I absIolutely adored my month in anchorage at ANMC. I know I want to do pulm/CCM, and wanted to use the rotation as an opportunity to get more ICU exposure, gain more procedural experience, and see a different pattern of practice outside of an urban, academic setting. On all of those fronts, it did not disappoint.

The rotation is very flexible on schedule; I opted for 3 weeks of ICU and 1 week of pulmonary clinic. The ICU doctors really enjoy working with residents and love to teach. I got a ton of hands-on experiences managing trauma and neuro-ICU patients that we don’t get much exposure to as residents. I also put in a ton of lines and did other procedures, including my first chest tube! The week in pulmonary clinic was also a delight. I had the opportunity to work with Dr. Clark who is a brilliant and thoughtful pulmonologist. It was also a nice opportunity to talk with patients more in a lower acuity setting and get to know their culture and stories.

There is also a lot to do and see in Anchorage and the surrounding areas, especially in the summer! You can chunk days off together, and I used the week of pulmonary clinic to really enjoy my long days. I visited Denali, went fishing in the Kenai Penninsula, did several hikes, biked the Coastal Trail, and more!

Overall, I’d recommend ANMC to anyone who wants more ICU or procedural experience. It has been the best rotation I have done as a resident and was an incredibly valuable educational experience.

Residents choose to rotate at ANMC for a variety of reasons, but I found working in a hospital dedicated to caring for Alaska Natives to be the most rewarding aspect. That said, I felt like I arrived in Anchorage with little background knowledge on the patient population and the hospital where I would work. During my rotation at ANMC, I compiled this powerpoint as a reference – it is a mix of information on the hospital’s history, Alaska Native population health statistics, and additional resources for learning more before and during the rotation (health equity papers, local must-visit museums, etc.) I hope these references help lay some of the ground work for the unique environment and culture. This beautiful state has a rich history that strongly impacts the health and daily lives of its people and the opportunity to meet and learn from them first-hand is inspiring. If you have any feedback or would like to add additional resources, please email me.

Have a wonderful rotation!

[Editor’s note: Michela put together this fantastic PowerPoint of background information about ANMC and the Alaska Native population it serves. Strongly recommended for anyone going to Anchorage!]

Anchorage, Alaska. Home to bears, moose, liver dialysis and abundant subclavian central venous access. I chose to spend all 4 weeks of the rotation in the ICU and would definitely recommend the experience (although I hear that residents enjoy their time with all specialties up here).

At ANMC all critically ill patients end up in one unit under the care of the ICU team, so you will see patients admitted with trauma and other “surgical problems” (NSTI, ICH requiring craniectomy etc.) in addition to the things we are more used to managing. If the variety doesn’t interest you it’s possible to pick up only the more classic medicine patients, but you will at least have the opportunity to manage a broader spectrum of critical illness. You will probably get to do lots of procedures (all manner of central lines, bronchoscopy) and intubate relatively often if you are so inclined. A more unique thing you will see here is MARS “liver dialysis” which gets used for acute liver failure and Tylenol overdose. The attendings and other hospital staff are very friendly and a lot of fun to work with.

At least in the summer there is lots to do here, four weekends is just not enough time to see all the cool stuff in the area. The hiking/wildlife is incredible. Homer and Seward make great weekend trips. This also seems like the place to be if you like fishing.

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.

Overall, you can’t really beat this rotation!

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.