Emergency MedicineEmergency MedicineAn evolving specialtyAn evolving specialty

OutlineOutline Presenters Presenters Profile of the typical Emerg doc Profile of the typical Emerg doc A typical day in the EDA typical day in the ED Why EM / Why not?Why EM / Why not? Evolution of EM in North AmericaEvolution of EM in North America Emergency care in CanadaEmergency care in Canada Routes of trainingRoutes of training How to navigate through CaRMSHow to navigate through CaRMS

The Typical Emerg The Typical Emerg Doc: QuizDoc: Quiz Songs on IPOD at gymSongs on IPOD at gym Favourite kind of musicFavourite kind of music Favourite AM drink after night shiftFavourite AM drink after night shift Most common excuse for missing Most common excuse for missing

meetingsmeetings Attention span-long vs shortAttention span-long vs short # of near death experiences per # of near death experiences per

weekweek

Who am I?Who am I?

GORDON RAYMOND GORDON RAYMOND JONESJONES

ER DOCS: who are ER DOCS: who are they?they? Varied personalityVaried personality Big picture Big picture MultitaskingMultitasking Less detailLess detail Sense of humorSense of humor Like peopleLike people CompassionateCompassionate Hands onHands on

Unpredictable life Unpredictable life stylestyle

Unpredictable Unpredictable work environmentwork environment

Thick skinThick skin Broad clinical Broad clinical

knowledgeknowledge The “surfer dudes” The “surfer dudes”

of Medicineof Medicine

Types of patient seen Types of patient seen in ED anywhere: in ED anywhere: Sick pts with complex underlying Sick pts with complex underlying

diseasedisease Trauma minor-seriousTrauma minor-serious 20-30% peds, infectious and trauma20-30% peds, infectious and trauma 10% psych/social10% psych/social 1% critical care1% critical care 10% life threatening10% life threatening

Emerg MDs skill set:Emerg MDs skill set: Procedural skillsProcedural skills Procedural sedationProcedural sedation Resuscitation/trauma/violenceResuscitation/trauma/violence ToxicologyToxicology Environmental emergenciesEnvironmental emergencies ReassuranceReassurance Consultation/ Gate keeperConsultation/ Gate keeper

Skill set continuedSkill set continued Primary care providers to 30%Primary care providers to 30% Expert at dealing with Expert at dealing with

undifferentiated ptsundifferentiated pts Disaster medicineDisaster medicine Safety net to the poorSafety net to the poor

Post residency Post residency fellowshipsfellowships TraumaTrauma ToxicologyToxicology Critical careCritical care International healthInternational health ForensicsForensics Peds emergPeds emerg Medical educationMedical education UltrasoundUltrasound

Critical careCritical care Simulator medicineSimulator medicine Environmental Environmental

medicinemedicine ResearchResearch AdministrationAdministration Sports medicineSports medicine EMS/Disaster MedEMS/Disaster Med

Evolution of Evolution of Emergency CareEmergency Care Emerg depts 60s -70s staffed by:Emerg depts 60s -70s staffed by:

All members of medical staffAll members of medical staff Moonlightng residentsMoonlightng residents Immigrant MDs who could not work Immigrant MDs who could not work

elsewhereelsewhere

Evolution of EMS, residency programsEvolution of EMS, residency programs

Emergency/Emergency/unscheduled care in unscheduled care in CanadaCanada Primary care office settingPrimary care office setting Walk in clinicsWalk in clinics Urgent Care centersUrgent Care centers Hospitals:Hospitals:

Small, medium and large community Small, medium and large community hospitalshospitals

Tertiary Care CentersTertiary Care Centers Quaternary care centersQuaternary care centers

Family MDs provide Family MDs provide the majority of E.D. the majority of E.D. carecare 20-30 FRCP graduates per year 20-30 FRCP graduates per year 100- CCFP-EM graduates per year100- CCFP-EM graduates per year About 100 FPs per year take CCFP About 100 FPs per year take CCFP

EM special competency examEM special competency exam Hundreds of CCFP grads per yearHundreds of CCFP grads per year Many MDs with 1 yr internship do Many MDs with 1 yr internship do

EMEM

FRCP programFRCP program 5 years5 years Started mid 1980sStarted mid 1980s Most grads in urban tertiary care Most grads in urban tertiary care Leadership roles-teaching, admin, Leadership roles-teaching, admin,

subspecialtysubspecialty 1 year of program: fellowship 1 year of program: fellowship

interestinterest

FRCP PGY 1FRCP PGY 1 Internal medicine 2 moInternal medicine 2 mo Gen Surg 2 moGen Surg 2 mo Peds 1 moPeds 1 mo Peds EM 1 moPeds EM 1 mo Psych 1 moPsych 1 mo OBGYN 1 moOBGYN 1 mo Emerg 4 moEmerg 4 mo

FRCP PGY 2FRCP PGY 2 Neurosurg 1 moNeurosurg 1 mo Plastics 1 moPlastics 1 mo Ortho 2 moOrtho 2 mo Anaesthesia 2moAnaesthesia 2mo ICU 2moICU 2mo Emerg 4 moEmerg 4 mo

FRCP PGY 3FRCP PGY 3 Cardiology 2 moCardiology 2 mo Peds EM 2 moPeds EM 2 mo Emerg 8 moEmerg 8 mo

FRCP PGY 4FRCP PGY 4 Toxicology 2 moToxicology 2 mo Administration 1 moAdministration 1 mo Emerg/elective 9 moEmerg/elective 9 mo

FRCP PGY 5FRCP PGY 5 Emerg/elective Emerg/elective Exam prep--consequencesExam prep--consequences

CaRMSCaRMS Canadian programs-25 + spotsCanadian programs-25 + spots Queens 50-60 applicants per yearQueens 50-60 applicants per year Interview-(1 day)-20-25 Interview-(1 day)-20-25

candidatescandidates

We look forWe look for Career interest in EMCareer interest in EM Well rounded teachableWell rounded teachable Some emerg electivesSome emerg electives Emerg referencesEmerg references Research + or –Research + or –

5 year program: Pros5 year program: Pros Clinical comfort at graduationClinical comfort at graduation Expertise/egoExpertise/ego Fellowship opportunitiesFellowship opportunities Leadership in EM opportunitiesLeadership in EM opportunities Less burnoutLess burnout Academic centersAcademic centers

5 yr Program cons5 yr Program cons 5 years is a long time5 years is a long time Limited to larger center practiceLimited to larger center practice Not financially better Not financially better Exam hard-cant work until you Exam hard-cant work until you

passpass Competitive entry processCompetitive entry process