Internal Medicine WWAMI page

Overlooking Livingston and Livingston Peak

My month in Livingston was wonderful.  The small town (~7000) is in a beautiful setting…”A River Runs Through It” was filmed there for reference.  Dr. Wadle is a great doc and good teacher.  The entire staff at the clinic, nursing home, and hospital are welcoming and really make you feel like you belong.

Nuts and Bolts:  The 25 bed hospital has a med-surg floor and a 4 bed ICU.  I had a bit lighter month with only a few inpatients at a time and no ICU patients.  You round on them each morning and stop back in the pm if there are any active issues.  Then head over to clinic for a usually pretty full day of patients.  Easy to go back and forth b/c the clinic is right next door to the hospital.  Also run over to the hospital for stress tests throughout the week and colonoscopies every other friday alternating with nursing home visits.  There are also 24 hr ER shifts…I saw ortho stuff and kids which was a bit different than usual but great.  I had a ton of continuity between the ER, inpatients, clinic, and nursing home visits.  Was on one weekend to round but otherwise had weekends free.   The patients are great, all ridiculously friendly and welcoming.

Despite the various work activities that keep it interesting, the pace  is  more laid back and there is plenty of time for fun especially if you are into outdoor activities.  Yellowstone is only 50 miles away and is gorgeous any time of year.  Spent a few days snowshoeing and exploring the wildlife.  Dr. Wadle is big into cross country skiing and running so took me out for both of those activities and even provided the ski equipment.  There is also a fair bit of downhill skiing close by that is supposedly wonderful ( i was too chicken to try and too busy with other fun activities).  In addition, because it is somewhat of a tourist area, the restaurants in Livingston are actually pretty darn good, as is the local gym I joined for super cheap.  There are also a ton of small art galleries downtown (big artist community).  And, of course, can not forget the hot springs of which there are many, but I recommend Chico just south of town.

I could say so many more wonderful things.  I highly recommend this rotation and would be happy to answer any specific questions.

Lookout point from a snowshoe/ski trail in yellowstone

Moose on the snowshoe trail at yellowstone

My month in anchorage at the Alaska Native Medical Center was a really wonderful! Most of the nuts and bolts have been posted by Kanishka so I won’t belabor them. I went in December in the middle of my R2 year and despite being shorter days (yes there is about 7 hours of light at the worst), the city in the snow was beautiful. There are multiple trails within the city if you enjoy cross country skiing, showshoeing, nordic skiing.  Its also very close to Alyeska, the local ski resort.

In terms of my medical experience, I did 2 weeks of ICU and 2 weeks of hospitalist. I think one of the biggest advantages here is that the internists do nearly all the procedures and I had the opportunity to learn to  intubate, do a lot of lines, and EGDs.  All the specialty services that you consult are just the attendings (no fellows) so often times they will allow you to be a part of any procedures they may do as well (I was able to go to the O.R. w/ ENT to help w/ a trach). The teaching in the ICU is great as well. On the hospitalist service you are able to be fairly independent and many of the attendings you work with are pretty close to residency so you can really see the transition if that’s what your interested in for a future career.

I would definitely recommend this experience to anyone. It’s a great opportunity to work very closely with attendings and they are very excited to have us!

Zita Shiue, R2
zshiue@uw.edu

I loved my month in Soldotna, couldn’t have asked for a better experience! December was a lovely time to be there–the days weren’t as short as it would seem, due to extended dusk and dawn, and the fresh snow was beautiful. Peninsula Internal Medicine is a very special clinic–the docs and patients are wonderful. The hospital, which is across the street, has recently gone to a hospitalist system–a big change for everyone, and one that is still playing out.  I spent most mornings at the hospital following a few patients, then went to clinic in the afternoon, and worked primarily with John Bramante, who is a fabulous individual and doctor and community leader. The division of time between inpatient and outpatient is flexible, depending on the resident’s interests. I found the clinic time so valuable and fun that I ended up slanting things that direction.

The apartment residents stay in is feet away from the Kenai river, and is very nice and cozy. Currently one of the hospitalists and his wife live next door. There is cross-country skiing just outside of town, with groomed trails that are lit until 9pm. The beach in Kenai is a short drive, and Homer is about an hour and a half away. The doctors and clinic staff are very welcoming.

I recommend this rotation highly and would be happy to talk more–feel free to contact me.

Jocelyn James, R2

I went to Dillon early in my R2 year and very much enjoyed my month there. I spent the first half working with Dr Ron Loge and the rest with Dr Sandra McIntyre. They are both wonderful (and beloved) internists who completed their residencies at UW–about 25 years apart. We rounded in the (20 bed) hospital in the mornings, spent the days in clinic, then rounded again in the evenings. We saw a broad range of medical problems and it was great being able to follow patients closely because I was in one place all day, every day.
I highly recommend this site to anyone interested in an experience of real rural primary care that is mostly outpatient with a bit of inpatient, procedures, nursing home visits, and home visits.

It was an unseasonably warm Sept/Oct and I hiked in the mountains around Dillon and went on weekend trips to both Yellowstone (3 hours away) and Glacier (about 6 hours). It was a great month! Email me if you have questions.

Lauren Carpenter

Hi, this is Jason Goldman (jdgold@uw.edu) and I was at Alaska Native Medical Center, in Anchorage, AK during the Sept 2010 block. Looking back at Kanishka’s post, he pretty much said it all so I won’t reiterate all those details which are very accurate.

I did the intensivist rotation, although they would be OK if you did 1/2 and 1/2 of any combination of the intensivist, hospitalist or outpatient. My wife also came with me and did a rotation (for her NP training) at ANMC at the Ob/Gyn clinic. The intensivist was a bit longer hours than the other rotations (Justin Schram was there at the same time
and did 1/2 hospitalist and 1/2 outpatient), but very rewarding. It’s just you and the Pulm-Crit Care attending. The ICU is ~15 beds and you’ll carry usually half the patients. There is a mix of medical and surgical patients, so that’s a bit of variety in taking care of some trauma patients (although the surgeons also round). The cases were bread and butter mostly (they don’t get over medialized there!) with a mix of some cool presentations (Takotsubo’s, Liver abscess & shock, etc).   You’ll have plenty of autonomy, but enough supervision, you’ll likely get to do some cool procedures too! 

ANMC is a sort of cultural center and when you’re leaving in the evening, sometimes there will be some ceremonial chanting or dancing in the lobby (this circular meeting place). The patients and their families were really sweet and gracious people.   

You’ll definitely get time to travel around the state, we went to Denali, canoeing/fishing on Kenai Peninsula and sea kayaking out of Seward. The long days are pretty sweet!

Please email with any questions!

I hadn’t seen the comments about Soldotna before I went. The rotation had just been highly recommended by other residents so I went. The other reason I chose Soldotna was because my girlfriend, who is a family med resident, was able to join me and work with a family doc in Soldotna. After reading the comments on this blog, there isn’t a lot for me to add. The rotation is a great one and I would also recommend going to any resident. If anyone has any questions about the rotation, feel free to contact me.

I joined Dr. Charlie Crane in Sandpoint for March, 2010. He is one of four MDs in a bustling practice that is primarly clinic with inpatient including ICU crossover. Schedule is highly flexible depending on interests — Dr. Crane does most everything. 

The town is small and picturesque. The clinic and hospital are separated by a couple of blocks. The conditions on Schweitzer were really pretty good, and we were on the mountain about 3 days a week. 

All at Dr. Crane’s practice are extremely welcoming. Lodging was housesitting his partner’s 40 acre farm, and meant collecting chicken eggs, feeding the rabbits and running with the german shepherd.

Overall an unbelievable experience, highly recommended, and a great opportunity to strengthen primary care, skiing, and farming skills.

Howdy, my name is Kanishka Garvin, and I’m currently an R3 and just finished my WWAMI rotation at the Alaska Native Medical Center in Anchorage. It was a great experience and strongly encourage anyone interested to do it.

The rotation had been primarily a hospitalist rotation, though now, they have opened opportunities for more critical care experience by adding an intensivist rotation as well as a clinic/outpatient component. You can choose one of the three exclusively or do some combination. The experience is whatever you make it of it. (FYI, they provide you with free housing and car rental.) I chose only the hospitalist component. You rotate with a different attending each week and usually carry 4-6 patients of your own. When you change attendings, you carry those patients with you for continuity. The attendings are great teachers and have been at ANMC for a long time. They really like UW residents and enjoy teaching. They give you full autonomy with your patients. You round by yourself and usually touch base with your attending if you have any questions later in the morning. The hours are usually 8:30 to 4 (very flexible, no overnight call obviously) unless your attending is admitting that day, then you stay a little later til 6 or 7. (this is only once a week.) You do work one weekend but they give you a 4-day weekend to make up for that. (which is great for long travels into Alaska).

The medical center itself is a beautiful facility with a unique patient population. It is a referral center exclusively for the Alaska Native population and you will frequently meet patients from the Arctic Circle, the Aleutian Islands, or somewhere else in the middle of nowhere. I’ve learned a ton about a variety of Native cultures and some of the medical issues related to them. There is a lot of bread and butter here with a lot of alcohol-related issues (dilated cardiomyopathy, GI bleeds, etc. ) However, there are fair number of cases you will see here not in the lower 48 states. There is a high prevelance of post-partum cardiomyopathy in Native women which you will take care of. In addition, there are a high prevelance of infectious diseases unique to here due to the dietary and hunting pratices of Alaska
Natives. They include botulism (the highest anywhere in North America), echinococcosis, and trichinosis (from bear/walrus meat).

Alaska is probably one of the most scenic places I’ve been. I think Washington State and the rest of the Northwest pale in comparison. I recommend coming between April and September for good weather and daylight. Anchorage itself is like any other American town with everything you need, though surprisingly diverse. You can still retain some of the ethnic fare from Seattle with decent Thai and Indian but there are a lot of good local restaurants and bars for that “Alaska” experience. There is a nice downtown area and tons of parks around for cycling or hiking. And it’s not unusual to encounter a moose or two since they are everywhere. The best thing about Anchorage is that it is a great launch pad to visit the rest of Alaska. I was able to go north to Denali National Park (use your long weekend for that) which was only 4-5 hrs away. If it’s a clear day, one of the most scenic places in the world with Mt. McKinley and tons of wildlife. I saw grizzly bears, moose, caribou, coyotes, and even a lynx. You could even go further north to Fairbanks and beyond to the Arctic Circle. Then, to the south of Anchorage, there are a lot of places to go on the Kenai Peninsula. I went to Whittier (1 hr) for glacier viewing and to the coastal town of Seward (2.5 hrs) where I saw killer whales, sea lions, and other wildlife in the ocean. Homer is another coastal town (6 hrs) that would be a good overnight trip to launch from Anchorage, and you could stop in Soldotna (3 hrs) or other towns along the way.

In conclusion, I had a great month getting to experience Alaska. And my clinical experience was fantastic both from a medical and cultural standpoint. I highly recommend this WWAMI site! Please feel free to contact me with any questions.

I loved my WWAMI month in Sandpoint, ID so much that I went twice!  The month is a neat balance of inpatient, outpatient with oodles of continuity, and procedures—EGD, colonscopy, and TEE.  Dr. Crane’s breadth of knowledge is truly awesome and he enjoys both teaching and learning from you.  You get most if not all weekends off and can go skiing at Schweitzer ski resort in winter or swimming in Lake Pend Orielle and backpacking and huckleberry picking in the summer.  I’m happy to talk to anyone about this experience! 

Lake Pend Oreille in Sandpoint, ID