Katelyn Bonkowski vowed she would never go into family medicine — "ever!"
But that was before her turn in the Central Michigan University College of Medicine's Comprehensive Community Clerkship.
"I thought family medicine was going to be boring, but it was actually really fun," she said. "After six months, I thought, 'well done, CMED, you convinced me to go into family medicine.'"
While producing graduates interested in family medicine isn't the primary aim, the program does provide an intensive family medicine experience, said Rebecca Molter, manager of the clerkship program at CMU.
The 6-month clerkship immerses students in a single medical practice to experience health care within a community, rather than move them through the more traditional 6- to 8-week family medicine rotations, Molter said.
"There is no other program like it in Michigan."
Through the clerkship, now in its third iteration, students learn the major specialties of general practitioners from one practice rather than separate providers.
The goal is to give students enough time to gain the skills and confidence to become an integral part of a practice and to understand the community where the patients live. They gain enough experience to share in the care of patients from introduction through diagnosis, treatment, management and follow-up — keys of the clerkship.
It was one-on-one, so all of Dr. Lynch's knowledge and experience were directed toward me. — Katelyn Bonkowski
A student's typical week consists of five half-day sessions where they meet and examine new patients, design treatment plans, and consult with a supervising physician. They may go on hospital rounds with their supervising physician, attend learning sessions on specialties or visit other health care providers in the community. They also teleconference with other students in the program and a faculty member to learn from each other.
Bonkowski was assigned to Dr. Brodi Lynch's 5-year-old family practice, part of St. Mary's of Michigan Standish Hospital health care team. It was the first time Lynch had taken part in the program.
The two newbies immediately hit it off.
"We have the same sense of humor, and almost the same personality, allowing us to bond quickly. I feel that she was able to trust me and was quick to teach me things. She's the reason I want to go into family medicine," Bonkowski said.
"She really fit in well with our little hospital here," Lynch said. "I want her to come back when she's done with school."
On the job
First, Bonkowski had to prove herself.
In the beginning, a typical day for Bonkowski was to look over patients' records as they came into the practice. In the examination room, she and Lynch would talk with the patient, discuss symptoms or perform an examination, then consult before discussing their findings with the patient.
"It was more job shadowing at first," Lynch said.
Later, Lynch would have Bonkowski do the entire exam, come up with a diagnosis and propose a treatment plan, then Lynch would go in and do her assessment, and they would come together to finalize a plan.
"We did a lot of procedures," Bonkowski said, "like skin biopsies, sutures and freezing off warts during well-child visits. It's a little bit of everything in the family clinic, and I loved that."
Katelyn Bonkowski (left) and Dr. Brodi Lynch visit with a patient at Lynch's Standish clinic.
Bonkowski also would take shifts in the hospital and the emergency room — new hands-on experiences for her.
"I was nervous, because unlike the practice we have in years one and two with mannequins and standardized patients, these are real patients in real crises. But you learn quickly," she said. "You get to do a lot of things in the ER that don't necessarily show up in a primary care clinic, so it was a really good balance."
A case to remember
One day, a new patient who had not been to a doctor in more than 20 years came into the practice.
"Katelyn did the evaluation," Lynch said. "She came out and said, 'I am worried about this lady. She doesn't look good.'"
Lynch evaluated the woman, agreed with Bonkowski and sent the woman to the hospital for testing. Lynch later got a call from the lab saying the woman's hemoglobin was critically low. It just so happened that Katelyn was rotating through the ER later that afternoon, and she got to treat the woman, who later was released.
"That was kind of cool for her to see a patient's treatment from multiple different angles," Lynch said.
The CCC difference
Relationships are key in medicine, especially in a family practice, Lynch said.
"The program's six-month structure speaks for itself," she said. "If a student came in and only spent a few weeks with me, which is how it is traditionally in family medicine rotations, I don't think that they would ever develop the relationship with patients and their preceptor or get to see the scope of family medicine from beginning to end, like Katelyn did. I give CMU a lot of credit for that."
"It was one-on-one, so all of Dr. Lynch's knowledge and experience were directed toward me. You are there for so long that you develop relationships and become trusted. It validated for me that I want to work where I can create the relationships like I had in Standish."
Fellow medical student Manjit Bhandal had a similar positive experience with the CCC.
"This is one of the best experiences I've had throughout my time in medical school and, honestly, probably the most worthwhile experience of my academic career," she said of her placement with faculty member Dr. Paul Simmons in Mount Pleasant.
"I'm from California," Bhandal said, "and without seeing the need that is in this community, I would have never had such a strong pull to come back, but that is exactly what I would like to do. I fell in love with the patients here and the small-town community atmosphere."