At Sioux Falls' Coyote Clinic, students are the doctors

Talk about it

SIOUX FALLS (AP) — Students run the show at the Coyote Clinic.

They greet patients.

They diagnose and treat them, draw their blood, write prescriptions and give them advice based on what they've learned so far in three or four years of medical school.

They do everything except collect their money, because everything's free.

It happens inside an Avera Health clinic at 300 N. Dakota Ave. in downtown Sioux Falls. One evening a month, from 6 to 9 p.m. the second Tuesday, the clinic becomes the Coyote Clinic, as students from the Sanford-USD School of Medicine come in to do the work. They use the name "Coyote" in honor of the mascot of the University of South Dakota.

The students see about a dozen patients each session in an arrangement that works both ways. Students need the experience. Patients need care they wouldn't be able to pay for.

"We learn from them, and they are patient with us," said Rachel Sunne, 25, a fourth-year medical student.

One patient last week was a young woman who had pain in her knee after falling on ice and aggravating an old injury. The students suggested a three-part remedy of ice, rest and ibuprofen and discussed the possibility of physical therapy down the road.

Another patient was a man in his 50s with high blood pressure. He was new to Sioux Falls, had no job or insurance. They checked him, gave him sample medications and he was on his way.

A typical session has nine students working under area physicians who take turns supervising. Three of the students are recent college graduates in their first year of medical school. They come only to watch.

Three others are second-year students who act as nurses. They check patients' vital signs and do first interviews.

Student diagnosis

The other three are third- or fourth-year medical students. They conduct the second interview covering symptoms and the patient's medical history, do an exam and come up with a treatment plan.

They run their plan past the doctor waiting in the next room, who gives counsel as needed and signs off on any prescriptions. It's a form of supervised care not unlike what happens every day across the state in hospitals and clinics where USD students work under a doctor's watch to complete their required rotations.

"That's how medical school works," Sunne said. "The student sees the patient. Then the student and the doctor go back in together."

The Coyote Clinic opened in 2006 as an idea pushed by a group of students including Heather Spader, Cathy Hajek and Aaron Grauman. Students would volunteer time seeing needy patients and, in so doing, learn something of how a clinic operates. The idea matched what Avera had been doing with a free clinic since 1992, so the two programs became companions. They once were at an Avera clinic at 10th and Blauvelt, then moved in 2007 to the current downtown site two blocks south of the Minnehaha Courthouse.

"It wouldn't exist without the students," said Dr. James Barker, medical director of Avera's downtown clinic and a co-director at Coyote.

Barker, 65, practiced internal medicine 30 years in the Twin Cities before moving to Sioux Falls in 2002. He works alongside co-director Dr. Kevin Whittle, who practiced 30 years at the VA. Other doctors from the VA, medical school, Sanford and Avera also rotate to cover evening sessions.

Barker said the students' interest must come from an itch to be involved. Administratively, they get off easy, because there's no billing and no insurance. Medically, they find themselves surprisingly well prepared.

"They really know more than they think they know," Barker said. "A third-year student working with a physician knows what to do with about 80 percent of what comes up."

If something is outside the learning curve, the doctor steps in. If a situation suggests an X-ray or magnetic resonance imaging, the clinic is no help, except to give a referral elsewhere with a reminder that what happens elsewhere won't be free.

"What's free is what happens under this roof," Barker said.

Not reliant on tests

One volunteer is Chelsea Mann, 24, a 2006 Lincoln High School graduate. She thinks the setup at the clinic forces students to develop relational and diagnostic skills without relying on equipment or tests. It emphasizes the role of learning from a patient's history and a medical exam.

"You don't want to lose the art of the history and the physical," she said.

She hopes for a career in family medicine in a small Midwest city such as Yankton, where she's a third-year student and lives with her husband, David, who commutes to Vermillion as a paraprofessional in special education. Her volunteer work in Sioux Falls is confirming her career wish and is providing surprising lessons in the process. She hadn't known about dental services at the nearby Falls Community Clinic or Faith Temple's weekly food giveaway until she met patients needing those things.

"For me, working at Coyote Clinic opens my eyes to a lot of resources in town," she said. "We may have a patient that comes in with knee pain who also has a jaw ache. We look in his mouth and see rotting teeth. We obviously can't extract the teeth, but we can refer him. Students learn a lot through that process."

Sunne graduated in 2005 from Brandon Valley High School and in 2009 from Mount Marty College. She once thought she'd be a teacher or physical therapist. But her mother's work as a nurse and a day shadowing cardiologist Bruce Watt at Avera Heart Hospital led her to think about becoming a doctor instead.

The question would be where. Her husband, Grant, who teaches math online to home-school students, could do that anywhere. Medical school has given her four weeks training in Parkston and another four weeks in Gregory, enough of a taste for her to want to return someday to a small town in South Dakota. Work at the Coyote Clinic has given her a jump on what she might experience when she gets there.

Tags: sioux falls, news, updates, healthcare, education, state, medical, students