The origin of the word “doctor” in the Merriam-Webster dictionary is teacher.* Rural surgeons have the opportunity to be unique teachers and as the American journalist and historian Henry Brooks Adams once observed, “A teacher affects eternity; he can never tell where his influence stops.”†
My hospital, McPherson Hospital, KS, has been a teaching facility since the late 1990s. With the support and foresight of the leaders at Kansas University (KU) School of Medicine, Kansas City, and a local family practitioner, Greg Thomas, MD, our town of 13,000 has been host to dozens of students during the last 18 years. This column describes that experience along with suggestions for how to start a rural surgical training program for medical students and residents.
Personal early exposure
Even before I was a physician or surgeon, I benefitted from the belief that it is every surgeon’s responsibility to teach the next generation. At 17 years old, I walked into the office of David K. Selby, MD, FACS, who had just returned from leading the 101st Airborne MedEvac unit in Vietnam and subsequently set up his orthopaedic surgery practice in my hometown of Garland, TX. Dr. Selby, who died in 1997, was an idol of mine and to this day his mentorship influences my decisions and judgment.
Dr. Selby, without the support of an outside organization, developed an independent summer pre-med program for students. Where he went, we went, and he paid us out of his own pocket. Some of us never went to medical school (a success for those not suited to the lifestyle), and some of us did, including John F. Eidt, MD, FACS, vascular surgeon and director of the American Board of Surgery.
Starting the KU program
I decided to follow Dr. Selby’s lead, and in my first year out of residency I developed an independent pre-med program. My first student became a general surgeon and took my place in my Dallas practice when I left to become a rural surgeon. In McPherson, I did the same thing, but within a few years it became obvious that more could be done with the help of the medical school. We initially developed a fourth-year rotation elective as a pilot, and our first student, Apostolos (Likee) Evangildes, MD, became a urologist.
After receiving positive reports from the students, KU, as part of its program to develop rural-based education, asked if we would take on medical students who were in their third-year basic surgery rotation, and of course we enthusiastically agreed to do so. Our program has taken on two students nearly every other month since the collaboration began.
My partners at the time, Erik Rieger, MD, FACS, and Clayton Fetsch, MD, FACS, have worked with students since this initiative started. Dr. Rieger moved to Canyon City, CO, eight years ago and Dr. Fetsch continues to work with me today.
The students’ duties are to learn as much as possible about the realities of being a physician, to understand the role of the general surgeon who is practicing far from the university medical center, and to meet the curricular requirements for the third year of medical school. This experience offers these students the opportunity to get a peek at the other side of life after their training. Because we have no fellows, residents, or interns, these medical students are our first assistants, commensurate with their abilities, and see patients as much as possible before anyone else. Hence, these students have the opportunity to make a diagnosis rather than be told to work up the appendicitis in room 308. They become a part of our team and are expected to conduct themselves like any other medical professional. More than once, a student has called me tremulously at 3:00 am because he or she couldn’t sleep and had checked on an ill patient who they feared might be taking a turn for the worse. More than once, that sort of attitude has saved the day for a patient. So, the benefit is not just to the student but to the patients as well. Rarely do patients refuse to let the student be a part of their care. Most patients feel a special pride in being able to “teach” a student.
Maybe one of the best days of my teaching experience was in March 2016 in New Orleans, LA, when I was helping with the certifying examinations. One of the associate examiners approached me and said that one of his residents, David Klima, MD, wanted me to know that he was taking the exam that day. David was an outstanding student, and he is the only student of mine who has operated on me. While he was on rotation as a third-year medical student, I cut my hand while working on the left engine of my airplane. I phoned him and said we were going to see how good he was. I met him at the office and he expertly sutured my laceration. I can’t even find the scar now. David is currently finishing his pediatric surgery fellowship in Birmingham, AL. My students are scattered around the U.S. in both rural and urban environments. I am proud of all of them, surgeons and nonsurgeons alike.
Mutually rewarding experience
The rotation at McPherson is extremely popular for many reasons. Most participants say that they long for the opportunity to be on the front line of care and part of the surgical team. Some students want to see if rural medicine is for them, and all of them enjoy seeing that a rural physician has an interesting and full life. KU is wise in letting the students find locations where they can actively participate.
It is rare in any medical school these days for an attending surgeon to have extensive one-on-one time with third-year students. Our rotation works out to be about 40 hours a week of face time with daily didactic sessions as well as practical training in the operating room. Our staff and administration have been supportive, which is essential to the success of the program, and our small town raised enough money to build a dormitory and library for the students, since housing is an essential part of a remote location rotation.
Developing and implementing this type of program is not difficult if one has the desire to do it. Remember that this work is not a path to riches and that mainly you commit to these types of activities for free because teaching the next generation is part of your mission as a surgeon. The first step is to reach out to the medical school nearest you. So far, I’ve found great support from the chief of surgery and the third-year student rotation directors. Let them know that you would like to be part of their effort and get to know the faculty. My bet is that many medical schools will welcome the assistance.
Teaching medical students is a rewarding experience, and I’ve become a better surgeon as a result. Some say students slow them down. Well, I slowed down Dave Selby when I was 17 years old, but he felt it was worth it. I think he was right.
*Doctor. Merriam-Webster.com. Available at: www.merriam-webster.com/dictionary/doctor. Accessed May 25, 2016.
†National Education Association. Quotes about teaching. Available at: www.nea.org/grants/55158.htm. Accessed May 25, 2016.