MUN medical student not daunted by issues
Kady Ibrahim says the learning opportunities offered may not be seen in a larger centre
SPRINGDALE — Recruiting and retaining family doctors is a challenge throughout Newfoundland and Labrador, but even more so for rural areas.
With two years left of her training, Kady Ibrahim is not daunted by the issues that are out there.
“No, I think it was more so the opposite. I think it intrigues us to go more because there is more learning to do as a young physician or a physician in training,” said Ibrahim, a second-year medical student at Memorial University.
She is already planning to practice in a rural area and hopes to find an opportunity within the Newfoundland and Labrador Health Services’ Central Health region.
That’s why she makes it a point to focus her clinic rotations on rural medicine.
Originally from Ontario, Ibrahim has lived in Newfoundland for several years and was working in addictions as an epidemiologist before entering medical school.
It was that work, seeing many people who were prescribed pain medications for acute issues who then became dependent on their medications, that drove her interest in becoming doctor.
When she’s made her selections for clinical rotations Ibrahim has chosen communities where there is known substance abuse issues.
Last year she completed a clinical rotation in Harbour Grace and this year she chose Springdale, where she’s been shadowing Dr. Todd Young. Young operates a family practice at his Main Street Medical Clinic and runs Medicuro, a virtual clinic. He’s also an assistant professor of family medicine at MUN.
She’ll start clerkship when she enters her third year this fall and all her placements will be in central, mostly Gander and Grand Fallswindsor.
She said the opportunity to learn from a wide variety of cases and wide array of backgrounds while shadowing a family physician in a rural area is something students may not see when doing the same thing in a larger centre.
In Springdale she’s worked in community health, public health, acute care, emergency, family practice, virtual practice and at an addiction clinic.
“So, we’ve got the full range of exposures and it’s short, but it sets us up very well for clerkship to know what’s available and what’s not available,” she said.
In rural settings, she said, students get the opportunity to see patients more closely and get more one-on-one time with the physician.
“It’s really helpful for us as learners to have someone who is a veteran in the field actually take time and teach us how to see a patient,” said Ibrahim.
Things like what order to go in, how to come back and dictate notes and what tests to order for which condition.
The experience has already taught her so much and there are things that she’ll carry with her for years to come, like the importance of knowing your patient.
“There are physicians like Dr. Young who genuinely take the effort to do the full exam but also know their patients,” said Ibrahim. “That’s something that not all of us have the privilege of doing when you’re in a bigger city.”
Knowing your patient and finding out what’s important to them is something that is stressed by the medical school and Ibrahim said she is grateful for the training she is receiving at MUN.
Through that she can derive satisfaction knowing that she is not only helping people but helping them understand what’s going on.
“So, then they feel empowered to make decisions and they don’t feel like they’re tied to their health condition,” said Ibrahim. “They have resources that they can rely on themselves and make informed decisions for themselves.”
“There are physicians like Dr. Young who genuinely take the effort to do the full exam but also know their patients. That’s something that not all of us have the privilege of doing when you’re in a bigger city.” Kady Ibrahim MUN medical student
CHALLENGES
Being in a rural placement also shows her that the challenges and gaps in the system that are talked about so much do exist. For instance, when the X-ray machine was down at the hospital patients had to be sent to Grand Falls-windsor for X-rays.
Certain tests require blood samples to be sent out to be analyzed, and some communities, like Baie Verte, don’t have any doctors.
Stepping up to the plate can come with concerns with one being financial. Ibrahim said the financial incentives and other things being done by the province to recruit and retain doctors are wonderful, but she doesn’t know how much it will help to start up a practice. It’s a business that needs to be set up properly and people hired.
There also needs to be supports already in a community, mentors like Young with experience who are just a call away.
Ibrahim said it can be hard for existing doctors to offer that when they have a full patient load. Ibrahim said it can be hard for existing doctors to offer that when they have a full patient load.
There are also challenges outside of the medical realm, like being far from amenities, the lack of anonymity and privacy.
On the positive side, she people are welcoming you with open arms.
For some picking up and leaving an urban centre is not easy when they have family there or partners who are working.
Her partner’s family is from the Botwood area so moving to central will not be quite as difficult for her. She’ll have family around, people she can be herself with and not Dr. Ibrahim.
THE TEACHER
Young will often tell students that one of the hardest jobs they could try and develop is to be an excellent rural physician.
“I think rural medicine is a great place to come,” he said. “One of the things that really isn’t talked about much is we know there’s chronic shortages in physicians in a lot of our smaller communities.
“One of the disadvantages of that is it has limited the number of people who are on faculty who can have learners come from our medical school.”
Ibrahim and fellow medstudent Shae-lynn Lahey are the first two to come to the town in about five years.
“That’s why stability and having physicians working in our rural sites is really important, because only then can we increase our capacity to have learners,” said Young, who is hopeful more will come.
“We know that rural rotations in medical school certainly offers a unique setting and population-based practice for family medicine and for those who are interested in just learning the basics of medicine but also anything related to rural health and medical practice in the future.
“We’ve always said that if we’re going to recruit to our communities, in rural communities we need to be having learners there and getting them exposed.”
Young said having learners come to the community helps build relationships and correct misconceptions that students may have.
He has residents with Medicuro who trained with him as medical students and while they may not be in the community, they are still providing service to rural communities.
He has a previous learner who is a specialist in Grand Falls-windsor who when he gets a call from Springdale has an awareness of the community and some of the complexities of delivering care because he has been there.
Young believes health care should be delivered having nurse practitioners and nurses and working together as a team.
He said being able to model that for students is an excellent opportunity.
He’s sure Ibrahim will see that Springdale is doing some cool things and take that away with her.