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3rd-year med-school rotations: distant lessons in work, life
Dehydration? Seizure? Long QT? Arrhythmia?
On the heels of examining Cyrus Clendanie, an 8-year-old who’d passed out and conked his head the day before, Jamie Oh posed conditions that might’ve spurred the event.
Hypotension? Vasovagal?
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Oh, a University of Washington medical student on rotation in Alaska, bounced ideas off of Anchorage pediatrician Willow Monterrosa. She gently queried him about each suggestion’s likelihood and evidence.
“Patient history makes it unlikely it was a seizure, but we want to rule out a cardiac cause or a neurologic cause,” she said as they honed in on a treatment plan.
Cyrus was one of about 150 children that Oh and Monterrosa saw during a three-week outpatient rotation that ended just before Christmas.
Then Oh repacked his suitcase, left the midday dusk and returned to Seattle. He’s happy to be back in his own bed for a while.
Third-years like Oh can opt for a study track in UW’s WWAMI program that takes them to participating clinics across Washington, Wyoming, Alaska, Montana and Idaho. They examine patients, take health histories and acquire experience under close supervision of physician-preceptors like Monterrosa.
“He’s here to get a glimpse into pediatric medicine,” she said of Oh. “In outpatient, a lot of it is seeing kids for routine checkups. You learn developmental milestones; third-year students have no idea whether babies roll over at 2 months or 10 months.”
Seeing about 10 kids a day with Monterrosa, Oh grew adept managing coughs and colds, wheezing, immunizations. “Ear infections are hard because there can be some squirming,” he said, but overall, the hands-on work is invaluable.
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“We have (virtual patient) cases to study in second year, but it really doesn’t solidify in your mind. It wasn’t till now that I have a sense of what a 4-month-old is like.”
Monterrosa described trainees’ presence in her clinic as a win-win: They build skills; she stays grounded in medicine’s essentials.
“My favorite thing is getting questions that I struggle to answer. Having a student ask, ‘Why this antibiotic in this case?’ helps me stay sharp on things I don’t always think about after doing this for so long. Being reminded of the why behind what we do is helpful.”
The other benefit, she said, looking at Oh, “is knowing you’ve had a good exposure to seeing that kids are not little adults, that you appreciate that it’s really different medicine with kids. That matters whether you continue with pediatrics or not.”
Oh’s Anchorage pediatrics clerkship was preceded by six weeks in Libby, Mont., learning and doing family medicine. (He’ll return to Montana in March-April.)
Although UW arranges trainees’ housing and sometimes even a car at its WWAMI outposts, long stretches in unfamiliar towns “can take a toll on your mind and body,” Oh said.
Site trainees are in learning mode almost 24/7: in clinic five days a week and, on weekends, figuring out how to decompress without the company of good friends and, hopefully, without becoming a recluse.
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Oh, 25, described part of his experience:
“Personal time depends on the rotation and, within the rotation, where you are. Say you have psychiatry in Seattle, you’re working 10-12 hours some days. Other places just don’t practice that long.
“In Anchorage during inpatient, which I did the first three weeks, I’d get in about 6 a.m. to pre-round – reading up on patients, doing physical exams before you present – and usually leave at 5 or 5:30 p.m. or, if you’re the sign-out person, 7. I often stayed past 7. It’s a long day. And in the middle of that, we had a week of nights, which is 7 p.m. to about 10 a.m.
“Outpatient we have an hour of morning didactics; a doctor lectures about a topic. From 8:30 on, you kind of schedule your own days. You can spend a half-day with specialty clinics like peds cardiology or dermatology or neurology, and you’re required to spend at least four half-days a week with your primary attending, which for me was Dr. Monterrosa.”
Outside of clinic, trainees are on their own to find a comfort zone. In Montana, Oh’s eyes were opened to bucolic charms of patients saying hello in the grocery aisle, numerous deer sightings and home-cooked meals at attending physicians’ homes.
At times, though, the town (pop. 2,700) felt uneasily small. Oh couldn’t find a coffee shop open past 6.
“You can do anything for six weeks, but at the same time, living alone can seem a little isolating,” he said. “I got a lot of studying done.”
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Anchorage, by contrast, felt like a social horn of plenty, with pubs and cafes open late, but it still required an internal reset. Oh had left Libby after work on a Friday, driven nine hours to Seattle and the next day climbed on a plane to Anchorage. There he met three other trainees that shared his dorm suite. They got along fine, but there was no guarantee that would be the case, he said.
And discovery took longer in the winter darkness: The group cooked and dined out for five weeks before they found the cafeteria nearby.
Now back at UW Medical Center for a rotation of surgery and obstetrics, Oh reflected on his whirlwind half-year.
“You remember the patients you see, as well as the preceptors and attendings you want to emulate. But when I’m reminiscing years from now, I think I’ll remember the things I did outside: the amazing views, hiking to Bomber Glacier (outside Anchorage), my almost run-in with a moose on the trail, the Libby Loggers' (high school) homecoming football game.
“For WWAMI students heading into their third year, I’d say don’t be afraid to try something and someplace new. We’re able to travel and live in a brand new place every six weeks for as many rotations as we want. That’s an opportunity you don't get often in life.”