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!
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.
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.
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!
Doesn’t get much better than Alaska in July/August when I was in Anchorage. You get a sweet apartment that comes with a bed INCLUDED AND a rental car. When I was there I split time between the hospitalists and the outpatient world. My recommendation to people going there would be to skip the inpatient side of things (can’t speak for MICU) and do all four weeks in the ambulatory setting. The hospitalists are all really cool but you will mostly be dealing with alcohol withdrawal, some CHF and CVAs. The ambulatory setting on the other hand has AWESOME pathology and really super interesting medicine since people come from all over Alaska. The general internal medicine model is super interesting there as patients are primarily followed by ARNPs, PAs, family med, etc for there general primary care needs and are referred to an outpatient internist for interesting/difficult cases. You also have the opportunity to work with an Endocrinologist (who is awesome), nephrologist, dermatologist, GI doc, etc. I spent a lot of time in GI and by the end he wasn’t even dressing up for the EGDs and I was doing them independently as they are mostly diagnostic scopes in patients who arguably don’t need them.
You will also get more time off and have earlier days to enjoy the endless sunshine. Everyone gets a 5 day weekend and that’s the one I used to go to Denali where it was in the mid 70s, the mountain was out every day and I saw tons of grizzly bears, moose, and other creatures of the wild. Do the coastal trail, climb flat top, go fishing, get a kayak and bike from one of the hospitalists and cruise around. Let me know if you questions or need advice on what to do.
It should definitely be #1 on your schedule wish list.
I spent october of 2012 in anchorage at the ANMC MICU. I had originally set it up as a split block: half MICU, half wards, but decided to just extend my ICU time once I was there.
It’s a very interesting ICU to work in. As always, spectacular nursing staff and respiratory therapists make ICU rotations some of my favorite. They use pressure control instead of AC style ventilation as a default up there, which is a transition that was definitely useful if a bit challenging at first.
There’s an incredible variety of patients, ranging from the worst hyponatremia I’ve ever seen (Na of 98, a combination of beer potomania and schizophrenic polydipsia, wowza), to intense alcohol withdrawal, to the usual mix of sepsis and stroke management.
The opportunity to do procedures varies a bit based on the pathology mix, but even on slow days I would head across the hall to the OR and do scheduled intubations. There was a nice mix of bronchoscopy, intubations, central lines, LP’s, and art lines otherwise. Some people had much more procedural months than I did, I only did 3 or 4 of each of our internal medicine procedures.
The attendings come from all over, as they rely on a fair number of locums. Dr. Madhani-Lovely is spectacular, and will force the residents to really justify decision making with an evidence base when she is on service.
The hospital itself is great, and the sheer splendor of alaska is literally breathtaking at times. When I would leave the parking lot near sunset, I’d sometimes find myself waxing poetic and wishing for paints. The logistics of licenses and such can be a bit of a drag, so try to get started on those things way in advance. In general, the people in the hospital are pretty motivated to help you out.
I spent this last October in Anchorage which was a great experience. You are provided lodging in a modest apartment and a rental car. October was a great time of the year to go, as it wasn’t too cold and there was no snow on the ground so exploring the surrounding areas was not particularly difficult.
I split my time between the hospitalist rotation and the outpatient clinic. The hospitalist I was paired with was none other than Ted Wright, former UW Boise track graduate. I carried about 7-8 patients and admitted every weekday. The hours were not bad. The case mix was bread and butter medicine (pneumonia, urinary tract infection, chest pain, DKA). One of the more interesting parts was discharge planning as the patients you take care of come from some very remote areas in AK. In fact, they have a hotel in the hospital to stay at while you get outpatient follow up if needed.
The outpatient clinic experience was subspecialty medicine (renal, ID, pulm, rheum). The paired faculty are great and there was a lot of teaching.
Still cold, but an amazing four weeks. I highly recommend rotating at the Alaska Native Medical Center in Anchorage!
You will be given a choice of (1) outpatient clinic, (2) inpatient medicine, or (3) ICU. You can pick 2 of 3 if you want to mix/match. I chose a mix of outpatient clinic (and requested a GI focus) and inpatient medicine.
For outpatient clinic, you can work with a general internist and see everything, but you can also request to work with the specialists, assuming they are available. There are two infectious disease docs, a gastroenterologist, a rheumatologist, a neurologist, a dermatologist, nephrology PA, pulmonary, etc. Many of the specialists see patients in the clinic, but also perform inpatient consults. You get more weekend time off.
For inpatient medicine, I was assigned to an Attending (who rotates weekly). I carried about 5 patients of a 12-15 pt service. Rounds are pretty informal and you have independence, but still have opportunity to discuss the plan with the Attending. I admitted from the ED. There is good support for PT/OT, social work, etc.
ICU is a busy service, generally. Less weekend time off, but a lot of procedure opportunities.
Alaska Native Medical Center:
Beautiful facility. Very modern. The patients are also amazing, mostly Native and from villages hundreds of miles away requiring travel in by a bush plane. I learned so much about Alaska geography and native culture throughout the month. The patients are very warm and friendly. I really enjoyed interacting with them.
A big city. Plenty of supermarkets, coffee shops (Kaladi Bros!), restaurants, gyms, museums, etc. Even in March, snow can be challenging and I would recommend considering upgrading to a slightly nicer car with all-wheel or 4-wheel drive, especially if you plan to take some road trips.
If you have time off, consider going to:
Drive 2.5 hrs south to meet up with the Soldotna resident and then continue on south to Homer, AK
Seward (I never made it here)
Fairbanks is quite far and unless you have a lot of time, you would probably need to fly. You can also take the Alaska Railroad
In winter, plenty of downhill skiing, cross-country, snowshoeing. You can even organize dog-sledding/mushing, ice fishing, snowmobiling or a flight over Denali if you want.
If in March, try and see the start of the Iditarod (pretty amazing!) and the Northern Lights.
Despite the negative five degree weather, snow, and a highly functional Kia Forte… this was an absolutely amazing rotation. I spent 4 weeks in the ICU working as a fairly independent entity with my own patients and responsibilities. The highlights of this were close interactions with the attending, making vent changes on your own, and the procedures. I did somewhere around 13 subclavians, 5 IJ, 1 tunneled line, 2 broncs, and helped with an EGD. The staff are great and they are interested in you and your education. I would get in around 7:30, round at 8:30 and usually leave around 7 pm unless it got busy. Overall a great rotation. Anchorage is nice, but cold. Although I did do a fair amount of running which was spectacular! I would totally recommend this to anyone interested!
I just got back from a month at ANMC in Anchorage. I did 2 weeks of hospitalist and 2 weeks of outpatient clinics. Like previous posters have said, you see a lot of cancer and alcohol-related complications on the inpatient side. And it’s true that you can get exposure to EGDs and doing treadmills, if you like those kinds of things. You can pretty much see whatever you want, in terms of procedures or surgeries and whatnot since the place is small enough and the staff are very accommodating.
I’d like to put in a plug for the outpatient experience, since not many people have posted about that thus far. You rotate through different clinics everyday, including a combined rheum/pulm connective tissue disease clinic (where you see more scleroderma with interstitial lung disease than you have ever seen in your life), GI clinic, hepatitis clinic, general medicine. The outpatient attendings are all great teachers and excited to have us there. The patients are great, appreciative, and come from very interesting places.
Aside from the clinical experience, the rotation is very well-organized with great support from the coordinators. They give you a long weekend so you can go explore Alaska. I made it to Seward for a glacier/wildlife tour and also to Denali National Park. I don’t know if I was unlucky with the weather but by the second week of September there were more rainy days than sunny ones. But no matter what the weather, the Alaskan wilderness is majestic.
Just make sure you have one of those nice cameras with the big lens if you want to take good pictures of wildlife. You don’t want to have to be too close to a grizzly.
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
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