By Jiayi Hu, Sameer Masood, and Manveen Puri

The duration of residency training may vary depending on the specific medical system in which one trains. In Canada, residency can last from two to six years or longer if one wishes to pursue a post-graduate degree at the same time. In addition, fellowship opportunities are available after residency for further clinical or career development. Here, we will discuss three residency streams as examples to highlight differences in program design and career prospectus.

1. Plastic Surgery
Plastic surgery residency, like most surgery programs, is a five-year program through the Royal College of Physicians of Canada. The first two years involve rotations in other specialties, such as general surgery and orthopedic surgery, to attain a fundamental level of clinical competency before progressing to senior level training that is focused on plastic surgery.

The day usually begins at 7 am or earlier with rounding on patients, followed by daily clinical activities at 8 am such as operations, minor procedures, or clinics. The day concludes at 5-6 pm after all patient and emergency issues have been addressed. Typically, there is an on-call resident every day to manage any patient issues that arise overnight. There is also usually dedicated formal teaching days every week, as well as informal teaching sessions during clinical encounters.

At the end of residency, one may choose to work in the following settings: academic, community, and private practice. Many residents choose to take on fellowship training to further develop and refine their skills, as well as to strengthen their job prospects. For plastic surgery, fellowship options may include subspecialties in hand surgery, craniofacial surgery, and paediatrics.

2. Emergency Medicine
Specialist training in Emergency Medicine is a five-year program in Canada through the Royal College of Physicians of Canada and four years in the US. There is also an option to pursue emergency medicine training through family medicine. Since emergency medicine is a broad field that encompasses aspects of virtually all the areas of medicine, the practice involves a significant amount of non-emergency medicine training i.e. surgical rotations, paediatrics, psychiatry, gynecology, etc. Like most training programs, there is graduated learning and responsibility, and the training focuses on emergency medicine solely in the senior years.

Most programs offer an option to pursue additional training in the 4th year of the program. A variety of opportunities exist and residents may choose to pursue additional clinical training in the form of a fellowship (critical care, ultrasound, toxicology, etc.), additional post-graduate education such as a Master’s degree in education, research, etc., or a research fellowship amongst other options.

Clinical work is predominantly shift based (usually 8-10 hour shifts) and can be at an academic or a community hospital. The scope of practice is extremely broad and includes acutely ill patients requiring resuscitation, such as trauma patients or patients with life-threatening organ failures, paediatric patients, psychiatric patients, and patients with a variety of common minor problems. Hence, as an ER physician, one must be able to have excellent decision-making skills and great problem-solving abilities.

Beyond clinical work, there is a variety of options available such as clinical teaching, simulation training, quality improvement, and other administrative positions.

3. Family Medicine
Since the early 1990s, Family Medicine in Canada has been a specialty with its’ unique two-year residency program. Prior to this, all medical school graduates completed a “rotating internship” year and were qualified as “General Practitioners (GPs),” a model that continues to exist in many parts of the world. The creation of a separate residency program was born out of the increasingly complex skills required to practice Family Medicine successfully.

Family Medicine in Canada is also unique because of the vast disparity in health human resources between rural and urban areas. The lack of traditional “specialists” in many rural communities results in vastly different scopes of practice. Outside the family medicine clinic, family physicians in Canada may find themselves providing care in many other settings including emergency medicine, obstetrics, hospitalist medicine (care of inpatients), palliative care, anaesthesia, and surgical assists. Also, many family physicians practice in an area of special focus because of personal interest or the needs of a given community. Examples of focused practices include travel medicine, pain medicine, sports medicine, cosmetic medicine, and hospice care. The list is as long as the variety of patients that family physicians encounter. Underlying this diversity is the principle that family physicians are specialists in general practice, that is, the care of the undifferentiated patient.

Given this flexibility, the two-year residency program has become increasingly competitive in recent years. Programs vary in design across institutions, but have family medicine as their base plus a broad range of core rotations in areas such as pediatrics, psychiatry, obstetrics, internal medicine, and emergency medicine. There is also elective time to explore practicing in a particular setting or area of focus. Residents who are interested in receiving additional training in an area of interest also may apply to various programs such as emergency medicine, hospitalist medicine, and sports medicine for a fellowship or “plus one” year.

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