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I'm currently a preclerk med student wanting to go into family medicine and looking for advice from upper years/residents on how they have found the FM programs at different schools across Canada for a comparison. Looking specifically to know how competitive, intense, innovative the programs are and what kinds of opportunities are offered. Any help would be greatly appreciated! 

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This is a great idea for a thread.

I'd welcome any thoughts on the following:

1) institutional culture at the different programs,

2) presence of any unique learning opportunities with specific populations (ex. addiction, chronic pain, inner-city, penitentiary, etc.) and,

3) any thoughts on the structure of the programs themselves

(ex. I've read some mixed things on this forum regarding the structure of U of C's urban FM program with it having some longitudinal or half-day component that people did not necessarily find beneficial--I really don't know what to make of this or what the possible issue is, I'm just referring to those previous rumblings on this forum if anyone can clarify that and provide more information). 

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Well Family Medicine is so broad and diverse. This all depends on your own personal career goals, which you may not know yet as a preclerk. I can say off the bat though that Urban Toronto and Urban BC programs are generally the most competitive because many people want to be in Toronto or Vancouver.

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Another thing I found surprising is how diverse the actual hours/call schedule is from program to program.  I am in what is known as a "princess program."  The only 24 hr call we have is for obs and peds nursery we do out of BCCH.  FM residents are supernumeray (we are not a service based residency) for all call (both FM and off-service call, though we are always first call).  I have a family and so like the relative ease of the program.  I have friends in other FM programs both in BC and Alberta where the residency is completely service based and the hours are absolutely insane for FM (ie. one friend in a notoriously busy FM program, worked close to 100 hours/week on obs rotation, other friends out of province the off-service hours are the same as for a specialty residents, 36hr CCU shifts, 0500 starts for surgery rotations etc...).  Something to think about when picking a program.  In general (though far from a rule) the non-academic sites tend to be more family friendly.

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I've heard a few residents recommend pursuing rural FM training as superior to urban FM training as it is much more hands on, you get a lot more responsibility and procedural time, etc.

I've also heard that generally urban FM programs aren't as strong as rural ones.

This second statement was only from one person based on impressions from their colleagues in FM. To me, that sounds a little too broad of a statement to make, but I don't have as much knowledge on the programs out there.

Any thoughts on this?

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6 hours ago, freewheeler said:

I've heard a few residents recommend pursuing rural FM training as superior to urban FM training as it is much more hands on, you get a lot more responsibility and procedural time, etc.

I've also heard that generally urban FM programs aren't as strong as rural ones.

This second statement was only from one person based on impressions from their colleagues in FM. To me, that sounds a little too broad of a statement to make, but I don't have as much knowledge on the programs out there.

Any thoughts on this?

Any programs without royal college residencies will give you more hands on and probably more responsibility.   

Different programs have different strengths.  Urban programs are great for things such as addictions, working with marginalized populations, EM, high volume obs etc... Rural sites will definitely push you to maximize your procedural skills and train you for cradle to grave FM (which really doesn't exist anymore outside rural settings).  Regional sites are usually a balance between urban and rural.

Finally, remember you can do electives wherever you want as an R2.  There were some residents in the year ahead of me whom I hardly ever saw as they were constantly away doing electives.

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On 8/5/2017 at 5:37 PM, freewheeler said:

I've heard a few residents recommend pursuing rural FM training as superior to urban FM training as it is much more hands on, you get a lot more responsibility and procedural time, etc.

I've also heard that generally urban FM programs aren't as strong as rural ones.

This second statement was only from one person based on impressions from their colleagues in FM. To me, that sounds a little too broad of a statement to make, but I don't have as much knowledge on the programs out there.

Any thoughts on this?

I think in a lot of cases, rural gets pumped up because they're usually unpopular sites for both residency and work afterwards. However, they do have some real advantages for the right people. First, rural programs tend to have better faculty-to-resident ratios. This means some more individual attention from multiple preceptors and potentially the opportunity to see more uncommon conditions/perform procedures if your preceptors are proactive about pulling you into cases that give you such opportunities.

Second, rural residencies work under whatever scope of practice exists in that community, which tends to be wider than in urban settings. This typically involves some Emergency Department coverage as well as some inpatient coverage, depending on the local set-up for FM docs, neither of which are overly common in urban programs. Depending on the set-up, OB care and nursing home coverage can be a part of rural residency programs, though those are common in urban programs as well.  

Whether these advantages mean an overall higher-quality program I think comes down to the individual person as well as the program. If you really want EM and/or inpatient exposure, or want to work in a rural setting with a rural population, rural programs have some clear advantages. If you're not interested in ever being in the ED, covering inpatients, or working rurally, then the advantages are less clear and really depend on the individual programs themselves.

Where off-service rotations are done can matter quite a bit too, though the urban vs rural divide is not necessarily what matters here. Doing off-service rotation in non-academic centres, where Royal College residents aren't running the show, can be a major advantage in getting some better training and independence in these specialties. However, rural FM residents often have to do these rotations in the same academic centres as urban residents. In these cases, the "regional" programs, programs set up in or near larger city centres but not primarily affiliated with an academic hospital, can have the edge.

Point is that there is a difference between urban vs rural, but distilling a program down to just those two categories is too simple in looking at program quality or fit. There are good urban programs and good rural programs. There are bad urban programs and bad rural programs. You can get a lot of independence in some urban programs, as well as in some rural programs (I'm in an urban program and have as much independence as I want, even at this early stage). It's the individual program and individual site, along with how well the site matches your learning goals, that matter for whether you'll get a good quality residency education in FM.

On 8/5/2017 at 7:42 PM, a7x said:

Any input on which programs or sites are better for someone interested in an emerg +1?

Anywhere that the preceptor(s) take on regular EM shifts where their residents join them. Electives at any program allow for EM exposure, but if you can work it into your standard FM blocks, that's the ideal situation. These programs tend to be more rural.

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On 8/6/2017 at 12:45 AM, medisforme said:

Any programs without royal college residencies will give you more hands on and probably more responsibility.   

Different programs have different strengths.  Urban programs are great for things such as addictions, working with marginalized populations, EM, high volume obs etc... Rural sites will definitely push you to maximize your procedural skills and train you for cradle to grave FM (which really doesn't exist anymore outside rural settings).  Regional sites are usually a balance between urban and rural.

Finally, remember you can do electives wherever you want as an R2.  There were some residents in the year ahead of me whom I hardly ever saw as they were constantly away doing electives.

What site were you in in BC? also what is the site you reference as having very demanding hours. Anyone else have any advice in terms of finding more relaxed programs? 

thanks

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1 hour ago, medstudent2020 said:

What site were you in in BC? also what is the site you reference as having very demanding hours. Anyone else have any advice in terms of finding more relaxed programs? 

thanks

Many city based FM programs are chill, or have the potential to be chill. Don't go to a rural or mid-sized program where you are more so in front-centre versus being a fly on the wall or the "extra" resident on off-services. 

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10 hours ago, medstudent2020 said:

So have people found Urban programs to be more relaxed (ie less hours and less call) than rural programs? I have heard the opposite as well. Less call is always something I am looking for

At the end of the day when you find a school you're interested in you're going to have to do research about actual clinics to get a realistic idea. My rural clinic was done around 330 because they run out of patients, 30 minutes down the road the rural clinic did OB and ER call and it wasn't unusual to be there from 8-11 every third day. When you're staff there may be pressures depending on where you are but at the end of the day you still get to decide call/hours/commitments and as a consequence decide it for your residents as well.

The only general rule I found was that community clinics seemed to be better than academic practice;s but even then I've seen solo practitioners with over 5000 patients and an academic staff who never has less than 2 residents with 900. Take home point is to use that interview day well to get the lay of the land.

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any advice on Quebec FM sites ? whether at McGill or french universities ? I mainly want to get an idea on how different the programs are from each other ( McGill vs French universities or differences between the 3 french universities themselves ) in terms of competitiveness, types of population exposure and potential to do R3 in hospital medicine ?
Would appreciate any answer ( in French or English )

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Any recommendations on specific rural programs (especially if considering EM)? I know an above post said to look for places where staff does emerg shifts, but do any have better reputations than others? I’ve heard good things about UBC, Calgary, Manitoba, NOSM, and MUN’s rural FM programs

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On 10/16/2019 at 12:11 PM, MDwannabe02 said:

Any recommendations on specific rural programs (especially if considering EM)? I know an above post said to look for places where staff does emerg shifts, but do any have better reputations than others? I’ve heard good things about UBC, Calgary, Manitoba, NOSM, and MUN’s rural FM programs

I won't go to UBC, because their medical school and residency has higher rates of intimidation/ not known for being a good teaching site and less support/supervision while still being a busy academic center. There is 33.3% of suicidal ideation among UBC family medicine residents according to this new CFP article: https://www.cfp.ca/content/65/10/730.abstract

Personally, I've heard a lot of horror stories about UBC clerks being bullied and intimidated. UBC Is a popular school because of its location. But Vancouver has the HIGHEST cost of living, with second lowest paid resident salary after Quebec (whom has a very low cost of living). TO be honest, residency is so busy, you won't really have time to enjoy life and go out too much. 

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On 10/17/2019 at 11:25 PM, LittleDaisy said:

I won't go to UBC, because their medical school and residency has higher rates of intimidation/ not known for being a good teaching site and less support/supervision while still being a busy academic center. There is 33.3% of suicidal ideation among UBC family medicine residents according to this new CFP article: https://www.cfp.ca/content/65/10/730.abstract

Personally, I've heard a lot of horror stories about UBC clerks being bullied and intimidated. UBC Is a popular school because of its location. But Vancouver has the HIGHEST cost of living, with second lowest paid resident salary after Quebec (whom has a very low cost of living). TO be honest, residency is so busy, you won't really have time to enjoy life and go out too much. 

I recently spoke with a recent McGill FM grad. To my surprise, she told me that there is a high rate of burnout among McGill FM residents, with a significant proportion having to take time off for personal wellness. This comes as a surprise to me, as I have always thought that FM is a laid back and "relaxed" residency. Apparently I am mistaken. Can someone else chime in about FM residency at other sites?

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On 10/16/2019 at 9:11 AM, MDwannabe02 said:

Any recommendations on specific rural programs (especially if considering EM)? I know an above post said to look for places where staff does emerg shifts, but do any have better reputations than others? I’ve heard good things about UBC, Calgary, Manitoba, NOSM, and MUN’s rural FM programs

Sask, MUN and Manitoba have excellent track records for ccfp-em pathways for training.  Calgary is a definite no, unless youre in rural streams.

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23 hours ago, JohnGrisham said:

Sask, MUN and Manitoba have excellent track records for ccfp-em pathways for training.  Calgary is a definite no, unless youre in rural streams.

 

Can you please elaborate regarding Calgary? It was definitely a place I was considering since I do have family there, however, it is not where I currently live. Thanks.

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On 12/4/2019 at 12:30 PM, JohnGrisham said:

Sask, MUN and Manitoba have excellent track records for ccfp-em pathways for training.  Calgary is a definite no, unless youre in rural streams.

The one thing I will say about MUN rural family is that the rural locations are REALLY rural compared to what someone living in Ontario would call rural. The entire population of the province is only 500k (and it is a huge province). The largest city is <200k and is situated at the extreme east (although St. John's is an awesome spot). If you are on the west coast in say Corner Brook (~30k people) it's an 8 hour drive. The other "major" centers for healthcare on the island is Grand Falls/Gander, which are 16k/12k and 4/3 hours from St. John's respectively.

The province is very rural outside St. John's (especially if you also don't count Corner Brook). Unless you are into fishing/hunting/hiking/ATVs/snowmobiles, there isn't much to do. 

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7 hours ago, NLengr said:

The one thing I will say about MUN rural family is that the rural locations are REALLY rural compared to what someone living in Ontario would call rural. The entire population of the province is only 500k (and it is a huge province). The largest city is <200k and is situated at the extreme east (although St. John's is an awesome spot). If you are on the west coast in say Corner Brook (~30k people) it's an 8 hour drive. The other "major" centers for healthcare on the island is Grand Falls/Gander, which are 16k/12k and 4/3 hours from St. John's respectively.

The province is very rural outside St. John's (especially if you also don't count Corner Brook). Unless you are into fishing/hunting/ATVs/snowmobiles, there isn't much to do. 

100% agree. Have been in the province 4 times now, and though there is alot of natural beauty, and most people are very friendly(usually the case when you have a new person around who you want to stay), there isn't much else other than some community based events/activities every now and then. 

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6 hours ago, JohnGrisham said:

100% agree. Have been in the province 4 times now, and though there is alot of natural beauty, and most people are very friendly(usually the case when you have a new person around who you want to stay), there isn't much else other than some community based events/activities every now and then. 

I forgot drinking. If you are into drinking, it's the place to be. Hahaha

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16 hours ago, NLengr said:

The one thing I will say about MUN rural family is that the rural locations are REALLY rural compared to what someone living in Ontario would call rural. The entire population of the province is only 500k (and it is a huge province). The largest city is <200k and is situated at the extreme east (although St. John's is an awesome spot). If you are on the west coast in say Corner Brook (~30k people) it's an 8 hour drive. The other "major" centers for healthcare on the island is Grand Falls/Gander, which are 16k/12k and 4/3 hours from St. John's respectively.

The province is very rural outside St. John's (especially if you also don't count Corner Brook). Unless you are into fishing/hunting/hiking/ATVs/snowmobiles, there isn't much to do. 

I always wondered, when it comes to rural training in these places - there just isn't really high volume of pathology? I mean if you spend 2 weeks in a rural ED, you may not even have 1 intubation or line put in on any patient nor any traumas. Simply because the population there did not have any issues. I always of rural training being good but is it just in theory or is it legit? 

Busy community settings seem to provide more in my experience. 

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There is a balance. For instance if you are a family med resident doing an ER rotation in a teaching hospital, there's going to be a fair number of trauma, intubations, procedures, exoctic cases etc. However there will likely be med students/residents/fellows all training as well and so the chances of you doing the procedures are relatively low. On the other hand, if you're the only person in Nowhere's local clinic, traumas/codes/uncommon presentations are going to be rare, but when they do come you'll be doing everything yourself, and so may actually get more overall experience.

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