Medical students reach out to patients in Greater Minnesota

by Mickie Barg

Medical School student Hugh Smith left the crush of the Twin Cities and University campus Oct. 16 to experience the daily activities of a rural Minnesota doctor.
Now, Smith is one of 34 third-year medical students participating in the University’s Rural Physician Associate Program, which offers students an option of spending nine months in a clinical setting outside of the Twin Cities area.
At the Forest Lake Allina Medical Clinic, Smith sees patients under the direction of former RPAP participant Dr. Harvey Frank, and Dr. Carl Peikert, and participates in patient care with specialists in pediatrics, obstetrics, gynecology, dermatology, emergency medicine, surgery and cardiology.
“The program offers independence and a chance to direct our education,” Smith said. “I can have control and continuity and spend more time on what interests me.”
Smith’s first two years of medical school involved classroom work. Normally the third and fourth years include a series of six-week clinical rotations with a range of specialty doctors.
With RPAP, Smith stays in one clinic and is responsible for a variety of educational experiences such as community-based project development and patient interviews, diagnosis and treatment plans.
“With this program, there is a continuity of care,” Smith said. “I can follow-up on patients two or six months later where the other way I would see them once and then never see them again.”
Since the program’s inception in 1971, more than 900 students have been indoctrinated in this fashion. Its goal is to encourage medical students to practice primary care medicine in rural areas or small towns in Minnesota.
“It started as a legislative request for the Medical School to produce doctors who would leave the Minneapolis-St. Paul area and do primary care,” said program director Walter Swentko. “There were a lot of places in Minnesota that didn’t have any doctors.”
At the Forest Lake clinic, several RPAP participants who graduate from Medical School, return to practice medicine at the clinic.
“Many of the students have returned and gone to work here,” said Forest Lake clinic manager Kathy Dill. “It is also fulfilling for the physicians to be involved in the students’ success.”
Smith’s mentor at Forest Lake, Dr. Harvey Frank, who was a RPAP participant in the 1970s, was sold on family practice after going through the program and has been a program mentor ever since.
“The students keep me on my toes,” Frank said. “They do outside reading on a case and bring points back to me — they are very motivated.”
Students go to smaller communities near the Twin Cities like Forest Lake and as far away as Rosseau near the Canadian border, Swentko said.
“The larger towns are still outside of the metro area and in need of certain kinds of physicians,” Swentko said.
In general, the first two years of medical school are spent learning history, how to do a good physical and diagnose patients. If a doctor is in an environment where they can just order a test they sometimes forget some of those things they have already learned, Swentko said.
In a place like Big Fork or Black Duck there are no CT scans or MRI facilities available. A doctor must learn different skills to take care of patients without the technology available in a large medical center. They rely on personal skills. For some it is a challenge to go beyond that frame of thinking and rely on themselves, Swentko said.
For many it’s the first experience in clinical medicine. They are out there for nine full months and are practicing almost as if they are first year residents, Swentko said.
“Community physicians and other health care professionals are helping, leading and guiding them to be a unique professional person so they come out well prepared for their fourth year of medical school and beyond,” he said. “When they go into their residency they are very well prepared.
Smith said he is thrilled with his decision to participate in the program even though he remained skeptical about how many complex cases he would see at the clinic.
“I was worried that I would only see patients with runny noses and sore throats but I see a lot of different patients and do a lot of exams,” Smith said.
He said his initial anxiety over receiving a positive clinical experience was alleviated on his first day at the clinic. He assisted in diagnosing a patient with Lyme disease.
“It was like seeing the Holy Grail on my first day,” Smith said.
For the first two weeks after his arrival, doctors carefully monitored his work. After recognizing his knowledge and work ethic, they gave him more freedom to direct patient care plans.
“I would never have be able to do that in other rotations,” he said.
In urban areas patients see their primary care doctor and, if needed, patients see specialists or go to the larger facilities for tests.
In Forest Lake and other small towns, specialists visit clinics on a regular basis so patients can be more easily treated.
For Smith, the constant stream of specialists through the clinic gives him the opportunity to spend more time learning about all areas of medicine without leaving town.
Before going to the Forest Lake clinic, Smith said he would never have considered relocating to a small town, but now sees the many advantages.
“I think the hardest thing will be returning to the (Twin Cities) and having my responsibility taken away,” Smith said.