Emergency Education Programs

It can be challenging for family practice residents or physicians who wish to locum in rural areas to gain needed experience and comfort to deliver emergency medicine in rural communities. The Emergency Education Programs are changing this.

The Emergency Education Programs currently have 3 sites: Nanaimo (NEEP), Northern (NoEEP) and Kamloops (KEEP). The Programs offer participants a three-month clinical and academic fellowship in emergency medicine that focuses on emergency medicine, procedures, point-of-care ultrasound, and resuscitations. They are also creating an environment that allows for cross-pollination with the Certification in the College of Family Physicians-Emergency Medicine (CCFP[EM]), and for local leadership in the transfer of these skill sets to practicing rural physicians.

“NEEP is, without question, the highest quality training I've had (medical school and residency included). I could focus on what was relevant to my practice, the academic sessions were excellent, the preceptors were highly skilled, the administrative support was awesome. It was a lot of hard work, but I'm so glad I did it. I hope NEEP can help prevent full-service rural doctors from becoming a dying breed. Thank you for everything.”

Participant

Achievements

Strengthened the transfer of emergency skills to rural sites

The Emergency Education Program teams have continued implementing the core goals of providing expanded skills training to six providers with relationships to rural communities per cohort in both locations (Nanaimo and Northern sites) during the spring (April-June) and autumn (September-December). This adds an additional 12 graduates this year, bringing the total to 56 graduates—many of whom have remained in rural locations. This has further strengthened the transfer of these emergency skills to rural sites where graduates have remained and can now act as resources to the local physician/nursing communities. Ten of these graduates have gone onto successfully challenge the Emergency Medical (EM) enhanced skills exam. These now-certified EM physicians have remained in their rural communities to act as locally based resources. 

Furthermore, opportunities for more formal rural-based training has resulted in an enhanced skills graduate to take on a position as a full-service mixed practice physician in the rural community of McBride, rather than staying in the Lower Mainland as many previous graduates of the one-year program have historically done.

Initiated outreach initiatives to enhance teaching resources in rural locations

The Emergency Education Program created an outreach component of its program in which it supports one of its graduates to organize and act as an apprentice instructor in a Point-of-Care Ultrasound workshop to her group in Smithers. The team connected her with two other graduates from another nearby community (Hazelton), who also taught at the local Smithers workshop, supported by the Northern Emergency Education Program faculty. This not only benefitted the local community of providers in Smithers, but also connected both communities with enhanced teaching resources from the Northwest area of the province to cause local growth and training opportunities that are based closer to home in a rural setting. While the program continues to support these local efforts in knowledge and skills transfer, they hope to create a critical mass of instructors in these more remote areas of the province. 

Built training capacities and developed infrastructure to launch third training centre in Kamloops

The program has expanded to build training capacities and organize infrastructure at the Royal Inland Hospital in Kamloops, welcoming the first cohort of rural fellows at a third centre of training. This first cohort of a further three per session or six per year is starting with the first group in early April 2023. In doing so the team has also purchased ultrasound equipment for the Kamloops site as well as refurbishing U/S machines at the program’s other two sites. The infrastructure created at the Kamloops site and training capacity will also assist in the expansion of the Canadian College of Family Practitioners (Emergency Medicine) enhanced skills program outside of the Lower Mainland, connecting these trainees with a more rural training site and cross-pollination opportunities with rural fellows. Kamloops will welcome its first rural based Emergency Medicine trainees in July 2023.

Explore the Numbers

12 Graduates in 22/23

Provided expanded skills training to 12 providers with relationships to rural communities.

56 Graduates to date

Since the program launched in 2017, 56 providers have completed training, many of whom have remained in rural locations.

3 Training Centres

Built the infrastructure and training capacity at Royal Inland Hospital to launch third training centre in Kamloops, which will start in April 2023.

10 Certified EM Physicians

After successfully challenging the Emergency Medical (EM) enhanced skills exam, ten graduates have remained in rural communities.

Making a Difference

The program has created a steering committee to ensure ongoing communication and give program consistency across the multiple sites. Representation from the program (Dr. Kevin McMeel), RCCbc (Dr. Ray Markham), and REAP (Dr. John Palowich) provide input from the various stake-holder groups to ensure the geographically separated sites maintain the mission of enhancing its original rural focus.

This group will also assist in the transition from one time funding to ongoing program funding over the course of the next year as it moves from a proof-of-concept vision to a fundamental sustainable training scheme.

Meanwhile, testimonials from residents and physicians who have completed NEEP and NoEEP training shows the valuable impact of the Programs:

One graduate said they felt “much more comfortable using ultrasound in ER,” which was invaluable given there was no CT in Port Hardy.

“Working in Vanderhoof ER and I diagnosed a central slip tendon laceration — would not have known to look for that before NEEP! Newfound comfort with procedures including procedural sedation, lumbar puncture, joint reduction, which I have done several times since NEEP… I also now have more confidence in general in dealing with acute situations in rural and remote settings and therefore my work has less of a negative psychological impact.”

Participant

“NEEP training helped me manage a patient in cardiogenic shock with a lactate of 13 and potassium of 7.8 when there was no plane to come get the person and take them to ICU.”

Participant