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Intern
Gets A Real Look At Rural Medicine With R/UOP
 Ilwaco
- “I’ve always wanted to do medicine, it enables me to
think critically and solve problems,” says Sara Van
Nortwick. “I’m very interested in general surgery ...
It’s a good match for my interest.”
While she was seen walking
the halls of Ocean Beach Hospital in scrubs, Van
Nortwick isn’t employed there - yet. Instead she
received hands-on clinical experience in our rural
community. Starting her second year of medical school at
the University of Washington, she is the first student
to receive a surgical internship at the hospital through
the Rural/Underserved Opportunities Program (R/UOP).
Originally from Mount Vernon, she arrived in Ilwaco on
May 12 after R/UOP coordinators assigned the student to
general surgeon, Dr. David Friedman.
“I’ve always been on
clinical faculty, such as when I was at Tufts Medical
School and the University of New Mexico Med School,”
Friedman explains. “I asked around for clinical faculty
opportunities for clinical teaching and I was put in
touch with the [Western Washington] R/UOP coordinator,
Jodi Palmer.”
An opportunity for students
between their first and second years of medical school,
the R/UOP program encourages students to gain some
real-life clinical experience with rural physicians in
Washington, Wyoming, Alaska, Montana and Idaho (WWAMI).
Participating physicians are volunteers. Friedman
describes the program as a combination of clinical
exposure with training.
According to the R/UOP Web
site, the program is funded by Area Health Education
Centers in Washington, Wyoming, Alaska, Montana and
Idaho; Idaho and Washington Academies of Family
Physicians; Department of Family Medicine; Dean’s Office
at the University of Washington School of Medicine;
WWAMI medical programs in Wyoming, Alaska, Montana and
Idaho; and other supporting foundations. More than 50
percent of medical students from UW and participating
states have opted for R/UOP in the past five years.
With over 100 students
placed throughout the WWAMI region, Palmer says students
are typically placed with a family physician or internal
medicine physician. Van Nortwick is one of only two
students assigned to intern with a general surgeon in
2008. Prior to this year, one other R/UOP intern was
assigned to a family physician at Ocean Beach Hospital
and Medical Clinics. A physician in South Bend also
serves as a preceptor for R/UOP.
Still trying to narrow down
her surgical interests at the UW, Van Nortwick is the
daughter of two Washington State University alums. Her
father is employed with Boeing and her mom is a piano
teacher.
During what Friedman calls
“four weeks of uninterrupted exposure to clinical
medicine, “ Van Nortwick saw patients, completed
consultative work, spent time in the emergency room,
learned about cancer screening and surgical simulation
techniques, and helped with upper and lower endoscopies,
colonoscopies, liquid nitrogen treatments and a temporal
artery biopsy. She observed the process used to transfer
patients to a larger tertiary facility, as opposed to a
primary facility. Some of the patients transferred had
diverticulitis (a digestive disease) and lung, liver or
esophageal cancer.
They discussed colonoscopy
cost-effectiveness, surgical coverage and availability,
healthcare economics, critical access hospital
statistics, and reimbursement models from throughout the
state. The surgeon also finds it important to focus on
how to best approach community health issues, looking at
“cost ramifications” and “spending healthcare dollars
wisely.” They also researched the passing rates of board
certification programs in the United States and
discovered that Washington does very well, as does
Dallas, Texas.
“It’s good for her as a new
healthcare provider to understand all of that, it’s
necessary,” says Dr. Friedman.
Friedman says when working in a more rural area he often
takes a broader approach to his patients’ needs and
often acts as their general care provider.
Dr. Friedman also introduced
Van Nortwick to his wife and OBH dermatology nurse
practitioner, Mary Friedman. Together, the pair taught
the student about treating skin cancers, identifying
types of lesions and melanomas, and performing skin
sutures and surgeries.
“It was very nice to see how
dermatology and surgeons work together,” noted Van
Nortwick.
With a boyfriend who will be
a Stanford medical student in the fall and plans to be a
neurosurgeon, Van Nortwick says the Friedmans helped her
better understand the challenges couples face when both
of them work in the medical field.
“They helped me in all
aspects - personal and educational,” she smiles.
Dr. Friedman also taught the
student about rural trauma management and invited her to
sit in on a monthly trauma review meeting.
Van Nortwick learned about
teleradiology in a rural hospital setting by meeting
with Dr. Allen Ford, a contracted radiologist who treats
OBH patients every four weeks. Friedman and Van Nortwick
also visited other health facilities on the Peninsula,
such as Willapa Behavioral Health.
During her visit to the
Peninsula, Van Nortwick received a $500 stipend to cover
incidental expenses and stayed in an apartment near the
Port of Ilwaco. When she wasn’t learning techniques and
tending to patients, she checked out local lighthouses,
Cape Disappointment and the Coast Guard station, the
beach, Oysterville and local dining establishments.
“It’s really great to get
clinical exposure,” says Van Nortwick, who has had other
clinical opportunities in Seattle and Pullman. After a
year of classroom studies, the 23-year-old says she was
ready for a more hands-on approach. “I’ve always liked
rural communities and I may want to do rural medicine
one day. Through this I was able to see the rewards of a
rural hospital and working with a general surgeon. It’s
a nice facility and there are great people here ...
There is definitely a
community feel that isn’t always found elsewhere ... I
just want to say thanks to everyone and Dr. Friedman for
doing this for me - they all went above and beyond for
me.”
Her last day at the hospital
was June 3 and her plans include starting a research
project in the University of Washington Medical School’s
surgical simulation lab.
Friedman says his patients
seemed to enjoy the medical student’s presence and he
hopes that R/UOP program has gained interest from other
OBH physicians. He plans to host another intern next
summer.
From the Chinook Observer, June 24, 2008.
By Amanda Frink, Observer Staff Writer
Reprinted with permission.
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