When Jen Nykiel ’10 MD ’14 examined seriously ill patients over the summer on Block Island, she made sure not to only check their vital signs but also the weather forecast.
Nykiel was one of 12 Alpert Medical School students and medical residents from affiliated hospitals to work at Block Island Medical Center during the island’s tourist season, said Janice Miller, a family practice physician and the island’s only full-time doctor. Block Island is an isolated island off the coast of Rhode Island with a full-time population of fewer than 1,000 residents that swells with 10,000 to 15,000 daily visitors during the tourist season from June to October, said Miller.
On the island, practitioners can deal with unusual factors when evaluating patients: In Nykiel’s case, weather could be of concern because under foggy conditions, airplanes and helicopters cannot land, so patients must leave by boat.
Compared to those treated during Nykiel’s rotation at Rhode Island Hospital, patients on Block Island provided different types of cases.
Among tourists, moped injuries and ear infections stemming from swimmer’s ear were common occurrences, Nykiel said. Full-time residents tended to experience more trauma injuries and Lyme disease, she added.
In addition to Miller, Block Island Medical Center’s clinical staff includes a nurse and nurse practitioner.
Without any medical specialists on Block Island, medical students and residents handle a greater variety of injuries, Miller said.
“Lacerations I see all the time at Rhode Island Hospital, but fishhooks — that was new,” Nykiel said.
At an academic hospital, a hand surgeon will repair a laceration, but on Block Island, a primary care doctor will repair the hand, she said.
In cases of severe illness or injury, patients are evacuated via boat, airplane or helicopter, Nykiel said. Transportation on the ferry to the mainland takes about one hour, while transportation by air takes only 11 to 13 minutes, she said. With no pharmacy on the island, Block Island Medical Center stockpiles common medications and receives all others from the mainland, Nykiel added.
Nykiel said she plans to apply to a residency program in emergency medicine. Though she never previously considered working in a small town, her time on Block Island led her to consider the option.
By contrast, Neil Jackson MD ’14 said he knew he wanted to practice medicine in a small town before working on Block Island this past July. After graduating from college, Jackson taught English in Malaysia on a Fulbright Scholarship and worked on a farm in rural Nicaragua.
Working on Block Island confirmed his desire to practice family medicine, he said.
On an average day, Jackson would see 15 to 20 patients, a “heavy workload” more typical of a third-year resident than a medical student, he said.
Both Jackson and Nykiel stressed the creativity required for practicing medicine in a rural setting.
“Most of medical education is spent with academic doctors within the realm of hospitals,” Jackson said. “Real world medicine is more of a delicate dance between doctor and patient.”
The program placing medical students and residents on Block Island dates back to the early 1980s and was already in place when Miller arrived on the island 12 years ago, she said.
The program allows medical students and residents the opportunity to see more cases while giving Miller the opportunity to teach, she added.
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