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Rural Family Physicians in North Dakota Reach Out to Educate Students About Family Medicine
Their efforts are one of the biggest reasons why the state has been able to produce a steady supply of family physicians, according to Beattie. North Dakota's lone medical school typically graduates 62 students each year, and about 24 percent of those students end up going into family medicine, a percentage that places North Dakota within the top tier of states producing family physicians, according to the summer 2011 issue of the North Dakota AFP's Family Medicine Quarterly bulletin (page 10 of 13-page PDF; About PDFs).
- North Dakota family physicians use real-life experiences to educate medical school students in their state about a career in family medicine.
- Students are able to train with family physicians throughout the state via a variety of programs.
- Family physicians serve as educators and mentors, providing an example for medical students to emulate and encouragement for them to choose family medicine.
Unlike most medical schools, the University of North Dakota School of Medicine and Health Science does not have a health center attached to it, which forces the school to rely on community hospitals and community health care systems to help teach its medical students. As a consequence, the medical school and the North Dakota AFP have worked together to develop programs to train family medicine students using local family physician practices, which provide invaluable experiences for the students, as well as the practicing physicians.
"Having the students really gives you a good perspective because they are here to learn," says family physician Aaron Garman, M.D., medical director of the Coal Country Community Health Centers, which are federally qualified community health centers. "They are enthusiastic about patients, and they keep that enthusiasm going in the practice."
Family Physician Program Concentrates on Junior and Senior High-school Students
"I want to practice rural family medicine in North Dakota with an emphasis on obstetrics," says Natalie Crawford, a senior at the University of North Dakota who participated in the Mission Physician program as a high-school junior four years ago. "Mission Physician made it seem like this could be a reality for me."
Family physician William Mann, M.D., developed the idea for Mission Physician and provided the driving force for the program, which is funded by the Altru Health System, a grant from the Dakota Medical Foundation and individual contributions. Mission Physician takes place at the Altru Family Medicine Residency program and Altru Health System.
It highlights a variety of practice venues inside and outside of the residency program, relying on family physicians and family medicine residents to provide much of the program instruction. Six graduates of the 2008 Mission Physician class are applying for entry to medical school this year, according to Mann.
Mission Physician targets junior and senior high-school students from rural areas because they are more likely to pursue a career in family medicine than their counterparts from urban areas, according to program officials. The program itself is made up of five intensive five-day training and instruction seminars that cover a range of practice areas. Program directors assign about 10 students to each seminar.
Participating students have an opportunity to perform basic procedures, such as X-ray interpretations, vision and hearing assessments, lung-function testing, casting, and suturing. Students also have a chance to visit the different departments in the hospital departments, and they can shadow various specialists to get an idea of how they practice medicine.
"Mission Physician has grown into an opportunity for students to see the reality of family medicine," says Heidi Bittner, M.D., medical director for Altru Clinic-Lake Region in Devils Lake, N.D., and an associate clinical professor at the University of North Dakota School of Medicine and Health Science in Grand Forks. "The experience is invaluable to these students, who otherwise may not realize that their goal is truly attainable."
Students at the North Dakota medical school are required to participate in an eight-week family medicine rotation before graduating. In addition, the North Dakota AFP operates the Don Breen Rural Externship in Family Medicine (2-page PDF; About PDFs), which places medical students in family physician practices for a one-month summer rotation between the first and second years of medical school.
Reaching Students Early
One of the goals of the externship is to reach medical students early in their medical school careers before they commit to a particular specialty. The program strives to get the students as involved as possible in patient care.
Mathew Malek, a second-year medical student from Minot, N.D., spent a month at an Altru Health System clinic this summer as a Don Breen extern. He notes that he was able to get a lot of hands-on experience in delivering babies, taking patient histories, irrigating ear canals and taking out stitches. "The whole point of the externship is to put students in the shoes of the physicians so that we can see what it is like to be a family physician on a day-to-day basis," says Malek.
He describes the hands-on knowledge he gained as invaluable, adding that his experience strengthened his resolve to pursue a career in family medicine.
"I try to push the envelope so that the students can no longer sit by the wall and watch someone else do the work," says Garman, a rural family physician whose community health center trains Don Breen students as well as third- and fourth-year medical students and family medicine residents who want more of a rural experience. "They have to do the work and have to take ownership in the patient's care."
In some instances, the externship plays a determining role in convincing students to choose family medicine instead of another specialty. For example, Chelsea Heppner Traverse, a fourth-year medical student was waffling between a career in pediatrics or family medicine before taking part in the Don Breen Externship two years ago.
Traverse was able to work with a variety of patients and perform numerous tasks during her month-long stay with a family physician practice. She soon discovered that she enjoyed working with patients from all age groups and backgrounds, and she decided to become a family physician as a result.
"It is very interesting to see students when they have a preconceived idea of what they want to do with the rest of their life and watching them change as they go through a family medicine preceptorship," says Garman.
The ROME Program
Like the Don Breen program, students are matched with family physician practices. But they also are required to work with physicians from other disciplines, such as internists and surgeons. There are five family physician sites in the state that host the ROME program, including the Altru Clinic-Lake Region.
"If a patient comes into the emergency room and needs an appendectomy, the student will go with the surgeon to examine the patient," says Bittner. "They also will go to the surgery itself and will see the patient in postoperative care."
Facts About the North Dakota AFP
Number of chapter members: 289 members
Date chapter was chartered: 1950
Location of chapter headquarters: Hazen, N.D.
2012 annual meeting/scientific conference date/location: Oct. 26-27/Grand Forks, N.D.
The Don Breen and ROME programs also serve a larger purpose of dispelling misconceptions about the family physician profession, according to family physicians and students in the state.
"There are all of these horror stories about how terrible it is practicing in a rural setting -- about how overworked and underpaid family physicians are," says Jeff Hostetter, M.D., the director of the North Dakota Center for Family Medicine, one of three family medicine residencies in the state. "That's why it is important to get students out into the field to see the reality."
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