Quality Of Calgary Fm Training?

[blacktowel]

Hey everyone,

 

Working on the ROL, considering primarily FM. Calgary seems to be a great city with friendly residents and PD, but there are always unmatched spots annually. During the presentation, it seems that their training is much more "chill" than others across the country.

 

My main concern then would be the level of competence of grads after residency. Does anyone have any personal experience or comments on this?

 

Thanks!

[LittleDaisy]

If you check for last year 2016...There are FM spots left over in Ottawa (10), Western (13), and McMaster (3)...They are all great programs..

I don't think that unfilled spots after first iteration means that much about the quality of the program though.

Less than 50% of CMGs are interested in Family Medicine and don't want to back up with FM, and hence why sometimes the empty spots after first iteration.

Hey everyone,

 

Working on the ROL, considering primarily FM. Calgary seems to be a great city with friendly residents and PD, but there are always unmatched spots annually. During the presentation, it seems that their training is much more "chill" than others across the country.

 

My main concern then would be the level of competence of grads after residency. Does anyone have any personal experience or comments on this?

 

Thanks!

[Fresh fry]

A lot of people don't like the way they split their program into half days versus blocks. So instead of being on 1 or 2 blocks of surgery and 1 block of obs and 6 of fm all at once they split it up and you do half days spread throughout the residency. The services they rotate don't particularly like it either as it causes all sorts of coverage and continuity issues and so they feel that the fm residents are more of a burden than anything.

 

I am not an fm resident but have friends in both years of that program and elsewhere in Alberta. Anyone who i know who chose it, chose it for location.

 

I would agree to what was said above that yes there are lots of open spots in lots of programs but Calgary is particularly under-subscribed.  

[Keith Wycliffe-Jones]

Hi everyone

Replying to this as PG FM Director in Calgary...hope thats OK?

 

1) re  subsequent competence after grad. As we move forward with competency-based education and focus more on outcomes, this is absolutely the question we should be asking(and answering) for all residency programs.Its actually tricky to meaure though. We recently ran a small pilot project here comparing just 2 quality indicators(BP mx and A1C) for patients of Calgary grads with non Calgary grads practicing in AB.We found no difference. This is an area that needs more work for sure...this was an example of just one approach that could be expanded in future.

 

2) re  "Chill" approach-we certainly encourage a supportive, collaborative learning environment but our assessment processes are rigorous...we are still the only FM Program that requires sign off on all 23 EPAs to complete training.For this, residents have to be ready, and show they are ready, for independent practice...if they are not we provide remediation etc until they are.I should say also that our graduating residents confirm they feel the program adequately prepares them for practice consistently in our exit surveys.

 

3) re Half day experiences; We do move our Residents around a lot to expose Resdients to a large number of longitudinal learning opportuntiies which does affect continuity in these but we focus our continuity efforts on our "Home" FM clinc experiences.....Residents are in their FM clinics for 2 days a week for 2 years(except when on immersion or elective rotations when they are on a half day per week).This is where continuity really happens and where its most important in terms of becoming a compeent Family Physician.

 

Hope this helps.

[stephenpeters2]

Hey everyone,

 

Working on the ROL, considering primarily FM. Calgary seems to be a great city with friendly residents and PD, but there are always unmatched spots annually. During the presentation, it seems that their training is much more "chill" than others across the country.

 

My main concern then would be the level of competence of grads after residency. Does anyone have any personal experience or comments on this?

 

Thanks! 

 Unmatched spots might be because the program is not ranking enough applicants.  I have upper-class men who went through the program and they have no complaints or concerns about the teaching they received. All passed their certifying exams at first seating. Calgary is not very popular compared to Six or Van. Ottawa has a very good program and the city is beautiful but they NEVER fill up in the first round. These things are not straight forward as they look

 Did you get an opportunity to talk to some of the residents during the social meet? 

[Arztin]

Hi everyone

Replying to this as PG FM Director in Calgary...hope thats OK?

 

1) re  subsequent competence after grad. As we move forward with competency-based education and focus more on outcomes, this is absolutely the question we should be asking(and answering) for all residency programs.Its actually tricky to meaure though. We recently ran a small pilot project here comparing just 2 quality indicators(BP mx and A1C) for patients of Calgary grads with non Calgary grads practicing in AB.We found no difference. This is an area that needs more work for sure...this was an example of just one approach that could be expanded in future.

 

2) re  "Chill" approach-we certainly encourage a supportive, collaborative learning environment but our assessment processes are rigorous...we are still the only FM Program that requires sign off on all 23 EPAs to complete training.For this, residents have to be ready, and show they are ready, for independent practice...if they are not we provide remediation etc until they are.I should say also that our graduating residents confirm they feel the program adequately prepares them for practice consistently in our exit surveys.

 

3) re Half day experiences; We do move our Residents around a lot to expose Resdients to a large number of longitudinal learning opportuntiies which does affect continuity in these but we focus our continuity efforts on our "Home" FM clinc experiences.....Residents are in their FM clinics for 2 days a week for 2 years(except when on immersion or elective rotations when they are on a half day per week).This is where continuity really happens and where its most important in terms of becoming a compeent Family Physician.

 

Hope this helps.

Thank you for taking time to clarify!

And this is why you (in the sense of anyone) should think before posting on this forum

[mononoke]

If everything is half day, how does it work when it comes to transportation between sites? Some of the hospitals are quite far apart in calgary

[hamham]

If everything is half day, how does it work when it comes to transportation between sites? Some of the hospitals are quite far apart in calgary

At Calgary, it's mandatory for all residents to have a car. 

[toastman]

lolz

[JohnGrisham]

That feel when the person with 2 posts is going up against 600.

*popcorn*

[filter105]

could someone in Calgary program shed a light on situation of uptodate subscription for residents? I thought U of C (students and residents alike) had free subscription to it but it was ????discontinued. (While other schools such as U of A family medicine have started providing subscription for their residents).

[LostLamb]

I am not in FM but am a Calgary grad and resident.

 

AHS and the U of C Libraries both felt that UpToDate was not as good or cost effective as other available resources, and as such both of them have discontinued providing institutional subscriptions. I think they replaced it with DynaMed (which i've never found particularly user-friendly so I don't end up using it...).

 

A number of residents have decided to purchase individual subs and I believe you can get a discount through CMA? I haven't gotten around to exploring it, but it is an option...

 

HTH

LL

[bloh]

Ultimately your leaning is up to you and a lot of what you learn will be supplemented by your own motivation.

 

Having said that Calgary has potential to be a great program but at the moment it's oversubscribed by at least 30%. This dilutes the experience both in the clinic and the "ACEs" which are essentially half/full day clinics in various specialty clinics. You end up doing silly stuffy like observing dieticians, dental hygienists, etc.. I have taken sick days not because of a physical illness but because I was afraid for my sanity whenever I had something exceptionally stupid on my schedule.

[Myshelle]

I’m interested in Calgary’s FM program but I’m worried about the educational value of the ACEs based on the previous posts. Are there any suggestions on how one can get the most out of the ACE experience? For example, would the program allow it if students asked for the same ACE multiple times throughout the course of a block to simulate a mini elective instead of having a hodgepodge of different half day clinics where you risk doing only shadowing?  

[Supernintendo Chalmers]

Calgary FM resident here. I can comment that overall my ACE experience has been pretty solid, and any ACEs that are observerships/I felt I wasn't getting anything out of them I provided feedback for accordingly. The program is very flexible (with further changes being put in place to make ACE blocks even more flexible) and the administration is very happy for you to ask for specific ACEs you would like to do/have repeated ACEs throughout the block. For example, I wanted more experience with certain specialties/areas for my upcoming ACE block and I have the same ACEs every week with other ACEs set more as full day/ day and a half experiences which gives your preceptors more trust to let you do more. Other colleagues have asked to do a week in the same clinic as an ACE which has been allowed. So to answer your question yes, you can ask for the same ACE multiple times and you have a say in how you structure your block. 

[bloh]

Are they really doing that? It's a zero sum game. So if you get 10 nephro aces, then your colleague is spending 2 weeks shadowing a dental hygenist.

[mjd2012]

On 2017-02-06 at 9:54 PM, LittleDaisy said:

If you check for last year 2016...There are FM spots left over in Ottawa (10), Western (13), and McMaster (3)...They are all great programs..

I don't think that unfilled spots after first iteration means that much about the quality of the program though.

Less than 50% of CMGs are interested in Family Medicine and don't want to back up with FM, and hence why sometimes the empty spots after first iteration.

Just wondering.. where do you find the stats on unmatched seats? Thanks!

[Keege T]

This thread is a bit dated now, but to anyone cheching it out, -  University of Calgary Family Medicine has only gotten worse in the past years. Terrible leadership, very unsupportive, micromanagement and not treating residents with respect, and a poor ratio of high vs low value learning experiences/ preceptors. They actually had 20 unmatched CARMs spots this year, which is a steady increase over the past few years, and definitely can't be explained away as a coincidence at this point. University of Alberta has a far more solid Family Medicine program at this point. 

[nolongerpremed]

29 minutes ago, Keege T said:

This thread is a bit dated now, but to anyone cheching it out, -  University of Calgary Family Medicine has only gotten worse in the past years. Terrible leadership, very unsupportive, micromanagement and not treating residents with respect, and a poor ratio of high vs low value learning experiences/ preceptors. They actually had 20 unmatched CARMs spots this year, which is a steady increase over the past few years, and definitely can't be explained away as a coincidence at this point. University of Alberta has a far more solid Family Medicine program at this point. 

I heard similar things from friends.. I am disappointed b/c U of C FM is my number one choice

[yup]

15 hours ago, Keege T said:

This thread is a bit dated now, but to anyone cheching it out, -  University of Calgary Family Medicine has only gotten worse in the past years. Terrible leadership, very unsupportive, micromanagement and not treating residents with respect, and a poor ratio of high vs low value learning experiences/ preceptors. They actually had 20 unmatched CARMs spots this year, which is a steady increase over the past few years, and definitely can't be explained away as a coincidence at this point. University of Alberta has a far more solid Family Medicine program at this point. 

Would you mind elaborating? Especially about the the high vs. low value of learning experiences/preceptors? Thanks!

[islam620]

21 hours ago, Keege T said:

This thread is a bit dated now, but to anyone cheching it out, -  University of Calgary Family Medicine has only gotten worse in the past years. Terrible leadership, very unsupportive, micromanagement and not treating residents with respect, and a poor ratio of high vs low value learning experiences/ preceptors. They actually had 20 unmatched CARMs spots this year, which is a steady increase over the past few years, and definitely can't be explained away as a coincidence at this point. University of Alberta has a far more solid Family Medicine program at this point. 

Recent Calgary FM grad. I would beg to differ. I had a great experience in the program and feel a couple negative experiences have really perpetuated thaw negative feeling around the program.There has been a change of leadership about a year-2 years ago but I think it was actually a positive change. She’s a younger PD but more connected with the residents than I feel like prior PD was. Overall, current leadership has been really responsive to resident feedback, especially to facilitate changes through covid, and there have been a lot of changes to address the above issues implemented in the past/coming few months. They are moving again to the ‘block’ system. Compared to my friends in other programs, I feel similarly well trained and comfortable in practice. Feel free to message any questions. 

[Keege T]

10 hours ago, yup said:

Would you mind elaborating? Especially about the the high vs. low value of learning experiences/preceptors? Thanks!

In first year, there are a lot of "ACEs" - ambulatory clinic experiences. They basically send you to a random clinic, often for just a half-day (then you go somewhere else for the other half-day). Very few of these experiences are useful at all. Often the clinic doesn't even know you're coming. It's not enough time to learn any actual medicine, the preceptor just wants to get on with their clinic and feels burdened with yet another resident they'll never see again, and it's a lot of pointless travel and direction-seeking.

They make you submit "field notes" - little feedback forms describing a learning experience from every half-day (!), which preceptors HATE to do because it's just ridiculous. It's awkward as hell asking a busy preceptor for this.

I found they also do quite a poor job retaining good preceptors and dropping bad ones, despite collecting regular feedback from residents. There was a particularly bad preceptor at the Central Teaching Clinic, whom so many residents complained about, that he was finally "encouraged" to take a sabbatical for two years... but now he's back. Surprise. This is just one example. Also, they tend to just assume away precepetor problems by taking it as absolute truth that all preceptors are good, and any problem stems from resident factors. This is unhelpful, and has resulted in major problems for the few residents who were unlucky enough to have a difficult main preceptor, who mentors and evaluates you for the entire two years (people have had extreme problems switching, and have been asked to "work out" their issue with the preceptor, after the issue was apready escalated to program director).

Returning to the first issue, because there is a relatively high proportion of just weaker preceptors in "home clinics" (academic teaching clinics where residents work 2-3 days a week for the entire two years), you just run out of things to learn from them. By the end of the second year, you could end up in a weird situation where you start being more competent than your preceptor at times, yet have to hold back, lest you get on their bad side, or even worse - get slapped with a professionalism issue.

A significant proportion of residents were fortunate enough to avoid all of above issues. There are some home clinic preceptors who are excellent, and you could get lucky/be proactive and get quality rotations for the most part. But there's little recourse to help if you run into any problems, and a high chance you'd end up with many mediocre rotations and have a bad time in home clinic.

 

 

[medigeek]

On 8/14/2020 at 12:10 AM, Keege T said:

In first year, there are a lot of "ACEs" - ambulatory clinic experiences. They basically send you to a random clinic, often for just a half-day (then you go somewhere else for the other half-day). Very few of these experiences are useful at all. Often the clinic doesn't even know you're coming. It's not enough time to learn any actual medicine, the preceptor just wants to get on with their clinic and feels burdened with yet another resident they'll never see again, and it's a lot of pointless travel and direction-seeking.

They make you submit "field notes" - little feedback forms describing a learning experience from every half-day (!), which preceptors HATE to do because it's just ridiculous. It's awkward as hell asking a busy preceptor for this.

I found they also do quite a poor job retaining good preceptors and dropping bad ones, despite collecting regular feedback from residents. There was a particularly bad preceptor at the Central Teaching Clinic, whom so many residents complained about, that he was finally "encouraged" to take a sabbatical for two years... but now he's back. Surprise. This is just one example. Also, they tend to just assume away precepetor problems by taking it as absolute truth that all preceptors are good, and any problem stems from resident factors. This is unhelpful, and has resulted in major problems for the few residents who were unlucky enough to have a difficult main preceptor, who mentors and evaluates you for the entire two years (people have had extreme problems switching, and have been asked to "work out" their issue with the preceptor, after the issue was apready escalated to program director).

Returning to the first issue, because there is a relatively high proportion of just weaker preceptors in "home clinics" (academic teaching clinics where residents work 2-3 days a week for the entire two years), you just run out of things to learn from them. By the end of the second year, you could end up in a weird situation where you start being more competent than your preceptor at times, yet have to hold back, lest you get on their bad side, or even worse - get slapped with a professionalism issue.

A significant proportion of residents were fortunate enough to avoid all of above issues. There are some home clinic preceptors who are excellent, and you could get lucky/be proactive and get quality rotations for the most part. But there's little recourse to help if you run into any problems, and a high chance you'd end up with many mediocre rotations and have a bad time in home clinic.

 

 

Any examples of what you'd consider more competent than the preceptor? Just curious. 

[Keege T]

On 8/24/2020 at 9:18 PM, medigeek said:

Any examples of what you'd consider more competent than the preceptor? Just curious. 

For example, in home clinic, we saw a 20s F patient on Adderall XR and mental health comorbidities (some anxiety/low self-esteem/depression), presenting with fatigue NYD. Organic causes already ruled out. I was ready to talk to her about exploring anxiety further, vs sleep, vs lifestyle for fatigue. She mentioned that she once had allergy testing and had a positive reaction to "tree bark". My preceptor somehow deduced from this that the patient could be allergic to the cellulose in the capsule of Adderall XR, and advised her to break open the capsules and dilute the med in a glass of water. I questioned the connection between "tree bark" (what kind of tree?) and cellulose (made from tree pulp, not bark), and the general unreliability of skin-prick tests.  I also said that as far as I remember, Adderall XR has immediate-release adderall inside and relies on a slow-release mechanism from the capsule. To which I was ridiculed and got on preceptor's bad side. Afterwards, I was able to confirm that YES, breaking apart the capsules results in a high dose of immediate-release Adderall. I had to call the patient at home, apologize profusely and "take responsibility" for the bad advice.

Another time I was reprimanded for not supervising an R1 adequately, causing him to use the wrong kind of suture... (but at the time that happened, the preceptor was in the room with him and I wasn't). Another time, a preceptor simply refused to believe that I knew about issue X (which is actually very common, but a new diagnosis increasingly recognized in the past 10 years due to better imaging), and cited it as a professionalism issue. Many more examples. It's just so discouraging, having to spend your energy on fending off the constant psychological passive-aggressiveness, when you should be able to devote 100% of it to learning and delivering your best patient care, and your program should support you instead of constantly trying to knock you down a peg.

[Maruo]

I've heard very poor things about the program (all anecdotal). Mostly around staff placing a lot of work on the residents without much supervision or learning