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.
Overall, highly recommended!
Missoula was my second WWAMI month and quite different from the first. Missoula is a university town and significantly bigger than Livingston. There are multiple hospitals, plenty of subspecialists, and even some UW students running around; it has less of the “small town doctor” feel. That said it’s quite different from Seattle, and the exceedingly well-connected Dr. Schlesinger is eager to customize the rotation – I did two weeks of sports medicine and two weeks at a Community Health Center. But one gets the sense Dr. S could arrange anything from the ICU to podiatry, probably with someone not used to having a resident and excited to do some teaching. Go to Missoula to get away, see a different place, do some hiking/skiing, and all of that, but also take advantage of the opportunity to learn whatever you want.
I am so glad that I chose to do a WWAMI rotation in Missoula. It was an eye-opening experience in so many ways. I spent the month with Dr. John Trauscht, an oncologist with the Montana Cancer Specialists. I felt spoiled to have so much one-on-one time for teaching. I spent time doing a mix of inpatient and outpatient work, and had much more autonomy than I thought would be possible. Every day after clinic we would sit down to review cases from the day, and sometimes review peripheral smears and bone marrow biopsies with his 2-headed microscope.Â We were able to generate learning points as well as new questions for me to look up in the literature. I felt like the learning was so high yield. The most amazing thing was the patients, who were so nice and down-to-earth. Dr Trauscht led by example in not over-medicalizing the conversations with patients, and he challenged me to do the same. Also, there was ample opportunity for exploring the area in my free time. There is a really neat ghost-town nearby, and futher out is Glacier Ntl Park. The town of Missoula itself is also super-fun. There are lots of cute cafes, boutiques, and local music venues. Overall, it was a fantastic experience. I highly recommend this site.
I was putting in a lot of hours, by my choice, because I was learning so much. The community doctors constantly impressed me with how good they were at everything. They were amazing diagnosticians. The oncologist I worked with, John Trauscht, was an outstanding teacher, and I loved his curiosity. John had a great way of communicating with his patients, bringing everything to their level, and always gave patients the choice of doing nothing. I saw all of his new patients and performed bone marrow aspirates and biopsies, so I was first to see and diagnose patients rather than the fifth or sixth person down the chart. One memorable patient was a middle-aged man with Burkitt’s who continued to decline despite aggressive chemo. He developed PCP in the hospital and then an HIV test came back positive. The diagnosis was incredibly devastating and it was interesting to see everybodyâ€™s reactions. He died three days before I left. Taking care of him made a huge impact on me â€¦ I loved Montana. Everyone in Missoula loves living there, and I felt very much a part of the land.