{"id":47772,"date":"2026-07-07T15:03:32","date_gmt":"2026-07-07T20:03:32","guid":{"rendered":"https:\/\/blogs.und.edu\/und-today\/?p=47772"},"modified":"2026-07-07T15:03:32","modified_gmt":"2026-07-07T20:03:32","slug":"when-no-cavalry-is-coming","status":"publish","type":"post","link":"https:\/\/blogs.und.edu\/und-today\/2026\/07\/when-no-cavalry-is-coming\/","title":{"rendered":"When no cavalry is coming"},"content":{"rendered":"

A surgical training course at UND helps equip rural physicians for emergencies when they can\u2019t call for back-up<\/strong><\/p>\n

\"Surgeons
Dr. Ben Axtman (right, in black T-shirt) trains with his students – other North Dakota surgeons – in the UND School of Medicine & Health Sciences Gross Anatomy Laboratory for the School\u2019s annual Advanced Surgical Skills for Exposure in Trauma (ASSET) course in November 2025. Photo courtesy of UND School of Medicine & Health Sciences.<\/figcaption><\/figure>\n

Editor\u2019s note:<\/strong> This story originally appeared in the Spring 2026 edition of North Dakota Medicine<\/strong><\/a>, the quarterly magazine published by the UND School of Medicine & Health Sciences<\/strong><\/a>.<\/em><\/p>\n

****<\/p>\n

By Brian James Schill<\/strong><\/p>\n

\u201cRural surgeons aren\u2019t typically doing these big trauma cases,\u201d explained Bismarck native Dr. Ben Axtman, \u201cbut if a patient comes in and the hospital doesn\u2019t have time to transport them \u2013 or with North Dakota\u2019s weather \u2013 they\u2019re going to be in a situation where they need to do at least damage control.\u201d<\/p>\n

This is why, Axtman said with a gesture to his colleagues in the Gross Anatomy Lab on the fourth floor of the UND School of Medicine & Health Sciences (SMHS) building in Grand Forks, everyone could use a refresher now and then.<\/p>\n

To that end, the critical care surgeon at Sanford Health in Bismarck and director of surgery for the SMHS Southwest Campus is in his second year of managing the School\u2019s Advanced Surgical Skills for Exposure in Trauma (ASSET) course. Sponsored by UND, Sanford Health, and the nonprofit Trauma Foundation, the annual continuing medical education (CME) course gives area surgeons an opportunity to hone their skills by exposing them to a handful of complex cases.<\/p>\n

\u201cASSET gives surgeons practice with some of the more difficult surgeries they might see, whether blood vessels in the neck or chest, cases behind the clavicle, behind the knee,\u201d continued Axtman as he watched his \u201cstudents\u201d gathered around a cadaver-patient. \u201cThese are things that aren\u2019t commonly performed, but when they need to be performed, need to be performed emergently.\u201d<\/p>\n

\"Area
Area surgeons hone their skills in the UND School of Medicine & Health Sciences Gross Anatomy Laboratory. Photo courtesy of UND School of Medicine & Health Sciences.<\/figcaption><\/figure>\n

Prioritizing rural<\/h2>\n

Given its location in an overwhelmingly rural state, North Dakota\u2019s only comprehensive school of medicine and health sciences has focused on rural healthcare since its founding in 1905. The school\u2019s physician assistant (P.A.) program, for example, emphasizes rural training modules and rural clinical rotations, while its M.D. program works hard to prepare graduating medical students for post-graduate residencies in family medicine, internal medicine, pediatrics, obstetrics and gynecology, surgery, and emergency medicine \u2013 all of which are in high demand in rural parts of the state.<\/p>\n

This is because many areas of the state \u2013 and especially its \u201cfrontier\u201d counties, as the U.S. Census Bureau puts it \u2013 are in the midst of a health provider shortage. Furthermore, recruitment to these counties presents an ongoing challenge.<\/p>\n

Since recruiting specialists in any profession can be difficult for rural communities, Axtman and his team have prioritized supplementary training for those surgeons who have already committed to practicing in North Dakota.<\/p>\n

\u201cAs surgery becomes more and more specialized, we have to hone our skills \u2013 especially if it\u2019s something we don\u2019t do as often,\u201d mused Axtman, who had no qualms about coming home to North Dakota to practice after a residency in Oklahoma and trauma critical care fellowship in Texas. \u201cFargo is our Level One trauma center, but we have practicing rural surgeons already here, so getting them this educational experience is important. Even with the evolution of interventions in radiology and stents and those things with trauma, sometimes you\u2019re just forced to operate here and now.\u201d<\/p>\n

Time is of the essence<\/h2>\n

One of those surgeons committed to providing surgical care here and now is Dr. Robert McMillan.<\/p>\n

Following medical school in Omaha, Neb., and a surgical residency in Milwaukee, Wis., the Jamestown, N.D., native came home in 2019. Employed by Sanford Health, McMillan, who bases his general surgery practice out of Jamestown Regional Medical Center, returned in part because he had an opportunity to practice alongside his father Dr. Bill McMillan for a few years before the elder McMillan retired in 2024.<\/p>\n

\u201cWe have limited resources in Jamestown \u2013 we\u2019re miles away from the nearest, big trauma center,\u201d said the younger McMillan. \u201cSo a course like this is really valuable for rural surgeons, who might find themselves in a situation where they have an emergency case and just have to do what they can.\u201d<\/p>\n

Because time is of the essence, said McMillan, referencing a case involving a carotid artery exposure to the patient\u2019s neck.<\/p>\n

\u201cReviewing all of this and refreshing things where maybe it\u2019s been a few years since you\u2019ve done it or seen it is important,\u201d he said. \u201cIt\u2019s really valuable, and you can keep that edge with your skills so that a patient can at least be stabilized until they can get to Fargo.\u201d<\/p>\n

\"Area
Area surgeons receive training as part of the Advanced Surgical Skills for Exposure in Trauma (ASSET) course. Photo courtesy of UND School of Medicine & Health Sciences.<\/figcaption><\/figure>\n

More surgeons, more surgeries<\/h2>\n

While North Dakota does have more surgeons per 10,000 persons when compared to the Upper Midwest and the U.S., the vast majority of surgeons are based out of either Grand Forks County or Cass County, leaving the western parts of North Dakota with a relative provider shortage.<\/p>\n

This maldistribution problem is also a target of the course. Held in November 2025, the course saw a wide array of interests among its dozen participants from across North Dakota: several residents from UND\u2019s General Surgery Residency program, a few rural surgeons, trauma surgeons from North Dakota\u2019s only Level One trauma center in Fargo, and a pair of colorectal surgeons who take trauma cases in Bismarck.<\/p>\n

Although a small cohort is often better for learners, Axtman said that he\u2019s hoping to grow the course, particularly among surgeons based in western North Dakota.<\/p>\n

\u201cIdeally, we\u2019d continue to expand this course and offer it to more of our surgery residents,\u201d he said, crediting his nurse practitioner Jake Knudsvig-Partida with helping build and coordinate the training event.<\/p>\n

\u201cExpanding it to more rural surgeons would be great, to help keep them current. I just had a patient the other week who needed emergency surgery in a rural facility where the attending surgeon wasn\u2019t fully comfortable operating, even though the patient\u2019s deteriorating condition required a \u2018damage control\u2019 procedure \u2013 which the surgeon did. The patient did well and was sent to me in Bismarck for follow-up, but if this rural provider had been trained on that sort of case, that\u2019d be even better.\u201d<\/p>\n

About the author:<\/h2>\n
\"Brian
Brian James Schill<\/figcaption><\/figure>\n

Brian James Schill is director of Alumni & Community Relations, Communications & Engagement at the UND School of Medicine & Health Sciences.<\/em><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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