A Day in the Life of a Fourth Year Student

Thanks to the unique design of the Vermont Integrated Curriculum, fourth year students at the Larner College of Medicine have 14 months to explore specialties, hone their research and teaching skills, and gain practical experience in a range of health care settings as they interview for residency and complete their USMLE Step 2 Exams. Learn more about some recently graduated students who used their fourth year to advance LGBTQ healthcare, serve in an underserved, rural location, and take steps toward becoming a military physician. 

Advancing LGBTQ Health Education through the Scholarly Project

All fourth year students are required to complete either a teaching month or a scholarly project, both to reinforce foundational sciences and to encourage the development of students as physician-scholars. For his scholarly project, Nicholas Bonenfant, M.D.’17, worked with Michael Upton, M.D., assistant professor of psychiatry, to develop a series of educational eModules and presentations on topics related to LGBTQ health issues. Bonenfant matched into pediatrics at UVM Medical Center.

Can you describe the project? What were the main goals?

Initially, this project started off with addressing a finding discovered by a group of third year Larner College of Medicine students for their public health project. They found that one of the largest barriers to prescribing PrEP in Vermont is a lack of knowledge and training around this medication. PrEP is a medication taken daily by individuals who are HIV-negative but at high risk of acquiring this infection, to reduce their overall risk. According to the CDC, when taken consistently, PrEP has been shown to reduce the risk of HIV acquisition by up to 92 percent. The module, which has been presented to various groups of providers and students, covers everything from indications, clinical monitoring, to cost/insurance coverage in Vermont. Post-intervention questionnaire data has demonstrated that it’s a useful tool for educating and making primary care physicians more comfortable with prescribing PrEP and identifying high-risk patients.

Under the leadership of Dr. Upton and his recent Frymoyer grant, though, the scope of the project has morphed into something much bigger: the development of a series of educational modules on LGBTQ health. The two most recent modules I developed discuss and address the profound health disparities and difficulties that transgender children/adolescents and LGBTQ youth of color face. These modules also offer a wide array of other information, such as locally/national-based resources and the multitude of ways that pediatricians can advocate for their transgender and sexual minority patients.

The major goal is for this series of modules to be incorporated into medical school and resident curriculum here at the University of Vermont and beyond; we presented this process at the Improving OUTcomes national conference in Sacramento, Calif., at the end of March 2017.  

A Doctor and a Military Officer

As a member of the U.S. Army, Bridget Colgan, M.D.’17, has a different match experience than many of her peers. She applied to both the military Joint Service Graduate Medical Education Selection Board (JSGMESB) and the civilian Electronic Residency Application Service, with a goal of matching at a military institution in the specialty of her choice. She completed her surgery acting internship at Walter Reed National Military Medical Center. Colgan is currently a surgery resident at Tripler Army Medical Center.

Why did you decide to serve in the military?

I was commissioned to the Army a few days before beginning medical school, so I have been in three and a half years as of August 8. I joined for several reasons. I am receiving the Health Professions Scholarship, which is a military program that pays for medical school, many expenses (such as board exams and textbooks), and includes a stipend for our living expenses. I had always considered joining the military – I almost went to the Air Force Academy out of high school – but chose to pursue music instead. Then as a musician, I considered doing the ROTC program for military bands out of high school, and then after college auditioned for a few of the military bands. I even had the opportunity to play with the West Point band while I was in college, so it was always on my mind. As a military surgeon I have a great opportunity to lead a useful life. Someone once said to me the best part of being a military physician is that we have two jobs – we are doctors, but we are also officers in the United States military, and we are entrusted with that responsibility as well.

How will your time at Walter Reed inform your future practice?

As my first exposure to military medicine, it helped me gain an awareness of what awaits me in the future. Although it is very similar to the civilian medicine I have experienced, I also treated a few wounded warriors and many veterans, and one four star general from World War II, which was a unique experience. I had a lot of anxiety going into the rotation. Walter Reed seemed like a huge hospital; at first I had no idea how I could fit in there, but I had an amazing time. It made me realize how far I have come in my medical education. I am excited about my decision to become a surgeon, and I look forward to working with excellent military surgeons like those I met at Walter Reed.

An Understanding of Rural Healthcare

Fourth year students have the opportunity to choose electives in areas of medicine that are of particular interest to them, as they continue to hone in on their future career path. Sarah King, M.D.’17, completed a Family Medicine elective at Grace Cottage Hospital in Townshend, VT, introducing her to the challenges that come with providing medical care in a rural setting. King matched to internal medicine at Boston University Medical Center.

Your time at Grace Cottage was a Family Medicine ‘underserved rotation.’ Could you elaborate on what this means? What did you take away from this elective?

The purpose of the underserved rotation is to gain exposure to an underserved health care setting providing comprehensive care. I began to realize through the month that I spent in Townshend that there is a shortage of care, despite multiple hospitals in the area.  One thing that I heard from a number of patients is that there truly is a shortage of primary care physicians.  They felt lucky to be cared for by an established physician at Grace Cottage. Some local practices have a high turnover rate for primary care doctors, so that can leave patients without a consistent and familiar care giver.  We have entered an age that focuses on preventative medicine, something that I’ve felt passionate about even before I came to medical school.  How can we practice preventative medicine if PCPs are struggling to keep up with an over booked schedule? Even in Townshend, with excellent nurses and physicians who were on top of health care maintenance, many visits were strapped for time. Often appointments came down to a choice – discuss the chief complaint or talk about the importance of setting up your colonoscopy, mammogram, second pneumonia vaccine, and so forth. On top of this, many patients have significant financial constraints that test the ability of the system to provide much needed care. I saw the undeniable value of community health teams, social workers, counselors, who can fill both the knowledge gap (with respect to community services), and can take the time that the PCPs may not have.

Read more about the experiences of fourth year students at the Larner College of Medicine in the upcoming issue of Vermont Medicine.