By BRIAN WHEPLEY
KU News Service
Third-year medical student Jack Thomas considered going somewhere besides his hometown of Scott City to fulfill KU School of Medicine-Wichita’s rural training requirement. But the appeal of a familiar family medicine clinic and time with his family, friends, dog and mother’s cooking won out.
“It’s interesting seeing people you know. My first day there I saw one of my neighbors and had the chance to reconnect and help them,” Thomas says of the family medicine clerkship.
“I always look to connect rural students back to their rural roots if they’re interested,” says Lynn Fisher, M.D., associate professor of family and community medicine and assistant clerkship director. “It’s like a puzzle,” he says of balancing locations and student interests that can include going back home and facets of family medicine such as obstetrics, pediatrics, surgery, emergency care and hospital care.
Thomas is no stranger to the Scott City Clinic, as he participated in Scholars in Health as a Kansas State University undergraduate. The program identifies Kansas residents interested in becoming primary care doctors in underserved areas and, having met academic and other requirements, guarantees medical school admission. As a scholar, he shadowed Scott City physicians.
This time around, his immersion shifted from watching to doing. That ranges from writing case notes to navigating the electronic medical record system to following a visiting general surgeon and an ear, nose and throat specialist. He’s done morning rounds and gotten to see patients on his own and with Libby Hineman, M.D., and colleagues Chris Cupp, M.D., and Matthew Lightner, M.D. – all KU School of Medicine graduates.
“It’s been different in that I’ve been going in and seeing and talking to patients and then presenting a differential diagnosis,” Thomas says. “The three doctors are really good teachers and very helpful in me gaining clinical skills like physical exams.”
And he’s gotten hands-on, from removing skin lesions to sewing stitches to what Hineman calls “a perk of coming way out here,” helping deliver a baby via C-section one week and scrubbing in for a laparoscopic procedure the next.
Family medicine, “it’s a nice rotation to do at the beginning of your third year before you get into all those specialty rotations,” says Hineman, who’s known Thomas since starting practice in Scott City in 2006.
Finding a painful path to medicine
Growing up in the town of about 4,000, where his father works in natural gas sales and mother was a radiology technician, Thomas wasn’t immersed in medicine. That changed during his junior year of high school when the distance runner – a state champion in cross-country and the 3,200 meter – tore a critical hip cartilage, the labrum, at a critical time, college recruiting season.
“It was my whole life,” he says of running, so the injury was devastating and the journey to successful treatment and recovery left an impression.
He saw different orthopedists for assessment and feels fortunate to have found a Colorado hip specialist who delivered a sobering timeframe for recovery but also provided the expertise to enable Thomas to heal and earn a spot on the K-State cross-country team. He’d run for two years in college before fully turning his attention to a new passion, medicine.
Thomas, whose first two years of medical school were in Kansas City, initially wanted to pursue orthopedics but has shifted toward dermatology, an interest furthered by a family history of skin cancer and skin issues of his own. He sees the need for rural dermatologists and can envision a practice with visits to multiple rural locations, and Hineman says they’ve discussed how a rural specialty practice is more doable now than in the past.
Still, Thomas has made no final decision on a specialty: “I want to go through all the other rotations to see if there’s something I really enjoy.”
How the clerkships work
Medical students have long had a required fourth-year, four-week rural rotation. Starting last year, though, students choosing to do the longer third-year family medicine clerkship in a rural location can use it to satisfy the fourth-year requirement.
It’s a change that allows students more time for fourth-year electives but also – as Hineman and Fisher mentioned – encourages earlier exposure to rural practice. As a result, it’s an opportunity for students to be sold on family medicine before the residency match process kicks in and makes a switch more challenging.
Fisher handles the Wichita campus’ rural placements, about 40-plus annually for third years, while the Kansas City campus coordinates those for its students and Salina’s. Volunteer preceptors – the local physician mentors – are available in almost every county with full-time family physicians.
“Some sites take multiple students almost every month of the year. Some sites will take a student three or four times a year. Some sites may take a student once or twice a year. It just runs the gamut,” says Fisher, noting sites might drop in and out if they lose physicians. Scott City, for example, stopped taking students when it went from five doctors to three.
“The doctors, a lot of them KU graduates, are wanting to give back to future students. Teaching helps keep you on your toes, and we know it also helps prevent burnout,” Fisher says. “I think hospital systems do it because you never know when that potentially could land you a future recruit. Sometimes students love a site so much that they may go back multiple times because they really have an interest.”
Seeing rural practice in action can be a powerful recruiting tool. Fisher notes his fourth-year med school rotation in Quinter led to his 15 years of rural practice. Scott City will soon return to a full complement of five doctors and restore obstetrics care when Morgan Gillam, M.D., and Brittany Peach, M.D., KUSM-Wichita and Via Christi family medicine graduates, join the practice. Both did rotations during residency there.
“They loved the community, but they also loved our practice and how we worked together,” Hineman says. “It gave them that peek into, ‘Hey, I might want to work there someday.’”
In addition to teaching about medicine, Hineman says, preceptors can share how a small-town physician can achieve a work-life balance – or something close to it – amid late-night deliveries, ER and vacation coverage, and raising a family. Often, the job extends beyond medical care: “The physicians play such an important role in the community, and community members look to them for leadership,” Thomas says.
While still debating a specialty, Thomas appreciates family medicine.
“They take care of the whole family and take care of people their entire lives. They know how to form relationships with patients,” Thomas says. “You’re doing a lot of procedures, filling the role of general surgeon, delivering babies, acting as an internist. You have to know a lot about everything.”