LO089: Out of province elective restrictions: implications for Royal College Emergency Medicine training

Introduction / Innovation Concept: Several provinces (AB, SK and QC) have recently introduced restrictions to out of province (OOP) electives. Concurrently, enhanced competency training is a prominent part of RCPSC Emergency Medicine (EM) programs (Thoma et al., 2015). We present the implications of OOP elective restrictions on RCPSC-EM training and education. The revised 2008 RCPSC-EM requirements specify a minimum of 6 months devoted to achieving a particular expertise pertinent to the practice of EM. The most restrictive policies permit up to 3 months OOP during the 5-year residency. This limits residents’ ability to pursue enhanced competency training opportunities outside their training site. Enhanced training might be a graduate degree, fellowship or clinical year designed by the resident and program director. Enhanced training can help achieve specific career goals, meet the needs of the institution where the resident will practice, and contribute to the growth and development of EM in Canada. Methods: New OOP policies are evaluated using the Health Reform Analysis (HRA) and SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis methodologies. Stated and implied reasons for reform are evaluated and stakeholder perspectives (health system authorities, partner universities, resident physicians and the general public) provided. Curriculum, Tool, or Material: The material includes previous out of province elective policies and recent reforms. Conclusion: Policies for the 4th year EM elective time are variable across universities. This has resulted in inconsistent approval of residents’ requests for OOP enhanced training. Thus, enhanced training that might be approved at one site, may not be at another. Several test cases already exist and will be presented. This data has not been previously collated or reported to our knowledge. Varied interpretation of newly emerging policies has implications for the consistency, equity, and future of EM residency training in Canada.