Hyogo Medical University: A Deep Love and Broad Understanding for Humanity

Japan is facing several challenges at the moment, especially its demographic change, which is creating a shortage of workers. The workforce is estimated to be short over 10 million workers by 2040. To address this challenge, the government has set an ambitious target of attracting over 400,000 foreign students. What role can higher education institutions play in trying to address Japan’s shortages of labor and its need to globalize?

We’re actually not expecting many foreigners to come for medical education here, but I think it’s a matter of time. We don’t see much of a role for medical institutions right now, but maybe in the future, perhaps in ten years, it could become more in need for foreign healthcare professionals. The reduced population combined with an overwhelming number of senior people in Japan will inevitably lead to more demand for medical treatment and, thus, for people to work in hospitals, so we may not have enough hospital workers to cover the needs.

It also involves certain credentials because to work in hospitals in Japan, you must have a special medical certification, nursing certification, rehabilitation certification, or others. This is an issue for the government as they need to consider how to handle these certifications for people from abroad who want to come and work in Japan. If you look at hospitals in the UK, for example, you’ll find at least 50% of all the healthcare professionals come from across the globe because they already have this kind of environment and system built to accommodate these foreign workers easily. Unfortunately, Japan is not yet at that level.

Another problem is financial, in particular how people are compensated for their work in the hospitals. There are no regular increases in the fees or monthly payments to doctors or nurses in Japan. This is because Japan has a great national health system where all Japanese people have national medical insurance, so when they go to the hospital, everybody is treated equally with the lowest possible fees. Unfortunately, medication prices are not getting any lower, but in contrast, we cannot increase the salaries of medical professionals, and this affects the attractiveness of working in Japan. This not only relates to foreign talent but also to Japanese students in the medical faculties, who have the same concerns, and fewer and fewer people may be being attracted to study medicine or healthcare because of this in the future.

We foresaw this trend happening, and we supported a special facility at Sasayama city to attract and train certified care worker from Vietnam, for example, to allow them to work in Japan. Nurses and rehabilitation therapists are an easier target because it’s slightly easier for them to get certified to work in hospitals than it is for pharmacists or doctors.

Japan is well known for its talent for robotics and automation, but if we talk about nursing care or rehabilitation, that’s something that still requires a personal touch. Do you foresee the need for more human capital in that sense, or do you see automation or robotics as a way to compensate for that?

Automation and the use of robotics may be something that has a place in Japanese hospitals. Of course, you cannot fully replace the human touch with robots or machines, but to some extent, it’s possible, especially for more routine tasks like personal care. As for workers from overseas, that’s something that might be especially beneficial because Japanese people are generally shy and also reluctant to be cared by other Japanese people, but perhaps they will be more comfortable with foreign nurses or therapists. So that could be part of the solution.

You have four faculties, including medicine, pharmacy, rehabilitation, and nursing, and you went through a restructuring in 2022. What sort of challenges did you have when you were trying to organize this large-scale restructuring of the university, and what benefits do you believe it will bring you in the future?

That restructuring is a strategic alignment of these four faculties to improve the quality of medical care in hospitals. We promote an Interprofessional Education (IPE) and Interprofessional Work (IPW) and they facilitate the interaction of faculty members and students of four faculties with each other.

Japan is widely known as a super senior society with an overwhelming number of people over the age of 60. The reason I say that interprofessional work and collaboration with practical skills at the education stage are important is because some diseases are incurable but must be treated, and this becomes more evident with an older population. This is something that we, as a medical education facility, would like to take care of in the future. For example, researching drugs and their effects on patients while also considering the practical skills needed to treat people and to help extend life to the maximum degree while allowing patients to remain a valuable part of society and to make them happy at the end of their lives.

That role is interesting in that you’re not likely to hear much from a company driven by a profit line. It’s up to institutions like yours or the government to implement those kinds of strategies.

One important thing about our IPW system is that it helps connect people who have special skills in medical treatment from totally different sectors of medicine. As you can imagine, once these specialists are in the hospitals, they often don’t have a chance to connect with other professionals. Obviously, nurses occasionally talk to doctors, but generally speaking, there are fewer opportunities for different types of professionals to talk to each other and exchange opinions about how to treat people best. For example, in Europe and the United States, nurses have a high social status, but there is a clear division of roles with other professions. I would say that one aspect of Japanese society is working together for better results, so here we are, trying to adopt the same principle by working together to create better results.

I just briefly explained the benefits of s Integrating the four faculties that we have. As for challenges, in a way they were the motivation of the restructuring because we have a private hospital here as well and you have to be outstanding and compete with other private hospitals to attract more patients. The quality of care we provide is a big part of that, so we felt that restructuring would help with that.

You mentioned giving your students an opportunity to collaborate. One thing that we saw in your disease omics analysis course, which was established in 2019, is that you have an industry and academia collaboration with Shimadzu Corporation. This course uses metabolomics, which relies on mass spectrometry for analysis. How does this collaboration between industry and academia contribute to your research and development capabilities?

There were different reasons for academic and industry collaboration prior to working with Shimadzu Corporation. One main reason is funding because Hyogo Medical University is a private university and we do not receive sufficient financial support from the Japanese government compared to national universities.  Another reason is that we can get access to advanced machinery and cutting-edge technology, and we can bring this technology to our labs. It’s also a win-win situation because Shimadzu can see actual results in the hospital. For example, they provide devices and expertise for preventative cancer treatment, and we have access to patient data from our laboratories. As a company that develops these machines, that data is very important, so this collaboration benefits both sides.

Are there any other collaborations that you’re looking at now or that you’d like to pursue in the future?

The cooperation we have with Shimadzu is ongoing, so we expect they will want to test other devices here in our facilities. Before that, we had experience dealing with pharmaceutical companies, working with them to do clinical testing. We welcome collaborations for both R&D and clinical testing of new drugs.

Another example is cooperating with a company called Kubota, a major manufacturer of industrial machinery, agricultural machinery, construction machinery, diesel engines, construction materials, steel pipes, and environmental equipment. The goal is to treat the disease mesothelioma caused by asbestos, which was a problem in some production facilities that use asbestos in their sites. The way it works is that we created an endowed chair where companies that would like to tackle that problem can contribute on a charity basis. Besides that we have more than ten endowed chairs by various companies, serving as a foundation for investigating a drug or device that could possibly treat many diseases in the future.

As you mentioned, Japan is the world’s first super-aged society, meaning that currently there are almost 30% of people over the age of 65. This trend is expected to increase as the years go by. Japan is not unique; it’s just the first country to age like this. Both Korea and Germany have over 20% of their populations over 65, and I think China is not far behind and some of the world’s largest populations are following suit. As the world looks towards Japan, what expertise or lessons can be shared as the first super-aged society?

It’s a very difficult question that may be more appropriate for the government to assess, answer, and disseminate. I would go back to the answer that I gave earlier about the national medical insurance policy, where each person with this medical insurance is more or less treated equally. The gap between rich and poor is relatively small here in Japan. In comparison, other capitalist countries often have a huge gap and wealthy people often go to a private hospital with the best treatment and the most experienced doctors, while others do not receive the same level of medical care. Whether Japan's unique universal health insurance system can continue in a super-aging society is a major challenge.

We noticed that you have a department that offers English for medical purposes and a narrative in medicine course, which fuses the study of literature and medicine. The goal is to equip the new generation of doctors not only with English skills but also with improved medical communication skills. What do you feel are the main shortcomings in the way that medical communication is currently being taught, and how does this course set out to overcome those shortcomings?

In terms of medical communication, we have courses taught in Japanese and English. We’re trying to teach people something more than just essential medical studies because you have to be a good person as well as have special knowledge. Non-verbal communication is also important because Japanese patients expect top-notch service, not just from the standpoint of qualifications as a doctor, but also dress, demeanor, empathy, and communication. Thus, inter-medical communication education is very important beyond just a paper certification. To treat other people, you must have the right character.

I already mentioned our interprofessional collaboration, and having a hospital helps to further that connection. We call it early clinical exposure, where students have the opportunity to go to the hospital before graduating to experience the working environment there. It’s very helpful for them to understand and imagine their future practice.

Throughout the course of study, from year one to year five, English is embedded into every aspect of the curriculum. During the first year, we had what I would say was simple English with native speakers from the Berlitz English language school. In the second and third years, we have clinical English, which is English for medical practitioners, that teaches medical terminology. The fourth year is clinical diagnosis, where we bring doctors from the US. Finally, in the fifth year, we again have teachers from the Berlitz language school, but now the focus is not simple English but professional medical English that was taught throughout the previous years.

This year, a doctor from Harvard is coming to teach.

How did you connect?

One of our professors in social medicine met this doctor back when he was studying abroad.

Talking about connections with overseas colleges, your experiences go back to 1980 when you connected with the University of Saarland in Germany, and you now have agreements with more than eight universities in six countries to promote exchanges, not only of students but also faculty. What role do these partnerships play, and are you currently looking for any new partnerships?

There are two reasons for having these academic partnerships in countries such as the US, Germany, China, and Australia. The first is to have an exchange of students, and the second is to foster collaborative research and development. The latter is helpful since some practitioners from other countries may have different knowledge about medicine, pharmaceutical science, rehabilitation, etc. It has been on hold since COVID-19, but we are beginning to resume international exchanges.

When these students come here, what sort of services or structures do you have in place to help them mix with Japanese students, experience Japanese culture, settle in, and potentially find employment?

We have a special guest house for foreign students to make their stay in Japan as comfortable as possible, and in that guesthouse, everybody tends to speak English. Our students also go there to study or practice English with those foreign students. We also have extracurricular activities beyond what they study in the faculty. They study what Japan and Japanese culture are all about, and sometimes, they have opportunities to travel around the country and see amazing places. We have a Center for International Exchange that works with these students from the initial stage all the way to the end of their stay in Japan.

To answer your question about employment, of course, we try to promote it, especially since we have a hospital right here that could potentially use their skills. Unfortunately, we don’t have many examples of foreign students who graduated or studied here and later wanted to take the next step of working in Japan. We do have some examples of foreign nursing students finding employment in nursing facilities in Japan, but not many, and we don’t have a special program for promoting employment in Japan either.

If we were to return to interview you again on the last day of your presidency, what would you like to achieve by then?

As a dean, I want to see our students be more ambitious because there is an aspect of Japanese culture where students tend to be shy and introspective and maybe a bit closed to the outside environment. I would like them to be ambitious because now is a great time to go abroad to study and get some new insights and new practices. To do this, students need to think outside the box, go beyond the boundaries, get all the information that’s out there, and open themselves to the world. That’s the message I’m going to be delivering to all the students that come my way.

For more information, visit their website at: https://www.hyo-med.ac.jp/en/