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Dr. Alyssa Hoverson, left, a dermatologist at Altru's TruYu clinic, explains routine skin checks to Trondheim exchange student Anders Asberg while visiting with patient Alan Coxe at TruYu. Photo by Kile Brewer/Grand Forks Herald

Trondheim medical students learn about health care in Grand Forks

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Trondheim medical students learn about health care in Grand Forks
Grand Forks North Dakota 375 2nd Ave. N. 58203

As they learn and work with doctors in Grand Forks, two medical students from Norway are finding that they have an instant connection with their patients.  

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When Anders Asberg and Torbjorn Kruke speak, patients recognize their Norwegian accent — and react.

“They love it,” Asberg said. “They say, ‘I’m from Norway as well,’ or ‘My family is from a place in Norway.’”

He and Kruke, both 22, arrived here in July for about five months of study and training in medicine, as part of an exchange program between UND and the medical school they attend in Trondheim.     

They are studying with physicians who practice dermatology, radiology, emergency medicine, psychiatry, orthopedic surgery, rheumatology and infectious disease. They are working from one to four weeks at a time in each discipline.

“We’re learning by doing,” Kruke said.

Dr. Alyssa Hoverson, a dermatologist, said her patients enjoy meeting Asberg, who is working with her at Altru’s TruYu clinic.

“About 90 percent of our patients have some kind of tie to Norway.”

Teaching a Norwegian medical student is not much different from teaching one from UND, she said.

Asberg “speaks English well and has a good educational background.”      

‘Best fit’

Of the three exchange programs he and Kruke considered, “Grand Forks was the best fit,” said Asberg. “UND had all the classes I would need.”

Other exchange programs — at Minnesota and Kentucky — were less attractive, he said. Choosing either one would have meant having to “catch up” on their studies after rejoining their medical class in Trondheim.

When they return home, they won’t have to take classes they’ve missed, Kruke said.

“We just have to pass our exams,” Asberg said.

Dr. Linda Olson, who has directed the exchange program at UND since it started in 2001, said she and her colleagues “have customized their experience to what their curriculum asks for.

“At other schools, they’re just put in with the rest of the class. It’s kind of ‘make do as you can.’”  

Olson’s efforts to pave the way for Norwegian medical students have enhanced UND’s reputation.  

 “Everyone who’s come to UND has been super-positive about it,” Kruke said. “Everything has been taken care of.”

Details, such as where to live and how to get around, have been handled by Olson, an associate professor of family and community medicine at UND.   

“Linda takes good care of us,” Kruke said. “I don’t know what we would have done without her.”

Under the exchange program, some Norwegian students have also received medical education and training in rural communities throughout North Dakota, Olson said.

Promote study abroad  

Norwegian educators encourage their students to pursue educational experiences outside the country, she said. “They have kind of a philosophy that students should go abroad, because they come back with new ideas.”

Among the advantages of UND’s program is the personal contact they have with patients — more than their classmates in Norway experience, the students said. 

They are also gaining an up-close look at how the U.S. health care system differs from Norway’s.

The greatest benefit for students is “learning that there are different health care systems… and there’s good and bad in both kinds,” Olson said.

The basics of “treating patients is pretty similar, but the system — the payment structure and the relationship between the patient and doctor — can differ.”      

In the U.S., physician salaries are based on the medical procedures that are performed, Kruke said. “In Norway, (doctors) are paid not as much by what you do, but by the hours you put in.”

Although per capita income is higher in Norway than the U.S., the average doctors’ salaries are lower, he said.    

With its sparse population spread into remote regions, Norway’s health care system depends more on general practitioners, Kruke said.

“People are supposed to go first to a general practitioner (who) can handle most (ailments).” 

As a result, most people are not referred to medical specialists, who work in hospitals, he said. There are few private practice clinics.  

“About half of the physicians end up as general practitioners,” Asberg said. “They are important (to the health care system) as ‘gatekeepers’ for medical care.”

The biggest difference he sees between the two health care systems “is availability,” Asberg said. “It seems to be really good if you have insurance.

“In Norway, anyone who needs health care will get health care — and as much as they need.”   

“The general idea,” Kruke said, “is that you should have the things you really need to survive. You shouldn’t die because you don’t have the money to pay for drugs or treatment.”

Sight-seeing  

While in the U.S., the medical students have taken time to visit American relatives. Asberg has relatives in Boston and Los Angeles. Kruke’s relatives who live in the Red River Valley area hosted a family gathering for him and his mother when they arrived.  

They visited Yellowstone National Park and took in a Twins game in Minneapolis. They hope to see a Vikings football game and watch the New York Rangers hockey team play in New York.

“The only good hockey player from Norway plays with the Rangers,” he said, referring to Mats Zuccarello.   

When they return home, they will complete two more years of a six-year medical curriculum. (The U.S. medical curriculum requires four years of study.) 

Medical education in Norway begins after high school, but high school students generally are a year older at graduation than those in the U.S.  

A total of 29 Norwegian medical students have participated in UND medical school’s exchange program, which generally hosts two students per semester, or four per year, Olson said. About half as many UND medical students have gone to Norway.

“There’s a higher financial burden for our students to go there,” she said, citing the steeper cost of living in Norway.

In roughly equal numbers, UND medical students have gone to Trondheim and Tromso medical schools, both of which have exchange agreements with UND. 

Experience at Tromso’s medical school, in the northernmost region of Norway, is especially valuable for UND students in the school’s INMED, Indians Into Medicine, program, Olson said. That school is located in an area with a high concentration of Sami, an indigenous people who are culturally similar to American Indians.     

Four UND medical students have applied to go to Norway next year to take part of their fourth year of medical education.

“That’s the most applications we’ve had at one time,” she said.

Olson and other UND faculty members have travelled to meet with educators in Norway and those educators, in turn, have visited UND with the goal of building their relationship and mutual understanding. 

“Norway has been very accommodating,” Olson said. “So have we.”

The success of the exchange program is probably due in part to its location in an area that’s heavily populated with people whose ancestors emigrated from Scandinavia.  

“Our culture is to welcome Scandinavians,” Olson said.

“I think that our medical students and doctors are proud that Norwegian students want to come here.” 

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