Soldotna, December 2010

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

Dillon, MT

make hay while the sun shines (a field near town)

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

Alaska Native Medical Center, Sept 2010.

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!

Soldotna (Aug/Sep 2010)

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.

Sandpoint, ID

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.

February in Soldotna

Everything on this blog about Soldotna is true.  Read the other entries and check out my pictures from a road trip down to Homer (70 miles South of Soldotna).  Click on the pics for full size images.
A moose wanders through town
The Kenai Range
The view from Homer
An abandoned bus on the Homer spit
Bald Eagle guarding the Homer spit

Alaska Native Medical Center, Anchorage, Sept 2009

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.

Sandpoint Rocks

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

Lake Pend Oreille in Sandpoint, ID

Spring in Soldotna

I just spent a month in wonderful Soldotna, AK and highly recommend it for anyone considering a WWAMI month. It’s great opportunity to experience rural medicine at it’s finest. Over half of the attendings are UW graduates and display a range of practice styles that are all top notch. An average day entails arriving at the hospital at 7:00 or 7:30 depending on the day for one of various conferences/meetings. The rest of the morning was spent rounding on patients. I had anywhere from 1-4 at any time that represented some of the more interesting admits from the previous night or during the day. There’s a different attending on call each day and I checked in with them throughout the day to see if there were any new admits.

If not admitting patients, I spent the afternoons helping see patients in the clinic. I had the chance to help read echos and perform endoscopies throughout the day as well. This is one of the coolest things about practicing in a small community. Without a cardiologist or gastroenterolgist in Soldotna, the generalist have trained to do these procedures themselves. This also meant that for consults, patients at times have to be airlifted to Anchorage. If that happens, I highly recommend talking with the flight nurses and pilot about accompanying your patient in flight to see the transport process first hand. The helicopter sits just outside the ED and as it lifts off, you have an incredible aerial view of the Kenai Peninsula en route to Anchorage.

Aside from work, there is plenty of time to enjoy all that Alaska has to offer. I was on call only one weekend, but had the rest of the weekends and all evenings free to explore The Wilderness. There are two fishing villages: Homer and Seward that are magical and only 2 or so hours away. Spend your weekend evenings at a bed and breakfast and your days exploring the water for whales, sea otters, and shorebirds in a kayak or on a boat tour. If you’re here during the Spring you might be invited to watch Dr. Kelly, a commercial fisherman in his other life, unload his latest catch of halibut. Dr. Bramante, a dog musher in his other life, will introduce you to his 30 dogs and take you on a run with them. The attendings here really embrace the work hard play hard mentality and their passion for both is infectious! Come and see.

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