Wilderness Medicine in thick trees
Pictured above: Left to right, Class of 2023 medical students Ben Weaver, Nina Feinberg and Zachary Osborn participate in a mock rescue, with KC Collier, M.D., emergency medicine resident, role-playing a person with harness-induced suspension syndrome.

Into the Woods: Wilderness Medicine Elective Gets Fourth-Year Students Outdoors

by Janet Essman Franz

“Remember the view, and breathe,” Sarah Schlein, M.D., FACEP, advised her student, Nina Feinberg ’23, as Feinberg prepared to descend a steep rock face in Vermont’s west Bolton woods. Clutching the rope clipped to her waist harness, Feinberg took a deep breath and backed down the crag, with fellow medical students cheering her on. After a few hesitant steps, she looked around: “Okay, I’m fine, it’s really pretty.”

Rappelling and rock climbing are among the activities that fourth-year medical students participate in during a two-week elective course in Wilderness Medicine. The intensive curriculum takes students out of the hospital and into the woods, lakes and mountains. Developed and led by Dr. Schlein, associate professor of emergency medicine and fellowship director for the UVM Health Network Wilderness Medicine Fellowship, the course provides an opportunity to focus on both the content and problem-solving of caring for patients in remote environments.  Chance Sullivan, M.D., clinical instructor for emergency medicine and a Wilderness Medicine Fellow, also instructs the course.

"We put people in scenarios, and we talk about what happens. Not just about the medical parts, but about the communication, leadership, and where things break down. The goal is to make mistakes and learn from each other,” said Schlein.

Repelling in to rocks and a helicopter rescue
Pictured above: Megan Eubank '23 completes a rappel; Medical students practice rappelling into rocks and helicopter rescues; Nate Dow ’23 searches for a foot hold as he ascends a cliff during week two of the Wilderness Medicine Elective course.

The students spend each day of the course outdoors, learning and practicing skills for rescuing people from drowning, diving accidents, altitude sickness, hypothermia, crush injuries, and suspension trauma. They kayak and canoe at Waterbury Reservoir, hike Mount Mansfield, and camp overnight in backcountry woods. They also train with New York State forest rangers in the Adirondack high peaks, learning about mountain top rescues and how to properly hoist people into a helicopter. In a winter version of the course that will be offered for the first time this January, students will experience backcountry snow sports, ice climbing and winter camping while learning how to use avalanche beacons, start fires in the snow, and treat frostbite and ski injuries.

Feinberg took the course because she enjoys spending time outdoors and the challenge of trying new things, which she hopes to apply to her career as an obstetrician-gynecologist. “I love the idea of being a doctor without being in a hospital,” Feinberg said. “My dream is to work part-time in a hospital and part time on expedition, helping people who want to be outside. For example, I could work at a research base in Alaska, or on hiking trips in the Grand Canyon specifically for women. It would be cool to be the doctor on board.”

Kyle Kellett ’23 feels at home in wilderness settings: He rock climbs recreationally and serves on the Colchester Technical Rescue dive team. He enjoys helping others conquer their fears in the water, on the mountain and in the preoperative unit. As a future doctor, he plans to focus on anesthesia: “It’s hands-on, fast paced, high stakes medicine. I also love the people interaction part. Surgery is a scary thing for people coming into the hospital. I like being the last face they see, talking them off the ledge, giving them some comfort.”

Collage of four images of students in a thick forest
Pictured above: Megan Eubank manages the belay for a fellow student clinging to a rock face; Fourth-year students participate in mock rescues in the backcountry woods of Vermont; Sarah Schlein, M.D., (far left) quizzes students on the potential complications from and treatments for crush injuries during the Wilderness Medicine Elective course; Fourth-year medical students Adam Kohutnicki and Ben Weaver rest and refuel after a challenging mountain ascent.

The opportunity to use problem-solving skills and think quickly in an austere environment attracted Megan Eubank ’23 to the Wilderness Medicine course, along with the adrenaline-inducing thrill that comes with rappelling and climbing. As a future doctor, she plans to pursue a career in emergency medicine. “I really like the variety of patients, the pacing, and the idea of not knowing what you’re walking into each day. Every day is different, so you never get bored,” she said. 

The Wilderness Medicine course challenges students in ways they are not typically challenged in their coursework or clinical rotations. They learn fundamentals of rural emergency care and build critical skills for saving lives in stressful situations without resources and support.

“For the past three to four years, we have learned how to care for patients in a hospital setting, with equipment and resources. Now, “we are applying what we have been learning in an austere setting, where we don’t have the support and tools you have in a hospital,” said Zachary Osborn ’23.

In one rescue scenario, the students encounter a rock climber who fell to the ground and is pinned down by a car-sized boulder on his legs. The role-player, Bill McSalis, a nurse in the UVM Medical Center emergency department, feigns shock and pain as moulage blood runs down his limbs. Nearby, his climbing partner, played by KC Collier, M.D., a resident in the emergency medicine department, hangs suspended by a rappel rope and pretends to feel leg numbness before losing consciousness. The students debate how to move the boulder and whether to lower the suspension victim to the ground. They check vital signs, look for head and spine injuries, treat shock and give fluids. Schlein, pretending to be an emergency responder with the Colchester Rescue, asks the students who is in charge and what is happening. 

Afterward, the students, role players, and faculty talk about what happened and how it went. In the debrief, Schlein asks them to ponder potential complications from crush injuries, such as rhabdomyolysis, which occurs when damaged muscle tissue releases its proteins and electrolytes into the blood. She quizzes the students on the reasons a person might faint while hooked up to a harness, and they discuss treatments for suspension syndrome, when a rapid drop in blood pressure results in a sudden loss of consciousness. They discuss how they could give fluids and deal with hyperkalemia or hypocalcemia in the wilderness. They consider how they worked together to care for the patients, what went well, and how they could improve.

“Your roles were so clear. You worked well as a team,” Schlein said. “You were kind with the patients, and you didn’t get distracted by the situation. It was fun to watch.” 

“I felt supported by my team,” said Alex Cohen ‘23, who took on the role of leader for the scenario. “I had so many things going through my brain: I have to manage things, think about safety, make sure everyone has their helmets on. We had some differences of opinion about whether to lower KC to the ground, and whether to move her. I thought we managed conflict well.”

Gaining confidence to take charge and make quick, life-saving decisions is at the heart of wilderness medicine training, and that was Schlein’s intention when she launched the first course in 2018. 

“Working in the Emergency Department, I saw a need for our students to find their voices as leaders at the head of the bed,” Schlein said. “In a few short months they will be doctors. On an airplane, at a park or a hike, when something happens, eyes will turn to them. I want our course graduates to not only have medical knowledge but an approach and mindset to have the situational awareness to take the medical lead in those situations.”

Participating in outdoor recreation with comrades provides students an interval of relief amid a trying time in their academic journey. During the fourth year of medical school, Larner students participate in required acting internships in internal medicine, surgery subspecialties and emergency medicine. They spend summer preparing for and complete Step 2 of the United States Medical Licensing Examination and apply for residency match programs. In the next few months, they will engage in additional specialty training, teaching practicums or scholarly research, and additional electives of interest.

“This is a stressful time during medical school. Our residency applications are due in two weeks, and most of us spent summer doing Step 2, away rotations and getting letters of recommendation [for residency match programs],” said Osborn. “Spending time in the woods with my friends is a chance to take a deep breath at the end of a tough summer.”