Twenty-seven years ago, urged by small-town physicians who witnessed their numbers dwindling, the UW medical school created a formal program to prepare more physicians for rural practice. Today UW medical students can take required third-year courses at 37 sites in five states, residents (recent M.D. graduates from around the nation) train at 25 sites, and nearly a hundred rural physicians open their homes and clinics to medical students for one-on-one elective placements for the summer. The medical school also oversees a physician assistant training program, and has joined other UW health sciences schools in a new initiative for interprofessional training among students in nursing, medicine, pharmacy and other health professions.

Since the WWAMI program started, 2,864 students have graduated from the UW medical school. About 10 percent practice in rural areas, according to the American Medical Association Physician Masterfile. A winter survey of UW residency graduates showed that 57 percent practice in WWAMI-land.

That a major research institution like the UW School of Medicine would educate students in community practice was considered a heresy to some medical educators at the start of the WWAMI Program.

"In the 1970s, a number of medical students were beginning to focus on the education of the generalist physician, but there was a notion this had to be separate from a scientific center. This seemed wrong to me. I felt the two should go hand in hand," recalls Theodore Phillips, who founded the Department of Family Medicine and later was associate dean for academic affairs. Over the years, Phillips was proven right.

"Towns and hospitals around the WWAMI region like having UW students and residents," says Assistant Dean Philip Cleveland. "The involvement of these small communities has been the cornerstone of the UW's achievements in rural medicine."

Dayton, Wash., a town of 2,597 in the southeast corner of the state, is one of nearly a hundred examples across the WWAMI map. When medical students come to train with Michael Luce, as they have most summers for the past 10 years, they notice that the occupation of "country doctor" suits Luce to a T. He provides health care to everyone from great-grandmothers to their seconds-old descendants.

Most community physicians like Luce teach for the UW as unpaid volunteers. When passing on their medical skills and knowledge, they add something more: they make plain their daily lives so that students can determine if that is how they, too, want to live.

Community faculty often leave the doors to their offices ajar. Students feel free to come in and talk with them about academic or personal matters. Many also give their time to civic causes. They take their medical students with them to kindergarten health screenings; to sporting events where they are the team physicians; to first-aid tents at parades, rodeos and canoe races; to ranger stations to give physicals to volunteer forest firefighters; and to search and rescue teams in the wilderness.

Dr. Rebecca Anderson checks patient Doris Ashbrook's vital signs at a WWAMI site in Missoula, Mont. Training with her is Renee Stapleton.

Shrinking the hundreds of miles between the medical school and outlying physicians calls for electronic ingenuity coupled with human compassion and friendliness. Many UW medical faculty connect to rural physicians through the MEDCON phone consulting service, or sit at one of the UW telemedicine stations. Not only can UW and rural doctors see and talk to each other through a high-speed link, they can jointly review diagnostic images, such as X-rays or ultrasounds.

Like TV sports commentators during instant replays, they use computer pens to circle questionable spots: Does this the ultrasound image show a surgically repairable birth defect on the fetus? Is there a hairline fracture on this X-ray of an injured high school athlete? Doctors at both ends of the circuit can even put on long-distance stethoscopes. Together, they can listen to, then discuss, the heart or lung sounds of a patient.

Doctors also can consult with UW physicians via the Internet, tap into UW health sciences library resources, and send and receive patient records and diagnostic images over a high-security graphic Web system called U-Link. For example, a rural doctor can transmit a picture of a patient's skin rash, and have a UW dermatologist comment on what it might be.

Communications technology also lets rural physicians keep pace with rapid advances in medical knowledge. In a speech to WWAMI leaders, Medical School Dean Paul Ramsey pointed out that much of the medical information required by the average physician is out-of-date in five years. For overworked rural physicians, who often can't get away to attend conferences, staying current can be daunting. The UW is starting several electronic endeavors to instruct rural doctors via videotapes, telemedicine or the Web.

Research Also Part of WWAMI Training Efforts

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