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It is designed to deliver a sustainable model of working for the smaller, remote, rural or challenged healthcare system and is likely to be applicable to such systems elsewhere. © Royal College of Physicians 2020. All rights reserved.Introduction More than 6 million Canadians live in rural areas (approximately 20% of the population) and emergency services are a critical safety net for them. Objectives We want to create, in Baie-Saint-Paul (rural emergency department, Québec, Canada), an experimental milieu where all stakeholders develop