Wilderness Medicine Fellowship

Massachusetts General Hospital has been offering wilderness medicine training since 2003. We trained our first wilderness medicine research fellow in 2005 to 2007. The Wilderness Medicine Fellowship began in 2008. The one-to-two year program is designed to provide graduates of emergency medicine residency programs with advanced training in wilderness medicine practice, research, and teaching. We train tomorrow’s wilderness medicine leaders, and we truly believe in our motto The Earth needs a good doctor.™

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.

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

While our Fellowship is structured around a range of organized teaching, research, and clinical opportunities, 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). We encourage you to compare it with other programs.

After completing the program, our fellows will be confident in their ability to provide medical care in the most remote locations under the most austere conditions. Our Division has cultivated relationships with numerous organizations across the globe, allowing fellows to gain invaluable field experience. Our staff and fellows have even served in leadership and field positions with these organizations, some of which include:

• Himalayan Rescue Association (Pheriche, Nepal)

• Denali National Park, National Park Service, Climbing Ranger Patrols

• US 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

Past fellows have established quality improvement programs within the northwest arctic region of Alaska while working in Kotzebue, provided field support for climate researchers in the remote Alaskan tundra, and taught point-of-care ultrasound to emergency physicians in Samoa. Success in this fellowship is only limited by the imagination.

The knowledge and skill set of an emergency physician is ideally suited for the practice of wilderness medicine. When not in the field, fellows will practice emergency medicine at MGH’s Emergency Department. Working there offers excellent opportunities to develop as a clinician and medical educator while supervising residents and advanced practice providers. The expected clinical time requirement is 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).

Fellows are expected to actively pursue quality research and develop research skills applicable in becoming a leader in wilderness medicine. The Division provides each fellow with a yearly $7000 CME and research stipend to help advance your training and scholarly projects.

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.

There are numerous research opportunities within the department as well as with faculty throughout MGH, the Harvard teaching hospitals, Harvard University, and 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)

• Woods Hole Research Center – Chersky, Siberia with the Polaris Project. You can 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 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 MGH, HMS, the U.S. Dept. of Defense, CIMIT, and the National Institutes of Health. Additionally, MGH is the home of the International HAPE Registry. Dr. Harris is the Registry Master and Chair of the Steering Committee. The Steering Committee is comprised of Drs. Peter Hackett, Peter Bartsch, Marco Maggiorini, and Buddha Basnyat.

Fellows maintain regular and direct contact with the fellowship director to oversee successful planning and execution of fellow’s individual research projects, including publication of your work.

Additional opportunities exist for extended experience through:

• Gokyo Porters’ Clinic (Khumbu, Nepal)

• International HAPE Registry

• Northern Forest Canoe Trail

• Primal Quest

We encourage all who are interested in wilderness medicine to be in touch with us as early as possible. We are friendly people who like to talk about wilderness medicine. We tend to take a long view of relationships. Over the years, we have discussed our program 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 of prospective fellows who have expressed interest as many as five years in advance.

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

Please contact us before formally applying. When applying, your application package should include:

• At least two letters of recommendation

• Letter of support from your emergency medicine residency program director

• Current CV

Email the package to Dr. N. Stuart Harris (nsharris@mgh.harvard.edu) and Dr. Luke Apisa (lapisa@mgh.harvard.edu).

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