Rural Critical Care Fellowship
The one-year Rural Critical Care Fellowship started in July 2021 through a partnership with the Montana Family Medicine Residency.
Within rural practice, family medicine physicians are often required to care for high acuity patients in the emergent or hospital setting without specialist support or backup. This non-accredited program aims to develop fellows’ clinical skills in emergency and critical care. Emphasis on communication, leadership, and teaching skills will give fellows the competence and confidence to lead rural healthcare teams caring for high acuity and critically ill patients.
This program is the first of its kind in our region and is targeted toward newly qualified family medicine physicians interested in rural practice. Two fellowship positions are available each year.
The fellowship curriculum will consist of a series of progressive educational rotations including:
- Trauma and critical care
- Advanced procedures such as intubation, tube thoracostomy, and central venous access
- Electives focused on fellows’ particular areas of interest, such as point of care ultrasound
- Emphasis on communication, leadership and teaching skills
- Learn to lead rural teams caring for high acuity and critically ill patients
Fellows will alternate between Billings Clinic and critical access hospitals (CAHs) across the region. Lodging is provided in rural communities.
Physician-Led Medicine in Montana at Billings Clinic
Billings Clinic is nationally recognized for clinical excellence. Located in the magnificent Rocky Mountains in Billings, Montana, this friendly college community has great schools, safe neighborhoods and family activities. Exciting outdoor recreation minutes from home. 300 days of sunshine!
- Billings Clinic is the region’s largest health system, integrated multispecialty clinic and tertiary referral center
- Highest volume Emergency Department in Montana
- Established aeromedical transport program
- Certified Trauma, Stroke and Chest Pain Centers
- Advanced Simulation & Experiential Learning Lab
- Magnet® recognized for nursing excellence
Q&A with Montana Rural Critical Care Fellow Alyssa Lautenschlager, MD
Dr. Alyssa Lautenschlager is the 2021-22 fellow in the first year of the Montana Rural Critical Care Fellowship.
Why did you choose the Montana Rural Critical Care Fellowship?
My goal with this fellowship is to be able to provide the best care that I can for my patients. I heard about the Rural Critical Care Fellowship while I was working in the Emergency Department at a Critical Access Hospital in Browning, Montana. Due to the remoteness of the hospital's location, it was imperative that I be able to care for a broad spectrum of medical conditions, from car accidents to rodeo injuries to GI bleeds and severe sepsis. I was inspired by the energy and dedication of all the physicians and staff at Billings Clinic and decided that this would be a great place to further my training to be able to better serve the community and my patients.
What do you like best about providing family medicine with emergency medicine in rural areas?
The people. Both patients and other employees. There is a camaraderie among everyone who works at rural hospitals. We get to know everyone well and work together on both big and small problems. I love the teamwork that you can have in these locations.
What are the biggest challenges as a family physician providing emergency medicine at critical access hospitals?
As you might expect, one of the biggest challenges is the limitation of resources. For example, one hospital that I have worked in does not have a ventilator. We have had to manually bag intubated patients until flight can arrive. Many are very limited on the amount of blood they carry. Getting certain labs or imaging studies can be very challenging. It requires you to problem solve and be a little more creative in your care.
What are three new things you’ve learned in the first three months of your fellowship?
I have had the opportunity to learn many things over these first three months. One of the most useful has been the management of critically ill COVID patients, which is particularly applicable working in medicine today. Another theme among my ICU rotation was post-cardiac arrest care. I have also had the opportunity to expand my procedural skills, including trauma-related skills such as chest tubes and central lines.
What would you say to other family physicians considering the Montana Rural Critical Care Fellowship?
It has been a great experience so far and I am excited about the new skills that I have learned in such a short time. Everything will help my future patients. It's definitely hard to step away from being an attending physician and leave my position at my previous hospital, but it will be worth it in the long run. I would recommend it for anyone looking for more experience, with the goal of taking care of critically ill patients in rural settings.