UW News

July 31, 1997

Orcas Island Medical Center becomes a family medicine teaching site for the University of Washington School of Medicine.

UW Health Sciences/UW Medicine

What’s it like to practice family medicine on a small, rural island in Puget Sound,where the nearest hospital, on the mainland, can be reached only by sea or sky? Some University of Washington (UW) third-year medical students now have the opportunity to find out.
Selected medical students at the UW’s community clinical teaching site in Anacortes, Wash., rotate to Orcas Island for three weeks of clinical experience. Headed by family physician Dr. Harold Clure, the Anacortes program, along is one of about two dozen UW family medicine clerkships across the five-state region of Washington, Wyoming, Alaska, Montana, and Idaho. Although the locations differ, the clerkships all have the same learning objectives for UW medical students taking their six weeks of required family medicine training.

Dr. David Shinstrom, a family physician who directs the new rotation at the Orcas Island Medical Center, previously taught family medicine for 10 years at the Maine-Dartmouth Family Practice Residency in Augusta, Maine, a program affiliated with Dartmouth Medical College in New Hampshire. Shinstrom began practicing in Eastsound on Orcas Island in 1993. He has been joined by family physicians Dr. Diane Boteler and Dr. Todd Cowdery and physician assistant Chris Gower. All have taught medical students in other places.

The Orcas Island rotation exposes medical students to a full range of family practice, from prenatal and maternity care through the care of babies, children, teens and adults, including elderly people with complex or chronic conditions. In addition to providing regular medical care for island residents, the clinic looks after island visitors and offshore boaters if they become acutely ill or injured. Because travel off the island is at the mercy of the weather, Shinstrom and his clinic staff are skilled in managing a variety of serious conditions and provide a greater scope of treatment than is usual in most urban primary-care practices, where specialists are close by.

According to Tu Thai, the first UW medical student to take the rotation, “In my short time here I’ve already seen three patients evaluated as possible fly-outs for medical reasons. I witnessed judgments that had to be made in deciding: Is it safe enough for the patient to stay put? Can someone watch them all night in case their condition changes?”

Maureen Crowe, emergency medical services supervisor, San Juan Fire District #2, said, “If a medical student is at all interested in rural medicine, Orcas is an excellent place to learn by good example. We value our doctors because they give of themselves to our small community.” The islanders raised funds to build the modern clinic off a country road outside town, and show their support for the clinic staff in many other ways.

Thai was impressed at how well Shinstrom and his staff knew their patients, and with their neighborliness. The physicians regularly go to the town’s senior center to have lunchtime conversations with local retirees. Two physicians are pilots, which enables them to care for their patients at Island Hospital in Anacortes or Islands Convalescent Center in Friday Harbor, Wash. The physicians’ community involvements include assisting at public events at the island’s airport, working with a local agency to prevent domestic abuse and working on establishing a family resource center. Now that it’s a medical school teaching site, said manager Beth Geiger, the clinic would like to broaden its public and patient education role.

Before the clinic became an official rotation, Clure sent medical students over on the ferry from Anacortes for a few days of training. The students enjoyed the teaching style of the doctors and other staff, especially their ability to convey new skills and their welcoming students as part of the team, and wanted to stay longer.

Dr. Kathleen Ellsbury, UW associate professor of family medicine and head of the medical student education section of the UW Department of Family Medicine, said, “We’re delighted to see the development of the Orcas Island experience for medical students. Dr. Clure in Anacortes has located several educational opportunities for medical students and worked together with Dr. Shinstrom to initiate the Orcas site. Dr. Clure has been a leader in the required clerkship, and has served several regional medical roles, including helping originate community family medicine training 26 years ago. The Orcas experience with Dr. Shinstrom and others at the Orcas Island Medical Center will allow students to see high-quality medicine as practiced on an island in Puget Sound–a setting that presents unique opportunities and challenges for medical providers.”