Work hard, keep your “eyes on the prize”

Twenty years into her nursing career, fourth-year student Marika Stubbs was a nursing program lecturer at Otago Polytechnic in Dunedin, New Zealand when one of her students asked if she would write a recommendation letter for her medical school application. Her student was applying to Oceania University of Medicine. Marika had not only heard of OUM, she had been following the school for about a year. She had come across it when she was researching online. She had thought about medical school over the years, but she remained committed to nursing. It had been a reliable career for her in raising her family.

“There are only two medical schools in New Zealand and they are geared toward undergraduate school leavers. They aren’t graduate entry programs like OUM and they don’t actively recruit for older students. They are designed more for the student who just got a high grade in physics or chemistry,” Marika says, adding that they tend to have an age cutoff for applicants and a traditional 9-5 class schedule that simply doesn’t work for non-traditional students.

It was a year after she wrote that letter of recommendation, in 2014, that she applied and got accepted into OUM. Her former student Brandy Wehinger, MD, is a member of OUM’s Class of 2018 studying for her NZREX.

Like many nurses who found their way to OUM, it was Marika’s desire to provide a higher level of care to her patients that brought her to medical school.

“Oddly enough, some of those things that had frustrated me over the years about how doctors and medical students address a case I’m now doing myself, because I see things very differently,” she says. “Now that I’m in the ‘doctor head space,’ my approach to illness and problem-solving focuses more on science.”

Marika says that nurses tend to see a more holistic picture of a patient, not just their health issues, and how stress at home, for example, may be impacting their situation.

“As nurses, we may know more about a patient’s career, stories about their children, or their dog’s name,” she says. “Combining that personal knowledge with the science behind illness is another way to problem-solve and lets me approach patients differently. I was already a good nurse, but now I’m learning to think like a doctor.”

Due diligence is important

And that decision to go from a nursing career to becoming a physician cannot be made overnight, Marika emphasizes, adding that she spent nearly two years digging deep into the OUM website, reviewing the student handbook, and talking with her family so they had a realistic picture about what was ahead.

“It is important to involve your family and support network in the process,” she says, “because they are going to come along with you. They will be the ones seeing you at the kitchen table struggling over something at 3:00 am so they need to understand the importance of putting in the study time. It’s important to realize that there are no shortcuts to getting through medical school, so if someone thinks they can study a couple hours, they are wrong. It will not go well for those people during exam time.”

Creative financing

Obviously, part of the decision-making process in considering medical school also has to be the financial implication, according to Marika. While OUM’s flexible curriculum allows students to continue working at some level during the pre-clinical phase of study, once clinical rotations begin, that is no longer an option.

“You have got to think ahead about how you are going to pay for medical school,” says Marika, who worked fulltime as a nurse during her first two years at OUM. In order to have more control over her work schedule during that time and also preserve the ability to generate income throughout the clinical curriculum, Marika formed an occupational health company and identified freelance opportunities in nursing. She had a few contracts that she managed and staffed during her pre-clinicals, but once clinical rotations began, she hired a locum to cover her contracts. Marika has completed all core clinical rotations and is finishing electives while she studies for the final exam.

Four weeks wouldn’t be enough

Her first clinical rotation in early 2017 was the 12-week Internal Medicine rotation at Tupua Tamasese Meaole (TTM) Hospital, OUM’s primary teaching hospital at the National Health Complex in Samoa. While a four-week rotation at TTM is a graduation requirement, Marika says four weeks would not have been enough.

“Twelve weeks in Samoa was the best thing I’ve ever done,” she says. “It was a challenge and an expense to spend three months there, but it was so worth it. You see things and treat things you will likely never see again. It is a unique environment that offers amazing hands-on experience that will help you with all of your other rotations.”

Marika says she can’t speak highly enough about Dr. Viali Lameko, OUM’s Vice Chancellor and Director of the Internal Medicine Clinical Rotations, adding that you will learn physical examination skills from him that you will not learn elsewhere. While some students may be surprised by the lack of equipment at TTM when they first arrive, they come to learn that it isn’t always necessarily needed, Marika explains. She feels there may be a tendency to over-rely on blood work and diagnostic testing in the West.

“I learned from Dr. Lameko and continue to do traditional physical exams that doctors typically don’t do as frequently anymore. You can absolutely diagnose patients from a thorough, clever exam,” Marika says. “Dr. Lameko is incredibly generous with his time, and in turn, he has very high expectations for his students.”

Doing social good

Marika also has high expectations and admirable goals for herself when considering her plans post medical school. She wants to do “real social good” and perhaps work with the aging population in rural New Zealand.

“Talk about a growth industry – I’d love to be a GP with a focus on Gerontology, perhaps in a rural hospital. I would also love to do work with the Fred Hollows Foundation – the Australians will know what I’m talking about. Medicine allows us to do real social good,” Marika says.

Marika’s family is no stranger to answering the call to address health issues. Her husband, Ryan, found himself entrenched in an Ebola outbreak in Sierra Leone for several months when she was amid her eFoundation courses and working fulltime early in medical school. “I wouldn’t advise having one of you on a serious international health project while the other is beginning medical school,” she says. “It was a very intense time.”

Marika and Ryan have three grown children between them. “They are all proud of my journey, especially my daughter, who just graduated from university herself. She likes to say ‘My mother is a medical student. What does yours do?’” says Marika. Soon her daughter will need to change that statement to “My mother is a doctor.”