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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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