(This is an extended version of an article from our spring/summer 2010 newsletter.)

Ever since its early days, operating out of a single room in a low-income hotel in Portland's Old Town neighborhood, The Wallace Medical Concern has been a place where doctors-in-training learn at the elbow of experienced physicians.

In fact, sometimes, quite literally at the elbow.

"When we had a doctor, a nurse, a medical student and a patient in the room, we had to negotiate who would move first," remembers Wallace founder and volunteer Medical Director Dr. Jim Reuler, thinking back to the early third-floor setup at the Estate Hotel. "Our 'clinic' was a tiny spot right on a floor where people were living."

According to Reuler, having health-care professionals in training work side-by-side with established doctors isn't just part of Wallace's practical tradition, it's part of the mission. "They learn a tremendous amount," he says.

And over the past several years the nonprofit's stature as an in-the-trenches training ground has only grown.

In addition to an ongoing relationship with Oregon Health & Sciences University (OHSU), Wallace now has established training programs with nursing schools at the University of Portland and Washington State University, Vancouver as well as the Providence Health Systems internal medicine residency program. In addition, OHSU dermatology and Legacy Health podiatry residency programs staff special clinics every other Thursday at the downtown Portland location.

Students volunteering at Wallace take patient histories and conduct exams, then work with experienced providers to arrive at the correct diagnosis. For many, it's an eye-opening opportunity to serve people who might otherwise go without health care. Often the students aid people who because of their circumstances wait to seek care and often present with a more complicated set of symptoms.

Jonathan Fowlkes, 28, now a third-year OHSU medical student, started out as an intake volunteer putting together patient charts at Wallace in 2003 because of his interest in medicine. He was already working at a lab at OHSU, but thought Wallace "sounded like an interesting place." Today, in the "organized chaos" of the clinic setting, Fowlkes-the-med-student is able to work with attending physicians more directly than he can routinely at the teaching hospital. And their knowledge and compassion rubs off.

It's what being a "preceptor" site for teaching is all about.

"Someone like Jim Reuler," Fowlkes says, "who has been teaching medical students for 30 years, almost immediately sees what I missed or didn't understand." And if Reuler shows up 15 minutes before a clinic's scheduled start, Fowlkes notes, the veteran doctor most certainly asks to see some of the dozens of patients anxiously waiting outside. In the face of endless needs, "He just kind of walks in and says, 'Let's start--why not' ", Fowlkes says. "`We don't have to wait for anything.' "

Sometimes the educational connection to Wallace starts even earlier.

"Over the last nine or 10 years, as we've developed more volunteer opportunities, we've had more students volunteering in high school or college who are planning to apply to medical school," Reuler says. "They work as intake people and clinic coordinators, and it's an important experience for them because increasingly medical schools want to see that students have had exposure to the medical setting."

By volunteering, Reuler says students help prevent the health-care safety-net from "completely fraying."

Internal medicine doctor Maureen Wright with Kaiser Permanente, now president of Wallace's Board of Directors, remembers her roots. Twenty-six years ago, when she was an OHSU medical school student and Jim Reuler was her instructor, she worked as a Wallace volunteer, accompanying Reuler to the hotel and on house-calls to shut-ins.

"It certainly gave me a greater appreciation for the needs in the community: for health-care, and housing and food," Wright says.

Today, still volunteering with Wallace clinics, she loves passing what she knows to the next generation of health care providers.

"It's delightful for an attending to be working with a curious resident," she says, noting that Wallace would have a hard time existing without residents, and third- and fourth-year medical school students.

"You use your teaching skills, and you learn from them as well. They enjoy it, and really learn things you don't see in the teaching-hospital setting."

She recalls one student who had never seen an active case of hepatitis before coming to Wallace.

"It's a different kind of illness exposure than what you'd have up on the hill," she says, referring to OHSU.

Wallace's health-professionals-in-training learn how to help even when patients cannot afford expensive medications. They experience the "melting pot" like never before – "one night at clinic there can be six different cultures represented in our patient pool," Wright says. They also are able to provide critically needed podiatry and dermatology services that don't exist at other Portland-area safety-net clinics. Another connection with OHSU is the Physician Training in Global Health program. Here professionals (mostly physicians with a smattering of nurses) are "retrained" before they engage in medical mission work in underdeveloped countries around the globe.

Decades spent in a specialty has meant their training as a primary care provider is out of date and sometimes just plain forgotten. Dr. James Peck, a veteran of last fall's program commented, "As a vascular surgeon for 30 years, I wasn't prepared to go overseas and treat rashes, pneumonia, malaria, or urinary tract infections. Solving those basic problems is a very great contribution in so many parts of the world. My ten-week program meant two days in the classroom along with every Wednesday night at the elbow of another physician at Wallace. Recently I went to serve in Nigeria through Doctors Without Borders having a lot more confidence thanks to those volunteer teachers at Wallace!" Another cohort of a dozen participants (with an average age in their 50s) will arrive next fall.

Clearly the line between mentor and student is not just blurred, but can be drawn often as a circle, with each providing a valuable experience for the other. And all of these Wallace "students" will tell you that they get rewarded, again and again. Not just at clinic, but for years later.

One takes time to serve in a hospital in Nigeria and another is lecturing at the Oregon Health & Sciences University medical school. One serves on the Wallace Board and another takes in dozens of Wallace patients at her specialty office in Portland through Project Access NOW. So those who were at once both teacher and student also learned to give back to honor those who gave to them.

Robin Franzen Parker, Writer
David Childs, Photographer