Nanaimo and Northern 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 Nanaimo Emergency Education Program (NEEP) and the Northern Emergency Education Program (NoEEP) are changing this. 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.  

Our Achievements

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Expanded point-of-care ultrasound workshops

We expanded our point-of-care ultrasound workshop this year to include Family Practice Anesthesia program participants and CCFP(EM) residents. This increased our cohort of learners, exposed NEEP and NoEEP fellows to another group of upskilling family physicians committed to practicing in non-urban communities, and expanded the network of colleagues committed to non-urban practice, which enabled both groups to master a practical rural skill set. Support from the Rural Coordination Centre of BC was integral to this expansion; otherwise, CCFP enhanced skills trainees would have no opportunities to connect and train with our rural fellows in such an intense setting. This experience enhanced and strengthened both groups’ views on the feasibility of rural mixed practice settings. 

 In addition, we have now trained enough rural fellows to have some return and assist in these workshops. This reinforces graduates’ skill sets, making them a stronger resource in their local communities, and provides a deeper frame of reference for current trainees to see the post-graduate opportunities for their ongoing rural work. 

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Expanded training in definitively rural, lower-resourced locations

We continued receiving a high level of interest in NEEP and NoEEP and have leveraged this interest with UBC’s Enhanced Skills Program to lay the foundation and infrastructure to support expansion of the formal CCFP(EM) training program to locations with a more rural focus. July 2021 saw the expansion of the program out of the Lower Mainland to include two positions based in Prince George, connected to Nanaimo, in which residents spend the bulk of their time training outside the Lower Mainland. Their “rural” component of the program is truly rural in centres similar to Tofino and Quesnel, as opposed to their urban counterparts, who are exposed to Kamloops and Nanaimo as “rural” centres. In these smaller, more definitively rural emergency departments, these residents work with mixed–practice, experienced preceptors in significantly lower–resourced settings. These opportunities expose them to the possibility of using their training in a wider variety or practice settings than just the Lower Mainland. The residents are offered attendance with our fellows at NEEP and NoEEP academic days, and have commented positively on the practical, hands-on appeal of these academic sessions.  

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Enhanced physician retention in rural settings

Many NEEP and NoEEP graduates remain in rural settings. On the maps, yellow pins indicate those trained in NoEEP (12) based in Prince George, while blue pins show those trained in NEEP (34). A substantial number (9/46; red pins) of our graduates have continued with this training and furthered their interest to further pursue EM certification via the practice eligible route. These graduates have become certified and remained in their rural locations. They now provide a further resource to their communities and their colleagues/hospitals. These individuals closely represent the original intent of the CCFP’s Enhanced Skills Program. 

Making a Difference

Dr. Kevin McMeel is living every program director’s dream: The Nanaimo and Northern Emergency Education Programs, which he leads, are so successful that they continue to attract more applicants than they have the capacity to train.

Given the Programs’ demonstrated success—and to meet ever-growing needs—Dr. McMeel and his team proposed significant changes to the Programs to the Joint Standing Committee (JSC) on Rural Issues in November 2021.

“Rather than continually reapplying for grants to the JSC, we requested an ongoing grant—and they showed considerable interest in prioritizing this project in their budgeting process,” says Dr. McMeel. “We also requested that it be rolled into the Rural Education Action Plan (REAP) program funding in including accepted applicants as qualifying criteria for REAP funding. The budget was adjusted to reflect the actual and slightly increased funding costs incurred.” 

Further to this, Dr. McMeel and his team have identified a third site for expansion—Kamloops—to accommodate growing demand and geographically diversify training sites and options.

“We have identified local champions in Kamloops and cultivated an environment with their group to move forward with this expansion,” says Dr. McMeel. “And we also partnered with UBC Department of Family Medicine’s Enhanced Skills Program to further expand their Emergency Medicine program into Kamloops with the addition of two residency positions based in the Interior to follow a successful implementation of the project at that site.”  

The team is also exploring a potential future expansion to a fourth site—and fourth health authority—for a program based at Lion’s Gate Hospital within the Vancouver Coastal Health Authority.

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

“Managed a difficult airway with successful intubation in a rural ER requiring multiple troubleshooting maneuvers during which I was able to draw directly on SIM and in situ experience with airway management from NEEP. If I had encountered this patient prior to NEEP training, this patient may have died. Multiple examples where point of care ultrasound has either improved quality of patient care or aided in transfer decisions.”
“NoEEP was excellent and has allowed me to practice with more confidence. I have a lot to learn still but I also feel that NoEEP gave me the tools to be  able to continue learning on my own.”
“I had a 26-year-old who had a cardiac arrest (Torsades) from severe alcohol withdrawal and electrolyte disturbance (likely—no labs where I am). My colleague began the resuscitation while I drove from 40 min away to assist.  When I arrived, we had ROSC but she had status epilepticus refractory to meds.  I ran the intubation and though there were some challenges (first and second pass failed), I was able to remain calm and work through the algorithm for difficult airways to improve my third chance, which I succeeded at. We transported her by helicopter to the closest hospital and she actually survived.”