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Remember that all of this presentation business is somewhat of an artificial construct. When you are done your training you will not regularly present like this. When you do tell people about your cases it will usually involve only a couple sentences to consultants. Nevertheless, presentations are important during training… The trick here is to imagine yourself as a attending physician receiving your case presentation. When I receive such presentations I already have a preliminary differential diagnosis in my mind. As the trainee reports information I am trying to slot the various pertinent positives and negatives reported into this preliminary differential. If the presentation does not follow a logical format, or contains a ton of irrelevant information, it is very challenging for me too use any of the information reported. This can be frustrating and is a disservice to the trainee as it makes it difficult for me to truly assess their clinical skills. They might know a lot. But I just can’t make heads or tails of the random bits of information reported. The key in this case is being aware of what pertinent positives and negatives are for the various key items on the differential. For a very junior trainee this can be a big ask. Often when a junior trainee makes a presentation what I’m really looking for is gaps in knowledge, based on random things they say, that I can teach around. I will need to do the history and physical from scratch myself in all respects anyways. I do not know your level of training, but if you are in the first half of clerkship I would not worry too much about this. A preceptor being frustrated with your presentations at this stage of training says more about the preceptor than it does about you. To get better at the skill this is the exercise I often suggest to the med students and residents I supervise: 1. before you see the patient read the chart and obtain all the easily accessible information. Understand the chief complaint. Then based on this information physically write out your differential diagnosis based on this obviously limited information. Try to be as broad as possible. This primes your brain around which questions are important to pursue at the bedside, and helps you be more organized. You could literally ask your questions at the bedside by running down your list of differentials. Assuming you know the relevant questions to ask for each item. I firmly believe the more organized you are in taking your history directly translates into how organized your presentation will inevitably be. There is probably a medical education study in that very question, but I digress… 2. Take your history and physical as you normally do, but keep in mind the list of differentials you just created. Often as you obtain more information you will need to pursue additional differentials.Usually you also obtain enough information to quickly start eliminating items off of the differential list you just created prior to meeting the patient. 3. Leave the bedside. Now before charting go back to your list of differentials. As you formally chart your findings look at the items on your list and draft your pertinent positives and negatives for each item together. If you think you have enough information to eliminate an item on the differential scratch it off your list. The items remaining on your list may require investigations. Therefore, when charting your plan consider the differentials which are not eliminated from your list. 4. When verbally presenting your case use this framework. Cluster your facts around particular items on your differential. Conclude with your plan as it pertains to the differentials which remain on your list. I find that this process, although somewhat tedious for the learner, helps them organize their thinking and therefore their presentations. It essentially puts onto paper the underlying thought process which every physician undergoes when they are presented a new case. Now as a “PGY10”, I go through this thought process for every patient I see at a nearly subconscious level. So more important than presentations for the long term is developing an efficient and replicable way of thinking. It minimizes clinical errors. Ultimately that’s what you are doing here. I find that many of my learners after doing this for a few days can quickly transition into throwing away the list and can still remain organized without this “training wheel”.

There are opportunities out there for outpatient work with an FRCPC. Within my practice group alone I know FRCPC docs doing sports medicine, pain medicine, addictions, aerospace medicine, etc, and various types of procedural work within clinics. I count myself among this group. They are all FRCPC trained. I would say this is becoming increasingly more common, particularly amongst those who finished residency within the last ten years. Now that I am coming up on five years post residency, I find myself actively actually encouraging others who are newly minted staff to consider “side gigs” to leverage your training outside of the emergency department. I think this is key for many ppl in order to fully enjoy a long-term career within emergency medicine, to maximize one’s potential to expand, and to make your life more interesting.

Emerg doc here. Get vaccinated. The risk benefit is a no brainer. Nearly the only patients I’m intubating now are unvaccinated. The risk calculus is a no brainer.

If your program will give you time to do it, supports you doing it, and you don’t pay full price, it’s a good idea IMO. The reason being is that it will certainly cost you more in lost income once you are done residency. This also assumes you have a reason for doing the masters in the first place. A masters for the sake of the paper is a waste of money and time. I did one masters during residency. It was value added. The second masters I did after residency. It’s end value has yet to be determined. It may or may not pay off. We shall see...

I’m totally bias here being trained in the 5 year stream. But I just can’t fathom one being able to accumulate the equivalent knowledge, confidence, and department management skills needed without dedicated support provided by a training program. Becoming an expert in emergency medicine takes more than some CME, some hours logged and an exam.

I went into my emergency medicine residency considering critical care. It was one of a handful of potential options I was considering for the “extra specialization year” built into the 5 year training. In my first three years of residency I spent just shy of 1/2 year in the ICU, and didn’t like it that much. In the ED sick patients often get better, get worse, die, or stay the same and get admitted over the course of a shift. The ICU with all it’s hours of rounding and the gradual changes in patients status didn’t really fit what I was looking for from a work satisfaction standpoint. Don’t get me wrong. There is also some fascinating medicine going on there. When it was interesting, it was really interesting. But it just didn’t have the turn around of the ED which I really enjoy. My impression is that critical care docs work really hard when they are on. There are different models out there, but many cover the ICU for a couple days. Those few days seem to be fairly focused on the ICU with call etc. During the off times most of these folks go back to their regular programming, such as being an emerg doc, anesthesiologist, respirologist, surgeon, etc.. I imagine what sort of overall lifestyle this job presents is probably highly dependent on what else you are doing when not covering the ICU. As an aside, the ICU rotations during emergency medicine training are some of the highest yield over the five years. Many residents come out of the ICU and return to the ED with a much improved repertoire of knowledge and skills. So even if critical care isn’t your cup of tea, it’s hugely translatable towards determining the type of emerg doc you will be.

I will take a look at the UBC forum.

If you like gambling, invest your LOC... Otherwise I would not invest even cold hard cash let alone capital from a loan. Personally, I pulled everything I had in the market out when COVID started rampaging through Iran in February... The pandemic writing was on the wall when this virus reached that country. The political response to the pandemic has often been not rational. The scientific response one of many unknowns. So in my opinion there is no way to truly predict what the markets will do in the immediate future. What firms will get bailed out, which regions will get hit hard, what public health policies will be implemented, what sort of second wave will occur, it’s all a black box. The economic hurt from this is just starting. Long after COVID is dealt with we will still be picking up the financial wreckage on a markets scale. It would not surprise me if we enter into a decade similar to the 1930s markets wise... I would hold tight until more rationality returns and all the supply chain restructuring is sorted. Over time the more reliable investments will become more clear.

I’m an emerg doc working in an academic centre. Here are my answers. 1. You do see a certain proportion of patients that have non-emergent chief complaints. On some days this makes up the majority of the patients I see. Most patients fall into the grey zone. They may or may not have an emergency and I need to sort that out. That process is the most time consuming part of my job. In the group of patients that obviously do not have an emergency they can be broken down into one of two categories. 1) The patient is not aware that their concern is not emergent and is concerned. 2) The patient is aware that they do not have an acute issue but for some reason cannot access a GP. As emergency physicians we are the safety net of the healthcare system. When things go south out in the community for whatever reason, medical complication, access issue, resource issue, social-economic issue, we are the folks that are the “last line of defence“. That’s as much part of our role as resuscitating the acutely ill. This said, I see a huge amount of verity. It is one of the joys of the job. Just last night I resuscitated a polytrauma, with sig facial injuries (difficult intubation), I managed patients such as; ACEI angioedema, a STEMI, a few NSTEMIs, a cholecystitis, cellulitis, a serotonin syndrome, a few elderly falls needing stitches, a few homeless people looking for social help, a sick septic and suspected COVID patient, cellulitis, pacemaker malfunction, urinary tract infection, a end stage cancer patient needing palliation, renal collic... That’s just what I recall from last night off the top of my head... 2. It depends. My job is to make sure a patient lives to get definitive treatment, or to initiate definitive treatment and while doing so disposition them to some place where recovery can occur safely. This may mean stabilizing and consulting. This may mean diagnosing and treating. Part of this job is also managing a department that has multiple very acute and rapidly evolving patients. So all these factors play a role. At times it is about stabilizing +/- diagnosing the patient for they can get to an OR or ICU (such as the trauma patient above). Other times it’s about ruling out other potential badness, diagnosing, getting the patient set up with a treatment plan and arranging follow up outside the hospital (such as the renal collic patient above). When you decide to consult in house will depend on a few factors. Outside of the clinical factors unique to the patient, two big considerations are the availability of other services, and your overall department situation. If you are in some rural place you may have no choice but to manage into the subacute phases because of resource realities. If your department has multiple critical ill patients and limited emergency expertise, you may also consult earlier once initial management is started due to those resource realities. As an aside, one part of the job that is often not considered early on by trainees is the managerial aspect. The emergency department is very unique in the managerial challenges it presents. Personally I find that part of the job one of the most enjoyable aspects.

Graduate degrees are so variable regarding "value". In my experience, over 50% of the value of such a degree depends on the network opportunities that arise. I do not know anything about the program you refer to, but I would start by trying to contact some alumni, or by trying to get a sense of where those who completed the degree ended up. It would be interesting to see who has enrolled and who is teaching the courses and what their background is.

Of course the exams where cancelled for this reason... Why were provisional licenses granted over just having them sit it out? A human resource rational plays a role there.

300-400 people a day are dying in Italy. The situation there is like nothing seen since WW2. Having people out there doing something is better then having no one... Canada is entering into the same situation. Final year residents are being given temporary liscenses to practice independently without writing the exams. Exams are cancelled this spring. We need the people. The scale of what is coming is truly unlike anything we have seen in generations.

This question makes me smile. I will add one more to the nope column.

That is the world we now exist in. What was normal 4 weeks ago is now history. These are exceptional times. Every resource we have is being put towards COVID-19 preparation. It will be like this for the foreseeable future. Everything medical education will be playing second fiddle. We are not even close to the peak of this. And it’s likely going to be many many months before we get to the other side. Not ideal for you. But these are the times.

Just expressing my own opinion here. But I would count on some setup existing where new medical students can start classes. As others mentioned, pre-clerkship is mostly just didactic and group based learning. Most of it could be done online quite well. It will probably be an unusual year. But I have a hard time imagining the stream of new physicians being cut off entirely.