on 2/13/2001 3:18 AM, James R. Damos, M.D. at jdamos@facstaff.wisc.edu
wrote:
> Hi all. We have felt the same as Dave Rushlow in our Baraboo RTT. So far, in
> our RTT we have matched 100% with excellent allopathic and osteopathic med
> student candidates. This year may be different. We may not match. The
> candidate pool is small. We will likely send in a match list of 9 applicants
> for 2 slots. We have toyed with looking at inviting IMG students for
> interviews who were not quite in the same league as our other applicants but
> we have decided not to. We would rather not match. We are too busy in our
> rural community to take on a "major project" resident.
>
> This I feel is a tragedy for rural family practice. Many med students don't
> know what they are missing. We feel our residents are getting excellent
> experiences relevant to rural health out here in Baraboo, Wisconsin compared
> to the core programs. Having worked in both the urban core program in
> Madison and now being full time in Baraboo, I know our residents do more
> procedures and care for sicker patients. They become skilled in instrument
> obstetric delivery, do neonatal resuscitations and continue caring for the
> patient afterward for the hour before the NICU arrives. We have no
> obstetricians or neonatologists in the entire county. They feel comfortable
> in the ICU.
>
> This AM, one of our third year RTT residents intubated a 65 yr old lady in
> our ICU that was crashing with a left lung wipeout pneumonia that was
> nosocomial. She had gotten worse rapidly. Eric calculated her initial
> ventilator settings with the help of one of our family physician faculty,
> started her on Vancomycin and Ciprofloxacin after cultures were obtained,
> got her foley in, a central line in, and arranged for helicopter transfer to
> Madison. He was doing this all while managing a pitocin induction on a
> primigravida with toxemia and getting to the office at 9 to see patients. I
> feel he can manage this because of his training out here. He loved it and
> was very experienced at managing these multiple complex tasks. He has
> learned how to mobilize a team of hospital staff members who are fellow
> community citizens to help him. There is joy that they all feel in caring
> for a patient who may be a neighbor and/or friend. It is a joy for us as
> faculty to see this maturity in a resident over 3 years. Teaching has made
> the jobs of our rural faculty more rewarding. These resident's role models
> are family physicians doing these things themselves. What better way of
> matching teacher's strengths with learner's needs. I don't think core
> program residents would have gotten these same experiences.
>
> I see our rural faculty working hard in an underserved area, teaching, and
> seeing a large volume of sick patients with the RTT residents. It is
> discouraging then to get emails from the med school at University of
> Wisconsin telling us of the myths that the limited care subspecialists are
> spreading to the medical students. This explains why the applicant pool is
> small;
>
> 1. Don't choose family medicine, it is a dead end street
> 2. Rural medicine is wiping snotty noses.
> 3. There is no continuing medical education in rural areas
> 4. Rural practice is boring.
>
> All these quotes are from UW med students who have heard them from limited
> care subspecialists, many of whom have never practiced outside the
> University. I have read the Textbook of Rural Medicine just published by
> Geyman, Norris and Hart. It is good. I remember reading the book "The
> Making of a Surgeon." The show "ER" I am sure has excited many students.
> Perhaps a "Diary of a Year in Rural Practice" should be published by this
> RTT group to dispel some of these myths? A professional writer-author could
> interview many of the RTT residents and teachers. I bet it wouldn't take
> long to put together the stories.
>
An excellent idea!! Better yet a "Diary of a Year in Rural Residency." We
have already started to compile a collection of cases from our longitudinal
case-based conference called "Clinical Jazz," for example. One of our 3rd
year residents is completing a scholarly project looking at the content of
practice in rural as compared to urban residency training.
-- Randy