Programs with wilderness med focus

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Rockhouse

Rockhouse

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Hey all,

working on long lists for residencies, just trying to get any idea on which programs have some focus on wilderness medicine. I tried to search for it already and couldn't find anything, so a link or something similar would be great as well. Thanks,
 
Any EM program will have elective time in which you can do WM if you so chose. I would be suspicious of those with a focus in it since the challenges of a career in EM are going to be dealing with the critically ill elderly and not the snakebit young.
 
AmoryBlaine said:
Any EM program will have elective time in which you can do WM if you so chose. I would be suspicious of those with a focus in it since the challenges of a career in EM are going to be dealing with the critically ill elderly and not the snakebit young.
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I almost posted the link to your classic thread on "International Emergency Medicine," but thought better of it...
 
WilcoWorld said:
UNM (http://hsc.unm.edu/emermed/W_Med/WildernessMedicine.shtml)
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I don't know about the rest of the program, but I spent a 4th year elective on UNMs Wilderness Med rotation and it was the best month of my Medical school experience. Dr Macias, Dr Alcock and the rest of the staff make it a damn fun and learning month. They also do a lot of High altitude medicine as well as disaster and international medicine courses as well.
 
AmoryBlaine said:
Any EM program will have elective time in which you can do WM if you so chose. I would be suspicious of those with a focus in it since the challenges of a career in EM are going to be dealing with the critically ill elderly and not the snakebit young.
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... and yet, there are the few that do make a career out of wilderness medicine, international health, etc... one prime example would be Luanne Freer who runs the everest base camp clinic during the summer climbing season, and I believe does clinical work at Yosemite the rest of the year.
http://www.himalayanrescue.org/hra/article.php?sno=20

I'm not disagreeing that *most* US EM physicians will, for most of their careers, be dealing with the "septic elderly", but if you want to, you can certainly make yourself an exception. A key to this would certainly to position yourself appropriately - ie, publish in the area, do a fellowship, have great mentors who share your interests and have contacts, etc. So asking about these things for residency (while not the most important thing), does make sense.

As for other programs with a wilderness EM focus: I know that Cornell/Columbia runs a semi-annual wilderness medicine elective for students and residents, and they get pretty involved in it (but yes, it's in NYC, so not as much wilderness as other places... but they spend at least a week each time in the Adirondacks or Utah, Arizona, etc.)
 
quideam said:
... and yet, there are the few that do make a career out of wilderness medicine, international health, etc... one prime example would be Luanne Freer who runs the everest base camp clinic during the summer climbing season, and I believe does clinical work at Yosemite the rest of the year.
http://www.himalayanrescue.org/hra/article.php?sno=20

I'm not disagreeing that *most* US EM physicians will, for most of their careers, be dealing with the "septic elderly", but if you want to, you can certainly make yourself an exception. A key to this would certainly to position yourself appropriately - ie, publish in the area, do a fellowship, have great mentors who share your interests and have contacts, etc. So asking about these things for residency (while not the most important thing), does make sense.

As for other programs with a wilderness EM focus: I know that Cornell/Columbia runs a semi-annual wilderness medicine elective for students and residents, and they get pretty involved in it (but yes, it's in NYC, so not as much wilderness as other places... but they spend at least a week each time in the Adirondacks or Utah, Arizona, etc.)
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And I'm not suggesting it's not worth any consideration, just that when you are looking for a residency you should look for one that is focused on preparing you for 99.9% of the jobs in a particular field. Especially since alot can happen during residency (marriage, kids, debt) that can get in the way of that dream job getting paid $250k to run the base camp at K2.

Once you have trained and have a marketable skill (like working in an emergency room) you can basically establish your hobbies in any way you see fit.
 
AmoryBlaine said:
And I'm not suggesting it's not worth any consideration, just that when you are looking for a residency you should look for one that is focused on preparing you for 99.9% of the jobs in a particular field. Especially since alot can happen during residency (marriage, kids, debt) that can get in the way of that dream job getting paid $250k to run the base camp at K2.

Once you have trained and have a marketable skill (like working in an emergency room) you can basically establish your hobbies in any way you see fit.
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All true. But I think everyone would agree that the vast majority of EM programs out there do a great job preparing their residents for jobs afterwords, whether they be in academics or in the community. So if almost all programs meet that requirement, then the difference becomes things like location, emphasis on certain aspects of EM - many international opportunities, excellent ultrasound program, lots of toxicology, or whatever. So I think that, once you have a list of otherwise great programs, trying to parse things down by looking at how well their "extra" offerings match your interests is extremely important. I don't think there's any program out there that would do a great job of preparing you to work in Nepal but not in suburbia. On the other hand, there are plenty of residencies that produce great community docs that have very little exposure to international EM, so by the time you finish you may not be in a position to plug yourself in to something you would have otherwise loved to do. Being exposed to these different opportunities is important for both figuring out what you want to do and giving you the connections and tools to help you do it.
 
Oh, and Freer doesn't get paid $250K to run the base camp clinic!! I don't think she gets paid anything at all for that, actually. She does get to be an expedition doc these days though...
 
quideam said:
All true. But I think everyone would agree that the vast majority of EM programs out there do a great job preparing their residents for jobs afterwords, whether they be in academics or in the community. So if almost all programs meet that requirement, then the difference becomes things like location, emphasis on certain aspects of EM - many international opportunities, excellent ultrasound program, lots of toxicology, or whatever. So I think that, once you have a list of otherwise great programs, trying to parse things down by looking at how well their "extra" offerings match your interests is extremely important. I don't think there's any program out there that would do a great job of preparing you to work in Nepal but not in suburbia. On the other hand, there are plenty of residencies that produce great community docs that have very little exposure to international EM, so by the time you finish you may not be in a position to plug yourself in to something you would have otherwise loved to do. Being exposed to these different opportunities is important for both figuring out what you want to do and giving you the connections and tools to help you do it.
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Tempting, but I'll pass. 😀

I actually disagree quite strongly (and respectfully). I think coming at emergency med programs with the opinion that they are all basically equal and that you should sort them out based on things like their focus on international emergency medicine is not a mature approach. This is not trying to reopen the "best program debate" in any way.

I think students going into internal medicine are on average far better at evaluating residency programs. They tend to focus on specifics of workflow (how many call months, is there a nightfloat, what is the role of the senior resident), opportunities for mentorship (figuring out who is who and in what field), and specifics of realistic career goals (how successful is the cardiology/GI/Onc match?).

In EM students tend to be far more interested in things that are related to a tiny subset of patients (who manages the airway in trauma?), related to elective time (are their rotations where I can take my digital camera?), and sometimes things that are completely and totally inconsequential (is the patient population legit enough?).

Bring it!
 
Haha, I guess I have to disagree with you again 🙂

I never said that "all programs are basically equal" - there is obviously a lot of variety, and that's what makes the decision so difficult. What I said is that most programs will train you to be a great EM physician who can graduate, pass the boards, and get a good job. And I think that's absolutely true. So, knowing that, what else is there? And that's where the more personal considerations come up - such as, yes, what the population is like (insured/uninsured), who runs traumas, number of elective months, etc.

Btw, as a quick aside - I do think that very "specific" questions such as who manages the airway, which agents you can use for procedural sedation, etc., are critical. Not because the ability to, say, use propofol is the cornerstone of EM - obviously not. But by asking these sorts of questions, you get an idea for how much autonomy residents have and how much respect and independence the department has. If traumas are shared, airway is shared, procedural sedation agents are limited, many ultrasounds have to be done "formally", etc., then I get the sense that the EM department isn't as strong in the hospital. On the other hand, departments where EM basically runs everything seem to be far stronger - and, to me personally - this is incredibely important. Do these things matter for the vast majority of community practices that EM graduates end up joining? Probably not. But it's very important to me and my objectives, so I ask.

As far as the factors you brought up that you say IM people are better at discerning - I think those kind of questions are also things we ask. Who doesn't ask about number and length of shifts, number and quality of off-service rotations, leaders in your field (which, by the way, also applies to the original concern of having people interested in wilderness medicine), etc. They are all factors. But does picking a program because it has 8's instead of 10's or does 18 shifts a month instead of 19 make any more sense than picking a program because the toxicology program is particularly strong, or because there are many affiliations with international sites? I think they are all valid factors and it's up to the individual to decide which things matter more.
 
I agree with Amory. So little of ER is wilderness medicine that it makes no sense whatsoever to waste precious elective time playing doctor in the wilderness.

Really, if you are going into the wilderness, you should be safe. You shouldn't need doctors there. If you want to climb K2, you'd darn well know a lot more about high-altitude physiology than some city-slicker resident that wishes they could get paid $300,000 a year to climb mountains rather than slave away in an ER.

I know I'm simplifying the issue, but the idea of a "wilderness medicine doctor" is kind of ludicrous to me. If it is an issue caused by the wilderness, it is either trauma, hypothermia, hyperthermia, high-altitude sickness, or snake-bite. Learn those issues, and you don't need a month in a "wilderness medicine course".

Accidents on scene in the wilderness occur at such low frequency that being in the wilderness is unlikely to be very educational.

I listened to a New Mexico Resident give a presentation on his experience in a ski area in Alaska. In one month, they took care of one guy who got high-altitude sickness, and the rest was sun-burns and pictures of him skiing (which he could have done just as easily 40 minutes from his home ER). It was a month long vacation for the guy. Fascinating, fun, but come on, not really contributory to your education.

I listened to a fellow resident give a presentation on his "medical expedition" to K2. Same thing, except without any transports. They handed out blistex and sunscreen to Shirpas for a month (I'm not making this up).

If you like the wilderness, take a vacation and visit it. The only use for a "wilderness medicine doctor" is to publish papers and teach wilderness medicine courses.
 
Jarabacoa said:
I agree with Amory. So little of ER is wilderness medicine that it makes no sense whatsoever to waste precious elective time playing doctor in the wilderness.
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I'm training in Utah partially because it's the sort of environment in which I want to spend the rest of my career. We offer a wilderness medicine fellowship at this program. Many people who choose to do a WM fellowship do so to supplement their education. Often, you gain more "hire-ability" if you have something to contribute to the practice you join. In parts of the country like this, that's no small matter. We treat cases like trench foot, high altitude sickness, frostbite, heatstoke, the aftermath of animal encounters, avalanche victims, and partake in evacuations and field stabilizations every day. We also send members into community to educate the public on safe practices in our endless backyard playground.

Yes, you can probably bone up on wilderness medical issues enough during just your residency. But still, I have to wonder-- if someone truly loves wilderness medicine, and it's what they want to do with their lives, why **** on it? What is it to all you nay-sayers, anyway?
 
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Because you can't "do Wilderness Medicine". That job doesn't exist, at least, not in the traditional, I'm going to get paid for the effort I put into it kind of job.

I work at an ER that is at 7,100 feet. Nearby peaks are 12,000 feet tall. In the winter, it can reach well below 0 farenheit at night, and I don't see "Wilderness Medicine Patients" on a daily, or even monthly basis.

The closest thing I've seen in my long career of 7 months as an attending here is an old lady that wandered outside her nursing home and froze to death in the snowbank.

What does the Wilderness Medicine Fellowship there in Utah consist of? I was a med student on some away rotations there, and spent a few days at a clinic by the ski slopes. I was on an orthopedic rotation, and it was a great fracture, dislocation, torn ACL clinic, but it could in no way be construed as a "wilderness medicine experience". The one seriously injured patient I saw we treated like a hot potato and shipped in the blink of an eye.

Residencies encourage this kind of nonsense to attract gung-ho residents, and then perform the bait and switch maneuver, when 99% of previously interested medical students realize that their goal of practicing "Wilderness Medicine" or "International Medicine" isn't tenable.

If you want to go into academics, a fellowship might get you a job, but for 95% of jobs that aren't academic, they would laugh at a fellowship in wilderness medicine. "That's nice, you wasted a year of your life getting paid a pittance and we would have hired you without it. Boy, this guy is a sucker, maybe we don't want to hire him."
 
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As someone who's a WFR, and someone who's had several accidents in the wilderness myself requiring evacuation, I think the whole "wilderness medicine" thing is a bunch of baloney.

You don't need an MD in the wilderness. If you're hurt in the wilderness you need to get the f$%( out and get to a hospital where they can treat you properly.

The only legitimate role I can see for an MD in wilderness medicine is teaching WFR and WFA courses. Other than that it's just a bunch of cowboys and Indians.

You're better off taking a vacation and going hiking/skiing/climbing.
 
AmoryBlaine said:
Any EM program will have elective time in which you can do WM if you so chose. I would be suspicious of those with a focus in it since the challenges of a career in EM are going to be dealing with the critically ill elderly and not the snakebit young.
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I am an EM-1 and i have personally seen 3 snake bites in the young already. but i have seen countless old and septic folks as well.

its all location dependent.

Kajun
 
YOOOUK09 said:
As someone who's a WFR, and someone who's had several accidents in the wilderness myself requiring evacuation, I think the whole "wilderness medicine" thing is a bunch of baloney.

You don't need an MD in the wilderness. If you're hurt in the wilderness you need to get the f$%( out and get to a hospital where they can treat you properly.

The only legitimate role I can see for an MD in wilderness medicine is teaching WFR and WFA courses. Other than that it's just a bunch of cowboys and Indians.

You're better off taking a vacation and going hiking/skiing/climbing.
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Ummmm....
W-EMT here, also pres. of my medical school's wilderness med interest group/club....so I like the stuff.
While I agree that there is not always a lot you can do for folks that are badly injured in the backcounty, the leadership needs to come from somewhere. Search and rescue groups, the military, expeditions, disaster relief groups, wilderness med educators (WMI, WMA, SOLO, etc) and all the research in the field better come from MD/DOs, preferably those with a good amount of wilderness experience. While few will make a living off of it, there is no reason to put down those seeking extra training, courses, and fellowships in WM.
I am sorry but the WFRs are not going to cut it when the local county search and rescue group is looking for someone to act as their medical director, trainer, or leader. The WFR will be leading troops of kids on summer trips and carrying litters.


Pinner Doc said:
I'm training in Utah partially because it's the sort of environment in which I want to spend the rest of my career. We offer a wilderness medicine fellowship at this program.
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Utah EM residency
:bow:
:xf:


dave
 
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Much ado about nothing. I wasn't looking for career advice. It is funny that you guys are getting all excited about such a small question. Perhaps "focus" wasn't the best phrasing in my initial question. Long story short, I would like some exposure to wilderness medicine. Some places may have more of that than others. Sure, 95% of my time will be spent in a hospital taking care of old people. I am square with that, and I wouldn't pass on that training. As far as the other 5% of my time, I would like to stay involved in S&R, low-tech wilderness first aid, EMT/Medic traing and the like. I'd like to know about it and maybe teach it because it is interesting to me, not because I think that is the ONLY job I could enjoy, or that I am going to make that the entirety of my career. I've been a wildland firefighter in the past, and I am in the military, so this kind of thing might come up from time to time in my career. Just looking to expand my list of possible programs on an interest. Hard to learn about the field if there is no faculty that has any interest in it. Seems like some of you guys were just cruising around looking for something to stomp on. If you don't have any programs you know of, let it go.
 
Jarabacoa said:
Because you can't "do Wilderness Medicine". That job doesn't exist, at least, not in the traditional, I'm going to get paid for the effort I put into it kind of job.

I work at an ER that is at 7,100 feet. Nearby peaks are 12,000 feet tall. In the winter, it can reach well below 0 farenheit at night, and I don't see "Wilderness Medicine Patients" on a daily, or even monthly basis.

The closest thing I've seen in my long career of 7 months as an attending here is an old lady that wandered outside her nursing home and froze to death in the snowbank.

What does the Wilderness Medicine Fellowship there in Utah consist of? I was a med student on some away rotations there, and spent a few days at a clinic by the ski slopes. I was on an orthopedic rotation, and it was a great fracture, dislocation, torn ACL clinic, but it could in no way be construed as a "wilderness medicine experience". The one seriously injured patient I saw we treated like a hot potato and shipped in the blink of an eye.

Residencies encourage this kind of nonsense to attract gung-ho residents, and then perform the bait and switch maneuver, when 99% of previously interested medical students realize that their goal of practicing "Wilderness Medicine" or "International Medicine" isn't tenable.

If you want to go into academics, a fellowship might get you a job, but for 95% of jobs that aren't academic, they would laugh at a fellowship in wilderness medicine. "That's nice, you wasted a year of your life getting paid a pittance and we would have hired you without it. Boy, this guy is a sucker, maybe we don't want to hire him."
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Totally. This is the up front stuff you see at alot of programs but what you're going to be expected to do is take care of ED/ICU patients and do it fast and well. I think it's hilarious that programs simultaneously brag that they have done away with inpatient medicine and added electives like WM and International. You only get one chance to train...
 
AmoryBlaine said:
Totally. This is the up front stuff you see at alot of programs but what you're going to be expected to do is take care of ED/ICU patients and do it fast and well. I think it's hilarious that programs simultaneously brag that they have done away with inpatient medicine and added electives like WM and International. You only get one chance to train...
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Depending on the international rotation (there's a whole spectrum, of course), I think it can be one of the most valuable learning experiences out there. Take a guy who's been in a nice academic ED and stick him in a high-volume trauma center in Johannesburg and it'll be a month of hell and chaos he'll never forget. I'm not saying it's necessary - but it is certainly rewarding. And certainly far more so than debating Mr. Smith's constipation for the eight time (should we increase his senna tabs to tid? Hmm... or maybe we should try Miralax... hey, why don't we have the nurse do a tap water enema and see what happens? Oh, goody.)
 
dgriss1 said:
Search and rescue groups, the military, expeditions, disaster relief groups, wilderness med educators (WMI, WMA, SOLO, etc) and all the research in the field better come from MD/DOs, preferably those with a good amount of wilderness experience.
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I second this. I was an WEMT and did SAR/ ski patrol before school. The person who is going to decide if the people on the search and rescue team should carry IV supplies or should be allowed to put shoulders back in should have some actual time on the ground before making those decisions, not just having read a few books about wilderness medicine.

While few docs will have that be their career, many medical directors oversee an agency that cover some area of country where wilderness medicine comes into play. So an elective or a chance to work on those skills may be time well spent.

Aside from dealing with these situations as a job, many doctors will find themselves in a pre hospital emergency situation. Be it a broken leg on a hiking trip or Katrina. I was on the ground in 9/11 and saw MD's trying to figure out how to sling a shoulder and it was pretty ugly. You can argue that you learn enough in residency to get by in these situations. But many people feel that it is worth their time to learn a few techniques and practice splinting a leg or two rather than have to make it up off the top of their head during a stressful situation.
 
quideam said:
Depending on the international rotation (there's a whole spectrum, of course), I think it can be one of the most valuable learning experiences out there. Take a guy who's been in a nice academic ED and stick him in a high-volume trauma center in Johannesburg and it'll be a month of hell and chaos he'll never forget. I'm not saying it's necessary - but it is certainly rewarding. And certainly far more so than debating Mr. Smith's constipation for the eight time (should we increase his senna tabs to tid? Hmm... or maybe we should try Miralax... hey, why don't we have the nurse do a tap water enema and see what happens? Oh, goody.)
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Well the argument is not so much what is rewarding personally but what is useful professionally. In that vein, we are going to see far more internal medicine than third world trauma...

But I agree, there are internat rotations and there are internat rotations.
 
jbar said:
I second this. I was an WEMT and did SAR/ ski patrol before school. The person who is going to decide if the people on the search and rescue team should carry IV supplies or should be allowed to put shoulders back in should have some actual time on the ground before making those decisions, not just having read a few books about wilderness medicine.

While few docs will have that be their career, many medical directors oversee an agency that cover some area of country where wilderness medicine comes into play. So an elective or a chance to work on those skills may be time well spent.

Aside from dealing with these situations as a job, many doctors will find themselves in a pre hospital emergency situation. Be it a broken leg on a hiking trip or Katrina. I was on the ground in 9/11 and saw MD's trying to figure out how to sling a shoulder and it was pretty ugly. You can argue that you learn enough in residency to get by in these situations. But many people feel that it is worth their time to learn a few techniques and practice splinting a leg or two rather than have to make it up off the top of their head during a stressful situation.
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These decisions are easy. People not trained in shoulder reduction should not do shoulder reductions. (which means, short of being an ER doc, an orthopedic surgeon, or an FP with extensive ortho experience, you shouldn't be attempting this crap, especially without IV sedation.) If you are not absolutely sure that the shoulder is not broken, then you probably shouldn't be attempting reduction (you need an orthopedic surgeon involved at that point). If my family member was injured and some paramedic in the field started yanking on their arm, I'd have some choice words for their director. Paramedics with adequate training in IVs, and IV medications should carry IV medications.

The skills you are describing have to do purely with leadership and EMS direction. These skills are obtained by being a good doc, and interacting with EMS in the hospital and in the field.

I splint several limbs a week, thank you very much. Do I do it with palm limbs and dental floss? No, but me knowing how to do that is not going to help people in the wilderness. If I am in charge of an EMS system that does wilderness rescue, I would buy them splints, not send them into the field with a pocket knife and tell them to wing it.

If you want to use "low tech first aid" to help people, ER residency is not the place for you.
 
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I take it all back. I was watching that British dude that gets dropped off in the middle of nowhere with no supplies and has to hike out, surviving on the native plants and animals. I saw the episode where he was thirsty so he squeezed the water out of rhino crap (or was it elephant) to not die of dehydration. That was the single most manly thing I've ever seen. I've found my new idol.

I don't have many cool organic crunchy people for friends. Maybe if I learn wilderness medicine, they will let me go on their back-pack trips with them. I can peel bark off trees and have them chew it when they get headaches. I can show them the best beetles to eat when they get urinary tract infections. I can build a contraption to distill my own urine so they can have more water to drink. I mean, come on, who wouldn't want McGuyver for a wilderness companion!
 
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Jarabacoa said:
These decisions are easy. People not trained in shoulder reduction should not do shoulder reductions. (which means, short of being an ER doc, an orthopedic surgeon, or an FP with extensive ortho experience, you shouldn't be attempting this crap, especially without IV sedation.).
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That is all well and good in the front country, but it doesn't really help a WEMT who is leading a hiking trip two weeks into the backcountry of Alaska. Shoulder reductions are part of the teaching of WEMTs because they may be in situations where someone with reduced CSMs is going to be in pretty bad shape if it's going to take a week to get them to a doctor.
 
jbar said:
That is all well and good in the front country, but it doesn't really help a WEMT who is leading a hiking trip two weeks into the backcountry of Alaska. Shoulder reductions are part of the teaching of WEMTs because they may be in situations where someone with reduced CSMs is going to be in pretty bad shape if it's going to take a week to get them to a doctor.
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This gets at the heart of the issue. The one use for wilderness medicine. So people can tell their buddies, "We can go do crazy stuff in the back-country, get seriously injured, not have access to modern transportation, and still be fine because...I know wilderness medicine." Complete lunacy.

It would be a great skill to be able to do an appendectomy in the field, but the chances of that being needed are astronomically low. Besides, if you want to learn how to reduce a shoulder, you work in an ER, you don't go to a wilderness medicine course.

If you want to learn medicine, you go to where the practice of medicine is happening, not to the wilderness to literally practice on fake patients and run through scenarios that could possibly happen.

The only examples of things that would be helpful to patients in the wilderness are either things that would be taught to any paramedic, or they are things that would be taught to any ER resident.
 
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Jarabacoa said:
This gets at the heart of the issue. The one use for wilderness medicine. So people can tell their buddies, "We can go do crazy stuff in the back-country, get seriously injured, not have access to modern transportation, and still be fine because...I know wilderness medicine." Complete lunacy.

It would be a great skill to be able to do an appendectomy in the field, but the chances of that being needed are astronomically low. Besides, if you want to learn how to reduce a shoulder, you work in an ER, you don't go to a wilderness medicine course.

If you want to learn medicine, you go to where the practice of medicine is happening, not to the wilderness to literally practice on fake patients and run through scenarios that could possibly happen.

The only examples of things that would be helpful to patients in the wilderness are either things that would be taught to any paramedic, or they are things that would be taught to any ER resident.
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There's a lot of back and forth going on, and i'm honestly not sure why. I think that everyone would agree that skills specific to "wilderness" or "international/developing world" medicine are not things you generally need in your every-day practice in the ED. But they ARE legitimate skills - not only for practical purposes, but also to give you a better understanding of where you're working and what you're dealing with. Some personal examples:

I spent a month in the Himalayas with a group called the Himalayan Health Exchange. We spent a month trekking in Jammu-Kashmir (northern border of India), setting up clinics for local villages as we went along. 95% of what we did was incredibly routine and only mildly educational - scabies, vitamin deficiency, pterygium, etc. Not too exciting, although I did see some fantastic clinical findings that I definitely haven't seen in the US. But we also had several cases of altitude sickness (where one guy got pulmonary edema and had to be evacuated out), drained several abscesses (had to sterilize a blade in the field), and learned a lot about the chronic effects of living at altitude (physiology, etc). Not to mention some down-and-dirty dentistry! This group is also affiliated with HRA (Himalayan Rescue Association), which runs clinics on some of the major trails leading up to Everest. Physicians volunteer up there for 2-3 months at a time and aside from treating climbers for sprains, infections, HAPE, etc., they also treat a lot of the locals.

What is all of this useful for? Well, nothing if you're just going to practice in an ED somewhere. But if you want to work on expeditions, or work in Nepal or any developing-world location at high altitude, or even just climb, it's extremely useful to have this exposure. There's also a ton of critical care research going on at Everest. If nothing else, it was a month that opened my eyes to some very "out of the box" possibilities and things I can do with my career later on.

I think that programs with a specific focus - EMS, wilderness, international, etc., are not just valuable for the skills they offer but for the exposure to opportunities outside the beaten path. How else do you learn that you love diving medicine and want to go work with Navy divers if you haven't spent time in Hyperbarics? How do you even find out about Himalayan health posts if you don't have the opportunity to go and work there? I've met several US EM docs doing incredible things - setting up an emergency clinic in Rwanda, working with the IRC, disaster relief during the Tsunami and later in Pakistan, volunteering with MSF, working in South Africa, Zimbabwe, Australia... and so on. The opportunities are endless, IF you make the right connections - that's where the "wilderness medicine focus" question comes in, and that's why it's incredibly relevant for those that are interested in it.

Even if you only spend 5% of your time doing things that directly involve these niche areas, it's amazing. It's what keeps many people going. And I don't understand why those who aren't interested in them are getting so worked up about it.
 
My point wasn't if the best way to learn shoulder reductions is a wilderness medicine course, it was to point out that there is a reason why certain skills are taught to wilderness EMTs and WFRs that people don't do in the front country, because the ED is so close. Therefore, if you are an MD who wants to interface with people who are being trained to do those skills in wilderness situations, or you want to decide which skills should be allowed in the woods, you need to understand the conditions that those providers are working in.

If you go spend a few weeks out in the field you will get that understanding of these situations much better than reading about it. Do most ED docs need that? No. But those who want to spend time dealing with wilderness medicine organizations certainly can consider if there are chances to do that training at a given residency.

I don't see why people think this is different from tactical medicine, dive medicine, EMS or anything else that has fellowships or additional courses. Yes, you will learn enough if any residency to get by in a wilderness situation, or to interface with EMS. But if you do additional training in that field you will be more experienced and have more skills. It is up to the individual doc how far they want to take that training.
 
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