Steps to Success in Enhanced Training in Emergency Medicine: The CCFP-EM Year

In Mentorship by Kevin Junghwan DongLeave a Comment

This post is the first of a series of opinion pieces dedicated to resident physicians and medical students applying, experiencing, and studying for the Canadian College of Family Medicine – Enhanced Training in Emergency Medicine (CCFP-EM) year. Be sure to also listen to the companion podcast:

Are you a Family Medicine resident about to graduate and embark on an extra year of training in Emergency Medicine (EM)?

Are you worried you don’t know what it is really like to be an Emergency Medicine resident and you want to find a guide to help maximize your learning in a short and extremely fast year?

As a recent CCFP-EM graduate, I can strongly relate to your fears. The one year of extra training is an important one, and you will learn a plethora of information that will be pertinent to your success as a future Emergency physician. Thus, it is paramount that you maximize and optimize this year. In this blog post, I hope to act as a guide and provide insight into how to get the most out of your training.

For those individuals who do not know what the CCFP-EM program is, it is an Emergency Medicine residency fellowship (or added competency program) stemming from the tree of Family Medicine in Canada. Residents completing this program will have the ability to complete the Emergency Medicine Licensing Exam (administered by the Canadian College of Family Physicians) and practice EM across the country. It is a highly competitive program and as a one year program, the training is rigorous and substantive. Residents are expected to achieve a large volume of objectives, and experience various teaching requirements in different specialties to achieve competency for independent practice.

Steps to a successful year:

1. Plan ahead: Ask for your schedule in advance

A month or two before starting your fellowship, start planning your year in advance. First, contact your administrator to request your schedule and objectives. This is important for many reasons:

  1. You will likely have 1-2 electives that you can self schedule. Many of these electives will have time and location restrictions, which you will need to work through.
  2. Plan out your schedule for vacations and family obligations.
  3. Plan out your reading schedule around specific rotations and electives.
  4. Plan out deadlines for assignments.

This allows you to have a good idea of what your entire year will entail and prepare you better to tackle it.

2. Speak to a former EM resident

As it is a one year program, there are no upper and lower year co-residents to seek out mentorship. This means you must lean on recent graduates who have been in the same shoes, gone through the same stressors, and dealt with the same challenges. Make sure to reach out even before you start your fellowship to contact the Chief Resident (or any previous residents of the program) and find ways to optimize your experience. I found that asking about exam preparation and figuring out what to study was immensely useful.

3. Wellness is important to a successful year

If you are happy and balanced, you will be a better employee and caregiver to your patients. It is a myth that you should not go on vacation because you will miss out on clinical opportunities, however, there are steps that you can take to optimize your experiences. It is perfectly reasonable to take time off and set this up beforehand instead of burning out and then requiring it last minute.

  1. Plan ahead to see which rotations you think would be best for you to take time off. This is dependent on your strengths and weaknesses, previous clinical experiences, and what you want to get out of your training.
    1. For example, if you had plenty of chances to do Anesthesia electives prior to your EM year, this may be the ideal time to take time off.
  2. Speak to former residents who may have tips on which rotations are high yield learning opportunities that may be worth completing the entire block.

4. Be professional, nice and friendly.

Make sure to get to know the Emergency Medicine staff, fellow residents, nurses, and the entire interdisciplinary team well. Be professional, friendly, and respect the system. Once you do this, people will trust you and they will want to be around you. Additionally, you will be exposed to interesting cases or procedural opportunities. I was able to perform airways, orthopedic reductions, and central-lines by seeking out ways to be helpful. Be respectful and engaged in your working environment and opportunities will present themselves.

5. Get close with your fellow residents.

Once you start the program, your fellow residents become your family. You will spend the bulk of your time with them and if you work together to improve, you will all become more successful at the end of your training.

  1. Make a group chat and exchange phone numbers.
  2. Make sure to share interesting cases (with confidentiality) and learn together.
  3. Prepare for your exams together especially when you are practicing for the oral examinations.
  4. Keep in touch after graduation and ask each other clinical and administrative questions. This is extremely valuable as an independent practitioner.

Don’t forget about your Royal College Program – Emergency Medicine (FRCPC) colleagues. I was fortunate to find amazing friends from both the CCFP-EM and the FRCPC groups. You will participate in many joint medical and extra-curricular events and it is a perfect opportunity to bond as one. Even though we are in different streams, our end goal – to take care of patients – is the same and I learned quickly that my educational and personal experiences were enhanced when both groups worked in harmony.

6. Exam preparation

The Emergency Medicine Enhanced Training year is designed to make you competent and ready for independent practice. The foundation of the Emergency Medicine licensing exam is very similar to the Family Medicine examination (written and oral components). The objectives for the examination are on the Canadian College of Family Medicine (CCFP) website. Here are ways to prepare for the examination throughout the year:

  1. Create a reading schedule and prepare in advance for the academic half days.
  2. Formulate a good habit of reading around your cases and identifying your weak points to make them your strengths.
  3. I found listening to medical education podcasts extremely helpful as mobile adjunct study tools.
  4. Read Tintinalli’s Emergency Medicine Textbook for 45 minutes-1 hour every night. This may sound difficult, but you will not regret your work at the end of the year.
  5. Prepare for the oral examinations early. Find a few colleagues to practice regularly. You can make your own cases or use an existing resource to help you prepare.
  6. Read over the objectives from the CCFP website and make a schedule around it. This will help with planning out your study days.

Concentrated studies will start May-June. The exam is in mid-September, so you want to give yourself at least three months to prepare.

Here are resources I used to prepare:

  1. Tintinalli’s Emergency Medicine (Just the Facts version is a good resource)
  2. Medscape or Uptodate
  3. Rosh Review Emergency Medicine Quiz
  4. Emergency Medicine Oral Board Review
  5. Podcasts (EMRAP, EMcases, CrackCast, etc.)
  6. Notes taken from Academic Half Days

Find what works for you, make a schedule, and stick to it. I guarantee it will pay off.

7. Job Preparation

The ultimate goal of this year is to become ready for EM independent practice. Finding a good job based on your interests and life goals with the ideal working environment will be a key objective for your future career. Think about where you want to practice, what kind of practice you want to have (academic, rural, community, etc.), and all of the other aspects of life that are important to you. Interviews for jobs start in September-October of the same year that you start your EM fellowship. Speak with your mentors to help prepare yourself for the next phase.

Figure out what hospitals are around you, the population of patients they see, the payment structures they have, and the resources/consultants available to help with your clinical practice. Additionally, once you find a job at one Emergency Department, stick with it before you start committing to other job opportunities. In the first three months of your practice, you will be extremely busy studying for the exam, learning to transition to practice, and digesting the information. You will need all of your time and energy to your studies and your job. Lastly, identify your supports and find ways to balance your life. Working will become more enjoyable when you have great colleagues and friends in close proximity. Seek out an environment that challenges you to become a better practitioner and person.

In Summary:

  1. Plan ahead: Get your schedule early and plan your year/electives strategically.
  2. Find mentorship: Speak to former residents and find mentors who can make the path easier for you.
  3. Wellness: Plan ahead for your wellness days and take time if you need it.
  4. Seek out opportunities: Be professional and ask for opportunities.
  5. Make friends: Bond with your colleagues. It will go a long way.
  6. Exam Preparation: Make a study schedule, read a little bit everyday, and practice.
  7. Job Preparation: Identify your career goals and seek out a place that fits these goals.

Congratulations on your acceptance into your respective EM programs. Enjoy your success and I hope this guide will provide as an introductory map to your evolution as a competent future Emergency Medicine physician.

Article Edited by: Fareen Zaver, Uploaded by: Amy Chung 

Images Adobe Stock

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Kevin Junghwan Dong

Kevin Junghwan Dong

Kevin Dong is an Emergency Medicine physician in Hamilton, Ontario. His interests include medical education, mentorship, and making video/podcasts. He is a recent graduate of the CCFP-EM program and the Digital Scholars Fellow for the 2018-2019 year.
Kevin Junghwan Dong
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Kevin Junghwan Dong

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