severe encephalitis during cancer treatment with immune checkpoint inhibitors. It made me think hard about how you support and communicate with patients facing serious illness, as well as their families.

Roose: At least from a medical student's point of view, I didn't see a big gap in the ability of doctors between Japan and the U.S. What did stand out was that there were more tests and treatment options available than in Japan. The range of care you could offer a patient felt wider in the U.S.

―― Studying abroad must also have let you look at healthcare in Japan more objectively.

Roose: The thing that struck me most was the U.S. health insurance system. Because the U.S. runs mainly on private insurance, I saw cases where patients had to stop coming in because their care wasn't covered, or where a drug we'd prescribed couldn't be used because it fell outside their plan.

―― That would be unthinkable in Japan.

Roose: Right. I even watched senior physicians negotiating with insurance companies. In Japan, because we have universal health coverage, getting the care you need is taken for granted, but being there made me realize what a privilege that really is.

Matsumura: That said, I also saw moments during my clerkship where the support was remarkably generous. Instead of abandoning patients who couldn't afford their care, social workers and others would team up to support them. I thought that was wonderful.

Sugii: I was struck by how streamlined and efficient the healthcare system was in the U.S. You could pull up a chart right from your own phone or laptop, and everyone’s roles were clearly defined, allowing each person to focus on their own role. And partly because healthcare is so expensive in the U.S., hospital stays were much shorter than in Japan.

Fukazawa: Germany was eye-opening in a completely different way. For one thing, they really value work-life balance. They'll take breaks even mid-surgery, and the hours were pretty flexible.

Matsumura: They take breaks in the middle of surgery?

Fukazawa: They do, actually. They'd swap out and take breaks in shifts. That really brought home the difference from Japan.

Sugii: In Japan, there's that sense of seeing it through to the end, right?

Fukazawa: Exactly. But watching the doctors in Germany, I got the impression that they focus intensely for short periods and perform at a very high level.

―― So the whole set of values around work is different, too.

Fukazawa: That said, I did sense there's a flip side. It can be less convenient for patients. Between the short opening hours at many stores and the long waits at hospitals, I came to appreciate that Japan offers genuinely high-quality service.

Sugii: For me, being abroad gave me a new appreciation for how attentive and thorough medical care is in Japan. Medical care in the U.S. felt very efficient and fast-moving, while in Japan, different healthcare professionals stay in close communication with one another as they care for patients, and I think that gives patients a real sense of reassurance.

―― What did you gain that you could only have gotten by going abroad?

Fukazawa: Studying abroad isn't just about studying. So much of it is the people you meet, right?

Roose: Absolutely. At one point, one of the attending physicians invited all of us visiting students to their home. It was such a warm atmosphere, and you could really feel how welcome they made us.

Sugii: For me, what stood out was meeting a Japanese doctor who was really making their mark there. In the operating room, he worked seamlessly alongside the American surgeons, and it was genuinely impressive to watch. It was also clear how highly respected he was by the doctors there. Despite all he had accomplished, he was incredibly humble and down-to-earth. It made me think, “That's the kind of doctor I want to be someday.”

Matsumura: Getting to meet doctors who'd come up through Keio meant a lot to me, too. It meant a lot to learn that the Keio network extends overseas.

Fukazawa: I got so much help, even from Japanese doctors who had no direct connection to Keio. Once you're abroad, you really come to appreciate the bonds between fellow Japanese.

―― Finally, how do you each hope to build on this experience going forward?

Roose: I think Japan is going to see more and more international patients in the years ahead. When that happens, I want to be a doctor who can care for them confidently in English. And as I practice in Japan, I want to keep a constant eye out for new medical advances that haven't yet taken hold here, and, where it makes sense, look for ways to bring them into Japanese practice, so I can widen the range of care I'm able to offer patients, even a little.

Matsumura: In the U.S., I learned a lot about team-based care and how medical training is structured, which also gave me a fresh appreciation for Japan's own strengths. Drawing on what I have learned from both healthcare systems, I hope to contribute to improving healthcare in Japan as a doctor.

Sugii: I want to carry the proactive approach to learning I gained from this experience into my future clerkships and residency. I hadn't had much interest in research before, but seeing how closely clinical work and research are connected, I've also started to see the appeal of clinical research. In the future, I want to become a surgeon who can contribute to transplant medicine.

Fukazawa: The ways of working and the values I saw in Germany gave me a way to look at Japanese healthcare from the outside. Japan has many strengths of its own, but I want to continue thinking about how we can improve healthcare here by drawing on the best practices of other countries.

―― So this wasn't just about "studying abroad," it also became a chance to take a fresh look at healthcare in Japan.

Matsumura: I really do think so.

Roose: It was only after leaving Japan that I came to see its strengths as well.

Sugii: At the same time, it made me think about what Japan could learn from other countries.

Fukazawa: For me, studying abroad broadened not just my medical knowledge but my own values. Looking back, I am again grateful to the university and to my parents for giving me such a valuable opportunity.