Up and Down the East Coast in Seven Clerkship Rotations

Sarah Kelso '17
uvmmedicine blogger Sarah Kelso ’17

A few weeks ago, I finished the last rotation of my third year of medical school.  Seven rotations in twelve months is a lot, yet it went by so fast.  The University of Vermont College of Medicine sends students to several clinical affiliates for clerkships, which is when we start to delve into clinical medicine, learning procedures and taking care of real patients.  The main locations are Eastern Maine Medical Center in Bangor, Maine; Danbury Hospital and Norwalk Hospital in Connecticut; and St. Mary’s Medical Center in West Palm Beach, Florida.  There are also many rural options throughout Vermont and Maine during the primary care rotations.  During my clerkship year, I rotated through most of these off-campus hospitals.

I wanted to spend clerkship year in a variety of locations to experience working with different patient populations, introducing me to a diversity of people you don’t necessarily see in northern New England. Now that I’m finished, I found this to be one of the greatest benefits.  At UVM Medical Center, where I spent my first rotation, patients come from all over Vermont and northern New York. My first rotation outside of Burlington was at a rural family medicine practice in central Vermont.  There I was able to experience small town culture and learn about the difficulties patients faced when they live more than an hour removed from any large medical centers.  Most of my patients were retirees, farmers, or laborers at the local ski resorts, and I had many conversation about the vegetables they were hoping to grow that summer, and how many days they had skied that winter. It was a pleasure to meet a population that led lives very different from my own.

As I moved outside of Vermont, the diversity of patients continued to increase. During my pediatrics rotation in Maine, I experienced what it is like practicing medicine in a location where patients’ socioeconomic situations are extremely diverse.  One patient I followed was from an elite Texan family who vacationed in Bar Harbor every summer, and her family had the resources and education to fight for the best care for her.  A week later, I cared for a set of premature triplets whose large family hailed from a remote part of Maine and needed many taxi vouchers in order to be able to afford visiting the hospital.  It was interesting to see how the hospital did its best to treat them equally and provide the best care.

St. Mary’s Medical Center in Florida and Norwalk Hospital in Connecticut boasted ethnically diverse populations and medical emergencies all too common in urban areas.  During my surgery rotation in Florida, I saw many gunshot wounds, something that my peers in Vermont almost never experienced.  I also learned what a bang stick is (for those that don’t know, Google: bang stick, alligators).  At Norwalk Hospital, I learned to use a translator to gather histories and to include diseases unusual in the United States on my differential.  One of my favorite moments at Norwalk Hospital was when I formed a connection with a patient by simply bumbling my way through speaking his native language of Spanish.  The appreciation apparent in his face made my embarrassing efforts completely worth it.  These moments allowed me to develop a strong foundation in how to provide good care to diverse patients and populations.

As much as patient populations differed during my clerkship rotations, the hospital cultures differed as well.  The University of Vermont Medical Center is a large, academic hospital with many specialties and subspecialties.  Rarely are we unable to accommodate a patient’s needs at the UVM Medical Center. Because Eastern Maine Medical Center is a community hospital, sometimes patients’ medical needs are outside its capabilities. I remember when my team scrambled to arrange Medflight for a young girl needing an immediate operation on a newly diagnosed brain tumor, and the closest capable center was two states away in Boston.  Similar situations would occur at St. Mary’s Hospital in West Palm Beach, which was an even smaller community hospital.  However, it was amazing to see how the faculty combined the latest literature advice with their currently available resources to provide care for their patients.

Sometimes it was not only the resources and specialty availability that changed, but also the structure of the teams with which we worked.  St. Mary’s Medical Center did not have residents as part of the faculty.  This means I was able to experience firsthand what a career in surgery is like, and I had amazing opportunities to first-assist on multiple surgeries and perform surgical tasks that residents perform at other institutions.  My education at St. Mary’s was also more one-on-one than in other clerkships.  Norwalk Hospital, where I studied internal medicine, did have residents.  I was able to work on a larger team consisting of an attending, two residents, a fourth year medical student, and me.  Everyone had different roles, and my education there was part of the broader education of the entire internal medicine service.

Being able to experience the different hospital cultures at the clerkship sites helped me become more versatile.  I also had the pleasure of meeting physicians with diverse backgrounds and careers, which has broadened my knowledge of career options.  Despite the many differences between the hospitals, they all had one thing in common: the faculty and staff at every location were welcoming and excited to teach.  Despite having a patch on my white coat that read “University of Vermont Medical Center,” I never felt like I was an outsider.

While the diversity of patient populations and hospital cultures were probably the most notable benefits of rotating through different clerkship locations, I also had the opportunity to explore the East Coast.  During my family medicine rotation in Central Vermont, I spent a few spring afternoons riding my bike up and down the twisty mountain roads, and taking in views of beautiful farms just beginning to bloom with flowers and crops.  While rotating in Maine, I filled my weekends with athletic activities, like hiking Mount Katahdin, the northernmost mountain on the Appalachian Trail, and completing a sprint triathlon that benefited the local YMCA.  When I could break free from the hospital on my surgery rotation in Florida, I would visit the beaches or local pools.  I also tried Cuban food, which is very delicious! Upon returning to the cold north, I used Norwalk’s close proximity to New York City (only an hour by train to Central Station) to visit around Christmas.  Norwalk, too, is a great place to get a diverse array of foods.  Exploring all of these places with my classmates was a blast, and I feel like I was able to connect with my patients better through learning about where they live.

As I start my fourth year and the rest of my medical education, my clinical abilities and confidence in providing medical care to a diversity of patients has greatly increased because of my time at UVM’s clinical affiliates. I will forever be grateful for their dedication to my education. During my fourth year, I plan on returning to both Norwalk Hospital and St. Mary’s Medical Center for rotations, but for now I am now back at UVM Medical Center.  I have to admit, it does feel good to be home.

What are your thoughts about this topic?