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Rural training in Willmar, Minn., offers valuable experience for future doctors (with video)

Ingrid Anderson answers a phone while working at Affiliated Community Medical Centers in Willmar. Anderson is one of four students at the University of Minnesota Medical School who have spent the past nine months completing clinical rotations in west central Minnesota. Tribune photo by Ron Adams2 / 2

WILLMAR -- Ingrid Anderson learned in medical school about carotid bruit, the noise made by turbulent blood flow when the main artery in the neck is narrowed from cardiovascular disease.

But she had never encountered the real thing until last month.

"It was 'Oh, my! I heard it,'" said Anderson, a third-year medical student at the University of Minnesota.

The experience was one of many "aha!" moments making up the past nine months for four medical students undergoing clinical training in Willmar. The hands-on education deepens their knowledge and helps them gain skills in everything from prenatal care to communicating with patients.

"I almost feel like I've learned more this past year than in two years of medical school," said Emily Korman, who's attending Des Moines University in Iowa and will graduate next year as a doctor of osteopathic medicine.

Anderson, Korman, Zach Merten and Noah Retka are the latest in a series of third-year medical students to train in rural west central Minnesota. Anderson, Korman and Retka are completing a rotation at Affiliated Community Medical Centers in Willmar. Merten is training at Family Practice Medical Center in Willmar.

The time they spend here is among many steps in the arduous process of the making of a doctor. Ultimately it helps shape the physicians they'll become.

By their third year, medical students have earned a bachelor's degree, been accepted into medical school and spent two intense classroom years mastering a knowledge of human anatomy, disease, pharmacology and more. They have practiced on actor-patients and a few real patients.

Now they're ready for the clinical training that's a major component of the third year at U.S. medical schools.

During the nine months medical students spend in Willmar, they follow the preceptor physicians they work with. They might go on hospital rounds first thing in the morning, then spend the rest of the day in the clinic. Maybe they'll help with simple surgical procedures or assist in delivering a newborn. Hands-on experience is interspersed with classroom training on subjects from dermatology to infectious disease.

"Every day is different," Anderson said. "You're always on your toes. You always feel there's more to learn."

At a teaching hospital, third-year medical students often have limited chances to see real patients, said Dr. Tony Amon of Family Practice Medical Center. But at a rural clinic, "they're seeing patients all the time," he said. "They see them when they're sick and when they're healthy. The real benefit is perfecting their skills and their style and how to relate to people."

More than this, it helps the students grow into their roles as future doctors.

Working alongside the staff at Family Practice Medical Center, Merten saw daily examples of continuity of care.

"You meet patients early on and we're still taking care of them now," he said. If the patient is pregnant, "eventually you get to be there and assist in their delivery," he said. "It's a powerful experience."

Julayne Mayer, who's in her sixth year of coordinating student rotations at ACMC, said it's "pretty cool" to see the transformation that takes place.

"They're realizing they can be part of the process," she said.

For Korman, a defining moment was being put in charge of an ER patient with appendicitis. "I went home and went, 'I'm a real doctor!'" she said.

"You walk into a room and you're like, 'I can handle this.' I'm OK doing things I would never have been comfortable with nine months ago," Anderson said.

Just as crucial, the students learn to recognize when they need help.

"I think it's really important to have a lot of self-confidence, but it's even more important to know your limitations," said Retka.

By interacting with patients and observing mentors, they're also learning to develop their own approach to the doctor-patient relationship.

"All of us had very good mentors that were practicing physicians or faculty at medical school," Amon said. "As students, you find a personality or style to match yours. You find what works."

An emergency room physician at Rice Memorial Hospital impressed Korman with the opening line he used on patients: "I'm sorry you have to be here."

"I thought that was a great way to open up the conversation," Korman said.

A key ingredient in the training experience has been the willingness of local patients to have a medical student involved in their care.

"Their participation is extremely appreciated," Anderson said. "We have this unique privilege of being involved in people's lives. We really take that seriously and value that."

This fall they return to the classroom for their final year of medical school before graduating and joining the ranks of new physicians headed into residency training. All four are interested in primary care, an area in high demand in rural Minnesota.

"It's fulfilling a need," Merten said. "I also feel it's going to be very satisfying for me to take care of people from birth to old age."

Providing training sites for future physicians doesn't come cheaply. Minnesota's Medical Education Research Costs fund, which subsidizes medical and dental training at teaching hospitals and some rural sites, contains $23.9 million for the current biennium. The fund has endured significant cuts in recent years. Although $12.8 million was restored this year for 2014-15, many sites continue to subsidize training costs out of their own budgets, and most rural sites receive no funds at all.

Local providers say they remain committed to training as an investment in the future workforce.

Programs such as the University of Minnesota's Rural Physician Associate Program have demonstrated that when medical students are exposed to rural settings during their training, they are more likely to choose rural practice after they graduate, Amon said. "We feel it's part of our mission to educate."

"What's been really amazing is to find all these preceptors," Mayer said. "It's rare that you get turned down, because they all understand the importance. ... We know that we are providing those experts that are going to take care of us someday."

The students' enthusiasm for learning "makes it a joy" to work with them, she said. "They're experienced when they come. They're confident. They step up to a request. You would like every one of them to come back. You just know they're going to make a big difference."

Anne Polta

Anne Polta covers health care, business/economic development and general assignment. Her HealthBeat blog can be found at Follow her on Twitter at @AnnePolta.

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