I recently had the pleasure of rotating at Central Maine Medical Center’s rural track program in Rumford, Maine.  I was struck by how much being back in a small town made me appreciate what I have been missing since I have been away from my own hometown in order to study medicine.  There was an excitement to teach that medical students tend not to expect, but feel as if they’ve won a contest when they experience it.  It was incredibly refreshing as a student, who often feels as an imposition or burden on providers, to feel as if the emphasis of the rotation was on the quality of the teaching and not purely on the ability of the student to self-learn.

Full spectrum care
At no other point in my medical training to date had I been exposed to true full spectrum care.  In brief, you would start the day by rounding on clinic patients who were admitted to the hospital.  The small hospital of twenty five beds and friendly smiles at every turn, removed the intimidation factor that larger hospitals have a tendency toward, which can interfere with learning opportunities. When finished rounding in the morning, we headed over to the clinic for the day to see patients.

I had the opportunity to see anything from well child visits and prenatal appointments to management of chronic disease.  There were various procedures scattered throughout my days consisting of skin lesion removal, colposcopy and IUD insertion or removal.  On one particular day a female prenatal patient was induced for postdates first thing in the morning, a full patient panel was seen during the office day with checking on the prenatal patient briefly during lunch, and finally delivering her little baby boy around six in the evening after wrapping up at the clinic.  That day left an everlasting impression of what full spectrum family practice could be.

Hands on training
If another physician I didn’t happen to be working with in the office had an interesting patient or exam finding, they would take the opportunity to come find me and allow me to experience the patient in person.  Enough cannot be said about the value in this for a medical student.  Countless times in the past I can recall a physician describing that unusual patient they had earlier in the day and how they wished I had been there to see and learn from the case.  Hearing about these patients and missed opportunities is not helpful in terms of learning and development of my medical management skills.  There is no replacement for that personal interaction with patients and hands on care.

It was clear that the members of the medical staff are more than just co-workers.  After just a few brief interactions it became obvious that they knew each other’s families and were familiar with and invested in their community.  I was able to observe how they were able to share this relationship with their patients as well while maintaining professional boundaries.  They were also happy to extend their friendliness to a medical student, genuinely interested in my background and living situation, always approachable and helpful with all of my questions.

Tailor-made rotation
I appreciated that I was recognized as a fourth year medical student and that my rotation was tailored to reflect that.  Although history taking and exam findings remained important, the emphasis was placed onto differential diagnosis and development of a management plan.  I was asked during various points of my rotation if the way it was being run was meeting my expectations.  There were multiple occurrences where faculty members encouraged me to share with them what more I was hoping to gain from my experience at a rural facility.   I am truly grateful for having had the opportunity to participate in a month of full spectrum rural medicine; it was worth the sacrifice of time for traveling.