{"id":13532,"date":"2025-06-04T14:59:08","date_gmt":"2025-06-04T19:59:08","guid":{"rendered":"https:\/\/blogs.und.edu\/for-your-health\/?p=13532"},"modified":"2025-06-27T08:45:00","modified_gmt":"2025-06-27T13:45:00","slug":"everyone-means-everyone","status":"publish","type":"post","link":"https:\/\/blogs.und.edu\/for-your-health\/2025\/06\/04\/everyone-means-everyone\/","title":{"rendered":"Everyone means everyone"},"content":{"rendered":"

UND School of Medicine & Health Sciences faculty and students on an elective rotation that has them pitching in at the North Dakota State Penitentiary.<\/p>\n

\u201cThis rotation serves as a reminder that there are underserved populations hiding in plain sight \u2013 and they\u2019re right here.\u201d<\/p>\n

The \u201chere\u201d in question, said Dr. Stephanie Gravning, is the North Dakota State Penitentiary in Bismarck, N.D., where Gravning serves as Correctional Health Authority.<\/p>\n

A community faculty member for the UND School of Medicine & Health Sciences (SMHS), Gravning coordinates a North Dakota Department of Corrections & Rehabilitation<\/a> (DOCR)-based course \u2013 IMED 9129 or \u201cCommunity Intensive Internal Medicine\u201d \u2013 for third-year UND medical students.<\/p>\n

The Department of Internal Medicine<\/a> course is designed, its syllabus suggests, to give students a chance to understand \u201cthe barriers and concerns that impact patient management in different community settings, including prison inmates and ICU patients.\u201d<\/p>\n

Language matters<\/strong><\/p>\n

Actually, clarified Gravning, the term \u201cinmate\u201d has fallen out of favor.<\/p>\n

\u201cThat\u2019s what we used to term people who are incarcerated, but now they\u2019re residents,\u201d she explains. \u201cThey live here. This is their home.\u201d<\/p>\n

This change in language is massively important not only for the rehabilitation of former offenders, said Gravning, but for their healthcare, and population health more broadly. The change helps normalize for current and future physicians the need to treat a patient population that, like any other group, requires often complex medical interventions.<\/p>\n

\u201cWe do diabetes hypertension, annual physicals,\u201d said Gravning. \u201cWe\u2019re doing colon cancer screening and sleep studies on-site. We have people confined to wheelchairs. We have feeding tubes. We have IV antibiotics. Everything.\u201d<\/p>\n

Inspiring hope and managing systems<\/strong><\/p>\n

Preventive medicine notwithstanding, the 2009 graduate of UND\u2019s M.D. program framed the course as more of a \u201csystems\u201d rotation.<\/p>\n

\u201cWe do try to get some clinical care in for students, but it really becomes a programs overview,\u201d continued Gravning. \u201cHow do we provide a standard of care? What\u2019s our structure? How do we use our support staff to the edge of their certifications to be able to maximize their availability and their ability to provide services? It\u2019s a unique program.\u201d<\/p>\n

This systems overview was exactly what attracted UND medical student Mercedes Hoffner to the rotation.<\/p>\n

Nodding alongside Gravning, the Nebraska native said that whatever expectations she had when she enrolled in the elective have been more than exceeded.<\/p>\n

\u201cGetting to meet some of the people living here, was just, honestly, an inspiring experience,\u201d said Hoffner. \u201cI\u2019m getting a good sense of how the health system works, and how they streamline things here. It\u2019s not only cost-effective care, but also shows me evidence-based medicine in action. And seeing the administrative side has made this a really comprehensive experience.\u201d<\/p>\n

Admitting that she had not yet seen many patients one-on-one, Hoffner, who is actually most interested in practicing pediatrics, said she is getting good exposure to health systems management.<\/p>\n

\u201cIt gives me a lot of hope, seeing the progress and the rehabilitation actually being done here,\u201d she said.<\/p>\n

\u2018Superior interviewing and examination skills\u2019<\/strong><\/p>\n

Established in 2003, the rotation was managed for years by Gravning\u2019s predecessor Dr. John Hagan.<\/p>\n

While he was already at the DOCR, Hagan took on the role of third-year clerkship director for the SMHS Southwest Campus in Bismarck in 2008. That\u2019s when the rotation really took off for SMHS medical students.<\/p>\n

\u201cThese students choose these opportunities,\u201d Hagan said. \u201cAs a result, they develop superior interviewing and examination skills, and are forced to utilize critical reasoning, structured differential diagnoses, and evidence based medicine.\u201d<\/p>\n

And although the experience can be intimidating, smiled Hagan, UND medical students step up \u2013 \u201cwithout exception\u201d \u2013 to meet the challenge of caring for the DOCR\u2019s unique patient population.<\/p>\n

Also stepping up is 2012 UND grad Luke Roller, M.D.<\/p>\n

The Associate Dean for the SMHS Southwest Campus in Bismarck, Roller is knee-deep in a project designed to better diagnose and treat DOCR residents using ultrasound technology.<\/p>\n

\u201cI was talking with Stephanie and she wanted more ultrasound services out there,\u201d said Roller, referencing the technology that was on-site but out-of-use at the penitentiary. \u201cWe don\u2019t want to have to transport those patients to the hospital if we don\u2019t have to because it\u2019s a huge cost \u2013 a huge logistical challenge. But they didn\u2019t have a radiologist at the facility, and didn\u2019t have a technologist. So I said, \u2018Yeah, I can provide all those things.\u2019\u201d<\/p>\n

A radiologist by training, Roller\u2019s solution to what amounted to a bureaucratic conundrum was to round up the right group of volunteers \u2013 himself included \u2013 to help provide a needed service at the DOCR facility.<\/p>\n

Having undertaken a rotation at the penitentiary himself years ago as a student, Roller was sensitive to Gravning\u2019s challenge. So he jumped in to help in 2024, identifying the facility\u2019s needs in terms of software, hardware, and people.<\/p>\n

Fast forward to summer 2025 and Roller said his team makes it out to DOCR to provide ultrasound services \u201conce or twice a month.\u201d<\/p>\n

Everyone means everyone<\/strong><\/p>\n

Using COVID as an obvious example, Hagan said that whatever one might think of those living in correctional facilities, it is incumbent upon communities to meet the healthcare needs of penitentiary residents.<\/p>\n

\u201cCorrections health is public health at its finest,\u201d he added. After all, viruses and bacteria don\u2019t stop at the prison gate. \u201cSince almost all DOCR inmates will be released back into the community, we\u2019re providing care and modeling best health practices for our future neighbors or co-workers,\u201d Hagan explained. \u201cWhen we care about our patients\u2019 health, they care about their health.\u201d<\/p>\n

All of this is another example of how the UND School of Medicine & Health Sciences serves the entire state of North Dakota.<\/p>\n

Gravning was drawn to the role of Health Authority, she said, both out of a desire to do something different and to give back to North Dakota in a way that not everyone is able to do.<\/p>\n

\u201cI am in this position because of the internal medicine rotation,\u201d she said, adding that she provides services alongside a full-time physician assistant and other providers at the DOCR facility.<\/p>\n

\u201cWithout that and the mentorship and guidance of Dr. Hagan, my life in medicine would be drastically different \u2013 and not nearly as cool.\u201d<\/p>\n

Roller was just as direct in his commitment.<\/p>\n

\u201cI feel very strongly about this: I got my education from and for the state of North Dakota,\u201d he said. \u201cIt\u2019s not like I paid the entire cost of my education alone. The people of North Dakota, through the state legislature, helped me. A lot. Because of that, I\u2019ve always felt like I owe the people here something.\u201d<\/p>\n

And by \u201cpeople of North Dakota,\u201d Roller means everyone living in the state.<\/p>\n

Even those living in a correctional facility.<\/p>\n","protected":false},"excerpt":{"rendered":"

UND School of Medicine & Health Sciences faculty and students on an elective rotation that has them pitching in at the North Dakota State Penitentiary. \u201cThis rotation serves as a reminder that there are underserved populations hiding in plain sight \u2013 and they\u2019re right here.\u201d The \u201chere\u201d in question, said Dr. Stephanie Gravning, is the […]<\/p>\n","protected":false},"author":36,"featured_media":13538,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[7],"tags":[3497,3615,3614,3498,3612,3613,516,802,632,600,3616],"class_list":["post-13532","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-corrections","tag-gravning","tag-hagan","tag-inmate","tag-nddoc","tag-pentientiary","tag-public-health","tag-rehabilitation","tag-resident","tag-roller","tag-ultrasound"],"acf":[],"yoast_head":"\nEveryone means everyone - 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