Neepawa hosts next generation of doctors


By Kate jackman-Atkinson

The Neepawa Banner/Neepawa Press

Neepawa has a long tradition of opening its doors, and clinics, to medical students as they complete their training.  For Dr. Brian Milligan, the experience has come full circle. Milligan, who first came to Neepawa as a medical student, has helped make Neepawa a site offering training for physicians completing their residency in family medicine.

The process of becoming a fully licensed family physician is long and at various stages, individuals will spend time working with patients. Milligan explains, “We take learners across that whole spectrum, starting in medical school.” Milligan, as well as other doctors in the Beautiful Plains Medical Clinic, have teaching positions at the University of Manitoba, which allows them to train young doctors.

A person studying to be a medical doctor begins by completing an undergraduate degree. They then enter a four-year MD program. The first two years of the program are spent learning through books, classrooms and labs.  In the third and fourth year, learning is done on the job, by working with practicing physicians in hospital and clinic settings. 

Once the MD program is complete, the student has become a doctor and can do a number of activities, including writing prescriptions.  However, before obtaining their full license, the learner must complete a residency program in their desired specialty, which is practice under supervision. The length of residency depends on the specialty. 

Patients in Neepawa are familiar with seeing students at various stages of their MD program. Between first year and second year, students participate in Rural Week, where students come and spend time in rural practices. Milligan explains, “At that point, [the students] don’t know very much at all and they’re just there to give them a first exposure to rural medicine.” 

In addition to Rural Week, in the summer, the clinic will sometimes host first and second year MD students who want to do early exposures to rural medicine to get a better sense of the specialty. 

In their third year, students begin spending their time working with patients. During third year, students spend four to six weeks going through every core specialty, such as family medicine, obstetrics, orthopaedics, internal medicine and psychiatry. The Beautiful Plains Clinic is one of the sites for the family medicine rotation. Other sites that commonly take students include Brandon, Dauphin, Portage, Winkler and Steinbach.

After third year, the students have done all of their core rotations and during their fourth year, they choose the rotations in which they want to spend more time. “Those are called electives and we take fourth year elective students here too,” said Milligan. A fourth year elective rotation with Dr. Poettcker first introduced Milligan to Neepawa. The elective rotations last two to four weeks. The program has been successful and Milligan said, “We seem to be becoming increasingly popular. We are getting more requests to do electives with us and we’re actually having to turn some people down because we just can’t accommodate them…It’s a really good position to be in.”

Recently, the clinic has begun taking more advanced learners. Within the last year, Neepawa has also begun taking on residents. These learners typically come in their second year and are within 12 months of being completely licensed and able to practice on their own. “They get a lot of autonomy,” said Milligan, who mostly works with the residents.

When it comes to residents, Milligan explained that the clinic prioritizes physicians looking to practice in rural areas. “Because we’re a rural site, we take residents preferentially out of the Brandon residency program.  Brandon has become a satellite residency program for the University of Manitoba. But there aren’t very many of them, there might be two a year,” he said. The rest of the time, the clinic takes students out of Winnipeg. “Winnipeg is looking for people to train their residents and we’re more than happy to accommodate that,” said Milligan.

While in Neepawa, the students will stick with one doctor for their rotation.  This doctor will be their main supervisor and they’ll pick up extra call shifts with other doctors. This method gives some continuity and allows the learners to know what’s expected of them and the supervisors know what the student can and can’t do.

During the first week of December, the doctors in the clinic were working with a resident, a fourth year elective student and a third year core rotation student. Milligan explains, “That’s pretty much the max, except during Rural Week, when we have four to six at a time.”  He continued, “At a site our size, if you start getting more than that, students start getting diluted experiences.”

As students progress through their education and training, they work with more autonomy from their supervisor. However, the work is always reviewed by their supervisor.    

Milligan explains that a medical student can’t see a patient without the doctor also seeing the patient, even if it’s something basic, like taking stitches out or checking blood pressure. Once the student graduates and becomes a resident, they are a doctor and don’t require as much supervision. A resident can see a patient by themselves and the attending doctor can review the case at the end of the day.  Milligan explains, “I review all of the notes [made by the resident] and I edit them, I will call the patient to clarify or talk to the resident…[patients] can rest assured that we will talk about the case with the resident and review it.” Milligan added, “I think if anything, [the quality of care] has improved when you start teaching.”

Because local doctors are working with learners at many different stages of their education, Milligan acknowledges that there can be challenges for patients.  “I think it might be confusing for the public because they see someone one time who is in Rural Week and doesn’t know anything and the next time, they see a second year resident and never see their attending or actual doctor and ask, ‘How come the last guy had to be supervised?’,” he said. 

Milligan explained that patients have the option of only being seen by their regular doctor.  “[A patient] can always say, ‘I’d rather see my doctor’.  That’s perfectly fine, they’re never given any grief,” he said. 

While teaching takes extra time and effort for the community’s doctors, for Milligan, there are a number of benefits to taking on students. “First of all, it keeps me sharp, learning is a two way street. There hasn’t been a  student who’s come who hasn’t taught me something,” he said. Continual learning is an important part of medicine and he feels that teaching students helps to improve his knowledge base.

Taking on students also exposes rural physicians to the most current education. “The students are fresh out of university with the latest information, the latest lectures, the latest studies. [Taking students] helps translate some of that knowledge out to the rural sites more effectively,” he said.

The students are keen to work and tend to be very thorough as they build their knowledge base, which is a benefit to patients. Milligan said, “I think it’s good for the patients to sometimes get a different perspective on things, it’s almost like a free second opinion.” He added that more than once, after a receiving a physical performed by a learner, patients have commented that it’s been the most thorough exam they’ve received. 

Taking on students also creates a long-term benefit to the community, as a way to help with recruitment. Not only does it expose students to a community, it also creates an environment that’s attractive to many young doctors. Milligan notes that sites that do lots of teaching have lots of doctors. 

Beyond all of that, Milligan enjoys sharing his knowledge with others, “I like teaching, I like passing on what I know. It’s one of the things I enjoy.”

Successfully teaching the next generation of doctors can’t just be done by the community’s doctors and Milligan praises the community’s residents. He explains, “For the most part, the community has been very receptive to the students… In general, a lot of the students have come back and said, ‘The people of Neepawa are really great about having students,’.” This isn’t the case with all communities, explained Milligan, “Some communities aren’t [welcoming to students], they come to learn and gain experience and want to do exams and procedures and every other patient said, ‘I only want to see my doctor.’ That’s frustrating for them, it’s hard on them. Here, the patients have been very open to having students, it’s been a very positive experience.”