Transcripts of Interviews

Prairie Public Television Interview with UND Medical School Student

Eight UND medical school students talk with Prairie Public Producer, Matt Olien, about their perceptions of rural health care, their innovative medical school curriculum, and their career plans.

Prairie Public
Tell us about your experiences so far here at the medical school.

Katie Hunt
So far my experience here has been very positive. I really enjoyed the curriculum that we have. Every week we are able to actually experience a real patient and then apply that to the topic that we're learning for that week so I've enjoyed actually being able to see how my new knowledge is going to apply to working with a patient.

John Sillery
Well I'm a real huge fan of the curriculum, and anyone who knows me knows that. I would have a hard time learning if it was just based on classroom learning, if I was expected to see things written on a board and just learn in that way. If I was to learn the Kreb cycle or something like that that medical students are expected to learn just from a book, I would never be able to learn it. But by being able to apply it to the weekly patients that we see, to see a diabetic patient suffering from their disease and understand how that all falls into what we're learning from the books, that really helps me to learn and to thrive in this curriculum.

John Lyng
I agree with what's been said already. I'm definitely a person who likes to learn by doing, and to me it just makes sense to learn medicine by doing it instead of on the old style of curriculum where you sat and lectured and tried to absorb as much as you could. When you can actually apply your skills and you get the human part of it by having interaction with the patients, it just seems to set in a lot better.

James Bares
I think that another aspect of this curriculum that's really great is it allows the students to basically set their own schedule. And for somebody like me who has a family at home, it's a very positive thing because it allows me to set my schedule around my family and not the other way.

Jill Melicher
I'm a first year at UND, and people have asked me how do you like med school this year, and I told them I love it more than I ever thought I would. And I think it's because you're practicing in a clinical setting from day one, and by practicing I mean you're learning everything in a context of a clinical setting. You're not learning all of your biochemical pathways and genetics and then thrown in to see a patient two years later and have to integrate that into your thought process. And so in that respect, I can't imagine learning it any other way. You learn what you need to know and what's important to the case and integrate that into the systemic form where you also are able then to apply what is important to the patient with the disease. And to me what's most important is that you can apply the psychosocial and the biochemical issues together.

Justin Buls
I absolutely love the curriculum. Some of the best aspects are actually having patients come in and discuss the case and have us work through various problems with them. The medical school encourages us to go and have specific experiences where we actually interview patients, or mock patients, and actually examine patients in our first real semester of medical school. I find that it alleviates much of the anxiety and is incredibly beneficial.

Jared Bratvold
I agree completely with the things that have been said so far. I think this curriculum is probably the best curriculum that's in the country right now. It gives us the freedom to be able to integrate our own learning needs in with what we need to learn for specific issues. I think it's wonderful that in our second year at least we get to go to the hospitals and interact with patients on a doctor-patient level rather than just models that you would come in and interview. It's just helped a tremendous amount to learn that way versus just studying a book.

Krista Olsen
I definitely learn by application so the patient-centered learning portion of the curriculum has been a major benefit to me. In the IPC portion of our curriculum, we have the opportunity in the second semester of our first year to interact with patients, and so you're able to enter the hospital in the second semester of your first year right off the bat, At many other medical schools you're not able to do that. In your second year, you're able also to interact with doctors and interact with patients and do not only the history-taking but also the physical exam and then do patient presentation to the physician. Between our first and second year we have the opportunity to do a rural medicine externship where we work one-on-one with a physician, a family physician generally, and see patients and also do patient presentations so we get a whole broad range of interaction. That's been great.

Prairie Public
The third year program is a ROME - Rural Opportunities in Medical Education - program where you can go and work at a rural clinic or rural hospital. How many of you are interested in doing that, and why?

John Sillery
I'm strongly interested in the ROME program. I came from a small town -Glendive - and worked in the hospital there for ten years so I'm not really a traditional student, but I know the things that you can see in a small town. You have more of a rounded experience because you'll get to see the patients not only in the office but also as part of the community. And I really support and feel strongly that these small communities need some form of medical care available to them.

Jill Melicher
As a second year, I've chosen not to participate in the ROME program for my third year, and I'll be doing the traditional third and fourth year in Fargo. And the reason why I've chosen to do that is I believe that I want to specialize, and I think I'll get a greater interaction with specialties and subspecialties in the area of my interest so I've chosen not to partake in the ROME program.

Prairie Public
Are there drawbacks to working in a smaller clinic?

John Lyng
I will probably chose not to work in a rural area because I intend on specializing in emergency medicine which would be much more common in an urban area. But another drawback would be that my fiancé really wouldn't have a lot of job opportunities for in a small rural area. Her major is hotel and restaurant management and you really don't find a whole lot of those in the smaller towns. You need to go to the bigger cities for those jobs.

Prairie Public
Some of you folks here are from smaller towns. What have you seen change in your town over the years with medical service?

John Lyng
The services keep in step with technology. They've used the tele-medicine. They have specialists come in from the larger clinics like from the MeritCare Clinic in Fargo. But I've seen some of the services decline. Mayville doesn't want to deliver babies anymore. That's been a choice of the physicians and a choice of the hospital. There's just too many things that can go wrong with births, and when they do go wrong, they're pretty major, and it's just better to deliver babies where there's more resources available to help care for them.

Prairie Public
How about in Glendive?

John Sillery
It's important for a young physician starting out to figure out what your family's willing to put up with. From what I've seen in Glendive, the most difficulty that the physicians have is with their spouses adjusting to a small town life. Typically coming out of a medical school residency environment, you've been in a large city for a number of years and then to come to a town of 4000 people is a major adjustment. So you need to have your family behind you 100%. I think another problem that rural physicians face is that there are fewer people to fall back on than in an urban environment. I think in an environment like Grand Forks there really aren't too many physicians that could take a week off and be missed. Someone else can take care of his patients if need be. In a rural situation, you don't always have that luxury, and so you're expected to care for your patients 24 hours a day, seven days a week, and I think that that can get very demanding for physicians in rural environments. I think most physicians would agree that rural physicians have to work harder than urban physicians because of that.

James Bares
One of the down sides to rural areas such as in Beach where you have to drive an hour either direction to get decent medical care. Other than go into the clinic , there's a lack of medical facilities if somebody goes into labor or if there's a trauma. Transport time is at least an hour to the nearest facility, and I think that's part of the problem in rural areas.

Prairie Public
Is it a health issue for people in your area if they can't get to the facilities they need to get to?

James Bares
Absolutely. It is definitely a health issue. I think what's deeper than that though is the health care professionals that they do get in the area such as Beach tend to be around for a year or two and then leave so there's also a lack of trust toward the health care professionals in those areas, and that's detrimental to public health.

Jared Bratvold
Bagley has a little community hospital and a clinic. One of the things that I noticed in addition to health care being provided, our rural communities really have to become innovative of how they deliver that health care with limited staff. And that's not only physicians, that's all allied health. In a rural situation, the physicians become more interactive with the nurses and specifically health care nurses where they try to have maybe a little bit longer stays. The health care providers become really a lot more intimate with their colleagues and patients in a rural situation.

James Bares
Regarding access to medicine abd staffing, I've noticed that in Mayville and smaller rural areas and in the western part of the state, there isn't necessarily a lack of physicians but there is a lack of other health care professionals. I've read numerous articles over the past few years on how ambulance squads are struggling to get their shifts covered, and that's definitely an issue that rural communities have to address. And if it's difficult to get physicians to stay around, for some of the same reasons it's difficult to get EMTs and first responders.

Jill Melicher
Well, Fargo has been referred to as a mini Mayo basically. You have access to the whole gamut of health care that you require, whether its neurology, oncology, things like that so that's been wonderful. I know that in some areas Fargo will refer to either the U. of M. or Rochester, but it's not a great distance so most of your medical care can be taken care of in Fargo.

Krista Olsen
Guess I'd piggyback on what Jill said. Growing up we never questioned if you had to see a specialist that you'd have to pack up your bags and leave for a weekend. They'd be two doors down. However, I also do have to agree that I think they were great in providing that primary care service. My family physician knew me from my first checkup until I went off to college. Growing up in Fargo I never really felt that there was a lack of specialists. If you needed to see someone, they'd be in the same medical setting that you were already in or you could make an appointment for the next day, and you didn't have to pack up your bags and have the concern of getting to the next medical center. But I did feel that there was a continuity to my care. I still keep in touch with my family physician. I think it's important to being a family practice physician or a generalist to have that continuity of care and relationship with your patient. And maybe that's even more unique in a rural setting where you're likely to know the entire family and the history of the family. You can treat the patient for more than general primary care due to the lack of other specialists in the area.

Prairie Public
Justin, do population and medical trends differ in Montana?

Justin Buls
Yeah, western Montana seems to be growing as a whole between Bozeman and Kalispell, and as it grows, it seems like the medical community grows with it and almost surpasses it. The number of physicians in specialty units outweigh those in most parts of the country, even in big cities. There are a dozen orthopedic surgeons whereas in a community like Grand Forks, there's maybe eight, and Grand Forks is maybe twice, three times the size. But not everybody has that unique experience. I noticed one of the good things about is that even though there are a lot of physicians they're still on a community level with their patients. With only 30,000 people, most people know each other. That makes it nice on a patient-physician level where you know who you're talking to and even see them out in the community.

Prairie Public
How about in Minnesota, Katie?

Katie Hunt
Between the University of Minnesota and your local family practice physician, you definitely always had a sense that no matter what happened, you would be taken care of. Especially in the Twin Cities with the Mayo Clinic only an hour or so away, you knew you had access to the finest care available so there is definitely a sense of security. I think that's something that I really do enjoy about a larger city. But, in the more rural areas l I think you do get more of a continuity of care than you get in a larger city. The physician will know your entire family, know your history, see you in the community, and really know you on a level that perhaps a physician in a large community may not.

Prairie Public
Are you interested in participating in the ROME program, or practicing medicine in a small town some day?

James Bares
Growing up in a small town I guess that's all I know. I think the people aspect of working in a small town and knowing everyone is a bonus. In the old days when somebody needed help, they came knocking on your door and in payment they gave you a hog or something like that. I think those are the good old days, but that's not really realistic anymore. I think the main point is I just enjoy the people in rural North Dakota, and I would like to go back there and work.

Justin Buls
Yeah. I just think it's a way of life. Just because you change your profession and become a physician versus somebody who works in the mill doesn't mean that you don't want to pursue that way of life. The comfort level that you surround yourself in the community where people know you and you know them just adds an aspect to life that makes it easier to continue on.

Jared Bratvold
As far as my participation in ROME goes, I was a nurse for five years previously in a rural community before attending medical school. I'm familiar with a lot of the services and capabilities in a rural setting, and I think to benefit my patients I need to get an idea of what actually occurs at a larger institution and in larger hospitals, and the diverse facilities that are out there. But I definitely want to return to a smaller community because the lifestyle living in the country, having that freedom to be a quarter mile away from your neighbors yet go in and know every single person in the community and provide their health care in such an intimate setting is what medicine is to me.

Katie Hunt
At this point in my education, I feel that I need to really get exposed to all the different options and different ways of treating people that are out there. I understand that with ROME you probably will see just as much and get just as good an experience as you would in a more traditional setting. But for my own peace of mind, I want to go through more of the traditional curriculum that I've seen work for generations of doctors ahead of me.

Krista Olsen
I don't feel small town medicine is for me. I loved growing up in more of a rural setting, but that's not really where my passions lie in life in medicine and why I went into medicine. And so I don't think that I will end up practicing in a rural setting.

Jill Melicher
I'd like to come back to Fargo and practice in Fargo. But I'd like to get out for awhile. I think it's important to broaden your horizons, do something else for a little bit, live in a bigger city and then return.

Justin Buls
I personally would like to do the ROME program, but with a family and a child that kind of makes it hard to pack up and move to a small community when you kind of have a home base and a support system already set up so. That would be my only reason why I wouldn't chose to do ROME.

James Bares
Another aspect about working in a rural community that a lot of people don't realize. Most people say they would not work in a rural community because of the workload and the demand on the physicians in those areas. But nowadays realistically that isn't the case so much because most clinics are set up on a satellite basis so physicians live in a town like Bismarck or Dickinson or something like that and they drive out to the clinics so their work hours are probably better than most physicians that do work in an urban area because they drive out there at eight in the morning, and they're done at five, and they drive back to Bismarck or wherever, and that's that.

Jared Bratvold
My best friend went through the nontraditional ROME learning program. It was actually quite fascinating to watch him go into the clinic and have patients become excited and say, 'Oh, you're really a student?' They'll divulge a lot more to the student sometimes rather than the physician, and it'll be like, "No I want the student to do this. I want them to actually work on me and perform and perfect their skills. I don't care if the scar isn't exactly perfect or anything." So in that respect, ROME would be a really great opportunity for a lot of my classmates.

Prairie Public
Have any of you had experiences with the J1 physician program?.

James Bares
For the most part the J1s move on within two or three years. I think that's the downside to these physicians. They're not around long enough, and the people in the community don't trust them. I don't know if it's necessarily so much that they're foreign or from a different country as much as that they're not there long enough to build trust.

Justin Buls
Yeah. Around Kalispell they rely on physicians coming out of school and even help pay for their student loans so that they'll come there. And the doctors stay there till their loans to get paid off, and then they leave. It makes it hard for the community to trust that physician when they know he's not going to be there tomorrow.

John Lyng
Some of the Armed Forces scholarships are available right off the bat, but when you do that, you have to make the decision well do I want to have a choice where I go when I get my M.D. or do I want to have the Air Force or Army or Navy say you're going to go to Biloxi, Mississippi, or you're going to go off to Afghanistan or whatever. If it was just me that had to make the decision, I would probably go with the Air Force, but I have to consider that I'm going to have a family by the time I'm done with medical school, and my wife might not want to go where the Armed Forces send me.

Prairie Public
So the choice of where you want to be and what you want to do is more important than getting the loans repaid?

John Sillery
Definitely. I think some independence in where you're going to go and getting a chance to actually be able to go there real time and interview six months or three months ahead of the time is important. You're going to be there and see what's available and see how the health care facility is responding to the needs of the community. I think you need to have that. I need to have that flexibility. Of course my wife has a list of places that we're supposed to go too so I have some restrictions there.

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