Ccfp - Em

[masterb]

Hi,

 

After some exploration and research, I am coming to terms that CCFP-EM is the best route for me. I would like to practice community based emergency medicine in a mid-sized community (population/catchment ~ 100,000-200,000), with a mix of family. Keeping in mind that this is a competitive and risky route, in terms of electives during CCFP residency, what are absolute requirements to demonstrate interest and ability to do well in +1 emerg (tried to search this but had a hard time finding the answer)?

Also, when doing emerg electives during CCFP residency, how many other institutions should one do an elective in? Should they all be in one province or inter-provincial?

 

 

Are there certain CCFP programs that set you well for being competitive when applying for extra EM year? I am not tied to a particular location however, I would like to be in a busy CCFP program - I looked into some rural programs but in all honesty, doing family medicine in a community of 1000-3000 where emerg isn't busy, and family med clinic is low volume isn't appealing to me because I enjoy being busy and putting in a lot of work, don't enjoy being idle when working.

 

Are there any success stories out there for people who actively matched to family medicine as first choice with a desire to match to +1 EM? care to share your story publicly or via PM?

Thanks in advance.

MB

[ratatat]

Good thread. I'd like to know this too.

[Dany]

I am coming to terms that CCFP-EM is the best route for me. I would like to practice community based emergency medicine in a mid-sized community (population/catchment ~ 100,000-200,000), with a mix of family.

 

Hi MB,

If you would like to just practice part-time EM in a mid-sized centre with 100-200k population catchment, a CCFP-EM may not be required.

The fact is that a significant majority who finish the +1 year in CCFP-EM end up doing straight full time EM (for all kinds of reasons).

That being said, i totally understand your career plan. I am personally thinking of doing northern rural medicine (GP+EM) for like 1-2 yrs after my R3 (haven't even started yet), which is more out of financial considerations (remote FM +/- EM is more lucrative than full-time EM in reasonably bigger centres, and there is no such thing as full-time EM in remote small communities - they're all covered by local GPs)

 

Anyhow, best of luck!

[ratatat]

Hi MB,

If you would like to just practice part-time EM in a mid-sized centre with 100-200k population catchment, a CCFP-EM may not be required.

The fact is that a significant majority who finish the +1 year in CCFP-EM end up doing straight full time EM (for all kinds of reasons).

That being said, i totally understand your career plan. I am personally thinking of doing northern rural medicine (GP+EM) for like 1-2 yrs after my R3 (haven't even started yet), which is more out of financial considerations (remote FM +/- EM is more lucrative than full-time EM in reasonably bigger centres, and there is no such thing as full-time EM in remote small communities - they're all covered by local GPs)

 

Anyhow, best of luck!

 

What types of things did you do to make yourself competitive for the PGY3? Did you do all of your electives in Emerg? Did you do them at a wide range of centres?

 

Thanks for your help.

[Jochi1543]

I'm in Chilliwack, BC where we do a lot of extra emerg on top of the regular ER rotation (1 shift per month minimum, and options to pick up many more). Our program is well-known for its ER training, both in terms of grads going onto PGY-3 and in terms of preparing people to work independently in smaller communities without having to get the extra training. Roughly half my year is planning to do an R3 in emerg, and the program is good at making time for you to get in ER electives before the R3 applications open. E.g. we generally don't have any electives in PGY-1, but for all my colleagues who are interested in doing the 3rd year training, our coordinator has rearranged their rotations so they can do at least 1, if not 2 months of electives in PGY-1.

[Dany]

What types of things did you do to make yourself competitive for the PGY3? Did you do all of your electives in Emerg? Did you do them at a wide range of centres?

 

Thanks for your help.

 

What I did was just arranging ALL my pre-CaRMS electives in ER, including two 2-wk blocks in first year, and two 4-wk block at the beginning of R2 (remember to ask your program to arrange your electives in R2 before the CaRMS time, i.e. before Sep-Oct of your R2 year).

My first-year electives were done at my site, the R2 year I did one block in the same city where my university's R3 program is located, then one block in another R3 program center out of province.

 

I think i mentioned before on this forum but I really don't consider myself a strong candidate. I tried really really hard, but the vast majority of my residency ITARs (incl Emerg) are just "meets expectations" - which I know (though my FM program director denies) essentially means "too average means below average". Also I am not the chief resident, nor do I have any related research experience.

 

The CaRMS process was quite unfavourable with few interview invitations, just as I feared. I was really devastated at that time but still decided to give it a shot, flying across Canada to chase the slim hope that only exists in theories. Anyhow there were lots of ups and downs during the last two months of 2013, and I still got no clue how the heck I ended up in one of the programs.

 

Bottom line is I did try hard, and the result was all good, but I don't think that was directly causative. I feel like a hunter aiming an umbrella at a lion and pull the trigger, then the lion is shot dead. Yes I did pull the trigger yes the lion is shot dead, but I'm not sure that it was my bullet.

 

sorry if it's not very cheerful

[ratatat]

What I did was just arranging ALL my pre-CaRMS electives in ER, including two 2-wk blocks in first year, and two 4-wk block at the beginning of R2 (remember to ask your program to arrange your electives in R2 before the CaRMS time, i.e. before Sep-Oct of your R2 year).

My first-year electives were done at my site, the R2 year I did one block in the same city where my university's R3 program is located, then one block in another R3 program center out of province.

 

I think i mentioned before on this forum but I really don't consider myself a strong candidate. I tried really really hard, but the vast majority of my residency ITARs (incl Emerg) are just "meets expectations" - which I know (though my FM program director denies) essentially means "too average means below average". Also I am not the chief resident, nor do I have any related research experience.

 

The CaRMS process was quite unfavourable with few interview invitations, just as I feared. I was really devastated at that time but still decided to give it a shot, flying across Canada to chase the slim hope that only exists in theories. Anyhow there were lots of ups and downs during the last two months of 2013, and I still got no clue how the heck I ended up in one of the programs.

 

Bottom line is I did try hard, and the result was all good, but I don't think that was directly causative. I feel like a hunter aiming an umbrella at a lion and pull the trigger, then the lion is shot dead. Yes I did pull the trigger yes the lion is shot dead, but I'm not sure that it was my bullet.

 

sorry if it's not very cheerful

 

Thank you Dany. I'll most definitely try to arrange electives early in second year. Also, congratulations!

[DuckieLoon]

Agree with above. I'm not applying to CCFP-EM, but for CARMS matching to larger centres, i hear that electives in ER, peds ER, and an elective in ICU/anesthesia are looked upon favorably (e.g., especially for procedural skills such as starting intubations, fem/central lines, etc). Obviously, having your ATLS, NRP, PALS courses under your belt before carms also shows commitment I think.

 

Above all, I think having Evals that emphasize team player, genuine, great to work with, etc goes a long way for matching into R3. Looking around, I haven't met an FM-EM R3 who isn't fantastic to work with, collegial and who enjoys teaching. Emulate the behaviours of those who have been successful before you, right?

[ER scrub]

Agree with above. I'm not applying to CCFP-EM, but for CARMS matching to larger centres, i hear that electives in ER, peds ER, and an elective in ICU/anesthesia are looked upon favorably (e.g., especially for procedural skills such as starting intubations, fem/central lines, etc). Obviously, having your ATLS, NRP, PALS courses under your belt before carms also shows commitment I think.

 

Above all, I think having Evals that emphasize team player, genuine, great to work with, etc goes a long way for matching into R3. Looking around, I haven't met an FM-EM R3 who isn't fantastic to work with, collegial and who enjoys teaching. Emulate the behaviours of those who have been successful before you, right?

 

Good post but I wonder about the value of sacrificing an emerg elective to get anesthesia in (unless you can somehow do it post carms). Frankly I think it's something that will make you better without a doubt, but in order to show commitment to programs other than your home school, I would think the emerg elective would give you a better shot at matching. It's just so tough with minimal elective time. It goes back to the issue with the carms system.

 

On a side note, I haven't heard one person talk favourably about the PALS course in terms of using it's teachings early on in residency, but would it look good on the CV? Definitely wouldn't hurt (and if your at a school that is generous with reimbursement then its a no brainer).

[Knovecc]

just a checklist of all the resuscitation courses/trainings I could think of, which could show your commitment in EM (*=mandatory to most FM programs)

 

ACLS*

ACLS instructor

NRP*

ALSO*

ATLS (not mandatory but practically is)

PALS

EDE-1

EDE-2 (that's quite high-end)

NEAMC

Wilderness Medicine Course

CARE-RR

 

ppl are welcome to add to this by far non-exhaustive list

[masterb]

Hi All,

Thanks for the responses. With regards to the different courses, is there time to complete them during PGY1 and do most programs fund the courses or do you fund them out of pocket or via what ever education allowance is provided to each resident.

[BoyInTheBubble]

I would not do most of those courses during residency. Yes, some are arranged by your program or mandatory (ACLS, NRP), but many PGY3-EM courses teach those. Or pay for them.

 

*ATLS is not usually mandatory in family med, but is usually mandatory prior to start the pgy3 program. I would recommend doing this.

 

I would go through the CaRMS files of schools you are interested in, and see what they provide. No point in paying thousands of dollars when the program teaches you the ultrasound and airway skills, or pays for you to do PALS.

 

An alternative thought would be, is paying that money for the course worthwhile to demonstrate your interest on your cv? doubt it.

 

Another alternative is that if you don't match, you then do all those courses. You can self-teach the whole pgy3 year it's just more challenging.

[ER scrub]

I would not do most of those courses during residency. Yes, some are arranged by your program or mandatory (ACLS, NRP), but many PGY3-EM courses teach those. Or pay for them.

 

*ATLS is not usually mandatory in family med, but is usually mandatory prior to start the pgy3 program. I would recommend doing this.

 

I would go through the CaRMS files of schools you are interested in, and see what they provide. No point in paying thousands of dollars when the program teaches you the ultrasound and airway skills, or pays for you to do PALS.

 

An alternative thought would be, is paying that money for the course worthwhile to demonstrate your interest on your cv? doubt it.

 

Another alternative is that if you don't match, you then do all those courses. You can self-teach the whole pgy3 year it's just more challenging.

 

Is it really mandatory prior to PGY3 - I thought that if you matched, then you would do it at the start of the program and the fees (approx $1200) would be covered. But yeah I agree that over half of those courses are not needed and if anything, if you actually attempted to do them all, I'd think you'd be a worse candidate than someone who was able to spend that time actually on shift, reading around actual cases, getting to know people, rather than expanding the CV. But it is carms afterall....there's probably a PD somewhere out there who digs that stuff.

[Dany]

But it is carms afterall....there's probably a PD somewhere out there who digs that stuff.

 

During my CaRMS interview tour, one of the PDs asked me what courses I took. I told him that it's on my CV, then he leaned towards my CV on the desk and started counting... quite hilarious

 

The attitude of "none of those non-mandatory courses is necessary as I'll learn them all in PGY-3 for free" is sort of like "none of the elective EM electives is necessary as I'll get plenty of EM exposure in PGY-3" - it makes sense theoretically, but practically it will make your way harder getting the R3 year.

[ER scrub]

"way harder" - really? not doing ATLS matters that much? just curious bc I know more EMs who didn't have ATLS pre PGY3 than those who did.

 

I also think electives are significantly different than doing a course - and as far as electives go, every single EM doc has told me they are crucial, and this makes obvious sense. However if your a FM resident at a non trauma centre who won't see much trauma at all in the first two years, I doubt ATLS will make you materially more competitive (i.e it was obvious the PD in your example didn't even know you had taken courses, and you likely got the interview based on being a strong candidate)

 

anyway, just my two cents

[BoyInTheBubble]

Stop making assumptions about things you read and hear from people. Take some responsibility for yourself. Go online to CaRMS and read all of the program descriptions you are interested in and see for yourself.  Or go to the program's actual website.

 

Think about it this way, if half the schools require it then you are worsening your own chances by not having it. Half the schools will think you haven't been dedicated enough to complete the requirements in 2 years.  

 

The PGY3 year is busier than the family medicine year. Anyone can sit through ATLS and complete the requirements. If you're aiming for the minimum, don't do the extra year. If you want to get really good at managing trauma and other emergencies, it's very helpful to start the extra year of training with a good set of basic EM knowledge. You want to go above and beyond the basic cases that get presented in courses like ACLS and ATLS. The courses provide the framework but not the details of what to do when a real person comes in that has other problems that weren't mentioned in the book...

 

That being said, you can learn ATLS and everything else for free and be just as prepared.  But it's harder to demonstrate that on your CV!

[ER scrub]

Is your post directed at me? You realize I wasn't asking any questions and I'm well aware of requirements.

 

Also, to clarify, there is not a single program I know of that requires you to have ATLS prior to the pgy3 year.

 

Other than that opinions are opinions.

[BoyInTheBubble]

Is your post directed at me? You realize I wasn't asking any questions and I'm well aware of requirements.

 

Also, to clarify, there is not a single program I know of that requires you to have ATLS prior to the pgy3 year.

 

Other than that opinions are opinions.

queen's, western, calgary, probably others

[Dany]

"way harder" - really? not doing ATLS matters that much? just curious bc I know more EMs who didn't have ATLS pre PGY3 than those who did.

 

I am not talking about one course specifically that matters much, I am just talking about the attitude/mindset aforementioned aka "I'll get it later in R3"

No you don't absolutely need ATLS to get an R3, not at all.

From this document, 5.6% of applicants didn't even do EM electives - and with a little calculation, you can tell that 60% of them did get matched to R3. That being said, I'd prefer to be on the 94.4% side.