In the fall issue, we set out to celebrate the WWAMI program, which turned 40 in 2011. WWAMI is an innovative, responsive program, one whose core objective has held steady: to train primary-care physicians and other healthcare personnel from and for a five-state region — Washington, Wyoming, Alaska, Montana and Idaho. Especially in areas with too few physicians.
In the following stories, we continue to celebrate the program’s 40th anniversary by looking at the big picture: what WWAMI is doing for our communities and our world. Activities such as training and encouraging medical students. Fostering community-based research. And changing healthcare here — and in Africa! We also interviewed several community leaders in WWAMI to get their take on the program. Enjoy!
Before Vanessa Maycumber started her first year at the UW School of Medicine, she spent two weeks shadowing a family physician at Blackfeet Community Hospital in Browning, Mont.
While her soon-to-be peers were packing and spending time with friends, Maycumber was acquiring clinical experience, meeting the family physician who would be her preceptor, and learning about a community she would repeatedly return to over the course of her medical-school career.
Maycumber is one of a select group of UW School of Medicine students who are part of a four-year-old program called TRUST (the Targeted Rural Underserved Track). TRUST offers a comprehensive curriculum, a support network and clinical experience for students interested in practicing rural medicine.
Started in Montana in 2008, the track is now also available for rural-focused students in Western and Eastern Washington, with plans to expand the program to Idaho and Alaska. Suzanne Allen, M.D., MPH, co-director of TRUST and vice dean for regional affairs, explains that TRUST’s aim is to increase the number of primary-care physicians working in rural or underserved areas.
“The notion was to create a special track… that would really encourage students to go into rural medicine,” says Allen.
The program seeks interested students, especially those from rural and underserved communities. Once accepted, students spend up to two weeks prior to entering medical school, as Maycumber did, in their “continuity community,” a rural health site to which they are assigned for the duration of medical school.
A TRUST student’s continuity community — along with receiving consistent mentoring at the site — are cornerstones of the TRUST experience. “For students to be able to go back to that same community for all four years of medical school is extremely important,” says Allen.
It gives them a taste of the kinds of relationships doctors can form with patients, given time. “The students see patients when they are having a new child and they see that same family when someone is diagnosed with cancer,” Allen says.
Students visit their community at least two other times during their first year and for their four-week R/UOP experience. (R/UOP is the Rural/ Underserved Opportunities Program, which takes place during the summer between the first and second year.) During third year, students return for their most in-depth experience: a 20-week WRITE rotation (WWAMI Rural Integrated Training Experience), which includes clinical experiences in most elements of primary care, from family medicine, to psychiatry, to pediatrics.
Other components of TRUST include required rural health electives, participation in the School’s Underserved Pathway program, career counseling and residency assistance.
Maycumber says that working alongside family medicine physicians in Browning is helping her understand the daily decisions and challenges of rural medicine. “One of many things I’ve learned is the importance of networking with other physicians in neighboring towns,” she says. “Even if you don’t have all the resources, you have colleagues in other towns that you can call.”
Part of the student experience is learning about a community. During Maycumber’s R/UOP experience, for instance, she attended a Blackfeet sweat lodge, a traditional cleansing ceremony. “It helped me experience some aspects of their tradition,” she says.
KayCee Gardner, a fourth-year student and one of the first TRUST students to graduate, will start a family medicine residency in Billings next year. She says that the decision to apply to TRUST was one of the best choices she’s ever made.
“I’ve learned so much,” she says. “I’ve been able to have this continual experience with one community, have established relationships with patients, gotten more hands-on rural training than the average student, and had extra classes in rural medicine.”
It’s clear the students value TRUST — and the program’s administrators will be evaluating its progress.
“We don’t have a lot of data points yet,” says Allen. “But we’re very hopeful that it will accomplish what we plan — the production of a larger rural healthcare workforce across our fivestate region.”
"Be prepared.” It should be a motto for teachers as well as Boy Scouts. Especially if the teacher thinks the student may faint during instruction.
Kenneth Robertson, M.D., FACP, an internal medicine specialist/hospitalist, remembers showing a medical student how to insert a central line in the intensive care unit at Ivinson Memorial Hospital in Laramie, Wyo.
“You take this big, huge long needle and go deep into the upper chest, under the clavicle, and put a catheter into the subclavian vein. Then you float a catheter close to the heart. And I looked around at the student and said, ‘You’re OK with this, right?’”
She said she was fine, but Robertson wasn’t surprised when she passed out moments later. Trainees don’t get enough sleep, or they forget to eat — or the medical procedure is a little grisly. It happens. “We were kind of ready for it,” he says.
Robertson is an instructor for the WWAMI program at the University of Wyoming. Having spent several years as a preceptor, he now teaches an introductory clinical medicine course to first-year medical students. Robertson relishes his association with teaching and with the WWAMI program.
“I’ve been involved since day one, minute one,” he says.
Wyoming was the fifth state to become part of the WWAMI program, joining the multi-state medical education program in 1996. Robertson is one of a number of teachers who’ve been involved in the program from the start, teaching first-year medical students what they need to know before they head off to the University of Washington’s Seattle campus for their second year.
Other people are equally invested in the WWAMI program, says Matthew D. McEchron, Ph.D., assistant dean of WWAMI medical education at the University of Wyoming. Namely, doctors, politicians, the Wyoming Medical Society and community members. “People were committed to the idea from the beginning, and a lot of people were involved in getting things started,” he says.
The state is betting that students educated in Wyoming will return there to practice, and the stakes are high. Wyoming has few big cities, and population centers are scattered, so it’s hard to draw in medical specialists — the population has to be large enough to support a practice. And, as in other rural communities in WWAMI, it can be hard to recruit and retain general practitioners. It’s difficult being the only doctor for miles around.
The bet, says McEchron, seems to be paying off; approximately 66 percent of Wyoming’s students return to Wyoming to practice. (The national mean for medical-student returns is 39 percent.)
Wyoming attracts people like Robertson. He loves the state for its small communities, its open spaces; he’s a rancher and a hunter, as well as a doctor and teacher.
Pamela J. Langer, Ph.D., an associate professor of molecular biology at the University of Wyoming, also felt the pull of the outdoors. “I’ve always wanted to live somewhere close to mountains, so I didn’t have to drive six hours to get there,” says the Philadelphia native. And, like Robertson, she likes the close-knit, supportive community of Laramie, evident even to casual visitors.
Langer, who researches the properties of spider silk for potential medical applications, is an adventurous teacher. More than once, she’s used theatre as a teaching aid. For instance, she recently had undergraduate students act as enzymes and receptors in order to come to a fuller understanding of a biochemical process implicated in cancer. “If you treat information in a different media, I think you understand it in a different way,” she says.
If Langer is motivated to teach, it is, in part, because her students — including the first-year medical students taking her biochemistry class — are motivated to learn. “I especially enjoy the WWAMI classes, because they’re small, and we have discussions about a lot of things…they can be interested in everything,” says Langer.
One of the foundations of the WWAMI program is that all first-year students receive basically the same education — whether they’re in Laramie, Pullman, Spokane, Anchorage, Bozeman, Moscow or Seattle. Courses have common objectives, and students at all first-year sites take common final exams to ensure the objectives have been met.
“We are very aware of what’s going on at different sites,” says Langer. She and her colleagues determined last summer that there’s a 75- to 80-percent overlap in course topics among the sites. That said, teachers bring their own strengths to the classroom. Not everyone has Langer’s creative approach, and not every teacher gives first-year students the exposure to clinical care espoused by Robertson.
And, of course, each class brings something to the learning environment. Last year, says Robertson, his class was very lively. “I couldn’t go five minutes without getting 10 questions about something,” he says. This year, he says, the students were quieter, more laid-back.
Regardless of class temperament, there’s a real benefit to having a class of just 20 first-year students at each first-year WWAMI university. The small, integrated setting is what Wyoming students are used to, Robertson says; it’s a reassuring start to medical school, one that teachers hope will help cement the students’ relationship with the community and pull them back to Wyoming when they’ve completed their training. A payback plan provides another incentive to return. The state underwrites the lion’s share of their tuition, and students repay the loan by practicing in the state for three years — or by paying back the money.
The WWAMI program in Wyoming is relatively young, but it’s effective, says McEchron. So are the doctors trained by the program, says Robertson.
“The [WWAMI-trained doctors] that I’ve run across over the years have been just excellent, all the way around,” he says.
Wendy Curran, a senior director at Blue Cross Blue Shield of Wyoming Ken Robertson, M.D., FACP, wears many hats: rancher, doctor and teacher among them. He was one of the first people to sign up to teach first-year medical students at the WWAMI-Wyoming program. Photos (including previous page) courtesy of Kenneth Robertson, M.D., FACP and the former executive director of the Wyoming Medical Society, is delighted by the program’s progress. An early advocate for the development of the WWAMI-Wyoming program, she remembers the moment when she heard a student say he’d been inspired to pursue medicine by a WWAMI graduate in his hometown. “I’ve come full circle,” she said to herself, “where the people who started the program are recruiting students.”
On a different note, she says that she sees a decided shift in what WWAMI doctors want. Students educated in earlier years were rugged individualists who wanted to run their own businesses. Today’s doctors, says Curran, are less likely to want to run a business and more likely to want to focus on medicine. Robertson, who became a hospitalist in 2007 after spending years in private practice, embodies something of both generations.
Shifting demographics, lifestyle expectations, the cost of medical education. Educating medical students so that they’ll return to WWAMI is a challenging proposition, one administrators continue to finesse. McEchron, like Curran, is sanguine. Because the tradition of teaching is now crossing generations.
“Many of our graduates who have returned to the state to practice are now also teaching within the program,” he says. “It’s exciting to see the circle becoming complete.”
When they were young, Donald R. Chisholm’s four children had a movie they liked to watch together. It wasn’t Disney, or a holiday special. It was a video of the C-section birth of the two youngest siblings, twins Hillary and Sarah.
“It was our favorite movie — the gory, bloody delivery of my sisters,” says Alison, the oldest, with a laugh. “It was definitely a different kind of family experience.”
At the time, the four children — the three girls, plus one son, Tyler — didn’t think much about it. It was simply part of their family’s culture. Their father, a 1979 graduate of the UW School of Medicine, is a respected family medicine physician in Coeur d’Alene, Idaho. Their mother, Robin, a former pre-med student herself, grew up with a physician as a father, and taught high-school biology and chemistry. The kids occasionally accompanied their dad on rounds and frequently ate dinner in the hospital cafeteria.
People often stopped them on the street to praise their dad. “We grew up believing that medicine would be a great thing to go into,” says Hillary. “Our father was clearly making a difference in the lives of the people around us.”
And one by one, they all decided to become doctors. With their father and grandfather as models and a shared interest in working with underserved populations, the choice of attending the UW School of Medicine — through the WWAMI program in Idaho — wasn’t difficult.
“I knew I wanted to return to Idaho and work in a rural area, so WWAMI was ideal,” says Alison. She recently started practicing ophthalmology in Coeur d’Alene. “WWAMI gives you grounding in real-life medicine rather than an ivory-tower experience.”
Although Don wasn’t part of the WWAMI-Idaho contingent, he’s pleased that his children have had that experience. “Clinical rotations [through WWAMI] give you critical exposure in the clinic, the operating room and other areas of training,” he says.
It’s likely that most, maybe all, of the four Chisholm siblings will return to the WWAMI region to practice. Tyler is in his third year of family medicine residency in San Francisco. He plans to return to the region with his wife, Megan Mendoza, M.D. ’09, another WWAMI graduate. They’d like to practice in a locale with a Spanish-speaking population, such as Yakima.
Sarah is completing an ob/gyn residency in Denver and plans to return to the Northwest to practice. Hillary, in her fourth year of medical school, wants to focus at least part of her practice on underserved communities. Alison, in addition to working in Coeur d’Alene, has done medical mission trips to Central America.
Don says, “Our hope is that all our kids will be in places where we can see them on a more regular basis. And we’d like to see excellent medical care in our community.”
Much further north in the WWAMI region, another family is starting a medical legacy of its own. Jean Tsigonis, M.D. ’78, is a family physician in Fairbanks, Alaska, and a mother of five. Abe Tsigonis, M.D. ’11, her oldest, is in his first year of general surgery residency in Wisconsin. Another child, Elizabeth, is going to medical school in California.
Like the Chisholm kids, Abe understood early on the special role his mother held in the community. “I saw my mom as a do-everything kind of person. Everyone knew her,” he says.
The kids also experienced Jean’s clinical work firsthand by traveling with their parents on medical missions to the Philippines, Costa Rica and Nicaragua, among other places. They often helped with simple tasks, such as bandaging and wound care.
Like his mother before him, Abe spent his first year at the Alaska WWAMI site. Attending classes in Anchorage in his first year, he says, “it was small enough that they let me bring my dog to the classroom.”
He also enjoyed the close relationships he developed with his teachers at clinical rotations in Alaska, where there were no residents and few other medical students. “On my surgery rotation it was just the doctor and me,” Abe says. “On my Fairbanks ob/gyn rotation, I actually got to work with my mom for a few deliveries.”
Abe has since married a WWAMIAlaska classmate, Katrin Tsigonis, M.D. ’11, also a first-year resident. The couple fully intends to return to their home state to practice. “It’s a place where you really get to influence the medical culture and can make a difference,” Abe says. “And there is a huge need for doctors.”
“I’m excited about Abe’s choice,” says Jean. “He’ll come back to Alaska, which is exactly what we need. It is critical for us to bring doctors back here.”
Research takes place throughout the WWAMI region: at universities, in community-based clinics, and on reservations. It’s all part of a practical, multi-state initiative for providing better medical care in our communities.
Take this real-life example from Pocatello Family Medicine at Idaho State University, where a woman of child-bearing age had been prescribed a medication for high blood pressure.
Although she wasn’t pregnant, the clinic could see a potential conflict: the drug, lisinopril, might be harmful to a fetus. Staff wondered: how many of our other patients are in a similar position?
Enter the Institute of Translational Health Sciences (ITHS) — specifically, Laura-Mae Baldwin, M.D., Res. ’84, MPH, the director of the ITHS’s WWAMI Region Practice and Research Network.
Baldwin and colleagues in the Department of Family Medicine, Al Berg, M.D., MPH, Res. ’79, and Gina Keppel, MPH, had begun to collaborate with the 18 resident training programs in UW Medicine’s WWAMI-based Family Medicine Residency Network. These sites were interested in community-based research, and the question about lisinopril (and other medications with similar potential effects) provided the trial balloon they needed.
In all, seven clinic sites signed on to the project, and staff, residents and fellows gathered information from more than 300 female patients. The data showed that other women were affected by prescription choices, and the clinics worked together to improve treatment.
“We identified the question,” said Rex Force, Pharm.D., a researcher at Pocatello Family Medicine in Idaho. “Then the collaborative process kicked in. The team at ITHS supported our idea and scaled it up to involve the network. It was a great experience.”
“[The project] wouldn’t have been possible if we had only done it at a single site,” says Baldwin. “We designed the project together, collected and analyzed the data together, reviewed the results together, and then presented the data to the [other] sites together,” she says.
The WWAMI Region Practice and Research Network, led by Baldwin, is one arm in the ITHS’s Community Outreach & Research Translation Core (CORT). CORT utilizes the power of community research to “translate” medical discoveries into therapies that help patients. Dedra Buchwald, M.D., leads the second arm of CORT, the American Indian/Alaska Native Community Outreach & Research Translation Core. A third arm is located at Group Health in Seattle.
“Without this kind of research, you can’t effect change in the health of communities,” says Leo S. Morales, M.D., Ph.D., MPH. Morales is co-director of CORT, an associate investigator at the Group Health Research Institute, and an associate professor of health services at the UW.
Although the three arms of CORT collaborate with different clinics and populations, they meet regularly to talk about pilot programs and learn from one another. And they’re working with Kari Stephens, Ph.D., and Ching- Ping Lin, Ph.D. ’10, from the ITHS Biomedical Informatics Core to bring a program called LC Data QUEST to clinics in the region.
LC Data QUEST pulls standardized data from electronic medical records, allowing the collection of HIPAAcompliant research data within and among clinics for approved studies. In addition to serving as a powerful data collection tool, the program can help doctors manage health screening and chronic disease — it issues automated care reminders and instructions for patients who meet certain medical criteria.
One of the next subjects that Baldwin and her colleagues plan to tackle — with Beverly Green, M.D., MPH, of the Group Health Research Institute — is blood pressure. Using a web-based model developed at Group Health, they’ve written a grant to test whether community pharmacists can help patients with hard-to-control blood pressure. The protocol worked well at Group Health. With modifications, says Baldwin, it should work in the WWAMI region.
Research topics like this one, which address urgent problems in primary care, are of great interest to practitioners like Jeff Kaplan, M.D., medical director of Memorial Physicians Group in Yakima, Wash. He and his colleagues anticipate partnering in the blood pressure study. “We’re looking for ways to change the ways we provide care,” he says, to make medicine more efficient and less costly. (Read more about Kaplan’s search for accountable care.)
With the work of partners like Kaplan, Green and Morales, and with support from the ITHS, research funding is helping ensure that medical discoveries reach everyone — eliminating the gap between laboratory and clinic.
“The gap occurs when there isn’t a good mechanism for disseminating research in communities,” Morales says.
Baldwin agrees. “If we used the strategies we already know work, and implemented them in communities to their full extent, we would have a much greater impact on health,” she says.
Dedra Buchwald, M.D., UW professor of medicine in the Division of General Internal Medicine, remembers an early meeting of the ITHS, where members discussed potential partners for community-based research. There were many choices, she says, given the enormous breadth of WWAMI — roughly one-quarter of the American landmass.
Buchwald, who has worked with American Indian and Alaskan Native communities for more than 20 years, suggested that the ITHS focus on those groups. Given a broad range of challenges and special circumstances, including poverty, poor health literacy, limited educational opportunities, widely dispersed populations, and the need to respect tribal sovereignty, American Indian and Alaskan Native communities suffer from major health disparities.
“If we can make a difference with this population,” argued Buchwald, “we can make a change for the better in almost any population.” Her colleagues agreed, and the American Indian/Alaska Native Community Outreach & Research Translation Core was launched.
Buchwald mentions the success of one ITHS-funded project that focuses on the use of graphic materials to increase health literacy in Native populations. She is developing other projects as well; some are funded by the ITHS, while others are funded by major grantors concerned with issues such as cardiovascular disease, cancer and hepatitis C in Native populations.
Buchwald notes, however, that there’s a challenge in conducting research with tribal communities or other small populations prevalent in WWAMI: numbers. How do you maintain the anonymity of a 90-year-old study participant if, for instance, there are only a handful of 90-year-olds in a tribe?
One answer may be partnering with other tribes to increase the numbers of study participants. Another is conducting qualitative research instead of quantitative. Buchwald hopes the year ahead — with the help of grants from the ITHS and the National Cancer Institute — will provide some answers.
If numbers provide a challenge in working with Native populations, so do other circumstances. Ron Whitener, J.D., a UW senior lecturer in law, executive director of the UW Native American Law Center, a graduate of Buchwald’s two-year fellowship for Native health researchers, and a member of the Squaxin Island Tribe, explains.
In conducting “bench-to-bedside” research — shorthand for taking information gained at the lab bench and translating it into medicine or therapies that help patients — a scientist recruits patients and follows protocols. Working with tribes, he says, adds another layer for the researcher. “You have an overlay of a sovereign government,” he says, referring to the U.S. government’s recognition of American Indian tribes as sovereign nations. This extra layer can lead to misunderstandings.
First, researchers and tribes may not agree on the importance of the researcher’s topic — or the tribe’s need to invest in it. Second, some researchers may not want the tribes to have a say in the research or the manner of its publication, though such requests are well within tribal rights. Then there’s the problem of history.
“Tribes have been researched to death in the U.S.,” says Whitener, often with poor outcomes. For instance, some researchers have overpromised the benefits of their studies, haven’t followed up with a tribe, or have broken contracts. Even so, says Whitener, tribes remain interested in research.
“They want to be involved,” he says. “But it has to be done in a respectful manner.”
Karina Walters, Ph.D., agrees that a respectful approach is key to working with Native populations. She’s the director of the UW Indigenous Wellness Research Institute (IWRI), a professor in the UW School of Social Work, and a member of the Choctaw Nation of Oklahoma. And she may soon be the newest collaborator in the ITHS’s American Indian/Alaska Native Community Outreach & Research Translation Core.
She and Buchwald have collaborated on projects and have shared resources and information — “Indian country is small, and we all do a lot of work together” — but another level of integration could raise the work in WWAMI to a new level.
Instead of the bench-to-bedside approach, says Walters, “what we would bring is the community-tobench approach,” where research is informed by tribal participants.
Walters makes her point by recalling one of her own cases. Elders from a tribe in Washington, concerned about their children — some of whom were contracting type 2 or adult-onset diabetes — contacted her for help. At the same time, the elders made sure Walters knew that they viewed being overweight as part of their culture.
First, Walters — an expert in the social and historical determinants of health — did some research. She found old tribal photos that showed a lean, fit people. Then she met the elders to talk about their “original instructions,” or the rules set out by their ancestors. Each person in the room said the same thing: that the instructions had changed when the tribe was moved to a reservation. No longer allowed to hunt, fish or travel, they were struck by famine. To keep their babies alive, the tribe overfed them when they could feed them at all.
It was an “aha” moment for the elders, says Walters, where they realized that a historical survival strategy — made in response to major, negative shifts in their way of life — was no longer useful.
Walters and her colleagues could bring a wealth of knowledge, ideas and approaches to work with the ITHS. And like Baldwin and Buchwald and their colleagues, Walters believes strongly in research collaboration in the WWAMI region.
Collaboration is key to communitybased research. If researchers have something to bring to the table, so do the communities with whom they work. It’s a new twist on a good model: making sure new and workable ideas in medicine are translated out in the field.
“What we’re saying is, we’ve got some knowledge,” says Walters. “But our communities also have some knowledge — how do we have these things work together?”
Thirty Kenyan medical students left the University of Nairobi in October 2011. Though traveling by land, their purpose held all the consequence of a maiden voyage.
The 30 students represented the school’s first investment in enriching medical education through clinical experiences in less-populated areas. If this sounds familiar, it is because Nairobi is tacking to a course begun 40 years ago at the University of Washington: the WWAMI program, a five-state partnership in medical education.
Almost immediately, the Kenyan students’ feedback was validating.
“It’s fantastic. They say this is giving them real, hands-on experiences that they’re not able to get at Kenyatta National Hospital, the main tertiarycare hospital,” says Carey Farquhar, M.D., Res. ’97, MPH, Fel. ’03. Farquhar is a UW associate professor in the departments of medicine, epidemiology and global health.
“I just found out they’re having weekly, case-based discussions through distance learning. They connect the four sites — in Garissa, Naivasha, Mbagathi and Mombasa — on a video conference, and one of the sites presents a case, which is then discussed by the students and a faculty member at the University of Nairobi,” she says.
Farquhar has been integral to the university’s vision: expanding clinical training beyond the capitol. She and the University of Nairobi’s Dr. James Kiarie (a UW affiliate associate professor in global health and epidemiology) are principal investigators of a $9.5 million grant that supports that goal.
Over two weeks in May 2011, Farquhar was on point when a delegation of Nairobi medical-school leaders visited for an immersion in the WWAMI program, the immensely fruitful partnership of UW Medicine and the states of Washington, Wyoming, Alaska, Montana and Idaho. A core WWAMI tenet is that medical students need to learn medicine where it is practiced — in the community, not just in academic hospital settings.
The Kenyan contingent learned how WWAMI nurtures stakeholder relationships, how faculty receive training at rural clinics, and which nuts-and-bolts issues require routine attention. Along with attending myriad presentations in Seattle, the visitors met with residents and students in Spokane, Wash., and Boise, Idaho, and visited rural clinic sites, simulation labs and classrooms.
“Students come to study in Nairobi and then they don’t want to go back to the rural areas. If we give them opportunities to do rotations as interns in those rural areas, they may actually feel like working there. That’s the major takeaway for me,” says Dr. Isaac O. Kibwage, principal of the College of Health Sciences at the University of Nairobi, after the visit.
The group — which included deans of medicine, nursing, dentistry, pharmacy and public health, among others from Nairobi — was impressed. Equally important, they were empowered to set desired changes in motion back home.
For instance, a telemedicine presentation they saw in Seattle informed the weekly videoconference in which remote students and Nairobi faculty discuss patient cases.
“Distance learning with webinars is a great way to keep students feeling anchored and connected when they’re in rural sites by themselves. It gives them a chance to check in, ask ‘What’s going on at your site?’ and exchange lessons about patient cases,” says Suzanne Allen, M.D., MPH.
As the UW School of Medicine’s vice dean for regional affairs, Allen oversees the WWAMI program. She wasn’t surprised to hear Farquhar’s account of Kenyan students’ initial feedback. It resembles the feedback she hears from students in WWAMI.
“The amount of experience they get, whether it’s helping with a surgery or delivering a baby or being with a family through a difficult time — it’s more hands-on than they might get here in Seattle,” says Allen.
“Students really feel the impact they can have on patients’ lives out in these smaller communities.”