Emergency Medicine

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Emergency Medicine

• An evolving specialty

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Outline

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

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The Typical Emerg Doc Quiz

• Songs on IPOD at gym
• Favourite kind of music
• Favourite AM drink after night shift
• Most common excuse for missing meetings
• Attention span-long vs short
• of near death experiences per week

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Who am I?
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GORDON RAYMOND JONES
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ER DOCS who are they?

• Varied personality
• Big picture
• Multitasking
• Less detail
• Sense of humor
• Like people
• Compassionate
• Hands on

• Unpredictable life style
• Unpredictable work environment
• Thick skin
• Broad clinical knowledge
• The surfer dudes of Medicine

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Types of patient seen in ED anywhere

• Sick pts with complex underlying disease
• Trauma minor-serious
• 20-30 peds, infectious and trauma
• 10 psych/social
• 1 critical care
• 10 life threatening

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Emerg MDs skill set

• Procedural skills
• Procedural sedation
• Resuscitation/trauma/violence
• Toxicology
• Environmental emergencies
• Reassurance
• Consultation/ Gate keeper

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Skill set continued

• Primary care providers to 30
• Expert at dealing with undifferentiated pts
• Disaster medicine
• Safety net to the poor

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Post residency fellowships

• Trauma
• Toxicology
• Critical care
• International health
• Forensics
• Peds emerg
• Medical education
• Ultrasound

• Critical care
• Simulator medicine
• Environmental medicine
• Research
• Administration
• Sports medicine
• EMS/Disaster Med

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Evolution of Emergency Care

• Emerg depts 60s -70s staffed by
• All members of medical staff
• Moonlightng residents
• Immigrant MDs who could not work elsewhere
• Evolution of EMS, residency programs

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Emergency/unscheduled care in Canada

• Primary care office setting
• Walk in clinics
• Urgent Care centers
• Hospitals
• Small, medium and large community hospitals
• Tertiary Care Centers
• Quaternary care centers

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Family MDs provide the majority of E.D. care

• 20-30 FRCP graduates per year
• 100- CCFP-EM graduates per year
• About 100 FPs per year take CCFP EM special
  competency exam
• Hundreds of CCFP grads per year
• Many MDs with 1 yr internship do EM

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FRCP program

• 5 years
• Started mid 1980s
• Most grads in urban tertiary care
• Leadership roles-teaching, admin, subspecialty
• 1 year of program fellowship interest

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FRCP PGY 1

• Internal medicine 2 mo
• Gen Surg 2 mo
• Peds 1 mo
• Peds EM 1 mo
• Psych 1 mo
• OBGYN 1 mo
• Emerg 4 mo

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FRCP PGY 2

• Neurosurg 1 mo
• Plastics 1 mo
• Ortho 2 mo
• Anaesthesia 2mo
• ICU 2mo
• Emerg 4 mo

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FRCP PGY 3

• Cardiology 2 mo
• Peds EM 2 mo
• Emerg 8 mo

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FRCP PGY 4

• Toxicology 2 mo
• Administration 1 mo
• Emerg/elective 9 mo

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FRCP PGY 5

• Emerg/elective
• Exam prep--consequences

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CaRMS

• Canadian programs-25 spots
• Queens 50-60 applicants per year
• Interview-(1 day)-20-25 candidates

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We look for

• Career interest in EM
• Well rounded teachable
• Some emerg electives
• Emerg references
• Research or

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5 year program Pros

• Clinical comfort at graduation
• Expertise/ego
• Fellowship opportunities
• Leadership in EM opportunities
• Less burnout
• Academic centers

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5 yr Program cons

• 5 years is a long time
• Limited to larger center practice
• Not financially better
• Exam hard-cant work until you pass
• Competitive entry process