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On 2/27/2020 at 9:31 PM, Redpill said:

Can you expand?

Here you go:

image.png.3cd47beb24c7717741203ffc3fbd47f6.png

 

Just joking here with the picture above.

I don't have a definition.

However, there are some medical students who just don't give a good vibe to others. Examples include bad mouthing other services/consultants/nurses/medical students etc. There is also a fine line between being confident and arrogant; and gunners sometimes don't know that line. Some people resume/electives are super focused on 1 specialty and reviewing comments from their other rotations show that they might not be as good/team player/intelligent as shown on when working on the specialty that they are gunning for.

In my opinion, if you like one specialty then you should work hard towards it. But also show up on all the other rotations with the same enthusiasm. I hope that helps.

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This is by far one of the most common questions people who are interested in EM ask. Lots of good answers on here about it.  It’s also a reasonable question with perhaps an unsatisfying non-black and

Here you go:   Just joking here with the picture above. I don't have a definition. However, there are some medical students who just don't give a good vibe to others. Examples

In a way it would make more sense for it to be the exact opposite (not that I'm advocating for that). To come to a provisional diagnosis and manage a patient without having CT available is probably a

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On 2/28/2020 at 6:37 PM, medigeek said:

I'll add to this question. Let's assume high efficient outpatient doc vs EM doc capable of doing above average shifts vs hospitalist in a good higher earning pay model. 

For same amount of work?

There is no magic formula.

If you are really going to make me guess than overall it will go something like this: hospitalist > EM > outpatient doc. No data what so ever to back up my claim.

Anectodal story I heard from someone else. There is a doctor who had a full time EM workload + full time FM practice with a number of rostered patients that is not ethical. Billed a good amount. A really good amount. Would I follow him? No. I have other hobbies and interests and priorities.

 

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On 3/2/2020 at 4:47 AM, rogerroger said:

Magneto, good idea starting this thread. I’m happy to check back here and answer questions as well. I’m FRCPC trained so can provide insight into that or anything EM related. 

Thanks for your help!!!!

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On 3/2/2020 at 7:21 AM, icewine said:

What practice scope do prehospital doctors have in Canada? I have not been able to find much on this. From what I have researched Canadian prehospital medicine seems more administrative in nature. Whereas in Australia where I am based prehospital and retrieval medicine mirrors the British model where doctors will frequently act as first responders and escort very ill patients from facility to facility. In Canada it seems that advanced care paramedics take on this role. Or do Canadian prehospital fellowships allow EM doctors to do this? I am thinking about applying for prehospital fellowships but I am not sure if I should apply in Canada especially if the role is more administrative as opposed to clinical. 

Many thanks for starting this thread.

The scope for prehospital doctors is anything to everything.

For routine transport, advanced paramedics will go.

For complicated transport, very sick patients - staff physician or fellow or senior resident will go.

5 year FR-EM can apply to all transport fellowships. 2+1 EM's can apply for some transport fellowships.

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On 3/2/2020 at 8:13 AM, RiderSx said:

Can you tell me what you love most and what you like least about EM?

I am drawn to EM because of the challenging and fast paced nature of the job. I love being on my feet and not knowing what's coming next, and that I would be the first line of care when people need help. But I have also heard that there is a lot of handover to and reliance on specialists as you wouldn't be an expert on any specific area. I have also heard patient interaction and relationships are minimal. Just what I have heard though. I could be very wrong about my perception of the field, so your thoughts are very appreciated!

What I love most: my education, training and experience have given me the privilege to help any patient (regardless of age, gender, medical illness, course of illness, severity of illness) and I either know how to help them OR how to get help for them OR how to make them comfortable OR how to decrease their suffering.

What I like least: Sometimes I know how to get help for my patient BUT I cannot for many many reasons.

 

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I was wondering if you could touch a bit about the exposure to trauma as a +1. I shadowed at a community ED not long ago and really enjoyed the pacing and atmosphere, but I find myself hesitant to do EM since I get quite queasy with severe traumas. Hopefully I'll get better with exposure, but assuming I don't would this be enough for me to rule out considering EM or the +1?

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7 hours ago, magneto said:

Hard to compare the earning potential.

I believe FM-hospitalist and EM's will both earn roughly more or less in the same ballpark. I don't have any data to back that up other than some anectodal stories.

As an aside, something I did not fully appreciate until becoming staff was just how variable compensation can be in a given speciality across the country geographically. EM seems to be one of the more consistent ones. But compensation in medicine can be very different between provinces and locations within provinces. It’s always a tricky question to answer “what does speciality X make?” You could give a Canadian average, but for many specialities the variability around this number will be very vast. 
 

It’s a more complicated question then many trainees appreciate, myself included retrospectively. Human resource management in healthcare is truly a Byzantine labyrinth. 

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On 3/10/2020 at 10:08 PM, struggling2getin said:

I was wondering if you could touch a bit about the exposure to trauma as a +1. I shadowed at a community ED not long ago and really enjoyed the pacing and atmosphere, but I find myself hesitant to do EM since I get quite queasy with severe traumas. Hopefully I'll get better with exposure, but assuming I don't would this be enough for me to rule out considering EM or the +1?

Trauma is a big part of ED and emergency medicine. If you don't feel comfortable with trauma then look into a specialty that overlaps with EM but has less trauma. The other option is to get more exposure and get comfortable with challenging situations. I hope that helps.

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3 hours ago, magneto said:

Trauma is a big part of ED and emergency medicine. If you don't feel comfortable with trauma then look into a specialty that overlaps with EM but has less trauma. The other option is to get more exposure and get comfortable with challenging situations. I hope that helps.

Thanks for the response! What would you say overlaps with EM? Radiology or internal?

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On 3/11/2020 at 12:08 AM, struggling2getin said:

I was wondering if you could touch a bit about the exposure to trauma as a +1. I shadowed at a community ED not long ago and really enjoyed the pacing and atmosphere, but I find myself hesitant to do EM since I get quite queasy with severe traumas. Hopefully I'll get better with exposure, but assuming I don't would this be enough for me to rule out considering EM or the +1?

A lot depends on where you do your residency, how motivated you are, and how you are actively getting the exposure.

E.G. you can be a FM resident based at the JGH in Montreal (a gigantic academic teaching hospital). There is no trauma there at all. Furtheremore, they send CCFP-EM and FRCP emerg residents + a bunch of other specialty residents there. As a FM resident, getting hands on exposure would be a bit hard. Also, you typically don't see as medically and or surgically complex in the average community hospital. Also, you don't see paeds patients at that hospital's ED typically. So no paeds EM exposure.

Another resident can be at a super rural site, where the local ED sees 20k patients per year. They will sure get their hands dirty, but how many big traumas will go through their doors? Not too many. They will be basically doing walk-in clinics there. I'm not sure you will have the skills to function in a big emerg after this type of residency.

In my opinion, for FM residents who want to work in the ED after residency, getting the most emerg exposure would be to be based at a site in between those two extremes. You'd see more cases, sicker patients, including trauma patients and paeds patients, and you can get more hands on experience when it comes to curriculum flexibility, and experience with procedures. There won't be as much of a hierarchy so the procedures are yours.

Obviously, if you do a 5 year program, you would see many traumas as a junior, be actively participating in many as a senior, so you should be fully ready after 5 years.

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1 hour ago, struggling2getin said:

Thanks for the response! What would you say overlaps with EM? Radiology or internal?

Several options:

1. Go into peds and then apply for peds-EM. Generally less trauma in peds but sometimes it can be pretty bad.

2. Anesthesia has a bit of overlap (mostly critical care and airway management) with EM. But you will be asked to manage trauma patients there as well. But there will be surgeon/ED doc usually as well.

3. Internal medicine. But you will have to do critical care rotations where you will be exposed to trauma patients.

4. Family medicine only and working in rural or small town EM (but trauma can show up anywhere). Or doing office practice with urgent care shifts.

5. Family medicine-hospitalist.

Those are some options.

 

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Regarding exposure to trauma medicine. 
 

While training (Med school / residency) I spent time rotating through two different trauma programs. Both included +1 and many other types of residents. I think they spent a single rotation on trauma. Maybe Magneto could elaborate further on this part of the +1 experience? The RCPSC folks in my program did two months minimum. That's what I did. It wasn’t uncommon for people to pick up electives later on in trauma as well. 

Stereotypically trauma tends to be one of the patient populations EM minded people enjoy. Seeing an elegantly run trauma team, is like watching a fine orchestra. Seeing such a team resuscitate a critically injured trauma patient is one of the more striking and impressive things that happen in a hospital. Witnessing such work as an impressionable Med student at Sunnybrook was one of the things that drew me into the speciality.

If you are interested in EM, I strongly recommend trying to get some time on a trauma team. Time well spent. 
 

Also keep in mind there are many avenues into a career that include trauma - anesthesia, surgery, EM. 
 

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On 3/10/2020 at 11:25 PM, magneto said:

Yes. It is possible. You need to tell you program director early in the training.

Did you do the STARS program or know people who have? Is this an emerg/acute medicine rotation (do you stabilize the patient before transfer) or more of a pre-hospital EMS type rotation?

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On 3/22/2020 at 6:51 PM, F508 said:

Did you do the STARS program or know people who have? Is this an emerg/acute medicine rotation (do you stabilize the patient before transfer) or more of a pre-hospital EMS type rotation?

I am in the CCFP-EM program and I did not do the STARS/flight like rotation. I know several people who have done the rotation.

It is an emerg/acute medicine rotation but could be like pre-hospital EMS type rotation. Hard to predict.

Most times patient has been fully stabilized or some-what stabilized by doc where the patient first showed up.

But sometimes docs in rural areas may need STARS/fully ED trained MD help and you stabilize the patient.

Sometimes you go to the scene.

It is a difficult rotation to secure because there is not enough capacity for all learners. There are pre-hospital ED fellows, FR residents etc.

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On 3/22/2020 at 6:53 PM, F508 said:

If you only had 1 elective as a CCFP +1, which rotation would you choose based on most important knowledge to gain / high yield for 2wk-1m rotation ?

Here are some suggestions:

1. ICU (high yield, you learn a lot about physiology, lots of learning and procedure but long hours, busy call, lots of call and very staff dependent rotation).

2. Anesthesia (it never hurts to get more experience with airway management and learn from specialists).

3. Medical toxicology (lots of learning, you get to appreciate pharmacology/toxicology etc.)

4. Stroke neurology

5. Ultrasound focused rotation (getting experience and learning on POCUS)

Don't pick surgical elective. Don't pick cardiology.

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On 3/26/2020 at 10:06 AM, magneto said:

Here are some suggestions:

1. ICU (high yield, you learn a lot about physiology, lots of learning and procedure but long hours, busy call, lots of call and very staff dependent rotation).

2. Anesthesia (it never hurts to get more experience with airway management and learn from specialists).

3. Medical toxicology (lots of learning, you get to appreciate pharmacology/toxicology etc.)

4. Stroke neurology

5. Ultrasound focused rotation (getting experience and learning on POCUS)

Don't pick surgical elective. Don't pick cardiology.

Oh ya? how come no to cardiology?

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Sorry if this question has already been asked but... 

What electives would you recommend to an incoming FM resident interested in applying to the EM +1? Obviously EM electives are important, but any other suggestions? 

Thank you so much for taking the time to help us out!

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7 hours ago, MissRobot said:

Sorry if this question has already been asked but... 

What electives would you recommend to an incoming FM resident interested in applying to the EM +1? Obviously EM electives are important, but any other suggestions? 

Thank you so much for taking the time to help us out!

ICU

Cardiology 

Anesthesia 

Sports Medicine

 

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On 4/6/2020 at 11:30 AM, MissRobot said:

Sorry if this question has already been asked but... 

What electives would you recommend to an incoming FM resident interested in applying to the EM +1? Obviously EM electives are important, but any other suggestions? 

Thank you so much for taking the time to help us out!

Here are some suggestions:

1. Emergency medicine

2. Emergency medicine

3. Emergency medicine

.....

100. Emergency medicine

101. ICU

102. Anesthesiology

 

Unfortunately, most programs won't interview you without an elective.

Even somehow you get an interview, it is rare to be ranked high (there are always exception in case someone mentions an anecdotal story here).

The most important part of the application is reference letters. Applicants who get a great or solid reference letter from one program has a very high chance of securing an interview at that program, (and if no red flags and otherwise solid interview), higher chance of getting placed higher on the ranked list.

It is very competitive. And some great applicants miss out. So try to do as many electives in emergency medicine. Show up prepared and willing to work hard. Keep a positive and sincere attitude. And hope for the best. I hope that helps.

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I wanted to write a small post in this thread regarding emergency medicine.

In general, every single specialty is important and crucial.

This is not a post about how emergency medicine is better than other specialists. IT IS NOT (READ line above).

But the current situation with COVID-19 highlights need for passionate emergency physicians who love to help others.

It is a stressful and challenging time in all parts of medicine. But emergency physicians, nurses, RTs, admin, cleaners, other ED workers etc. are at the front line in this challenging environment.

I am very proud of medicine as a whole.

I think we will continue to need more passionate emergency physicians so if you are on the fence, please ask any question here so that I can persuade you to join the effort.

If emergency medicine is not your gig, that's fine. We need our consultants and family physicians too!!! They back us up and provide support - I cannot do my job without them.

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