Future Considerations

I find myself entering a unique position. I have just entered my last year of residency training and will be spending it as a Chief Resident. I am now trying to decide what to do, upon completion of my three years of post-graduate medical training. My interests are:

Expedition Medicine

Travel and Tropical Medicine

Global Health

Rural and Remote Medicine

Now, the question is how best to prepare for these types of medical practice? Should I complete a fellowship (additional years of training), perhaps in sport medicine or emergency medicine? Advanced training in sports medicine would help me deal with muscular/skeletal injuries and outdoor sports-related problems. Emergency medicine, with its reductions of dislocated shoulders, laceration repairs and acute problems would be a helpful addition to my skills. There are several rural medicine fellowships, such as the program in Tacoma, Washington.

What about just completing a second residency (3 more years of training)? Instead of doing a rural medicine fellowship (for family medicine doctors), I could just do an additional residency in Emergency medicine. In America, there are several very interesting fellowships open to graduates of Emergency Medicine residencies. The program at Stanford looks especially cool. New Mexico also has a very nice looking Wilderness Medicine program. There is a Family Medicine program, in Montana, that has a wilderness medicine track, but I am already completing my study at a different program.

So how does one gather more knowledge about these specific areas of medicine? Existing specialities I have already begun seeking additional training in include:

Travel and Tropical Medicine
Diploma in Travel and Tropical Medicine and the ASTMH Certificate of Knowledge, Fellow of the Royal Society of Tropical Medicine and the International Society of Travel Medicine

Wilderness Medicine (including Search and Rescue)
The Fellow of the Academy of Wilderness Medicine (FAWM), I am still gathering units for my fellowship through attending conferences like the National Expedition Medicine Conference and the WMS Events.

Global Health
Master’s Degree in Public Health specializing in International Health and Complex Emergencies/Disasters

Rural and Remote Medicine
Co-authored a paper on Portable Field hospitals for Rural and Remote Health

I then began thinking of skills I might be in need of, with this type of career track:

Basic surgical skills such as removing an acute appendicitis, wound incision and drainage, etc

Obstetrical Skills including vaginal and ceserean deliveries

Pediatrics training involving infectious diseases, immunizations and nutrition, plus basic disease treatment

Emergency Medicine’s unique skill set such as fracture and dislocation reductions, toxicology and familiarity with acute issues

Infectious Disease as it especially pertains to tropical medicine such as disease prevention and treatment of illnesses such as malaria

This list is, by no means, a complete skill set and hopefully conveys the wide scope of knowledge practitioners in these fields require. I guess that my point is that there is considerable overlap of medical specialities needed to form a decent skill set for this “new speciality”. I think of it similiar to the growth of Emergency Medicine from Family/General Practice. The job of working in an emergency room was being performed, traditionally, by family medicine doctors with experience giving care to adults, children, obstetrics and general medical training. From this, the concept of a unique skill set that I see Emergency medicine as, evolved.

Is wilderness and travel and expedition and remote medicine all one, unique and new speciality?