Clinical Rotation in Taiwan
A Clinical Rotation at the National Taiwan University Hospital
By Wayne Tsuang, MS 4
Wayne Tsuang, MS 4
In 2006 I spent a month at the National Taiwan University Hospital. My experience began with 22 hours of flying to travel from Chicago to Taipei, the capital of Taiwan. Surrounded by mountains, the city is home to three million of the nation's 23 million inhabitants. The city is a blend of the historic and modern, with ancient temples hundreds of years old sitting not far from towering skyscrapers.
A malaria outbreak in Taipei forced the development of an integrated and comprehensive health care system, the cornerstone of which was "Taiwan Hospital." The Japanese, who occupied Taiwan up until the end of WWII, actually built the hospital in 1895. The hospital was renamed National Taiwan University Hospital (NTUH) in 1945. The original hospital structure still exists today, with renovated portions now used for outpatient visits and as classrooms for medical students. Modern hospital facilities were built in 1984 and NTUH continues to be the flagship hospital of Taiwan's health care system. There are over 1,200 beds, 600 physicians, and 25 operating rooms. Everything from primary care, to adult and pediatric trauma, organ transplantation, and advanced research into liver cancer all takes place within the hospital.
Medical school in Taiwan begins after high school and continues for seven years. Entrance is based solely on a student's performance on the National Joint Entrance Exam given in the spring of every year. Only the top scorers are permitted entrance to one of eight medical schools in Taiwan. Among those eligible for medical school, only those with the highest scores are accepted at National Taiwan University. Within the seven year MD curriculum there is no formal exposure to traditional Chinese medicine (acupuncture, herbal medicine, etc.). However, students are taught to extensively document in patient histories previous experiences with traditional Chinese remedies. There is a student club devoted to exploring and learning traditional medicine, and due to the high level of interest it is one of the largest clubs in the medical school.
What surprised me about the patient population was the sheer amount of liver disease. Hepatitis B is endemic in Asia for reasons that are not entirely clear. As a result, Hepatocellular Carcinoma (HCC) is rampant and the most common cancer in Taiwan. What heart disease is to the American population, liver disease is to the Taiwanese.
Perhaps the major difference in clinical practice is the impact of universal health coverage. During my visit, a patient's ability to pay was never an issue nor was it ever discussed during a clinic visit or procedure. Never did a patient gripe about the cost of healthcare or struggles with an insurance company as often occurs in the United States. However, universal health care is not without consequences. There is a low threshold for patients to seek healthcare and for physicians to order tests. As a result, an over-utilization of services occurs. Sometimes unnecessary tests are ordered, and patients seek clinic appointments more often than patients in the U.S.
Students interested in pursuing an away rotation should contact Lori Orr to review the process and administrative requirements.
