Integrated training program gives medical residents a broader view of patient care

By training in both family medicine and emergency medicine, residents gain a unique perspective on patient care

What does it mean to care for a patient through their health care journey?

For residents in the Saint John/Sussex Integrated Family Medicine and Emergency Medicine (iFMEM) program, it can mean seeing a patient in the emergency department during a medical crisis and following up with them days later in a family medicine clinic.

That continuity of care is one of the qualities that drew both Dr. Maggie Keyes and Dr. Nick Ellingwood to the innovative program — a collaboration between Horizon Medical Education and Dalhousie Medicine New Brunswick’s Department of Family Medicine — and continues to shape their training experience today.

The three-year program, one of the first of its kind in Canada, helps prepare medical residents to manage everything from chronic health conditions to life-threatening emergencies while training in both rural and urban settings.

Keyes and Ellingwood were drawn to the program’s integrated approach and its strong connection to the communities they call home.

“I wanted the chance to serve the communities that I grew up in,” said Ellingwood, originally from Quispamsis and now in his third year of residency.

Keyes, a Saint John native in her second year of the program, said being able to explore both of her passions for family and emergency medicine was a major factor.

“Getting to learn and work to the broadest scope of family and emergency medicine is what makes this program one of the best in the country,” said Keyes.

An integrated approach to physician training

One of the defining features of the iFMEM program is the opportunity to develop skills in two distinct, but complementary, areas of medicine.

Residents provide primary care in a community-based office at Horizon’s Sussex Health Centre (SHC) while also having privileges at Horizon’s Saint John Regional Hospital (SJRH). Most of their three-year training takes place in Sussex, where they collaborate with a family physician and regularly work in SHC’s emergency department. 

Family medicine and emergency medicine may seem like very different fields, but both require physicians to think critically, adapt quickly, and manage a wide range of patient needs.

“When I see patients in the emergency department, my biggest concern is to diagnose and treat any life-threatening medical concerns in that moment,” she said. “Whereas in family medicine, I am trying to optimize my patients’ quality of life, manage long-term health conditions and prevent disease.”

Ellingwood agrees that the combination creates well-rounded physicians.

“It allows you to be a true generalist,” he said. “I can be optimizing someone’s chronic diseases one day and managing a heart attack the next.”

In addition to family and emergency medicine training, residents also gain experience in specialties including general surgery, geriatrics, obstetrics/gynecology, pediatrics, and palliative care.

Following patients across their care journey

A unique advantage of the Saint John/Sussex iFMEM model is the ability to follow patients across care settings, which Keyes described as one of her favourite aspects of the program.

“I think it is really cool when I am working in the emergency department, and I get to treat one of my family medicine patients and then, as their long-term provider, can schedule a follow-up appointment with them in clinic shortly after,” she said.

Ellingwood shared a similar experience, noting that he often follows up with patients he first encountered in the emergency department.

“It’s rewarding to see patients in clinic the following week to ensure their care plan is still working for them,” he said.

Building confidence through rural emergency medicine

Both residents also point to training in Sussex’s rural emergency department as one of the program’s greatest strengths.

Keyes said rural emergency departments challenge physicians to think critically and adapt to situations where resources may be more limited.

“We still see lots of moderate- to high-acuity patients that we have to learn how to manage with often fewer resources, less personnel, and longer time to definitive care,” she said.

Ellingwood added that training in Sussex provides exposure to a diverse range of cases and allows residents to play an active role on every shift.

Serving the communities they call home

Perhaps most importantly, Keyes and Ellingwood say the program has strengthened their connection to the communities they hope to serve. Following residency, both plan to practise family medicine and emergency medicine in Saint John and Sussex.

Their shared commitment reflects one of the program’s greatest strengths: preparing physicians who are not only clinically skilled but deeply invested in the health and wellbeing of New Brunswick communities.

Whether treating patients in the emergency department, supporting them in a family medicine setting, or building lasting relationships in rural communities, participants in the Saint John/Sussex iFMEM program are gaining the skills and experiences needed to make a lasting impact.