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A-Stark

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A-Stark last won the day on November 15 2018

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  1. I'm not sure any of this shows the essentialness of clerks let alone that they're doing work that should be compensated like a job. In community centres, nurses will often enter "routine" bloodwork themselves without any MD input (imagine!) because they're used to things working like that. Assessments and rounding takes no time at all; the only stuff that I never feel quick at are the note-writing and, of course, patient/family counselling.
  2. Clerks should not overrate their importance to the system. They are students - very junior apprentices at most - and are doing all that work to learn how to do the job. Residents work still harder. But they still have a union and post-call days and, well, a salary with paid vacation and sick leave. I didn't think I was particularly underpaid as a resident - even despite the hours at times - but our call stipends sucked and still do because of bad outcomes with prior negotiations. Staff pay is almost inconceivably better, but you're now responsible for everything. And if you end up being up all night on a Friday you still might be on call Saturday, Sunday, Monday... but is 5pm Monday ever awesome! (Those days may or may not be coincidence.) Indeed. Teaching requires time and you can't - as a resident or staff - simply go by a clerk's assessment without questions or your own assessment. It's helpful to have someone around to write painstakingly detailed notes from time to time but I can't think of many instances where having a med student didn't just slow me down (at least after PGY1).
  3. I always have coffee with me apart from when I can't. But I'm APP so I don't get to bill as such. It is helpful when GIM does much of the overnight admitting, but I always go and see the patient myself - I don't think it's appropriate to rely on someone else's assessment when I'm assuming care, but then this whole "independent practice" thing is kinda new. And it is lonely! But there's something to be said for doing everything yourself. And when Thursday afternoon comes you get to peace out and avoid the place for a while (provided there's no IM call coming up soon...).
  4. Another fine example of the CPSO (and other colleges) coming up with policies that are either impractical, based on shoddy evidence/rationale, or both.
  5. Not sure we'll have intubating machines or AI that's well suited to individual tailoring of anesthetic plans in the foreseeable future.
  6. That's probably better pay than is typical (and would be for a big unit). It otherwise sounds like you were talking to academic intensivists. While in the GTA many GIM staff will be in the hospital most of the night dealing with emerg consults, the ICU staff doesn't get to lie in bed all night and actually needs to, you know, come in. The pampered academic types who have their fellows deal with everything are something of an exception - I tend to think they are overpaid relative to the "value" of their academic responsibilities. Given that the traditional model is 7 days/night of coverage straight, I'm not sure where you've gotten this idea. If you're on call in a community hospital, there is no "someone else" to do all your overnight work.
  7. I've generally heard that UofA has a good program, but I don't know too much about it otherwise. Edmonton is a much more laid back city than Calgary and has better pathology from a somewhat more "interesting" referral base. And it has all the transplant stuff. I didn't like the Calgary residents that I met on elective there, but that was my experience of exactly two people. Sask historically was something of a dumping ground for the second iteration. I think it's a reasonable program, but Saskatoon is small and flat and far from everything. I'm on a rotation in Toronto right now and it's been nice. I find their call system fairly problematic though - you end up as "backup" call and can be pulled in semi-randomly for coverage. Worse, people can call in "sick" leading you to be "activated" as a backup. In my core program, you couldn't get away with anything like that because we were small enough that anyone abusing the goodwill of their colleagues would get called on it immediately. Harder to do that when you have 50-odd PGY1 colleagues. I don't know much the NOSM program except that they do some rotations in Ottawa. It does not have a good reputation as a strong program. Dal generally trains good people and has recruited some strong GIM staff in the last several years. They still have a preponderance of subspecialists covering GIM call, but it's likely improving. Halifax is a lovely city but everyone is forced to go to Saint John for several months during more than one year of core training. Subspecialty spots have gotten really tight as the government has cut back. I don't think acuity is great on GIM there. Their EMRs are awful. MUN has the whole "intent-to-withdraw" accreditation business hanging over the program, but that will be a non-issue going forward. I don't think the decisions were made based on the especially accurate evidence. In my time, we tended to have a lot of early autonomy both on CTU and other rotations. There's more CTU than most programs and a lot more cardiology call (with CCU coverage) than average. Acuity is good, particularly since there's a "co-admission" structure where you will see sick patients in emerg first before ICU gets there. I do think that some of the Royal College requirements for "more supervision" may be diluting the experience somewhat, though. Procedural experience can be excellent but depends somewhat on initiative. Although MUN is not a big research centre, it tends to be easy to get involved, especially for any interested in cardiology. Newfoundland has lots of weird pathology and money-by-way-of-oil has helped create something of an ongojng IVDU/endocarditis spike. I have a lot of issues with more administrative things at the level of the hospital and health authority, but that has little to do with the program or the core resident experience. There's also a two-night annual retreat away in cabins next to Terra Nova National Park which is always a good time.
  8. Studying for 5 hours a day after work/school is overkill even for Royal College studying... and a recipe for burnout. As a resident, I just go running or to yoga a few times every week. Just make a bit of time for it. Now, if you want to maintain some kind of aggressive weight training program, it might be harder as you go farther on, but then I've always thought that the gym was beyond boring.
  9. Community GIM pays well, often very well. Certainly better than a lot of subspecialists.
  10. Because sometimes I can't resist piling on... While the MCCQE 1 isn't difficult to pass, I don't think it's a very straightforward exam. You need to take studying for it seriously. I mainly did practice questions, albeit ones meant for the USMLE Step 2 CK. That was because Toronto Notes is a terrible, superficial reference which at best functions as a refresher for material you might have already learned. And, forgive me for saying so, but pre-clerkship med students don't know very much, and it takes a while for clerks to function in hospital let alone get good at it. So I'd drop that condescending, arrogant attitude right now because it will not come off well in the future. Simply put, you don't know what you don't know. Otherwise, people do fail MCCQE 2, CCFP, and Royal College exams. It is always a setback, but people recover and move on. The trick is that these exams get harder as time goes on, but you are trained to a certain standard and study accordingly.
  11. I disagree. Clerkship is where you learn how to "do" and function in a clinical environment. Pre-clerkship prepares you for that, and aside from basic history taking and physical examination skills, the bulk of that is the accumulation of knowledge. It is not sufficient simply to "look things up". For example, I learned most of my anatomy at the beginning of first year. As with anything else, repeated re-exposure helps reinforce that initial learning, but you cannot go into clinical training without a certain knowledge base.
  12. Excellent post. Mac was in my top 3 ultimately. The only real downside is that Hamilton - while it does have its nice spots - remains something of a hole, and I'm not keen on the General as a hospital. At a certain point all programs have their strengths and weaknesses, but location may become a deciding factor. Proximity to family/friends and personal life stuff may end up being more important. I do think that the early ICU exposure is a nice feature of Mac's program. I assume that entails buddy call? I'm not sure if that's better than simply being thrown into solo call as an R2 in July. Though I imagine you don't cover CVICU at Mac...
  13. Every program is "academic", though the organization (and sometimes quality) of teaching will vary. I suppose it depends on what you mean by "autonomy". At my centre, I rarely do anything but work directly with staff - no intervening seniors let alone fellows. But of course some staff are micromanagers and others make a point of letting you run your own team.
  14. Yes, especially because of the sacral ulcers and nec fasc debridements. The hand surgery population is just a treat too. On the other hand, plastics does avoid dealing with fistulas, fissures, stomas, and hernias. And parastomal hernias. Generally speaking the OR is always better from the other side of the drape, particularly for those who occasionally need to scratch an itchy nose.
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