Fellowship in Wilderness Medicine

Overview

Massachusetts General Hospital has been offering wilderness medicine training since 2003. We trained our first wilderness medicine research fellow in 2005-07. The Mass General Wilderness Medicine Fellowship began in 2008. Our fellowship is designed to provide graduates of emergency medicine residency programs with advanced training in wilderness medicine practice, research, and teaching. Mass General trains tomorrow’s wilderness medicine leaders. The Earth needs a good doctor.™

The Mass General Wilderness Medicine Fellowship is a one- to two-year program designed to give graduates of emergency medicine residency programs the skills and knowledge to become tomorrow’s leaders in the field of wilderness medicine. 

Wilderness medicine traces its roots to the earliest days of medical care, when resource-limited, austere conditions were the norm. Now as then, the touchstones of our patient care are intellect, ingenuity, and a keen attention to each patient’s history and physical exam. We then ally this ancient human relationship with modern, portable, state-of-the-art technology, from ultrasound imaging to blood testing. Our focus is on the patient in front of us; our vision and reach are global.

Our Wilderness Medicine Fellowship provides:

• Training in the skills needed to care for themselves, their team and their patients under austere conditions where extreme environmental exposures (e.g. temperature, weather, technical/ hazardous terrain) are expected
• Experience providing effective patient care despite prolonged pre-hospital contact times, with limited resources and equipment
• Outstanding clinical training in the acute care of critically ill medical and trauma patients in our top-ranked, Level 1 Trauma Center/Emergency Department treating more than 98,000 patients a year
• Opportunities to hone in independent decision making skills
• Opportunities to build competence in technical outdoor skills (e.g. swift-water or high angle rescue) that will be required in the service of patient care and team safety

The Mass General Wilderness Medicine Fellow will enjoy:

• 1-2 years of rigorous clinical and wilderness medical training, at the completion of which they will be prepared to 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
• Spending extended field time practicing wilderness medicine
• Teaching wilderness medicine to students, residents, and staff, both in the classroom and in wilderness settings
• Learning advanced outdoor technical skills (whether ice/rock/alpine climbing, whitewater or sea boating, etc.)
• Practicing in the developing world (remembering that wilderness medicine is defined by the practice of resource-limited medicine under austere conditions—not exclusively by distance from human population centers)
• Exploring environmental policy issues as they impact human health and well-being
• Engaging in active collaborations from our backyard at Harvard University (with faculty at the Medical School and School of Public Health), to the outer edges of the planet (from Nepal, to Siberia, to Africa)
• Pursuing ongoing clinical care and research projects in austere regions from Alaska, to Nepal, Siberia and Africa

Mentorship

The fellowship director holds regular, direct meetings with the fellow to encourage the individual’s personal and professional development. Our fellows aren’t simply well-trained, they become active contributors to our Mass General community for the rest of their careers.

Outdoor Technical Skill Training

A range of opportunities exist to develop technical backcountry skills. Staff and prior fellows have access to world-class teaching through group and individual expeditions through:

• NOLS/WMI – Gila Wilderness, NM. Wind River Range, WY. Prince William Sound, AK
• National Park Service/ Alaska Mountaineering School – Denali National Park
• Huntington’s Ravine and Cathedral Ledge, 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. and Alaska)
• Far Eastern Siberia (Chersky, Siberia) – 6 time zones east of Moscow
• Baxter State Park (ice/rock/backcountry)
• Mt Rainier/Cascades National Park (mountaineering)
• Kilimanjaro
• Khumbu and Annapurna Regions of Nepal
• Japanese Alps/Mt. Fuji
• Hyperbaric/Dive Medicine Training in Hawaii

Teaching

Fellows have regular teaching responsibilities with the Harvard Affiliated Emergency Medicine Residents and Harvard Medical School students at Mass General, and can gain active participation and field time with the Wilderness Medicine Institute of the National Outdoor Leadership School (WMI/NOLS). Dr. Harris serves as Medical Director, Curriculum Writer, and Supervising and Field Faculty for the senior medical student course (Medicine in the Wild) taught with NOLS/WMI.

• Teaching of Medical Student Elective at Harvard Medical School
• Teaching with Mass General Continuing Medical Education courses
• MedWAR Experiences

International/Disaster/Simulation Opportunities

International Experience – Numerous opportunities for extended backcountry medical experience exist through our long-term relations with the Himalayan Rescue Association, NOLS, Woods Hole Research Center, and international colleagues. Additionally, opportunities include the Mass General Center for Global Health & Disaster Response (Thomas Burke, MD), Mass General Center for Disaster Response (Hillary Cranmer, MD), the Global Emergency Care Collaborative, The Institute for International Emergency Medicine and Health (Brigham and Women's Hospital), and contacts with Partners in Health colleagues in Rwanda. Numerous opportunities to gain experience exist through the Institute for Medical Simulation (James Gordon, MD) and the STRATUS Center for Medical Simulation (Brigham and Women's Hospital).

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.

Requirements

We encourage all who are interested in wilderness medicine to be in touch with us as early as possible. 

Applicants must be graduates of an ACGME-accredited emergency medicine residency program and have completed the program in good standing.

Curriculum

While our Fellowship is structured around a range of organized teaching, research, and clinical opportunities, Wilderness Fellows are expected to be enthusiastic, driven, and self-directed. Our curriculum is extensive and unique – not least because it exists – but has been rigorously vetted by the Graduate Medical Education Committee of the Harvard Teaching Hospitals.

Please review our curriculum (PDF download). We encourage you to compare it with others.

Clinical Experience

Wilderness Medicine is defined as resource-limited medicine practiced under austere conditions. At the end of the fellowship, the fellow will be confident in his or her ability to provide medical care in the most remote locations under the most austere conditions. Over the last decade, faculty from the Division of Wilderness Medicine have cultivated relationships with more than a dozen wilderness medicine organizations across the globe (see Curriculum). Staff and fellows have gained invaluable field experience with the Himalayan Rescue Association, Woods Hole Research Institute (Chersky, Siberia), USARIEM (Kilimanjaro and Pikes Peak), NOLS/ WMI, and Denali National Park. The breadth of Harvard’s expertise allows the fellow to choose from a long list of opportunities to learn the practice and art of wilderness medicine. Your roots will be planted in the fertile soil of Mass General and Harvard Medical School. Where you choose to grow is limited only by your imagination. The Division provides each fellow a yearly stipend towards CME and research.

The knowledge and skill set of an emergency physician is ideally suited for the practice of wilderness medicine. When the fellow is not in the field, he or she will practice emergency medicine in the Mass General Emergency Department. Working in the Mass General ED offers excellent opportunities for the fellow to develop as both a clinician and medical educator. Fellows work approximately 16 hours a week, supervising EM (PGY1-4), pediatric, internal medicine, and surgical residents. In addition, the fellow is expected to devote at least 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).

Our staff and fellows have served in leadership/field medical staff positions with:

• Himalayan Rescue Association (Pheriche, Nepal)
• Denali National Park, National Park Service, Climbing Ranger Patrols
• S. Army Research Institute for Environmental Medicine
• Woods Hole Research Center (WHRC), Polaris Project, Chersky, Siberia
• NOLS/WMI 
• Tokushukai Hospital’s TMAT Team (Kesennuma, Miyagi-ken, Japan).
• Explorers’ Club

Research Experience

It is expected that all Wilderness Medicine Fellows will actively pursue quality research as a key focus of their fellowship. The Department of Emergency Medicine supports each fellow with a research stipend and CME funding to help advance scholarly projects.

There are numerous research opportunities within the department as well as with faculty throughout the Massachusetts General Hospital, the Harvard teaching hospitals, Harvard University, and multiple outside collaborators. Current, active research includes collaborative projects with:

• Mass General Cardiology, Pulmonary and Critical Care, Neurology, and Surgery
• Research investigators at the US Army Research Institute for Environmental Medicine (USARIEM) (Natick, MA and Pikes Peak Lab).  We have pursued a number of different research projects with USARIEM over the last decade.
• Woods Hole Research Center – Chersky, Siberia with the Polaris Project: Contribute to this multi-year, National Science Foundation-funded research project in the remote Siberian tundra six times zones east of Moscow
• Himalayan Rescue Association (HRA) investigators, both in the Everest (Pheriche) and in the Annapurna regions (Manang). (We have published more than 10 different research papers with the HRA over the last decade)
• Faculty of Harvard Medical School and Harvard School of Public Health
• 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
• Global Emergency Care Collaborative (a consortium developing sustainable emergency care in Uganda)

Our research has been supported by grant funding through Mass General, HMS, the U.S. Dept. of Defense, CIMIT, and the National Institutes of Health.

Additionally, Mass General 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 Drs. 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; Vitamin D and Mercury levels in Chersky, Siberia, and case reports on rabid fox attack and acute arterial thrombus leading to 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.

Fellows maintain regular and direct contact with the 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
• Publication of your work

• Gokyo Porters’ Clinic (Khumbu, Nepal)
• International HAPE Registry
• Northern Forest Canoe Trail
• Primal Quest

How to Apply

It is never too early to be in contact with us about your future plans. 

We tend to take a long view of relationships. Over the years, we have discussed wilderness medicine fellowship training with EMT’s, college and medical students, residents and practicing physicians. 

While we have hired applicants who first approached us less than a year before starting their fellowship, we maintain an active roster an active roster of prospective fellows who have expressed interest as many as five years in advance. We are friendly people who like to talk about wilderness medicine. We ask you to begin a conversation with us early.

Interviews are conducted in Boston, typically in the 9-12 months before the fellowship start date of July 1^st. We have interviewed and hired as early as August 1^st.

Those in active practice, as well as graduating senior EM residents, are encouraged to formally apply.

Please contact us before formally applying.  As part of your application, we require you to submit at least two letters of recommendation and a letter of support from your emergency medicine residency program director as well as a current CV to Dr. N. Stuart Harris at nsharris@partners.org and Dr. Luke Apisa, Assistant Fellowship Director, at lapisa@mgh.harvard.edu. You will then be contacted regarding the interview date.