China Rotation Reflection by Nilson Wu, MD

Residency Rotation in China Reflection by Nilson Wu, MD

The international rotation at The Second Affiliated Hospital of Zhejiang University (SAHZU) in Hangzhou, China was one of my most formative and memorable experiences during residency. I wanted to see firsthand how anesthesia was practiced in a different country, especially one in which I could also practice speaking and understanding Mandarin, my mother tongue. 

During my time at SAHZU I was impressed by how streamlined and efficient the hospital system was. Most patients present to the pre-operative evaluation center for recommendations and clearance prior to surgery. On the day of surgery there is a designated procedure room where patients who need arterial lines and/or central lines go to for line placement prior to arrival to the OR. Patients are extubated in the PACU to shorten OR time and accommodate the large volume of cases. PACU holds are rarely an issue as they have ample staffing and overflow recovery rooms to use as needed. OR turnover time was consistently less than 30 minutes. 

I was also surprised by how resourceful SAHZU was. They have re-useable sterile cloth drapes and gowns. 20-gauge angiocath IVs are used for arterial lines and sterile saline is used instead of sterile gel for ultrasound guided procedures. For every OR case the anesthesia team receives a box of just enough supplies for the case (e.g. one video laryngoscope, a set of syringes and monitors) so that there is minimal waste. Acute normovolemic hemodilution is done much more commonly compared to at UCLA to save blood. These observations taught me to be more mindful of resource utilization when I returned to the U.S. 

Throughout the month, my assigned anesthesiologist mentor, Dr. Yu Shui, patiently answered all my questions, oriented me to the hospital system, and gave me the flexibility to shape my educational experience. I wanted to improve my regional anesthesia skills and line placement, so he assigned me mostly to the Acute Pain Service and procedure room. I was also able to participate in thoracic, cardiac (including lung transplants), and non-OR anesthesia cases. I attended two SIM sessions, where the case scenarios and discussion sessions were very similar to those at UCLA. I also gave two oral presentations to the entire anesthesia department: one case report and one presentation on the similarities and differences between SAHZU and UCLA. During the end of the rotation my Mandarin improved significantly. I could proudly say that my final presentation was done mostly in Mandarin (for context, my Mandarin is very elementary, and I knew zero anesthesia-related words prior to this rotation)!

Outside of the hospital, I enjoyed exploring the beautiful city of Hangzhou. Ordering food, using public transportation, and buying groceries was streamlined through the Alipay app. Most restaurants allowed payment via a QR code linked to the app that also translated the menu into English, so language limitation was never an issue. I spent time after work strolling around West Lake, admiring the pagodas, sipping their famous Longjing Tea, and trying the various cuisines around town that were delicious and affordable. On the weekends I traveled to Shanghai and Suzhou, both of which were only a short high-speed train ride away. 

Overall, my experience in China was unforgettable. I am grateful for all that I learned from SAHZU and am very appreciative of UCLA for granting me the privilege of participating in this wonderful program.