Kayaking is a great teaching tool. At least, that’s what Tobe H. Harberd, M.D. ’06, found.

When Harberd was fulfilling his Rural/Underserved Opportunity Program (R/UOP) experience with Mike Luce, M.D., Luce took him into the small-town clinic where he worked in Dayton, Wash. After all, that’s the point of R/UOP — to introduce students to clinical care between the first and second years of medical school. But Luce did more than that. Harberd stayed with Luce’s family, and they shared meals. They even went kayaking together.

“It wasn’t just medicine, it was the whole rural experience,” says Harberd, a native of a small town in Idaho who now practices family medicine in Chelan, Wash. “Because of my experience with Dr. Luce, I’ve tried to set up my R/UOP experiences with my students in a similar fashion.”

Old guard, new guard

Known as clinical preceptors, the community-based doctors who teach medical students and residents are a tremendously influential part of the WWAMI program. Medicine is only part of what they teach. Like Luce and Harberd, they provide students with the opportunity to think about what it will be like to live and practice in a specific community.

Another UW School of Medicine graduate-turned-preceptor, Bob L. Urata, M.D. ’77, Res. ’80, conducts a WWAMI Rural Integrated Training Experience (WRITE) program site in Juneau, Alaska. In the five consecutive months that selected third-year students can spend with him, they are exposed to outpatient services in family medicine, internal medicine, pediatrics and psychiatry. As an Alaskan who returned to Alaska to practice, Urata has high hopes that the experience will sway his first WRITE student to return, too.

Those hopes are motivated as much by necessity as by regard. Alaska — like other WWAMI states and, more generally, states across the nation — is facing a doctor shortage. Especially in primary care, and especially as doctors like Urata, now 60, approach retirement. “We’ve got to replace old guys like me,” says Urata.

Alaska native Bob L. Urata, M.D. ’77, Res. ’80, always knew he wanted to go home to practice medicine. Urata, now a preceptor, is shown with medical student Shannon Son, visiting for her R/UOP experience.

Hooked on WWAMI

“We really want to teach our trainees how to teach, because we think that’s going to be the name of the game,” says Paula G. Carvalho, M.D. ’84, Res. ’87. More teachers in the region mean more opportunities for students to learn. In this photo, Carvalho (the woman near the center of the frame) is about to teach fourth-year medical students and internal medicine residents how to insert a central line in a mannequin — part of a simulation exercise.

Paula Carvalho, M.D. ’84, Res. ’87, FCCP, pulmonary section head and head of the ICU at the Boise VA Medical Center in Idaho and UW professor of medicine in the Division of Pulmonary and Critical Care, agrees that WWAMI is crucial to retaining doctors in the region. But at one point, this self-described “Seattle-centric” medical student was reluctant to leave the Seattle campus. Would she learn as much about medicine outside of the city as she had in it?

Then came her obstetrics-gynecology rotation in Anchorage, Alaska. “I absolutely loved it,” says Carvalho. Ob-gyn was followed by other rotations — including pulmonary medicine — in Boise, Idaho. “Then I really got hooked,” she says.

Today, Carvalho designs innovative learning experiences for first- and second-year residents, third- and fourth-year medical students and trainees completing advanced pulmonary fellowships, among others. For example, she started a critical-care medicine curriculum a few years ago for medical students, one that prepares them for starting an internship.

Carvalho also works directly with UW Medicine faculty like Brian Ross, M.D. ’83, Res. ’87, UW professor in the Department of Anesthesiology & Pain Medicine, to teach trainees. Boise is a satellite site for the UW Medicine-based Institute for Simulation and Interprofessional Studies (ISIS), which uses sophisticated mannequins and computer models to offer medical training. Using such simulation exercises allows trainees to hone specific skills, like placing a central line for long-term intravenous drug therapy, doing a lumbar puncture, or caring for patients receiving mechanical ventilation.

The trainees appreciate these programs, Carvalho says. Last year, the fourth-year students (who are a little anxious when they arrive), wrote her a thank-you card. “We’re no longer afraid to be interns,” it said.

Big investment, big reward

If medical students benefit from the WWAMI program, says Urata, so do the states that participate in the partnership. With WWAMI, Alaska can help its citizens become doctors, and, he says, “we get to take advantage of one of the best primary-care medical schools in the U.S.”

What’s in it for the preceptors themselves, besides a significant addition to their workload? They love working with young people who are so enthused about medicine. And it reinforces a commitment to lifelong learning. “Working with trainees definitely keeps me on my toes,” says Harberd. Community doctors have to be prepared to answer trainees’ many questions — and they have to be prepared to teach.

“It’s fun to continue to learn, and I think that’s the key when you’re teaching students,” says Urata. And, like all good teachers, he knows that learning is a balance between watching and doing. Take this summer’s R/UOP student, for instance, whose clinical experience included delivering babies.

“We had her do a couple of deliveries,” says Urata. “And we were right there helping her.”