Dr. Brodie Marshall is an family and emergency physician at Sioux Lookout in Northern Ontario who completed the inaugural Thunder Bay satellite site SEME program in 2021-2022. Watch and read below to hear more about his experiences!
If you prefer reading the interview, see below for the transcript:
Michelle Yee: Hello everybody, I'm Dr Michelle Yee and one of the Assistant Program Directors for SEME and today we are here with Dr. Brodie Marshall. Dr. Brodie Marshall is one of the inaugural Thunder Bay SEME fellows that we've had. We thought it'd be a great opportunity to get to know some of the previous fellows and get some other perspectives on the program. So without further ado, why don't I have you introduce yourself and just you know tell us about yourself.
Brodie Marshall: Sounds good, hi everyone I'm Brodie. I'm calling in from Sioux Lookout in Northern Ontario today and that's where I've been practicing the last few years. I'm actually from Thunder Bay, so doing the program in Thunder Bay just made sense for me. I'll talk about that more in the future, but yeah, I went to medical school in Thunder Bay at the Northern Ontario School of Medicine. Then I went out to Cape Breton Dalhousie for my Family Medicine residency and basically I've been mostly in Sioux Lookout since I graduated around 2016.
Michelle Yee: So it sounds like you've been practicing for a little while already, and then you ended up more recently doing this program so, can you tell us a little bit more about what made you interested in doing additional training in emergency medicine.
Brodie Marshall: So yeah, maybe a third of my practice or so has been emergency medicine and I've always had an interest in it. I've felt fairly comfortable, especially with a few years of experience, under my belt, you know practicing and rural emergency departments and stuff but just sort of wanted to try to take the next step and there's always things that might come through the door at any moment that you've never seen before. Always a bit of that pre shift anxiety, so yeah just wanted to take the opportunity of getting a bit more comfortable with emergency medicine. I did have some curiosity about what you know full time emergency medicine made me feel like and so just the opportunity to do a couple months of full time emerge and see where that lifestyle was like and talk to staff about it and whatnot.
There are also graduates from SEME who you know locally and everyone has spoken so highly of the program. I've been recommended it so it seemed like a natural opportunity, especially once the Thunder Bay option came up. That appealed to me somewhat more than the Toronto option just being closer to home, and you know some other perks that we could get into.
Michelle Yee: Yeah so I mean you mentioned that a number of your colleagues had done SEME in the past and that's been great that Toronto has hosted this program for a number of years, but Thunder Bay it's brand new. They've just launched in 2021 and the program is a little bit different than the one in Toronto, and certainly we are so excited to see that we're able to cater to northern rural physicians even more and make it more accessible to them. But, knowing that it is a newer program, can you tell us a little bit about what your experience was. As well as maybe like kind of what that experience was for some of your colleagues, because I know it's a little bit more flexible, a little bit more adaptable.
Brodie Marshall: Exactly, you're right there sounds like there's more flexibility than the traditional Toronto based program. Similar to us, like it's three months to start, with four week rotations in emergency medicine and then, one month of electives, which I believe sort of standard, in either ICU, anaesthesia, or trauma. I did an ICU rotation in Thunder Bay. I understand there are opportunities to do trauma in a higher, level one Trauma Centre, and go outside of Thunder Bay for the elective. But I trust everything here.
It's sort of a non-longitudinal model, so I did a month long rotation and then I would come back to Sioux Lookout, and I can maintain some of my professional obligations here and in between rotation, so that that flexibility really worked for me in my practice also just gave me the opportunity to adjust some learning goals. And to gain some skills over a month rotation and bring them bring them back here to my practice and adapt, as appropriate, so that was beneficial.
I think unique to the Thunder Bay site, the first week of my of my emergency medicine rotation was ultrasound so there's a sort of master ultrasonographer that works in the Thunder Bay emergency department, who is a c-POCUS certifier, so I think all the fellows got to got to get there and get their core certification. And even pursue higher-level certification through that that week of intensive ultrasound. That was a big highlight.
The other highlights, there's an internationally recognized airway guru in Thunder Bay, so I got a half day in a cadaver lab with him, one on one just practicing advanced airways skills.
Then there's also sort of a two-day boot camp, which was 50% simulations and 50% skills and workshops.
And to supplement the academic stuff there's online academic modules that you sort of complete on your own time throughout the course and opportunities to join the CCFP-EM residents that were based in Thunder Bay for their academics as well.
Michelle Yee: Yeah so I did my med school and family medicine residency in Toronto, but I actually did my plus-one year in Thunder Bay. And I certainly got a very, very similar positive experience. I really had a phenomenal time when I was there, both from the perspective that in the clinical rotations, Thunder Bay sees really high acuity, and they see good trauma.
Like certainly it's not a Trauma Centre, but I actually found that some of my greatest experiences in my training were in Thunder Bay, because of the fact that it's not the same. When you're in Sunnybrook doing a trauma rotation you stand at the foot of the bed and you're the trauma team leader and that's it. When you're in Thunder Bay, you're the person intubating and putting in the chest tubes and everything else. And all the preceptors, they are so happy to have you there and teach you. And they really let you lead it. It's like a trial by fire and sometimes you're like, I don't know if I'm doing this right and they'll just be there to support you and give you that opportunity. I had a really great experience kind of doing all my clinical rotations there.
Brodie Marshall: Yeah we have great teachers in Thunder Bay and super high acuity place to learn.
Michelle Yee: Exactly as you spoke, I would say the ultrasound training was phenomenal. They really put an emphasis on making sure everybody got IP certified. Then Yen Chow, who does all of the airway stuff. He was like a huge person with the Baltimore cadaver series workshops. And he made such a big effort to get cadavers out to Thunder Bay, which is such a rare experience.
Brodie Marshall: Totally yeah I feel very fortunate.
Michelle Yee: So tell us a little bit about your experience in Thunder Bay as a city in general.
Brodie Marshall: Yeah for sure, I did grow up in Thunder Bay but I've been away for about eight years and the city has actually grown a tremendous amount in the last decade, like there's a lot modern culture. The restaurant scene is top notch, for example. There's just more of a thriving vibrant downtown for a smaller city. There's a lot a lot to do.
I think the recreation around Thunder Bay, you can’t beat that if you're an outdoorsy person at all, which which I am. There’s Lake Superior, the biggest freshwater lake in the world right at your doorstep there's amazing provincial parks. I'm a professional skier, and there’s some of the best skiing in the country and mountain biking. It's amazing. So yes, great place to spend a few months, I highly recommend it.
Michelle Yee: Yeah I was super impressed with the food scene, when I got there because I am a very classic Toronto snob when it comes to food. But there’s surprisingly tons of different cuisines and food that is easily comparable to some of the best restaurants in Toronto. And totally agree with all the outdoorsy stuff. It’s also really fun to be there for different seasons. The drive from Thunder Bay too in the summer is also so beautiful. There are so many different provincial parks, I didn't even know what to expect until I got there.
Brodie Marshall: Yeah some of the best stretches of driving in the country, for sure.
Michelle Yee: So having done the program now, reflecting on who might benefit from the program; there’s a number of different people are at different stages in their careers and they're thinking you know, should I do this now or later? What are your thoughts in terms of who might get the most out of this program?
Brodie Marshall: Yeah, this is a good question. I am presenting my experiences, 5-6 years into practice and yeah other people in the program who were essentially fresh out of residency. And I know there’s people in the Toronto program who are 15 years into practice type of thing. So between the two sites, it has worked really well for people at different stages of their learning. I think I could just make a pretty broad statement that I would recommend it to anyone who wants to improve their emergency medicine competency, wherever you are in practice. I think there’s definitely benefits to self directed learner, whether you're just trying to get comfortable with emerge, or whether you're bringing it to the next level. I think it’s very adaptable. And you get to know your preceptors so very well and it's a small enough department, to fit your learning goals. There's a lot of adaptability.
Near the end of the program I decided, I was interested in challenging the emergency medicine exam. So I feel now that I'm in an exam prep mode, and it's given me a really good head start to just review core emergency medicine topics. So I would also recommend it to people who are thinking of challenging the exam in the future.
Michelle Yee: That's great to hear just because you know, I think, certainly from the Faculty side of things, we see pros and cons to doing the program at different points of time. For sure, everybody kind of gets their own benefit from it. It somewhat depends on how often or comfortable they are working in the emerge now. But at the end of the day, I think all of us in emerge are lifelong learners and there's always so much more you can learn. The program is adaptable to whatever stage you're at.
Then something you mentioned that others might not be aware of is that we actually offer all of our SEME learners exam prep as an added feature. We don't talk about it a ton per se, as part of kind of our program because it's not like our major mandate, but certainly we're happy to have our faculty to help support our fellows in terms of challenging the exam and making sure that they feel prepared.
So for who might be entering the SEME fellowship, trying to figure out how they can get the most out of the program, do you have any advice for those who are about to start?
Brodie Marshall: I compiled this set of learning objectives, which I think is you know somewhat standard practice for you know residency rotations and stuff like that, but I made the point of doing some self reflection and identifying sort of deficiencies that I wanted to work on. So yeah I definitely would recommend that.
And having a good self, directed approach really benefits people.
Michelle Yee: I always get so impressed with the number of NOSM grads who graduate and then just go out and do ER; and we also get a lot of inquiries from people who've done family medicine and are interested in doing more ER; or new graduates who are saying hey let's go jump in and do some kind of comprehensive full scope family, along with emerge. How can those people improve their knowledge, whether it’s through SEME or other opportunities? What was your experience like jumping into practice and any suggestions for others?
Brodie Marshall: In retrospect, I feel like I could have benefited from SEME fresh out of residency and stuff but I somehow managed to keep my head above water and just jumped into rural emerge and fortunately, things worked out positively for me.
I’ve always been big on podcasts for supplementing my emergency medicine knowledge. Emergency Medicine Cases is my go to. EM-RAP. Things like that.
And a plug for Sioux Lookout, being a place where you can do some partnerships as a new locum working in Emergency department. You can be paired up with a with a regular staff member and get your feet wet with a little bit of backup.
I think number one on the list is the SEME program for sure.
Michelle Yee: Yeah one of the greatest things with emerge is there so many FOAM resources out there. Like the free, open air, medical education movement was such a big thing for emerge, whether that's through podcasts, or there’s paid version of it like EM-RAP or Hippo-EM. There's so much out there, that it's just kind of matter of how you absorb it.
Something I often recommend to people is conferences or courses. So it could be an airway course or CASTED. Even when people take ACLS, or ATLS or PALS, they often take it for the sake of just passing it so that they have a certification. But I often really, really recommend trying to kind of understand the learning around it, because with rural emerge, there’s so much overlap with family medicine, which is natural for a lot of the people who do full scope. But some of the procedural stuff is a little bit harder, and then the resusc stuff where when it comes in, it's actually infinitely harder to deal with than when you're in a large tertiary care center where you have tons of resources and additional hands. In rural places, you're really managing things independently and when those cardiac resuscitations or whatever come in, you really have to be comfortable with it.
I love that you mentioned mentorship stuff because there’s a number of different programs and at different sites, there’s sometimes opportunities for low level and high level supervision. Some of them have more formal mentorship programs that are offered through the government for additional financial support that can be really, really helpful for people who are just starting off.
Brodie Marshall: Yeah I would like to add CASTED to my list of suggestions. Super helpful. And AIME.
Michelle Yee: One of the greatest things about SEME that I really love is that for casting, Dr. Arun Sayal is actually one of our professors/lecturers. And I love that the teaching in SEME is all done by leaders in the field, who practice evidence based medicine and are really kind of focused on medical education.
For those of you who might not be as familiar with Sioux Lookout, we've been seeing more and more needs in Northern Ontario for emergency physicians. Would you be able to talk about what it’s like working at Sioux Lookout? What resources you have available? Because I imagine you guys would be happy to have people join the department.
Brodie Marshall: Yeah, I think a lot of departments after two years of the pandemic, with burnout and stuff, I think a lot of us are quite short so yeah we're definitely looking for people.
I can't speak highly enough of working in Sioux Lookout. There’s an amazing team and a tight knit group here. The medicine itself is quite unique where we are the referral centre for all of the remote Northern Ontario. I think our jurisdiction is like half the size of France, or something like that. We service remote fly-in First Nations communities.
And it creates this environment where you see a lot of different types of pathology. Unfortunately for the population, there's lots of barriers to access to health care so you see much more pathology. It's never a dull day working here for sure. There's a lot of interesting cases and really, really good supportive colleagues.
And the lifestyle here is really nice. Sort of similar to Thunder Bay, just amazing outdoor recreation, it's a great place to be for sure so.
Michelle Yee: You guys are actually one of the few rural ER’s which managed to have a CT scanner as well.
Brodie Marshall: We do have a CT scanner. We have three general surgeons, GP anesthesia. We have 24/7 access to a CT scanner, though emergencies only overnight. We recently got a respiratory therapist, so we feel much more comfortable not having to you know manage ventilators by ourselves.
Michelle Yee: Those are a huge pluses and that's awesome to hear. Just wrapping up, any other kind of final thoughts or words of wisdom that you want to share with anybody else.
Brodie Marshall: I would say, don't underestimate the power of learning. Like I was just really surprised in a way, how sort of energizing refreshing being a learner has been for me. It got me excited about medicine in a way, I haven't been in a while and has motivated to continue the momentum and do the emerge exam. I think it's a good way to shake up your career. If you know you're a few years in and looking for a spark, I was pretty impressed with how that really changed my work career wise.
Michelle Yee: That's awesome to share. Honestly we hear from so many of the fellows that they actually feel like they now realize how much they don't know after doing the SEME program. When you're working, you see the common stuff, which is what you get comfortable with. But the whole thing with emerge is you don't know what you don't know and anything can come through the door. And when it does come to the door, you have to suddenly be an expert at it, with no time and sometimes very little resources. I think having a program that goes through a structured approach with hitting high yield areas for critical resuscitations and simulation is phenomenal.
So thank you so much Brodie for taking the time to speak with us today. It was really awesome to hear a little bit more about the Thunder Bay program and we hope this helps others who are interested in applying to the program. Feel free to reach out to us if you have any questions.
Brodie Marshall: Excellent well thanks for the opportunity to speak. I feel grateful for getting to do the program. Take care.
Michelle Yee: Yeah I was super impressed with the food scene, when I got there because I am a very classic Toronto snob when it comes to food. But there’s surprisingly tons of different cuisines and food that is easily comparable to some of the best restaurants in Toronto. And totally agree with all the outdoorsy stuff. It’s also really fun to be there for different seasons. The drive from Thunder Bay too in the summer is also so beautiful. There are so many different provincial parks, I didn't even know what to expect until I got there.
Brodie Marshall: Yeah some of the best stretches of driving in the country, for sure.
Michelle Yee: So having done the program now, reflecting on who might benefit from the program; there’s a number of different people are at different stages in their careers and they're thinking you know, should I do this now or later? What are your thoughts in terms of who might get the most out of this program?