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bluecastel

Does rural FM residency improve chance of EM?

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5 hours ago, JohnGrisham said:

I would assume anecdotally that you would have more independence and hands on experiences in a more rural or resource-limited setting? Less competition compared to a big centre where there are 5 year residents taking more complex cases etc? Just speculating.

Totally agree, you would actually do more procedures as the only FM resident in rural practice setting, and look more competent during your electives in academic centres. In urban FM residency, in academic hospitals, when you have an acute ill patient or procedures like intubation & casting & lumbar puncture, the opportunity is often given to the senior in EM & junior in EM & or medicine resident. It`s really hard to do procedures unless you are doing night shift alone with the staff (seldom happens).

If you happen to do academic FM residency, I would recommend you do ER electives in rural & community hospitals with a lot of volume to get more hands-on skills 

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I would say "look more competent" is a hit or miss. I did a lot of rural FM electives and have now worked with a lot of rural docs and some of the shit they do is downright negligent. It all depends on your preceptors and if you're stuck learning from an idiot, I would argue that you would like far more incompetent. There just seems to be more accountability in an urban setting, whereas rurally docs seem to do whatever they learned in 1970.

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Depending on the place, rural FM programs can give more ER exposure on a regular basis during FM blocks, which is the main advantage. There is no hard-and-fast preference for rural residents in the +1 programs. More time in ER means more learning opportunities and experiences which can be showcased on ER electives and in interviews. I wouldn't say doing ER rotations in a rural setting is better than in an urban one, however, though there are some pros and cons. Rural ER rotations give some more independence, but volumes can be quite low, acuity is often quite low (more comparable to a walk-in clinic in many cases), and management options are limited by available resources. In true rural EM, you're not going to be doing intubations or lumbar punctures either, since the docs there won't do those things. And, as bloh says, rural FM, often done by FM docs without a +1 in EM, is highly variable and some are not very good at what they do.

Urban has less opportunity for the true high-acuity (crashing) patients as others get preference, but you get volumes and usually exposure to those who decide who gets the +1 EM fellowships, which is a big advantage.

From a pure learning perspective, non-academic, non-rural EMs can be the best if you can find a willing and capable preceptor. These are centres without regular EM residents but are in cities or large towns. They're staffed by EM docs (RCPSC or 2+1 FM) and have most - though not all - of the services of a major urban academic centre, with a high volume of patients and good mix of acuity.

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There is no way to know what happens within the black box of residency admission, CCFP-EM admissions or otherwise, we can only speculate. My main FM site is a community hospital, non-rural, but I ensured that I had a mixture of tertiary care exposures for both experience and reference building as well as rural emerg experiences which had me doing 24 hour shifts and being first call to go in if an overnight call came in .... yes that rural that the EM doc could go home for the night. Value in a variety of experiences. Many of the academic center EM docs recommend that career EM docs do some rural shifts monthly to maintain a 'different' set of skills honed working rural EM.

Beef

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To echo some of the above discussion, I definitely think regional centres are the best combination of volume and acuity.  The majority of them only train FM residents so there is no one else to take procedures.  I am at a regional centre and have no interest in EM, but just walking through the ER on a different rotation I have been invited to do intubations, assist with codes, casting etc... I know there are a few regional hospitals in BC that have very good +1 match rates for FM residents because of the experiences they get in residency.

Regarding the preference for Rural FM residents.  I could be wrong, but my understanding is that the +1 program was (is?) originally intended for FM docs to practice emergency medicine in a rural setting.  Not sure if that belief still predominates the selection committee's thinking.

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