Dr. Almost

Third-year medical students learn medicine hands-on through clerkship rotations

“If I am doing all of this in my second week, I can’t imagine what I will be doing in week eight.”

Brad Kohoutek, a third-year medical student at UND spent eight weeks in Wahpeton, his hometown, learning the basics of family medicine.

These clerkships in the third and fourth years at sites throughout the state provide students clinical experience ranging from physician practices in a rural health care system to urban medical centers.

The third year focuses on the basics, providing eight weeks each of family medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics and psychiatry.

During these clerkships, the students are almost doctors with the same commitments of hospital rounds, seeing patients in the clinic and being on call.

To teach these clerkships, the medical school relies on a cadre of more than 900 volunteer physician-faculty members throughout the state.

Kohoutek’s preceptor, Robert Ostmo, M.D. (B.S. Med. ’80), clinical assistant professor of family and community medicine, has been teaching students one way or the other for about 25 years.

“I consider it almost an obligation,” he said.  “The state spends a lot of money on educating medical students, so I believe we owe

it to the state to give back in some way.”

A day in the life

Dr. Robert Ostmo (right) watches carefully as third-year medical student Brad Kohoutek checks for signs of arthritis in a patient at MeritCare Clinic in Wahpeton. Photo by Mike Smith, MeritCare

Kohoutek starts his day early in the morning doing rounds with Ostmo at the hospital.  If Ostmo is on call at the emergency room, Kohoutek stands guard, being the first to see the patients

as they arrive to gather medical histories and do a basic assessment of the situation.  He then calls Ostmo and briefs him on the patient before he arrives.

“They trust us to do a lot,” said Kohoutek.  “Dr. Ostmo gives me freedom and other opportunities as well.  He tries to let me see a

lot of things.  It is obvious he enjoys having students.”

But, they aren’t doctors yet, so as Kohoutek joins Ostmo in clinic, Ostmo and the rest of the staff quiz him all day long.  During clerkships, students are also expected to present cases to

the physicians and attend lectures on a regular basis.

Kohoutek’s day doesn’t end when he goes home.

“I can’t sleep at night,” he said.  “I lay awake thinking about the day and what the next day is going to be like.”

There are also benefits for the faculty-physicians who oversee the students during their clerkships.

“It keeps me reading and challenged,” said Ostmo.  “There is also a selfish aspect to it.  You want to train these people the way you

would like them to practice, how you would like them to be as your physician because these are the doctors who are going to have to take care of us.”

Be prepared

Through the school’s patient-centered learning curriculum and by working with actor-patients, third-year medical students arrive at their first rotation in July of each year well prepared.  However, no matter how well prepared, there are differences between the classroom and the real exam room.

“It isn’t near the same,” said Kohoutek. “I knew I was capable, but I was still unsure.  It quickly turned into excited energy.”

This trepidation doesn’t seem to affect student’s performance.

“I’ve had exceptional students,” said Ostmo, who takes three students a year for their family medicine clerkships.  “They all arrive with great enthusiasm, ready to get out of the textbook and

practice what they have learned.  They are all incredibly bright and never hesitate to look something up and learn more, often times without even being told to.”

The third-year clerkships all lead up to the national shelf exam and the clinical skills exam, both are required to graduate from medical school and be admitted into a residency program.  The

individualized attention students get during clerkships help medical school faculty ensure students pass these exams.

“If a particular student seems to be struggling on a particular clinical skill, we can work with their clerkship preceptors to ensure they get plenty of instruction and experience in that area,” said Jon Allen, M.D., ’84 assistant dean, Northeast Campus in Grand Forks.

“You need that book-based learning,” explains Ostmo.  “But you need to learn to recognize what you learned from those books in real patients and the only way to do that is to see a lot of

patients.  The more you see, the more you learn.”

Planting the seed

For many students, the basic clerkships they do in their third year is the first time they are experiencing what their future careers might be like and they start considering specialties.  This is especially true when it comes to acquainting students to rural family medicine practice.

“In family medicine you get to see all kinds of stuff,” said Ostmo.  “In the other disciplines, you tend to be focused on the one situation–you miss out on seeing the patient as a whole in a broader picture.”

At least four weeks of the family medicine clerkship must be done in a rural community, but Kohoutek spent his entire eight-week rotation in Wahpeton.

“I love rural medicine,” he said.  “I love seeing familiar faces here.”

The positive experiences students have during clerkships affect their later choices of fourth-year elective rotations and residencies, but in the meantime, they work hard at a job of

an almost-physician and learning all they can about caring for patients.

-Amanda Scurry

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