jakomo

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Oct 1, 2014
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Hi everyone,

I am a new FM residency graduate. I have a strong interest in EM and inpatient medicine, and have been in talks with a rural hospital about possibly signing on to do both. Just to note, this hospital is located in Canada and is primarily staffed by FM docs. My residency prepared me fairly well for general inpatient medicine, but I am concerned about my preparedness for EM. I feel fairly comfortable with most 'common complaints', but when it comes to things like leading codes, cardioversion, intubation/mechanical ventilation, procedural sedation, I feel a little less comfortable. I have taken courses like ATLS, casting/splinting, ultrasound, ACLS/PALS, and have a good THEORETICAL understanding about what to do and when. but I don't want to be fooled into a false sense of security when compared to the real deal. I did have intentions of taking some airway courses as well, but COVID19 ruined those plans for the time being. I have considered fellowship, but due to visa issues/nuances in the Canadian medical system, it is not an option.

I wanted to hear some experiences or get ideas from FM docs that work rural ED and how they overcame these concerns or became competent with some of the above topics. Any stories or tips would be appreciated!

Thanks!
 

cabinbuilder

Urgent Care Physician
15+ Year Member
Nov 21, 2005
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The first question is HOW RURAL? Canada is vast. How close is the nearest trauma center? Will you need to use medevac plane or EM transport? Where does their trauma get shipped to? How many beds is the ER? Is the hospital only staffed with FP or do you have a surgeon there, OB?
 

Medic_90x

2+ Year Member
Apr 7, 2017
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The first question is HOW RURAL? Canada is vast. How close is the nearest trauma center? Will you need to use medevac plane or EM transport? Where does their trauma get shipped to? How many beds is the ER? Is the hospital only staffed with FP or do you have a surgeon there, OB?
Pretty uncommon to have some of the same resources that US rural hospitals have. In-house anesthesia also often is not a thing, or if it is - it's GP-anesthesia (FM who does anesthesia, essentially an improved version of a CRNA who is a doctor).
 

cabinbuilder

Urgent Care Physician
15+ Year Member
Nov 21, 2005
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Pretty uncommon to have some of the same resources that US rural hospitals have. In-house anesthesia also often is not a thing, or if it is - it's GP-anesthesia (FM who does anesthesia, essentially an improved version of a CRNA who is a doctor).
So you have worked in a rural Canadian hospital? I asked those questions since how rural depends on what you are expected to be able to see and what types of cases are automatically shipped since I did that job for 7 years. Not sure how your response has any bearing on the OP's questions???
 

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