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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A wonderful experience

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.

Soldotna so awesome

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.

Welcome to nirvana.
What awaits you on the drive out of Anchorage.
Nirvana.
Nirvana.
Denali.
Denali.
Mountains beyond mountains.
Mountains beyond mountains.
Great name for a boat.
Great name for a boat.
Bush flying.
Bush flying.
Annual migration of the common Winnebago species.
Annual migration of the common Winnebago species.
Playing in paradise.
Playing in paradise.

Jackson, WY

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.

Do yourself a favor and go here. Immediately.

Sandpoint

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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.IMG_1372

I cannot recommend this rotation enough! I will definitely be coming back to Sandpoint in the near future.

Susie

5 star review of the ANMC rotation!

The WWAMI rotations are a big part of what make our residency program special, and I recommend prioritizing at least one of these experiences during training. The ANMC rotation is an incredible experience that I would recommend to all comers, particularly those interested in specialty medicine. The people who work at ANMC are delightful, and the attendings (particularly Dr. Lovely and Dr. Gitomer) are so fabulous that they alone make the experience worth the trip. It was a fantastic month, both for my medical training and for my life experience. Since so many of the other posts go into detail about the rotation structure, amenities, etc., I’ll spend more time her talking about my personal experiences.

In the hospital: I spent my first two weeks at ANMC in the ICU and my second two weeks in outpatient specialty medicine. The ICU is a general critical care unit, so you take care of a combination of medical and neuro patients with all sorts of different pathology. This rotation is a great opportunity to do procedures (including subclavian lines); the attendings knew that I wanted to do as many procedures as possible, so even after I had gone over to the outpatient part of my month, the attending would come get me to place non-urgent lines. You see a lot of advanced pathology, and it’s a great way to start feeling comfortable with independence in the ICU setting. The outpatient specialty rotation was also tremendous. I rotated cafeteria style with several different specialties over the two weeks, but if you have a particular area of interest in mind, you have the freedom to focus your time. Alaska is tricky for delivery of specialty care, as the population is so spread out and sparse, so patients often fly 700 miles to come to Anchorage to see their specialists. This experience enriched my medical training profoundly, and I hope as many of you as possible choose to take advantage of it.

Outside the hospital: There is a lot to do in and around Anchorage, and I really enjoyed getting out of the hospital and going hiking, halibut fishing, sea kayaking, and getting to know the city. I was there during September of 2013, which is the rainy season in Anchorage. That time of year it was generally overcast/rainy and in the mid-50s, not unlike a slightly warmer version of a Seattle winter. Anchorage is a wild place, and I saw a lot of wildlife. Kinkaid park is a great place to see moose, but I also saw one in my attending’s neighbor’s yard one night. University Lake right next to the hospital has a nice walking trail around it and is home to a lot of beavers.  Potter Marsh on the south edge of town is a must-see, and you can frequently spot swans there. Alyeska ski resort is a short drive south of town if you like beautiful views of glaciers and the off-chance of seeing a bear.

Moose are everywhere in Kinkaid Park!
Moose are everywhere in Kinkaid Park!
This is Eklutna Lake, the water reservoir north of Anchorage, in late September, 2013, the day after the first snow was dusting the mountains.
This is Eklutna Lake the day after the first snow dusted the mountains.
I took this picture while sea kayaking in Kenai Fjords national park in late September, at the very end of sea kayaking season.
I took this picture while sea kayaking in Kenai Fjords National Park at the very end of kayaking season.

In short: go to Anchorage! Please feel free to contact me if you have any questions. I love talking about all the things I got to do and see in Alaska!

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