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.
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.
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.
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.
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.
This is the rotation for you if you’re looking for an incredible learning experience about rural primary care medicine AND you just don’t have time to fill out all the pesky paperwork to get an out of state medical license. Ki and Clara Shin are wonderful teachers, and they focused on meeting my learning objectives for the rotation, including prioritizing me working with the medical student in clinic. The patient population loves the Shins, and it isn’t uncommon for patients to physically return to clinic just to say thank you when their symptoms get better. The clinic staff are wonderful and very helpful.
Reading back further into this blog, it’s apparent that plenty has already been said about how wonderful the clinical [and natural!] environment in Soldotna is. I’ll just confirm that every bit of praise lavished at this WWAMI site is justly deserved.
No Virginia, there is no Santa Claus, but what does exist is a magical primary care practice called Peninsula Internal Medicine where you can find in abundance those qualities of being a doctor – the independence, the impact, the close relationships with patients and other providers alike – that we all crave yet find oh so elusive in residency.
Personally, as someone interested in health care systems, a month at PIM gave me the opportunity to step outside the academic bubble and see first-hand how things work in the private practice world. Whether you want to gain procedural skills, experience different models of health care delivery, or just spot some moose, this rotation is not to be missed.
Working in Jackson was one of the best months of my life. The rotation has now (as of July 2014) morphed into a mainly hospitalist rotation, though I am SURE that the awesome docs there would more than welcome a resident in their primary care clinic. Regardless, the people, setting, and culture are a perfect setting for the summer or winter months. I spent most of my weekday mornings at the hospital responsible for my own set of patients, and was able to do a few procedures here and there. In the afternoons, I took off to hike, fish, bike, or hang out with any number of people I met staying in the nearby apartments. The highlight was probably actually a 4-day trip I took to Yellowstone, which is incredibly beautiful and not too far away. All of the docs are open, kind, and great teachers, and go out of their way to make your experience what you want it to be.
Sandpoint is hands down the best WWAMI experience! You work with Dr. Charlie Crane who embodies the old-school internist of “doing it all.” He alternates working a week in the clinic with a week doing a hospitalist gig (and a little clinic thrown also) in addition to doing his own EGDs, colonoscopies, TEEs, intubations and reading his own ECHOs. I had hands on experience doing all the aforementioned procedures and also placed 2 subclavian lines and 2 tunneled lines plus several other procedures including an intubation! It was an amazing learning experience to work in a small town with limited resources and really improved my clinical skills.
Beyond the medicine, the outdoor opportunities here are endless. I skied 5 days (even though I was only there for one week when Schweitzer was still open), mountain biked, hiked and went on trail runs. In the summer, the lake is warm and there are ample watersport activities. The nightlife is also surprisingly busy for such a small town- I went to two different concerts and enjoyed hanging out at some of the local bars.
I cannot recommend this rotation enough! I will definitely be coming back to Sandpoint in the near future.
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