RAMS Wilderness Roadmap

WILDERNESS MEDICINE Wilderness Medicine (WM) is regarded as the practice of medicine in a resource limited and austere environment.

MED STUDENT (MS3/4)

JUNIOR RESIDENT

background

Senior RESIDENT

Resources

AUTHOR: Braden J. Tucker Contributors: Stuart Harris, MD; Susanne Spano, MD; Elisabeth Edelstein, MD; Hillary Irons, MD; Lara Philips, MD; Christanne Coffey, MD; Tracy Cushing, MD; Brendan Milliner, MD; and Gabriel Cade, MD Welcome to the Emergency Medicine Education Roadmap, your definitive step-by-step guide on how to succeed in Wilderness Medicine at every training level. Don’t know where to start? Click on “Background” or select your training level above. A full list of fellowships, conferences, and publications can be found in “Resources.” For pearls of wisdom from faculty and residents in the trenches, click on “Insider Advice.”

FELLOW

insider Advice

1 - SENIOR MEDICAL STUDENT M1-M2

Students that are interested in Wilderness Medicine (WM) are encouraged to identify the environment they plan to practice, and make training decisions around that goal. Early in medical school, become involved in or help create an interest group in WM. Participate in committees, attend conferences, and be involved with different educational opportunities. Seek out faculty members at your school that can provide opportunities to participate in WM research, events, or outreach.

• Maintain and develop new outdoor passions.

• Interest groups: learn from others why they want to do WM and their mistakes/successes.

• Volunteer in a free community clinic.

• Educational opportunities both teaching and learning.

• Find something you are passionate about and find opportunities to share that passion to show your interest in academics.

• Longitudinal participation in community outreach and underserved populations.

• International experiences can be helpful but not necessary.

M3-M4

Regarding selecting a residency program, pick a residency program based on aspects of the program that appeal to you rather than what fellowship you intend to complete following residency. One does not need to complete a fellowship in WM to become an academic leader in the field. The building blocks of WM can likely be supported in any residency one chooses whether or not they have a WM elective or a fellowship. When looking at programs that offer wilderness or austere medicine electives, take into considerations what aspects of WM you find most engaging and decide if the elective offered aligns with those interest. If you plan to attend a program that does not have WM electives then seek out opportunities to complete an away elective at a residency that does provide an elective of interest.

• WM electives, browse Visiting Student Learning Opportunities and apply early.

• Main priority should be development of clinical knowledge and excellent bedside manner.

• W M rotation was voted one of the most valuable rotations to complete, and a great way to think independently as it is skills and scenario based training.

• 3 vs 4 year programs not as important when applying for WM fellowships.

2 - JUNIOR RESIDENT During residency, exposure to the Wilderness Medicine (WM) environment and culture is critical to being informed about career choices and practice emphasis. As a resident be sure to rotate in locations of resource poor areas, participate in electives, continue to develop outdoor interest, and educational teaching/research passions. Attending committee meetings at national conferences such as SAEM or WMS in your first year can expose you to leaders in the field and necessary information to determine if WM is the best career fit for your interests. Mentors can help guide you to a program that will be the best fit for you. Additionally they can help you better understand what fellowship, research, and a career in academics entails.

• Credentialing in other WM educational programs can be an opportunity for applicants with limited exposure to WM electives.

• C ontinue to foster outdoor interests/hobbies and work/volunteer in austere environments. Shows interest and commitment to WM. Programs want to know why WM and what experiences/service opportunities you have had in the field.

• E xplore the field and grasp what it is. Remember: you can do ski patrol without the fellowship, this is intended to be an academic and leadership development program. Show what you want to get out of your fellowship. Programs want to feel that you can add to the experience.

• Be involved in WMS at some point early on to show your interest.

• Do a rotation at an institution that you are interested with a fellowship.

• Reach out to programs, faculty, and active participants in WM early in residency to show interest.

3 - SENIOR RESIDENT As a senior resident, continue participation in Wilderness Medicine (WM) electives, outreach, education & teaching, research projects, and personal interests in the great outdoors that you have cultivated since medical school and as a junior resident. Now is also the time to start looking at the different WM fellowships, expanding your professional network, and finding a program that is right for you. Seek advice from your mentor(s) as they presumably know you and your interest, and are in a great position to advise you as to what programs would be a good fit. SAEM, ACEP, along with the WM Society conferences are great opportunities to explore interests and meet others in the field. This is also a time to become more involved academically; volunteer to review manuscripts and participate in research projects if you haven’t already.

4 - FELLOWSHIPS Wilderness Medicine (WM) programs are committed to finding fellows that have demonstrated a passion for the field, have insight into the process/challenge of academic research, and an understanding of how WM will influence the scope of their practice.

Fellowship is 1-2 years in length depending on the program. Fellows are brought on as faculty, working some shifts in the emergency department while having a vast majority of their time protected for their education and research development. Apart from their own education, fellows are often involved with teaching medical students, residents, and other medical providers though didactics, WM curriculum or other certification courses. Many fellows gain additional certification (DiMM, FAWM, etc), participate in local and global events in their area of interest, and other personal pursuits.

This is a non-ACGME accredited fellowship but in 2009 the WM programs and faculty established a standard curriculum that programs use but individually adapt to their own areas of focus. The curriculum covers topics from environmental exposure and wilderness trauma to wilderness EMS with a strong emphasis on teaching and education as part of the curriculum. Outlined are core content and educational objectives for all fellowships. Click here for more information.

A limited number of programs accept applicants for other specialties but this will potentially change with pending SAEM accreditation which would limit it to only emergency medicine certified applicants. Please contact programs directly for more information.

5 - BACKGROUND Wilderness Medicine (WM) was established as the practice of medicine in a resource limited and austere environment. This discipline has been intricately linked with the advancement of medical practice in warfare, and is thought to have its roots with the naval physicians of early city states, who are considered by some to be the first practitioners of WM. Over time the field has evolved with the establishment of societies and associations that promote education, research, and advancement of wilderness training to the modern physician. In 2009 the standardized criteria was accepted by the existing fellowship programs to establish the current core curriculum for WM. While often applied in outdoor environments, WM is applicable in disaster situations, rural communities, and impoverished locations without access to the conveniences, support, and technology of modern medicine.

To learn more read “The Foundations of Wilderness Medicine: Some Historical Features.” PMID: 22656664

Careers

A career in WM for each practitioner is unique and depends upon personal interests. Some focus on a practice in a resource limited environment, while others place an emphasis on education, research, volunteering, or administration, based on personal preference.

WM provides the opportunity to expand an emergency medicine career to outside of the hospital. Research within the field is rapidly expanding as there is exponential growth of global health outreach as well as participants in outdoor recreational activities. This has resulted in a growing need to develop medical care in these resource limited environments. Many practitioners are involved in but not limited to: • Local search and rescue

• E MS services

• Expedition medicine

• D isaster medicine

• Event medicine

• R esearch

• International medicine

• T raining of other medical professionals

• Rural medicine

• P rogram directors

• Mission trips

6 - RESOURCES Conferences

Accreditation

• Society for Academic Emergency Medicine (SAEM) Annual Meeting

Currently Wilderness Medicine (WM) is not an ACGME accredited fellowship but this does not detract from its value for a physician considering a career in WM. A fellowship provides an extensive training that exceeds criteria for other wilderness training resources. More importantly a fellowship incorporates a scholarly component of research and education. The lack of accreditation is helpful as it allows for more flexibility in training emphasis unique to each program. The applicant will find that programs will have different educational emphases in addition to the core curriculum such as mountain, marine, tropical, disaster etc. Applicants will need to take into account the emphasis a program may place on a certain field of study when applying. Regardless fellows are well prepared and qualified for job placement, education pursuits, and practicing WM in a variety settings.

Journals, Publications, and Resources • Academic Emergency Medicine (AEM) •H igh Altitude Medicine & Biology •W ilderness and Environmental Medicine •T ravel Medicine and Infectious Disease •W estern Journal of Emergency Medicine •W orld Journal of Emergency Medicine • Wilderness and Environmental Medicine Podcast

Grants • Society for Academic Emergency Medicine (SAEM) •W ilderness Medical Society

Organizations • Society for Academic Emergency Medicine (SAEM) • Wilderness Medical Society (WMS) • Emergency Medicine Residents’ Association (EMRA) • American College of Emergency Physicians (ACEP)

7 - INSIDER ADVICE Dr. Stuart Harris, WM Fellowship Director, MGH “There are no an easy pathways in WM and very few clinical position. But WM provides opportunities to get involved and be a leader and educator in an expanding field. WM is a supplement to my regular clinical work. If you want to be involved you need to be committed to finding or creating your own opportunities.”

Dr. Susanne Spano, Program Director WM Fellowship, UCSF Fresno “For me, WM is the directing premedical care to EMS that are on the ground in the local national parks during emergent situations. Additionally, I have focused on the educational aspect of WM education, working with students, residents, and other training programs.”

Dr. Tracy Cushing, Program Director WM Fellowship, University of Colorado “WM to me is practicing remote, resource-poor medicine with unique environmental pathology and unique transportation/evacuation/prolonged care. There are also the need for specialized knowledge of environmental diseases and role between medicine and the environment in the era of global climate change. Become involved with these areas at an early stage.”

Dr. Scott McIntosh, Program Director WM Fellowship, University of Utah “The ability to expand my emergency career to something that I enjoy doing outside of the hospital and help people in challenging situations. Clinically there are many opportunities to work in mountainous areas (eg, Himalayan Rescue Association), remote areas (eg, Antarctica), and closer to home as well. Many people have research interests in wilderness and/or mountain medicine and can “practice” WM from their regular job.”