“This is what rural medicine is”

Taking OHSU graduate medical education to Oregon’s North Coast

March 28, 2016

The OHSU School of Medicine began a new, elective emergency medicine residency rotation at Columbia Memorial Hospital in Astoria earlier this year. 

Astoria, Oregon; courtesy Creative Commons

Shannon Lee, M.D., is the first OHSU resident to spend time training in the North Coast city of 10,000 people. Her four-week experience left her with a new appreciation for practicing in a small town.

"It was a completely new way to experience emergency medicine. This is what rural medicine is," said Dr. Lee.

Practicing emergency medicine in a location with a different population and resource availability than in urban settings allows trainees to develop a skillset needed for community practice. While all trainees in graduate medical education settings are supervised, Dr. Lee said the experience gave her "a lot of autonomy to be the primary provider."

"Rotations like this are a good approach to serving the rural community with board-certified physicians," said Lalena Yarris, M.D., associate professor of emergency medicine and residency program director. "Our residents who've taken that path have been really satisfied."

OHSU's emergency medicine residency program is highly competitive. In 2015, more than 1,100 applications were received for 11 open positions. Dr. Yarris said the program consistently recruits residents with an interest in rural communities, listing Lincoln City, Grants Pass and under-resourced areas in Hawaii among other locales in which residents rotate.

Six OHSU residents will rotate in Astoria this year, and program administrators plan to quickly expand the total to about 14 residents a year. Residents will choose between a two-week and four-week option. 

"The value of residents coming out to Columbia Memorial Hospital is they work one-on-one with the faculty member in managing all the patients in the department. It gives them an experience of autonomy they don't always receive in a large academic center," said Anthony Ferroggiaro, M.D., MHA, assistant professor of emergency medicine, OHSU School of Medicine, and medical director, Columbia Memorial Hospital Emergency Department.

Dr. Shannon Lee, resident in emergency medicine"I think the Astoria rotation is absolutely critical to our residency and will only serve to make us stronger residents," said Dr. Lee.

Introducing GME to Astoria was a natural extension of OHSU's already robust relationship with the city's community hospital. OHSU collaborates with Columbia Memorial to provide a range of health care services, including ophthalmology, radiation therapy, cardiology and a telemedicine program for stroke and pediatric specialty services in the emergency department. A number of providers have faculty appointments in the OHSU School of Medicine and participate in OHSU didactic conferences and continuing medical education events.

"Columbia Memorial Hospital has been incredibly welcoming and supportive of the residents," said Dr. Ferroggiaro. He said the relatively high-acuity cases in the facility make it an ideal site for evidence-based clinical practice and education. "We are truly at the forefront of rural emergency medicine practice by linking OHSU and CMH."

The emergency medicine rotation in Astoria is the newest of several successful OHSU GME programs helping to foster a physician workforce for rural Oregon. Others include Cascades East Family Medicine Residency Program in Klamath Falls and surgery residency rotations in Grants Pass and Coos Bay.

Dr. Lee will finish her residency training next year. Regardless of where she practices permanently, a month in Clatsop County has made an impact on her future.

"Before the Astoria rotation, I was focused on big city hospitals," she said. "Now I totally see myself in a small community hospital;it has changed the way I plan to practice."

Pictured top: Astoria, Ore., courtesy Creative Commons, user "aselfcallednowhere"

Pictured above right: Dr. Shannon Lee