Trends of International Electives in Medical Education Undergraduates in Japan.

Increasing numbers of medical students participate in international electives. However, this recent trend has yet to be examined in non-Western high-income countries such as Japan. The aim of this study is to assess recent trends in Japan, and to suggest ways in which those trends might be influenced. A retrospective cross-sectional analysis of responses to an 8-item questionnaire sent in August 2019 to 82 medical schools in Japan is reported. The responses were received in September 2019. Narrative responses were obtained regarding rationales for exchange programs, participant feedback, and challenges encountered. Responses were translated into English and categorized into themes. Of 82 Japanese medical schools, 56 (68%) responded to the questionnaire. Both the number of incoming and outgoing exchange students had increased steadily over the preceding 3-year period. The leading destinations for Japanese students were the United States (30%), other Asian (36%), and European countries (24%). Narrative responses reveal different rationales from those reported by medical schools in Western high-income countries. Only a few Japanese students chose low or middle-income countries as their destinations, as opposed to the trend seen in Western high-income countries. The reported challenges encountered by the exchange programs may provide insights for improvement. Exchanges have been greatly affected by the coronavirus disease 2019 pandemic. The results can serve as pre-pandemic baseline data and should promote further international collaboration for medical education under current circumstances.

Non-convulsive Seizures Mimicking Creutzfeldt-Jakob Disease with Rapid Resolution and Recurrence of MRI Abnormalities.

An 88-year-old man presented with acute altered mental status. Brain magnetic resonance imaging (MRI) demonstrated "cortical ribboning," which is classically associated with Creutzfeldt-Jakob disease. His rapid clinical improvement prompted a follow-up MRI three days after presentation, which showed resolution of the acute abnormal signals. The patient was eventually diagnosed with non-convulsive seizure. Five months later, he returned with a similar clinical presentation and MRI findings after self-discontinuation of anticonvulsant. It is important for clinicians to be aware that neurological changes associated with non-convulsive seizures can acutely mimic Creutzfeldt-Jakob disease, and to consider a short interval follow-up MRI for diagnostic challenges in acute settings.