Although we are the only medical facility within a 50 mile radius, and some might say we are "out in the middle of nowhere", we try to make each case we see into a teaching case, and attempt to run the Clinic as if we were making teaching rounds at a "big city" hospital. We do take advantage of the residents and fellows who are also rotating through the Clinic to do some teaching. Most months, there will be residents from around the country, mainly from Family Practice and Emergency Medicine programs. We also aid in the education of Sports Medicine Fellows from several programs around the country. We have a radiologist, Dr. Ed Weber, who visits regularly throughout the winter and does teaching rounds every day that he is here. He also reads all of our x-rays.
The students will be exposed to various orthopedic, minor surgical, urgent care illnesses, and medical emergencies. Many of the complaints that we deal with are unique to ski resorts. Our goal for the students is to be able to identify and treat these emergencies and medical conditions, as well as recognizing problems that should be moved to the next level of care.
Based on my own experiences here (I am an internist and allergist/immunologist by training, until moving to Big Sky in 1994), I will try to teach the students the techniques of orthopedic examination, basic office orthopedic procedures, reduction of dislocations and fractures, splinting and casting, and the use and application of orthopedic appliances. During this learning process, the students will also be exposed to emergency splinting and transportation on the slopes. They will learn my techniques for reducing dislocations (mainly anterior shoulder, occasional elbow, finger, and other) and reducing fractures (such as Colles' fracture of the wrist, a very common injury here). Another important aspect of the exposure in the Clinic is the evaluation and management of both minor head and neck injuries and major head and neck injuries (the ones that we stabilize and then send by ambulance to the next level of care).
"Tourist medicine", which falls under the category of "Family Practice" or "Urgent Care" is a big part of our daily routine. I would expect each student to feel comfortable taking a history and physical on adults and children, and then recommending appropriate treatment. One unique aspect of the practice here, at an elevation of 7500 feet, is the effect of altitude on the healthy individual, and the toll it takes on people who might come here to Big Sky with heart or lung disease.
Another problem with being at this elevation is dehydration. This is especially prevalent when someone has gastroenteritis and a fever, a fairly common occurrence. I would expect each student to be able to start and monitor IV fluid replacement, without the help of rapidly available lab data, and make decisions as to whether or not further surgical consultation (a ride to Bozeman by ambulance, 50 miles away) is necessary.
We do get an occasional acute MI (we have two defibrillators, one in the office and one up on the mountain for use on the slopes), and I would expect each student to be able to use each proficiently, as well as being confident in their knowledge of ACLS. Occasionally, we have to go by snowmobile or ski to a slope-side accident or acute MI.
Lacerations are a common skiing, snowboarding, and snowmobiling injury. We also have a number or restaurants at the resort, and the chefs are constantly slicing themselves. I would expect the students to be able to proficiently handle lacerations of all types, and they will be asked to do the suturing. Students are given ample opportunity, under our supervision, to perfect their suturing technique while rotating at the Clinic.
The student should feel comfortable reading bone and chest x-rays, including c-spine series, by the time they finish their rotation. We have in place tele-radiology technology, so that we can get rapid interpretations, or confirmations, on the films that we read. (Dr. Ed Weber, a radiologist in Fort Wayne, Indiana, also has a license to practice in Montana and actively participates in the student program).
We hope that the student would have a little time to enjoy the skiing and other activities of Big Sky. This has not been a problem in the past, as long as students are respectful of their clinic responsibilities and flexible with rotating through possible ski times with other students. One goal might be to ski down from the top of Lone Peak without becoming a patient in the Clinic!
Another goal is to expose the students to a private practice setting that is relatively free of the influences of HMOs and other insurance groups (we do work with Medicare, but in the winter, there are few elderly people getting sick or injured). We also accept Blue Cross/Blue Shield and Workman's Comp cases. Just seeing how a private practice is run is new to most students, and we encourage discussions on the economics of private practice,
At the end of each student's tenure here, I will personally write an evaluation to send back to the medical school.