“Be prepared.” It should be a motto for teachers as well as Boy Scouts. Especially if the teacher thinks the student may faint during instruction.

Kenneth Robertson, M.D., FACP, an internal medicine specialist/hospitalist, remembers showing a medical student how to insert a central line in the intensive care unit at Ivinson Memorial Hospital in Laramie, Wyo.

“You take this big, huge long needle and go deep into the upper chest, under the clavicle, and put a catheter into the subclavian vein. Then you float a catheter close to the heart. And I looked around at the student and said, ‘You’re OK with this, right?’”

She said she was fine, but Robertson wasn’t surprised when she passed out moments later. Trainees don’t get enough sleep, or they forget to eat — or the medical procedure is a little grisly. It happens. “We were kind of ready for it,” he says.

Robertson is an instructor for the WWAMI program at the University of Wyoming. Having spent several years as a preceptor, he now teaches an introductory clinical medicine course to first-year medical students. Robertson relishes his association with teaching and with the WWAMI program.

“I’ve been involved since day one, minute one,” he says.

Ken Robertson, M.D., FACP, wears many hats: rancher, doctor and teacher among them. He was one of the first people to sign up to teach first-year medical students at the WWAMI-Wyoming program.

Day one, minute one

Wyoming was the fifth state to become part of the WWAMI program, joining the multi-state medical education program in 1996. Robertson is one of a number of teachers who’ve been involved in the program from the start, teaching first-year medical students what they need to know before they head off to the University of Washington’s Seattle campus for their second year.

Other people are equally invested in the WWAMI program, says Matthew D. McEchron, Ph.D., assistant dean of WWAMI medical education at the University of Wyoming. Namely, doctors, politicians, the Wyoming Medical Society and community members. “People were committed to the idea from the beginning, and a lot of people were involved in getting things started,” he says.

The state is betting that students educated in Wyoming will return there to practice, and the stakes are high. Wyoming has few big cities, and population centers are scattered, so it’s hard to draw in medical specialists — the population has to be large enough to support a practice. And, as in other rural communities in WWAMI, it can be hard to recruit and retain general practitioners. It’s difficult being the only doctor for miles around.

The bet, says McEchron, seems to be paying off; approximately 66 percent of Wyoming’s students return to Wyoming to practice. (The national mean for medical-student returns is 39 percent.)

From campus to campus

One of the foundations of the WWAMI program is that all first-year students receive basically the same education — whether they’re in Laramie, Pullman, Spokane, Anchorage, Bozeman, Moscow or Seattle. Courses have common objectives, and students at all first-year sites take common final exams to ensure the objectives have been met.

“We are very aware of what’s going on at different sites,” says Langer. She and her colleagues determined last summer that there’s a 75- to 80-percent overlap in course topics among the sites. That said, teachers bring their own strengths to the classroom. Not everyone has Langer’s creative approach, and not every teacher gives first-year students the exposure to clinical care espoused by Robertson.

And, of course, each class brings something to the learning environment. Last year, says Robertson, his class was very lively. “I couldn’t go five minutes without getting 10 questions about something,” he says. This year, he says, the students were quieter, more laid-back.

Regardless of class temperament, there’s a real benefit to having a class of just 20 first-year students at each first-year WWAMI university. The small, integrated setting is what Wyoming students are used to, Robertson says; it’s a reassuring start to medical school, one that teachers hope will help cement the students’ relationship with the community and pull them back to Wyoming when they’ve completed their training. A payback plan provides another incentive to return. The state underwrites the lion’s share of their tuition, and students repay the loan by practicing in the state for three years — or by paying back the money.

Coming full circle

Pamela J. Langer, Ph.D., is always pleased when her undergraduate students — like Lauren Johnson and Mark Wefel, above — are accepted to the UW School of Medicine. Johnson and Wefel, now first-year medical students, were teaching assistants in Langer’s clinical biochemistry class at the University of Wyoming in 2011.

The WWAMI program in Wyoming is relatively young, but it’s effective, says McEchron. So are the doctors trained by the program, says Robertson.

“The [WWAMI-trained doctors] that I’ve run across over the years have been just excellent, all the way around,” he says.

Wendy Curran, a senior director at Blue Cross Blue Shield of Wyoming Ken Robertson, M.D., FACP, wears many hats: rancher, doctor and teacher among them. He was one of the first people to sign up to teach first-year medical students at the WWAMI-Wyoming program. Photos (including previous page) courtesy of Kenneth Robertson, M.D., FACP and the former executive director of the Wyoming Medical Society, is delighted by the program’s progress. An early advocate for the development of the WWAMI-Wyoming program, she remembers the moment when she heard a student say he’d been inspired to pursue medicine by a WWAMI graduate in his hometown. “I’ve come full circle,” she said to herself, “where the people who started the program are recruiting students.”

On a different note, she says that she sees a decided shift in what WWAMI doctors want. Students educated in earlier years were rugged individualists who wanted to run their own businesses. Today’s doctors, says Curran, are less likely to want to run a business and more likely to want to focus on medicine. Robertson, who became a hospitalist in 2007 after spending years in private practice, embodies something of both generations.

Shifting demographics, lifestyle expectations, the cost of medical education. Educating medical students so that they’ll return to WWAMI is a challenging proposition, one administrators continue to finesse. McEchron, like Curran, is sanguine. Because the tradition of teaching is now crossing generations.

“Many of our graduates who have returned to the state to practice are now also teaching within the program,” he says. “It’s exciting to see the circle becoming complete.”

By Delia Ward