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Third-year medical students learning rural medicine

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Bothwell welcomed third-year medical students Madison Bulger, Magdaleno (Mags) Gutierrez and Brittney Marshall as the first Longitudinal Integrated Clerkship (LINC) students this summer. The three are in the University of Missouri School of Medicine Rural Track Pipeline Program and will be at Bothwell for clinical training for one year. In contrast to a traditional block curriculum, the students have been meeting and following their patients across multiple care settings and different disciplines. 

The rural LINC program includes a variety of educational methods over the course of the year. Students participate in the care of children and adults in outpatient clinics and the hospital operating room and emergency department. They will continue to be exposed to rural medicine and the unique challenges and benefits of providing care for the community. 

LINC is a proven and major advancement in medical education that has been adopted by many prestigious medical schools across the United states for training medical students. Bothwell is the first to work with the University of Missouri as LINC training is new in Missouri. 

“It’s a win-win opportunity and partnership for both Bothwell and MU,” said Dr. Philip Fracica, Bothwell’s chief medical officer. “The students’ clinical goals will be met, and we have the opportunity to create relationships and show them what it’s like to practice medicine in a rural setting.”

The year of clinical training is meant to allow enduring learning relationships to develop with patients and physician-teachers. Additionally, there is less chance of burnout from medical students in this type of training, producing empathetic, enthusiastic and caring health care providers patients want and need. Bulger, Gutierrez and Marshall all have an interest in caring for rural and medically-underserved populations and have a heart for these patients. 

Growing up in rural Harviell, Missouri, Bulger has seen firsthand when people in smaller communities are unable to access quality health care. She has always had a love for science, but in third grade, her family was affected by the lack of medical care in her area. Her grandmother had lung cancer and was unable to receive the needed medical care

in her region. This motivated Bulger to pursue medicine and learn as much as possible, especially through the opportunities LINC will present. 

“It’s been an absolute privilege to be able to follow a patient to their appointments across various specialities and for them to remember me, be excited that I'm here with them and trust me to participate in their health care,” Bulger said. “The experience has been very rewarding and makes all of my years of studying and dedication to get to this point more than worth it.”

Gutierrez has a unique perspective as he first attended law school and received his Juris Doctor from the University of North Dakota School of Law. While pursuing his degree, he took a health law class and wrote a paper on the new Affordable Care Act and its impact on providers. He discovered he could better influence policy and have a direct benefit to patients’ health by becoming a physician. Even though he is from the large city of Long Beach, California, his heart is with patients in rural America. 

“Rural health care is truly unmatched,” Gutierrez said. “I feel like I am a part of the community. My patients aren’t just patients to me, they feel like family and nothing beats getting to spend all day helping my family.” 

Guitierrez also said studying in the rural area and being a part of his patients' lives and witnessing birth to death has humbled him, aiding in his journey to becoming a compassionate doctor.

Marshall has always been amazed by science and the human body since she was young. She comes from a family of caretakers in Southwest, Missouri, which helped support her love for people. Marshall completed the four-week Rural Track Summer Community Program at Bothwell in 2020, where she worked with Dr. Stephanie Lind at Bothwell TLC Pediatrics. She is excited to learn medicine from a life cycle point of view versus unrelated segments and how she will make a difference. 

“My favorite thing about LINC so far has been the people,” she said. “It has been incredible to be able to have patients that feel like my patients, who are excited to see me at their appointment or at their bedside and ask about me when I can’t be there. I am surrounded by invaluable mentors and teachers who are helping me grow into a physician.” 

Marshall also said she has been impressed with the number of specialties available at Bothwell, but has seen patients experience the lack of some specialties when they have to go elsewhere for care. 

“It has shown me just how important it is to recruit health care providers of all levels and specialties to rural areas,” she said. 

Fracica said for a rural health care system like Bothwell Regional Health Center, one of the greatest challenges is attracting a sufficient number of high-quality providers to its community. Bothwell’s relationship with MU has been enormously beneficial for the health center’s recruitment efforts and the ability to enhance the future of rural health care. 

“I believe this exciting innovation in medical education will help our students, our patients, our community and our state,” he said. “LINC training has been shown to produce doctors with a higher degree of empathy for patients and who are more likely to choose to practice primary care medicine in a rural community, which is good for Bothwell.”

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