IM vs EM?

[thebouque]

Perhaps once upon a time we considered both of these options, and perhaps once upon a time we talked to people who have a strong and valid opinion about this. Furthermore, Just because you aren't in either program doesn't mean your opinion is less valid.

 

It's inappropriate for you to say that 2+1 and 5 year ER are equal on all fronts on these forums because this is a question that's highly debated and a lot of med students come here for answers. I myself was one of them, and I had to go out and seek the answers myself from truly knowledgeable people, which is what I'm bringing back my post saying that from the get-go 5 year has a clinical edge + fellowship and job prospect advantages over a 2+1 but these even out over the years as clinical experience is gained.

 

yeah sure indeed

[AdamP]

hello professors

 

op, i was the same way as a preclerk, the way i decided was to do both in clerkship and think about what i liked better. (IM)

 

it may be helpful if you're planning to do research to do ER stuff as the 5 year program is significantly more competitive than IM

 

cheers boss.

[rogerroger]

Firstly, let me declare my unavoidable FRCPC bias.

 

The CCFP vs FRCPC "debate" is a political hot potato. The best way to understand any cultural or practice differences between the two is to shadow several different EM docs from both streams. I know, easier said than done, and you probably won't notice huge differences. What a future EM resident may find more interesting and valuable is to spend time in an urban academic ER and then go to a very rural ER. Compare these experiences, there will be differences. As a FRCPC emerg doc you will more likley be geared toward the urban practice setting. As a CCFP emerg doc you will be more likley to work in the rural or non-university ED setting. Yes, I know there are exceptions. I'm talking averages here.

 

Realistically, practice differences are trivial. I probably could not reliably guess which staff were CCFP or FRCPC trained despite working with them everyday at an academic center. If you look at data you will find that CCFP and FRCPC docs both admit at about the same rates. Junior staff admit acute patients less, senior staff admit more, regardless of training. You will also find that many from both streams are involved in research and/or medical education if they are at an academic center.

 

As a resident I can comment on residency training differences. These differences are unavoidable. The FRCPC guys need to fill those extra years with something...

 

From a residency standpoint a lot of the curricula is the same. The specialty is the same, so this should not be surprising. But you can get a sense of the difference in training by skimming the two respective textbooks used in these programs. CCFP uses Tintinalli. In my opinion Tintinalli is a great and concise book. It is 1700 pages long. I use it very often. The FRCPC programs use Rosen as their examinable text. Rosen's is a beast weighing in at 2800 pages. In many ways I prefer Tintinalli. However, something fills those extra 1100 pages. The FRCPC curricula tends to focus way more on pathophysiology and underlying theory behind treatment and diagnostics. To put it simply, Tints will tell you how to recognize and treat a condition. To do your job. Rosen's will tell you why you recognize it and why your treatment works in meticulous detail. I suspect this difference often has little practical translation into practice. Yet, as a resident this cultural difference is always somewhat palpable beneath the surface. As residents and trainees you discuss the same topics in a slightly different way from a slightly different angle. I notice this more when talking with fellow residents. When it happens it is kinda neat from a novelty perspective. Regardless of what has been said on this forum I don't think any of us EM residents view the other stream as inferior.

 

The FRCPC programs have major research cirricula built into them. You are gonna do some real academic lifting in the five year program. Completing publishable quality academic work is a Royal College expectation. Interestingly, data shows that residents on average (not EM specific) tend to lose interest in research during residency. But like it or not, you are doing it in the five year program. It is not uncommon for residents to be juggling two different projects simultaneously as junior residents in my 5 year program. The degree of how much academia is emphasized probably varies between individual programs. But if you hate research you will probably find this aspect of the FRCPC stream uber annoying. Regularly scheduled research meetings are just a fact of life in the longer stream.

 

FRCPC and CCFP exams are slightly different. Word on the street is that the CCFP exam focuses more on HPI and exam features. FRCPC focuses more on diagnostics and management. Again, these are style differences. There are a few examinable procedures which are included in the FRCPC stream which are not in CCFP stream. These "special" procedures are uncommon to do in practice. The FRCPC training may also expect you to know a couple more ways of doing the same thing...

 

Another training difference I have noted is the emphasis on department management. I don't yet have personal experience in this regards as this is something which seems more regulated to the R4-5 years. However, it appears as though the FRCPC senior residents receive some substantial training on department flow and management. I'm sure this background is useful as a junior staff. Department management is a very important part of EM. However, I'm pretty sure that with experience you figure this out regardless of training stream.

 

Then we come to jobs. Sure, CCFP docs work in the urban ERs. However, in my opinion, based on speaking with freshly minted FRCPC and CCFP staff, those urban ED jobs are getting harder to find. Don't get me wrong, EM is still a pretty sweet gig from a job standpoint. But looking at the trend, FRCPC residency spots have gone up over the last several years. The places that will get crunched first for available spots are the urban academic EDs. The FRCPC trained will probably have a leg up in the job market. They are, after all, trained specifically for those academic ED's. Working in these academic centers is a reason why the FRCPC stream can justify its existence. In fact, some FRCPC residents wounder if there will be those much sought after academic jobs readily available for them post-residency let alone those from the CCFP stream. The academic positions might get pretty tight for the CCFPs 3-5 years down the road. A lot of this is rumor, but it makes sense to me. If anyone has any hard data in this regards I would be curious to see it.

 

Overall, the two streams offer unique paths to becoming an emerg doc. But both are fine. I actually think both cultures offer each other a lot, Canada is fortunate to have the two streams. If you care about being a good emerg doc you will get there regardless of which program trains you. The choice is mostly a matter of personal preference. But still, it is a big decision and should be talked about more. If you are set on EM it is ultimately a decision which will influence 3-5 years or your post-med school life in a major way as a resident and maybe beyond when considering job prospects..

[rogerroger]

Well you raise a few points there.

 

I think if you are academia geared you would probably enjoy the FRCPC stream. It is not unheard of to complete CCFP-EM training and then enter into a FRCPC program. Some people decide on this part of their careers later on. Regarding the theoretical focus on EM knowledge, many CCFP staff at an academic center seem to have obtained this background on their own over the years. If we view the FRCPC stream in a lighthearted way you could say it is the spoon fed "remedial" EM program.

 

I also think we are products of our environment to a degree. In my opinion residency training may shape ones interests more strongly than we appreciate. What you "like" is probably highly influenced by the training style you are exposed too.

[Lactic Folly]

Junior staff admit acute patients less, senior staff admit more, regardless of training.

Is this meant as written? Can you elaborate on the reason? I'm curious.

[Byrne]

Is this meant as written? Can you elaborate on the reason? I'm curious.

 

Have heard this quoted previously, but cannot recall the study. I think one of the explanations the authors came up with was that perhaps senior staff became more conservative after being burned by a miss earlier in their careers.

[rogerroger]

Is this meant as written? Can you elaborate on the reason? I'm curious.

 

http://www.ncbi.nlm.nih.gov/pubmed/19272216

 

For those who are really interested, we are talking specifically about CTAS 2 admission rates.

[Lactic Folly]

Thanks for the link. It's interesting because the common perception (rightly or wrongly) is that junior staff have a lower threshold for obtaining additional imaging on their patients.