Gain Experience Through Premed Wilderness Medicine Programs

Introduction

Dr. Ryan Gray: The Premed Years, session number 202.

Hello and welcome to the two-time Academy Award nominated podcast, The Premed Years, where we believe that collaboration, not competition, is key to your premed success. I am your host Dr. Ryan Gray, and in this podcast we share with you stories, encouragement, and information that you need to know to help guide you on your path to becoming a physician.

Welcome to The Premed Years if this is the first time joining us. You have a lot of catching up to do, 201 prior episodes of great information for you, and it’s all still relevant which is the best part. I just got back from Tampa, Florida where AMSA held their third I think annual premed fest conference which was a great conference. Over 300 students at USF, a great conference put on by AMSA, tons of great speakers, I talked to a lot of the students there who had nothing but great things to say about all of the presenters, and speakers, including myself. I spoke about the medical school interview, which I had a blast, I had over 100 people I think in the room, so I think if you have the opportunity to go to an AMSA conference near you, check it out. There are going to be some on the east coast including New York, I think there’s one in Puerto Rico, and obviously the AMSA convention in D.C. in February. So check those out and if you register, you can use the code MSHQ17 to save a little money as well.

Alright so this episode is an interesting one. I speak to an awesome gentleman who teaches physicians, and residents, and now premed students which is why I’m interested to have him here on the podcast, all about wilderness medicine and what that means. And we got into the conversation and the more and more that he was telling me about wilderness medicine, the more and more I was like, “Why is it called wilderness medicine?” I think it’s confusing because it’s not just medicine out in the woods and in the wild, it’s medicine that you need to practice, and know how to practice when there are no resources or very limited resources. So don’t let the name wilderness medicine turn you off. This is an awesome conversation and you’ll hear how you as a premed student can have the opportunity to join one of these courses that are being held to teach you about some wilderness medicine, and more importantly get you interactive with physicians, and learning some interesting things. It’s a great experience, and hopefully if you come to one here in the Colorado area I’ll have the opportunity to meet you, because it sounds like I will be hanging out and saying hello when they have these as well. So I look forward to possibly meeting you in the future at one of these wilderness medicine courses that are specifically geared towards you, the premed. So let’s go ahead and jump right in.

Todd welcome to The Premed Years, thanks for joining me.

Todd Miner: My pleasure, thank you Ryan.

Dr. Ryan Gray: Now you are- I’m crowning you the wilderness medicine king. Is that an appropriate title?

Todd Miner: Well prince might be more accurate, and sometimes joker, but definitely that is my forte and strength and what I bring to the medicine world.

Dr. Ryan Gray: To the lay person, explain what wilderness medicine is.

What is Wilderness Medicine?

Todd Miner: Yeah it’s definitely a double edged sword because part of it is, it’s kind of a sexy topic. ‘Oh we’re going to deal with snake bites, and avalanches, and frostbite, and wilderness survival, and search and rescue.’ But then it kind of pigeonholes us. If I could go back in time I would describe our field as austere medicine because it’s really about where- it’s like the classical Peace Corps book where there is no doctor. What we teach is where there is no hospital, where there is no clinic, how do you deal with illnesses and injuries and prevention when we don’t have the benefits of civilization, of 21st century medicine, with all its assessment tools, and invasive techniques, and powerful pharmacological resources. What do we do? It’s kind of old fashioned medicine in a way, and it’s not always practiced in the wilderness. It can be practiced in low resource countries, in disasters, and with superstorm Sandy for instance- my definition of wilderness medicine is either one hour or two hours from definitive care. So in superstorm Sandy and downtown Manhattan when the streets were flooded, the power was out, the cell towers were down, the hospitals were closed because their power was off; people were way more than two hours from definitive care and there’s austere wilderness medicine right in New York City. So it is a topic of medicine that is I think growing in popularity in the sense that more and more people are heading out to the woods, and the back country, and to austere environments internationally. But in some ways it’s just old fashioned bedside doctoring in the sense of supportive care.

Dr. Ryan Gray: It almost reminds me- as a flight surgeon in the Air Force I’ve been to survival school, I’ve done all that fun stuff, but it’s almost like responding to an aircraft mishap, that’s something that I would do as a flight surgeon, and going out and triaging casualties based on the available resources that we had. And it sounds like it’s that same sort of mindset and skillset of saying, ‘We might be in downtown Manhattan, or maybe we’re in New Orleans after Katrina, we should and are usually used to having everything at our disposal, but we don’t. So how do we go from here?’

Todd Miner: Yeah absolutely. I mean that’s one of the I think interesting parts of wilderness medicine is that one is always faced with limited resources, and so improvisation is the name of the game, and it is how do you deal with those limited resources and make the most of whatever you do have in hand for the best patient comfort as well as the care and comfort of yourself and the rest of your party? Because you’re often in a wild environment that isn’t always the most comfortable.

Dr. Ryan Gray: Has there ever been any discussion of renaming it to wilderness and disaster medicine?

Todd Miner: You know I think there are probably some programs that may- there’s probably a dozen, two dozen strong programs across the country in wilderness medicine, and disaster definitely plays into I think all of those programs, because again it’s the same principles apply. We’ve actually started a new course called Disaster Response Advanced First Aid designed for lay people and first responders to take what we’ve learned in wilderness medicine and apply it directly to a disaster situation. And so they’re definitely intertwined, and some of it I think is semantics or labeling, but I certainly- I wouldn’t bat an eyelash if a program included disaster in their name.

Dr. Ryan Gray: Yeah, interesting. Now what is your background to give you all of this knowledge?

Todd’s Background in the Field

Todd Miner: Well I guess I started by flunking out of college as an undergraduate, and hitchhiking up to Alaska with my tail between my legs to start all over. I grew up in the suburbs and it wasn’t a matter of whether I was going to college but which college, and when I promptly flunked out I tried to get as far away as I could, ended up in Alaska, and fell in love with the wilderness and the spirit up there, and ended up starting to assist in- I took a mountaineering class at the local community college, I started to assist in it, eventually started teaching those classes and started guiding and leading expeditions and climbs of the big peaks in Alaska as well as in Central and South America, and started my own guide service briefly, that’s a tough way to make a living. And then started teaching at the University of Alaska and been doing that since the late seventies. So many years, lots and lots of field time, and if you spend that much time in the outdoors you’re going to see a lot of injuries, accidents, illnesses, most of which are very minor but some of which are beyond that. So it just gave me a lot of experience and as I started doing more and more outdoor education and guiding, I got more and more interested in the wilderness medicine aspect because I had to take the wilderness first responder classes, I started helping to teach them, and then connected with a colleague when I was at Cornell University from the Weill Cornell Medical School that wanted to start a wilderness medicine program at Cornell, so I helped found that and basically I’m a sixty year old medical student. I have been hanging out with docs now for about a dozen years and continue to learn a great deal from them, and then I bring in a pretty deep and rich wilderness background, so it’s a really great synergy when I partner with a physician and we teach, whether it’s premed students, or medical students, or residents, or CME’s for physicians and other health professionals.

Dr. Ryan Gray: What has been the response- so you started at Cornell and you start a program there to teach wilderness medicine, and that was part of a response to Katrina, correct?

Todd Miner: Yeah I received a phone call out of the blue about ten years ago from a faculty member at Weill Cornell Medical College who was looking for a collaborator on a grant he was writing. He had a number of emergency medicine docs and EMS providers, went down to Katrina to help out, and they basically got their biscuits spanked when they were down there. They really didn’t know how to set up tarps, or put up their tents, or treat water, or use their stove, so they were not nearly as helpful to the survivors of Katrina and the locals as they wanted to be, and when they got back they wisely realized they needed to get some more training. And so Jay Lemery, my colleague connected with me and we wrote a grant. We didn’t get it funded but it was the start of a beautiful friendship. We ended up teaching some classes together, we started a wilderness medicine elective for med students, and really enjoyed teaching that class. We got great feedback consistently; these third and fourth year medical students would tell us that it was the best class they had in their four years of medical school, and that really I think charged both of us. And during this time I was the Executive Director for Cornell Outdoor Education in Ithaca, about five hours away from New York City and the medical school, and saw a similar need on the Cornell campus with premed students. We had a number of just really bright, really energetic premed students who were part of our outdoor- they were our outdoor leaders for the Cornell Outdoor Education program. They expressed a lot of frustration at the- I think one of them called it the ‘atomization’ of the curriculum where they felt that- medicine felt like it was going to be generations away for them. They were stuck in classes, and labs, and lectures, and really were hungry to get their hands dirty with medicine, with actually talking with physicians and getting involved. And they were- they just didn’t have that opportunity so we tried to set up a premed program at Cornell, and unfortunately couldn’t get it through the curriculum approval process but we were able to thankfully rectify that at the University of Colorado. The hunger of the premeds for actually getting involved with physicians was palpable.

Dr. Ryan Gray: Yes, it’s a common email that I get from a premed student that will say, ‘How do I get shadowing? How do I get clinical experience? I find it so hard.’ And you’re sitting here with this program now at University of Colorado that says, ‘Hey come join me for a week.’

Todd Miner: Yeah, exactly.

Program Offered at University of Colorado

Dr. Ryan Gray: So talk about that. Talk about the program and why you set it up at the University of Colorado, and what the response has been.

Todd Miner: Sure. So my colleague Jay- we both were finding wilderness medicine to be more and more important parts of our career trajectory, but our bosses didn’t see that as an important part of our work and so we were frustrated. Jay got recruited to go out to Colorado about five years ago and spent the next couple years suggesting that I come out and join him, and I finally got frustrated enough that that’s what I did, and we found a very open and ready environment there for innovation, and new kinds of classes. And so we put together a two week program; the first week focused on emergency medicine on the medical campus, in the hospital, very much hands on. Sort of a mini med school type of approach with lots of labs and lots of lectures, and then a week focused more on wilderness medicine and application up at a camp in the Rocky Mountains. So if you’re going to be in Colorado, as nice as Denver is, you’ve got to get up into the mountains and experience the real Colorado, so we wanted to give students that opportunity. So they get a really I think excellent introduction to the profession of medicine. We have about twenty different attending physicians and residents come in as guest lecturers, they share their stories about how they- what they majored in, what they did in between undergraduate and medical school if there was that gap, why they went into their specialty, what they love about medicine, what they hate about medicine. And so we always start our lectures with that kind of personal story that I think every student somewhere during the two weeks connects with at least one, physician or medical profession- healthcare professional, and there’s I guess a connection there for lack of a better word. So that’s a real powerful part of the program, and then it’s intense, we go from 8:00 in the morning until 8:00 at night. We try to give them a half day off to enjoy Denver a little bit and then we’re up in the mountains, and in the winter, the January session, they get to dig- create a snow shelter whether it’s an igloo or a quinzee, and optionally sleep out for the night in that. In the summer we do a three day mini backpack trip to really get away from the plugs and the screens, and truly immerse ourselves in the great outdoors so that they can appreciate Colorado and the natural world as well as make the wilderness medicine part that much more relevant.

Dr. Ryan Gray: Are you saying there’s no iPhones or iPads or iPods?

Todd Miner: I am, for three days, yes. There’s no cell phone coverage. I personally love it, some students find it frustrating. I don’t know which one they find more frustrating; the lack of a shower for three days or the lack of their iPhones, but they all at the end laugh about it and I think are proud that they were able to- because a lot of these students had never camped before, much less backpacked, or much less winter camped in an igloo. They’re stretching themselves and I think that’s part of the reason that they rate the classes so high, is that they’re getting to do all these new experiences, and they’re getting to do them with students from all over the country. So this has been a bit of a- more than a bit of, it was a big surprise to me, a pleasant surprise how much the students get out of talking with a student from all the way across the country who has similar challenges, similar pressures, similar worries, similar dreams and aspirations, and they compare notes, and they learn from each other, and I think they have a better idea that they’re not on this journey alone, that there’s a lot of people out there, and they see each other- it’s not competitive, there’s no curve, there’s no grading, so they’re free to be themselves and to learn and to share with twenty or thirty other peers, and that’s a big strength I think.

Dr. Ryan Gray: Yeah, I think there’s something where you remove the ‘normal’ society, especially from a premed student that’s used to the cut-throat world of premed, and you put them out in the wilderness where there’s not all of these expectations or societal norms, especially for people that haven’t been out in the wilderness before, and people actually just open up and become people.

Wilderness Medicine as a Team Sport

Todd Miner: Yeah well I mean medicine is a team sport and so is the wilderness. You can’t- the Bear Grylls aside, the reality is it is something where you have to work as a team, you have to work together. Somebody’s going to get the fire started, somebody’s going to get the food ready, somebody’s going to pitch the tarp, and with everybody working together it’s a very comfortable and fun experience, and it doesn’t take long for folks to realize that and get into that groove, and it’s great. In some ways I wish we did the camp first because that’s what- that’s the really great bonding experience, but because of altitude issues, the camp is up at 9,000 feet, we do our first week in town and they get a lot of the lectures and the PowerPoints out of the way there before we head up and apply learning up at the camp.

Dr. Ryan Gray: So being in the Air Force as a flight surgeon, I had to go to survival school- SERE, and they taught us how to kill a rabbit, and a chicken, and de-feather the chicken, and skin and gut the rabbit. Do you teach that sort of stuff too?

Todd Miner: No, it is the opposite of boot camp, it’s the opposite of survival camp. It’s about having fun, and being- learning to be comfortable, we feed people well. And they still learn a lot, I mean they learn to do one-match fires, they learn to pitch tarps and tents, they learn about bear safety, they learn about map navigation and they’ll improvise litters, and do search and rescue scenarios, so there is a lot of probably similar learning, but the tone is very much focused on fun and thriving rather than surviving.

Dr. Ryan Gray: Is there a particular student that comes to these events or classes? Are they students that- are they mostly male students that know they want to be emergency room physicians, or is there a good mix of everything?

Todd Miner: There’s a good mix. I mean my favorite students are the ones that come from the city or the suburbs and have never camped before. This is like their eyes- they’re looking behind them wondering when the bear and the cougar is going to get them any second. And by the end they’re regular Annie Oakley’s or Daniel Boone’s. Those are my favorite students, but no it’s a really good cross section. We probably have slightly more female than male students. There’s definitely more of an interest in emergency medicine but we’ve had students that are- most of them just want to get into medical school and they’re smart enough to realize that they can figure out their specialties down the road. But I think there is because of the nature of the class a big interest in emergency medicine, but we’ve had folks who want to be nurses, folks that want to be PAs, folks that are interested in psychiatry, and orthopedics, sports medicine, you name it.

Dr. Ryan Gray: Yeah and I would assume- and this is just kind of funny, with the looming zombie apocalypse I think these are great skills to have.

Todd Miner: Yeah, oh no absolutely. Disasters are- whether it’s natural disasters in climate change, or whether it’s terrorism, the disasters are- you can’t open the front page without seeing something going on. And so this preparation for a non-911 world where one has to be much more self-aware, have situational awareness, be able to be self-sufficient I think is a life skill whether somebody ends up using it in medicine or ends up in a whole different career track, these are great and very valuable skills to have.

Where Skills Can be Utilized

Dr. Ryan Gray: Do you know of anybody that’s come to your class to prepare for going to- for like an international medical mission trip?

Todd Miner: Not so much the premed classes, though there’s definitely- we do have that. We have a class called Global Health Advanced First Aid, it’s a three day class that is focused specifically on that topic, and we get some really- I mean we get Peace Corps volunteer who’ve come back and want to head back to a low resource country to help out, or who want to advance in the Peace Corps. We get folks who are interested in going very- not casually but maybe it’s a once in a lifetime mission trip with their church or synagogue, there’s folks who are global health majors who want to go into this field professionally and they all I think benefit greatly from this class which looks at travel- international travel to austere environments. And again, takes that core wilderness medicine curriculum and then puts an international and low resourced perspective on that content.

Where to Learn More

Dr. Ryan Gray: That’s awesome. So for the premed student listening to this, how can they get involved whether it’s through the University of Colorado’s program, or how can they just start learning about this in general?

Todd Miner: Sure, well there’s- I mean they can go to our website which is www.ColoradoWM.org, or they can just Google ‘Colorado wilderness medicine,’ and we’ll pop up there, if not at the top, pretty close to the top, and learn about our programs. We offer our classes in the summer and then in December we’ll be in Costa Rica, in January we’ll be back in Colorado, in March we’ll be in the Channel Islands National Park out in California, as well as a Spring Break program in Colorado, and then in the summer we’re in Colorado and Costa Rica. So lots of programs there for premed students, and we welcome students from all over the country, international students, postbac students. We get a number of students who have been out of school for a couple years and are looking to come back and using this class as a springboard for that. And for students who can’t afford the time, or the money, or the travel, at their own institutions I would highly recommend getting involved with their outdoor program on their campus. They will have usually offer wilderness first aid or wilderness first responder classes. These are great hands-on classes, kind of like a mini EMT program where students can learn a lot about basic medical care, and again, learn these practical skills whether it’s something they’re going to use in medicine long-term or whether just something that they might use at a backyard picnic. One of the fun things that- fun parts about my job is hearing from students who have used their skills- I always ask them, we have a little graduation ceremony. I say, “Please if you’re ever- we hope you never have to use these skills, but if you do, let us know because we want to hear how it went, and was it helpful?” And I probably get every other month or so get an email or a phone call from one of our past students who tells us about how they used a skill when a student got knocked out in a volleyball game, or a skier was lost, or a kid broke his arm falling out of a tree. These are skills that are- I don’t think anyone ever wants to be the- I think premed students don’t want to be the bystanders, they want to be able to help, and these kinds of classes whether students do them with us or with many of the other great programs around the country, will give them the confidence and the skills to be able to respond, and help out, and make life better for somebody who’s in a miserable situation.

Dr. Ryan Gray: Yeah, I remember in medical school- this was before survival school, I was driving with my girlfriend at the time, my wife now, we’re driving down the highway and right in front of us was a pretty bad car accident, and we were the eager beaver medical students and we got out and were like, “Hey can we help?” And I guess I was the only one there that knew how to like make a sling. This one lady had an arm injury and so I put her arm in a sling. And you never know when these skills are going to come in handy. You don’t have to wait for a superstorm Sandy or Katrina to come through.

Todd Miner: Or medical school, yeah. Those are great examples, and they’re going to happen. And you know I have to admit a little shock the first time I taught a wilderness medicine elective to third and fourth year med students, and this was ten years ago and I know medical school curricula changed and are getting much more hands on early on, but these medical students were- they were kind of shell-shocked when we first threw them into scenarios and asked them to actually touch patients, and move patients, and treat patients. They were- our wilderness first responder students at Cornell were much more adept by the end of the class than these third and fourth year medical students. So getting some early hands on patients’ assessment, scene assessment, basic first aid I think is something that is invaluable.

Biggest Takeaway of Wilderness Medicine Program

Dr. Ryan Gray: As you’ve gone through teaching premeds wilderness medicine and they’ve left the program and you’ve heard back from them, what do you think is the biggest takeaway for a premed student as they leave your program?

Todd Miner: Well I think it gives them a backstage pass to medicine, and I think it’s the conversation- the intimate conversations they can have around dinnertime, at lunch, over a cup of coffee with all of the physicians and other health professionals that come in and out of the program that share their stories of how they got to where they are, and I think that our students find that inspiring, I think they sometimes find it reassuring that, ‘Oh I can take a couple years off and it’s okay. I don’t have to go straight to medical school. I can major in government or English and still get into medical school. I can flunk a class and still get into medical school.’ So they- I mean five years later from a two week class, I don’t know what exact skills or knowledge a student retains, but I think that heartfelt conversation is definitely something that they do take away and keep and it inspires them. I think- again we try to open up the eyes of our participants that for some of them med school isn’t necessarily in their future, or the right future for them, and come talk to an emergency department nurse, come talk to a respiratory therapist, have a cup of coffee or a beer after class with a PA. And I know there’s been several students that have really thanked us for helping them get past that tunnel vision and feel really good about their career tracks. So I think that’s been really helpful for some of our students.

Final Thoughts

Dr. Ryan Gray: Alright again that was Todd from the University of Colorado School of Medicine, and if you are interested in learning anything more about the wilderness and environmental medicine courses going on there, go check out www.ColoradoWM.org, and as always you can find links to everything that we talked about in our show notes. You can find those every time at www.MedicalSchoolHQ.net/ and then the episode number, so this one is session 202. So www.MedicalSchoolHQ.net/202.

Thanks Todd for joining me on the podcast and sharing the awesome stuff that you’re doing at the University of Colorado.

I do want to take a second and thank the one student that has left an amazing review for us in iTunes. We have KevinRGan who says, ‘The premed advisors of my dreams. Doctors-‘ Ryason? I think that was our nickname in medical school. No I think it was Rallison. They combined our name, almost like a Jennifer and- what do you call Jennifer and Ben Affleck? I forget. Anyway, ‘Doctors Ryan and Allison Gray have given me so much hope with regards to the medical school application process. I found their podcast two weeks ago upon switching my path from the biotech industry to medicine, and I could not be more grateful for their efforts.’ I wish everybody would find us as soon as this student did, and switching into the premed world and go, “Hey I found a podcast already.” So tons of great information, and great review here. Good luck on your journey, Kevin, as you complete it.

So anyway, if you would like to leave a rating and review you can do so at www.MedicalSchoolHQ.net/iTunes.

Alright I hope you got a ton of great information out of this podcast, and you learned a little bit more about wilderness medicine, and if you are interested again, go to www.ColoradoWM.org and check out everything that Todd and his team are doing out at the University of Colorado.