Falling in love with rural medicine

“There’s no traffic in the country,” says Dr. Doug Myhre, associate dean of Distributed Learning and Rural Initiatives at the Cumming School of Medicine (CSM).

A short commute isn’t the only reason why medical students are attracted to a career as a rural doctor. Many students who participate in the University of Calgary Longitudinal Integrated Clerkship (UCLIC) program, an opportunity for medical students to spend one year working in a rural community, fall in love with rural medicine.

“Rural medicine is very different in scope than urban practice,” says Myhre. “Rural doctors do everything — from psychiatry, emergency medicine, surgery, obstetrics and pediatrics — they specialize in everything for the community they’re working in. The scope of services a family doctor provides in rural communities is much wider than what’s practiced in the city.”

Beginning in 2008, the UCLIC program originally began with five communities and nine students. Since then, the program has expanded to 12 communities and 23 participating students. The year-long program is designed to give students a taste of life as a rural doctor, including the continuity of community and patients that urban doctors might not experience.

“In my previous rural practice, I had families who came in and we could talk about their grandparents who had passed, referring back to the family tree,” says Myhre. “It’s a long-term relationship. It may not seem like you see them very often, but when you spend 15 minutes with a patient twice a year over the course of 30 years, you do develop a relationship.”

Myhre explains that the program is also about social accountability. Since rural doctors perform many different functions, you don’t just lose a family physician when a doctor retires or leaves the community. You also lose an obstetrician, a surgeon and more. The realities of rural medicine appeal to many students, who often end up staying to work in the community after graduation.

“We work closely with Alberta Health Services to ensure that students are being sent to areas where they’re needed,” says Myhre. “The CSM isn’t only known for our intensive three-year medical degree program, but also for being innovative in our approach to administering long-term clerkships in remote areas. We’re the only school in the world with a long-term clerkship in the third and final year. Other schools hesitate to implement these types of programs due to concerns that students won’t be able to get their academic courses and research days done. The UCLIC program has implemented many inventive ways to make sure this happens. Students communicate with us electronically on a weekly basis. We give exams and do all sorts of things online. You don’t need to be inside the Foothills hospital to learn medicine.”

One student who experienced this first-hand is Dr. Nathan Zondervan, who completed his UCLIC placement in Yellowknife, Northwest Territories. “Applying to the UCLIC program was an easy decision for me,” says Zondervan. “I live for the outdoors and after a few years in the city I was ready for a new adventure. Rather than constantly switching rotations as is done in the urban environment, I thought consistent exposure would allow for greater skill development as I progressed through clerkship.”

Zondervan sees his time in Yellowknife as a period of great challenges and opportunities. “I was frequently asked to take on a higher level of responsibility than I would have if I stayed in the city. I was always on the frontline of patient care. Although I always felt supported, I often had to manage acutely ill patients until the doctor arrived from home and would also frequently act as the first assistant in urgent surgical cases.”

Zondervan is now a fifth-year general surgery resident and is considering the next steps in his career. “Working in Yellowknife has helped me see that I could have a very satisfying career in a rural community,” he says. “As I approach the end of my training, I’m considering community surgery as a realistic opportunity for myself and my family.”

In the future, Myhre hopes to see up to 50 per cent of the medical class taking part in UCLIC. The program’s reach has continued to grow year-over-year and is now working with institutions such as Flinders University in Adelaide, South Australia, to help them evaluate and improve their rural medicine programs.

“More and more of our specialists outside of UCLIC are beginning to go out into rural communities, too,” says Myhre. “People just fall in love with the lifestyle and the experience.”