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
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.”