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SEME Alumni: Toronto - Dr. Kevin Si (10 min)

Michelle Yee: Hey guys, my name is Dr. Michelle Yee. I'm one of the Assistant Program Directors for SEME and today we are here with Dr. Kevin Si. Kevin was one of our most recent graduates, and I just wanted to give him a chance to share with you guys his thoughts on the SEME program. So Kevin, start off by telling us about yourself.

Kevin Si: Thanks Michelle. So I'm a graduate of the University of Toronto. I completed medical school there. I did residency there as well in Family Medicine. And during my residency, I really saw myself as a hospitalist actually, and that's where I saw my future going until I did my rural practice. I ended up in Southampton, which is beautiful, and it's about 3 hours north of Toronto. It was kinda towards the end of my residency, and I really really found myself loving emergency medicine and not enjoying hospitalist as much as I had envisioned before. And at that time, it was impossible to apply for a plus one. And working in that emerge, I realized I didn't have many of the skills I needed for those patients. Like I had patients that come in who'd need to be intubated or needed a central line because they were going to go to ICU that was maybe an hour away. So it was really interesting being there, and I loved the medicine, but I really didn't have the skills necessary to do emergency medicine. And so at that time I kind of found myself stuck between a rock and a hard place.

I didn't really know about SEME at that time until I came back to Toronto, and I did an elective out of Etobicoke General because I wanted more acute care experience. And that was the first time that I had met somebody who had completed SEME and actually was working in a downtown center. Now I know that that's probably not what SEME was created for and envisioned for. But it was interesting to me that somebody with similar experiences to me, graduating from a residency in Toronto, and completing SEME, felt comfortable enough to work at one of the highest acuity and highest volume centers. So I ended up talking to him and actually there were 2 graduates there that I ended up getting to know that graduated from SEME, and they spoke really highly of the program. I ended up then going to St. Joe's for another elective, and I met another recent SEME grad, who also spoke really highly about the program. So long story short, I applied for SEME. I got in. I worked in Fergus for 2 months as a single coverage emerge, which is also rural, about 30 min north of Guelph. Loved it, came back, did SEME, and now I’m working in Georgetown, Etobicoke, Brampton, and also Peel Urgent Care.

Michelle Yee: Thanks for sharing Kevin. Yeah, it's funny, because I remember you working with me as a resident on shift at Sinai, and I remember that you actually were not interested in emerg. Like you were doing great still. Certainly you were on track, and everything, too. But that's not how you envisioned your life. So tell us a little bit more about the SEME program.

Kevin Si: I can't speak more highly of a 3 month program. Like I can't envision something being so high yield as compared to SEME. It's 3 months, you do 3 rotations. 2 of them are emerge, one is an icu anesthesia, and/or a mix of both, or trauma. And then once a week you do simulations, and you focus on such high yield topics. I found that those were probably the things that were missing the most from my experiences, just doing simulation every week, and really getting down to the nitty gritty of acute care medicine. That was the most valuable experience. I’ve made such good friends through the program too. Like we still have the Whatsapp Group. We still chat, so you know, the day to day of SEME, you do your work, you go to your rotation. But that core day on Wednesdays was the highest yield experience that I've had in my medical training. I think I actually missed it a lot. Like we do simulations maybe once a month at my current site, and I'm always yearning for more. Actually I feel like during SEME I was better at my codes, and I was just so much more prepared, so that was my experience. I loved it. I had such a good time. I know that all of my other co-fellows also felt the same way.

Michelle Yee: One thing I remember during the program, you were just so receptive towards feedback. You were so interested in learning and getting more. Talk to me about what that felt like to go back and be a learner after already having technically graduated.

Kevin Si: A lot more hesitant sometimes to do it right. I think that it was easier for me because I had just graduated, and I'd only been 2 to 3 months of being staff, and I really had no ego at that time. I was like, I'm a sponge. I will ask anyone if they have any advice for me. I'm willing to because it’s valuable to see that there are different perspectives in Emergency Medicine and people have different skills. I think it was challenging going back to needing an evaluation and sometimes getting constructive feedback on your performance. And obviously, you take a pay cut, that was a big one too that can't be understated. But I think the things that I've learned over those 3 months and the skills that I've gained through that experience are irreplaceable, and I think a lot of it has to do with just being a lifelong learner. Like keeping that no ego going into your shift, and seeing even younger graduates. I have medical school students that teach me things during my shift sometimes too. And I think that was the approach I took into SEME and I gained so much from that. It’s always good to just self-reflect and see that there are a lot of things that you can learn from others.

Michelle Yee: You talked about the fact that a lot of people who do SEME are really trying to get that comfort level around those acute high risk, high acuity, resuscitation, sort of situations. Talk to people about your comfort level with that before the program and after it.

Kevin Si: It's probably better said as an anecdote. I just remember having a guy come in with a hemothorax who was stable, but could have become unstable at any time, and basically his whole lung was filled with blood, and he needed a chest tube. So I called the general surgeon through criticall in Fergus, and he's probably an hour away, and he says, “Why don't you just put a chest tube in?” And I sat there, and I thought about it for a long time. And he's like, “You've done one right?” And I was like, “I think I did. In ATLS on a mannequin.” He's like, “Okay, no, no, no, no, just call your general surgeon. Get him to come in and do it.” And I ended up admitting the guy and having the general surgeon do it in the morning, and thankfully the patient was stable. But I just remember that it's okay if some people aren't comfortable doing that. But I remember that fear and having that fear level being like 10 out of 10, that this patient was going to crash on me, and I didn't have the necessary skills to help him.

And after I finished even the first month of SEME, like after, finished ICU, and then doing our skills day, where we practiced chest tubes, I would say like, now I I have like very little fear in doing it. And if you compare my critical skills from then I would rate it maybe like a 2 out of 10. I could intubate. But I wasn't able to do a central line. I wasn't able to do a chest tube, and I was very uncomfortable doing any pigtails. Now I do those routinely, so I would say now I'm more like an 8 or 9 out of 10. There's always more to learn. I'm getting better every day at ultrasounding before I do my procedures. But such a world of a difference.

Michelle Yee: Awesome thanks so much for sharing. As we wrap up, any other last thoughts or things that you wanted to share with people who are interested in the program?

Kevin Si: Yeah, I would say that something that I noticed was that the people who had done some emerge before starting, I felt that they got a lot more out of the program. Not to say that many others didn't, but the ones that didn't, I believe their idea was that they were going to start emerg after SEME, which I believe that they're doing now, so it was still a fruitful experience for them. But I think the piece of advice I’d share from my own experience and the experience from my co-fellows was that even a little bit of emergency medicine before starting SEME, it's good for you to learn what things that your community doesn't offer, and or what skills you don't have. Like in Fergus. I didn't have to learn how to do a central line, because we didn't have an ICU there, so that was totally okay. But I think that it's good to know your community, know what services you provide, and what you don't provide, and what skills you need, and you get that from working in your own emerg.

Michelle Yee: Well thank you again, Kevin. It was such a pleasure to have you as part of our program, and I really appreciate you taking time to speak with us today.

Kevin Si: Of course, anytime thanks for having me.

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