Innovations in Medical Education:
Thirty Years Later, WWAMI Still Going Strong

Successful program continues to help rural health care in the Northwest

This is the fourth installment in a 2003 series of columns that will examine efforts to break new ground in medical education curricula.

Bedside Manner: University of Washington medical student Heidi Lowery (left) meets with a patient in Sterling, Alaska, while Katy Sheridan, a UW alumna, looks on.

For more than three decades, the "WWAMI" medical education program has provided a lifeline of rural care for five northwestern states. WWAMI - which stands for Washington, Wyoming, Alaska, Montana, and Idaho - began in 1972 at the University of Washington (UW) in Seattle, which has the only medical school in the region. Besides UW, the schools include the University of Alaska, Washington State University (WSU), the University of Idaho (UI), Montana State University (MSU), and the University of Wyoming (UWy), which added an extra "W" to the WWAMI family when it joined the program in 1996.

The program helps the sparsely populated states with a stream of badly needed doctors by offering roving clerkships to medical students throughout the Northwest, along with incentives to practice in rural areas once they finish their education.

"We have enough doctors, but not in the right places," explains Dan Hunt, M.D., associate dean for academic affairs at UW. Students do clerkships in one of the five states during their third and fourth years. "Physicians need to be trained in small towns so they can practice in them …The bottom line is serving the underserved" in rural areas, he says.

This year, the program will include 120 students from Washington, 20 from Montana, 18 from Idaho, and 10 each from Alaska and Wyoming, says Dr. Hunt, who has been on the UW faculty for 25 years.

The program also has a K-12 program in place with the goals of identifying promising students with interest in or aptitude for medicine and increasing participation of underrepresented minorities. It also includes a college-level Minority Medical Education Program (MMEP) that serves as a medical school pipeline for minorities, students from rural areas, and other disadvantaged students.

In addition, the program has set up a research consortium of those states that have received NIH funding through the Biomedical Research Infrastructure Network (BRIN). The BRIN program helps to promote biomedical research; the consortium will meet in Seattle on April 21.

WWAMI also is involved in international student and faculty exchanges, and focuses on curriculum issues with foreign medical faculty, Dr. Hunt says. WWAMI has undertaken faculty exchanges with West China University and is sending students to Kenya and Peru this summer for AIDS-related work, he says, attributing this to the "international vision" of UW's medical school dean, Paul Ramsey, MD

'Medical school without walls'

Over the years, WWAMI has evolved to incorporate new programs and policies. "The program has changed dramatically," says Michael Laskowski, Ph.D., WWAMI's director at WSU and a biology professor at the UI and UW. "I don't think the people who started it in 1972 would recognize it today," he says. Because the program has students who hail from different states, "we call it a medical school without walls," he says.

WSU and UI are just seven miles apart. "It's a unique program here, because we have a combined [WWAMI] program and a state program," says Dr. Laskowski. Idaho has had its "ups and downs" with the numbers of students in the program over the years, but the number has generally remained steady since it started with 20 students in 1972.

In Wyoming, students have the option to come back to the state and practice there for three years to pay off their tuition. "We want them to have exposure to rural areas," says Sylvia Moore, Ph.D., R.D., the WWAMI director at UWy.

Students can do some clerkships in rural areas, while others, such as NICU (neonatal intensive care unit) training, have to be done in Seattle, Dr. Moore says. Program directors say the clerkships are designed to give rural doctors a wider perspective, since they often have to perform everything from routine general medicine to birth deliveries and more complicated procedures.

Last month, WWAMI drew an endorsement from the Billings (Montana) Gazette, after a state legislator proposed cutting the program. The cut "would cost Montana far more than it would save the state general fund. Montana is already short of primary-care doctors and loss of state support for medical education would worsen the shortage," the paper wrote in a March 17 editorial.

From the student perspective, the program appealed to Wyoming native Henry Gottsch, a first-year UWy student who is getting ready to relocate to Seattle for his second year this summer. "I chose [to enter the program] because I will be more likely to get a job here" in Wyoming, he says. Gottsch, whose wife is working on her Ph.D., wants to return home to Wyoming. "We'll be thinking about family, and this is where we want to be," he says.

By Michael G. Malloy

Editor's note: For more information, visit www.washington.edu/medical/som/wwami.

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