Fellowship in Wilderness Medicine
The Wilderness Medicine Fellowship at Massachusetts General Hospital began in 2008. This fellowship is designed to provide graduates of emergency medicine residency programs with advanced training in wilderness medicine practice, research, and teaching.
Wilderness Medicine is defined as care of patients in environments more than one hour away from definitive medical care.
The Wilderness Medicine Fellowship Program is a one to two year program designed to give graduates of emergency medicine residency programs the skills and knowledge to become leaders in the field of wilderness medicine.
An effective Wilderness Medicine Physician should possess:
- Clinical training in the acute care of critically-ill medical and trauma patients - this most clearly defined by the skill set of a well-trained emergency physician.
- Ability to care for themselves, their team,and their patient in a wilderness setting where extreme environmental exposures (e.g. temperature, weather, technical/ hazardous terrain) are expected.
- Ability to provide effective patient care despite prolonged pre-hospital contact times, with limited resources and equipment.
- Comfort with independent decision making, often with limited data.
- Ability to effectively deploy technical outdoor skills (e.g. swift-water or high angle rescue) in the service of patient care and team safety.
The goals of our fellowship program include:
- Providing a one or two year clinical and wilderness experience, at the completion of which, fellowship graduates should be prepared to lead or provide expert wilderness medical care anywhere on the globe.
- Pursuing intellectually-rigorous research to advance the state of knowledge in wilderness medicine and publish these results.
- Providing opportunity for extended field experience in the practice of wilderness medicine.
- Providing experience teaching wilderness medicine to students, residents, and staff - both in the classroom and in wilderness settings.
- Providing opportunity for the fellow to learn/ develop advanced outdoor technical skills (whether ice/rock/alpine climbing, whitewater or sea boating, etc).
- Providing access to medical experiences in the developing world (remembering that wilderness medicine is defined by the practice of medicine in resource-limited environments - not exclusively by distance from human population centers).
- Encouraging exploration of environmental policy issues as they impact human health and well-being.
- Providing access to the breadth of Harvard University with ongoing collaborations with faculty at the Medical School and School of Public Health.
- Providing an ongoing, clinical emergency medicine experience in a Level I trauma center in a busy urban ED.
Applicants must be graduates of an ACGME accredited emergency medicine residency program and have completed the program in good standing. Two letters of recommendation, including a letter from the residency program director, and a current curriculum vitae should be submitted to Dr. N. Stuart Harris, Fellowship Director, nsharris@partners.org. Interviews are conducted in the late fall in Boston.
While our Fellowship is structured around a range of organized teaching, research, and clinical opportunities, MGH Wilderness Fellows are expected to be enthusiastic, driven, and self-directed.
Mentorship Regular, direct meetings with the fellowship director.
Teaching Fellows have regular teaching responsibilities with the Harvard Affiliated Emergency Medicine residents and Harvard Medical School students at MGH.
Active participation and field time with the Wilderness Medicine Institute of theNational Outdoor Leadership School (WMI/NOLS). Dr. Harris serves as Medical Director, Curriculum Writer, and Supervising and Field Faculty for the seniormedical student course (Medicine in the Wild) taught with NOLS/WMI. Additional opportunities for leadership/ teaching with NOLS/WMI for physician level CME are currently being developed (Wind River Range Expedition for Physicians).
Teaching of Medical Student Elective at Harvard Medical School.
Teaching with MGH Continuing Medical Education courses.
Research Regular and direct contact with fellowship director to oversee: Planning of fellow’s individual research projects.
How best to anticipate/ navigate IRB concerns.
Acquisition of "real-world" experience in development and execution of successful wilderness/ international research programs.
Clinical Experience Our staff and fellows have served in leadership/ field medical staff positions with:
- Himalayan Rescue Association (Pheriche, Nepal)
- Primal Quest
- NOLS/ WMI
- Explorers’ Club
- U.S. Army Research Institute for Environmental Medicine
- Additional opportunities exist for extended experience through:
- Gokyo Porters’ Clinic (Khumbu, Nepal)
- Denali backcountry patrols (U.S. Park Service)
- International HAPE Registry
Outdoor Technical Skill Training A range of opportunities exist to develop technical backcountry skills. Staff and prior fellows have taken advantage or have access to world-class teaching through group and individual expeditions through:
- NOLS/WMI
- Alaska Mountaineering School
- Huntington’s Ravine/ North Conway, NH (ice/rock)
- Maine/Massachusetts/Alaska/ British Columbia Coasts (sea kayaking)
- White water/ backcountry boating (Dead, West Branch, Kennebec, Allagash Rivers locally, with experience across the Southeastern and Western U.S.)
- Baxter State Park (ice/rock/backcountry)
- Mt Rainier/ Cascades National Park (mountaineering)
- Mt. Kilimanjaro
- Khumbu Area of Nepal
- Japanese Alps/ Mt. Fuji
- Hyperbaric/Dive Medicine in Hawaii
Simulation Opportunities Numerous opportunities to gain experience exist through the Institute for Medical Simulation (James Gordon, MGH) and the STRATUS Center for Medical Simulation (Brigham and Women's Hospital).International Experience – Numerous opportunities for extended backcountry medical experience exist through our long-term relations with the Himalayan Rescue Association, NOLS, and international colleagues. Additionally, opportunities include the MGH Center for Global Health & Disaster Response (Thomas Burke, MGH), the Institute for International Emergency Medicine and Health (Brigham and Women's Hospital), and contacts with Partners in Health colleagues in Rwanda.
Explorers’ Club (NYC) -- 
Fellows may be invited to the Annual Explorer’s Club Dinner and to consider participation in active research expeditions with this storied group.
The fellowship is designed as a part-time attending position in the MGH Emergency Department, working approximately 16 hours a week, supervising EM (PGY1-4), pediatric, internal medicine, and surgical residents. In addition, the fellow is expected to devote approximately 16 hours a week to wilderness medicine related activities. Overall clinical responsibilities are approximately 0.6 FTE.
Duties include, but are not limited to, independent reading and research, teaching of residents and medical students, participation and development of outside courses, attendance at administrative and financial meetings, and research (development of an independent project and participation in ongoing studies).
It is expected that all Wilderness Medicine Fellows will actively pursue research as a key focus of their fellowship. The Massachusetts General Hospital Department of Emergency Medicine supports each fellow with a research stipend to help advance scholarly projects.
There are numerous research opportunities within the department as well as with faculty throughout the Massachusetts General Hospital and Harvard University. Current, active collaborations include projects with:
- MGH Divisions of Cardiology, Pulmonary and Critical Care, and Surgery.
Research investigators at the US Army Research Institute for Environmental Medicine (USARIEM) (Natick, MA and Pikes Peak Lab). - Investigators with the Himalayan Rescue Association (HRA) (We have pursued a number of different research projects with the HRA over the last decade).
- Faculty of Harvard Medical School.
- Investigators with the joint MIT/Harvard Medical School venture, the Center for Integration of Medicine and Innovative Technology (CIMIT).
- WMI/NOLS on educational outcomes for wilderness medicine courses.
- Our research has been supported by grant funding through the MGH, HMS, CIMIT, and the National Institutes of Health.
Additionally, MGH is the home of the International HAPE Registry. Dr. Harris is Registry Master and Chair of the Steering Committee. The Steering Committee is comprised of Dr’s Peter Hackett, Peter Bartsch, Marco Maggiorini, and Buddha Basnyat.
To date, faculty and fellows have published their research on a range of topics including: the first description of ultrasound to diagnose HAPE; the treatment of HAPE at high altitude; correlation of optic nerve sheath diameter with symptoms of acute mountain sickness and in cases of HAPE; efficacy trials for high altitude headache analgesia; response of the right ventricle and pulmonary vascular pressure in response to acute hypoxia; and case reports on rabid fox attack and acute arterial thrombus requiring loss of limb.
Interested fellows are encouraged to pursue their specific interests in developing research projects that will be rewarding in the immediate term, and that will prepare them for a career as a leader of wilderness medicine.
Those in active practice, as well as graduating senior EM residents, are encouraged to apply.
In early fall (September) submit two letters of recommendation and a letter of support from an emergency medicine residency program director as well as a current CV to Dr. N. Stuart Harris at nsharris@partners.org. You will then be contacted regarding the interview date in late fall. All fellows should prepare for a start date of July 1 each year.
Contact: nsharris@partners.org
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