As a GP who splits her time between small town Ontario and Nunavut, I gained invaluable skills through the SEME program. Down-to-earth preceptors and hands-on-style teaching provided the ideal training for safe rural emergency care. While the clinical rotations occur in hospitals in the GTA to facilitate exposure to high-acuity cases, SEME preceptors understand the constraints of rural hospitals. Many of them specifically sought out rural locums to better tailor their teaching. Around each acute case we discussed variations: For Mr Y’s head injury, what would make me lean toward early transfer for CT vs serial observation? In the trauma resuscitation of Ms X, what should I do to ensure that the big picture doesn’t get lost when I’m the only one capable of intubating and doing chest tubes? I confront these questions nearly every shift, and I always think back to my chats with SEME preceptors.
Academic days gave us solid and practical foundations. The simulations were so high-yield: under stress, we put together everything we know and worked as a team; the debriefs were full of clinical pearls, from resource management to team dynamics. SEME has made me a more knowledgeable and safer provider. My colleagues who have worked with me before and after notice the difference, and always ask “Should I do it too?” My answer is always unequivocally yes. SEME is unparalleled in its relevance to and support of rural providers. I can think of no other program more deserving of the CFPC Continuing PD program award.
Dr. Yi Wei Hu – 2018
The SEME program was an incredible learning opportunity. It was extremely well organized and focused to help support family doctors working in rural communities be able to provide quality care to their patients. I found the simulation training to be invaluable; it was so useful to work through such a breadth of real life acute care scenarios. I’m not aware of any other training program providing that level of simulation training, especially in combination with very high impact teaching sessions. My confidence and ability to manage acuity in the rural ED has greatly improved and I am very grateful for the experience of SEME!
Dr. Natalie Munn – 2018
The Supplemental Emergency Medicine Experience provided me with ample opportunity and instruction to advance my emergency medicine skills and knowledge. It significantly raised my level of confidence to practice in rural emergency departments – something I was hesitant to do following my family medicine residency. The program was incredibly flexible to meet my personal objectives and was responsive to all suggestions and feedback for how to maximize my learning. The combination of clinical rotations, lectures, procedural sessions and simulation offered a complete package of education on high yield emergency medicine topics. The program was also quite practical in addressing how rural and community settings would differ in their management of certain situations compared to an academic centre, and also provided the fundamentals of coordinating and preparing patients for transport when required.
Ultimately, SEME provided me with a tremendous opportunity to advance an important area of my rural practice. Emergency medicine has become a large portion of the work that I do, and I feel confident in providing great care to my patients. The clinical rotations and simulation sessions have advanced my abilities as a leader, which has positively impacted the whole emergency department team. Completing this program has greatly accelerated my abilities in emergency medicine in a safe, structured and highly specialized fashion. I strongly recommend SEME to all of my colleagues that are looking to initiate or advance their practice in emergency medicine.
Dr. William Stuart – 2018
I am a rural family physician, and started working in a small community in clinics, the emergency department and as a hospitalist shortly after graduating family medicine residency. I worked for about a year before doing the SEME program, and then I returned to the same practice afterwards. While I expect to always feel a little bit anxious in the emergency department (after all, sick patients can show up anytime), the SEME program has helped me feel more comfortable and prepared for those cases. The SIM portion of the program was of particular importance; it allowed me to gain experience in leading the management of critically ill patients in real time, and gave me the safety of knowing that if anything went wrong, the only person that would be hurt was made of plastic. Furthermore, I had the opportunity to work with some fantastic teachers and leaders in emergency medicine, who taught me procedural skills at the bedside of real patients – things that cannot be learned from books. By my first shift back in my rural community, I was using the skills I learned. I was able to do a hematoma block and reduce a wrist alone in my single-coverage emergency department – before SEME I probably would have needed to call anesthesia in to do a procedural sedation, and would have felt much less comfortable with the wrist reduction itself.
Dr. Nina Ramic – 2018
I am very grateful to have had the opportunity to have trained in the SEME program! As a family medicine resident, you are pulled in countless directions along your learning journey, which ultimately amounts to great difficulty in obtaining the proper skills required to feel competent in a rural emergency setting. The SEME program is an invaluable, clinically focused but academically oriented training experience that allowed me to feel more confident in serving my patients in a limited resource setting. The simulation sessions provided me with the necessary knowledge in dealing with extremely stressful emergency resuscitation scenarios. I have had more than a few cases since SEME involving the typical ‘crashing patient’ and have no doubt felt that I managed the patient in a more optimal way. The ability to learn from many staff physicians who have been in the field for many years as a post-residency learner is a unique and indispensable opportunity. Another fantastic benefit of the program is meeting many like-minded physicians with similar career goals who are passionate about their work and in serving their communities. Thank you to all of the hard working staff that have made the program possible!
Dr. Shauna Gallagher – 2018
I have always wanted to practice in a community where family physicians play an important role in terms of clinical, emergency, inpatient, policy, and educational work. To this end, participation in the SEME program was undoubtedly one of the most important periods of my career. Expertly executed and meticulously planned, the most obvious benefit of SEME was that it provided me with the knowledge necessary to provide direct care for ER patients in my community. The clinical rotations were excellent. The degree of hands-on learning was astounding, most notably the simulated learning. Small-group topics were high-yield and provided by quality speakers. My experience in SEME has also aided my time spent teaching Family Medicine residents at a training site geared towards learners whose desire is also to practice rural and small-community medicine. I would recommend this program to any family medicine physician seeking to increase their skills and leadership in community emergency medicine.
Dr. Aaron Wynn – 2018
The SEME program gave me, hands down, the three most rewarding and high-yield months of my career as a medical learner. Returning to a training program after having several years of practice, I came to the SEME program with a much clearer set of learning objectives motivated by the stresses and challenges I’d faced with working in rural ERs. The SEME program substantially enhanced my clinical and personal skills in caring for the sickest of the sick. Being able to run resuscitations with the feedback of experienced mentors, and having the opportunity to hone procedural skills in the ICU were among the many invaluable educational experiences that the SEME program provided. I’ve since returned to practice more enthusiastic about patient care and continuing education than ever before. Furthermore, the weekly SIM-based sessions were consistently top-notch, integrating both clinical and communication skills. The program also went above and beyond in offering personal support, such as through a formal mentorship program. I think the SEME program would be a fantastic nominee for the CFPC Continuing PD program award- responsive to the needs of adult learners, innovative and continuously improving, and above all, helping to meet the health care needs of communities throughout the country.
Dr. Nick Wang – 2018
I am very grateful for my time with the SEME program. Previous to this program, I was working in the ambulatory section of a rural ER. I was looking to add the main ER as part of my practice, however I was hesitant as I was not comfortable with major codes/traumas/procedures. This program touched on all my weakness and allowed greater exposure to the high yield skills we require in these situations. Although it is run out of urban centers, there is enough exposure to be able to bring the skills back to rural environments. The teachings also focus on what we would need as rural physicians.
I came back to the ER with more confidence in running codes, setting fractures and dealing with trauma, along with even more comfort in dealing with common presentations to the ER. The SIM sessions and hands on procedural learning have been critical to my learning and the opportunity to apply it in practice under supervision also helped me increase my confidence. I don’t think I would be as comfortable in small hospitals with single coverage if I did not have this type of exposure under my belt. I am very happy to have had this opportunity and would opening recommend this program to anyone working in rural emergency medicine.
Dr. Lavaniya Mangaleshwaran – 2018
The SEME program is one of the best career decisions that I have made. The opportunity to attend weekly, high quality academic sessions taught by seasoned experts, participate in regular simulations, and do clinical rotations with leaders in emergency medicine made this an invaluable experience for me. While being a comprehensive rural physician was always my career goal, I seriously considered giving up rural emergency medicine after my residency training due to a lack of confidence dealing with higher acuity scenarios. During SEME, I witnessed my confidence and clinical skills rise exponentially; many of my mentors during the program commented on this as well. After attending the SEME program, I do feel qualified as a new staff, and am now working in a northern rural emergency department, where for the majority of my shift, I work as the only physician in the department. I have highly recommended the SEME to several current family medicine residents interested in rural emergency care, as well my colleagues currently practicing. There is a deep need for highly-skilled, committed, comprehensive rural general practitioners in this nation, and I strongly believe that the SEME program helping to meet that need.
Dr. Heather Laasko – 2017
SEME is an excellent program that has given me exponentially increased confidence to practice Emergency Medicine in a rural ER. The academic days are enjoyable and provide a wealth of practical hands-on experience and knowledge, while the rotations (especially the “elective” ones) have helped me develop skills that I would not have gained just by working on my own in the ER. After completing the program 2 months ago, I have now been working in the ER and feel comfortable dealing with many scenarios that I am sure I would have been unprepared for without the program. Having just graduated residency prior to the SEME program, I did not feel ready to practice ER independently and think there is a good chance I would have either never started working in the ER or would have stopped it shortly into my career. Thanks to the SEME program, I feel much better prepared and plan to work in the emergency department to help serve rural communities now and in the future.
Dr. Zack Bordman – 2017
SEME has provided me with invaluable tools which I use on a daily basis in my practice as a Family Physician serving remote and under-resourced Indigenous communities. In the two months since completing the SEME Fellowship, I can think of multiple occasions where my additional training made a significant difference for my patients. The most memorable occasion involved a seven-person head-on high-speed car crash that I managed in a small remote hospital four hours away from a trauma centre. Through the training that I obtained through SEME, I was able to quickly triage the patients and decide that the patient that the paramedics were most concerned about, was not the sickest patient. The sickest patient had subtly abnormal vital signs (fast heart rate and low blood pressure). I used my ultrasound skills which I practices during my fellowship to identify blood in the patient’s abdomen and was able to secure a quick transfer to a trauma centre where the patient was found to have multiple life-threatening injuries and had lost two-thirds of her blood volume into her abdomen. Because of my training, I had the confidence to call for and immediate transfer without having any blood tests or x-rays. Without adequate emergency training, this transfer easily could have been delayed several hours at which point the patient likely would not have survived her injuries. As a result of this case, this remote hospital has agreed to double the size of their blood bank from two units to four units which will help future patients with life-threatening bleeding. This is just one example of the positive impact of the SEME program.
Rural and remote family physicians care for many of the most vulnerable and geographically isolated communities in our country. SEME provides invaluable training to help us in our challenging practice environments.
Dr. Sharon Reece – 2017
I am extremely grateful for the experience I had during SEME. Prior to the fellowship, I did several rural and remote locums right after graduation where ER work was part of the family practice. I remember several shifts having to manage very acutely ill CTAS 1 patients, and feeling so nervous and scared. After having done SEME, I went back to these same rural communities to work and sure enough, I had to run codes and manage very acutely sick patients once again. This time around felt COMPLETELY different. I had a lot more confidence. I felt I had more knowledge and clinical experience under my belt, and a good approach to common ER presentations. I was also a lot more comfortable with leading a resuscitation and running codes, most of which were directly attributable to the regular SIM sessions through the SEME program. I am very happy to have had the opportunity to learn through this program, and I have even been recommending SEME to some of the local rural doctors I have worked with because of how much it has helped me in my practice.
Dr. Stephen Lee – 2017
The supplemental experience in emergency medicine (SEME) program is a well-crafted pathway to clinical courage for rural physicians dedicated to generalist practice. While the program is designed by urban ER specialists, it is really for us. The SEME staff honestly care about the lived experience of rural doctors and so they’ve listened to years of feedback to make the program best in class for post graduate enhanced skills training in emergency medicine.
Before I did the SEME program, I was certainly capable, but nervous a lot of the time. There were things I knew I hadn’t done or seen but could be expected to do on any given shift. This is still true. But the SEME program allowed me to see a little more and manage a little more in a structured, high-intensity way.
I am struck by how my skills in visualization of acute resuscitation scenarios and critical procedural skills have improved. I can imagine more eventualities, and how I would deal with them without feeling mentally blocked by fear and inexperience.
The difference between the SEME program and an emergency medicine residency rotation is clarity of purpose: we were there to get better at being alone in scary situations at home without actually being alone. We were there to work at the edges of our competencies and to grow. Not in 5 years. Not after a licensing exam. Not even to please our shift supervisors. Now. For us and our communities.
Dr. Ashley White – 2017
The SEME program was fantastic. I was interested in emergency medicine since the start of family medicine residency and did may electives. However, after all that training I still didn’t feel comfortable practicing in rural and remote areas where resources are low. The training in SEME made me more confident in my knowledge and my skills. Though the whole program was amazing, the trauma experience had the biggest impact on my current practice. In a trauma centre, many consultant services are involved in a single trauma. But in a rural trauma, I need to be all those services. Through the SEME training, I am now able to visualize what other consultants would be doing in a trauma setting, but be able to do it all with a small team of nurses and myself. There are many places in need for physicians and SEME prepares you to serve in low resource areas.
Dr. Melissa Lui – 2016
I wanted to reach out and thank the SEME team again for having given me the opportunity to take part in the program. The program was superbly run, the lectures (live and online) were first-class, the mentors were invaluable, and the clinical and procedural exposure was some of the best I have personally experienced.
The SEME program fills an invaluable niche in the Canadian medical education landscape – one that should ultimately serve as a model for other provinces to emulate. I often reflect on my experiences in the SEME program, and it has all pointed towards better patient care. I hope other interested practitioners will have the continued opportunity to access to such a great program.
Dr. Cyrus Salek – 2016
The skills and experience that I learned during the SEME program helped me feel confident and able to provide quality emergency medical care up north and in small communities where I locum. The skills are even transferable to my work as a hospitalist, where I respond to acutely unstable admitted patients. In the past month I have had someone seize multiple times, another patient with COPD require intubation, a myocardial infarction and numerous other patients in similar critical condition. I think the SEME program was instrumental in increasing my confidence managing acutely ill patients.
Dr. Britt Lehmann-Bender – 2016
I applied to the Supplemental Emergency Medicine Experience (SEME) program immediately after completing my family medicine residency because I wanted to enhance my acute care skills. The program exceeded all of my expectations! I was able to enhance my critical care knowledge and procedural skills through the online modules, small-group seminars, and simulation labs. Upon completing the program in December 2016, I was ready to confidently practice emergency medicine in a rural setting. I am forever grateful to the SEME program!
Dr. Kara Wollach – 2016
I had left ER Medicine for about 7 years. I had been very reluctant to work ER shifts again. But SEME was amazing and changed my life! I reinforces by previous skills, learnt clinically relevant new skills. I am now working as a full-time rural ER Doc. Thanks SEME.
Dr. Matyas Hervieux – 2016
The SEME program has given me much more confidence and better skills and knowledge in caring for my patients in the ER. Every day that goes by and with every encounter I feel better equipped to handle those emergency situations that caused me a great deal of stress before. I have acquired great resources and contacts since being in the program. I feel that I get less push back from tertiary care centers when trying to refer a sick patient because I am more thorough in my approach and diagnosis. Emergency situations are still stressful for everyone but this program gave me great skills and a consistent approach when dealing with very ill patients. I can’t stress enough how valuable the SIM lab was in reinforcing team leader skills and not having tunnel vision while caring for a critical patient. On my first shift back to work on July 1, I inserted a chest tube in a trauma patient (successfully)! I have since done several intubations, fracture reductions, MIs managed severe sepsis and anaphylactic reactions. Thanks for creating this wonderful program that we as rural physicians can benefit from.
Dr. Norma Charriere – 2016
I am a recent graduate of the SEME program and was very satisfied with the entire experience. Along with a solid clinical base, the program provided valuable knowledge through a wide range of educational modalities including simulation labs, small group lectures, technical skill seminars, and on-line modules. The program is designed to and administered with the learner in mind. I would recommend the program to any family physician looking to enhance their emergency medicine training.
Dr. William Gott – 2016
Prior to starting the SEME program, I had worked for several years in two smaller community emergency departments in Southern Ontario. Although I felt ready to start working in the ER out of family medicine residency, I found the development and enhancement of my skills to be slower than expected. The SEME program provided a structured set of learning objectives that helped to improve my knowledge and develop my procedural and critical care skills. It prepared me for life as an ER doc in a busy community ER department in Northern Ontario.. Thanks again!
Dr. Brian Lemenchick – 2016
The SEME program has had a definite impact on my clinical practice. During the program, my preceptors allowed me to tailor my rotations to meet my objective of working in rural settings. The Simulation Sessions gave me a solid approach to managing critically ill patients and the opportunity to build my procedural skills. As a result of these experiences, I have been able to work more confidently and competently in the Emergency Department.
Dr. Rob Ciccarelli – 2015
SEME is the perfect program for rural and remote family doctors who want to enhance their ER skills. Since finishing the program I feel much more confident in my ability to take care of sick patients. I would highly recommend it to anyone looking to take their ER skills to the next level.
Dr. Adrien Selim – 2015
What an amazing course. It made me feel immensely prepared for rural practice and in my subsequent rural locums, my colleagues have recognized my enhanced skills and even treated me as an ‘expert resource’.
Dr. Adil Shamji – 2014
I simply would not have felt comfortable staffing an ER prior to taking SEME, and I am fairly comfortable at the prospect of staffing one in the near future. This course has been invaluable.
Dr. Luke Russell – 2014