Do you feel valued, slighted or superior?

This post started because a student requested an observership with an FRCP consultant.

As an EM that has weathered a few storms with this group, I have not personally felt the EM VS FRCP tensions for some time, and frankly there are larger fish to fry (forgive the nautical metaphors as the salt water is in my blood). This student’s request has, however, revealed concerns that need to be heard and addressed, or they will continue to distract us.

If an observer desires a specific experience, and can find someone who can and will provide that experience, so be it. That does not imply to me that one experience/practitioner is more valued to our group than another, only more valued to that student for the specific goals at that time.

The broader question of our value to each other and the group is a different one and is difficult to measure. Because I have been around for a while, I think I am right in my perception that all my colleagues in this group judge me for my strengths and weaknesses, and are there for me when I need them, regardless of whether I am an EM or FRCP, old or new. We have quite a good group here compared to some other places. It is good to have this discussion so those who feel slighted can be heard, and those who feel superior can tell us why. I will copy my comments to the forum.


As a longstanding advocate of the CCFPEM route as immensely valuable to our specialty (started Sudbury program, CCFPEM consultant recruiting in Riyadh and pushed for same in London on my arrival in 2000), I feel saddened that some are still questioning the value, respect and status of CCFPEM vs FRCP. We are colleagues and as Roy so rightly says, our worth is judged by our actions. Just look at the immense research and teaching contributions from both camps. We can be proud of our accomplishments and let’s look to keep moving forward.

The student requesting a subset of experience is something we can take for what it is. As others have said, if that’s what they’re looking for , let 'em have it.

Total = $0.05 (now that we have no more pennies, no more 2 cents worth)

Like Grant, I was one among the first CFPC(EM) to join the group, and unlike Grant, I was also one of the first women to join the group in many years - I always felt welcomed and valued as a member of the group.

That being said, I have heard from some CFPC(EM) colleagues who have felt at some time or another that they are not as valued as our FRCP colleagues - this has definitely improved over the years, and our more recent, fairly structured partnership track reflects this. I have heard via residents that there are a few in our group who do believe we shouldn’t have CFPC(EM)s working in an academic centre (I won’t mention names, it isn’t relevant) but I do believe these few are in the minority and they do not reflect the overall feeling of the group. Frankly, that is their problem … not mine!

There are 5 year and 3 year trained colleagues who contribute heavily to education, research and administration and I don’t see a difference in practice patterns other than in recent grads who are still a bit green - I know my first year in practice was a huge learning curve!

Different routes to training, yes. But at the end of the day, we all work together and contribute our own strengths to the practice of emergency medicine.

A request from a student to shadow an FRCP consultant given the context of the request is not unreasonable - though I do wish that this had been provided up-front. Let’s face it, CaRMS is competetive and these students need all the letters of reference they can get and the only way to accomplish this is to work with FRCP staff. Grant and I receive requests from PGY-2 family residents to work with us for the same reason (though they work with other staff as well) - they want to make themselves known when it comes to applying to the PGY-3 positions.

This is concerning. If someone is aware that a colleague or colleagues should not be working here, he should at least inform Gary and that colleague of his concerns. Complaining to a third party doesn’t help anything. As you say, this is here-say and if true it reflects a minority.

When asking why an FRCP was required, I was asking in the context of a 2nd year medical student observership - not the emerg keening clinical clerk or resident. To me, the needs of these two groups are very different. One has a clear need for facetime with a group of people who pay dues to a specific college and the other I would argue does not.

An FM2 wanting to work with Christine or Grant or other CCFPEMs to improve their chances of securing an R3 position, or a clinical clerk wanting to work with certain clinicians to secure a specific type of reference letter for their FRCP program application makes perfect sense. Networking and face time are very important for everyone involved. We don’t allow these FM2s or clinical clerks to stipulate that they only work with their chosen group so why would we do this for early year medical students?

What are the needs of preclinical medical students seeking an ED observership? Should these be entirely determined by the requesting student? I cannot remember this ever having been debated but maybe it should.

I think all of these students need a great exposure to the career of an Emerg doctor, mentoring and support and if there is interest, help with appropriate networking as they move forward into the clinical part of their career. The letters after the supervisor’s name have no impact on his/her ability to deliver this. College specific advanced networking and letters of reference – these should be part of the clinical clerk and resident years. In my opinion this should cover all of the observership requests unless there are truly exceptional circumstances. Does this cohort of seven preclinical medical students who have all decided to focus their emerg experience with an FRCP mentor constitute exceptional circumstances? Do these students, who have not worked 5 minutes in a clinical setting, have enough of an understanding of the subtleties of the specialty of Emergency Medicine to narrow their scope in this way or any way? Or do they think that when making their observership request through the FRCP residency director this is the right way to ask for it? I don’t know the answer to this but think it isn’t unreasonable to ask.

Should all special requests be put forward without question? Several people agree with this – “if they want it, let them have it”. For me to agree, I need one more clause in there. If they want it – and there is something objectively unique that will be provided – then let them have it. If not, one size fits all. I have been around long enough to have experienced a time when some medical students and residents have requested only the male supervisory experience. The active decision by consultants to not allow them to make that choice helped close another divide that needed to be closed.

Clearly not many answers here but think it is OK to keep asking questions.