The Challenge Continues

“I remember going to his house and living there with him. I remember the calls that came in the middle of the night and going to the ER with him and other experiences that most medical students never have. What that experience did for me was wonderful.”

Peterson began his medical education at the two-year University of Minnesota Medical School, Duluth campus, then transferred to the Twin Cities campus where he graduated in 1989—a pattern hundreds of students have followed since the inception of the Medical School's Duluth campus in 1972.

The time Peterson spent with Rysavy was through the Family Practice Preceptorship Program offered in Duluth, a hands-on internship offered to first- and second-year students to give them a taste of the life of a family practitioner in rural and small-town Minnesota. The program is based on the belief—borne out by experience—that students who do preceptorships are more likely to go on to practice medicine in rural locations.

Maximizing the Rural Experience
The preceptorship is part of the Medical School -- Duluth Campus's dual mission—to help fill the growing need for rural doctors as well as for Native American doctors serving the Native American population. At a time when only 3 or 4 percent of medical school graduates across the country end up practicing in rural areas, more than half of all doctors who began their medical educations in Duluth have gone on to take up posts in small towns and cities like St. Cloud, Two Harbors, and Willmar—most as family practice doctors, the rest as pediatricians, surgeons, internists, and specialists in other areas.

Like Dennis Peterson, Steve Tekippe, M.D. President of the Gateway Clinic in Moose Lake has been working with medical students since he joined Gateway twelve years ago. In 2006-7 Tekippe also guided third-year medical students who enrolled in the University's Rural Physician Associate Program (RPAP). RPAP students spend 9 months with their preceptors, working in the local clinic and hospital and living in a community like Moose Lake.

Working with the students is personally rewarding, Tekippe commented. “A lot of the students we've had are the brightest students I've encountered. Their enthusiasm rubs off on me as a provider, and I feel that I'm getting rewarded as a physician just by seeing how fast and quickly they become great physicians over time.”  (Pictured: Devon Dannon, RPAP student and Dr. Steve Tekippe at the Gateway Clinic, Moose Lake, MN)

Tekippe also believes that primary care in a rural setting gives students “the biggest bang for the buck as far as doing the most for patients in the time that they have on the job.”

Ruth Westra, DO and Chair of the Family Medicine Department in Duluth echoed Tekippe's thoughts. “I think the greatest value of RPAP is the continuity experience and longitudinal experience that students gain. They get to follow things that happen to patients, from the clinic to the surgery, from their pregnancy through their baby's first check-up and more. RPAP also helps them make a decision about their future early, Westra added. “By seeing the relationships that physicians have in the community, they see a wonderful role model for their future careers.”

Sarah Sprengeler, a 2007 medical school graduate remembers her preceptorship and recalls observing family doctors delivering babies and performing C-sections, colonoscopies, endoscopies, tubal ligations, circumcisions, and vasectomies. And she learned from pharmacists, social workers in nursing homes, and even family dentists.

“The physicians I met in Moose Lake reminded me of the family doctors I had known and loved growing up. My clinical skills were miles ahead of where I thought I'd be by the end of my second year because these doctors had been so generous with their time. I wanted to spend as much time as I could, learning from them. 
Read Sarah's personal story about her medical school experience.

Dr. Robert Westin, preceptor in the Cuyuna Range Clinic in Crosby, MN talks about being energized by the students under his guidance. “It tends to rejuvenate me as I go on seeing patients even after the student has gone.  I think it does the same type of thing for the nurses and other staff as well.  They join in the “excitement” of finding the student interesting cases to see. And patients appreciate knowing that they can be involved in the educational process for future doctors.  It is fun to watch the student's face light up when a patient informs me that `This one is going to make a good doctor!'”

Sandra Sandstrom, a second year medical student at the end of 2007 who worked with Westin said, “What I have learned in lecture often changes dramatically in practice from patient to patient. My preceptorship experiences have helped me to understand how my education is applied clinically. Also, seeing something in the hospital or clinic that I have learned about in lecture solidifies my understanding of important concepts. It is much easier to remember something after seeing it first-hand.”  (Pictured: Sandra Sandstrom and Dr. Rob Westin discuss a patient at the clinic in Crocby, MN)

A different kind of medical school
Medical students in Duluth are required to do a family practice preceptorship in both years they study at the school. During their first year, they meet with their preceptor for four hours at a time 10 times during the academic year. At the conclusion of the first year, they are paired with rural and smaller community physicians for a three-day period. During the second year, students continue their experiences in a smaller community, spending three days at a time three times during the academic year.

The preceptorships are designed to give students a clear idea of what the life of a rural family practice doctor is really like with the understanding that this exposure will reinforce a student's desire to pursue medicine in a smaller community.

In 2006, almost 1300 students applied to the Medical School, Duluth campus, and 55 were accepted. Grades, personal maturity, and motivation are all characteristics the school's admissions committee looks for, but perhaps the most critical factor is whether a prospective student has ties to and is interested in living and working in a small town in Minnesota.

“When it was initiated in the late 1960s, this school was established to be a different kind of medical school,” says Jim Boulger, Ph.D., Professor of Behavioral Sciences and head of the Center for Rural Mental Health Studies and alumni director for the Medical School, Duluth campus. “Study after study showed that rural America was underserved in terms of the number of family practitioners and other kinds of doctors. We are a mission-driven school, founded to address that specific problem.”

Shortly after the School opened its doors in 1972, another underserved population was added to the school's mission-driven educational program—Native Americans. Not only was (and is) there a shortage of doctors to serve Native Americans, there is also a dramatic shortage of Native American doctors—perhaps only a dozen or so in all of the United States back when the school graduated its first class. While the need is still great, the school's Center of American Indian and Minority Health (CAIMH) has made vast strides in recruiting and training Native American medical students in a culturally supportive manner.

It was this emphasis on Native American health care that brought Chuck Branch, a firefighter/paramedic, to the University of Minnesota - Duluth Campus. (pictured leading CAIMH Drum at the 2006 White Coat Ceremony)  “Once I made the decision to continue my education, I knew that I had to connect these two aspects into one program: who I am and what I want to do with my life. As a result, I only applied to universities that had Centers of Excellence like CAIMH in Duluth. CAIMH sponsored me to go to an Association of American Indian Physicians conference where I was able to attend a pre-admission workshop with other Native Americans in my same situation. This helped tremendously and, in addition to the conference itself, showed that I was not alone in my desire to pursue medicine while maintaining my cultural identity. I made contact with scores of other Native American Health Care Professionals who share the same goal as I do: to be a liaison for Native American patients in Health and Healing, whether it is through Western Medicine or Traditional Medicine. Over my lifetime, I have sought out one form or another depending on the situation and both of them have their merit.” Branch was recently notified that he was the recipient of a prestigious 2007 Minority Scholars Award from the American Medical Association Foundation.
Read more about the Center of American Indian and Minority Health

An expanded focus
According to Raymond Christensen, M.D., assistant dean for rural health on the Duluth campus, initiatives are underway to flesh out ways the University can better serve rural areas of Minnesota. The most recent is the Rural Health Scholars Program (RHSP). Part of Med 2010, the Medical School's five-year process of transforming medical education by the year 2010, RHSP's major goal is to improve the likelihood that medical students from rural areas are selected and are better trained and equipped to commit to and follow through with practicing in rural areas.

“Can we do a better job of choosing applicants to make sure that we accept only students who want to live in rural communities?” Christensen asks. “Are there better ways of training them in the whole range of abilities they will need to practice in, say, Baudette or Olivia? Are there different ways of structuring the preceptorship program to make it possible for students to spend enough time in one community that they might put down roots there? These are some of the things we are looking at.”

Christensen says that they also will examine ways to help medical students planning on rural family practice defray the rising cost of their educations—a major consideration when it comes time to choose whether to pursue a small-town primary care practice, where the financial compensation is not as great as with an urban-based subspecialty. “When a student leaves the University of Minnesota they often have a debt load of up to $150,000. That's just one of the reasons that scholarships are so important to these dedicated students,” he said.

In the meantime the students continue to experience small town life and practice. In 2007, second year medical student, Heather Sieben (pictured on left with with Drs. Julie Bell and Ruth Westra at the clinic in Little Falls, MN) reflects on her experience in Little Falls, MN: “I have learned that even this 'suburbs' girl really enjoys the 'community' aspect of the smaller town. Little Falls is the ideal size to be anonymous at times yet known at others. I really enjoy the opportunities there are in this size of community within the community.”