Medical Students, Small Towns, and the Power of Relationships

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By: Scott Hippe, fourth-year medical student, University of Washington School of Medicine

Scott Hippe is currently traipsing about the Pacific Northwest on his clinical rotations. His interests include rural medicine, the outdoors, and listening to or telling a good story. He will be applying to a residency in family medicine this year.

Before ever setting foot in a medical school classroom, I spent a week observing competent, compassionate rural physicians care for the diverse health needs of their community. This was the first of my experiences participating in the WWAMI Targeted Rural Underserved Track (TRUST) Program—described in a recent report by Greer and colleagues—which paired me with a small town in north-central Washington State named Chelan. Entering the program I had few expectations and little idea where it would take me. Now, over three years after my first experience, the program has guided my career plans. I will be entering a family medicine residency with a rural emphasis and I intend to practice in an underserved area in the Pacific Northwest. What between then and now sent me down this path? In a word, relationships.

Relationships with my patients. In my third year, I spent a total of eighteen weeks in my TRUST continuity community, and during that time accumulated over 800 patient encounters. I established relationships and followed patients longitudinally. I was surprised by how much I enjoyed seeing patients that I knew for follow-up visits. Many individuals come to mind, such as the elderly woman with severe chronic obstructive pulmonary disease, the middle-aged man with syncope and phantom gastrointestinal bleeding, and the pregnant woman I saw weekly for two months before delivering her baby. The relationships I formed with these and many other patients resonated with my desire to connect with the people I serve.

Relationships with my community. As part of the TRUST curriculum, I was tasked with various community health projects. I explored a home visit curriculum for mothers in the postpartum period and raised awareness of safe medication disposal practices. Through organizing these projects I formed relationships within the school district, food bank, senior center, and community service groups. I also spoke multiple times over the airwaves with the former mayor on Chelan’s “Second Cup” radio talk show. In medical school, I learned that addressing the social determinants of health requires interventions outside the hospital. TRUST put me close to the community partners whose contributions are necessary to address those determinants and improve overall community health.

Relationships with my providers. I have known the physicians in Chelan for over three years. This benefited me directly because I was able to do more as a third-year medical student than I could when I was bound by the traditional medical hierarchy. I assisted on Cesarean sections and learned the basics of endoscopy. My attending physicians were comfortable letting me interact with patients, so I gained skill and efficiency in running my own office visits. But even more important than what I was able to do was observing the commitment these doctors have to the health of their patients and community. After three years of interacting with many physicians, these are the ones I want to be like when I “grow up,” the ones who inspire me to be the best I can be.

I was placed in a small town to learn medicine. It has been the highlight of my time in medical school and led me to a career in primary care. In an era when student specialty choice and national specialty needs are tragically mismatched, programs like TRUST can overcome the factors that deter students from choosing primary care.

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