ANMC/Anchorage!

I spent May 2017 in Anchorage and had a great experience at ANMC. I ended up only having 3 weeks there and did 1 week in the ICU, 1 week in a mix of clinics (Rheum, Endo, Pall Care) and 1 week of ID consults. In general if there for 4 weeks I’d recommend 2 weeks in the ICU to get the hang of it and a range of experiences and I think the staff there prefer it for some continuity. Schedule in the ICU was M-F 7am to 7pm for sign out (able to leave early some days). I worked with Dr. Worth who is great and trained at UW! I also really enjoyed the clinic experience – great way to learn more about the native health system and how subspecialty care is delivered to such a broad geographic area. Great teaching too and pretty relaxed schedule. Lastly ID consults was great with really interesting cases and fun attendings who love to teach. I was initially given a pretty short list of options of what to do but when I got there but I found that people were happy to have me in most clinics and if you ask they will make most things work.

As far as Anchorage itself it’s a very livable small city and easy to adapt to quickly. People at the hospital were all really welcoming and eager to provide recommendations for what to do and see. May was a fun time of year there as spring was really just starting but days are long. Be sure to check if hikes in the area are still icy/snowy! For housing AirBnB worked well to find a spot – midtown isn’t the most attractive part of town but halfway between downtown and ANMC. Start housing search early if you want to do a monthlong rental especiall in summer/spring. Enterprise renal car through UW also very easy to do.

I loved visits to homer (halibut fishing!), seward (kenai fjords tour/kayaking), hikes around anchorage (power line trail, eagle river nature park, flat top).

Portage Glacier Hike, at end of Whittier Tunnel
View of Anchorage from Earthquake Park
Otter enjoying Seward!

 

 

 

Soldotna!

The Soldotna rotation was amazing and I would highly recommend it! I was there this past April and had a blast. I worked primarily with John Bramante who is a former UW grad / chief and all around an awesome doc. Good learning in a relaxed environment with opportunities to manage a broad scope of problems. For example, I had a chance to evaluate and manage new hep B, hep C, sarcoidosis, Addison’s disease, possible carcinoid, and a variety of malignancies. You can learn more about doing endoscopy, echos, and stress tests. There is a good mix of conferences. Overall, this rotation has great work/life balance and there is plenty of time to explore Soldontna and surrounding towns. Scenery is breath-taking and there are hikes galore. See rave reviews by other residents as well.

View from backyard of the apartment.

Kenai coast line 

Get Sold on Soldotna!

Spent an incredible 4 weeks here in September/October, and can’t recommend it enough!

You work 4-5 days a week at Peninsula Internal Medicine, an independent practice with 5 MDs and 2NPs but right across the street from Central Peninsula Hospital where you’ll go for some procedures, ECHO reading, and of course, free lunch. You work predominantly with the legendary Dr. Bramante who is an incredible internist and even more incredible human being. Most of my experience was outpatient, alternating seeing patients with him on one of his normally scheduled clinic days. The patients are super interesting from both a social and a medical perspective (you see a fair amount of the standard T2DM, HTN, CAD, COPD/combo of the above but I also diagnosed/helped manage things like IPF, polymyositis, HIV, CML, aldosteronoma and a host of others).  I also spent time working with some of the other physicians in the group including Dr. Kelley, Dr. Pokorney and Dr. Mitchell and even got to do some outpatient clin ed with the med student who was there at the same time. Overall everyone is super awesome, friendly, and smart and all are supportive of you doing the things you want to do and having the experience you want to have. This includes doing a week or two of inpatient if you are so inclined.

Soldotna itself is awesome, as is the Kenai Peninsula in general. Your drive down is breathtaking and just the beginning – activities are limitless! Make sure to spend at least a day if not a weekend in Homer, a beautiful town surrounded by magnificent mountains and nonstop views, good food, and cool art shops. Also journey over to Seward, where they have a nice little aquarium, kayaking in the summer, and you can take a short hike right up to the edge of Exit Glacier. So many amazing hikes and areas to explore like the Skilak wildlife refuge, North Beach in Kenai, and Cooper’s landing.  I was also lucky enough to be there at the right time to go Halibut fishing with the Kelley’s and no doubt JB will invite you over to run with the pups. Truly a once in a lifetime experience to be pulled on the back of a 4 wheeler by a pack of dogs while clutching your attending for dear life. Incredible!

You’re also provided with a cozy apartment right on the Kenai river and a short drive from the clinic. Everyone takes care of you and is more than excited to have you over for dinner and show you all the amazing things Soldotna has to offer. I also had the opportunity to present a grand rounds style lecture for local providers. Definitely prioritize a rotation up here, you won’t regret it!


Black bear at the Alaska wildlife conservation center


Kenai river in your backyard (literally!)


Halibut fishing with the Kelleys!


View from the Homer spit


North beach at Kenai with relaxed resident feet included as proof of ample down time


Exit glacier near Seward


Ready for a run!

ICU at ANMC in Anchorage, AK!

Let me start by saying that if you’re reading this and are already scheduled to do your WWAMI rotation at ANMC though haven’t yet submitted your Alaska resident license application…stop reading and go do it. For real, you’ll thank me later. Getting that beast of an application out of the way about 4-6 months ahead of time will allow you to cruise on up to Anchorage stress-free knowing that you’ll be all set for your rotation!

Anyway, with that said, I spent my entire month of March in the ICU at ANMC and as those before me have already said, this was absolutely one of the best experiences that I’ve had in residency! As the only resident in the ICU, everyone is super willing to give you procedures and the attendings are all excellent teachers. By the end of the rotation I had done about 10 central lines (mix of IJs and subclavians), 2 intubations, 3 bronchoscopies, many arterial lines, and even a handful of chest tubes! Overall, you get a ton of autonomy and really feel like you are the primary provider for your patients, while the attendings are always available for guidance. The staff at ANMC are awesome and the ICU nurses in particular are very knowledgeable and always willing to help. From a cultural and systems perspective, working at ANMC is also really interesting as it serves the Native population not only in Anchorage but from all around Alaska. Many patients are flown in from various parts of the state, including Little Diomede, which is the westernmost island of 110 people that is right on the US/Russia border in the Bering Sea! The ICU itself is about 20ish beds, and they’re actually in the middle  of some construction to expand it. The acuity of patients ranged quite a bit, and we certainly had some sick folks with interesting pathologies.

As far as Anchorage goes, it’s not a very big place but definitely has a lot going on! If you’re heading out in March, I would recommend catching the start of the Iditarod. Overall it was pretty darn chilly with temps in the negatives most of the month until late March and snow/ice pretty much everywhere. I stayed in an apartment close to the hospital and got around just fine in my trusty Ford Focus rental car, though there were a couple of hefty snow storms and those not used to driving in the snow might feel better with a 4WD. Otherwise it was awesome exploring the city and surrounding area. Check out the pics below!

Start of the Iditarod!
Resting up before the big race.
The Diphtheria antitoxin is on its way!
I thought the thermometer would stop at 0, but apparently it goes into the negatives…
Flattop mountain just outside of Anchorage. ‘Murica!
Skiing at Alyeska in Girdwood, just 45 minutes outside of Anchorage.
Denali on a rare, clear day.
Walking across Portage Lake to Portage Glacier.
Portage Glacier
Found some old skates at a thrift shop and got in on some pond hockey!
Pond hockey after work.

 

St. Patrick’s Hospital, Missoula, Montana

I spent the month of January 2017 in the ICU at St. Patrick’s Hospital in Missoula, which was awesome.

The work: St. Pat’s is different than many other WWAMI locations I’ve heard about, it is still in a rural setting but is actually a level II trauma center and provides a fair amount of specialty care, so a lot of patients get flown there from the surrounding smaller hospitals. This means the ICU takes care of a wide variety of medical, trauma/surgical, and neuro patients. The ICU team is more focused on the medical patients, but you can get involved with the others if you’re interested in getting more experience with these patient populations in the critical care setting. The attendings were all great to work with and motivated to help you get procedures, and there was ample opportunity to do them. I spent a day in the OR with a couple different anesthesiologists and got some concentrated time doing intubations, which was set up for me by one of the ICU attendings when I asked to do it. There is a family medicine residency program there and medical students from UW, so there are conferences during the week and they ask you to present a journal club and a morning report, which was fun.

The fun: Missoula is  like a mini-Seattle. There’s tons of great outdoors activities, numerous breweries, and a nice downtown area with some good restaurants. In general, if you like Seattle and Seattle-type things, you will love Missoula.

Overall, highly recommended!

Soldotna. Do it.

Literally one of the best months of residency… literally.   I recommend using two wishes.  I think you can do that.   The clinical experience is diverse.  A sample day can include EGDs, colonoscopies, stress tests, reading echos, and doing primary care with limited resources for subspecialty care.  The physicians at PIM are fantastic educators.  You’ll spend most of your time with #GHITKU legend, John Bramante.  If he or Dr. Mitchell have inpatient responsibilities spend a few days seeing what the hospital is like.  There is so much to do in the evenings/weekends.  Seriously, this month is the best.

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Wenatchee

 

Continue reading Wenatchee

Dr. Crane and Sandpoint are the best!

I absolutely loved my month in Sandpoint, Idaho. Dr. Crane, and now Jesse Abbot Klafter (UW residency alumn), are both awesome to work with and great teachers. You get exposure to both rural inpatient and outpatient medicine. There is great continuity, as you are often seeing the patients you took care of on the wards, in clinic for follow-up. There is also a ton of flexibility on this rotation in that you are free to take as little or as much call as you want.

The town of Sandpoint is pretty small, I believe about 7,000 people. You really get to know the people you work with and the town itself. If you get a chance to stay with Sharon, you definitely should. She does a great job introducing you to the town and local hot spots. Speaking of which, there is plenty of awesome things to do in Sandpoint. You are half an hour from Schweitzer in the winter and close to great hiking and biking trails in the summer.

In sum, choose this WWAMI. It’s pretty great!

 

ANMC, Anchorage

I highly recommend the ANMC rotation, as so many others before me have! It’s a fantastic clinical experience, and there are endless outdoor activities in and around Anchorage. Amiko Uchida and I did this rotation in April at the same time, which made it extra fun.  Spring in Alaska can be unpredictable (it’s historically rainy, muddy, and cold), but we lucked out and had snow in the mountains during our vacation week at the beginning of the month, and mostly clear, warm weather (~50 degrees) while in Anchorage.

I spent two weeks in the ICU, which is a very hands-on, procedure-heavy rotation. The critical care docs are great teachers, they give you tons of autonomy, and you’ll take care of very sick patients flown in from remote parts of the state. In my two weeks here, I did 4 central lines, multiple bronchoscopies, an intubation, arterial line, and more.

I worked in GI clinic with Dr. Bowers for my third week, and I had a cafeteria-style ambulatory block my fourth week. Dr. Bowers is a phenomenal teacher – you’ll see clinic patients in the morning and then he’ll teach you how to do EGDs and colonoscopies in the afternoon (I did at least 5 EGDs and helped with biopsies for multiple colonoscopies). There were multiple days in GI clinic when I was able to go home at 3PM, which gave me lots of time to explore Anchorage.

Overall, you can’t really beat this rotation!

Hiking near Portage Glacier, an hour south of Anchorage
Hiking near Portage Glacier, an hour south of Anchorage
Portage Glacier
Portage Glacier
Seward, AK - a rare sunny day!
Seward, AK – a rare sunny day!
Visiting the Alaska Wildlife Conservation Center
Visiting the Alaska Wildlife Conservation Center
Snowshoeing in Hatcher's Pass, AK - north of Anchorage
Snowshoeing in Hatcher’s Pass, AK – north of Anchorage
10PM sunsets in April!
10PM sunsets in April!
Co-resident bonding in the mountains
Hiking Flattop Trail after work
Eklutna Lake
Eklutna Lake
Amiko and I getting some perspective...
Amiko and I getting some perspective…

An All American July in Livingston, MT

I spent the best rotation of my residency experience in Livingston MT (town of 7,000 nestled between the bigger cities of Bozeman and Billings) on the banks of the Yellowstone River about 1 hour north of Yellowstone Park and about 13 hours east of Seattle. The rotation itself is spent working with an internal medicine physician (and former Chief Resident in Boise ID/UW) Dr. Wadle. His energy and enthusiasm for his career, teaching and this town were infective. Your time on this rotation is spent about 70% outpatient and 30% inpatient with time also spent reading ECHOs and doing scopes (EGD/Colonoscopy) with Dr. Wadle as well as covering a few shifts in the ED and visiting the local nursing home. The variety was stimulating as was the ability to admit patients from clinic or ED into the hospital and continue to be their physician for their entire medical experience! The hospital in Livingston (a critical access 25 bed hospital and an affiliate of the bigger Billings Healthcare system) will be brand new for future residents on this rotation–opened in the Fall of 2015. The patient’s presented to the hospital and clinic with complaints that ranged from the day-to-day aches and pains and chronic illnesses of a rural community with requisite mining, farming, logging accidents mixed in) as well as some more rare experiences due to being near Yellowstone and the Rodeo circuit (bison goring or bucking bronco injuries anyone?)

On my time off I enjoyed the town of Livingston–I challenge you to find a better 4th of July parade anywhere and the rodeo over the 4th of July is a must if you are there. The people are friendly and welcoming–although don’t be surprised if you recognize patient’s at the grocery store! The town has a weekly farmer’s market (with food trucks and live music) and the town and several surrounding ones have great music festivals. There is so much hiking to be done–in Yellowstone as well as closer mountain ridges (Dr. Wadle is an outdoor enthusiast and can provide a plethora of recommendations). I had some great food in both Livingston and Bozeman, as well as at the hospital itself (which believes in farm to hospital cooking!)

I can’t recommend this rotation highly enough. Please reach out if I can answer any specific questions.
Amy Thomas

 

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