What Volunteer Clinical Faculty Do: Ann Thrailkill Sees to the Health Needs of Women Veterans

January 2013Ann Thrailkill

Volunteer clinical faculty and preceptors offer students individual perspectives and hands-on experience in a variety of health care settings and specialties. The cumulative effect of what these volunteers impart plays a significant role in the care any health system delivers. This series aims to shed light on the unique roles these valuable mentors play.

This month we hear from Ann Thrailkill, an assistant clinical professor with UCSF School of Nursing and a nurse practitioner in the Women Veterans Health Center at the VA Palo Alto Health Care System.

I received my BS in nursing in 1964 from Boston College, when a BS in nursing was a rare thing. After working at Tufts Medical Center, I eventually moved to Florida and was working in private practice in 1973 when I heard about the nurse practitioner role – and then became one of 12 people accepted to the family nurse practitioner program at the University of Miami, graduating in 1976.

Of course, few people really understood the role, and I wound up working in private practice with a urologist, who was happy that I could do his physicals, take histories, conduct preops and suture. Eventually, I became interested in women’s health – I even did some work for a traveling midwife – and in occupational health, returning to school to get a master’s in that. Then, when I moved out to California, I decided to apply for a job at the Palo Alto VA, in part because I liked the idea of taking care of veterans.

Twenty-six years later, here I am.

I’ve had many roles here. Today I’m a nurse practitioner in the women’s health center and OB coordinator for the Palo Alto VA at all its sites. I have a panel of about 500 women, ages 96 to 20 – I’m their primary care provider – and I do GYN for patients who are referred to me. Up until two years ago I also served as the Women Veterans Program Manager, with broad jurisdiction over the western United States as VISN (Veterans Integrated Service Network) 21 Women Veterans Program Manager. Eventually, I stepped down because they asked me to give up my clinical role and I decided what I loved most was being hands-on. During my tenure here we’ve received the only Clinical Excellence in Women’s Health Award in the VA system.

I’m also involved in research and serve as a preceptor for, among others, Stanford residents and nurse practitioner students from UCSF, whom I’ve been precepting for about 20 years. I realize that students can learn from the blackboard and slides, but until they actually interact with a real patient, it’s not the same. They’ll run into situations that are not succinct, because everybody is so different. There always will be variations; students have to learn to make adjustments.

For example, take a patient who is very frightened, who has undergone military sexual trauma or sexual trauma as a child. For me – or anybody – to do an exam, you need to build trust, and that can take time. It’s not always a clear path. I tell my students, “You have to listen to the patients, and you may have to let it go that day; it might not be the day.”

What I enjoy most is seeing these students grow and become more confident. They learn to manage their practice time; I see their presentation improve and how they are able to prioritize the needs of the day much more effectively. That’s important, because you need to be efficient or you can’t survive. It’s about volume in a lot of places, so you have to be able to do good work fast. Sometimes there are language barriers, or some other obstacle arises that might slow you down, but I watch the students learn to make adjustments. They make sure they are able to fit in their panel, communicate and prioritize.

I think it’s important for anyone who has been fortunate enough to have preceptors to play this role for others. Mainly, I do it because earlier in my career, someone gave me their time and expertise and I’ve always appreciated that. And I learn something new every day, I really do.