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Medical student Erin Rasmussen checks the breathing Aaron Gerlach, 13, Wednesday morning at the Platte Medical Clinic as part of the Frontier and Rural Medicine program through the University of South Dakota. (Sean Ryan/The Daily Republic)

Medical students learn about working in state's small towns

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WINNER — Heather Walker didn't grow up in Winner, but she's starting to adjust to the dialect of ranchers from the area.

It has been a bit of a culture shift for the third-year medical student, even though she grew up in Vermillion, a place she still considers to have a small-town vibe. But she admits the first few times she talked to farmers and ranchers of the Winner area was an adjustment, even though she was equipped with the skills after studying communication at the University of South Dakota.

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"It has been different, there's no question," she said. "But in a good way."

Walker and David Kapperman, both located at the Winner Regional Healthcare Center, are two of six third-year students from USD's Sanford School of Medicine who are in the inaugural class of the Frontier and Rural Medicine program, or FARM.

They're spending nine months in a rural community and are learning what it means to practice family medicine in a rural South Dakota community. Erin Rasmussen, at Platte Health Center Avera, and Josh Doorn, working at the Avera St. Benedict Health Center in Parkston, are also participating in the program in central South Dakota. Two more students are working in Milbank and Mobridge and will be there through next spring after arriving in early July.

FARM Director Susan Anderson, who teaches at the School of Medicine and lives and practices in Canistota, said the school has sent students to locations like Winner and Platte for decades as part of the school's rural rotations to work there three or four weeks at a time. But the difference with this program is to build a connection that would make students more apt to return and practice in a small town.

"We know we're going to have a shortage of physicians in our state," Anderson said. "We need more physicians. Access to care is a major priority for patients today, and there's research that shows that students are more likely to practice where they train. This is very important."

Real-life training

In Platte, Rasmussen is meeting with patients, who she will see multiple times during her nine-month stay and building relationships that she says are uniquely small-town.

In many instances, the students are following the doctors and taking notes. In others, the students will be taking the lead.

Rasmussen, originally from Vermillion, said there are moments where she's scared or nervous about what needs to be done or what the next step might be for a patient, but the physicians in Platte have been more than helpful. For that reason, she knows she doesn't want to be a surgeon.

And all of the third-year students in the FARM program have time to decide what exactly they want to specialize in, because that decision is made during their fourth, final year of medical school.

Rasmussen's mentor at the hospital is Jerome Bentz, who has practiced in Platte for 31 years and specializes in family medicine and geriatrics. Known for his signature bowtie, Bentz said if you're working in a small-town hospital, you're going to need to be well-rounded.

"You really do a bit of everything," Bentz said. "I think we want to be a part of helping that next generation of doctors, and this is a very good place to get that training."

Kapperman mentioned he has not seen the exotic diseases his medical textbooks talk about, but there have still have been plenty of unforgettable moments.

Walker said she'll never forget the first case of severe pneumonia she came across. Parkston's Doorn said he's gone from an elderly patient's heart attack to the birth of child. And while that's a routine occasion at a rural hospital, Doorn said that's not exactly something that's learned in a textbook.

"The good thing is that the physicians aren't going to leave you hanging, but I was nervous," he said. "Because it's a baby and they seem fragile. You just want to make sure everything goes OK."

The students' training comes on top of regular class work, delivered through lectures and online modules that may cover patient care or safety techniques. A first-year medical student at the school will pay $54,184 to attend USD; non-residents pay more than $90,000 per year. The medical facilities in each town provide housing for the students, easing the burden of living expenses.

'Helping us learn from our mistakes'

A typical day involves the students conducting morning visits to patients in the hospital. They follow a doctor for the remainder of the day, sometimes going in to see a patient and asking about history and symptoms, and then coming out and conversing with the physician.

Sometimes, the student is correct in their diagnosis and sometimes they're not, but the doctor will always give the student guidance. Kapperman said that's humbling but a good learning experience.

"The doctors are really good about helping us learn from our mistakes, and there's no pressure in making a mistake," he said. "They're telling us to trust what we've learned and to use our gut a little bit."

The students will see a certain number of patients in a specific speciality area during their nine-month time, whether that's pediatrics or rehabilitation as part of the school's curriculum. Anderson said the students are mirroring what is being done at hospitals in Sioux Falls or on campus in Vermillion.

Kapperman, a Hartford native, said Winner is also a good place to train because there's a wide variety of ethnicities and an equally interesting array of afflictions and maladies that he will come across. Building a rapport has been important, too. Walker said she's commonly thinking about patients after she's off the clock.

Kapperman and Walker being placed together in Winner works well for one big reason: they're engaged, set to be married next month.

Walker said they were good friends when entering medical school, working together in an anatomy class study group. But their relationship budded from there and they started dating in March 2013. They got engaged earlier this year. Balancing work, school and wedding plans are being juggled.

"When we're not studying or working, we're thinking about the wedding," Kapperman said. "So it's pretty hectic."

Because the training can be stressful, Walker said it's nice to have someone to talk to and know exactly what the other is going through.

Big advantage for small towns

Anderson described the experience as being a win-win. The program was approved in 2012 and built to expose up-and-coming physicians in rural areas. This is the first year students are being placed in the field.

"It's a type of immersion training, really," she said. "This is really for those students who are driven and self-directed and are among our strongest students."

South Dakota has joined other regional states in creating a rural primary care program for medical students and modeling the program off the University of Minnesota's Rural Physician Associate Program, which has two-thirds of its graduates practicing in Minnesota and two-thirds of those Minnesota practitioners working in rural areas.

Anderson said she has been impressed with the level of community engagement. Each of the six students in the five participating communities have taken up a community involvement activity, whether that's patient education or pre-concussion testing for athletes. For Kapperman and Walker, they plan to work with the Winner School District this year to educate students on health care-related careers. Walker said that's not an opportunity she had when she was in high school.

"It certainly would be benefit for young people to know what is out there," she said.

Platte Health Center Avera CEO Mark Burket was eager to have his hospital as a site selected to host students.

He said it was incredibly competitive to be chosen, but Platte has all of the requirements the school asked for, including long-term patient care, surgery, outreach speciality clinics and attractive student housing. Each of the sites has to be in a community with fewer than 15,000 residents. Anderson said the school is currently taking applications to add two sites around the state to the program, adding that students are jumping at the opportunity. The second year of FARM participants -- the graduating class of 2017 -- have already been named.

"This is something that we've really wanted to do for a long time," Burket said. "We know we have a very good standard of care and this is important to the future of this hospital and this community."

Rasmussen admitted that some of her classmates are apprehensive to moving to a small town because of the fear of the change in lifestyle in a small town.

"It's not going to be for everyone," she said. "When I think of working in rural medicine, I can't think of a better place than Platte."

Doorn said he and his wife, Nicole, have been able to acclimate themselves in Parkston by attending baseball games and other community events, like the street dance. Nicole found a job with a local accounting firm. Being from Sioux Falls, Doorn said he picked the community in part because he knew it from wrestling against the Trojans in high school.

That's the case for Kapperman and Walker, who say they try to make it to the Winner Drive-in Theatre every chance they can, a place they call a perfect date spot. Rasmussen has jumped right in, jumping into the Platte pool as a swim coach for the town's youth team.

That's the other part of being a rural physician that the students are quickly learning about: connecting with patients in the community.

"It's certainly something that is unique to the rural sites, because you usually don't see your patients outside of the clinic," Doorn said. "It's enjoyable and great to really get to know people outside of just being sick."

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