Never Too Young

DECEMBER 2018 ANZCA BULLETIN

Never too young... Embracing National Anaesthesia Day Research funding: Indigenous health: $A1.5 million awarded What we’re doing for 2019 projects Your PAEC ANZCA’s Professional Affairs Executive Committee Chair, Clinical Associate Professor Leonie Watterson, explains 48 PAEC’s role and how it beneﬁ ts fellows. Contents 4 President’s message 50 Safety and quality news 5 Chief executive ofﬁ cer’s message 53 Anaesthesia and cosmetic surgery 6 Letters to the editor 54 Discover the world with the library’s 7 President's portrait unveiled new discovery service 8 ANZCA and FPM in the news 58 ANZCA Clinical Trials Network: New multicentre studies in the pipeline 10 Advocacy – a year in review 59 Foundation update 14 ANZCA’s professional documents: What would you do? 62 CPD news 16 Hospitals and practices embrace 63 CPD: Lifelong learning ANZCA National Anaesthesia Day 64 Changes to the ANZCA Training 23 The 2018 Ray Hader Award for Program National Anaesthesia Day Pastoral Care 70 Faculty of Pain Medicine A record number of hospital and private practice 24 ANZCA participates in Indigenous 78 Successful candidates “champions” in Australia and New Zealand meetings helped promote our sixth successful campaign. 82 Tri-nation Alliance strengthened 16 28 Indigenous health: Spinning 83 ANZCA Anaesthesia and Pain Medicine a healthy yarn History and Heritage Grant 30 Desert experience a preparation 84 Special interest group events for life on Mars 88 New Zealand news 32 Gaza medical mission a lesson in 90 Australian news humanity and resilience 98 Obituaries Research grants 34 Anaesthesia and pain medicine The ANZCA Research Foundation has allocated research boosted by $1.5 million $A1.5 million to a diverse range of anaesthesia and pain medicine projects in Australia and 48 The ANZCA Professional Affairs 34 Executive Committee: Advancing New Zealand for 2019. our fellows’ interests

ANZCA Bulletin Submitting letters and other Copyright The Australian and New Zealand material ANZCA may promote articles College of Anaesthetists (ANZCA) We encourage the submission of that appear in the Bulletin in is the professional medical body letters, news and feature stories. other forums such as the ANZCA in Australia and New Zealand Please contact ANZCA Bulletin website and ANZCA social media that conducts education, training Editor, Clea Hincks at chincks@ platforms. and continuing professional anzca.edu.au if you would like to Copyright © 2018 by the Australian development of anaesthetists contribute. Letters should be no and New Zealand College of and specialist pain medicine more that 300 words and must Anaesthetists, all rights reserved. Extreme environments physicians. ANZCA comprises contain your full name, address None of the contents of this Two fellows tell us what it’s like to be about 6700 fellows and 1500 and a daytime telephone number. publication may be reproduced, trainees mainly in Australia They may be edited for clarity thrown out of their comfort zones. stored in a retrieval system or and New Zealand. It serves the and length. transmitted in any form, by any 30 community by upholding the means without the prior written highest standards of patient safety. Advertising inquiries permission of the publisher. To advertise in the ANZCA Cover photo: Jacob, 5, takes a keen Please note that any views interest in National Anaesthesia Bulletin please contact [email protected]. or opinions expressed in this Day activities at Auckland’s publication are solely those of North Shore Hospital. the author and do not necessarily Photo: Dr Ashwina Rao. Contacts ANZCA represent those of ANZCA. Medical editor: 630 St Kilda Road, Melbourne ISSN: Dr Nigel Robertson Victoria 3004, Australia 1038-0981 (print) Telephone +61 3 9510 6299 2206-5423 (online) Editor: Facsimile +61 3 9510 6786 Clea Hincks [email protected] Indigenous health Art direction and design: www.anzca.edu.au A new “yarning circle” pain Christian Langstone Faculty of Pain Medicine management program for Production editor: Telephone +61 3 8517 5337 First Nations people has been Liane Reynolds [email protected] 28 trialled in North Queensland. www.fpm.anzca.edu.au Sub-editor: Carolyn Jones Advertising manager: Vivienne Forbes

2 ANZCA Bulletin December 2018 3 President’s message Chief executive ofﬁ cer’s message

benefi t of anaesthesia and pain medicine Perioperative medicine is a prime The Faculty of Pain Medicine’s Our fellowship survey that was working together under the banner of one current example that involves all these workforce has also grown to 362 active completed in the fi rst half of 2018 college is clearly evident. The college is in stakeholders working together in an fellows (329 in Australia and 33 in New indicated that fellows wanted to see a position to provide important logistical atmosphere of mutual trust and respect, Zealand). This represents a growth of 3.4 more college activity in advocating and collegial support and the work of for which our profession is providing the per cent from 2017 to 2018. Over the last on behalf of anaesthetists and pain the faculty contributes signifi cantly to leadership (not ownership, trust me) and the safety and quality of the care that co-ordination. fi ve years, the average growth in Australia medicine specialists. Submissions to we all deliver. Once again though, the Finally, I recognise that if we are to has been 5 per cent per annum while only governments and other agencies have strength of this relationship should address the inequities in healthcare 3.5 per cent per annum in New Zealand. consumed signifi cant resources in both not be taken for granted, and requires delivery that exist in certain communities Not surprisingly, 90 per cent of the Australia and New Zealand – and with attention, commitment and respectful within our two countries, and that exist pain medicine physician workforce a number of successes. Notably, the acknowledgment of our differing between us and our global neighbours, is based in major cities. We continue successful campaign to have codeine circumstances and challenges. then we absolutely need to work in with our efforts to locate more training products moved from schedule 3 to The importance of partnerships partnership with our colleagues in those positions in non-metropolitan centres and schedule 4 was supported by many extends into the world of research, communities. I use the term partnership to establish sustainable pain clinics in medical colleges, but the Faculty of Pain where our Clinical Trials Network pointedly, in that working as partners those areas. Medicine and ANZCA took a lead role in is internationally recognised as gives due recognition to the principle that supporting the Australian Therapeutic the exemplar of collaboration. The we are working as equals, and that we all 2018 in review Goods Association’s recommendation to network conducts large, public-good, benefi t from the interaction. I am acutely The development of perioperative governments, despite ongoing opposition I am becoming increasingly aware of the collaborative multi-centre trials which aware (and grateful) of how much I have ANZCA’s workforce medicine as an ANZCA-led initiative critical importance of both the internal each offer the potential to guide changes learnt from my colleagues in Indigenous, from vested interests. ANZCA reviews the anaesthetist and pain has been a positive start to a multi-year and the external partnerships our college to our management practices and lead to migrant and rural communities, and in Finally I would like to recognise medicine workforce numbers half-yearly program. Other medical colleges and enjoys, and in recognising that their value improved patient outcomes. Currently, Papua New Guinea. the outstanding work throughout this along with the numbers of trainees in societies have accepted our invitation to and functionality should not be taken for trials are recruiting from more than Our relationship with the community year to enhance the training portfolio Australia and New Zealand. join our steering committee and working granted. 130 sites in Australasia and around the will be most constructive if our system. This was an ANZCA-wide project In Australia, there are 4786 active parties, recognising that perioperative Having had the privilege of attending world and include PADDI (Perioperative membership refl ects that community involving fellows and almost every the recent ANZCA and New Zealand Administration of Dexamethasone and and I remain convinced of the benefi ts of anaesthetists and in New Zealand, 740 medicine will be implemented in different department and is designed to provide Society of Anaesthetists (NZSA) Annual Infection), ITACS (IV iron for Treatment workforce diversity across all demographic active anaesthetists, giving a total of forms throughout New Zealand and a much better online experience for Scientifi c Meeting I have been reminded of Anaemia before Cardiac Surgery), and ethnographic domains. We compare 5526. There are a further 735 retired Australia as well as between private and trainees and supervisors in tracking of the reality that Aussies and Kiwis have T-REX – (Neurodevelopmental outcome favourably among the other colleges in anaesthetists in both countries. The public settings. much in common, but equally, we need after standard dose sevofl urane versus terms of gender representation, and the progress through the training program. number of active anaesthetists represents As 2018 comes to an end, while we to recognise our own distinctly different low-dose sevofl urane/ dexmedetomidine/ benefi ts of this representation to our The project was completed in an increase of 3.2 per cent in the 2017-18 are in the early developmental stages, characteristics. Leaving aside the usual remifentanil anaesthesia in young profession are obvious. We have recently November, on time and on budget year. The average growth in the active a direction has been set and working jokes about underarm bowling, applying children), the ROCKet Study (Reduction undertaken a number of important steps and has been rolled out in time for fellowship for ANZCA as a whole is 3.6 relationships with those outside ANZCA sand-paper to cricket balls, the capabilities Of Chronic Post-surgical Pain with to improving opportunities for Indigenous the commencement of the hospital per cent per annum. Australia has grown and who are interested in perioperative of our respective rugby teams, and quirky Ketamine), the Balanced Anaesthesia trainees, however there remains much employment year in New Zealand. accents (it did take me a long time to work Study – (the infl uence of anaesthetic work to be done, and I wonder how at the rate of 3.4 per cent per annum and medicine are sound. The Perioperative I take this opportunity to thank out what “fush ’n’ chups” were), our two depth on patient outcome after major well we are doing in providing training New Zealand at the rate of 4.5 per cent per Medicine Special Interest Group (SIG) our hundreds of volunteers who have countries do differ in terms of the private surgery) and POISE-3 (tranexamic acid and opportunities to young doctors from recent annum. meeting that was held in Melbourne in contributed to the college’s achievements and public health frameworks, rural and hypotension avoidance to reduce the risk migrant communities. In 2016 the National Medical Training October attracted almost 500 delegates. throughout the year. I would also like urban divides, (particularly in relation to of cardiovascular complications after non- I am unclear as to why ANZCA should Advisory Network, an agency of the We are quietly enthusiastic about the simple geographical practicalities), and cardiac surgery). be in this position, though it gives me to recognise the work of our staff who Commonwealth Department of Health, plan we have laid out for the next several the realities of different jurisdictions. I attended last month’s Hong Kong cause to think that we need to be more support every college committee and forecast that the Australian anaesthetist years. I don’t pretend to call myself a College of Anaesthesiologists (HKCA) proactive in recognising the benefi ts of bring invaluable expertise to ANZCA’s workforce would grow at 4 per cent per ANZCA continues to be active in the sociologist, and neither am I an ASM where we discussed joint ventures training a workforce whose heterogeneity operations. anthropologist (though who knows, in education, examinations and research. refl ects that of the population that we annum and could trend towards over- provision of overseas aid under the one day I might be referred to as an As two professional cohorts with many serve. I would urge all of us to encourage supply. We can see from these fi gures direction of the Overseas Aid Committee, John Ilott anaesthesiologist), but travelling around similar goals and challenges, ANZCA and support young doctors from these that the fi ve-year average (3.6 per cent) is led by Dr Michael Cooper. Our annual Chief Executive Offi cer, ANZCA New Zealand it is apparent the fabric of and HKCA can work closely together marginalised communities who are below the forecast. ANZCA’s fellowship report will provide details of the various society differs to Australia in varying to leverage each other’s expertise in seeking to enter into FANZCA and/or survey also reported that fellows were projects. In addition to the valuable degrees of subtlety. Of particular note I am these realms, and I look forward to FPM training, and to recognise how their working on average four hours per week annual projects and scholarships, we will increasingly reminded of New Zealand’s strengthening and formalising this inclusion enriches our profession. longer than they were three years ago. self-identity as a bilingual and bicultural important collegiality. In closing, consideration of be making additional funds available The workforce supply and data from the ANZCA Research Foundation in nation, and the prominence of Māori Trust and respect seem to be critical partnerships obviously lends itself to trends for anaesthetists suggest that the culture in day-to-day life. cornerstones of successful partnerships, a reminder about the importance of 2019 to fellows who have ideas for new workforce is likely to remain in balance Of course our two countries have and if they are lost, it can be diffi cult nurturing our relationships with those projects. More details of the application far more in common than we have in to regain them. Invariably, any activity who are nearest and dearest to us. I hope for the next fi ve to seven years. This does process will be provided early in 2019. opposition, and clearly we each have embarked upon with anything less than we all fi nd time for some sort of a break not imply that the workforce in every much to gain by working together. The completely good faith is eventually over the festive season, and to enjoy those location at every point in time will be in challenge seemingly is to maximise revealed as such. We do enjoy a reputation relationships. balance. We know there are some centres the opportunities presented by our not just for excellence, but for integrity, A heartfelt thank you to all of you who where there is over-supply from time commonalities while acknowledging and it is crucial that we maintain this contribute so selfl essly to our profession, to time. On the other hand, we remain and respecting each other’s different reputation. The willingness with which and to our community. concerned about the number of regional environments. other Australasian colleges, other Go well. centres who continually struggle to The highly successful recent Faculty of international colleges, our societies recruit FANZCAs due to under-supply in Pain Medicine Spring Meeting in Cairns and government all engage with us is Dr Rod Mitchell those areas. provided a model of the strengths of multi- testimony to the reputation we enjoy. ANZCA President disciplinary collaboration, and the mutual

4 ANZCA Bulletin December 2018 5 Letters to the editor President's portrait unveiled

A photographic portrait of ANZCA’s Professor Scott’s wife Dr Liz Wilson, What’s in a name? Guidelines on Monitoring During Anaesthesia The time has come to • Scope of anaesthesia practice be clearly Some background defined in our professional documents. explore – again – whether Discussion on the title anaesthetist • A marketing or public relations group be we should align ourselves versus anaesthesiologist is not new. The consulted re the need for and impact immediate Past President Professor their son Chris and daughter-in-law following examples highlight this: The 2017 revised PS18 ANZCA Guidelines on Monitoring with the majority and call of a name change. ourselves “anaesthesiologists” 1998 • The marketing group advise on the best or continue to be known In 1998, “Terminology – Anaesthetist/ implementation of any such change. Anaesthesiologist” was discussed at the as “anaesthetists”, say the • That the first item be reviewed every 1 presidents of the three core October ANZCA Council meeting. The two years. Anaesthesiology following is extracted from the minutes groups representing the from this meeting: The relevance of the first item was that David A Scott by Chris Budgeon was Michelle were special guests for the specialty in Australia and During Anaesthesia include recommendations on the use of “During consideration by the August the scope of practice of anaesthesia New Zealand. Executive of the President’s Report on extended beyond the operating room into Time for change? the ASA Federal Executive Meeting preoperative assessment and preparation, Should we stay … the revival of the anaesthetist/ and into postoperative care and anaesthesiologist debate was highlighted. management, that is, perioperative care. “anaesthetists” or It was suggested that to widen discussion However, again, no change ensued. could we become on this issue, information on the pro 2013 neuromuscular function monitoring. unveiled at the college’s Melbourne offi ce unveiling of the portrait at the ANZCA and con arguments could be included in In 2013 the College undertook a survey “anaesthesiologists”? the publications of the College, ASA and that identified that one in 10 community The most widespread term globally for NZSA. It was agreed by the Executive members did not know that anaesthetists doctors who practice the specialty of that the matter of terminology should were doctors, and that 50 per cent thought anaesthesia is anaesthesiologists (or be (highlighted) at Council for further that only some anaesthetists were anesthesiologists). discussion. doctors. This is a widely understood term and “(It was noted) that this topic is being 2017 PS18 cites a single reference paper, this reference was There are many ways this message can differentiates doctors in many countries increasingly debated and suggested that it in November. The portrait was taken in CEO and President’s end-of-year drinks Anaesthesia is the second In 2017 a name change for the speciality be communicated via formal advocacy from non-specialist, or even non-medical should be undertaken in an open forum. most important medical and specialists has been raised again by: and lobbying, but this lacks traction if “anaesthetists”. He noted that only the UK, Australia and intervention – ever. the public view is ill-informed. Media In Australia and New Zealand this New Zealand now use anaesthetist as • The Australian and the New Zealand It sounds like a big call but consider for promotion and programs such as ANZCA’s distinction is not as essential because opposed to anaesthesiologist. Following societies of anaesthetists following on a moment that after the management of National Anaesthesia Day are part of our protected name (by the Australian brief discussion, it was agreed that a case from discussion at the World Federation infectious diseases (that is, public health, a strategy to enhance our profession’s Health Practitioner Regulation Agency or ‘for’ and ‘against’ should be published of Societies of Anaesthesiologists antibiotics, vaccination/immunisation, identity in the Australian and New the Medical Council of New Zealand) is in the Bulletin. Dr Thompson undertook (WFSA) 2016 conference and the authored by Dr Sorin Brull et al and was published in European Society of Anaesthesiology in September at Professor Scott’s hospital, event. ANZCA President Dr Rod Mitchell and antisepsis/sterilisation), anaesthesia Zealand communities. specialist anaesthetist. No one else is able to compile an article with input from in its various forms enables life improving We will continue to do these things. to represent themselves using this term. interested parties.” 2017. and life-saving interventions to be But maybe we need a more fundamental On the other hand, a strength of the No change ensued. • Informal discussions by ANZCA with the provided to tens of millions of patients change to enhance our specialty’s identity title anaesthesiologist is that an “–ology” College of Anaesthetists of Ireland (CAI) 2 2004 annually, radically improving their with the community while also aligning represents a discipline based on scientific and the Royal College of Anaesthetists quality and duration of life safely and our specialty’s name with a larger part of What is an rigour and research. It is certainly our In 2004, the then-ANZCA President (RCoA) in the UK. effectively. the global community. research that has led to the sophisticated, Professor Michael Cousins established Anaesthesiology in 2017 . PS18 also lists some background • Feedback from ANZCA Fellows and The pioneers of our specialty were a taskforce chaired by Professor Guy The following article is provided to safe and effective anaesthesia that we trainees during the consultation period St Vincent’s in Melbourne and will be told the gathering that the college was predominantly medical practitioners who anaesthetist? Ludbrook to research, review and discuss inform the discussion on whether we practice today. In the community, an for the ANZCA Strategic Plan 2018-2022. through innovation and the development should change the name of our specialty “–ologist” is more instantly recognised broadly with the fellowship a name • A specific request from Dr John of safer and more efficient techniques laid from anaesthesia to anaesthesiology [an-ees-the-tist] as a specialist or expert in the area of the change to the speciality of anaesthesia Crowhurst through correspondence to the foundations of what was to become and us from anaesthetists to “–ology”. to anaesthesiology and a name change the Australian Society of Anaesthetists’ today a specialty. anaesthesiologists. In clinical practice we deliver from anaesthetist to anaesthesiologist. (ASA's) Australian Anaesthetist Our specialty is based on expert As I stated in my previous president’s anaesthesia. It has been historically the This taskforce did not make a firm reading including similar guidelines from overseas. magazine and formally to the ANZCA training and education, ongoing research message – let’s have the conversation, practice to call the provider of anaesthesia recommendation for change but produced and development, and a high level of a report for ANZCA Council in September chief executive officer and president very fortunate to have benefi tted from you will decide! hung in the college’s council room in an anaesthetist. So, why should we even at the 2017 ANZCA Annual General professionalism. It is important for think about changing? 2005 with the following recommendations our continued ability to progress these Professor David A Scott in summary: Meeting in Brisbane. attributes for the care of ever-increasingly President, ANZCA • In social media, an active Twitter complex patients, that these standards conversation is ongoing debating the are maintained. merits of a name change. The background paper to PS18 (PS18BP) quotes Dr Brull’s It is easy for the public, for politicians and decision-makers, and even for our “It has been historically the practice (continued next page) Melbourne. The portrait of Professor Scott Professor Scott’s leadership as he is professional peers, to underestimate how dependent safe and effective anaesthesia to call the provider of anaesthesia is upon skilled practitioners and ongoing an anaesthetist. So, why should we research. even think about changing?” article: “Objective measurement … is the only method to wearing scrubs in theatre was captured widely recognised for his expertise determine appropriate timing of tracheal extubation”. Based over several hours at the hospital. in research, safety and quality, on this the PS18BP concludes that “quantitative monitoring Budgeon, a Melbourne-based pain medicine and cardio-thoracic Anaesthesiologist or Anaesthetist: is recommended to assess depth of blockade prior to reversal and assessment of What’s in a name...? photographer whose work is included anaesthesia. adequacy of reversal”. in the collection of the National Portrait “David is a deeply thoughtful and I have been an anEsthesiologist in the However, not mentioned in PS18BP is that the Brull reference continues that there Gallery in Canberra, also created the considerate person of true integrity USA for many years and still regularly is a “lack of availability of an easy-to-use, accurate, and reliable monitor … this portrait of Professor Scott’s predecessor who is always prepared to listen,” encounter members of the general public technology is not yet commercially available”2. Dr Mitchell said. who are surprised to learn I am a medical So PS18 recommends use of a product whilst the article it has based this Dr Genevieve Goulding. doctor who performs such an important recommendation on states that the monitor we should use is not yet commercially and comprehensive role in perioperative available. medicine. The Brull reference article continues that a “monitor is currently under Changing the title will alone not erase development” by Senzime2. Dr Brull is a board member of Senzime and owns over 4 this ignorance and elevate our public million shares in the company and 10 per cent of its capital value3,4. Dr Brull’s article professional standing – even if you retain is perhaps aptly named “Current Status of Neuromuscular Reversal and Monitoring, the additional “A”. Challenges and Opportunities”. FANZCA PS18BP acknowledges that there is debate over this issue and does fall short of Dr Philip Brown, 5 California, US mandating the use of neuromuscular monitors at this time . Dr Anna Pedersen, FANZCA Nothern Beaches Hospital, NSW References: 2019 ANZCA Council 1. PS18 2017 version. From (ANZCA website): www.anzca.edu.au/documents/ps18-guidelines-on- monitoring-during-anaesthesia.pdf accessed May 14, 2018 elections 2. Brull, SJ and Kopman, AF Current Status of Neuromuscular Reversal and Monitoring, Fellows are invited to nominate for Challenges and Opportunities. Anesthesiology. 2017; 126:00–00 six vacancies to the ANZCA Council. 3. https://www.senzime.com (accessed August 2017) Prior to submission, each nomination 4. https://www.senzime.com/investor-relations/share/The available literature relating to PS18 form must be signed by two fellows of Guidelines on Monitoring During Anaesthesia the college, as well as by the nominee 5. PS18 BP 2017 version (ANZCA website): www.anzca.edu.au/documents/ps18bp-2017.pdf and submitted to the Chief Executive accessed May 14, 2018 Offi cer before 5pm AEDT on Friday, January 11, 2019. Response If more than six nominations are The available literature relating to PS18, including Dr Brull's reference, generated received an electronic ballot will take robust discussion at recent ANZCA Safety and Quality Committee meetings, and place from March 8-22, 2019. serious consideration was given to if and how the recommendation to encourage If you intend to vote, please ensure neuromuscular function monitoring should be made. There is evidence that your preferred email address is up inadequate reversal or use of inappropriate doses of reversal agents can contribute to date via www.anzca.edu.au/ to morbidity. A subsequent article, albeit with Dr Brull as co-author (and confl icts membership/login or by contacting declared), and the AAGBI guidelines www.aagbi.org/sites/default/fi les/Standards_ [email protected]. To avoid your of_monitoring_2015_0.pdf also support the college's position. voting keys going to spam folders, The authors believe the principle of encouraging such monitoring is appropriate, please add noreply@electionrunner. despite concerns regarding the limited availability of “accurate” monitors. This com to your safe sender list. advocacy has driven improvements in monitors over time including pulse oximetry Results of the ballot will be which has advanced in reliability and accuracy. There are many other such announced at the ANZCA Annual instances including measurement of blood pressure, temperature, end-tidal carbon General Meeting which will be held dioxide, and processed EEG. As the clinical need is demonstrated, these monitors on Thursday, May 2, during the 2019 improve and become more accessible. ANZCA Annual Scientifi c Meeting in Finally, there is more than one accelerometer-based NMB monitor available in Kuala Lumpur. Australia and New Zealand. For more information visit Dr Peter Roessler and Professor David A Scott www.anzca.edu.au/front-page- PS18 Document Development Group news/2019-anzca-council-elections.

6 ANZCA Bulletin December 2018 7 ANZCA and FPM in the news NAD 18, opioids and anaphylaxis hot topics for media coverage

A joint FPM, Painaustralia and FPM’s joint media release with Scriptwise warning against Australian Pain Society media release combining opioids and sleeping tablets was also included in the Since the September 2018 edition of the ANZCA welcoming private health insurance Health Matters column in The Australian by health editor Sean Bulletin, ANZCA and FPM have featured in: reforms which are due to start from April Parnell on September 20. Dr Craigie was quoted in “The dope on 2019 was covered by The Australian pharmaceuticals” article which reached an audience of 95,000 • Three TV reports (with extensive syndication). newspaper’s health editor Sean Parnell people. • 10 print reports. in his Health Matters column on October Fellow Dr Jennifer Stevens was quoted in a Daily Telegraph • 40 online reports. 26 reaching an audience of 95,000 article “Taking a united stand on scourge” about Australia’s people. Fellow Dr Marc Russo was also opioid epidemic on September 21. Dr Stevens said people were • 90 radio reports. interviewed for ABC online, The World not aware of how dangerous strong opioids can be. The article Today and ABC radio news about the reached 233,000 readers. The story was then followed up by the Media releases since the previous Bulletin: proposed changes to private health Ten Network’s The Project on September 28 for a fi ve-minute insurance cover. segment about opioid use, “Most overdose deaths now due to Friday October 26: FPM Dean Dr Meredith Craigie and prescription drugs” which reached an audience of 580,000 ANU’s Dean of Medicine calls for more women specialists Vice-Dean Clinical Associate Professor people. Friday October 19: Mick Vagg were interviewed live in the Specialist pain medicine physician Dr Harry Eeman was studio by the ABC’s Far North radio interviewed by ABC Radio Melbourne morning host Jon Faine Australian researchers search for ‘holy grail’ of pain morning host Kier Shorey in Cairns on on October 30 about the organisation Doctors with Disabilities relief Friday October 19 ahead of the start of Australia. The four-minute segment reached an audience of Wednesday October 17: National Anaesthesia Day attracted media The West Australian ran a page 1 the Spring Meeting that afternoon. Dr 108,000 people. Craigie and Clinical Associate Professor Pain experts call on Minister Hunt to review $20 million interest in Australia and New Zealand story on October 5 about three WA pharmacy pain trial with news stories across radio, print and anaesthetists Dr Bruce Powell, Dr Andrew Vagg were interviewed for 20 minutes Carolyn Jones online outlets including the Herald Sun, Heard and Dr John Thompson who were on a range of topics including opioids, Media Manager, ANZCA Tuesday October 16: medicinal cannabis and private health Channel Nine news, Radio New Zealand seriously injured in three separate cycling Life-saving stroke treatment focus of new research insurance reforms. and Fairfax New Zealand. In Australia, accidents. Perth anaesthetists ANZCA Clinical Associate Professor Vagg was Anaesthetists push for targeted delirium and memory councillor Dr Chris Cokis and fellow Dr New Facebook group for new fellows ANZCA distributed three media releases also interviewed by the Cairns Post before loss research Are you looking for a forum to share information with other for National Anaesthesia Day: one on a Andrew Miller were interviewed for the the Spring Meeting about why consistent new fellows, and discuss the unique challenges in navigating Botched cosmetic surgeries prompt new patient safety trial of chocolate-fl avoured tramadol, story by medical editor Cathy O’Leary. access to good quality, co-ordinated pain a new specialist medical career? Or perhaps you’re looking for information one on anaesthesia and cosmetic surgery Anaesthetist and intensivist, fellow medication is a better option for patients some peer support or to build networks with others in a similar and another release on delirium and Dr Peter Saul was profi led in a Newcastle than medicinal cannabis. The September Thursday October 11: situation as yourself? anaesthesia. A media release on research Herald story “Caring for life, talking about 23 story referred to the faculty’s position Following the phenomenal success of similar groups for Chocolate-fl avoured painkiller a breakthrough for into life-saving stroke treatment was death” on September 15. Dr Saul believes that the only responsible way to use ANZCA trainees, we’ve set up a closed Facebook group for children distributed in New Zealand. In total, dying is a subject most of us try not to cannabis-related products in a pain ANZCA and FPM fellows in the fi rst three years of fellowship. It’s the National Anaesthesia Day coverage think about, let alone discuss. The story setting is in a properly conducted clinical Wednesday September 12: facilitated by the New Fellow Councillor Dr Christine Vien, along attracted an audience of nearly three reached 35,000 readers. trial. The story was syndicated to nine with fellow representatives in each Australian region and New Pain groups note passing of PHI reform legislation with million people. For more details on Fellow Dr Ian McKenzie, the Director other News Limited online sites including some concern Zealand. It’s a great way to connect and collaborate with other coverage see the feature on page 16. of Anaesthesia and Pain Management the Herald Sun, The Daily Telegraph, the new fellows. Channel Nine news broadcast a two- at Melbourne’s Royal Children’s Geelong Advertiser and the Courier-Mail A full list of media releases can be found at Visit the ANZCA Facebook page for more information. Hospital was one of the hospital’s key reaching a readership of 100,000 people. www.anzca.edu.au/communications/media minute story on October 2 about ANZCA’s Facebook.com/ANZCA1992 ongoing concerns with pholcodine in spokespeople for the planned surgery to Dr Craigie was interviewed by cough medicines because of its link to separate Bhutanese conjoined twins Nima ABC online for a report which ran on anaphylaxis. Channel Nine in Sydney and Dawa Pelden. The twins’ story has International Overdose Awareness Day on expressed interest in the issue in May attracted local and international media August 31 to raise awareness of accidental during the ASM in Sydney and with fellow coverage. overdoses of combining prescription Dr Paul McAleer there as chair of the The Sydney Morning Herald drugs. The article followed a joint FPM Australian and New Zealand Anaesthetic interviewed fellow Dr Rob Hackett about ScriptWise media release warning of the Allergy Group it was a great opportunity a campaign to standardise Australian dangers of combining prescription drugs. The 800-word ABC article reached an for us. The interview was done on the hospital emergency numbers. The move audience of 232,000 people. Dr Craigie forecourt of the Sydney convention centre to have a uniform number is supported was also interviewed for ABC Radio and the story fi nally made it to air as an by ANZCA, the Australian Resuscitation National’s Breakfast program on August Council and the NSW Health Minister “exclusive.” It was broadcast nationally 28 about real time prescription monitoring across 59 Nine network news stations Brad Hazzard. The August 22 story and this reached an audience of 138,000 and reached an audience of over 800,000 attracted 90,000 readers. people. people. The Faculty of Pain Medicine has featured in several news articles and radio interviews on a range of issues Above: Fellow Professor Britta Regli-Von since the last ANZCA Bulletin. Ungern-Sternberg featured in a Nine News report about her ANZCA Research Foundation- funded study into chocolate-fl avoured tramadol for children at the Perth Children’s Hospital.

8 ANZCA Bulletin December 2018 9 ANZCA and government: Building relationships Advocacy – a year in review

Australia New Zealand

• Health practitioners competence assurance amendment bill Some of the initiatives discussed at the 2018 advocacy in review (New Zealand Health Select Committee). meeting which will be further explored in Advocacy and Strengthening Throughout 2018 ANZCA has worked to engage with government • Regulation of Australia's health professions: keeping the coming months included: and other stakeholders to ensure the college’s views are communications recertifi cation of National Law up to date and fi t for purpose (COAG Health • Actively pre-selecting trainees with acknowledged and considered. A particular highlight has been Council). a rural background to enter the for chronic pain vocationally-registered the college’s work on advocating for safe sedation to apply to all Tasmanian Anaesthesia Training practitioners administering sedation. During the year ANZCA We know from the ANZCA fellowship survey that members value services doctors Program. hosted safe sedation “roundtables” in both Australia and New the submissions and advocacy work of the college. As illustrated An in-depth research document on the Members of ANZCA’s New Zealand Zealand. Representatives from a range of medical, nursing and above, advocacy can take a number of forms and in 2018 the • Rotating trainees in the south (Hobart), costs and burden of chronic pain in New National Committee and staff from dental practitioner groups engaged in the workshops, with college has worked hard to engage with government and other the north (Launceston) and the Zealand has highlighted a need for more the New Zealand offi ce attended the the primary aim of developing an agreed set of overarching stakeholders about issues that matter to our members. We look northwest (Burnie) as part of their pain medicine specialists. annual meeting of vocational education safe sedation competencies that could be incorporated into forward to continuing to represent your views in 2019. training. The "The Problem of Chronic Pain advisory bodies of the Medical Council their curricula. The ANZCA Safe Sedation Project Group is now • Developing post-fellowship pathways and Scope for Improvements in Patient of New Zealand (MCNZ) on September consolidating the feedback from the workshops to fi nalise a set where newly qualifi ed anaesthetists Outcomes" report by the Sapere research 11, 2018. Strengthening recertifi cation of of competencies, which will then be sent to relevant colleges and Government programs can begin work in the rural northwest group was commissioned by the Faculty vocationally-registered doctors was the organisations for their approval and use. ANZCA staff have recently attended regional committee meetings of Tasmania with options of short- of Pain Medicine (FPM), shows more than main item on this MCNZ agenda. In other advocacy work, the college continues its in New South Wales, Victoria, Queensland and Tasmania to term rotations to Hobart for skills one in fi ve adults in New Zealand (around There are some important differences representation on a number of steering committees and working discuss Specialist Training Program (STP) priorities and the maintenance. 770,000) experience chronic pain and that in the MCNZ’s proposed approach to the groups with various government departments and agencies. progress of the implementation of the revised distribution model • Developing a rural provisional the numbers will increase as the risk-based approach the Medical Board These include the Ministerial Working Group on Out of pocket following the 2017 program review. In addition, visits have also fellowship, incorporating exposure population ages (to around in Australia (MBA) is considering. The expenses, the Medical Benefi ts Schedule Review, the Rural been made to training sites in Darwin, Perth, Albury, Lismore to relevant elements of professional 1.26 million by 2048). MBA is looking to mandate requirements Locum Assistance Program, the Victorian Medical Workforce and Adelaide, as well as a number of regional training hubs. rural practice such as leadership, The Sapere report says that without for ageing doctors, isolated doctors, Planning Advisory Group and the Queensland Medical ANZCA continues to engage with external stakeholders, retrieval medicine, intensive care, and additional investment, pressure on and where there have been multiple Practitioner Workforce Plan. including jurisdictional health departments, as part of ongoing Indigenous health. current services will continue to increase, notifi cations. This is not part of the During the year ANZCA's Safety and Advocacy staff met management of the STP, including the related Integrated Rural ability to respond to patients’ needs will proposed New Zealand approach. ANZCA • Exploring “virtual training sites” where with over 50 government and non-government stakeholders in Training Pipeline and Training More Specialist Doctors in decline, wider health system costs may is generally supportive of the MCNZ’s trainees experience broad, quality Australia including: Tasmania programs. increase, and patients’ quality of life will proposed recertifi cation approach, which training at more than one private likely deteriorate. is considered a “therapeutic” approach • Australian Department of Health (Health Workforce Branch, hospital. Postgraduate Training Section, Health Workforce Reform Although the report confi rms much of (for the doctor), not a “diagnostic” Branch). ANZCA meets with the Tasmanian what the faculty has known for some time, approach for the regulator. it adds weight to painting the picture of • Victorian Department of Health and Human Services. Health Service the problem that is not widely understood Supporting ANZCA’s • Tasmanian Department of Health and Human Services. On September 13 ANZCA CEO John Ilott, Director, Safety and in New Zealand. It highlights the paucity • Queensland Health. Advocacy Clea Hincks and Tasmanian Regional Committee of the pain medicine workforce and pain representative on the Chair Lia Freestone met with Tasmanian Department of Human Australian • Australian Indigenous Doctors’ Association. management services in New Zealand and and Health Services secretary Mr Michael Pervan and his Chief submissions: provides more evidence to work towards Te ORA advisory group • National Aboriginal Community Controlled Health Medical Offi cer Professor Tony Lawler to discuss the Training • Australian Society of Plastic a service where people have access to Dr Courtney Thomas is ANZCA’s Organisation. More Specialist Doctors in Tasmania (TMSDT) program, which is Surgeons – Plastic and reconstructive appropriate specialist chronic pain representative on the Māori Medical part of the Specialist Training Program. The lack of pain services • Regional Training Hubs. surgery draft curriculum. services. The New Zealand National Offi ce Practitioners Association (Te ORA) in the north and northwest of the state, and how the program advisory group. The group is scheduled The college also made more than 45 written submissions in has started to work on an advocacy and might be utilised to address this issue was also a key topic. • Council of Australian Governments to have its fi rst meeting in late November response to a range of policy initiatives and inquiries. Some communications plan with the FPM New ANZCA welcomes the opportunity to work with the Tasmanian Health Council – Regulation of 2018. Being part of the advisory group examples of the range of topics include: Zealand National Committee to ensure department and the Tasmanian Health Service in exploring new Australia’s health professions: the information is used effectively. This supports our Indigenous health strategy, keeping the National Law up to date • Sexual boundaries in the doctor-patient relationship (Medical models of service delivery to allow better access to healthcare. will include engaging with government particularly in terms of partnership with and fi t for purpose. Board of Australia). ANZCA strongly supports the Tasmanian department’s approach agencies and other Māori. It also enables ANZCA, along with to assess and plan the clinical workforce in Tasmania with a • Misuse of drugs (medicinal cannabis and other matters) key stakeholders. other colleges, to develop a closer working view to long-term success. relationship with Te ORA. amendment bill (New Zealand Health Select Committee).

10 ANZCA Bulletin December 2018 11 ANZCA and government: Building relationships Pain services feature in Tasmania and New Zealand advocacy (continued)

New Zealand

Convened by Dr Lee Fleisher, Professor, and Chair of Establishing a PHARMAC Anesthesiology and Critical Care, Perelman School of Medicine advisory group of the University of Pennsylvania and Dr Carol Peden, Professor of Anesthesiology, Keck School of Medicine, University of ANZCA is establishing an advisory group to give expert advice Southern California, the group will develop Actionable Patient to inform submissions to PHARMAC’s consultations on national Safety Solutions (APSS) which will be released at the upcoming contracting for anaesthesia small equipment and consumable 7th Annual World Patient Safety, Science & Technology Summit devices from. Expressions of interest from suitable people have in California on January 18, 2019. been sought and the group proposes to have its fi rst meeting In May 2018 ANZCA became the fi rst organisation from before the end of the year. Australasia to become a Committed Partner and the fi rst specialist training college to join. To fi nd out more visit Patient Safety Movement http://patientsafetymovement.org/. Following the Patient Safety Movement’s 2018 Midyear Planning Meeting in September, co-convened by UCI Health, ANZCA Immediate Past President Professor David Scott has joined New Zealand submissions: a group of multi-disciplinary patient safety experts to focus on Delirium, in collaboration with the American Society of • Medical Sciences Council – Draft policy and guidelines for locum practice. Anesthesiology Brain Health Initiative. Delirium is an emerging topic in patient safety. An estimated • Medical Council of New Zealand – Sexual and professional 2.6 million patients affected by delirium in the United States boundaries in the doctor-patient relationship. alone and between 30 to 40 per cent of delirium is estimated to • Ministry of Health – National Ethical Standards for be preventable. Failure to acknowledge the presence of delirium Health and Disability Research. in a patient can lead to an inappropriate discharge, extended hospital stays, increased readmission rates, and increased • Medical Council of New Zealand – Recertifi cation mortality rates. of vocationally-registered doctors.

Contributing to Papua New Guinea ANZCA sponsored prizes Donation to PNG for excellence in anaesthesia anaesthetists for 2017 in PNG The anaesthetists at Port The ANZCA sponsored prizes Moresby General Hospital in for excellence in anaesthesia Papua New Guinea recently for 2017 in PNG were presented received a cardiac ultrasound by Dr Michael Cooper, Chair of probe worth about $A10,000 the Overseas Aid Committee, as a donation from Fujifi lm on November 2 at the weekly SonoSite Australasia. The department of anaesthesia company has also agreed to meeting at Port Moresby General update the software in PNG’s Hospital. SonoSite ultrasound machine which will give it enhanced The recipients are: cardiac imaging capability. Dr Raymond Kalai – best overall undergraduate performance This will enable the PNG anaesthetists, especially Dr Arvin in the anaesthesia module, School of Medicine & Health Karu, to perform trans-thoracic echocardiography (TTE) in the Sciences, University of PNG, 2017. operating theatres at PNG's major referral hospital. Dr Clementine Goimba – best overall performance in the The chair of ANZCA’s Overseas Aid Committee Dr Michael Diploma of Medicine to go on to the Masters of Medicine training Cooper delivered the SonoSite gift to the hospital early last scheme in Anaesthesiology, School of Medicine & Health month. Sciences, University of PNG, 2017. Above: Dr Cooper (left) and Greg Luck, Country Manager-Managing They each received a certifi cate from the college and a cash Director Australia and New Zealand, Fujifi lm SonoSite. prize. The Garry Phillips Prize for the best performance in the fi nal Masters of Medicine (Anaesthesiology) was not awarded in 2017.

12 ANZCA Bulletin December 2018 13 ANZCA’s professional documents What would you do? Dr Peter Roessler explains ANZCA’s professional documents using practical examples.

The college acknowledges the boundaries of current thinking, and by two digits – for example PS28. Of Externally developed guidelines importance of transparency and any then administer appropriate research course there are exceptions, and that for endorsement by ANZCA must be statement or guideline relating to processes and procedures to test the applies to administrative professional evaluated in accordance with A02 Policy anaesthesia, the Faculty of Pain Medicine hypotheses. At times, data and evidence documents that are policies and therefore on Endorsement of Externally Developed and perioperative medicine is available may be confl icting and unresolved in preceded by the letter A (administrative) Guidelines. The process is different but fi t and accessible on the website. With the which case our fellowship may approach and followed by two digits such as A01. for purpose. revision of the college website there will management in different ways. All ANZCA professional documents All other college publications of be enhanced search functions to assist Another matter that has become developed or reviewed since 2010 are statements, joint statements, and position with fi nding documents and publications. evident is confusion between ANZCA accompanied by a background paper. statements that are not preceded by PSXX With the above scenario the way professional documents and other Older ones will have background papers are not professional documents and the college can assist in each of these statements or position statements developed at the time of their review. consequently not subjected to the same queries will differ. Regarding the wearing emanating from the college. In that In professional documents parlance processes. of masks for central neuraxial blocks regard, the purpose of “prof docs” is there are three categories – policy, I hope this clarifi es the differences Dealing with a dilemma this will be referred to the relevant stated at the beginning of the relevant statement, and guideline. These are between professional documents and guidelines covered in PS28 Guidelines section in the ANZCA Bulletin and defi ned in A01 item 1.3. The term other documents or statements that the In an engaging morbidity and mortality on Infection Control in Anaesthesia. The ANZCA E-Newsletter in each edition. statement is used in other settings but college may publish, and also identifi es meeting some fi rmly held beliefs guidelines provide guidance based on “The professional documents of ANZCA in the case of professional documents the types of queries with which you can are debated among the participants principles and best available evidence and FPM are an important resource for the level of “strength” is intended to be helped and where to look for answers. during discussions following morbidity on a range of infection control issues. promoting the quality and safety of patient lie in between policy (mandated) and If all else fails the door is always open in associated with a subarachnoid block However, the document does not stipulate care. They provide guidance to trainees guideline (recommended). Professional the Safety and Advocacy Unit. performed on a patient for their urological how the mask should be worn or tied. and fellows on standards of clinical care, document statements will always be procedure. There are different types of masks with defi ne policies, and serve other purposes preceded by PSXX and be accompanied by Dr Peter Roessler Two themes emerge – one regarding different means of affi xing them, and that the college deems appropriate. a background paper. Director of Professional Affairs, Policy the wearing of masks while performing they vary between facilities. Flexibility Government and other bodies refer to the block, and the other relating to the and pragmatism without compromising ANZCA’s professional documents as an type of needle and baricity of the local standards is essential to avoid restricting indicator of expected standards, including anaesthetic agent. Unable to come to a services and community access to in regards to accreditation of healthcare consensus the suggestion is raised that services. facilities. Professional documents are this query should be forwarded to the Flexibility also offers the opportunity subject to regular review and are amended college. to modify or adapt techniques to suit in accordance with changes in knowledge, After the meeting, one of your individual circumstances. The second practice and technology.” Professional documents – update colleagues approaches you and asks issue relating to the type of needle Professional documents provide The professional documents of ANZCA and FPM guide • A Document Development Group has been established to your opinion on how to best resolve the and baricity of the solution is very guidance on standards of clinical care as argument. trainees and fellows on standards of clinical care, defi ne revise PS06 The Anaesthesia Record. Recommendations on much an individual preference and opposed to specifi c clinical management. policies, and serve other purposes that the college deems the Recording of an Episode of Anaesthesia Care. Would you support the suggestion each practitioner will make decisions Clinical guidelines are currently appropriate. Government and other bodies refer to them as to seek college advice? on the basis of evidence and personal displayed on a webpage that is separate indicators of expected standards. In addition, the ANZCA Currently in pilot The college is a repository for many experience. Consequently, the college will from professional documents. They Training Accreditation Committee (TAC) refers to the • A01 Policy for the Development and Review of Professional inquiries from fellows, jurisdictional confi rm that these sorts of issues are not include, for example, the Perioperative professional documents in regard to accreditation of training Documents (in pilot until July 2019). and regional authorities, and the public, the subject of professional documents or Anaphylaxis Management Guidelines, facilities. The professional documents are subject to regular • PS63 Guidelines for Safe Care for Patients Sedated in Health regarding a range of issues. Many are very college endorsed clinical guidelines and and other ANZCA-endorsed externally review and are amended in accordance with changes in Care Facilities for Acute Behavioural Disturbance specifi c in nature and seek answers that may recommend referring to the literature developed guidelines such as Malignant knowledge, practice and technology. (in pilot until April 2019). are not black and white. They are often or the college’s excellent library facilities. Hyperthermia Resource Kit. The complete range of ANZCA professional documents • PS64 Statement on Environmental Sustainability in While anaesthesia is a science it The process for development or review related to appropriateness of techniques, is available via the ANZCA website (www.anzca.edu.au/ Anaesthesia and Pain Medicine Practice (in pilot until selection of medications or very fi ne is not yet an exact science and some of professional documents is rigorous resources/professional-documents). Faculty of Pain Medicine February 2019). detail. The queries are presented either aspects remain an art. Advances in and governed by A01 Policy for the professional documents can be accessed via the FPM website as a request for college guidelines or anaesthesia are related to research Development and Review of Professional (www.fpm.anzca.edu.au/resources/professional-documents). • PS65 Guidelines for the Performance Assessment of a Peer (in pilot until September 2019). statements or alternatively if the college where it is important to ask questions, Documents, and may be recognised by Recent updates explore ideas that may challenge the the title which is preceded by the letters has a position on the matter. • PS49 Guidelines on the Health of Specialists and Trainees has Feedback is encouraged during the pilot phase for all PS (professional standard) and followed been updated to include Welfare Advocates as a mandatory professional documents. All comments and queries regarding requirement for ANZCA accredited hospital departments. professional documents can be sent to [email protected]. • Work has commenced on the review of PS43 Statement on Fatigue and the Anaesthetist.

14 ANZCA Bulletin December 2018 15 ANZCA National Anaesthesia Day October 16, 2018

Anaesthesia Day: one on a trial of chocolate fellows, hospitals and practices. Support and č>iÃÌ iÃ>Ã½ÌÃii«° Fairfax New Zealand ran a story on research Hospitals and practices embrace advice on the materials were provided by Dr fl avoured tramadol, one on anaesthesia and Ì½ÃÃÕV ìi«iÀ° into a multi-centre trial on optimum blood Rowan Thomas, Dr Peter Roessler, Dr Nigel cosmetic surgery and another release on 7 iÞÕ>Ài>Ãii« pressure during clot removal surgery, and 9Õ½LiÜiLÞ°°° 1ìÀ}iiÀ>>>iÃÌ iÃ>

We monitor your... delirium and anaesthesia. A media release Loud noises the Otago Daily Times ran a story “You are Robertson and Professor David A Scott. Brain on research into life-saving stroke treatment Ài>Ì }`vwVÕÌiÃ Breathing getting drowsy” featuring an interview with Professor Scott, ANZCA’s immediate past i>ÀÌÀ>Ìi]L` ANZCA National Anaesthesia Day pressure and

was distributed in New Zealand. In total, i}Ì ÌÀV` VÀVÕ>Ì president, also featured in an anaesthesia čÕÌv>>iÃÌ iÌV Dunedin Hospital anaesthetist Dr Andrew be creative and many took up the challenge required čvÕL>``iÀ °°°Ìii«ÞÕÃ>vi the National Anaesthesia Day coverage during surgery so you With the theme of “Anaesthesia Ü½ÌÀiÃ«`ÌÃÕ`] Smith. video produced by St Vincent’s Hospital in pain, temperature with gusto on October 16 this year. Some * ÞÃV>«> V >}iÃ]>`ÃÞÕ don’t remember isn’t sleep. It’s so much deeper” hospitals and clinics set up comprehensive Melbourne. attracted an audience of more than three Ì i«ÀVi`ÕÀi° Twitter and Facebook were both

million people. For more details on coverage Get ready for surgery by... extremely active on October 16. We shared foyer displays and demonstrations while New Zealand hospitals were again very r)GVVKPIƂVVGT National Anaesthesia Day 2018 • Drinking and smoking less ...and after the operation see the media news article on page 8. (STOP before is best). • We’ll care for you and • Talking to your keep you safe as you a range of photos from champions and fellows and trainees embarked on baking active and some hospitals in Australia anaesthetist. recover. • We’ll treat any pain and attracted record participation in nausea you might have. drives and bake-offs. Several hospitals, nominated two champions. Hospitals In the lead-up to NAD, fellow Professor fellows to highlight their diverse range Australia and New Zealand. such as Mater Hospital in Brisbane, in Western Australia were particularly Britta Regli-Von Ungern-Sternberg was Find out more at www.anzca.edu.au of activities and events. A total of 143 interviewed by Nine News at the Perth Increasing fellow engagement in nominated champions for the first time. supportive this year including King participants made 339 tweets using the Children’s Hospital about her ANZCA public hospitals, private hospitals NAD’s reputation also spread to Micronesia Edward Memorial Hospital led by Perth event hashtag #NAD18. We also launched Research Foundation-funded study into and anaesthesia practices has been a where the anaesthesia team at Chuuk State fellow Professor Nolan McDonnell (see the fi rst in a new suite of animated patient chocolate-fl avoured tramadol for children. highlight of this year’s ANZCA National Hospital in Chuuk, Micronesia with fellow Dr page 18 for the story) and Fiona Stanley information videos. “What is anaesthesia?” Anaesthesia Day (NAD). We had 50 NAD Andrew Beck celebrated the day. Hospital’s anaesthesia team’s display with This was broadcast nationally to more than was watched 18,000 times on Facebook, “champions” in Australia across the #NAD18 celebration cakes and cookies its rockmelon epidural simulator. One 30 metropolitan and regional television 300 times on Twitter and 1100 times on country from Hobart to Darwin, including were popular throughout Australia and WA champion was mystifi ed as to why his stations on October 10 reaching an audience YouTube. The Facebook video post was 12 private practices and an impressive 34 New Zealand with standouts the Dunedin delivery of NAD posters had failed to arrive of more than 1.5 million people. engaged with 2187 times (this includes in NZ. The Australian Anaesthesia Allied Hospital’s minion-shaped cake inspired by for the second year in a row only to discover The Herald Sun’s medical reporter reactions, comments and shares). Other Fox-FM in Melbourne and 4BC in Brisbane. Health Practitioners also nominated as the animated children’s fi lm and cupcakes that his four-year-old daughter had been Grant McArthur wrote a story on ANZCA’s Facebook activity on the day included 692 Dr Mitchell was also interviewed for a live champions this year. from the Anaesthetic Group Ballarat. hiding them under her bed! new information sheet on anaesthesia engagements with our factoid posts and and cosmetic surgery based on our media 10-minute segment on anaesthesia and 200 “likes” of the photo album. Over the We launched the fi rst patient Aspiring young anaesthetists, such asfi ve year-old Jacob Griffi ths who features on Media and social media release and launch of a patient information cosmetic surgery by Perth 6PR morning NAD period our page gained 200 new information video “What is anaesthesia?” sheet, reaching 500,000 readers in print and radio host Gareth Parker. followers – a noticeable spike. and used a new ANZCA fact sheet on the cover of this edition of theBulletin took National Anaesthesia Day attracted media a keen interest in the hospital activities at online and one million people through other Dr Nigel Robertson’s 16-minute interview questions to ask before undergoing interest in Australia and New Zealand syndicated News Ltd publications. College on Radio New Zealand was aired in the cosmetic surgery as a “hook” for the North Shore Hospital in Auckland. with news stories across radio, print and Carolyn Jones The ANZCA communications team president Dr Rod Mitchell was interviewed evening before National Anaesthesia Day. Media Manager, ANZCA media. online outlets including the Herald Sun, about the issue in pre-recorded audio grabs produced a poster, information sheets and Healthcentral.nz ran a comprehensive Now in its sixth year National Channel Nine news, Radio New Zealand and for radio news broadcasts which aired on the “What is anaesthesia” video (see page online story on the anaesthesia isn’t sleep Anaesthesia Day gives hospitals and Fairfax New Zealand. In Australia, ANZCA 70 regional radio stations across Australia theme and the chocolate tramadol study. Above: Images from ANZCA's National anaesthesia practices the opportunity to 19 distributed three media releases for National ) to promote the NAD18 message to including the Triple M regional network, Anaesthesia Day 2018.

16 ANZCA Bulletin December 2018 17 NAD18 hospital champions Pulse Anaesthetics Gillies Hospital (private) Australia QEII Jubilee Hospital Gisborne Hospital Queen Elizabeth Hospital Adelaide Grace Hospital (private) Albert St Anaesthetic Group Redland Hospital Grey Base Hospital Albury Hospital Riverina Anaesthetic Services Hawkes Bay Hospital Anaesthetic Group Ballarat Rockingham Hospital Hutt Hospital Armadale Kalamunda Group Royal Darwin Hospital Nelson Hospital Australian Anaesthesia Allied Health Royal Hobart Hospital North Shore Hospital Practitioners Royal Perth Hospital Manuka St Hospital Bankstown-Lidcombe Hospital Royal Prince Alfred Hospital Manukau Super Clinic Box Hill Hospital Sir Charles Gairdner Hospital Mercy Hospital Bundaberg Hospital Specialist Anaesthetic Services Middlemore Hospital Caboolture Hospital St Andrew's Anaesthesia Ormiston Hospital (private) Casey Anaesthetic Services St John of God Ballarat Hospital Palmerston North Hospital Casey Hospital St John of God Midland Rotorua Hospital Coast Anaesthetics and Medical St Vincent's Hospital Melbourne Mobile Health Surgical Bus (private) Dandenong Hospital Sunshine Coast University Hospital Southland Hospital Dubbo Base Hospital Tamworth Base Hospital Taranaki Base Hospital Fiona Stanley Hospital Tamworth Hospital Tauranga Hospital Gabba Anaesthetic Services Tamworth Private Hospital Thames Hospital Gosford Anaesthetics The Alfred Timaru Hospital Hollywood Private Hospital Wakeﬁ eld Anaesthetic Group Waikato Hospital King Edward Memorial Hospital Wairarapa Hospital Latrobe Regional Hospital NAD18 hospital champions Wairau Hospital Lismore Base Hospital New Zealand Wellington Regional Hospital Lyell McEwin Hospital Auckland City Hospital Whakatane Hospital Mater Hospital Brisbane Belverdale Hospital (private) Whanganui Hospital Modbury Anaesthesia Bowen Hospital (private) Whangarei Hospital Mount Gambier Hospital Chelsea Hospital (private) Nambour General Hospital Christchurch Hospital Nepean Public Hospital Dunedin Hospital Perth Children's Hospital

Perth hospital runs busy schedule for National Anaesthesia Day

The anaesthesia team at Western Australia’s largest maternity hospital used October 16 to highlight their specialty to patients, their families and staff with a series of activities and events. The King Edward Memorial Hospital for Women in Perth took up the challenge of promoting National Anaesthesia Day with Professor Nolan McDonnell as #NAD18 champion. Professor McDonnell and a team of clinicians and specialists made the most of the opportunity to promote anaesthesia by embedding their activities in the department of anaesthesia's daily schedule. Professor McDonnell said the National Anaesthesia Day 2018 theme of “Anaesthesia isn’t sleep, it’s so much deeper” ﬁ tted “in nicely with a lot of what we do at King Edward Memorial Hospital” such as labour epidurals, awake caesareans, peri-operative medicine and pain management. The anaesthesia team organised a display for the hospital’s Professor McDonnell said the day gave the department “the main corridor assisted by registrars. The display featured ideal opportunity to advocate for our specialty and the high level ANZCA’s posters, balloons and ﬂ yers, an anaesthesia machine, a of care and training that we provide.” training mannequin and airway devices. An afternoon tea for the department in the theatre suite The NAD message was also promoted by key clinical staff capped off the hospital’s support of the day. to patients during the hospital’s morning pain rounds with staff ready to answer questions about the specialty. Carolyn Jones Media Manager, ANZCA Above right: Professor McDonnell's Facebook post on October 16.

18 ANZCA Bulletin December 2018 19 Below: ANZCA President Dr Rod Mitchell congratulates 2018 Ray Hader Award recipient The 2018 Ray Hader Award Dr Jo Sinclair in Auckland. for Pastoral Care ANZCA fellow Dr Jo Sinclair, a In nominating Dr Sinclair for the specialist anaesthetist at Auckland’s award her colleagues in the anaesthesia Middlemore Hospital is the recipient department at Middlemore Hospital of the 2018 Ray Hader Award for said: “In the last couple of years she Pastoral Care. has established an intradepartmental She was presented with the award by welfare team which has won formal ANZCA President Dr Rod Mitchell at recognition from hospital management, the New Zealand Anaesthesia Annual and she is now working on creating a Scientifi c Meeting on November 10. welfare infrastructure across all medical Dr Sinclair’s interest in welfare issues specialities in our hospital… Jo has began as a trainee when she became instilled in us a recognition that welfare aware of the poor statistics around ‘matters’, that issues like burnout are real anaesthetists and suicide. She says and measureable, and [that they] impact on our effectiveness in caring for our students leave medical school full of a Established in memory of Dr Hader by kind of joy about being part of the healing patients, for our families and ourselves”. The Dr Ray Hader Award for Pastoral his friend Dr Brandon Carp, this award profession and she wanted to know what promotes compassion and a focus on the could turn that to despair. Care is awarded to an ANZCA fellow or trainee who is recognised to have made welfare of anaesthetists, other colleagues, According to Dr Sinclair, doctors tend patients and the community. In 2012 Dr to believe they are the healers and are not a signifi cant contribution to the welfare Carp agreed to continue sponsorship of allowed to be unwell so that gets in the of one or more ANZCA trainees in the the award and to expand the criteria to way of physicians getting help. She says area of pastoral care. This may have been recognise the pastoral care element of there has been a culture shift with medical in the form of mentoring and infl uence, schools now spending time on self-help. encouragement in education directly or trainee supervision. There has also been a shift in the indirectly, or in terms of overall welfare The winner receives $A2000 to be used literature about burnout in recent years. and leadership. for training or educational purposes and “It used to be about resilience and The award is named after Dr Ray a certifi cate. mindfulness training that the individual Hader, a Victorian ANZCA trainee who physician could do but now all the died of an accidental drug overdose in Adele Broadbent literature is more focused on addressing 1998 after a long struggle with addiction. Communications Manager NZ, ANZCA the issues in the system that the doctors are working in,” Dr Sinclair said.

22 ANZCA Bulletin December 2018 23 Indigenous health ANZCA participates in Indigenous meetings

ANZCA INDIGENOUS HEALTH STRATEGY FRAMEWORK

Governance ANZCA will ensure Aboriginal, Torres Strait Islander and Māori voices are represented at high levels across its governance structure.

Partnerships ANZCA will develop relationships and work together with Indigenous community groups, consumers, academic groups, service providers, and health organisations.

Workforce ANZCA will develop initiatives to support recruitment and retention of Indigenous doctors, undertake education through its training, curriculum and CPD program, and strengthen cultural safety training for all trainees, fellows and ANZCA staff. In addition to presentations on a range of clinical and non- NACCHO conference AIDA conference clinical topics including traumatic brain injury, rheumatic heart Advocacy ANZCA continued its support of the Australian disease and cultural safety, 20 workshops were conducted over ANZCA will advocate for health equity issues to be addressed In May last year, the Australian government, the National the duration of the conference. ANZCA was an active participant across a wide range of spheres, including research, Aboriginal Community Controlled Health Organisation Indigenous Doctors’ Association (AIDA) with at the conference – in addition to being a bronze sponsor, the education, policy, and service provision. (NACCHO), the Australian Indigenous Doctors’ Association participation in this year’s annual conference. college hosted an exhibition booth where staff were on hand and the Council of Presidents of Medical Colleges signed the over the three days to answer queries from aspiring medical “Partnering for good health and wellbeing for Aboriginal and This important event continues to go from strength to strength students and junior doctors. ANZCA and FPM also participated Torres Strait Islander Peoples” agreement (see ANZCA Bulletin and more than 400 attendees gathered in Perth from September in three workshops: It is well recognised that a key component of addressing September 2017). 26-28. AIDA was established in 1997 as a professional association inequities in Indigenous health is to develop a health workforce This collaboration commits to reducing the gap in health contributing to equitable health and life outcomes, and the • Dr Vincenzo Mondello, a specialist pain medicine physician better able to meet the needs of Indigenous populations. and consultant psychiatrist from Perth and Dr Ivan Lin, outcomes and life expectancy between Aboriginal and Torres cultural wellbeing of Aboriginal and Torres Strait Islander Medical workforces that are more representative of Indigenous Strait Islander peoples and non-Indigenous Australians. This people. a physiotherapist in Geraldton, ran a well-attended pre- communities are more likely to understand and be responsive conference workshop on managing persistent pain. agreement was reaffi rmed on September 12, 2018 at a special The 2018 conference was the largest to date and included a to the needs of these communities, and to deliver culturally Parliament House forum. diverse mix of Indigenous medical students, Indigenous doctors, • ANZCA President Dr Rod Mitchell, past president Dr Lindy appropriate care. Supporting, attending and participating in This year, NACCHO invited medical colleges to attend associate AIDA members and other stakeholders from all over Roberts and anaesthetic registrar Dr Dash Newington ran the annual AIDA conference is an important mechanism by their annual conference to provide delegates with an update Australia. one of the conference’s most popular workshops on airway which ANZCA can engage with students and junior doctors and on the work they are undertaking in recognition of this Keynote speakers included Dr Chelsea Bond, Research Fellow management and advanced life support. Targeting medical promote anaesthesia and pain medicine as a career, in line with agreement. ANZCA Indigenous Health Committee Chair Dr at the Poche Centre for Indigenous Health, Dr Tony Bartone, students, junior doctors and trainees, the ANZCA team was pillar three of the Indigenous health strategy framework Sean McManus and committee member Dr Dash Newington President of the Australian Medical Association, and Laureate ably assisted by local resident medical offi cer Dr Dylan John. (see above). joined representatives of eight medical colleges at a special Professor Nicholas Talley, Pro-Vice Chancellor Global Research It was encouraging to see so many new Indigenous medical half-day session where Dr Newington talked about ANZCA’s new at the University of Newcastle. • A highlight of every AIDA conference is the “Growing our graduates at the conference receive their commemorative fellows workshop” which provides an opportunity for members Indigenous health strategy and her own journey through the This year’s conference theme was “vision into action – stethoscope. We will continue to demonstrate ANZCA’s anaesthesia training pathway (see ANZCA Bulletin September translating the vision of innovation, leadership and cultural to have direct engagement with medical colleges to discuss commitment to improving Indigenous health and promoting the pathways and career aspirations. Following a “speed dating” 2018). strength into measureable and signifi cantly improved health college as a safe and supportive environment for these inspiring It was encouraging to hear about the range of initiatives outcomes for Indigenous communities. This goal aligns with format, each of the 15 specialist medical colleges represented is young doctors. allocated a table, with aspiring doctors invited to rotate tables under way and while recognising there is a long way to go ANZCA’s new Indigenous health strategy, outlined in the before all Australians enjoy similar health outcomes, a number September Bulletin, which challenges all of us to do more to lift every 10 minutes to interact with different colleges. Dr Mitchell, Anthony Wall Dr Roberts and Dr Newington were kept busy over two hours of signifi cant fi rst steps have been taken. ANZCA hosted an Indigenous health outcomes. Operations Manager, Policy, exhibition stall during the two-day event and staff were kept talking to aspiring specialists about anaesthesia and pain Safety and Quality medicine as a career, the life of an anaesthetist or specialist busy with inquiries about anaesthesia, pain medicine and the pain medicine physician and the training pathway college’s new Indigenous health strategy. to fellowship. Anthony Wall Operations Manager Policy, Safety and Quality

Above: ANZCA President Dr Rod Mitchell and past president Dr Lindy Above: ANZCA trainee and Indigenous Health Committee member Roberts ran a popular workshop on airways management. Dr Dash Newington presents at the NACCHO conference.

24 ANZCA Bulletin December 2018 25 Indigenous health ANZCA participates in Indigenous meetings (continued)

Improving pain management in Aboriginal community controlled health services

ANZCA receives Department of Health Specialist Training • Fostering interest in pain medicine and anaesthesia Program funding to develop and deliver educational projects careers in Aboriginal and Torres Strait Islander healthcare which support the delivery of training in expanded health professionals. care settings. In 2018, the college successfully applied to • Creating stronger links between Aboriginal health services the department to fund a pilot project to give anaesthesia and local specialist healthcare providers. and pain medicine trainees the opportunity to deliver • Improving the management of chronic pain conditions pain management training in Aboriginal community- in Aboriginal and Torres Strait Islander patients and controlled health services. The ﬁ rst stage of this project improving health outcomes. involves running Essential Pain Management (EPM) workshops for interested trainees in a number of locations ANZCA is grateful for NACCHO’s assistance in the around Australia. In stage two, trainees complete cultural development and roll-out of this project. The pilot will be competency training and then deliver EPM workshops in an evaluated to assess the project’s impact against the intended Aboriginal community controlled health service. outcomes detailed above. If successful, it is hoped to offer In addition to providing anaesthesia and pain medicine the program across a larger number of training sites. trainees with non-traditional training experiences in Aboriginal health services, project outcomes include: • Increasing the number of health practitioners, including Aboriginal health workers, with the skills to assess and treat chronic pain and train other professionals.

Above from left: ANZCA Operations Manager Policy, Safety and Quality, Anthony Wall, discusses how the college and faculty are working to close the gap with Minister for Indigenous Health Ken Wyatt at the NACCHO conference; ANZCA trainee Dr Dash Newington talks to Mr Oliver Tye, Policy Co-ordinator NACCHO.

26 ANZCA Bulletin December 2018 27 Indigenous health Spinning a healthy yarn

An innovative new strategy to increase engagement between First Nations people and health professionals who treat persistent pain has begun in North Queensland. A Yarning Circle is being trialled by the Townsville Hospital and Health Service (THHS) and North Queensland Persistent Pain Management Service (NQPPMS). NQPPMS director fellow Dr Matthew Bryant said yarning circles were an important way to learn from a collective group, to build respectful relationships and to share cultural and other knowledge. Dr Bryant said First Nations people were under-represented for pain management clinic referrals not just in North Queensland but throughout Australia and there was no clear, evidence-based understanding of why. “There is still work to do to make pain services in Australia culturally safe for consumers,” he said. “The sum of research literature focussing on Australia’s First Nations people and their acute pain experience consists of one study, interviewing fi ve Aboriginal women who were inpatients in Alice Springs Hospital. Ms Nichols said First Nations peoples may choose not to engage “Yarning Circles are a good fi rst step in identifying where we with health services for many reasons and this needed to be can improve our systems and pathways.” overcome. Earlier this year, the Townsville Hospital and Health Service “The great thing about a yarning circle is we can talk directly held its fi rst persistent pain yarning circle in Townsville which to consumers about how we can improve pain management was attended by 21 First Nations consumers. It was convened services for our Aboriginal and Torres Strait Islander by Aboriginal and Torres Strait Islander Wellbeing Assessment communities,” she said. Engagement Service team leader Lyn Nichols and Dr Bryant. Suggestions included: ensuring Indigenous health staff had Dr Bryant provided a brief medical presentation about why more of a role in supporting consumers to navigate complicated people develop persistent pain and models of care for consumers hospital and medical systems, improving GP education, before opening the circle up for group discussion. developing research projects to improve the understanding of the cultural aspect “of our pain” and developing simple The main themes raised by consumers at the group were: resources that are easy to understand. • Deep emotional pain takes precedence over physical pain. Dr Bryant and Dr Nichols said they hoped more yarning • Pain is diffi cult to talk about and easier to “bottle up”. circles would be supported throughout Australia to ensure the • A lifetime of pain was described by one consumer who said voices of First Nations consumers were heard. pain had become “a daily battle with my body”. “This is a culturally appropriate forum that I believe has the potential to give us a good insight into improving engagement • Perception that allied health services are diffi cult to access. with First Nations people and pain management services,” he • Pain is common – “everyone I know has a crook back or leg”. said. • Important protective factors include: family, love, support, “No one wants to see our First Nations people living in pain culture, spiritual wellbeing, “an acceptance of what is”, and when there are free, publicly available services to help manage the important tie with country. these conditions.” The Townsville yarning circle borrowed from a successful strategy led by the NSW Agency for Clinical Improvement.

Above: Lyn Nichols and Dr Matthew Bryant in Townsville.

28 ANZCA Bulletin December 2018 29 Extreme environments nments Desert experience a preparation for life on Mars

“Our diverse crew in unpredictable ways. We learnt about congestion the taste buds begin to crave the dangers we will face on Mars such as spicy food. included two radiation, solar storms, fi nite resources Long duration space fi ght is endlessly and death from simple equipment fascinating and is at the cutting edge of anesthesiologists failures. the medicine of the future. Living in this who also happened Most interesting of all we learnt simulation gave me new insights into about the psychological factors such the challenges of living and practising to be amateur rocket as adaptation to isolation and the medicine in one of the most austere scientists so we got to importance of interpersonal dynamics. I environments. Interestingly, the same Anaesthetist Dr Lorna Workman 34 million miles away from the nearest was part of a fantastic crew, all of whom principles of our daily practice apply; “We were fortunate to hospital and have limited resources. launch a homemade were American emergency medicine being well prepared, having excellent describes how she fulfi lled I am a staff specialist anaesthetist physicians or anesthesiologists and, most teamwork and leadership, good be taught by leaders in her fascination with aerospace at Westmead Hospital, Sydney, with rocket, 7000 feet into importantly, one who was a fantastic chef. communication and the principles of We learnt that an excellent cook is the crisis management. the fi eld, hearing about medicine by spending a week a specialist interest in aerospace the air.” medicine. I have long been fascinated most important crew member should you There are exciting developments being the day-to-day tasks of inside the Mars Desert Research by the challenges of exploring our vast be stranded on Mars! made in the world of commercial space Station in Utah. solar system and the way in which our Our diverse crew included two travel, which means that in the next few a NASA fl ight surgeon body adapts to this most extreme of anesthesiologists who also happened to years if you have a spare $250,000 you In May 2018, I went to Mars. Well, kind of. geological surveys. A plentiful supply of environments. Thanks to the Wilderness be amateur rocket scientists so we got to can become an astronaut with Virgin or how uniquely space As close as I will ever get anyway. duct tape came in handy for these repairs. Medicine Society, the Mars Desert launch a homemade rocket, 2135 metres Galactic. This will pose interesting Hidden away in the rust-red landscape Given this was a medical course, affects our physiology Research Station and the support of my (7000 feet) into the air. As the propulsion dilemmas to the future of medicine, as of the Utah desert there is a two-storey, inevitably disaster would befall some department, I got the chance to live out engineer on the project I had the honour these future astronauts are worlds apart in unpredictable ways.” eight metre wide cylindrical habitat (the unfortunate crew member and we would this childhood dream in a realistic live-in of carrying the rocket in the back of our from the highly fi t and healthy astronaut Hab) that looks a lot like Matt Damon’s need to solve various problems in the simulation. Martian rover as we drove to our launch cadre. SpaceX, Boeing and Blue Origin “home” in the movie The Martian. confi nes of a space suit, being far from As we donned our orange fl ight suits site. This rocket had eight kilograms of are also opening the door to space. Space It is the Mars Desert Research Station, home and even further from Earth. and waved goodbye to the camera, we explosive and aluminium perchlorate exploration will continue to encourage a private research facility established Even in the Hab we were not safe from entered our Martian habitat and our – the same fuel that is in the shuttle unprecedented international co- by the Mars Society in 2001 to educate disaster. For understandable reasons the simulation began. If we were to venture engines. operation, drive innovation in technology academics, students and the public about simulation scenarios are reused each year outdoors again, it would be with a full We are still discovering the physical and encourage us to look after the only how humans can survive on the second so I shall spare you the details should space suit and we would need to undergo challenges of human adaptation to planet that we call home. smallest planet in the solar system. you wish to experience the adventure for a full three minutes of 100 per cent spacefl ight and how best to counter them. Despite the toll on the human body I was part of a group of eight yourself! oxygen pre-breathe and depressurisation Probably the most important of these is and the challenges that face the Mars consultant doctors and three instructors When we weren’t out exploring, doing protocol. the ability of our bodies to re-adapt on our explorers of the future, it is inevitable who lived inside the Hab to simulate the household chores to maintain the Hab, Each day we would be given tasks by return after being weightless for so long. that we will one day set foot on Mars with challenges of living in the most austere of unblocking the toilet or rehydrating mission control back on Earth. These We haven’t yet found a good way to predictions that this could be as early environments, Mars. Guided by our expert dinner, we would be having lectures. We were usually a two-hour extravehicular preserve bone mineral density which as the 2040s. I often get asked, if I was instructors, including a NASA fl ight were fortunate to be taught by leaders in From top left: On a mission at the Mars Desert activity, where we would get into our means we’re putting astronauts at given the opportunity to go on a one-way surgeon, we learned how to cope with an the fi eld, hearing about the day-to-day Research Station; Dr Lorna Workman; A rocket space suits, jump in our Martian rovers increased risk of fractures on Mars and mission to Mars would I go? My answer – array of medical disasters that require tasks of a NASA fl ight surgeon or how test with the Hab at left; Dr Workman getting and repair a broken communication their return to Earth. Astronauts’ hearts try and stop me! Just don’t forget the some unique considerations when you are uniquely space affects our physiology into gear. relay, fi nd a crashed satellite or conduct also change shape and due to the nasal duct tape.

3300 ANZ ANZCACA BBulletinulletin DDecemberecember 22018018 31 Extreme environments Gaza medical mission a lesson in humanity and resilience

Egypt

“It is a privilege to be Without exception, they were gracious, Médecins Sans Frontières generous, friendly people. Despite more immersed in another rockets and drones than stars in the sky MSF is an independent international some nights, they are obviously resilient medical humanitarian organisation culture sharing and genuine. that delivers emergency aid to people I spent many long hours with the affected by armed confl ict, epidemics, with those who live healthcare exclusion and natural or Médecins Sans Frontières (MSF) is national operating theatre team who Christchurch specialist anaesthetist man-made disasters. currently in Gaza providing reconstructive in such different were such a pleasure to work with. They and development worker Dr Judy In the Palestinian territories MSF surgery for mostly young men with gunshot are almost all men as women there are provides medical and psychological Forbes has travelled all over the wounds to their lower extremities. These circumstances.” mostly in traditional roles in the home. assistance to people affected by the world in her nearly 40 years of paid injuries result in terrible fractures and However, they were always respectful ongoing confl ict, including long- massive soft tissue trauma often requiring Currently there is also little fuel to and considerate as well as boisterous and and unpaid humanitarian aid work, running mental health programs on multiple complex procedures. The patient provide more than a few hours of electricity cheerful. They were competent and hard- which has taken her to some of the the West Bank and support to victims population is very reluctant to consider per day, or functioning water and working, uncomplaining colleagues. We of burns and trauma in the Gaza Strip. world’s most challenging countries amputation which often would expedite sanitation facilities. Seventy-fi ve per cent shared so much about our lives. Sometimes For more information about MSF’s mobility. of the population is under 25 and at least it mirrored someone’s quote: “When all is including her fi rst mission to Gaza work, or about working for MSF as an My job was primarily to oversee the half are unemployed. Despite all of that, said and done, more is said than done”. in the Middle East. anaesthetist, visit www.msf.org.au. national anaesthetic providers who are plus the dreadful press headlines, ongoing But you could enjoy every minute of it. “You are welcome in Gaza” greeted Dr technically very competent. The equipment violence and temperatures of 35 degrees So, that is far too much in answer to Judy Forbes everywhere she walked in the hospital was basic but adequate and Celsius, a busy, vibrant life goes on. why I keep going. It is a privilege to be during the month she recently spent in good repair. We used a simple fl ow over Most nights are noisy with multiple immersed in another culture sharing working in the strip of land wedged vaporiser with isofl urane and had excellent wedding processions, which include a big with those who live in such different between Israel and Egypt’s Sinai monitoring. The biggest challenge was band on the back of an open bed truck. circumstances. I am grateful that I have Peninsula. frequent position changes and variable Then, in the early hours of the morning a skill needed everywhere which doesn’t Dr Forbes’ humanitarian aid work levels of surgical stimulation without any when it is a bit cooler and quieter, you even require in-depth faculty with another has taken her to some of the world’s quick means to mitigate these. As I have can hear the clip clop of the donkey carts language. I have worked in most disaster most challenging countries including worked in waterlogged tents with only bringing goods to the city. and war zones over the years, seeing the Afghanistan, Pakistan, East Timor, Sri ketamine and a fi nger on the pulse, the Everyone in the streets greets the very worst of man's inhumanity to man and Lanka, Haiti, Bangladesh, South Africa, conditions in Gaza equated to a well- few obvious foreigners with, "You are always come away thinking how all people Ethiopia, Tanzania, Bhutan, Cambodia, resourced situation. welcome in Gaza." everywhere just want a better life for their Solomon Islands, Nigeria, South Sudan, I was in Gaza for a month and it was my We were free to walk in specifi c areas, children. Burundi and Papua New Guinea. fi rst mission there. I had always wanted to especially to the closest hospitals, so we The Bulletin asked her to share her experience life in one of the most densely could chat with shopkeepers, patrons experiences in Gaza and explain why Above from left: One of the hardest hit areas of the North East Gaza populated places on earth where everyone of nearby cafes and curious bystanders strip during the 2014 summer war. (Photographer: Susanne Doettling she continues going out into the world of is virtually locked in due to the land, sea who were comfortable speaking English. MSF); Dr Judy Forbes; Locator map Gaza Strip; MSF surgical teams confl ict and deprivation. and air blockade. operating in Al Hawdaa hospital, one of the fi ve hospitals where MSF works. (Photographer: Laurie Bonnaud MSF); The leg of a patient needing reconstructive surgery. (Photographer: Alva Simpson White MSF).

32 ANZCA Bulletin December 2018 33 Dr Justin Skowno

Changes in cerebral mitochondrial oxygenation during paediatric and adult cardiac surgery Cardiac surgery, in both children and adults, has progressed substantially over the past several decades. The focus has moved from surviving surgery, to the post-operative quality of life of patients with improving neurocognitive outcomes as one of the central areas of investigation. However, neurocognitive defi cits are still a common feature of cardiac surgery and there are substantial gaps in our knowledge. One of the main issues is Lennard Travers Professorship the continued inability to directly monitor the brain’s wellbeing – Dr Justin Skowno during operations. Indirect measures of cerebral well-being, This is a prestigious award which provides support for a including cerebral tissue haemoglobin saturation and processed fellow of the college to work in an area of their choosing EEG values are in clinical use, but have thus far failed to clearly towards the advancement of knowledge in a nominated improve clinical outcomes, though research and development area of anaesthesia in Australia, New Zealand, Hong continues. Kong, Malaysia and Singapore. Mitochondrial oxygenation, at the level of cytochrome C oxidase, is a fi nal common pathway for all cellular metabolism ANZCA congratulates Dr Justin Skowno on being awarded the that can be monitored using broadband near infrared quadrennial Lennard Travers Professorship for 2019. The tenure spectroscopic techniques in the brain. The investigators aim to of the professorship is one year and Dr Skowno will hold the use mini CYRIL, a broadband spectroscopy system developed courtesy title “Lennard Travers Professor of Anaesthesia”. by the Biomedical Optics Research Laboratory at the University Dr Skowno is a senior staff specialist in paediatric anaesthesia College London, to monitor the mitochondria in brain tissue at the Children’s Hospital at Westmead and is a Clinical Senior in addition to standard monitoring and cerebral oxygenation Lecturer in the Discipline of Child and Adolescent Health, at the monitoring. University of Sydney. His PhD, from the University of Sydney, This work will advance our understanding of cerebral-level Anaesthesia and pain medicine was on “Tissue perfusion monitoring in paediatric anaesthesia, ischaemia during cardiopulmonary bypass, and increase our intensive care and surgery utilizing near infrared spectroscopy”. understanding of the relationships between blood pressure, Dr Skowno is on the editorial board of Paediatric Anaesthesia cerebral tissue haemoglobin oxygenation and mitochondrial and a peer reviewer for several other journals. His primary oxygenation in cerebral tissue which will improve the ability of research boosted by research interests are using medical monitors to improve the anaesthetists and perfusionists to detect cerebral ischaemia understanding of cerebral perfusion and metabolism under during cardiac surgery, and allow individually tailored blood anaesthesia, and the impacts of anaesthesia and surgery at pressure management in children and adults. a young age on neurodevelopment. He has a proven track The study will bring together Australian anaesthesia record in research with many signifi cant publications and is researchers in paediatrics and adults across two states and recognised internationally as an expert on neuromonitoring. also foster collaboration with an internationally world-class He is a collaborator in many large multicentre trials of major biomedical engineering group. Its focus on common physiology signifi cance to the future of paediatric anaesthesia. He has been that is crucial to safe anaesthesia and surgery further an invited speaker at national and international conferences, emphasises its potential to advance the specialty in this region. including the World Congress of Anaesthesia and the Dr Justin Skowno, The Children’s Hospital at Westmead, $1.5 million International Assembly of Pediatric Anesthesiologists. New South Wales. Dr Skowno will deliver the Australasian Visitor’s Lecture at $A66,846 the ANZCA Annual Scientifi c Meeting in Perth in 2020 as part The ANZCA Research Committee has awarded funding of $A1.5 million through the ANZCA of the Lennard Travers Professorship. Research Foundation for research projects in 2019. The funding supports the 2019 Lennard Travers The Lennard Travers Professorship stipend will assist Dr Skowno to pursue his study. Professorship, 10 new project grants, 15 continuing project grants, the 2019 Simulation/Education Grant, three novice investigator grants, a scholarship stipend and the pilot grant scheme. A total of 31 investigators and their teams have been supported for 2019, in addition to the CTN Pilot grants. These grants support important research initiatives that will be carried out in leading hospitals and universities in Australia, New Zealand and Hong Kong and are a vital part of ANZCA’s continuing contribution to improvement in the safety and quality of patient care in anaesthesia, intensive care, perioperative medicine and pain medicine through high quality medical research. For the annual ANZCA Research Grant round, the foundation is very appreciative of all of its supporters and sponsors, especially those who provide the named research awards: the Cole Family, the estates of the late Dr Robin Smallwood, Dr John Boyd Craig, and Dr Lillian Elaine Kluver, as well as CSL Behring and Professor Barry Baker.

34 ANZCA Bulletin December 2018 35 Named research awards

CPSP is currently understood to occur when the nerves in the Preliminary work by our group suggests that the sympathetic body that carry pain signals become permanently sensitised by nervous system (adrenaline system) is involved in keloid and burns repetitive activation, direct damage and inﬂ ammation around the scar development and pain. We detected increased expression of a

time of surgery. This results in the perception of pain in response key receptor protein, the alpha-1 adrenoceptor (α1-AR) (adrenaline to mild, harmless sensory triggers, or pain at rest in the absence of receptor), in the skin cells and nerves of skin biopsies from patients any triggers. Lidocaine, a commonly used local anaesthetic agent, with keloids and burns. This receptor inﬂ uences cell growth and is known to have a number of biological actions that may prevent migration, nerve excitability and blood ﬂ ow in the skin. We also

pain-nerve sensitisation. Preliminary evidence supports the use of demonstrated that α1-AR are involved in the pathophysiology perioperative lidocaine infusions to reduce the incidence of CPSP of neuropathic pain and CRPS, and interact with infl ammatory Harry Daly Research Award and the investigators now plan to test this hypothesis in a defi nitive, John Boyd Craig Research Award chemicals in tissues called cytokines. – Dr Andrew Toner large-scale trial across Australia and New Zealand. – Professor Eric Visser The investigators therefore wish to expand their research to The Harry Daly Research Award was established by the Before conducting a large clinical trial, it is necessary to The John Boyd Craig Research Award was established clarify the role of α1-AR in keloid scar formation, infl ammation and Faculty of Anaesthetists, Royal Australasian College of fi rst perform a pilot study that road tests a means of delivering following generous donations from Dr John Boyd Craig to nociception (pain) to determine if by targeting this receptor, they can Surgeons, in 1981. The Harry Daly Research Award may lidocaine infusions in a manner that is safe, effective and feasible the ANZCA Research Foundation to support pain related prevent or reduce pain and abnormal tissue using complementary be made in any of the categories of research award made on a larger scale. This will be done in at least 150 patients over research by fellows, particularly in Western Australia. in vitro and in vivo approaches. by the college provided the project is judged to be of a 12-month period across three hospitals in Western Australia. Understanding the role of α1-AR in wound healing, and its Patients will be randomly allocated to receive lidocaine or placebo interaction with infl ammatory mediators and role in painful scars, suffi cient merit. The award is made each year to the grant Clarifying the role of alpha1-adrenoceptors in painful infusions, delivered intravenously during surgery and continued may lead to better treatment strategies. This could not only help ranked most highly by the ANZCA Research Committee. cutaneous scars following surgery and burns postoperatively for 12 hours via the subcutaneous route. Patient to control pain but might also lead to developing a less invasive Surgical incisions or burns may lead to the development of safety will be comprehensively evaluated using prospective treatment to prevent occurrence of scars following an injury and Lidocaine infusions to prevent chronic pain after breast abnormally painful, itchy, thickened and raised cutaneous wounds surveillance strategies that detect local anaesthetic side-effects recurrence of keloids following surgical excision. cancer surgery known as hypertrophic scars and keloids. Chronic scar pain and toxicity. The effectiveness of the pragmatically designed Chronic post-surgical pain (CPSP) occurs in 12 per cent of mixed develops in 2-10 per cent of surgical patients, but this is signifi cantly Professor Eric John Visser, Churack Chair of Chronic Pain delivery systems will be assessed by the quantifi cation of plasma surgical populations and affects up to 47 per cent of patients higher in burns patients, 25-68 per cent. These pathological scars Education and Research, University of Notre Dame Australia levels when surgery completes and when six postoperative hours undergoing breast cancer surgery. In half of CPSP cases, pain develop as a result of abnormal wound healing and fi broblast (UNDA), Western Australia, Dr Natalie Morellini, Churack have elapsed. Finally, the feasibility of the key trial processes and is reported as moderate or severe in intensity and contributes to dysfunction, and are characterised by chronic infl ammation. This Chair post-doctoral research Fellow, UNDA and Murdoch the recruitment rate will be assessed. disability, low quality of life and mood disturbances. The scale leads to an excessive accumulation of collagen and extracellular University (MU), Western Australia, Professor Peter Drummond The research team will apply a tried and tested strategy, of this problem continues to grow as over 300 million surgical matrix in the dermis and a raised scar. While hypertrophic scars (MU), Professor Fiona Wood, Fiona Stanley Hospital, Western including the publication of a systematic review of the existing procedures are performed worldwide each year, with an estimated remain within the wound border, keloids extend beyond the borders Australia and University of Western Australia (UWA), Associate evidence, a survey of current practice, and the completion of their 2.5 million occurring in Australia. This is refl ected in the inclusion and invade surrounding normal skin. In addition to aesthetic Professor Mark Fear (UWA). detailed pilot study, to ensure progression to a large defi nitive trial. by the World Health Organization of “chronic postsurgical pain” problems, these scars are often painful, pruritic and both physically $A45,498 This strategy will ultimately inform anaesthetists whether long- in the upcoming 11th revision of the International Classifi cation of and psychologically debilitating. Keloid and hypertrophic scars term pain outcomes are improved after breast cancer surgery Diseases. Strategies designed to reduce the human, public health are not only a signifi cant burden for patients but also a therapeutic when perioperative lidocaine infusions are used. and fi nancial burden of CPSP are therefore a high priority for challenge for clinicians, as treatment is diffi cult and in the case of perioperative researchers and healthcare consumers alike. Dr Andrew Toner, Professor Tomas Corcoran, Professor keloids, they often recur. Stephan Schug, Dr Martin Bailey, Royal Perth Hospital, Currently, surgical excision or intra-lesion injections of either Western Australia. corticosteroid, bleomycin or fat suspensions are used to treat $A69,605 keloid scars and sequelae such as pain or pruritus. However, scar injections are extremely painful and surgical excision results in recurrence rates between 45 and 100 per cent. Furthermore, people with keloids are at increased risk of developing keloid scars following subsequent cutaneous injuries. Therefore, better understanding of the mechanisms behind abnormal wound healing and formation of hypertrophic scars and keloids is imperative for more effective treatment and preventive approaches.

36 ANZCA Bulletin December 2018 37 Named research awards (continued)

In this study, the investigators will replace the 6MWT with the Incremental Shuttle Walk Test (ISWT). The ISWT is a test which is paced according to an incremental speed dictated by an audio recording. The test speed increases every minute and the test fi nishes when the participant can no longer maintain the desired speed. It is also planned to directly measure the VO2Max with cardiopulmonary exercise testing (CPET), a test commonly used by professional athletes to measure their fi tness, and this study will be the fi rst to examine this relationship in pregnant women. The Russell Cole Memorial ANZCA Provisional/New Fellow (PNF) ANZCA The Elaine Lillian Kluver ANZCA Research The investigators then hope to be able to develop an equation Research Award – Professor Philip Siddall Research Award – Dr Courtney Thomas Award – Associate Professor Alicia Dennis that relates the distance walked in the ISWT to VO2Max measured The Russell Cole Memorial ANZCA Research Award was Professor Barry Baker, retired anaesthetist and ANZCA The Elaine Lillian Kluver ANZCA Research Award was by CPET. This may then allow VO2Max to be calculated from established following a generous ongoing commitment Director of Professional Affairs, and former Nuffi eld established following a generous gift to the ANZCA the simple and applicable ISWT rather than using CPET as this to the ANZCA Research Foundation from the family of Professor of Anaesthetics, University of Sydney, made a Research Foundation from the estate of the late requires signifi cant expertise to conduct and is relatively expensive the late Dr Russell Cole to support a highly ranked generous donation to the foundation in 2014 to support its Dr Elaine Kluver to support a highly ranked anaesthesia, making it an impractical test for continuous widespread use. pain-related research grant. ability to provide novice investigator grants. This award analgesia or pain-related research grant. This will allow ISWT to be used in early pregnancy to investigate is to support a highly ranked novice investigator, who is the relationship between VO2Max and the development of preeclampsia. Virtual reality as a treatment for pain in people with spinal either a provisional year trainee or a new fellow within Assessment of exercise capacity and oxygen utilisation If women at risk of preeclampsia can be identifi ed, we will then cord injury fi ve years of fi rst specialist qualifi cation. in women in early pregnancy be able to monitor them much more regularly, start treatments Spinal cord injury is a life-changing event that causes not only Preeclampsia is the most common cardiovascular complication of earlier and possibly prevent the condition through exercise debilitating loss of physical function, but is also associated with Māori experience with anaesthesia in the perioperative pregnancy, occurring in approximately 13 million women worldwide programs. The impact of these interventions and having a greater severe and persistent pain in the area of sensory loss. In the setting: A qualitative assessment each year and contributing 20 per cent of maternal mortality in high understanding of the mechanisms behind the development of majority of patients, even the most recent and effective medications ANZCA is committed to improving cultural safety and advocating for income countries. It can lead to premature birth, maternal seizures preeclampsia are likely to have very signifi cant and benefi cial show only limited benefi t and usually have intolerable side effects. Indigenous health. Their drive for safe and high-quality patient care and heart failure, increased risk of caesarean section and lifelong effects on pregnant women and their babies. Much of the diffi culty in fi nding satisfactory pain relief is due in anaesthesia extends to opportunities for contributing to improved problems of high blood pressure, kidney and brain disease. to complex mechanisms that involve many levels of the brain and health outcomes for Indigenous people in both Australia and New Our research group has been conducting clinical haemodynamic Associate Professor Alicia Dennis, The Royal Women’s Hospital, spinal cord. Our team has demonstrated that pain following spinal Zealand. In New Zealand, the Treaty of Waitangi provides a basis from studies in women with preeclampsia and in healthy pregnant Melbourne. cord injury is associated with changes in brain rhythms and the which government policy, and more recently ANZCA’s Indigenous women using transthoracic echocardiography (TTE) and cardiac $A45,074 Health Strategy, can be founded. There lies a commitment to provide pattern of activity in certain critical parts of the brain pain circuitry. magnetic resonance to better understand cardiac function and for “partnership, participation and protection” in policy making and Virtual reality (VR) has been used successfully for many years in striving for equitable outcomes. structure in women with preeclampsia. From these studies we in the treatment of acute pain following burns injuries, as it acts as Ma-ori are the Indigenous people of New Zealand and continue to have found that women with preeclampsia have higher cardiac an effective distraction technique that can shift the brain’s attention experience disparities in access to care and poorer health outcomes. outputs than healthy pregnant women. away from pain. However, the evidence in the treatment of chronic They continue to have a much lower life expectancy than non-Ma-ori Maternal medical conditions including obesity, anaemia pain is limited and no studies have examined the effectiveness and experience higher rates of socioeconomic deprivation, disability and respiratory disease are associated with preeclampsia, and of distraction-type VR in the treatment of pain following spinal and disease. Ma-ori mortality rates are higher across nearly all age reduced cardiovascular system fi tness is likely to contribute to cord injury. groups, and this has been most recently highlighted in the latest the development of preeclampsia. Objective, accurate and simple To date, VR has required sophisticated computers to process report from the Postoperative Mortality Review Committee (POMRC). assessment of fi tness is necessary in order to investigate the the software used in these programs which has largely been The POMRC found that Ma-ori living in the most deprived areas, relationship between reduced fi tness and preeclampsia. To test limited to the laboratory or in-hospital setting. However, the who had an elective admission with general anaesthesia, had a this, the investigators have been conducting exercise testing in rapid development of VR has changed this and it is now possible much higher 30-day perioperative mortality rate than New Zealand pregnant women to understand the normal responses to exercise Europeans. The Ma-ori Caucus, convened by the New Zealand Health to download ready to use applications that can be used on a - in pregnancy and to examine the association between the distance laptop connected to a headset. Therefore the ability for patients and Safety Quality Commission, included investigation of Maori walked during an exercise test, the Six Minute Walk Test (6MWT) patients’ experiences of care in the pre-operative setting among its to individually reduce the intensity of their neuropathic pain using and the maximum oxygen utilisation capacity (VO2Max) of a recommendations for future research. The role for both quantitative affordable VR software would be a major advance in the challenge and qualitative research was proposed and these recommendations pregnant woman. Our results have shown that the 6MWT is not of obtaining satisfactory relief of their debilitating pain. have been endorsed by the POMRC. a good predictor of VO2Max. This is most likely because the test The aim of this study therefore is to determine the effectiveness The chief investigator is both a Ma-ori doctor and a recently allows women to walk at their own pace rather than pushing them of VR in reducing pain in people with spinal cord injury. In addition, qualifi ed ANZCA fellow with an ongoing commitment to promoting to walk faster to a maximum speed. the investigators will examine whether the use of VR is associated and advocating for Ma-ori health. In this research proposal the aim with changes in brain activity that are associated with pain. is to assess the perioperative experiences of Ma-ori who require Persistent unrelieved pain is a major problem for a large care from an anaesthetist and to identify potential facilitators of proportion of people with spinal cord injury. The development of and barriers to their interactions with anaesthetists. With this an accessible, inexpensive treatment with few side effects has the understanding the investigator aims to produce recommendations - potential to benefi t this large group of people who are impacted for culturally competent anaesthetic care of Maori patients in the by pain. perioperative setting. It is hoped that this research will stimulate more widespread and ongoing review of engagement with Ma-ori Professor Philip Siddall, Greenwich Hospital, NSW, Professor patients as part of quality assurance activities in promoting safe James Middleton, Professor Ashley Craig, Associate Professor and high-quality anaesthetic care. A key motivation is in promoting Paul Wrigley, Royal North Shore Hospital, NSW, Dr Yvonne Tran, equitable access to care and equitable outcomes for Ma-ori. The chief Australian Institute of Health Innovation, NSW. investigator hopes to combine the fi ndings with their postgraduate $A68,327 qualifi cation in clinical education to design an educational resource to assist anaesthetists in this area. Dr Courtney Thomas, Christchurch Hospital, New Zealand $A20,000

38 ANZCA Bulletin December 2018 39 Simulation/Education Grant Novice investigator grants Project grants and Robin Smallwood Bequest

Associate Professor Stuart Marshall Analgesic techniques and outcomes in major Palmitoylethanolamide (PEA) for the Speaking up in the operating room: A grounded The Robin Smallwood Bequest was established following open and laparoscopic abdominal surgery: treatment of chronic pain – Dr Daniel Ellyard theory study – Professor Jennifer Weller a generous bequest from the late Dr Robin Smallwood to A feasibility study – Dr Katrina Pirie support a highly ranked grant in anaesthesia, intensive Chronic low-level infl ammation within the central nervous system Speaking up is a feature of effective teams, and is important for care or pain medicine. Major abdominal surgery is a common procedure, associated with (CNS) is increasingly being recognised as a potential contributor patient safety. Failure to speak up or unsuccessful attempts at signifi cant postoperative pain and morbidity. Effective postoperative to many types of persistent pain. Through the activation of glia, speaking up limit the opportunity for teams to correct mistakes, Crisis management cognitive aid to improve team analgesia is fundamental to recovery. Historically, epidural has especially microglia and astrocytes, it is thought that alterations in or prevent fl awed decisions or actions progressing to patient coordination: A multi-centre simulation study been the analgesic modality of choice. However, major benefi ts synaptic function lead to changes in the way that pain is processed harm. In addition, unprofessional behaviour including bullying and Although rare, emergencies under anaesthesia can lead to of epidurals have not been clearly shown in large randomised within the CNS. It is believed that these changes play a signifi cant discrimination have a negative impact on the team climate, and signifi cant morbidity and mortality. To help anaesthetic teams controlled studies, they are a challenge to maintain and are not part in the development of central sensitisation. There is also the latter has been linked to patient outcomes. Calling out these take the required action rapidly and appropriately, written without risk. Their place is increasingly questioned in the setting evidence that this glial activation may also account for many of behaviours may limit harm to staff, and improve team climate. “cognitive aids” such as fl owcharts and checklists are available of continuous improvement in surgical technique, including less the neuro-vegetative features common in persistent pain such as Clearly identifying and evaluating factors that predict speaking and immediately accessible in operating theatres. In many studies, invasive alternatives to open surgery. Early functional recovery anxiety, depression, fatigue, poor sleep and cognitive problems. It is up will be vital for developing interventions to promote it. these cognitive aids have been shown to improve the ability of is the aim of enhanced recovery after surgery (ERAS) protocols. hoped that medicines that are able to suppress CNS infl ammation Speaking up can be defi ned as explicitly communicating teams to coordinate their efforts and provide comprehensive and They provide guidance on multimodal perioperative care might help relieve pain, improve function and associated observations or concerns, requesting clarifi cation or explanation, rapid care. In a surgical setting, anaesthetic and other healthcare including analgesia and are increasingly implemented worldwide. psychiatric symptoms in patients with chronic pain. or explicitly challenging another’s decision or action. Speaking up teams commonly have large numbers of team members who Compliance with ERAS protocols has been associated with a Palmitoylethanolamide (PEA) is a naturally occurring fatty provides an opportunity to intervene before patient harm occurs, must coordinate their actions, and who often have very different reduction in postoperative complications and length of stay acid involved with known anti-infl ammatory properties and has to mitigate actual harm, or discourage unprofessional behaviour. training and knowledge. Furthermore, the number of tasks are in hospital, making their implementation an important been suggested to be involved in the regulation and termination of The investigators aim to explore factors that promote or inhibit also numerous and diverse in nature. A key function of the cognitive value-based care. infl ammatory responses within the CNS. It is currently classed as a climate conducive to speaking up, including differences between aid in this setting is to ensure coordination between the team A direct comparison of epidural, spinal morphine and a nutraceutical and available from compounding chemists without professional roles such as surgeon, anaesthetist, technician, members. Developing a shared understanding of the problem and intravenous lignocaine in open abdominal surgery, and spinal prescription. There is some evidence that administration of PEA and nurse. having each team member know how their individual tasks fi ts morphine and intravenous lignocaine in laparoscopic abdominal has analgesic benefi ts in a variety of causes of persistent pain, Semi-structured interviews will be conducted and focus groups within the whole is important for this coordination. surgery has not been done in a large multicentre trial. The although evidence is limited by signifi cant industry support. It does used to explore the experiences and perspectives of operating Some of the current cognitive aids endorsed by ANZCA consist investigators therefore plan a multicentre, randomised control trial have anecdotal evidence of positive effects and appears to be very room staff on speaking up. Grounded theory analyses will be of a number of cards, one given to each team member with tasks to investigate the clinical and economic implications of choosing well tolerated, with a low risk of serious adverse effects. Given the undertaken to develop a model to explain the psychosocial factors to accomplish relative to his or her role on the team. In contrast, alternative analgesic techniques to epidural in major open and limitations in current pharmacologic options in the management infl uencing speaking up in operating room teams which will then other cognitive aids have a single card or booklet available for a laparoscopic abdominal surgery. In addition to this study, a survey of persistent pain, it represents a potential useful addition to the inform improvement interventions. team leader or dedicated reader of the cognitive aid to use. The among ANZCA fellows will be conducted to determine current current therapeutic options. The results of this study will lay the foundations for a program leader or reader of the card calls out tasks to the other team anaesthetic practice for postoperative analgesia in open and The aim of this study is to assess the ability of daily oral of research on interventions to improve the climate of speaking members to coordinate their activity. A concern with the ANZCA laparoscopic major abdominal surgery. administration of PEA to achieve long lasting improvements in up in hospitals in New Zealand and beyond. This will also inform task card system is that it may fragment the team and prevent The primary objectives of this feasibility study will be to measure pain and function in patients being treated in a tertiary hospital development of role specifi c interventions contributing to further the development of a shared mental model of the crisis. From the ability to recruit eligible patients into the study and successfully pain clinic. Patients will be selected based on evidence of neuro- improvement of surgical safety, and communication between preliminary data of observation of simulation training, the task deliver each of the analgesic techniques according to the research vegetative features as assessed by the Symptom Severity Score operation room staff. cards may lead to problems of coordination among team members. protocol. Secondary aims involve optimisation of the protocol, as (SSS) from the 2011 revised ACR Fibromyalgia Criteria regardless The proposed project will advance our work on improvements of The aim of performing this research is to determine if teams well as testing the feasibility of using routine administrative cost of primary pain diagnosis. The study aims to have high external surgical safety focused on effective teamwork and communication perform more effectively and effi ciently with a single integrated data for health economic evaluations, the randomisation process, validity. Patients will be randomised to PEA or placebo in addition using multidisciplinary simulation programs and studies on human cognitive aid in comparison to the multiple, role-specifi c task the ability to capture data and identify the number of research to their current therapy for a period of six months. factors associated with safe surgery. cards. The study is a multi-centre simulation based trial with the nurse positions required for a multicentre study and fi nally, issues Outcomes will be assessed via the electronic Persistent Pain Professor Jennifer Weller, Dr Tanisha Jowsey, University participants being attendees at the ANZCA Effective Management relating to implementation of the trial at multiple sites. Outcomes Collaborative (ePPOC) questionnaires, with a primary of Auckland, Professor Sandy Garden, Wellington Regional of Anaesthetic Crises (EMAC) course across three sites. The results of this preliminary study will be used to design outcome of Pain Interference as assessed by the Brief Pain Hospital, New Zealand. Determining how design affects team functioning will be Inventory (BPI) at six months. a large-scale multicentre trial with the objective of obtaining $A68,635 of substantial benefi t to the anaesthetic community as it will outcomes that will accurately inform clinical practice. Dr Daniel Ellyard, Sir Charles Gairdner Hospital, Nedlands, guide the design of future cognitive aids, including electronic Western Australia. versions to track completed tasks. This will ultimately improve Dr Katrina Pirie, Royal North Shore Hospital, NSW. the effectiveness and effi ciency of the team during clinical $A20,000 $A11,786 emergencies, and lead to better outcomes for patients experiencing rare but potentially fatal events. Associate Professor Stuart Marshall, Alfred Health, Melbourne, Dr Barbara Burian, NASA Ames Research Center, US, Associate Professor Anna Clebone, University of Chicago, US. $A61,891

40 ANZCA Bulletin December 2018 41 Project grants (continued)

Trainees’ abilities to judge the level of Experimental therapy for the prevention A pilot study evaluating the efﬁ cacy of Impact of hormonal cycle on postoperative supervision they require in the workplace of chronic pain after surgery continuous erector spinae block quality of recovery in premenopausal women – Dr Damian Castanelli – Professor Matthew Chan – Dr Yoshiaki Uda – Dr Nicole Tan

In 2013, ANZCA introduced workplace-based assessments (WBAs) Chronic postsurgical pain (CPSP) is a common complication of Interfascial plane blocks refer to the injection of local anaesthetic A “good recovery” after anaesthesia and surgery is a key objective for to the ANZCA training program. One of these, the mini-Clinical surgery, affecting greater than 10 per cent of patients and adversely into a tissue plane, often between two muscles to facilitate loco- patients and their perioperative clinicians. It is not simply avoidance Evaluation Exercise (mini-CEX), is an observed assessment affecting their quality of life. Despite the magnitude of this problem, regional anaesthesia over a specifi c region of the body. Typically, of complications, but also freedom from discomfort, nausea, and undertaken during normal anaesthesia encounters. Supervisors there is a lack of effective strategies that reliably prevent CPSP. these procedures are performed in the preoperative period to a rapid return to preoperative levels of function and psychological provide structured feedback to trainees and make judgements Professor Chan and his team of basic science researchers are reduce postoperative pain, improve patient recovery and reduce wellbeing. Delayed or incomplete recovery can have wide-ranging about the level of supervision the trainee requires to perform the working on an ion channel in the nervous system, known as the opioid-related side-effects (sedation, reduced respiratory drive, effects for an individual and those around them. task safely, referred to as the entrustability scale. A previous study has shown that women generally have a poorer transient receptor potential canonical type 3 channel (TRPC3). In nausea and vomiting). One example is the transversus abdominis Earlier studies by members of the research team have quality of postoperative recovery than men, due in part to higher demonstrated that these judgements are reliable measures of preliminary research, the investigators observed an increased plane block for abdominal surgery, which evolved as an alternative pain scores and increased postoperative nausea and vomiting. the level of supervision that trainees required for observed cases. interaction of TRPC3 in the central terminals of nociceptors during to techniques such as epidural analgesia. Several factors have This fi nding persists for three days postoperatively, and is more Although the supervisors’ scores have been examined, what is the development of chronic infl ammatory pain. The release of contributed to the development and increased use of interfascial pronounced in premenopausal compared with postmenopausal not known is how trainees judge the supervisory input they felt Substance P, a neuropeptide related to the transmission of pain, plane block techniques. These include a shift from perioperative women. Differences in sex steroid levels of progesterone may they needed for an observed case, and how this compares to the was reduced with the administration of selective TRPC3 inhibitors. epidural analgesia to peripheral techniques, practitioner be responsible. Progesterone metabolites have anaesthetic and supervisors’ judgements. Similarly, the factors that contribute to Therefore, these data suggest TRPC3 is a potential drug target sonographic expertise, enhanced recovery after surgery strategies sedative-hypnotic effects via their action on GABA A receptors, the scores given by trainees and supervisors are unknown in the for CPSP. including the need for earlier patient ambulation, minimally the site of action of general anaesthetic agents. In pregnancy, setting of anaesthesia care in Australia and New Zealand. In a series of experiments, the team will determine the effects invasive surgery, the opioid crisis (prescription opioid-related increased endogenous progesterone production is believed to be the The aim of this study is to facilitate the development of refl ective, of TRCP3 inhibition using TRCP3 transgenic mouse models and morbidity), and an increased use of perioperative anticoagulation. underlying mechanism by which there are reduced requirements for self-regulated anaesthesia trainees. Self-regulated learning is pharmacological inhibitors (Pyr3 and Pyr10) on validated pain Erector spinae block (ESB) is an ultrasound-guided interfascial inhalational anaesthetic agents. Similarly, increased progesterone fundamental to professional development and ongoing learning. behavioural outcomes and pain signal transmission. They will also plane block fi rst described in 2016 to successfully treat severe levels in the luteal phase of the menstrual cycle are associated with However, the skills and knowledge involved with self-regulated conduct a genetic association study to determine the relationship thoracic neuropathic pain. ESB has been described in a relatively a lower dose of propofol to achieve loss of consciousness and lower learning must be learnt and developed over time. The extent between targeted genetic variants in TRPC3 gene and chronic large number of case reports in a brief period of time including anaesthetic volatile concentrations to maintain anaesthesia. to which ANZCA trainees have developed these skills and are Clinical studies have tried to determine whether complications postsurgical pain in 2000 patients enrolled in their Persistent Pain management of acute postoperative pain patients following elective therefore able to make accurate judgements about the level of such as postoperative nausea and vomiting are more common supervision they require for an anaesthesia encounter is unknown. after Surgery Study. laparoscopic ventral hernia repair, thoracic surgery, breast surgery during a particular stage of the menstrual cycle. These studies have From December 2018 when modifi ed WBA forms are introduced, Ultimately, it is hoped that the results will establish potential with reconstruction and bariatric surgery. However, its effi cacy is had confl icting results, due to a limited number of participants, trainees will be required to make those judgements by completing drug targets for the development of preventive and therapeutic yet to undergo vigorous scientifi c evaluation. measuring stage of cycle solely by asking women the date of their a “self-assessment score” using the same entrustability scale strategies, and enhance our ability to identify patients at risk The investigators aim to perform a pilot, multicentre, prospective, last period, or assuming that cycle duration was identical for each as their supervisors. However the way in which this new self- for CPSP. The impact on patients, their families, and the society triple-masked, randomised, placebo-controlled trial to investigate participant. assessment measure works is yet to be tested. as a whole, in terms of decreasing the number of patients who the effi cacy of continuous ESB. To achieve triple blinding and Therefore, the aim of this study is to determine whether Therefore this research will compare trainee self-assessments are disabled by chronic pain after surgery, will be socially and minimise the risk of bias, the patient is randomised to receive stage of hormonal cycle affects quality of recovery after surgery to the judgements made by the supervisors in voluntary mini-CEX economically signifi cant. continuous ESB with either local anaesthesia or with normal saline in premenopausal women. Cycle stage will be measured by assessments, to remove the potential infl uence of formal reporting Professor Matthew Chan, The Chinese University (placebo). The primary outcome is the pain score as rated by Brief questionnaires, urine pregnandiol and serum progesterone and requirements. It will also explore the factors that infl uence luteinising hormone levels. Quality of recovery will be assessed of Hong Kong, China. Pain Inventory at 24 hours. The novelty of study lies in that we use trainees’ and supervisors’ ratings through a series of interviews patient rated outcomes including Brief Pain Inventory, Quality of on the day after surgery by a questionnaire which assesses $A46,900 with paired trainees and supervisors involved in the same mini- Recovery and patient satisfaction. pain, physical comfort (including nausea and vomiting), physical CEX. These interviews will investigate ANZCA trainees’ insight into With a number of emerging novel blocks, there is a need to independence, emotions and psychological support. The concept of a their own progression towards unsupervised practice. good recovery is patient-centred, thus it is the patient’s assessment establish multi-centre trial networks in regional anaesthesia This research will provide insights into trainees’ abilities to of their recovery that is important. make self-judgements about how much supervisory input they to assess their effi cacy. This is a pilot trial to assess feasibility If an association between stage of hormonal cycle and quality required for a case, and how these judgements are made. This of a larger multi-centre trial. Therefore, we will record other of postoperative recovery is found, women will have the option information may be used to inform future improvements in ANZCA variables such as recruitment and retention rates, problems with to choose the best time for elective surgery in order to improve training, such as the WBAs, or identify areas for further trainee and randomisation, blinding, loss to follow-up of primary outcome recovery, reduce pain and postoperative nausea and vomiting, as supervisor/fellow education and development. In particular, the and protocol violations, and further information needed for sample well as limit the side-effects of treatment of these conditions. This process of discussion and reconciliation of scores for supervision size calculation. may also encourage research into quality of recovery in peri- and may prove to be a useful aid to the development of skills in self- Dr Yoshiaki Uda, Associate Professor Michael Barrington, postmenopausal women receiving hormone replacement therapy, refl ection and capturing this process through interviews may assist Dr Anjalee Brahmbhatt, Dr Robert Gotmaker, St Vincent’s a group who typically undergo more extensive surgery with a with the design of interventions to improve feedback that promotes Hospital, Melbourne, Dr Craig Daniel, The Gold Coast Hospital, prolonged recovery. Additionally, if a link is found, stage of hormonal refl ection and self-regulated learning. cycle should be assessed in all future studies involving women and Queensland, Dr Kelly Byrne, Waikato Hospital, New Zealand. Dr Damian Castanelli, Monash Medical Centre, Melbourne, recovery after surgery. Dr Jennifer Woods, Christchurch Hospital, New Zealand, $A24,898 Dr Nicole Tan, Epworth HealthCare, Melbourne; Professor Professor Jennifer Weller, University of Auckland, New Zealand. Helena Teede, Monash University, Melbourne. $A30,001 $A7570

42 ANZCA Bulletin December 2018 43 Project grants (continued) Grant review process

On behalf of the college, the ANZCA Research Committee thanks all reviewers listed below who ANZCA Research Committee members: reviewed one, or often more, grant applications for Professor David A Scott, Chair (Vic) your invaluable contribution to the award process. Professor David Story, Deputy Chair (Vic) Much effort goes into ensuring that the process is as fair and Dr Jane Baker (NSW) rigorous as possible. It starts each year with ANZCA Research Professor Matthew Chan (HK) Committee members reading the grant applications. Three reviewers for each grant are then selected for their expertise Associate Professor Alicia Dennis (Vic) Improving opioid handling after surgery Does Transfusion Related Immune Modulation around the project. One reviewer is the spokesperson and Dr Matthew Doane (NSW) a member of the research committee, while the other two – Dr Megan Allen occur following Intraoperative Cell Salvage: Associate Professor Lis Evered (Vic) A pilot study – Dr Michelle Roets are usually from outside the committee. These reviewers Opioid handling after hospital discharge following surgery has been include expert researchers from anaesthetics as well as other Dr Andrew Klein (UK) relevant specialties. The reviewer comments are sent back to demonstrated to be suboptimal both internationally and locally. Intraoperative cell salvage is a process where blood lost during Professor Alan Merry ONZM (NZ) the researcher applicant for response, and the spokesperson Our team has designed a multidimensional opioid stewardship surgery is collected, processed and returned to the patient. Use Professor Simon Mitchell (NZ) then collates all this information (including the reviewer scores intervention aimed at improving opioid management post- of intraoperative cell salvage may provide a cost-effective and and the applicant’s response – which is very important) into a Professor Philip Peyton (Vic) discharge in surgical patients. safer alternative to allogeneic blood transfusion. In particular, synopsis with a score. Each grant is then discussed by the whole Professor Tony Quail (NSW) The intervention will involve carefully considering discharge because patients are not exposed to blood from another person, ANZCA Research Committee during a day-long face-to-face opioid therapy in view of recent inpatient use through guidelines it seems likely that the impairment of immune responses that Professor Britta Regli-Von Ungern-Sternberg (WA) meeting, with their fi nal scores determined by the averages and junior doctor education, strict guidance for slow release occurs following allogeneic blood transfusion will be prevented. of secret ballot scores (out of seven) from each committee Professor Stephan Schug (WA) opioid therapy initiated after surgical care, communication with An evaluation of Transfusion Related Immune Modulation (TRIM) member. Associate Professor Tim Short (NZ) general practitioners to support limited opioid resupply and associated markers in intraoperative cell salvage blood has Confl icts of interest are declared and recorded and members educating patients at the time of discharge opioid dispensing with never been done in Australia. As more than 2.4 million surgical Professor Andrew Somogyi (SA) of the committee are excluded from consideration of any grants personalised counselling on safe medication storage and disposal. admissions occur in Australia yearly, the potential impact is for which they have a confl ict. The presence of Dr Angela Professor André van Zundert (Qld) This study will investigate the feasibility of introducing such an signifi cant. Watt, our community representative adds an extra safeguard Dr Angela Watt, (Vic) Community representative intervention, and to a limited extent the effi cacy of the intervention The aim of the study is to therefore confi rm that by receiving in this regard as does committee member, Dr Jane Baker bundle. This study will be conducted at University of Melbourne intraoperative cell salvage instead of allogeneic blood transfusions, Professor Jennifer Weller (NZ) and our external member, Dr Andrew Klein (editor-in-chief of affi liated public teaching hospitals (The Royal Melbourne Hospital, patients will have an altered plasma level of infl ammatory markers Anaesthesia). None of these three members actively compete Peter MacCallum Cancer Centre and The Royal Women’s Hospital). that identify a lower associated risk of TRIM, than when receiving for grants, and two are not eligible to do so. Patients will be recruited during their hospital admission and allogeneic blood transfusion. Finally, funding is allocated to the grants in descending Every year committee members and reviewers put a great followed up post discharge until three months post-surgery to This study was submitted in 2017 for peer review and awarded order of the fi nal averaged committee member scores, within deal of work into maintaining our high quality research grant assess medication handling and their acute pain experience. The funding in 2018. In August 2017, Dr Roets enrolled to undertake the limits of the funds available. Inevitably, in any competitive process, often in their own time. We would like to express our investigators hope to demonstrate improved opioid handling in a PhD with the University of Queensland, studying the cost and process some applicants are unsuccessful. As with most grant very sincere thanks to all of them, and to the CEO and ANZCA the sites where an opioid stewardship intervention is introduced. benefi t profi les of intraoperative cell salvage (including a potential programs, detailed feedback is not provided to applicants Council for their ongoing commitment to research – as a vital Therefore, there is potential to improve the safety of surgical to reduce TRIM through intraoperative cell salvage) and applied to after the committee has fi nalised its grant decisions, with the contribution to continuous improvement in quality, safety and patients and the wider community. ANZCA for scholarship support. exception of novice investigators. However, detailed feedback patient outcomes. Dr Megan Allen, Dr Charles Kim, Dr Karin Jones, The Australian Red Cross Blood Service has established models on grant applications is provided during the review process In conclusion, and importantly, I would like to express my The Royal Melbourne Hospital, Melbourne. to assess TRIM using a combination of ex vivo and in vitro assays. through reviewers’ comments to applicants, which refl ect most sincere thanks and deep appreciation to Professor Alan Merry Recruitment of patients from orthopaedic outpatient clinics is $A41,655 of the factors that will infl uence committee decisions. Most of who has stepped down this year as chair of the committee after continuing with the collection of samples during the standard cell the senior members of the committee have experienced many 10 years. Alan has contributed signifi cantly to the development salvage process within theatre at the Royal Brisbane and Women’s unsuccessful grant applications through ANZCA and other of the research strengths within and supported by the college. Hospital. Assays are conducted by laboratory personnel within the granting agencies such as the National Health and Medical I am grateful that he is continuing on the committee to support Australian Red Cross Blood Service in Kelvin Grove, Brisbane. Research Council and Health Research Council, NZ. This is our work. I would also like to congratulate Professor David Story The debate about TRIM has been ongoing in research literature. usually considered an essential part of the development of grant who has been selected by the committee as the new deputy If a test or assay can be found to specifi cally identify TRIM it may writing skills for future success, and perhaps it is this persistent chair. His support is likewise greatly appreciated. become possible to translate this large volume of evidence and pursuit of continual improvement that most characterises all potentially use these markers as a predictive tool for the presence ANZCA grant applicants. The committee recognises the very Professor David A Scott, Chair of TRIM after surgical procedures for many specialties, thus signifi cant time and effort involved in writing research grants, ANZCA Research Committee advocating for intraoperative cell salvage as a safer alternative and extends its thanks and encouragement to all applicants. and provide better patient care. The committee considered and approved some changes Dr Michelle Roets, Royal Brisbane Women’s Hospital to the grant eligibility rules, including limiting the maximum and the University of Queensland. number of years’ funding that can be applied for in a single $A20,000 scholarship application. These changes are designed to improve the opportunity for funding to as many applicants as possible. An overview of these changes are in the foundation update on page 59. Full details of the changes will be included in the December ANZCA E-Newsletter and on the ANZCA website.

44 ANZCA Bulletin December 2018 45 Grant review process (continued) Research grants Reviewers for the 2019 grant round: Dr James Griffi ths (Vic) Professor Michael Paech (WA) Dr Kara Allen (Vic) Dr Kerry Gunn (NZ) Professor Jaideep Pandit (UK) Dr Megan Allen* (Vic) Dr Richard Halliwell* (NSW) Dr Jaimin Patel (UK) for 2020 Dr Sara Allen (NZ) Professor Jonathan Hardman (UK) Professor Rupert Pearse (UK) Professor Brian Anderson* (NZ) Dr William Harrop-Griffi ths (UK) Professor Philip Peyton* (Vic) Associate Professor Carolyn Arnold (Vic) Dr Christopher Hayes (NSW) Dr Tuong Phan (Vic) Associate Professor Michael Barrington Dr Elizabeth Hessian (Vic) Professor Tony Quail* (NSW) (Vic) Clinical Associate Professor Kwok-ming Ho Professor Britta Regli-von Ungern ANZCA and ANZCA Research Foundation Novice Investigator Grant Grants Program Dr Martin Besser (UK) (WA) Sternberg* (WA) A major goal of the college and the foundation is to encourage and Dr Vaughan Bertram (UK) Professor Charles Hogue (US) Associate Professor Richard Riley (WA) Applications are invited from fellows and registered trainees of foster novice investigators. The ANZCA Research Committee invites ANZCA and FPM for research grants and awards for projects related early application by novice investigators to apply for mentoring during Dr Robyn Billing (NZ) Professor Nick Holford (NZ) Professor Paul Rolan (SA) to anaesthesia, resuscitation, perioperative medicine, intensive care the application process. Applications must be received by January 14 Professor Duncan Blake (Vic) Dr Richard Horton (Vic) Professor Colin Royse (Vic) medicine or pain medicine. In general, the work must be carried out in each year. Australia, New Zealand, Hong Kong, Malaysia or Singapore; however Associate Professor Robert Boots (Qld) Associate Professor Ruth Hubbard (Qld) Dr Simon Scharf (Vic) A mentor, who is an experienced investigator, will be appointed by ANZCA fellows or trainees who are temporarily working in other the Research Committee. The mentor will assess the application and Associate Professor Charles Brooker Dr Susan Humphreys (Qld) Professor Stephan Schug* (WA) countries for research experience may be considered for research provide prompt feedback. The applicant must then resubmit his or (NSW) support under special conditions, as per the grant guidelines. Dr Brian Jenkins (UK) Professor David A Scott* (Vic) her application to the College by the usual deadline. Late applications Dr David Buckley (NZ) Dr Simon Jenkins (SA) Associate Professor Ian Seppelt (NSW) The ANZCA research policy, and the full details of the ANZCA for either deadline will not be accepted. All mentoring provided to Dr Douglas Campbell (NZ) Associate Professor Max Kelz (US) Professor Nick Sevdalis (UK) grants program, are available on the college website, and should the applicant will be confi dential and not available to the Research be considered in detail by all applicants. The Research Committee Committee. Professor Matthew Chan* (HK) Associate Professor Ross Kerridge* (NSW) Professor Yahya Shehabi (NSW) has approved changes to the grant eligibility rules, including limiting For the purposes of this process, a novice is an investigator who: Dr Michael Charlesworth (UK) the maximum number of years of funding that can be applied for in Dr Fiona Kiernan (IRE) Associate Professor Tim Short* (NZ) 1) has not been awarded a peer-reviewed research grant in the a single application to two years. These changes are designed to Dr Michael Clifford (Vic) past, 2) has not published more than fi ve research papers in the Dr Charles Kim (Vic) Professor Philip Siddall (NSW) improve the opportunity for funding to as many applicants as possible. fi ve years prior to the year of application, 3) does not have an Professor Mark Connor (NSW) Dr Andrew Klein* (UK) Associate Professor Brendan Silbert* (Vic) All changes will be highlighted on the research pages on the website experienced investigator as a co-investigator on the proposed grant. and will be included in the prescribed forms. Professor Tomas Corcoran (WA) Dr James Koziol (Vic) Dr Ben Slater* (Vic) The maximum amount available for a novice investigator grant is Dr John Cormack (Vic) Dr Cornelia Landersdorfer (Vic) Professor Jamie Sleigh (NZ) The application forms and guides to applicants are available on $A20,000. Associate Professor David Cottee (NSW) the college website at www.anzca.edu.au/research/research-grant- Professor Anna Lee (HK) Dr Natalie Smith (NSW) application-forms-and-guides. Other ANZCA grants Dr David Cumin (NZ) Professor Kate Leslie* (Vic) Dr Barry Snow (NZ) The closing date for all grant applications is 5pm April 1, 2019. Academic Enhancement Grant Dr Dale Currigan (WA) Dr Denny Levett (UK) Professor Andrew Somogyi* (SA) Further information contact: Dr Allan Cyna (SA) ANZCA provides an academic enhancement grant which aims to Dr Scott Ma (SA) Professor David Story* (Vic) Ms Susan Collins foster the advancement of the academic disciplines of anaesthesia Professor Andrew Davidson* (Vic) Professor Pam Macintyre (SA) Dr Nicolaas Terblanche (Tas) Research Administration Coordinator and/or pain medicine. ANZCA Research Foundation Dr Kieran Davis (NZ) Dr Surbhi Malhotra (NSW) Clinical Associate Professor Michael Vagg +61 3 9510 6299 Support is provided for proposals encompassing broad areas of Associate Professor Alicia Dennis* (Vic) Dr Guillermo Martinez (UK) (Vic) [email protected] research; details of initial area(s) of investigation need to be outlined. Thus the grant aims to enhance foci of research activity. Dr Matthew Doane* (NSW) Dr Peter McCall (Vic) Associate Professor Roelof Van Wijk (SA) ANZCA Research Foundation Grants Applicants must have university status at the level of Professor/ Dr Kariem El-Boghdadly (UK) Dr David McIlroy (Vic) Professor André van Zundert* (Qld) Clinical Professor or Associate Professor/Clinical Associate Professor, Research Project Grants Associate Professor Victoria Eley (Qld) Professor Alan Merry* (NZ) Associate Professor Irina Vetter (Qld) but are not required to have administrative responsibility for a clinical Dr David Elliott (NSW) Dr Lachlan Miles (Vic) Dr Stuart Walker (NZ) Projects that will be considered may be in the fi elds of basic scientifi c department. research, clinical investigation or epidemiological research. The Dr Yasmin Endlich (SA) Dr Stephen Warrillow (Vic) Research foci eligible for support include: a new chair; an existing Professor Simon Mitchell* (NZ) maximum amount available for a project grant is $A70,000 with grants chair with new incumbent; an existing chair pursuing a new research Associate Professor Lisbeth Evered* (Vic) Associate Professor Jennifer Watts (Vic) being awarded for projects to be completed within two calendar years Dr John Moore (UK) direction; a second chair in an existing department; a professor/ following the year of the grant decision. Grant funding is usually for Dr Philip Finch (WA) Professor Peter Morley (Vic) Associate Professor Laurence Weinberg associate professor (or clinical professor/associate professor) who one year; however consideration may be given to the provision of (Vic) heads a research group. Reapplication by a previously successful Dr Brendan Flanagan (Vic) Dr Richard Morris* (NSW) second year funding for a highly ranked grant. applicant within fi ve years will receive a lower priority unless Dr Julia Fleming (Qld) Professor Jennifer Weller* (NZ) Professor John Murkin (Canada) Research Scholarships exceptional circumstances exist for the reapplication. The maximum Associate Professor Duminda Wijeysundera Dr Nick Fletcher (UK) Professor Paul Myles (Vic) amount available for an academic enhancement grant is $A100,000. (Canada) Scholarship grants are made within the project grant scheme and Professor Kirsty Forrest (Qld) Dr Gladness Nethathe (Qld) are awarded to fellows or registered trainees enrolled as research Simulation/education grant Dr Matthew Wiles (UK) higher degree students to support full-time or part-time research in a Associate Professor David Foster (SA) Associate Professor Toby Newton-John Applications are invited from fellows and registered trainees for the Professor Daryl Williams (Vic) recognised university or research institute in Australia, New Zealand, (NSW) 2020 Simulation/Education Grant, for projects in the fi eld of medical Associate Professor Craig French (Vic) Hong Kong, Malaysia or Singapore. They are available for one or two Dr Leona Wilson (NZ) simulation and education of relevance to anaesthesia and/or pain Professor Sandy Garden* (NZ) Dr Anne O’Callaghan (NZ) years, subject to category of award made and subject to satisfactory medicine. Applications should be made using the project grant Dr Niall Wilton (NZ) reports. The stipend and allowances are similar to those provided Associate Professor Stephen Gatt (NSW) Dr Fergal O’Donoghue (Vic) application form with Simulation/Education Grant selected in the by the NHMRC. Half-time research may be negotiated on a pro-rata appropriate box. These applications will be considered as project Dr Laura Green (UK) Dr Kenji Okuse (UK) basis upon application. *Reviewed two or more grants. grants and therefore several projects may be supported; however Professor Keith Greenland (Qld) Dr David Olive (Vic) the highest ranked fundable Simulation/Education Grant will be designated the Simulation/Education Grant for 2020. The maximum amount available for a Simulation/Education Grant is $A70,000.

46 ANZCA Bulletin December 2018 47 Your ANZCA The ANZCA Professional Affairs Executive Committee: Advancing our fellows’ interests

It doesn’t take more than a quick glance at the ANZCA website despite their relatively high levels of education and income. or any issue of the ANZCA Bulletin to appreciate the breadth and PAEC members As increasing numbers of women are entering the specialities extent of activity generated by the ANZCA community. ANZCA of anaesthesia and pain medicine, inequity will become more is a large binational organisation serving 1650 trainees, and Associate Professor Leonie Watterson, Chair PAEC pronounced unless action is taken to correct it. 6500 fellows and 160 specialist international medical graduates (NSW) ANZCA’s Gender Equity Position Statement represents the (SIMGs) of anaesthesia and pain medicine residing in Australia, Dr Simon Jenkins, Deputy Chair PAEC, Councillor (SA) next stage of this work. It is due to be launched in early 2019. New Zealand and further abroad. All these people, supported by Patient information resources ANZCA professional staff, make up the ANZCA community. Dr Christine Vien, New-Fellow Councillor (Vic) Each year, specifi c resources are directed toward patient While the end products of their activity are usually evident, it Dr Rodney Mitchell, ANZCA President (SA) information campaigns and materials to improve patients’ may not be so clear what goes on behind the scenes to generate Dr Nigel Robertson, Chair, ANZCA and FPM CPD experiences of anaesthesia and pain medicine and their general and co-ordinate this activity. That’s understandable. In addition Committee (NZ) awareness of the credentials and roles of specialists working to council, the Faculty of Pain Medicine (FPM) Board and the in these fi elds. National Anaesthesia Day is a focus of this regional committees, ANZCA is supported by trainees, SIMGs, Dr Phillipa Hore, Chair, Safety and Quality work, marked each year on October 16 with a media campaign fellows, ANZCA staff and community members who contribute to Committee (Vic) and promotional materials. This year, the video – “What is 34 committees and or working groups1. Dr Peter Roessler, ANZCA Director of Professional anaesthesia?” was launched as the fi rst in a series of patient This article focuses on the work of the ANZCA Professional Affairs - Policy (Vic) information videos to educate patients preparing for surgery9. Affairs Executive Committee (PAEC), one of nine committees We welcome expressions of interest from fellows who may reporting directly to council. PAEC’s purpose is to engage Dr Michael Vagg, Faculty Pain Medicine like to be involved in the work of our committee in the future. with and advocate for fellows and to advise and make representative (Vic) Supporting the sustainable growth of a diverse, high quality and healthy anaesthesia and pain medicine workforce is a core recommendations on matters pertaining to fellows of the college. Dr Marty Minehan, Fellow (NZ) PAEC is substantially a rank and fi le committee comprising goal of ANZCA’s 2018-2022 Strategic Plan. To achieve this goal Clinical Associate Professor Leonie Watterson mostly fellows of ANZCA or FPM. We strive to achieve broad Associate Professor Marcus Skinner, Fellow (Tas) PAEC sponsors the Workforce Strategy Reference Group whose Chair PAEC, ANZCA fellowship representation. As such, the committee includes terms of reference address planning and supply, training and Dr Bridget Effeney, Fellow (Qld) References: fellows from a range of geographic settings who collectively education, health and well-being, diversity and innovation in Ms Dorothy McLaren, Community representative (Vic) urban regional, rural and remote settings. 1. Committees, ANZCA [Internet] Melbourne [Cited date 24/10/2018] have experience in public and private practice, urban and rural/ Available at www.anzca.edu.au/about-anzca/council,-committees-and- remote practice, and anaesthesia and pain medicine practices. Ms Clea Hincks, Director, Safety and Advocacy (ANZCA) Doctors health and wellbeing representatives/committees#sub-committees-or-other We also strive to achieve gender equity and to include both Ms Jan Sharrock, Director, Fellowship affairs (ANZCA) The most recent graduate outcomes and fellowship surveys 2. Professional Affairs Executive Committee ANZCA [Internet] Melbourne younger and more senior fellows within our group. Fellow [Cited date 24/10/2018] Available at www.anzca.edu.au/about-anzca/ also reveals unacceptably high rates of reported bullying, council,-committees-and-representatives/committees/professional- representatives are co-opted to the committee through an open discrimination and sexual harassment. It was also clear that affairs-executive-committee 2 These surveys provide data that enables the college to expression of interest process . working hours for fellows have signifi cantly increased since 3. Scott, D.A. Workforce: ANZCA on track. ANZCA Bulletin September One of PAEC’s key roles is to be a sounding board for monitor workforce trends and to inform the college of where 2014 (from 35.1 to 40.7). This places fellows at greater risk of 2016 pp24-6. [Cited date 24/10/2018] Available at www.anzca.edu.au/ committees that report through it to council: the ANZCA and it should direct its attention, such as education, online illness and burn out. Consequently, the college has identifi ed documents/anzca-bulletin-september-2016-spreads.pdf FPM Continuing Professional Development Committee (CPD), the technology, college communications and advocacy work, and health and wellbeing as one of its four strategic goals for the 4. CPD: How some of our private practitioners are completing practice membership fees and services. For example, the CPD committee evaluation activities ANZCA Bulletin September 2016 p66. [Cited date ANZCA Indigenous Health Committee and the ANZCA Overseas 2018-2022 period. The Doctors’ Health and Wellbeing Framework 24/10/2018] Available at www.anzca.edu.au/documents/bulletin-sep- Aid Committee. These committees work largely independently has committed to providing additional guidance on completing launched in 2018 scaffolds the program which includes a range 18-fi nal-spreads.pdf however PAEC provides a forum for peer review of their the practice evaluation requirements of the ANZCA and FPM of services and initiatives including as examples, the Free 5. Doctors’ health and wellbeing ANZCA [Internet] Melbourne [Cited date recommendations. Discussions within PAEC consider the broad CPD Program in the setting of private practice as some survey Doctors’ Support Program, the directory of health services and a 24/10/2018] Available at www.anzca.edu.au/resources/doctors-welfare 3 impact of the work of these committees and specifi cally appraise respondents reported diffi culties associated with this . Recently, series of resources to support supervisors and managers dealing 6. Human Rights and Equal Opportunity Commission. Gender equality: issues through the lens of fellows where questions such as “How a section on bullying, discrimination and sexual harassment What matters to Australian women and men: The Listening Tour with performance or professionalism issues among trainees and/ Community Report. [Internet] Sydney : Human Rights and Equal would this affect people in private or rural practice?” and “How has been added the results of which have informed the college’s or specialist colleagues5. The Welfare of Anaesthetists Special Opportunity Commission; 2008 [Cited date 24/10/2018] Available would a new fellow view this?” are frequently asked. Other work health and wellbeing strategy. Interest Group also provides substantial resources supporting from www.humanrights.gov.au/sites/default/fi les/content/sex_ discrimination/listeningtour/ListeningTourCommunityReport.pdf considered and vetted by PAEC include newly created and or Workforce strategy this goal. recently updated ANZCA professional documents, overseen by 7. The Australian Commonwealth Government’s Workplace Gender Workforce modelling is an inexact science and while the college Gender Equity Equality Agency. Gender Strategy Toolkit: The business case for the Director of Professional Affairs, Policy and work generated has no direct control over workforce numbers there is an gender equality [Internet] Canberra (ACT): WGEA; 2016 pp 5-9; [Cited by ANZCA’s Safety and Advocacy unit which includes policy and It is well established that gender equity has substantial ethical, date 24/10/2018] Available from www.wgea.gov.au/sites/default/fi les/ appreciation that the specialist workforce substantially impacts social, and economic benefi ts to individuals and society6. Gender_Strategy_Toolkit.pdf communications. upon patient safety, fellow wellbeing and career opportunities PAEC’s second key role is to address issues that are relevant Gender equity is strongly associated with success outcomes 8. Watterson, L. Endorsing gender equity ANZCA Bulletin March 2018 p66. and satisfaction. in organisations where it is achieved7. In 2017, the college [Cited date 24/10/2018] Available at www.anzca.edu.au/documents/ to fellowship and which do not fall within the remit of other anzca-bulletin-march-2018-web-version.pdf The graduate outcomes and fellowship surveys provide made a commitment to advocate for gender equity through the committees and groups. Some of these issues are identifi ed and invaluable information on workforce issues for anaesthetists 9. Anaesthesia isn’t sleep – it’s so much deeper ANZCA [Internet] delegated to PAEC by council or the ANZCA Executive while establishment of the Gender Equity Working Group. Work began Melbourne [Cited date 24/10/2018] Available at www.anzca.edu.au/ and pain medicine specialists. For example, despite recent with an evaluation of gender equity within anaesthesia and events/national-anaesthesia-day/national-anaesthesia-day-2018 fellows directly raise others. The following paragraphs highlight concerns that increasing numbers of medical graduates will lead several of the initiatives overseen by PAEC. pain medicine across Australia and New Zealand. Numerous to an oversupply of anaesthetists, results of the 2016 Graduate reasons to celebrate were identifi ed, however there were also Graduate outcomes and fellowships surveys Outcomes Survey showed that over their fi rst three years of several areas of apparent inequity. Women are underrepresented The Graduate Outcomes Survey and Fellowship Survey is used practice, 100 per cent of ANZCA fellows successfully entered in leadership roles, while men utilise family and carer leave to gauge our fellows’ attitudes and perceptions of a broad range the workforce and that satisfaction and optimism has increased considerably less than women. Bullying, discrimination 4 of college matters. This includes overall attitudes to the training compared with previous surveys . and sexual harassment are experienced by men and women program and experience, and satisfaction with college services Broader projections through to 2030 suggest an anaesthesia in anaesthesia and pain medicine, but are more commonly (such as the CPD program and continuing medical education workforce that is in balance, with the potential to shift into experienced by women8. The bottom line is that anaesthetists Interested in volunteering? Please events). oversupply however an imbalance currently persists between and pain medicine trainees, SIMGs and fellows are not immune contact [email protected] regional and urban distribution of specialist anaesthetists. to the serious negative consequences of gender inequity,

48 ANZCA Bulletin December 2018 49 Safety and quality News

WebAIRS news Approach to the use of CPAP in Malignant hyperthermia resources The recent Australian Society of Anaesthetists National Malignant hyperthermia (MH) is a rare life-threatening Scientifi c Congress in October featured three presentations that patients with OSA and monitoring condition usually triggered by exposure to certain drugs used were supported by data collected using the webAIRS server. considerations for general anaesthesia — specifi cally the volatile anaesthetic The fi rst was a fi rst glimpse at the Triple A project (Airway agents and succinylcholine, a neuromuscular blocking agent. The Medical Council of NSW (MCNSW) has sought guidance in Incidents in Anaesthesia Audit – Australia and NZ) by Dr Malignant Hyperthermia Australia and New Zealand relation to postoperative monitoring of patients with obstructive Yasmin Endlich. The AAAP data (including denominator data) (MHANZ) was formed in November 2004 to provide timely, sleep apnoea (OSA) who use home continuous positive airway was collected from April to October 2018 with 12 participating current and consistent advice to health practitioners and pressure (CPAP). It has become evident that there are variations hospitals from Australia and New Zealand. Closely following consumers about MH treatment and testing. in practices amongst anaesthetists, which has prompted a the methodology of the National Audit Projects of the Royal Information about MH diagnosis and treatment was request for the college to develop a professional standard or College of Anaesthetists (UK), the AAAP data is being analysed originally housed on the Royal Melbourne Hospital website. consensus guideline on the topic. and a detailed presentation is planned for the 2019 Airway SIG This year, MHANZ has created a new website In responding to this request ANZCA has directed the MCNSW meeting, which will be held immediately prior to the ANZCA www.malignanthyperthermia.org.au to refl ect the increasing to the publication by ANZCA and FPM Acute Pain Management: Annual Scientifi c Meeting (ASM) in Kuala Lumpur at the end diagnostic complexity of MH. Scientifi c Evidence (4th edition), http://fpm.anzca.edu.au/ April 2019. An audit report will follow that summarises the An updated MH resource kit, which was endorsed by ANZCA documents/apmse4_2015_fi nal section 10.4 titled “The patient information and some of the fi ndings will be submitted for Council in September 2018, is available on the site. with sleep-disordered breathing including obstructive sleep publication in a peer reviewed journal. The website also includes packages of information relevant apnoea” (p558). This section makes a clear statement supporting The session titled “We cannot fi x what we do not know” to the role of the user, including sections for consumers, the use of CPAP in patients with OSA, and illustrates why there is included “What we have learnt from the webAIRS airway general practitioners, anaesthetists and geneticists. A training diversity in practices. data” by Dr Endlich and “The bowtie diagram as a method for section tests the comprehension of basic information about MH. The purpose of this communique is to draw attention the providing knowledge about critical Incidents” by Dr Martin Clinicians can register to receive updates about MH and the recommended approach to the use of CPAP in patients with OSA Culwick. website via email. and monitoring considerations. The Australian and New Zealand Tripartite Anaesthetic Data The website provides information about the use of charcoal Committee (ANZTADC) met on October 6, 2018 in Adelaide. fi lters in preparing anaesthesia workstations and some Strategic planning for ANZTADC is under way to review the information pertinent to those caring for MH susceptible persons current operations. More details will appear in the next issue in the community. MHANZ membership is made up of specialists in anaesthesia, of the Bulletin after the review has been completed. A referral form is downloadable from the website to ensure genetics, molecular biology and MH research working from one For the ANZCA ASM 2019 the following submissions have Safety alerts collection of consistent information about MH episodes and of the four testing units in Australia and New Zealand: been accepted into the program: Safety alerts are distributed in the “Safety and quality” MH patients across Australia and New Zealand. The forms are Victoria section of the monthly ANZCA E-Newsletter. A full list can be encrypted and will be directed to the relevant MH specialist • Masterclass: Using webAIRS to run a personal audit, a Malignant Hyperthermia Diagnostic Unit – Royal Melbourne found on the ANZCA website: www.anzca.edu.au/fellows/ team. departmental audit or a morbidity and mortality meeting Hospital (Monday April 29 1.30-3pm). safety-and-quality/safety-alerts. The website content has been compiled by the MHANZ group and includes revisions as a result of yearly refl ection at NSW • Scientifi c session: Airway Management SIG: Diffi cult airway MHANZ meetings (held each year in October) with the following Malignant Hyperthermia Unit – Westmead Children’s Hospital – expect the unexpected (Tuesday April 30 3.30-5pm). considerations: ANZTADC looks forward to seeing you at these sessions Western Australia • Case reports of MH from that period. in 2019. Malignant Hyperthermia Investigation Unit – Royal Perth • Literature review. Hospital Find out more about ANZTADC/WebAIRS • Updates from the European Malignant Hyperthermia Group Are you contributing to quality improvement in anaesthesia? New Zealand (EMHG) – at least one member of MHANZ attends the annual Register yourself on webAIRS: www.webairs.net Palmerston North Malignant Hyperthermia Unit – Palmerston EMHG meeting and delivers a report. North Hospital • New products and drugs. MHANZ encourages ANZCA fellows to access the website and • Genetics updates. take an active role in preparing their workplace for an MH crisis.

Dr Robyn Gillies, FANZCA, on behalf of Malignant Hyperthermia Australia & New Zealand (MHANZ)

“The Malignant Hyperthermia Australia and New Zealand updated website and webAIRS Anaesthetic Incident revised resource kit were endorsed by Reporting System from ANZTADC ANZCA Council in September 2018.”

50 ANZCA Bulletin December 2018 51 Safety and quality features Updating the difﬁ cult Anaesthesia and airway alert cosmetic surgery

Recent deaths and other medical emergencies involving patients undergoing cosmetic surgery Diffi cult airways, while rare, account for a signifi cant have prompted ANZCA to develop safety proportion of morbidity and mortality relating to anaesthesia information on anaesthesia and sedation. care. Recognising a diffi cult airway (DA) in a patient is not always reliable, even for experienced anaesthetists. Predictive Recent fatal incidents and reports of botched cosmetic bedside tests have low positive predictive values and ranking procedures has highlighted the importance of anyone considering a cosmetic procedure to seek specialist medical scores achieve little more. A documented previous diffi cult advice beforehand. or failed tracheal intubation has been demonstrated to be a Australians now spend $A1 billion a year on cosmetic strong predictor of a subsequent diffi cult tracheal intubation. procedures and treatments – more per capita than the US. A DA notifi cation process for airway events is recognised as an New patient safety information “Anaesthesia and cosmetic important aspect of safe patient care, minimising the risk of surgery” (www.anzca.edu.au/documents/cosmetic-surgery- future airway diffi culties in at risk patients. The UK Diffi cult factsheet.pdf) prepared by the college is aimed at helping Airway Society (DAS) endorses an airway alert template which consumers to learn and understand the important facts about was originally published in 2003, and this has been widely used. anaesthesia for cosmetic procedures. Since 2003 there have been developments in airway ANZCA President Dr Rodney Mitchell said the factsheet management equipment and techniques. Additionally, many had been developed by accredited specialist anaesthetists for Currently the DA alert form can be uploaded into the healthcare facilities are moving towards electronic medical anyone planning to have cosmetic surgery in Australia or New records. In light of these issues, as a fellow in 2017 I sought to electronic medical records used throughout Queensland Health Zealand. The factsheet details the questions people should ask update our department’s DA notifi cation process. I conducted facilities. This generates an alert, which is visible in the alerts before having a procedure. an audit of DA alerts in the department and a survey of and allergies tab in the electronic record. When the alert is “From breast augmentation to liposuction, thousands of anaesthetists, to highlight areas for improvement. I also selected, the completed DA alert document with relevant clinical cosmetic surgical procedures are carried out across Australia reviewed relevant literature, looking through journals, hospital information is displayed. It is possible to store and view multiple and New Zealand every year. Nearly all of them will require the websites and twitter for examples of what other alert letters completed forms, which display in chronological order. We are use of anaesthetic drugs. This will range from a low-dose local were available in the anaesthetic community. A new DA alert working hard to pursue methods to utilise this electronic alert anaesthetic to the use of sedation drugs, or a more complex form and associated process for adding alerts to the electronic across private facilities as well. Ultimately, we aim to implement general anaesthetic,” Dr Mitchell explained. Key points about anaesthesia and cosmetic medical record was rolled out at the Royal Brisbane and this process on a national basis. My Health Record is one avenue “Australia and New Zealand are two of the safest places procedures are: Women’s Hospital at the beginning of 2018. that is currently being explored. A move towards a centralised in the world to have a procedure involving anaesthesia, but • General anaesthesia must always be administered by a Meanwhile, some adverse patient outcomes involving “out of national process and database for such alerts would improve all anaesthetics have risks so it is important that anyone specialist anaesthetist or another medical practitioner theatre” diffi cult airways at another hospital, prompted Dr Jane patient safety and enable the capture of “big data” for research considering cosmetic surgery or procedures talk to their doctor who is specially trained to deliver general anaesthesia. Elms into thinking big picture about patient safety. Her proposal purposes. We addressed the need for standardised defi nitions, about their options.” Important information such as whether the practitioner was to treat a known DA alert similarly to a known drug allergy. to allow for data assimilation and communication across • Drugs for sedation may be given by a medical practitioner is qualifi ed to give an anaesthetic, the different types of That is, document it as an alert, and have the alert visible to all different electronic platforms, by introducing a new DA alert into who is not an anaesthetist but that person must be skilled anaesthesia, where the procedure is being performed and health clinicians, using existing electronic health records. We SNOMED-CT Australia, and defi ning this in the Alert Data Set in resuscitation. All specialist anaesthetists have these whether the facility is licensed are all covered in the factsheet. took our combined forces to meet with the Queensland steering Defi nitions in Queensland Health. skills. A great deal of thought, time and consultation has gone into Dr Mitchell said while cosmetic surgery is the only type committee for the Statewide Anaesthesia and Perioperative Care of surgery that does not require a referral from a GP, ANZCA • Low dose local anaesthetics can usually be safely Clinical Network (SWAPNet). SWAPNet embraced the proposal, the creation of the DA alert. Feedback was sought from the wider administered, however, large doses need to be given by anaesthesia community in Queensland and utilised in creating advises consumers to at least talk to their GP about what they and the SWAPNet Diffi cult Airway Alert Working Group was would like to have done. The Royal Australasian College of specialist anaesthetists as they carry signifi cant risks of formed. documents which are robust and clinically useful. These complications, including seizures and cardiac arrest. documents will be regularly reviewed and updated. Surgeons and the Australian Society of Plastic Surgeons are We are proud to say that considerable collaborative efforts also available for advice. from this group has resulted in the creation of an evidence- We would like to acknowledge the following people for their based and up-to-date DA alert form and notifi cation process. efforts in the project: This alert process is now being used throughout Queensland Dr Nicole Fairweather, Karen Hamilton, Dr Linda Beckmann, Health hospitals with the form available in both hard copy Christina Hansson, Jenny Cooper, Dr Nicholas Heard, SWAPNet, and electronic formats. In developing such a form, the need to Dr Pierre Bradley, Dr Keith Greenland and the ANZCA Airway balance adequate detail with simplicity had to be recognised. Special Interest Group. An explanatory support document, outlining defi nitions and suggested indications for use, was therefore also developed. Dr Libby McLellan The documents are now available for access online: (https:// Staff Specialist Anaesthetist, Royal Brisbane and Women’s clinicalexcellence.qld.gov.au/priority-areas/clinician- Dr Jane Elms engagement/statewide-clinical-networks/anaesthesia-and- VMO Anaesthetist, The Prince Charles Hospital perioperative-1). Co-Chairs, SWAPNET Diffi cult Airway Alert Working Group

Above from left: Dr Libby McLellan, Co-Chair, SWAPNet Difﬁ cult Airway Alert Working Group; Dr Jane Elms, Co-Chair, SWAPNet Difﬁ cult Airway Alert Working Group and Karen Hamilton, SWAPNet Coordinator.

52 ANZCA Bulletin December 2018 53 Library update Discover the world with the library’s new discovery service

UPD: Apps: Updated with a new streamlined A-Z listing. Other new features include: Just the facts! • Fully-optimised for mobile and hand-held devices. Think you know what the library has to offer? • Create and email lists, send links and export citations for all Below are some “fun” facts about the resources and library content. services provided by the library – all available free to fellows and trainees! • Māori language interface. •The library subscribes to 9500+ medical e-books. Future enhancements: •The library subscribes to over 900 full-text medical for future use. So if you’d like to reserve a book for use during Going forward into 2019, fellows and trainees will also be able to: exam preparation, then this is the feature for you! journals. To assist users with the above changes, a new borrowing •Connect to the ANZCA full-text when using Google Scholar. •Most of the libraries e-books and e-journals also provide guide provides a complete overview on searching for and • Create an article request using the discovery service citation. a PDF version which can be downloaded for offl ine use. borrowing print items from the ANZCA library. • View/search content from AIRR (institutional repository) •You can access the entire e-collection from anywhere NEW: Article-level search and access: Looking for that article within the discovery service. in the world 24/7. on sacroiliac joint pain from October’s Pain Medicine? Or want to • Access their personalised library accounts using their ANZCA/ •The library retains the print versions for some of its key locate the 1923 article on bronchopulmonary complications that Networks password. journals all the way back to their fi rst issue – this often appeared in the very fi rst issue of BJA? Users can now perform We are also planning on creating a number of new library includes additional content (such as supplements) On October 1, the ANZCA Library unveiled its new article-level searches for the content of any ANZCA subscription guides, as well as updating the content of our existing guides on that cannot be found online. title, and then connect through to the corresponding full-text. discovery service – so let’s delve into the new a much more regular basis. •The library has more than 2000 print books, with the service and what it means for you. NEW: Personalise your access: Want to set up your own As always, we’d love to get your feedback on the new service majority available for loan. Over the years, the ANZCA Library has been steadily expanding personal e-book library? Or bring together all the articles for and the updated pages, as well as any suggestions you may have •The library provides a free courier service to deliver/return its e-book and journal holdings to the point where users can now your latest assignment? Users of the new service are able to set for new content, resources you’d like to recommend or any issues its book loans. access more than 9000 e-books and more than 900 subscription up their own personal library accounts (see box out overleaf), you may be having: http://anzca.libsurveys.com/feedback. •You can request any article not available via the library journal titles. allowing them to save searches and create any number of article/ and have it sent direct to you free-of-cost. book/journal libraries using the lists feature. NEW: Discover anything, anywhere, anytime: With the •It’s possible to set up a personalised alert service new service, users now have the ability to search across the NEW: Library help: Search tips, video tutorials, a guide to Didn’t find it? Try worldwide! covering any ANZCA-subscribed journals using the entirety of ANZCA Library’s books, e-books and journals setting up your personal account and instructions for all the new While the vast majority of ANZCA’s library Read by QxMD app. using a single “Google-like” search interface, allowing them features. Access the Library Help page from the right sidebar on resources show as held, there are some articles that can only •The library performs over 150 topic-specifi c literature to access thousands of previously uncatalogued e-books and the library home page or the Library Links drop-down within the be accessed by expanding your search to Libraries Worldwide. searches each year for fellows and trainees. journals. This includes all the e-books (and journals) held in the discovery service. Simply click on the Libraries Worldwide facet in the left ClinicalKey, Access Medicine and Springer Medicine collections NEW: Library orientation: Summaries of the library resources sidebar or select the Do you want to expand your search to – which previously had to be searched on a collection-by- available sorted by user type (fellow, trainee, etc). A good place libraries worldwide? link. collection basis. to start for those unfamiliar with the services offered by the UPD: E-books: With library staff having to manually add library. every single e-book and journal, the old library catalogue and Search tips journals/e-books pages only ever held a fraction of the available It’s the bugbear of every anaesthetist’s (or is that content. As an example, the old e-books page listed around 700 anesthesiologist’s?) life, and that’s the alternate spelling of titles – which was a bit problematic given that there are nearly How to activate your personal library anaesthesia/anesthesia. And it can make searching for and 900 e-books with anaesthesia content alone, and more than 1100 account locating your book/journal/article a bit tricky. with something to say about pain! First time users of the new discovery service who would like But you don’t need to perform your search twice over: just As a result of the move to the new service, the old title to request items, view/renew items on loan, save searches or replace the “a” in “ae” with a “?” when searching on the new listing on the e-books page has been retired to make way for a create permanent lists will need to create a password for their service and it will bring back either spelling. comprehensive new A-Z list. personalised library account. It’s even possible to truncate a word using “*” to cover For users looking to access the more popular e-book titles, >> Go to anzca.on.worldcat.org/discovery all its variations! there is also a link to a more manageable “popular” e-books and select the sign in button in the top-right corner. For example: “an?esth*” will return results for listing on the Anaesthesia Essentials library guide. Then simply click the set/reset password link and follow the anaesthesia, anesthetics, anaesthestist, anesthesiology, etc. Finally, it is now possible to perform a keyword search for onscreen instructions to generate a password reset email to any title or author and then link through to the full-text. your preferred ANZCA email account. Other examples: UPD: Home page: A new layout and a new search box front and NOTE: This is not the same as your ANZCA/Networks • p?ediatric* UPD: Borrowing: The way users request print books has also centre. Perform a keyword search for anything or search for just password used to access full-text resources. Setting/resetting changed. The new process requires that users fi rst activate their • labo?r books, journals or articles. your library account password will not affect your ANZCA/ personal library account (see box out overleaf). Once activated, Networks password. the user can then login and request print items, and view/renew UPD: Journals: Updated with popular journals now sorted by their items on loan. The new service also allows users to see their category, and with access to a complete A-Z list that includes place in the request (hold) queue, as well as reserve print items thousands of open access medical journals.

54 ANZCA Bulletin December 2018 55 Library update What's new in the library

Cardiac intensive care Essentials of interventional New eBooks Brown, D. – 3rd ed. – Elsevier, 2018. techniques in managing chronic pain eBooks can be accessed via Manchikanti, L; Kaye, AD; Falco, FJE; Hirsch, Challenging neuropathic pain JA. – Springer, Cham, 2018. the ANZCA Library website: syndromes Freedman, M; Gehret, J; Young, G; Kamen, L. – Obstetric anesthesia for co-morbid www.anzca.edu.au/resources/ Elsevier, 2018. conditions Berrin, G; Ismail, S. – Springer, Cham, 2018. library/ebooks Chronic pelvic pain A case-based guide to eye pain Ledger, W [ed]; Schlaff, WD [ed]; Vancaillie, TG Oh's intensive care manual Lee, MS, Digre, KB. – Springer, Cham, 2018. [ed]. – Cambridge University Press, 2014. Handy, AW; Bernsten, J. –- 8th ed. – Elsevier, 2018. Anaesthesia, intensive care and Echocardiography in pediatric and perioperative medicine A-Z congenital heart disease: from fetus Perioperative pain management for Yentis, SM; Hirsch, NP; Ip, JK. – 6th ed. – to adult general and plastic surgery Elsevier Limited, [2019]. Lai, WW [ed]; Mertens L [ed]; Cohen, M [ed]; Narayan, D [ed]; Kaye, AD [ed]; Vadivelu, N [ed]. Geva, T [ed]. – 2nd ed. – Chichester, West – New York, NY: Oxford University Press, [2019]. Anesthesia in high-risk patients Sussex ; Hoboken, NJ: John Wiley & Sons Inc., Fellahi, J; Leone, M. – Springer, Cham, 2018. 2016. Preoperative assessment and management Analgesia in major abdominal surgery Essentials of cardiac anesthesia for Sweitzer, B. -- Philadelphia: Wolters Kluwer, Krige, A; Scott, MJP. – Springer, Cham, 2018. noncardiac surgery 2019. Kaplan, JA. – Saunders, 2018.

Multiple choice questions in pain S.A.A.D: a history of the society for New books for loan management the advancement of anaesthesia in Books can be borrowed via the Gupta, R. ¬– Springer, Cham, 2018. dentistry Sykes, Peter. – London: Society for the Oh's intensive care manual Recent contributions to AIRR: ANZCA Library catalogue: Advancement of Anaesthesia in Dentistry, 2003. Calling all ANZCA and FPM Handy, AW; Bernsten, J. – 8th ed. – Elsevier, Kindly donated by Dr Tim Smith. • Dennis AT, Buckley A, Mahendrayogam T, Castro JM, www.anzca.edu.au/resources/ 2018. The anaesthesia science viva book researchers – promote your Leeton L. Echocardiographic determination of resting library/borrowing Oxford handbook of anaesthesia haemodynamics and optimal positioning in term pregnant Bricker, Simon. – 3rd ed. – Cambridge: research and publications! 9th international symposium on the Allman, K; Wilson, I; O’Donnell, A. – 3rd ed. Cambridge University Press, 2017. women. Anaesthesia 2018; 73(11): 1345-1352. history of anesthesia [program]: – Oxford; New York: Oxford University Press, Want to expose your articles and research to a wider audience? • Brain K, Burrows TL, Rollo ME, Chai LK, Clarke ED, Hayes Boston ISHA-9 2017 2011. Kindly donated by Dr Jocelyn Slimani. The A to Z of peripheral nerves Neill, AL. – St. Leonards, NSW: Aspen Australia, Add your publications to ANZCA’s new institutional repository C, Hodson FJ, Collins CE. A systematic review and meta- Perioperative medicine for the Appraisal of current concepts in 2013. Kindly donated by Associate Professor (AIRR), and it will also be discoverable on both Google and analysis of nutrition interventions for chronic noncancer junior clinician anesthesiology Michael Harrison. Trove. Symons, Joel [ed]; Myles, Paul S [ed]; Mehra, pain. J Hum Nutr Diet 2018; doi: 10.1111/jhn.12601. [Epub Adriani, J. – Mosby; Kimpton, 1966. ahead of print] Rishi [ed]; Ball, Christine [ed]. – Chichester, The A to Z of skeletal muscles http://airr.anzca.edu.au Advanced trauma life support: West Sussex, UK; Hoboken, NJ: John Wiley Neill, AL. – St. Leonards, NSW: Aspen Australia, • Stuetzle KV, Pavlin BI, Smith NA, Weston KM. Survey of student course manual & Sons, 2015. 2013. Kindly donated by Associate Professor occupational fatigue in anaesthetists in Australia and New Michael Harrison. To learn more about the ANZCA and FPM institutional American College of Surgeons – 10th ed. – Persistence pays: The discovery repository and how you can contribute, check out the Zealand. Anaesth Intensive Care 2018; 46(4): 414-423. Chicago, IL: American College of Surgeons, of Dr William Russ Pugh's log and 2018. dedicated AIRR Library guide: http://libguides.anzca.edu.au/ • Seglenieks R, Painter TW, Ludbrook GL. Predicting patients journal of his 1835 voyage from research/airr. at risk of early postoperative adverse events. Anaesth British academic anaesthetists, England to New Holland Intensive Care 2014; 42(5): 649-56. 950-2000 Paull, J. – Lanena, Tas. Dr John Paull, 2017. Harrison, MJ. – Vol. 1 & 2 – Wellington, NZ: Kindly donated by the author. 2011, 2015. Contact the ANZCA Library Handbook of neuroanesthesia www.anzca.edu.au/resources/library/ Newﬁ eld, P [ed]; Cottrell, JE. [ed] – 4th ed. – contacts Philadelphia: Lippincott Williams & Wilkins, T: +61 3 9093 4967 2007. Kindly donated by Dr Jocelyn Slimani. F: +61 3 8517 5381 E: [email protected]

56 ANZCA Bulletin December 2018 57 ANZCA Clinical Trials Network ANZCA Research Foundation New multicentre studies Foundation update in the pipeline

During 2018 the foundation worked investigators, whosewhose career developmentdevelopment 2018 endorsed studies 2018 pilot grants closely with the Research Committee to is vitalvital fforor tthehe ffutureuture of researcresearchh in The Clinical Trials Network (CTN) Executive congratulates The CTN Executive congratulates the following emerging implement initiatives to further enhance thethe specialties.specialties. ThisThis yearyear sawsaw a recordrecord the following investigators on their endorsed trials: investigators on their pilot grants: the quality and accessibility of ANZCA numbernumber ofof fi rstrst timetime applicants,applicants, as wewellll • CLIP-II: Cryopreserved versus liquid platelets trial • COMPASS: Clinical outcomes measurement in perioperative research grants. as a recordrecord numbernumber ofof applicationsapplications ffromrom (Professor Michael Reade). medicine, anaesthesia and surgery study (Dr Jennifer Reilly). A particular focus has been achieving femaleffemalle principalpriinciipall investigators.investiigators. a balance between supporting important ItIt was alsoalso encouraencouragingging to see the fi rst-rst- • TRIGS: Tranexamic acid to reduce infection after • Defi ning “usual” target blood pressure after cardiac surgery: studies through multi-year funding everever grantgrant awardedawarded ttoo a susubmissionbmission forfor a gastrointestinal surgery trial (Professor Paul Myles). An essential step to inform the design of a large randomised grants, important for supporting studystudy involvinginvolving indigenousindigenous Māoriori papatientstients trial (Dr David McIlroy). • POISE – 3: Perioperative ischemic evaluation-3 trial investigators’ pursuit of large competitive in NNewew ZZealand.ealand. (Dr Thomas Painter). • LIDO pilot study: The lignocaine infusion on donor site pain grants for follow up clinical trials, and CCoCouncilunciil hashhas nownow apapprovedprovedd a pproposalroposal • NATO: Non-anaemic iron defi ciency and transfusion outcomes in patients with burns (Dr Kerry McLaughlin). maintaining strong support for fi rst time to bring grant decisions for Indigenous after colorectal cancer surgery study (Dr Lachlan Miles). • HOT-ROX: The hospital operating theatre randomised oxygen grants and growth in the number of healthhealth aandnd ooverseasverseas aiaidd spspecialecial prprojectsojects • VAPOR-C: Volatile anaesthesia and perioperative outcomes study (Dr Daniel Frei). grants provided. underunder tthehe foundationfoundation committeecommittee,, related to cancer study (Professor Bernhard Riedel). An initiative designed to improve this furtherfurther inintegratingtegrating ththee ggovernanceovernance ooff basebase for imimprovingproving clinical ppracticeractice Karen Goulding balance from 2019 onwards has been collegell grants in alignmentl line l with h the h and patient outcomes. The foundation • LOLIPOP: Long-term outcomes after lidocaine infusions CTN Manager the decision to limit multi-year grants college’s mission and strategic priorities. continues to receive reports from local for postoperative pain study (Professor Tomas Corcoran). to a maximum of two rather than three Recommendations for overseas aid and and internationally-recognised experts, • Intravenous amino acid therapy for kidney protection in years, with project grants now eligible for Indigenous health grants will come via that the ANZCA and foundation supported cardiac surgery patients: a multicentre randomised controlled a maximum of $A70,000 in the fi rst year the overseas aid and indigenous health grants program have played a major role trial (Associate Professor Gordon Doig). and $A50,000 in the second and fi nal committees respectively. The committee in the development of the ANZCA Clinical • MASTERSTROKE: Management of systolic blood pressure year. will monitor available funding, while the Trials Network, and that the network is during thrombectomy by endovascular route for acute This complements the existing limit foundation will continue to encourage now recognised as the world’s leading ischaemic stroke (Dr Doug Campbell). which allows researchers to be chief donations to support important work in trials network in its fi eld. investigators on no more than two active these areas. Please help secure the future of ANZCA grants at any one time; designed Urgently needed – funding ANZCA’s infl uential research program to protect the accessibility of grants sustainability for ANZCA supported – donate, or pledge your annual especially for investigators who have not research support through the prestigious previously been as successful as more The gradual long term growth in funding ARF Patrons program. experienced investigators. for ANZCA research funding support and At the same time we been mindful that Member Advantage the number of grants provided plateaued for many well-established investigators, The ANZCA Member Advantage member in 2018, and for the fi rst time, has fallen ANZCA grants are vital for their benefi ts program provides attractive slightly for 2019. research programs, and that funding for lifestyle benefi ts for ANZCA members. Despite the well-recognised success of exploratory and pilot projects is often More than 2800 members have now the ANZCA research grants program and Save the date diffi cult to secure. This is one of the joined the program, which depending on Clinical Trials Network, the sustainability reasons for introducing modifi cations to participation may in the future provide of the funding that underpins the the two active grant rule. The prestigious support for ANZCA research grant – Strategic program, and which is critical for its Douglas Joseph and Lennard Travers funding. Members wanting to join should future, is still highly uncertain. professorships are now exempt from this contact Anna Smeele at asmeele@anzca. This is why there is such an urgent Research requirement. edu.au to opt in. Anna will add your name need to increase the number of fellows In another initiative, unsuccessful to our monthly upload of new members to and external donors committed to Academic Enhancement Grant (AEG) the service provider, Member Advantage. Workshop regularly supporting the research applications may now also be considered The 11th annual strategic research and education grants program, and Thank you foundation donors in the project grant round. Finally, certain our talented emerging investigators The foundation warmly thanks all workshop will be held in Manly, NSW externally funded grants may also be – particularly the many promising generous donors for your wonderful exempt from the two grant limit, such from August 9-11, 2019. Registrations researchers yet to secure fi rst grants support and wishes you and all friends as the new regional anaesthesia grant needed to open the door to their future of the foundation a safe and happy and abstracts will open in early 2019. funded by the Medibank Better Health research careers. Christmas. For up-to-date information, please Foundation (open for applications). In recent years, ANZCA-sponsored There has been emphasis this year visit www.anzca.edu.au/ctn. research and education has made an on attempting to increase support for Rob Packer increasing impact on the evidence General Manager, fi rst-time applicants and emerging ANZCA Research Foundation

To donate, or for more information on supporting the foundation, please contact Rob Packer, General Manager,ANZCA Research Foundation on +61 3 8517 5306 or email [email protected]. Gifts can be made via www.anzca.edu.au/fellows/foundation.

58 ANZCA Bulletin December 2018 59 Continuing professional development CPD news CPD: Lifelong learning

Qualifi ed privilege – CPD Emergency Response The CPD committee will continue to Time. In a time-poor environment there is a desire for discuss the framework, acknowledging effi ciency. Every individual will have their comfort zone and correction Standards Review a large portion of the work towards place their own value on which aspects of CPD they consider It was incorrectly inferred in the June completed reaching the proposed framework had time effi cient. For example, the points gained for a half-day peer 2018 ANZCA Bulletin article “Can trainees’ been achieved in previous years through review while completing a regular list would be considered by (and fellows’ and other CPD participants’) The standards for the ANZCA and FPM launching the current 2014 ANZCA most as a time effi cient way of complying with the mandatory CPD Program's emergency response personal refl ections be used in court?” and FPM CPD program, and that the practice evaluation component of CPD. activities have undergone a review that qualifi ed privilege (QP) protection is framework’s objectives align with the Dr Rod Wilson in Bendigo, Victoria shared a story from the process, led by Dr Sarah Green, CPD Base Hospital. He said the hospital had enlisted the “duty” or available in Australia under the ANZCA college’s 2018-2022 strategic plan. committee deputy chair, to ensure “in charge” anaesthetist to give their time to manage peer reviews and FPM CPD Program to all practice Further information about the currency and accuracy is maintained. for those performing a service list. This met both an education evaluation activities (which includes the professional performance framework The purpose of the emergency response can be found on the Medical standard and provided dedicated clinical service commitments practice evaluation mandatory activities). activity CPD standard is to defi ne the Board of Australia’s website at to the local community. After further review and clarifi cation, minimum standard for education sessions www.medicalboard.gov.au/Registration/ Outside a public hospital many enlist a trusted colleague to only the following activities are protected to achieve recognition as a valid activity review their practice in a non-threatening environment. The under qualifi ed privilege: for satisfying the CPD requirement for ProfessionalPerformance-Framework. aspx. pressure of practicing anaesthesia in the presence of a colleague • Patient experience survey. the relevant emergency response, and when one may not have experienced appraisal for some time to assist hospital departments, private • Multi-source feedback. may feel daunting but the immense benefi ts of sharing clinical practice groups and continuing medical experience should be embraced. Often the teacher is taught and • Peer review of practice. education providers to develop and/or MCMZ proposed approach the examiner learns from the examined. conduct education sessions. The review is • Clinical audit of own practice or, to recertifi cation Private practice within a large group is ideally situated to assist now complete and the proposed changes signifi cant input into group audit In September, 2018, the Medical Council members to meet CPD requirements in an environment where of practice. have been approved by ANZCA Council. Confi rmation of the revised standards of New Zealand (MCNZ) released a participants learn, air grievances and interact socially to build a supportive community. Dr Jenny Carden is a busy private practice All other practice evaluation activities are was sent on October 1 to recognised discussion document detailing a anaesthetist who runs a regular journal club for her private group. not protected under qualifi ed privilege: course providers running emergency proposal to strengthen recertifi cation response education sessions (workshops/ for vocationally registered doctors. The Journal club allows exchange of ideas and in a trusted group of • Report of clinical audit fi ndings. courses). These workshops/courses must discussion document describes the need colleagues this may extend to practice review with morbidity and • Case discussions/conferencing. meet the updated standards by December for change, and details sector feedback mortality meetings. • Morbidity/mortality meetings. 31, 2018 and this work is progressing well. on the proposed strengthened approach. Public hospitals run journal review meetings however there CPD participants should continue to Following the document’s release, are many like-minded anaesthetists who regularly meet as a • Incident reporting/monitoring. record recognised emergency response preliminary discussions were had at group of private medicine practitioners to exchange peer review of • Review of patient care pathways. activities in their CPD portfolio as usual. September’s CPD committee meeting, complex clinical problems or complicated patients. If you aren’t in • Hospital inspections/accreditation. For more information please visit the where it was identifi ed the core one yet, initiate and start one. Technology can be useful if remote ANZCA website at www.anzca.edu. practice is an issue and visual or just audio telephone conference • Medico-legal reports/expert witness. component of interest to the college may au/fellows/continuing-professional- include: calls are valuable. • Root cause analysis. development/emergency-response- Clinical audit can be immensely rewarding and Dr Jennifer activities or contact the CPD team via • Increased emphasis on evidence, Lucas who works as visiting medical offi cer (VMO) at a number • Team training scenario within own work value of activities and peer review. environment with usual work team. [email protected]. of metropolitan hospitals has completed multiple audits of her • Use of a professional development plan Continuing Professional Development (CPD) can clinical practice well before it became an option under mandatory • Assessor for specialist international (PDP) to guide learning. be a tricky balance and contemplating the online practice review. During an interview she recommended a two- medical graduates workplace-based MBA's Professional to three-yearly review of one’s regular clinical practice cases, assessment. • Specifi ed CPD hours and type, using an purple dashboard when faced with the competing Performance Framework evidence-based rather than a time-based for example, major colorectal anaesthesia, which fi ts within a • Annual performance appraisal. approach. commitments of clinical work, family and triennium. The college provides templates to assist this process. update maintaining friendships might be considered by ANZCA provides an accessible online framework, which The change has been mandated by a The MCNZ recertifi cation discussion enables smooth participation in mandatory government tightening of reporting criteria under QP Following the Medical Board of Australia’s some like the fi rst steps in a journey of a thousand (MBA) Professional Performance document can be found at www.mcnz. requirements to allow continuing medical practice as a specialist by the Australian Department of Health. org.nz/assets/News-and-Publications/ anaesthetist. Please also note that all other elements Framework stakeholder’s workshop in arduous miles. However, never despair, with a little February, the MBA have advised a second Consultations/2018-Discussion-document- The philosophy of CPD is greater than a reactionary tick box of the CPD program are also not covered bit of effort there are not only clinical benefi ts but list and it extends us to participate as anaesthesia specialists workshop is likely to be held in early 2019. strengthened-recertifi cation-FINAL.pdf by QP. with the freedom to engage in academic growth. With care, This was postponed from the originally also immense personal rewards to be found in What does this mean for CPD consideration and planning CPD will provide us as anaesthesia advised schedule of late 2018, to ensure participants? completing a meaningful triennium. specialists with a meaningful framework to maintain and grow the MBA had more concrete proposals to There are no confi rmed planned changes Our national laws regulate that all medical practitioners must personally while providing excellence in medical care to the consult on and discuss. The MBA have to the CPD standard or portfolio at this undertake CPD and this must include refl ective elements, such Australian community who deserve the benefi ts of our dedication established an implementation group to time. If changes are required to meet as clinical audit, peer review or performance appraisal as well and training. Embracing CPD should be a natural extension of co-ordinate various elements of the MBA’s the MBA professional performance as activities to enhance knowledge such as courses, conferences lifelong learning. framework, along with a CPD advisory framework and the MCNZ strengthened and online learning (registration standard: CPD, Medical Board group chaired by Professor Kate Leslie, recertifi cation, ANZCA will communicate of Australia, 1 Oct 2016). Dr Debra Devonshire, FANZCA FANZCA. this to all CPD participants as needed. However, the aim of CPD is not merely to meet regulatory CPD Committee Regular communications will be provided or community expectations. CPD is more part of a plan for a as new information is available. balanced professional life where the individual chooses areas of academic interest, which weave into work so that CPD becomes Above clockwise from left: Dr Debra Devonshire and Dr Daniel Stanzsus; a seamless choice, not just a government or college mandate. Dr Debra Devonshire and Dr Paul McCallum; Dr Mark Fajgman.

62 ANZCA Bulletin December 2018 63 Faculty of Pain Medicine

Dean’s message News

particularly opioids and cannabinoids, sharing his extensive experience in pain New fellows Training unit accreditation New CPD emergency response and procedures and devices in pain interventions. It was a pleasure to have We congratulate the following doctors The following hospitals have been medicine as well as progressing the our Hong Kong colleagues as members of standard on their admission to fellowship by accredited for pain medicine training: faculty’s suite of educational offerings. A the organising committee and providing The faculty is pleased to advise that the completing the training program: new emergency response, “Acute Severe a range of presentations as well. Many Liverpool Hospital, NSW. fi rst pain medicine specifi c emergency Behavioural Disturbance in the Adult thanks to convenor Associate Professor Dr Alix Dumitrescu, FRACP, FFPMANZCA Northern Integrated Pain Management response standard on Acute Severe Patient (ASBD)” has been developed for Brendan Moore, and the organising (NSW). (Gosford), NSW. Behavioural Disturbance (ASBD) in the Adult Patient has been developed to FPM fellows and will become available committee. Dr Kylie Hall, FANZCA, FFPMANZCA Pain Specialists Australia, Vic. early in 2019. Community interest in pain is growing (Queensland). ensure all fellows of the faculty can and faculty fellows are increasingly being Pamela Youde Nethersole Eastern fully undertake the ANZCA and FPM There have been many opportunities Dr Charlotte Hill, FANZCA, FFPMANZCA Hospital, Hong Kong. CPD program, relevant to their scope for advocacy. The faculty commissioned asked to talk on local and national media (New Zealand). a health economics report on the and speak at educational events for our Royal Perth Hospital, WA. of practice. Please keep a look out for Dr Gurbir Kaur, DNB Anaesthesia, FFPMANZCA burden of pain in New Zealand which healthcare colleagues and the public. United Christian Hospital, Hong Kong. workshops details at the upcoming ASM will enable more effective advocacy for Pharmaceutical and other healthcare (Tasmania). in Kuala Lumpur. University Hospital Geelong, Vic. pain medicine services and training companies provide valuable support for This takes the number of fellows opportunities in that jurisdiction. In many of these events, however these admitted to 484. Besides having a wonderful time in Australia, the faculty has been working have the potential for confl icts of interest Boston, attending the International closely with Painaustralia on the National to arise. As ANZCA and the faculty Association for the Study of Pain (IASP) Strategic Plan for Pain Management and responded to the Council of Australian World Congress on Pain in September was addressing concerns about the recent Governments Health Council review an opportunity to recharge and refl ect private health insurance reforms. The of the Health Practitioner Regulation on the issues at the forefront of pain faculty is contributing to the Therapeutic National Law in November, it was a timely medicine. There were many excellent Goods Administration’s Opioid reminder of our obligations regarding presentations, workshops and posters on Regulatory Advisory Group determining advertising of pharmaceutical medicines, a wide range of topics and it was great to regulatory responses to Australia’s opioid therapeutic devices and medical services. see so many FPM fellows participating. problem. Helpful discussions continue Finally, the faculty board should refl ect Professor Fiona Blyth’s plenary with government around a Pain Device the views of the fellowship and address lecture on the global burden of pain set Implant Registry while the Procedures in the issues that are important to fellows the scene and Dr Dan Carr exhorted us Pain Medicine Working Group is making and trainees. There are opportunities to “fl ip the paradigm” in pain medicine steady progress. for early input from New Zealand and education to the sociopsychobiomedical The Spring Meeting was an the regions into the faculty’s decision- paradigm which underpins the FPM 2015 outstanding success providing making through the New Zealand Curriculum. educational opportunities across an National Committee and the Australian Opioid medication was another eclectic program. A focus on Indigenous regional committees as members of strong theme not unexpectedly and the health was most fi tting as we met in the Professional Standards Committee. workshop on the addition of “nociplastic” tropical Cairns. We were honoured to Thank you to the many fellows, trainees pain to the IASP taxonomy was have elders from the Yirrganydji people and staff who have worked tirelessly enthusiastically received. welcome us to country and Indigenous throughout the year to progress the As 2018 draws to a close it seemed speakers contributing to the program. The faculty’s strategic plan. timely to refl ect on the faculty’s vision, Indigenous art exhibition was a highlight. I wish everyone a safe and enjoyable “to reduce the burden of pain on Opioids, cannabis and interventions in holiday season and look forward to society through education, advocacy, pain medicine were key topics and the meeting more of you next year as FPM training and research”. Our challenges international speaker, Dr Stephen Ward, General Manager Helen Morris and I visit parallel those on the world stage, eloquently demonstrated how tenuous each of the regions to hear your views. namely addressing the burden of pain the evidence base behind commonly in Australia and New Zealand, the accepted guidelines can be besides Dr Meredith Craigie safe and appropriate use of medicines, Dean, Faculty of Pain Medicine

70 ANZCA Bulletin December 2018 71 Faculty of Pain Medicine (continued)

Pain medicine training program – considering the feedback

The revision of the curriculum and training program was To retain the intended philosophy that trainees commence Developing a more formalised structure to the practice the largest piece of work ever undertaken by the faculty. To their training time with a foundation of knowledge around pain development stage is another opportunity units have identifi ed maximise the benefi ts of the revised training program an medicine, new trainees will now complete the online Better to further evolve the training program. ambitious evaluation strategy, with regular opportunities for all Pain Management Program between the time of application and SOT training and support has been well received as has the involved in the training program to provide formal and informal week 11 of training. SOTs will sign off completion at the fi rst in- development of online learning resources to support trainees. feedback, was overseen by the Learning and Development training assessment meeting along with signing off completion Delivery of clinical skills courses by Geelong and Royal North Committee. of the general physical examination assessment. It is hoped that Shore based fellows have consistently been identifi ed as adding The key changes introduced in 2015 were the revision of the this change will reduce the workload burden of examiners and signifi cant value to the training experience. curriculum with the development of a more structured fi rst year staff regionally who have been supporting this examination for Strong interest from some trainees in enhancing procedural of training and greater fl exibility in the second year to allow the past few years. pain training is being addressed by including this as a trainees to pursue specifi c areas of personal interest. Feedback To emphasise that the workplace-based assessment tools deliverable on the 2018-2022 FPM Strategic Plan. Working groups to trainees was enhanced with the introduction of workplace- are a formative leaning tool to provide individual feedback to are being established at present to progress this initiative. based assessments and a revised in-training assessment trainees and identify areas of practice for future focus, the tools Feedback overall is that the revised curriculum is considered process. Learning support resources for trainees were created were renamed workplace-based progressive feedback (WBPF) to be more organised, systematic and a positive change from the with the development of the online essential topic areas in 2018. The Learning and Development Committee have been previous program. Areas for further refi nement or extensions learning modules, case studies, quizzes and a comprehensive discussing the role of the essential topic areas (ETA) in the to what is now being delivered have been consistent which has reference list. Two clinical skills courses were delivered to curriculum structure, and how they might be utilised to focus allowed identifi cation and prioritisation of upcoming work over support learning and online supervisor orientation and support learning within the WBPF and/or in-training assessment (ITA) the next few years. A 2018-2021 evaluation strategy has been resources developed. process. Consideration around the integration of Essential Topic developed by the Learning and Development Committee to Activities undertaken as part of the evaluation strategy have Areas into ITA process to enable a focus on competency-based continue to gather feedback and inform improvement pieces included surveys, structured phone interviews, workshops and progression will be an ongoing discussion for the committee. of work for the next few years. individual feedback provided to the faculty. Training units have highlighted challenges with recruitment Benefi ts identifi ed by unit directors of the revised training of trainees and balancing offering second year trainees Dr Aston Wan program include: individualised learning programs in their service or by linking Chair, Learning and Development Committee • The curriculum is more defi ned, including learning with other services, whilst also managing service delivery. The outcomes and non-clinical areas of competence, which revised accreditation standard requiring accredited units to have is also of paramount importance in clinical practice. It two full-time equivalent of specialist medical offi cers has also allows supervisors of training (SOTs) to assess progress and created a challenge for some units. benchmark trainees. During 2019 the Training and Assessment Executive Committee plans to explore how the faculty can support units • The sociopsychobiomedical approach means strong with recruitment challenges by supporting a small working connection between the trainee and allied health/nursing workload of an examiner. Recognising the increased workload group to identify some potential strategies and resources. staff. the Examination Committee has been actively seeking to grow • When there is a mixture of Practice Development Stage and the court of examiners and the pool of long case assessors. Core Training Stage trainees, the more senior can be a good Fellows who are interested in learning more about these roles are source of support and information for the more junior trainees. encouraged to contact the faculty offi ce. • It has provided continuity of care for a cohort of patients Following changes to the timetable of the fellowship presenting to our clinic, thereby leading to better patient examination there was feedback from candidates that they satisfaction. would like to see a change in that only candidates who are successful at the written examination be invited to sit the oral • The introduction of workplace-based assessment provided section. This change has been implemented in 2018 following a good objective trainee feedback in various aspect of the reorganisation of the faculty calendar. professional development. The identifi cation of areas for To encourage new trainees to make the most of their training improvement is benefi cial and they facilitate the role of SoT time from day one, a Foundations of Pain Medicine entry if all consultants can contribute. examination was introduced in 2015 to ensure pre-reading had • The online Essential Topic Areas resources, clinical skills been undertaken. This has been seen as helpful in allowing new courses and regionally run tutorials have helped trainees trainees to start training having given some consideration to identify the minimum standard with good trainees using the the literature. Resource limitations have meant that the faculty resources to pace their learning through the year. has not been able to deliver this assessment more than twice With the additional structure and an increase in assessments, annually. This has caused some frustration for new trainees there has been in increased workload for SOTs, trainees and who may have commenced a training position before sitting examiners. The role of long-case assessor was introduced in the examination and being able to accrue training time. It has 2017 to build the pool of fellows who could examine and support therefore been decided not to continue with the Foundations the long-case assessment without having to commit to the full of Pain Medicine Exam after January 2019.

72 ANZCA Bulletin December 2018 73 Faculty of Pain Medicine (continued)

Looking north in Cairns OIVI – the need for a statement

References: Monitoring sedation to aid the See the statement at Cullen DJ (2001) Obstructive sleep apnea identifi cation of and prevention www.anzca.edu.au/resources/ and postoperative analgesia--a potentially of opioid-induced ventilatory endorsed-guidelines/oivi-statement. dangerous combination. J Clin Anesth 13(2): 83-5. impairment (OIVI) in the acute However, there are some concerns Frederickson TW & Lambrecht JE (2018) Using pain setting – the need for with these approaches. the 2018 guidelines from the joint commission to kickstart your hospital’s program to reduce a statement 1. Provision of continuous electronic opioid-induced ventilatory impairment. monitoring for every patient given Anesthesia Patient Safety Foundation Opioid administration in the acute pain an opioid for management of acute Newsletter. https://www.apsf.org/newsletter/ setting continues to be associated with pain (including but not limited to june-2018/ Accessed November 2018 preventable harm, including death. In postoperative pain) in every Australian Gupta RK & Edwards DA (2018) Monitoring order to reduce the risks associated with for opioid-induced respiratory depression. and New Zealand hospital, although Anesthesia Patient Safety Foundation opioid-induced ventilatory impairment highly desirable, is currently not Newsletter. https://www.apsf.org/newsletter/ (OIVI), patients must be monitored possible. This is due to both fi nancial february-2018/ Accessed November 2018 appropriately so that OIVI is identifi ed considerations and a number of Lee LA, Caplan RA, Stephens LS et al (2015) at an early stage and appropriate limitations presently associated with Postoperative opioid-induced respiratory interventions instigated as needed. available monitors (Gupta & Edwards, depression: a closed claims analysis. Potential risk factors should also be 2018). Anesthesiology 122(3): 659-65. avoided where possible. Macintyre PE, Loadsman JA & Scott DA 2. Limiting the need for monitoring to the (2011) Opioids, ventilation and acute pain To improve the safety around opioid postoperative period and/or to patients management. Anaesthesia and Intensive Care prescribing in the acute pain setting, all getting only PCA or epidural analgesia, 39(4): 545-58. patients given any opioid by any route leaves other patients at signifi cant risk. Ready LB, Oden R, Chadwick HS et al (1988) should have regular assessments made of Deaths due to OIVI have also resulted Development of an anesthesiology-based their level of sedation. from opioids administered for non- postoperative pain management service. For some time now, the Anaesthesia surgical acute pain and from opioids Anesthesiology 68(1): 100-6. Patient Safety Foundation (APSF) in the delivered orally or by intermittent Schug SA, Palmer GM, Scott DA et al (2015) Acute Pain Management Scientifi c Evidence. US has recommended that, in order to injection. In 1988, Ready et al were the Melbourne, Australian and New Zealand reduce the risk of postoperative OIVI, fi rst to recognise that sedation was an College of Anaesthetists and Faculty of Pain continuous pulse oximetry should be indicator of OIVI even in patients with Medicine. http://fpm.anzca.edu.au/resources/ used to monitor patients not receiving respiratory rates that may be within a publications Accessed January 2017 A successful FPM Spring Australian and Hong Kong speakers Clockwise above from top left: Organising supplemental oxygen and monitors of “normal” range and they developed the Vila H, Jr., Smith RA, Augustyniak MJ et committee Dr Steven Wong, Dr Tony Ng, Dr included Professor Chi Wai Cheung, Dr ventilation (for example, capnography) fi rst sedation scoring system (Ready et al (2005) The effi cacy and safety of pain Meeting “Looking north, looking Matthew Bryant, Associate Professor Brendan management before and after implementation Steven Wong, Dr Chan Wing Sang, Dr used in addition to oximetry for al, 1988). Multiple publications since Moore, Dr Clara Wong and Dr Timmy Chan; that time have emphasised the risks of hospital-wide pain management standards: up at pain” was held from Lim Huey Sing, Dr Raymond Blackman, FPM Dean Dr Meredith Craigie thanking the those patients who are administered is patient safety compromised by treatment October 19-21 at the Pullman Ms Lara Pullin Gundungurra, Mr 2019 Spring Meeting Convenor, Associate supplemental oxygen (Weinger, 2006; of relying on respiratory rate as an based solely on numerical pain ratings? indicator of OIVI and that increasing Michael Eather and Dr Jason Lee who professor Brendan Moore for an eclectic Weinger & Lee, 2011; Gupta & Edwards, Anesth Analg 101(2): 474-80. Cairns International with 129 sedation is a more reliable early clinical explored interventional pain, opioids and program; Interventional pain session on Sunday 2018). In 2006 the APSF advocated such Weinger MB (2006) Dangers of postoperative sign (Cullen, 2001; Vila et al, 2005; delegates. Indigenous health. In lieu of speaker gifts morning, Dr Steven Wong, Dr Chan Wing Sang, use for “patients receiving PCA, neuraxial opioids. Anesthesia Patient Safety Foundation a donation was made to Yalari, educating Associate Professor Mick Vagg (Vice Dean), Macintyre et al, 2011; Lee et al, 2015; Newsletter. https://www.apsf.org/article/ This year’s meeting is a collaboration Associate Professor Brendan Moore (2018 opioids, or serial doses of parenteral Schug et al, 2015). dangers-of-postoperative-opioids/ Accessed with our Hong Kong colleagues with Indigenous children. The cheque was Spring Meeting Convenor), Stephen Ward opioids” (Weinger, 2006). In 2011 (Weinger November 2018 representation from the Board of Pain presented to Mr Michael Eather at the (international invited speaker); Indigenous & Lee, 2011) and early 2018 (Gupta & The aim of this statement is therefore Weinger MB & Lee AL (2011) No patient shall Medicine of the Hong Kong College conference dinner on Saturday at Salt health and wellbeing discussions with Dr Mark Edwards, 2018) the recommendations to recommend that in the absence of be harmed by opioid-induced respiratory of Anaesthetists on the Organising House restaurant. More than 110 guests Wenitong, Rod Mitchell (ANZCA President), were expanded to cover all patients given continuous electronic monitoring for depression. Anesthesia Patient Safety experienced the balmy night with Uncle Peter Hyde, Dr Sean McManus, Lara every patient given an opioid in the acute Foundation Newsletter. http://www.apsf.org/ Committee. The result was a scientifi c postoperative opioids. Later in 2018, newsletters/html/2011/fall/01_opioid.htm excellent food and wine. Pullin Gundungurra, Dr Raymond Blackman pain setting, all patients given any opioid program with a distinctly Asia-Pacifi c and Dr Michael Eather. another APSF newsletter article revised Accessed November 2018 perspective. The meeting featured We look forward to seeing you next the recommendations, reverting to by any route for the management of acute pain should have, at a minimum, regular international speaker Dr Stephen Ward year at Byron at Byron in Byron Bay! recommending monitoring only patients assessment of their level of sedation. (UK) who presented a thought-provoking with “PCA or neuraxial opioids in the combination of talks on low back pain, postoperative period” (Frederickson Professor Pamela Macintyre, Dr Kim sciatica and NICE guidelines. & Lambrecht, 2018). Hattingh, Professor Stephan Schug, Professor David Scott, Dr Meredith Craigie and Dr Phillipa Hore

74 ANZCA Bulletin December 2018 75 Faculty of Pain Medicine (continued)

2018 FPM fellowship examination

Twenty-two candidates successfully The candidates who successfully Victoria completed the fellowship examination in completed the examination are: Dr Catherine Algie 2018. The written section was held in 13 Dr Kate Drummond AUSTRALIA venues on October 5 with the viva voce Australian Capital Territory Western Australia section held at the Australian Medical Dr Jigna Hapani Dr Daniel Ellyard Council National Test Centre, Melbourne Dr Brian Lee on November 24. Candidates who were New South Wales successful at the written component of Dr Ala Abualsamh HONG KONG the examination were invited to sit for the Dr Gretel Davidson Dr Christina Cheng viva voce component. Dr Nikunj Parikh NEW ZEALAND Merit awards were presented to Dr Dr Andrew Weiss Desmond Ho (Singapore) and Dr Brian Lee Dr Saad Anis (WA). Queensland Dr Jennifer Hudson Dr Nick Chiang Dr Karen Joseph Dr Stephen Gilbert Dr David Sainsbury Dr James Forbes Above clockwise from top left: 2018 FPM SINGAPORE Dr Belinda Oddy Court of Examiners; Successful candidates Dr Desmond Ho at the 2018 FPM Fellowship Examination; Dr Konara Samarakoon Examination Chair Dr Eric Visser congratulates Dr Brian Lee, Merit Award winner; Dr Visser South Australia congratulates Dr Desmond Ho, Merit Award Dr Say Yang Ong winner. Dr Vidya Shirumalla

76 ANZCA Bulletin December 2018 77 Training Successful candidates

Kellie Maree Rozdarz Moon Hae Pyo Vaishnavi Vasanthi Sridhar Sandeep Singh Rakhra Renton Prize Benedict Francis Stephen Michael John Remilton The Court of Examiners recommended that the Renton Prize for the half year ended Dione Elizabeth Stuart Di Shan December 31, 2018 be awarded to: Stewart William Ure Lauren Michelle Smith Dr Grace Hollands, Victoria Allister David Erskine Ware Katherine Amanda Steinfort Benjamin Peter Warlow Dominik Aleksander Teisseyre “I grew up in Bathurst, country NSW, and moved to the big smoke to to start year 9. After fi nishing VCE at Sandringham College in Melbourne I Hon-Ming Tung I studied undergraduate MBBS at Monash University, and a Masters of of South Australia Genna Louise Verbeek Luke Neville Arthur Public Health through James Cook University. Timothy John Williams I'm thrilled to be a fi rst year trainee in the Monash anaesthesia Thomas Ian Grosser-Kennedy Angela Lian Jeen Wong Christopher James Harry training scheme in Victoria. I work at Frankston Hospital, and am Amr Mohamed Essam Hassan Mohamed particularly enjoying my exposure to obstetric anaesthesia, and acute pain. Dana Louise Hartley Zahran Keeping active with netball and yoga while studying kept me sane, and now Mitchell Keith Petersen-Tym with the primary behind me I've been training towards my fi rst triathlon in January Natalie Carole Thurston Western Australia (hopefully). Most of all I'm excited about having time for longer hikes, and proper Brianna Alysia White Samantha Charlene Bonnington cooking.” Yvette Claire Francoise Goodgame Tasmania Mark Edward McDonald Jonathan Richard Hills The Court of Examiners recommended that the Renton Prize for the half year ended Primary fellowship Elaine Rea Chilcott Eugene Joseph McKernan Aria Bradford Lokon June 30, 2018 be awarded to: Angus Stuart-Charles Mcnally Lillian Sarah Coventry Rosalind Elizabeth Oakes examination Dr Brian Chee, Victoria Suraj Sukumar Nair Brigit Ann Ikin Gabrielle Eve Sicari August/October 2018 Mylene Nassif Alistair James Park Frederick James Achille Torlot A graduate of the University of Melbourne Dr Chee was born in Sandakan in East Malaysia and moved to Australia 10 years ago for One hundred and fi fty-three candidates Mitchell Peter Nolan Matthew Colin Vandenberg Victoria medical school. Now a second year anaesthesia registrar at the Western successfully completed the primary Sarvpreet Pala Hannah Lucy Wray Diana Abu-Ssaydeh Hospital and the Royal Melbourne Hospital Dr Chee remembers “some fellowship examination. John Frederick Peniston-Bird Rawaf Ghali G Albarakati very wise words” from a registrar when he was a resident: “It’s not Bridget Marjorie Prior NEW ZEALAND Sarah Louise Allen enough that you like a specialty, the specialty has to like you in return. Nicholas Edward Stewart Charles Robert Wiremu Allen AUSTRALIA Benjamin David Allnutt It’s like a relationship.” Australian Capital Territory Yvonne Strohmeier Oliver Greg Ball Claire Elizabeth Attwood He considered various specialty choices after medical school but said he was very Mark Christopher Giddings Benjamin Daniel Tassie Matthew James Beard Daniel Brooks Reid fortunate to have had the opportunity to complete a critical care residency year in his Cameron Douglass Maxwell Victoria May Ward Frances Helen Campbell Katherine Amelia Carroll third postgraduate year where he was exposed to anaesthesia. Kathryn Louise Mence Kate Elizabeth Campbell James Alexander Cole “I had the great privilege of meeting anaesthetists who I enjoyed working with and Northern Territory Crystal Mei Gan Chandler who were very supportive of my endeavours to pursue a career in the specialty. I feel Rick Jonathon Davis New South Wales Robyn Julie Ison Trent George Cutts honoured to have received the Renton Prize. It is something I would not have once Jason Calder Denny Jack Bellamy Ciaran Patrick Downey dreamed possible, coming from a humble middle-class family in a lesser-known part Queensland Alex Man Ho Chua Harsh Deep Dubey Rachel Holly Edmond of the world with relatively limited educational opportunities.” Joseph Michael Bauer Simon Cole Rohan Hardikar Emma Elizabeth Foster “I am grateful to my mom especially for emphasising to me the importance of Christopher John Dawson Arielle Christa Beech Charles Alexander James Harding Rao Fu education in life from a young age.” Anne-Marie Winfi eld Dempster Ruth Miriam Blank Grace Breanna Hollands Michelle Ann Gatter Dr Chee teaches and mentors primary exam candidates and is pursuing local Jason Paul Denmeade Grant James Breadsell Sarah Ling-Yi Hong Sophie Elizabeth Gormack research and audits at his health network. Andrew Gerard Duckworth Michael Gregory Brown Andrew Huang Jonathan George Guirguis His interests outside medicine include impressionist and post-impressionist art, Cameron James Dunn Thiruvashrin Chetty Shaun Michael Hutchinson Qiao He classical music, opera and ballet. He is learning French as a post-exam project and Faith Fenella James Dyer William Brett Curtis Namrata Devi Jhummon-Mahadnac Melanie Gina Hwang enjoys hiking and kayaking. Jimmy Yen-Chun Fu James Edward Nevin Gardiner Matthew John Kilpin Rebecca Margaret Johansen “I enjoy baking, and would be very happy to bake for any department I work with!” Ronald Kam Fai Fung Maxim John Hatton Geetanjali Pooja Lamba Huw David John Jessica Lauren Gani Alexandra Ellen Hickey Jonathan Lin Zeyin Li Neha Gosavi Anoop Jain Tom Luo Ching Wern Ong Mary Kathleen Grealish C'havala Ruth Jaramillo Tess Alexandra Maplestone Kayleigh Anne Price Merit certifi cates Faisal Khan Sarah Jane Hayes Alice Louisa Moore Sam Whitley Schriek The Court of Examiners recommended that merit certifi cate at this sitting of the Paul Anthony Heatley Jennifer Lay Adam Daniel Morrow William Geoffrey Osborne Tomkins primary examination be awarded to: Joyce Hilda Leung Mary Hoang Kevin Jerome Murphy Svetlana Alekseyevna Treshina Dr Sarah Hayes, New South Wales Andrew John Inglis Danielle Louise McPherson Reubban Shivaprian Muthusamy Michael Thomas Wadsworth Dr Aria Lokon, Western Australia Sophie Shuang Liang Louven Bing Menzies Benson James Nardino Abigail Frances Weston Amy Chur-Yee Liu Brendan Anthony Mitchell Nicole Paterson Holly Eliza Martin Rhys William Morgan Lily Belle Poulier Andrew James Polukoshko

78 ANZCA Bulletin December 2018 79 Training Successful candidates (continued)

Final fellowship Queensland Western Australia Elayne Louise Anderson Jeremy Daniel Hickey Cecil Gray Prize The Court of Examiners recommended that the Cecil Gray examination Christopher David Arnott Yelena Gwendolyn Hoppe The Court of Examiners recommended that the Cecil Gray Prize Prize for the half year ended June 30, 2018 be awarded to: Konika Chatterjee Carl Lee for the half year ended December 31, 2018 be awarded to: Dr Alice Gynther, Queensland August/October 2018 Stephanie Ann Cruice Catherine Frances McGregor Dr John Newland, New Zealand Dr Gynther studied medicine at Diana Da Silva Hannah Perlman A total of ninety-six candidates Dr Newland studied medicine at the University James Cook University in Far North Edmond Daher Kahina Dianne Wotton-Hamrioui successfully completed the fi nal of Auckland, graduating in 2012. He is working Queensland and fi rst became interested in fellowship examination. Jonathan Andrew Francis at Waikato Hospital, New Zealand, where he anaesthesia following a placement in NEW ZEALAND the Cairns Base Hospital anaesthesia Rachel Erin Graham has undertaken the majority of his training. Shardha Chandrasekharan department. Alison May Jones Dr Newland was awarded the Renton Prize AUSTRALIA Melvin Mingwen Chong She undertook anaesthesia training at Australian Capital Territory Sebastian Paul Karalus in 2016 and says he credits “the Waikato Michael David Kerr William Ian Esson Nambour Hospital and the Royal Brisbane Hospital where Julia Elanor Hoy anaesthetic department’s teaching and support she is completing her advanced training. Sarah Naomi Kilvert Gihan Ganeshanantham for my exam success.” “During the stressful time leading up to the exam I relied New South Wales Steven James Klupfel Julius William Eruera Glasson “I chose a career in anaesthesia as it appealed to my Sanna Maria Aulikki Huhtamaki on mountain biking, yoga and spending time with my Ian Bollam Nihal Shekhar Kumta curiosity of science and desire to understand how things husband Gordon and friends to keep things in perspective. Alisa Kim Ireland David Eric Campion Kian Loong Lim work. Next year, I begin a cardiac fellowship at Waikato I’m moving to Victoria next year to start my provisional Michelle Jane Castro Luke Patrick Matthews Aoi Moniwa Hospital with a focus on teaching, ultrasound and research.” fellowship year which will be an exciting sea change. I have Angela Hui Lin Chang Laura Fay McDermott John Anthony Newland Dr Newland’s other interests include boatbuilding, water interests in obstetric and paediatric anaesthesia and in Ronald Cheung Kathryn Alice Loyna Meldon Ken Ka-Kin Nip sports, cheesemaking and classic cars. trainee education.” Oliver Frederick Clifford Simon Timothy Porter Benjamin John Simpson Varun Himanshu Desai Matthew Hugh Routley Sarah Louise Katharine Thompson Monica Joy Diczbalis Robert Leslie Gordon Smith Simon John Berndt Versteeg Martin Facini Jessica Teresa Taylor Andrew Marshall Wilson Merit certifi cates Emily Louise Fokkes Colin Bruce Urquhart Andrew Stephen Keith Woodhead Merit certifi cates were awarded to: Sameer Garg Dr Gordon Pirie, New South Wales Simon Gomes-Vieira South Australia SIMG examination Dr Daniel Zeloof, New South Wales Jana Greenblo Brian Lindsay Ambrose Five candidates successfully completed Darcy Thomas Buchanan Hamilton Miad Habibi Dr Nihal Kumta, Queensland the Specialist International Medical Adrian David Holmewood Nicholas Colin Harrington Graduate Exam: Kanathiban Theepan Kathirgamanathan Adelaide Denise Schumann Steven Robert Wilson Mehwish Khalil AUSTRALIA Lyvia Chwee Ling Khong Tasmania Australian Capital Territory Phillip Martin King Hamish Charles Bradley Devanshi Mahesh Rajput Avery Lou Lim Amit Ganguly Ciaran McNamara New South Wales Gordon Edward Pirie Victoria Rupali Rajesh Kini Baraniselvan Ramalingam Waltraud Maria Almhofer David Brian Reid Grant Ralston Crawford Queensland Victoria Sabbouh Jane Jing Dang Mrinal Madireddi Aylin Seven Kathryn Marie Fitzsimons South Australia Kanan Shah Sophia Grobler Fady Zakaria Israel Youssef Matthew James Spencer Michelle Andrea Haeusler Harshika Steele Nicola Terese Jarvis Victoria Louise Marie Sweet Niketh Alex Kuruvilla Ali Sabri Faris Michael Tran Michelle Nguyen Nikitha Vootakuru Tony Vuong Sarah Jane Wong Daniel Zeloof

80 ANZCA Bulletin December 2018 81 Anaesthetic history Tri-Nation Alliance ANZCA Anaesthesia and Pain Medicine strengthened History and Heritage Grant

In August this year, the Geoffrey Kaye Museum Further information about of Anaesthetic History announced the inaugural Anaesthesia and Pain Medicine History and the alliance Heritage Grant was open for applications. The Examples of medical education topics that are the focus of Tri-Nation Alliance include: purpose of the grant is to wholly or partly fund • Medical education research. projects that will advance the knowledge and • Indigenous health. understanding of the history of anaesthesia • Artifi cial intelligence (medical education and patient and pain medicine. centred care in the age of technology). The 2018 Anaesthesia and Pain Medicine History and Heritage Grant has been awarded to Dr Michael Toon, who will conduct research into the history of obstetric anaesthesia in Queensland. The aim is to advance standards and programs in The project will tell the story of the history and evolution of postgraduate medical education and in turn, improve obstetric anaesthesia and labour analgesia at Brisbane's two global health. tertiary obstetric hospitals, The Mater Mother's Hospital and the Royal Women's Hospital, through interviews with anaesthetists The MOU also establishes three levels of membership in the and obstetricians involved, and archival resources in addition to In outlining the progression of obstetric anaesthesia and alliance – partners, associates and affi liates. This will enable existing published accounts. labour analgesia between Brisbane major obstetric hospitals A new memorandum of understanding (MOU) interested societies and associations to apply to be members of The grant will fund the fi rst stage of the project which is the understanding of the forces, reasons and rationale for the the alliance. the planning and capture of oral history interviews that will evolution of practice will be advanced as well as the differences signed between medical colleges in Australia, Under the new formal structure one college supports the comprise the script of the completed documentary. The material in practice between centres. This will enable current clinicians New Zealand and Canada has formalised Tri-Nation Alliance for three years before handing on to another will be archived at the Geoffrey Kaye Museum of Anaesthetic to refl ect on their practice and increase knowledge and insight the vision, mission and objectives for future partner college. This includes taking the role of chair of the History as a valuable resource in and of itself. into potential future directions and what forces may shape this. executive committee, providing the secretariat team and The project will benefi t the anaesthesia profession, the An appreciation for the efforts and legacy of esteemed engagement. providing a professional conference organising team to deliver healthcare community and public through an education predecessors will also enhance the belief that current Representatives from the Tri-Nation Alliance – which comprises the annual tri-nation March events. and appreciation for the evolution in quality and safety practitioners are custodians of the quality of care that has been the Royal Australasian College of Physicians (RACP), Royal The Royal Australasian College of Physicians is taking this of anaesthetic care in the perinatal period. Dr Toon will established over generations. College of Physicians and Surgeons of Canada (RCPC), Royal role for three years from March 2018 to March 2021. engagement with, and acknowledge, predecessor clinicians, Congratulations Dr Toon. which is also of potential benefi t for those embarking on and Australian and New Zealand College of Psychiatrists (RANZCP), The MOU also helps the Tri-nation Alliance create a more Photo courtesy of the Mater Hospital Brisbane. Royal Australasian College of Surgeons (RACS) and Australian formal structure to its operations including an executive in the midst of rewarding anaesthetic careers. and New Zealand College of Anaesthetists (ANZCA) – signed the committee that consists of the chief executive offi cers and MOU in Halifax, Canada in October. presidents of the colleges. The MOU highlights the objective of sharing information, The Tri-Nation Management Committee is a new structure experience and expertise among the member colleges. It that includes the college deans or equivalents from each college. supports a vision to be globally collaborative in developing This group meets more frequently and is focused on delivering high-quality postgraduate medical education and lifelong business projects and annual collaborative events. learning opportunities. The MOU will be reviewed in three years.

Above: Signing the Tri-Nation Alliance MoU in Halifax, Nova Scotia: Dr Mark Lane, RACP President, Dr Margaret Aimer, RANZCP director, Dr Francoise Chagnon, RCPSC President, Dr Vanessa Beavis, ANZCA Vice-President and Mr John Batten, RACS President.

82 ANZCA Bulletin December 2018 83 New ACE Special interest group Special interest group Twitter events events account You can now follow ACE on Twitter at @ACE_ACECC for updates on all the latest SIG and CME activities.

Echo feast enjoyed by all in Adelaide at CTVP SIG Satellite Meeting Communication in Anaesthesia satellite workshop day a success

prevalent in the South African cardio surgical population. Echo The inaugural Communication in gaps at short notice with interactive lively “gurus” from NZ, Dr David Sidebotham and Dr Sara Allen served Anaesthesia (CIA) Satellite Workshop workshops expanding on the morning’s up some very palatable talks, as did Dr David Cardone (Adelaide). Day was held at the Adelaide Convention coverage of transactional analysis and Professor Joyce Wahr, Cardiac Anaesthetist, University of Centre at the start of the ASA NSC. Over unconscious bias. Minnesota, gave an insightful commentary on the importance 30 registrants from across Australia Later on in the day Dr Buchanan of human factors in patient outcome in the cardiac operating and overseas met together in a lively, and Dr Czuchwiki led workshops on challenging and convivial meeting that communicating with pain patients and room, which was a pleasant palate cleanse from all the rich explored some of the science and practical dealing with confl ict respectively. Dr echocardiography fl avours. Up-and-coming cardiac anaesthetists applications of communication in all its Mike Goldblatt, a self-confessed hypnosis from Perth, Dr Mark Johnson and Dr Neil Hauser, and Brisbane, forms. sceptic and cardiac anaesthetist, provided Dr Cameron Collard, provided a great blend of stimulating cases The meeting was opened by Professor a spellbinding session on establishing and case discussions for the audience to digest. Kirsty Forrest, Dean of Medicine at Bond rapport with distressed patients and the University who talked about how we see use of self-hypnosis techniques. Dessert ourselves and how we might be perceived The day ended with a delicious dinner Professor Colin Royse, University of Melbourne, and Dr Mark by others. Her exploration of unconscious at Georges on Waymouth restaurant. Markou, Director of Cardiac Anaesthesia, Flinders Medical bias was particularly interesting and a Registrants departed full of good food, new Centre, locked heads in a Master Chef pro/con debate to reminder that bias is all around us. ideas and plenty of practical ideas to take determine whether “diastology is dead”! Mark (pro) produced Judy McKimm, Professor of Medical into their daily practice. many laughs from the audience and put up some excellent Education at Swansea University, UK was I extend my thanks to Kirsty O’Connor arguments, but ultimately it was Colin (con), who narrowly our invited overseas lecturer and provided and the ANZCA team who provided an entertaining and thought-provoking excellent administrative support, Dr won the debate. The sessions were geared towards delegate exploration of transactional analysis as a Johanna Somfl eth workshop organiser interaction using the ACE meeting app for polling, which was a model for communication in the second for the ASA NSC, Professor McKimm and real hit in the fi nal session “Echo quiz”, where Tom, Dave and plenary presentation. Professor Forrest and all the presenters Justiaan tested the delegate’s knowledge with some weird and Following morning tea registrants for their excellent contributions and wonderful echo “vignettes”, matched perfectly to high quality divided up into a series of workshops to the registrants themselves for their Normally, the CTVP SIG have a “gap year” between their wines from the Barossa region. covering a range of topics from placebo enthusiastic participation. biennial conference, but this year, 65 anaesthetists and other effects with Dr Andrew Watson to I hope to welcome more participants to physicians with a passion for echocardiography gathered for a Second sitting paediatric communication and the use of CIA events in 2019. A great night out followed at Jolley’s Boathouse where a large metaphor with Dr Rob Laing. Although feast of echocardiography just prior to the ASA NSC in Adelaide. Above: Delegates in workshops. The concept, developed by Associate Professor David Canty turnout enjoyed another quality meal in the tranquil setting three of the workshop presenters were Dr Suyin Tan and made possible by Dr Thomas Painter and the ACE secretariat overlooking the Torrens River. unable to attend due to illness, Professor Convenor – Communication in Anaesthesia McKimm and Professor Forrest fi lled in Satellite Workshop Day from ANZCA, Sarah Chezan, was to facilitate CME compliance Recovery lunch the with the ANZCA professional document PS46: Guidelines on After a morning fast from the previous day’s delightful Training and Practice of Perioperative Cardiac Ultrasound in degustation, delegates returned the following afternoon for Adults. This document advises annual attendance at a meeting some hands-on training workshops. The selection included dedicated to echocardiography, review or performance of 50 practical training on high-fi delity ultrasound simulators loaned echocardiograms and participation in peer audit review of from the University of Melbourne with 10 transthoracic and 10 echocardiography. transoesophageal pathology cases, working towards the annual Entree requirement of 50 cases. The 3D echocardiography workshop Delegates enrolled in the TTE and TOE simulator courses enjoyed was infused with new tastes of live hands-on 3D acquisition with an entrée of pre-workshop interactive electronic learning both the iE33 and Epiq machines (Professor Colin Royse and including review and assessment of 20 echo case studies of Associate Professor David Canty) to a revamped QLAB training perioperative patients that could be counted towards their 50 session (Dr Bruce Cartwight). Justiaan and Neil moderated and echo reviews per year. judged two echo case quality assurance sessions, providing delegates with the opportunity to serve up their own offerings, Main course ticking the ANZCA CME criteria of quality audit review. The main course included an exciting day of lectures from The feedback from the delegates, both informal and formal a stellar cast from Australia, New Zealand, the US and was exceptionally high and will need be considered for a repeat South Africa. Invited keynote speaker Professor Justiaan in 2020. On behalf of the CTVP executive committee we thank all Swanevelder, cardiac anaesthetist and Director of Anaesthesia, those who contributed to such a successful meeting. University of Cape Town, dished up some excellent talks that generated healthy discussion on the use of echocardiography Associate Professor David Canty and Dr Thomas Painter for perioperative haemodynamic management as well as Co-convenors – 2019 CTVP SIG Meeting management of rheumatic heart disease, which is highly

Above left from top: Associate Professor David Canty and Dr Mark Johnson; Diastology debate results – Professor Colin Royse, Dr Mark Markou and Dr David Sidebotham.

84 ANZCA Bulletin December 2018 85 Special interest group Special interest group New ACE (continued) Twitter events account You can now follow ACE on Twitter at @ACE_ACECC for updates on all the latest SIG and CME activities.

Turning potential into performance Measuring, managing and minimising risk

This year’s Perioperative Medicine SIG meeting was held at the Risk assessment and risk modifi cation was, as the title of the Grand Hyatt, Melbourne. The meeting was preceded by the third meeting suggests, the common thread through all sessions. The strategic meeting with more than 50 invited stakeholders in line up of speakers, both national and international, was again perioperative medicine (PoM). After the development of a strategic exceptional. It was a pleasure to hear Professor Carol Peden, who plan for PoM at last year’s strategic meeting, the focus this year played a pivotal role in instituting many quality improvement The 2018 Combined Special Interest Group (SIG) meeting was New Zealand. Dr Shahina Braganza spoke on team wellness and was on the “economics of perioperative medicine”. projects in the UK and around the world, not only showcase convened by the Medical Education SIG and held at the Byron also spoke movingly about supporting colleagues through exam As many of you know, in the spirit of encouraging networking, the improved perioperative outcomes that have been achieved at Byron Resort and Spa from September 21-23. The theme was failure. Dr Tracey Tay presented the new wellness package for the convening committee chose once again not to have industry at through large scale quality improvement projects in the UK but “Turning potential into performance” and more than 120 people workplaces, “The long lives healthy workplace project” and spoke our meeting. One of my great pleasures is to observe the dynamics, also share ideas on how anyone can institute quality improvement attended. about its development. Dr Allan Cyan challenged us to think about networking and animated conversations that take place during the in their own practice and institution. Professor BobbieJean As with other years, the program of this year’s Combined SIG consent and Professor Kirsty Forrest and Maurice Hennessey meeting refl ected the diversity of the contributing special interest spoke about receiving feedback. breaks among: a true picture of interdisciplinary collegiality. This Sweitzer had many clinical pearls of wisdom for the preoperative groups: Medical Education, Welfare of Anaesthetists, Leadership There were a range of stimulating workshops. Maurice year did not disappoint. “Medicine is a team sport” was the topic assessment and optimisation of the high-risk surgical patient and Management, and Communication in Anaesthesia. Hennessey held a workshop on challenging conversations. of one of the plenary sessions. A reminder that success in medicine population while Professor Sunil Sahai shared his expertise in the The opening plenary featured the keynote speakers, Professor Participants had an opportunity to consider some diffi cult is not dependent on only one person; it is not a one-person perioperative care of cancer patients. Professor Denny Levett and Liz Molloy and emergency medicine physician Professor Victoria conversations in their own lives, not just those presented in the show. On the contrary, a successful outcome in the perioperative Dr Michael Swart delivered a bonus session on cardiopulmonary Brazil. Professor Molloy is an international expert on feedback clinical context, and to think about ways these conversations period, especially when dealing with a high-risk surgical patient exercise testing for risk stratifi cation, modifi cation and the value and co-editor of the book Feedback in higher and professional could be more effective. Professor Molloy also convened a population, requires a well-functioning multidisciplinary team to of shared decision-making in complex non-cardiac surgery. education. She spoke about how feedback is a process, not a workshop on “Feedback for learning: Doing it better”. Associate ensure the patient journey is less risky, more informed and better Finally, our national speakers were brilliant. We really are one-off event, and better thought of as a dialogue. She described Professor Scott Simmons took participants through a workshop overall. fortunate to have so many talented, passionate clinicians and how feedback discussions can be used to improve the practice of on “Using performance appraisal” to bring out the best in your This year we reached a milestone with 515 delegates attending, academics in Australia and New Zealand who truly care about others and ourselves. This has particular relevance to many of us. team. There was also a workshop on dealing with the aftermath Did you know that educators think their feedback is more useful of a critical incident. In addition, there were emergency response offi cially making our “humble” meeting, the largest perioperative improving care and outcomes for our patients. than it is perceived to be by the learners? Fifty per cent of episodes workshops in anaphylaxis and CICO. meeting in the world. It is hard to believe that this meeting The social activities included a successful welcome reception, of feedback include no useful suggestions for improvement. The New this year was the introduction of some research topics only started seven years ago with a modest group of around early morning yoga, that was enjoyed by many, and a lovely educators who are best at giving feedback spend a substantial to the Combined SIG program. Published researchers Professor 50 early adopters! What an immense achievement from all conference dinner at the MCG. Professor Ross Kerridge had amount of time talking about expected performance before the Jenny Weller, Associate Professor Marshall, Professor Molloy and involved, especially Professor Ross Kerridge, who has been a another great quiz up his sleeve, we had a fabulous performance activity. Professor Brazil took an interactive session and panel discussion key driving force. It is also a sign of the exciting times we have by Dr Jeremy Fernando, the Chair of the Perioperative Medicine Professor Brazil works at Gold Coast Hospital and has used on how to get started in research, particularly qualitative research. the pleasure of working in as doctors. After decades of increased SIG, and his talented children, and many delegates enjoyed a multi-disciplinary simulation to improve patient outcome On Sunday morning a number of fellows and trainees presented subspecialisation and progressively more fractionated care, dance to fi nish off a fun evening. measures in a range of different areas including clot thrombolysis. their own qualitative research. we now increasingly appreciate the importance of teamwork in We can’t wait to see you next year at the Sofi tel Hotel in She opened the meeting by speaking on the value of debriefi ng The 2019 Combined SIG meeting is being convened by the improving perioperative patient care and in doing so learn to Brisbane from November 7-9 for our eighth Perioperative Medicine and how to apply lessons from simulation to the real world. Leadership and Management SIG and will be held at the earlier rediscover the value of our colleagues from different craft groups, SIG meeting. Other highlights of the program included human factors date of July 26-28 in Manly, Sydney. It is sure to be another expert Associate Professor Stuart Marshall asking the audience thought-provoking meeting – save the date. who all have signifi cant expertise to add. to consider the similarities between the orchestra and the I would like to thank all the speakers, the attendees for their Continuing along the spirit of collaboration, we heard about Dr Jill van Acker healthcare team. Debate continues as to whether the trombonist enthusiastic participation, and ANZCA‘s Kirsty O’Connor and the progress of the ANZELA-QI pilot project, the fi rst binational Main convenor could take over when the fi rst violinist collapses, and whether Fran Lalor for their stellar work organising the meeting. intercollegiate quality improvement project of its kind. It has come Perioperative Medicine SIG meeting the anaesthetist could do the surgeon’s job! They’re a bunch of along in leaps and bounds and hopefully next year we will be experts coming together to perform but how are they supported in Dr Neroli Chadderton presented with the fi rst offi cial data on the perioperative care their work? Meeting convenor of patients undergoing emergency laparotomy in Australia and Dr Alison Lilley spoke about the Bawa Garba case and asked New Zealand. the question “Could this happen here?” Although this had an Above from left: Delegates enjoying the welcome reception drinks on Above from left: Strategic day attendees; Professor Bernhard Riedel, Australian focus many of the lessons were equally applicable in the deck; Professor Jenny Weller presenting; Professor Victoria Brazil Professor Toby Richards, Dr Catherine Gibbs, poster presentation winner presenting. Dr Saleimoa Bill Sami and Dr Dick Ongley; Professor Imogen Mitchell.

86 ANZCA Bulletin December 2018 87 New Zealand news

In the opening plenary, Dr Minto Opposite page clockwise from top: - New Zealand talked about investigating the longer term The ANZCA New Zealand National Committee A Maori name for Anaesthesia ASM outcomes for patients facing surgery. He chair, Dr Jennifer Woods (left) and President of ANZCA believes improving pre-risk assessment the New Zealand Society of Anaesthetists, Dr There were a record-breaking 450 will make all the difference to how Kathryn Hagen, opening the NZ A ASM dinner Māori fellows and a Māori trainee met at in Auckland. attendees at the New Zealand Anaesthesia patients are progressed and what the the NZ ASM in Auckland on November Annual Scientifi c Meeting (ASM) in expectations are: “Changing the question Dr Rod Mitchell, Dr Douglas Campbell, Dr 8 to consider the possibility of a Māori Auckland on November 8-10 which was Owen Sinclair and chair, Dr Jo Sinclair at name for ANZCA. ANZCA President Dr from ‘Is the patient fi t for surgery, could a session entitled from here to equity that jointly hosted by the ANZCA New Zealand we operate?’ to ‘Is surgery right for the Rod Mitchell, Vice-President Dr Vanessa National Committee (NZNC) and the New challenged the systemic racism in the health Beavis and the New Zealand National patient, do we operate?’” system that disadvantages Ma-ori and what can Zealand Society of Anaesthetists. Dr Minto is part of the Plymouth be done. Committee Chair Dr Jennifer Woods There was major appetite for the theme joined the discussions. Coronary Anatomy and Dynamic Exercise Dr Andrew Martin and Dr Lana Ferguson from “Face the future” as the enthusiastic Test (CADET) study investigating the Waikato Hospital did a joint presentation about Establishing a Māori name for the delegates packed presentations, effectiveness of different types of tests designing better pathways for frail patients college, an action identifi ed as part of workshops and exhibitions over the three carried out before major surgery to assess who are declared not fi t for surgery, and the ANZCA’s Indigenous Health Strategy, days in the centre of the City of Sails. need for more consultation with palliative care would demonstrate commitment to patient fi tness and the likelihood of a specialists. The program covered all areas of good post-surgery recovery. The project achieving equitable health outcomes for anaesthesia ranging from helping patients Keynote Dr Gary Minto, Associate Director Māori and refl ect that Te Reo Māori is an is a world-fi rst due to its unique approach of Research, Development and Innovation face the future, oxygen – a new look at an in combining assessments to give a fuller offi cial language in New Zealand. old therapy, global challenges, regional at University Hospitals Plymouth, United In New Zealand, government picture. Kingdom, who spoke at the opening session anaesthesia, trauma management, Dr Minto was followed by specialist on perioperative planning and prehabilitation. ministries and statutory organisations airways, research, training, obstetrics, anaesthetist Dr Andrew Martin and have both English and Māori names sepsis and stress. But it also included senior registrar palliative care Dr Lana displayed together as part of the crown’s stimulating presentations on issues Ferguson of Waikato Hospital for a joint recognition of its commitments under the outside the specialty. presentation looking at how the pathways Treaty of Waitangi. Many non-government A pōwhiri (Māori welcome) at the that acute patients follow sometimes organisations in the health sector also opening and a Pacifi c welcome the next fail the most vulnerable. Delegates were have Māori names. day led by the Richmond Road Primary challenged about whether they regularly Meanwhile Dr Courtney Thomas has School Samoan unit set the fl avour for a consulted palliative care specialists when been appointed ANZCA’s representative raft of presentations including from “Here looking at not heading down the path to on a Te ORA (Māori Medical Practitioners to equality” which looked at outcomes surgery for frail patients. Association) and medical colleges’ for Māori and Pacifi c people in the New ANZCA and NZSA hosted a health advisory group that had its fi rst meeting Zealand health system, climate change in reporter from Fairfax and distributed four in November. the Pacifi c and Pacifi c anaesthesia in the joint media releases during the NZA ASM. Dr Thomas joins Dr Amanda Gimblett Hawkes Bay. Two speakers featured on Radio New and Dr Stuart Walker in representing The keynote speakers were Dr David Zealand and three on Newstalk ZB with ANZCA at the Te ORA Hui-a-Tau which Auyong, Medical Director, Lindeman other associated print coverage. is being held near Wellington in late Ambulatory Surgery Centre, Section The 2019 combined NZ Anaesthesia January 2019. The Hui is a combined Head Orthopaedic Anaesthesiology, ASM and Annual Queenstown Update career expo and conference and there will Virginia Mason Medical Centre, in Anaesthesia (AQUA) will be held in be a booth staffed by the three fellows. Seattle, Washington, US; Associate Queenstown on August 21-24. The theme Professor Laura Duggan Vancouver is “Aspirations into action”. Professor General Hospital, Clinical Associate Alan Merry will present at the opening Professor, The University of British session to introduce the 2020 inaugural Columbia, Vancouver, Canada; Dr New Zealand Anaesthesia Education Gary Minto, Associate Director of Committee (NZAEC) Alan Merry Oration. Research, Development and Innovation at University Hospitals Plymouth, consultant anaesthetist, Derriford Hospital, Plymouth, United Kingdom; Associate Professor Richard Beasley, Medical Research Institute New Zealand, University of Otago, and Wellington Regional Hospital.

88 ANZCA Bulletin December 2018 89 Australian news

Australian Capital Territory Queensland

CME evening meetings Primary Viva Weekend Course The Queensland regional offi ce held its last two CME evening The Primary Viva Weekend Course was held at the ANZCA meetings for 2018. On September 20 the Queensland ACE CME Queensland regional offi ce from September 29-30. Twelve Committee welcomed Dr Jennifer Stevens from Sydney, who trainees attended the weekend course for some intensive presented “Make it personal: how to change opioid prescribing in practice ahead of the primary viva examination in Melbourne. your hospital”. The FPM Queensland Regional Committee hosted Many thanks to course convenor Dr Helen Davies, and to their last evening meeting on September 24 with guest speaker the fellows who volunteered their time to take part as mock Dr Dinah Blunt, who presented “Hypnotherapy in chronic pain examiners, and for making the weekend a success. Dates for management”. Both speakers gave insightful and interactive the 2019 Primary Viva Weekend Courses are now available presentations, and were well received by all who attended. We on the ANZCA Queensland web pages. look forward to another year of exciting CME evening meetings in 2019. Please refer to the ANZCA website for updates. Other news In August the Queensland team welcomed Iesha Iselin, the new Save the date – Queensland ACE Queensland Committee and QARTS Coordinator. The Queensland Regional Committee held its last meeting Regional CME and Christmas dinner on Thursday November 22 at Madame Wu We are delighted to announce that the annual Queensland ACE in Brisbane’s CBD. Regional CME meeting will be held on the Gold Coast in 2019. The ANZCA Educators Program (below) was held in the The meeting will be held over from August 31 to September 1 ANZCA Queensland regional offi ce from Wednesday October 17 at QT Gold Coast. Save the date now! More details to come. to Monday October 22, 2018. Thank you to facilitators Maurice Hennessy and Associate Professor Kersi Taraporewalla for their efforts in organising the program, which attracted 23 Courses update participants. Our Primary Lecture Program series proves to be an ongoing In August the Queensland regional offi ce welcomed Iesha Art of Anaesthesia The beautiful venue, together with the outstanding program success with 12 participants attending the lecture on Saturday Iselin, the new Queensland Committee and QARTS Coordinator. of experienced presenters, saw a near record attendance of 125 October 13, with an additional 6 participants joining the Greg Curran also joined the team in December as Queensland The Art of Anaesthesia meeting was held over the weekend of delegates at the Saturday lecture series. Word must be getting lecture remotely. The fi nal Saturday Lecture for the year on Regional Manager. September 15-16. This year’s venue, the iconic National Museum out that Canberra is a pretty decent place to visit during spring! November 17 was well attended and was streamed remotely of Australia, provided a spectacular backdrop for the meeting We had 15 healthcare industry exhibitors join us for the meeting, to six participants. themed “A game of risk?” Delegates were treated to a sunny (if and we would like to especially thank our major sponsors The ANZCA Queensland team is excited to reveal the new a little windy!) spring day in the nation’s capital, with delicious Medtronic and Seqirus for their ongoing support of the meeting. audio visual system in the regional offi ce in 2019. The Riverview food, great company, and a fantastic line-up of speakers. Three workshops were held on the Sunday morning – Can’t Room is now equipped with two new large fi xed screens, Dr Rodney Mitchell, ANZCA President, opened the Intubate Can’t Oxygenate (CICO), Anaphylaxis Management, voice-activated speakers and a fi xed camera in the ceiling. The meeting with a great presentation on risk in Indigenous and Prehabilitation with Professor Franco Carli. The CICO upgrade aims to provide a more interactive experience for both communities, drawing on his personal experiences working in workshop was held in the Calvary Hospital theatres and was presenters and attendees across a range of events and courses. central Australia. Dr Mitchell was followed by our delightful convened by Dr David Dao with assistance from Dr Ed Coxon, Dates for the 2019 Queensland trainee courses are now international speaker, Professor Franco Carli, who delivered Dr Carmel McInerney, Dr Derek Potgeiter and Dr Mitchell Blake. two very relevant presentations on prehabilitation and ERAS. The anaphylaxis workshop was convened by Dr Melinda Ford available on the ANZCA Queensland web pages. Dr Lachlan Miles and Dr Jai Darvall entertained everyone with with Dr Freya Aaskov, Dr Jennifer Myers, Dr Lanie Stephens, their exuberant presentations, and Dr Steve Bolsin gave a very Dr Nathan Oates and Dr Elizabeth Merenda assisting with the poignant presentation on clinical governance and lessons learnt facilitation. Both workshops were fully subscribed and provided from Bristol 25 years on. an opportunity for delegates to refresh their knowledge on these In the afternoon we concluded with a presentation from local important topics while also providing a means for completing speaker, Dr Holly Manley, on trainee welfare, and fi nally an their emergency response requirements under the ANZCA update on the MBS review by outgoing ASA President, Associate Continuing Professional Development (CPD) Program. The Professor David M Scott. Each and every one of our presentations feedback provided on each of the workshops was excellent with this year were exceptionally well received by the audience and delegates praising both the facilitators and the content covered feedback on the theme and line-up of speakers was excellent. in each workshop. Thank you to the conference convenors Dr Girish Palnitkar Above clockwise from left: ANZCA President Dr Rodney Mitchell opened and Dr Carmel McInerney for their tireless efforts in bringing the meeting; Dr Lachlan Miles, Professor Franco Carli, Dr Carmel McInerney, Dr Girish Palnitkar, Dr Jai Darvall; Associate Professor together a wonderful meeting. Steve Bolsin and Professor Franco Carli; Trade and delegates enjoying the delicious catering; Associate Professor David M Scott, Dr Carmel McInerney and Dr Girish Palnitkar.

90 ANZCA Bulletin December 2018 91 Australian news (continued)

Western Australia Victoria

AVANT and presented by Dr Nicole Lieses, Dr Marion Funke and Dr Lisa Primary Fulltime Alarcon. It was a three-hour workshop with 18 anaesthetists in attendance and Course organised by Dr Simon Bradbeer and We have had another large intake with 89 Dr Lisa Alarcon to discuss mentoring trainees attending our November Primary principles, tools for mentoring, case Fulltime Course at ANZCA House fi lling discussions and future mentoring both levels of the auditorium. There were directions. 28 presentations delivered throughout the The Neuroanaesthesia workshop was two weeks and a practice VIVA afternoon held on October 11 and was sponsored session held on the last day of the course. by Smiths Medical, organised by Dr Paul A big thank you to the course convenor, Kwei, and held at Kailis in Leederville. Dr Adam Skinner, our valued presenters, It was attended by 30 anaesthetists and the VIVA examiners for their help and focused on analgesic practice and to deliver another successful course to evidence for PLIF and was very well Victorian Registrars’ Victorian trainees and other trainees that received. travelled from all over Australia and New The Resilience workshop was held Scientifi c Meeting This year’s Victorian Registrars’ Zealand to attend. Our courses reputation on October 15 at the Keil Centre and continues to grow with many trainees was sponsored by MDA National and Scientifi c meeting on November 16 was a Quality Assurance successful event with 76 attendees. The mentioning they registered to attend organised by Dr Kevin Hartley. The after hearing positive feedback from past workshop focused on developing personal afternoon program had three sessions attendees. resilience and maintaining good mental Meeting with six registrars giving presentations health in work and personal lives, The second Victorian Regional Committee on either research or audit topics, it consisted of two 2.5 hour modules Quality Assurance meeting for the year along with presentations from fellows: Supervisors of Training Conference in Bunker emergencies, and the innovative and delivered by external facilitators and was held on Saturday October 20 and Professor David Story on “Pilot and interactive sessions offered unique there were 12 anaesthetists in attendance. convened by Dr Dean Dimovski. The feasibility studies”, Dr Andrew Marriott meeting Bay a great success insights and learning opportunities. The ASIST is a two-day interactive topics were "Blood pressure monitoring on “Research – the greatest team of afternoon comprised the CPD-approved workshop which was held on November in paediatric anaesthesia" delivered by Dr all”, Dr Praga Ajitsaria on “You’ve done Our Supervisors of Training meetings are The WA CME Committee held the Country CICO and ALS workshops, and the 29-30 and presented by Ms Lorna Hirsch, Rob McDougall and "Emergence delirium" becoming increasingly popular. In 2018 Conference from October 26-28, 2018 at the your research, you know the answer… inaugural trauma procedures workshop it focused on suicide fi rst-aid. ASIST presented by Dr Ben Turner. This was we delivered three meetings throughout Pullman Resort in Bunker Bay. About 100 now what?”, and also an update on led by Dr A Challen which was well teaches participants to recognise when followed by small group discussions of the year with our most recent being the delegates attended from around Australia scholarly roles activities was given by received. someone may be at risk of suicide and interesting cases and a summary session. Education Offi cer, Dr Damian Castanelli. fi rst full day meeting held on Thursday and enjoyed the beautiful weather and On the Saturday evening, delegates work with them to create a plan that will The cases generated good discussions and The sessions were chaired by Dr Tabara November 15 at the college. There were scenery. We hoped the delegates enjoyed had the opportunity to mingle and enjoy a support their immediate safety. Although these and the overall meeting received Dione, Dr Jason Denny, and Dr Diana Abu- two Educators modules – “Clinical the academic program and its innovative delicious evening at Bunkers Beach House ASIST is widely used by healthcare great feedback from the participating Ssaydeh and there were four adjudicators: supervision” delivered by Dr Ibrahim delivery, as well as took some time out for in Bunker Bay. A short beach walk from providers, participants don’t need any fellows. The Victorian Regional Professor Phil Peyton, Dr Craig Noonan, Yacoub and “Teaching a practical skill” by themselves, focusing on family, friends the resort, the delegates unwound and formal training to attend the workshop Committee will continue to deliver two Dr Praga Ajitsaria, and Dr Andrew Dr Rob Marr, along with a presentation on and enjoying all the region has to offer. were lucky enough to spot dolphins and – ASIST can be learned and used by Quality Assurance Meetings in 2019. Marriott whom judged the trainees “Helping trainees deal with exam failure” The theme for 2018 was “Modernising whales from the shore. anyone. crises: Battles shared, battles won”. There presentations in Audit and Research by Dr Antoinette Brennan, and updates Day two provided updates in pain and The WA offi ce would like to thank all from DPA Dr Vaughan Laurenson and the was a divergence away from some of the organ transplantation, and ended with ANZCA members who have organised, categories. more traditional topics presented at these A big congratulations to the two TPS unit. Each of these meetings have all an interactive panel discussion regarding facilitated and coordinated workshops been extremely well received and we will conferences; it represented the importance airway crises. This unique session winning trainees: Dr Jonathan Au (Audit and events throughout the year to continue to run these again to provide the of team work, and a nod towards our was a multi-disciplinary educational category) and Dr Patrick Tan (Research educate and develop the local anaesthetic valuable information and support to our colleagues that take their practice to the opportunity combined with specialists category) and thank you to all the community. We look forward to working SOTs in 2019. coal face of critical care. from the fi elds of emergency medicine (Dr with you again in 2019. Recently the 2018 trainees, sessional chairs, presenters and Thank you to Convenor /Deputy Day one comprised of lectures and M Salib) and ENT (Dr T Leahy) and offered recipient of the ANZCA/ASA Gilbert Troup judges for their contributions, along with Education Offi cer Dr Alex Henry, panel discussions led by the keynote specialist insight. Prize in Anaesthetics at the University of the convenor Dr Shiva Malekzadeth for all along with all the presenters for their speakers, Dr Natalie May and Dr In addition to the conference, the WA Western Australia is Catherine Nguyen. her hard work bringing this event together Simon Hendel, two highly-experienced offi ce has been busy organising local and making it the success that it was and contributions in bringing these meetings critical care specialists with a wealth together. workshops in partnership to support the Above clockwise from left: Bunkers Beach has been for several years. of experience and knowledge. They local anaesthetic community. focused on the rural and metropolitan House; Delegates enjoying the cocktail The Mentor Workshop was held on function; Trauma Procedures Workshop by management of trauma, and airway September 13 and was sponsored by Dr Andy Challen; panel discussion in the Above: Convenor Dr Shiva Malekzadeth, Windmills Room. adjudicators and presenters.

92 ANZCA Bulletin December 2018 93 Australian news (continued)

Victoria (continued) Tasmania

Upcoming CPD activities and courses It’s been busy in Tasmania! The Tasmanian ANZCA and ASA committees will host “CPD in a Tasmanian trainees continued their examination success with day – A one-stop shop for all your ANZCA emergency response a 100 per cent pass rate in the recent sittings of the primary workshops” in Hobart on Saturday March 2, 2019. This great CPD and fi nal examination. This wonderful result is a credit to the opportunity that presents all ANZCA CPD Emergency Response trainees and their hard work, but also to the teaching program workshops in one place on one day, including Cardiac Arrest, with great contributions from many teachers and examiners. CICO, Anaphylaxis and Major Haemorrhage. One venue, one Thanks to everyone who gave their time and expertise to day, all the workshops, and most importantly all your CPD support our trainees. Emergency Response points. The Tasmanian Regional Committee acknowledges and After the workshops we will hold the ANZCA and ASA AGMs thanks Dr Mark Reeves for his great work as primary examiner for the Tasmanian committees. In the evening there will be a and chair of the primary examination committee. Dr Reeves’ social function where people can share a laugh and a chat, and expertise framed in a simple practical approach has guided, maybe a drop of Tasmanian gin to the backdrop of our wonderful assessed and mentored many, many trainees through the city. challenges of the primary examination. The program has been fi nalised and registrations are open! The Tasmanian Anaesthetic Training Program (TATP) held We look forward to seeing you there. a successful and intensive trainee trauma teaching day in Launceston in October. Dr Deb Tooley convened the meeting Dr Mike Challis which was facilitated by ANZCA. Junior doctors came from all Convenor three public hospitals as well intensive care unit registrars, resident medical offi cers and anaesthetic international medical graduates. The University of Tasmania Medical School (NICS Building) generously provided ample space all day for lectures and fi ve group workshops. Tasmanian Trainee Day 2019 The program featured excellent interstate and local speakers Registrations are now open for the 2019 Tasmanian Trainee Day and relevant trauma simulation supported by a team of at Hadley’s Orient Hotel, Hobart on Friday March 1, 2019. Come facilitators. Thanks to Dr Sandy Zalstein (Staff Anaesthetist FPM CME evening seminar and learn how to tackle some of the big challenges of the future RHH); Dr Andrew Hughes (Care Flight Queensland); Dr Edda Hosted by Dr Clayton Thomas, the FPM VRC education offi cer, anaesthetist. Topics include bariatric anaesthesia, perioperative Jessen (ICU LGH); Associate Professor Reny Segal (Staff the “fi rst of its kind” meeting held in November on “Emotional medicine, diabetes management, the role of sustained release Anaesthetist Royal Melbourne Hospital) who contributed their and sexual abuse in the genesis of chronic pain: clinical and opioids and challenges associated with rural practise. A social time and expertise to this successful day. medical aspects” was to encourage presentations and facilitate event will follow to allow a relaxed opportunity to mingle with The Tasmanian Regional Committee recently held a discussions from both professions, on this signifi cant and often the speakers and your fellow trainees. professional development day in October for the Education neglected topic. Offi cer, all Supervisors of Training in Tasmania and the In the fi rst part of the evening, Dr Angela Chia, pain specialist Dr Hamish Bradley and Dr Alistair Park Tasmanian Welfare and Wellbeing representatives for our and anaesthetist at the Royal Women’s Hospital, spoke on why Co-Convenors hospitals. Mr Olly Jones (Director, Education at ANZCA) attended childhood abuse patients are more prone to develop organic and provided comprehensive updates on the new approach to medical problems and Dr Susan Brann, psychiatrist, on how WBAs, the ANZCA trainee survey and wellbeing initiatives. to explain why it leads to pain vulnerability and trauma There was lots of interactive discussion and collaboration. throughout a person’s life cycle. Thank you all attendees and particularly to Mr Olly Jones for The second part heard Mr Ian Dallas, lawyer and Mr Raph A variety of events on offer the ongoing support from the college. Ajzensztat, barrister, speak about how litigation can help the The Part 3 course was hosted by the ASA and held at Frogmore patient to “recover”, and how compensation systems deal with Creek winery outside Hobart on Sunday November 25. Thanks these patients, especially when the initial injury can lead to to all speakers and attendees. A Foundation day and Part Zero major long-term repercussions. course for trainees will be held on Friday February 16 and Above left from top: Dr Andrew Huang, Dr Elaine Chilcott, Dr Brigid Presentations were followed by a discussion panel. The Saturday February 17, 2019 in Hobart. Ikin, Dr Mark Reeves, Dr Lillian Coventry and Dr Alistair Park; Dr Sandy meeting was attended by more than 45 delegates, and was very The Tasmanian Winter Meeting is in the early stages of Zalstein presenting at the Tasmanian Trainee Trauma Teaching Day; Dr Hamish Bradley and family, Clinical Associate Professor Marcus well received. Our warm thanks go to the FPM VRC education planning. It will be held at the Josef Chromy vineyard outside Skinner, Dr Colin Chilvers, Dr Amit Ganguly and family, and offi cer Dr Clayton Thomas, Dr Diarmuid McCoy, the presenters, Launceston on Saturday August 24, 2019. If professional Dr Tom Mohler. our sponsor Seqirus, and all participants. development in the company of colleagues at a beautiful vineyard is your thing, then this meeting could be for you. Watch out for the program and registration. Above from top: Dr Clayton Thomas FPM VRC education offi cer; Dr Angela Chia, Dr Susan Brann, Mr Raph Ajzensztat and Mr Ian Dallas.

94 ANZCA Bulletin December 2018 95 Australian news (continued)

South Australia and Northern Territory New South Wales

Combined ANZCA/ASA SA Part Zero Course The Part Zero Course for new trainees was CME Meeting held at the ANZCA NSW Offi ce at Crows Dr Stephen Lam presented “Severe sepsis: pathophysiology and Nest on November 3. There were 44 new clinical implications” at the August CME meeting, held at the trainees attended the day program which historic Lion Hotel in North Adelaide in May. included sessions on training, navigating Dr Lam’s presentation highlighted the new 2016 defi nition of TPS, examination preparation, career sepsis, the surviving sepsis campaign and the sepsis guidelines. options, welfare and ended with a session The presentation was professionally recorded and distributed by partners of anaesthetists. Many thanks to remote South Australian and Northern Territory anaesthesia to those trainees, consultants and non- hospital departments for their training and CPD purposes and anaesthetists who volunteered their time is available for viewing on ANZCA’s YouTube channel. to take part. Thanks to the NSW Trainee Committee for organising a great day, which provided an opportunity for new trainees to meet and mingle with other trainees and consultants. Dr Jenny Stevens award Fellow Dr Jenny Stevens was awarded Supervisors of training "Collaborative Leader of the Year" at the 2018 NSW Health Awards on November 5. update The award was in recognition of the Forty-fi ve NSW SOTs gathered at the many projects that Dr Stevens has led at Sydney ANZCA Crows Nest offi ce on St Vincent’s Health Network involving Friday October 19 to be updated on the multidisciplinary groups across the education development unit update, TPS state to improve patient care. These demonstration, training and assessments SA Pain Management Unit projects arose from Dr Stevens’ desire to and TDP updates, and participate in the SA regional offi ce staff recently toured the new Central Adelaide address issues that anaesthetists & pain ANZCA AEP module, planning effective Local Health Network Pain Management Unit, which has been specialists deal with every day. The work teaching and learning, facilitated by Dr relocated from the Royal Adelaide Hospital to a purpose fi t highlights the broad role and experience Anne Jaumees. facility at The Queen Elizabeth Hospital (TQEH). of anaesthetists and their impact on Dr Meredith Craigie, Dean, Faculty of Pain Medicine and pain patients and clinical care. medicine specialist working at the unit said, “The move to the Dr Stevens was recognised for projects TQEH premises has been benefi cial for both patients and staff. including: We have spacious consulting rooms and treatment areas and - Insertion of fascia iliaca blocks (FIBs) in all rooms now have natural sunlight, which has proven to have the emergency department for patients numerous benefi ts to our bodies.” with fractured neck of femur factures Above from left: Michelle Gully, Jane Agalidis, Dr Meredith Craigie, (NOFs) by trained nursing staff to Teresa Camerelli and Louise Garvin. improve analgesia and minimise opiate use in the elderly. - Working with pharmacy to reduce Above from top: Dr Stephen Lam presenting “Severe sepsis: discharge scripts for opiates – targeting pathophysiology and clinical implications”; Dr Tim Porter and Dr Divahar Kumar; Steve Tebbett and Dr Stephen Lam. junior doctors, ward nurses and GPs. - Working with pharmacists on a Pharmalytics program to allow departments to track their drug use data and manage their drug usage Above: Dr Sharon Tivey and Dr Sally Wharton and budgets. It is hoped this will be enjoying a well earned break at the SOT extended to all NSW hospitals. meeting; NSW SOT meeting.

96 ANZCA Bulletin December 2018 97 Obituary Dr Thomas Christopher Kenneth “Kester” Brown AM, FANZCA 1935 – 2018 By all accounts, Kester’s father was Having passed his fi nals, he proceeded So began a 37-year career at the He was the author or co-author of Kester loved his sport, playing hockey a remarkable man and skilled doctor, to internship in London, Ontario, with Children’s hospital. He was appointed as a several books on paediatric anaesthesia, and tennis with gusto. Colleagues will often the only one in a large district. He the idea of ultimately becoming a country specialist anaesthetist in 1970, becoming including Anaesthesia For Children, recall his regular early morning tennis ran a 120-bed hospital, a 20-bed leper general practitioner. Towards the end director of the Department of Anaesthesia published in 1979, and 1992. He produced matches at the Children’s hospital, where colony, performing many major surgeries of the year, during which he was again in 1974, a position he held for 26 years. several fi lms and videos for teaching of he made up for any lack of speed with and cataract operations among his daily exposed to anaesthesia, he decided to seek Kester took on many roles within the anaesthesia techniques and resuscitation. sheer cunning. He played hockey until the routine. adventure and experience. Fascinated hospital, including director of theatre Kester was very involved in research age of 54, and had captained the hockey “It was hardly surprising, after all this by the North West Territories, he applied services, and divisional director. He throughout his career, publishing team for St Andrews and the combined exposure, that I should think of nothing to join the three-doctor practice in was a member of numerous committees, over 160 papers, often jointly with Scottish universities. He maintained his but medicine for my future career.” Yellowknife, a town of 3500 where the chairing many of them. In the process, authors from different specialties or fi tness, even climbing Mount Kilimanjaro After convincing his teachers that winter temperature could reach -4oC. given his nature, he came to know many departments. He was a great advocate for his 60th birthday. he was good enough to continue with A problem arose when he met a young of the hospital staff on a fi rst name basis, of collaborative research, including He published eight books on non- science, Kester gained his Higher School Australian physiotherapist, named Janet irrespective of their place in the hierarchy. such diverse institutions as the Monash medical subjects, including Catalyst Certifi cate, and in 1954, caught a ship to Penfold. The solution was to ask her to His calm manner and diplomacy meant University Department of Electrical a memoir of his medical career, and Scotland, to join the medical course at St accompany him to Yellowknife, and after that he was often called upon to resolve Engineering, the pharmacy college, a children’s book, Doggy Friends was Andrews University. He enjoyed the social travelling briefl y to Melbourne to be confl icts. RMIT Applied Chemistry, and Melbourne inspired by his love for his dogs. Until life, the sport, and even the cold weather, married, they proceeded north in 1961. Kester made major contributions to University Anatomy School. He served recently, Kester could often be seen while at times struggling with his Their marriage was to last more than 58 the college, when it was still a faculty on the Editorial Board of the journal, walking them near his home. studies. He learnt the value of practical years. of the college of surgeons, serving as Anaesthesia and Intensive Care from 1972 Kester’s lust for life was increasingly application in the process of learning new After 17 months in Yellowknife where state education offi cer, chairman of the to 1995, and was awarded the journal’s curtailed in recent times, as he bravely subjects, a principle that he continued to he experienced the full breadth of remote Victorian Regional Committee, teaching Ben Barry Medal. withstood his steadily worsening medical practice, and where Kester Thomas Christopher Kenneth Brown, apply for the rest of his life as a teacher. on faculty courses, and as an examiner. Kester was honoured by many Parkinson’s disease. With increasing and Janet’s twin daughters were born, He took time during vacations to work at a He chaired the joint faculty/ australian organisations, local and international. diffi culty swallowing, he was happiest in forever known as Kester, passed away he sought some additional training in tuberculosis sanitorium near Edinburgh, society of anaesthetists (ASA) Continuing He was made a life member of the ASA, the company of his family or reminiscing on November 14, shortly before his 83rd anaesthesia, still with a view to general learning nursing and other skills, giving Education Committee, the forerunner of as well as receiving the Gilbert Brown with friends. His amazing recall of birthday. practice. He took up a six-month post at him a valuable insight into the roles of “ACE”. He was awarded the Robert Orton Award. He was awarded honorary people, places and events was lucid until Kester was an extraordinary man, a Vancouver General Hospital. others in healthcare. Medal, and the Gilbert Brown Prize. membership of several International the end, when he passed away at home in paediatric anaesthetist by profession, but Kester’s interest in anaesthesia was While holidaying with his From 1973 to 1995, Kester was chair Societies of Anaesthesia, and the City the company of his loving family. one with a worldly view and a passion for noticed, and he was encouraged to grandmother in northern Scotland, Kester of Paris Medal. Kester’s legacy is the many people teaching. join the training program. He stayed in of the Scientifi c Program Committee of He was born in Tumutumu, Kenya, occasionally joined the local doctor while Vancouver for two-and-a-half years, and the Australian Society of Anaesthetists, Kester had many interests outside around the world who have benefi ted from in 1935, the third child and second doing a list of anaesthesia, so he was with rotations to the Children’s Hospital, culminating in convening the scientifi c medicine, however his family, Janet and his wisdom and teaching. Not just doctors son of Monteith and Judy Brown. His well prepared when required to do 12 his future was set. His time in Vancouver program for the World Congress of their fi ve children, was always utmost and nurses, but patients, especially parents, both Scots, had met on the ship anaesthetics in fi fth year. He did all 12 on was very formative. He was stimulated Anaesthesiology, held in Sydney in 1996. in his thoughts. With many journeys children, who will lead better and more as Monteith travelled to be a mission one morning during a tonsillectomy list, by a range of enthusiastic consultants, His often-innovative contribution in interstate and overseas, he was always fruitful lives. doctor in central Kenya in 1925. Kester using ethyl chloride and ether. Sharing undertook several research projects, these roles is commemorated annually keen to return home. In later years, as the I never heard Kester raise his voice in recalled the beautiful view of Mt Kenya lodgings with the son of an anaesthetist and learned much about organisation by the “Kester Brown Lecture” at the ASA family grew up, Janet often accompanied anger. He was always the “go-to” person from the house, where he was schooled led him to read Macintosh’s book on the in a large teaching hospital, as well as National Scientifi c Congress. him. to resolve a dispute. For him, every cloud by his mother until he was nine. His subject, further steering his life towards a embracing innovative approaches to Kester’s passion for world anaesthesia, Kester was an adventurer and took had a silver lining. older siblings away at boarding school, career and a passion. teaching. and the advancement of the specialty photographs wherever he went, and Kester spent much of his early years on Before entering his fi nal year, Kester In 1965, he spent six months at the in less developed countries, led to his several of his published books contain Dr Rod Westhorpe OAM, FANZCA his own with his parents, undoubtedly spent his vacation on the rugged north- Toronto Hospital for Sick Children, involvement in the World Federation large collections. Kester’s father had absorbing the beauty of remote places, eastern seabord of Canada, working with cementing his commitment to paediatric of Societies of Anaesthesiology, and he been a keen photographer, even building relishing the one-on-one education and the Grenfell Mission. As part of the TB anesthesia under the tutelage of Al served as president from 2000 to 2004. He his own camera, and he imparted his gaining an appreciation of the value of screening program, he x-rayed everyone Conn. Having decided to settle back in was well-known to many anaesthetists enthusiasm to his son. Kester was made compassion and medical care to less well- in northern Labrador, as well as assisting Australia, Kester applied to both the around the world, having visited and a licentiate of the Victorian chapter of the off communities. with anaesthesia. Royal Children’s and the Royal Melbourne lectured in some 70 countries. While Royal Photographic Society. He was then sent to boarding school in After six years of medical school, hospitals. He was offered jobs by both, director of anaesthesia at the Children’s He always carried a watercolour Nairobi, 140 kilometres away, returning Kester had amassed experience that few but Al Conn recommended that he spend hospital, he arranged for around 100 painting kit with him, and was often home only during school holidays. On one of us could imagine, and which shaped another year in adult anaesthesia before anaesthetists from more about 40 to be seen making a quick sketch. He of these visits, at age 14, he saw his fi rst his entire life. He had already developed going to the Children’s. countries to spend time in Melbourne for also painted in oils, and held several anaesthetic, ethyl chloride, followed by a worldly outlook, a gift for making The family travelled to Melbourne training in paediatric anaesthesia. All exhibitions of his work, as a member draw-over ether and trichloroethylene, acquaintances, a benevolence to others via Kenya, with Kester also visiting but two returned to their home countries of the Victorian Artists Society. Many administered by one of his father’s trusted no matter what their circumstances, and Sweden on the way. After a year, he was to become teachers and leaders in the visitors or hosts were the grateful medical assistants. The patient was an a passion for medicine with anaesthesia encouraged to apply for a new position at specialty. recipients of his framed paintings or infant with intussusception. fi guring strongly. the RCH, as medical offi cer to ICU. He was photographs, now proudly hanging in yet to sit the primary examination for the offi ces and homes throughout the world. FFARACS, which he passed soon after, followed by success in the fi nal exam just seven months later!

98 ANZCA Bulletin December 2018 99 Obituary Obituary Dr Richard Hugh Shephard Connock, FANZCA Dr Anna Lynda Illingsworth, FANZCA 1931-2017 1969-2018

as he graduated in medicine, married He quietly went on long service leave It didn’t take Anna long to fi gure out Besides being a mother and a doctor, Val, and got a job as a JRMO at Sydney from The Alfred in 1996 for two years that anaesthesia was the specialty for Anna was also a talented photographer Hospital. Dick and Val moved to Hobart and just never returned. If a function her and that New Zealand was where she with a gift for matchmaking. She not for two years so he could possibly pursue had been forced upon him he would have wanted to live. She started work as an only introduced a number of her friends a surgical career. Fortuitously for us in been an apology. He fi nally gave his last anaesthesia registrar at Taranaki Base to their future spouses but also took the anaesthetic community, training anaesthetic in early 1998 and escaped Hospital in New Plymouth and it was here the photographs at the wedding that in anaesthesia beckoned instead, and Melbourne to Humpty Doo (about 40 that we fi rst met when I moved to New followed. She was an avid reader with he accepted a job at the Royal Women’s kilometres from Darwin) working on Zealand in the mid-1990s. I was new to a great interest in new ideas and the Hospital in Melbourne in 1958. A 40 year a mango farm as the main shed hand the hospital and new to the country and world around her. She loved cooking and association with The Alfred hospital for about six months. He came back to she went out of her way to make me feel entertaining and was a very talented commenced the following year. Melbourne in late 1998 and a romance welcome. Over the next two decades we knitter. Music was very important to her. Dick Connock soon became a byword blossomed with Faye Kemp, a long shared a lot of laughs and adventures After Anna’s death there was an for skill and sangfroid in the rapidly standing and much loved staff member of and helped each other through many outpouring of messages from the many evolving cardiothoracic subspecialty our anaesthetic group. They married and challenging times as we worked as junior people whose lives she had touched. arena, and among many others he moved to a fi ve acre block on the outskirts administered the anaesthetic for of Drysdale on the Bellarine Peninsula doctors, completed our anaesthesia There were some words that kept coming Australasia’s fi rst heart transplant. With where Dick threw himself into the local training, started our families and watched up to describe the Anna that they knew his customary dry wit he described the community. As fi tting for the “can do” our children growing up. and loved. In no particular order these procedure as “a great technical success, sort of man he was, he joined the State Anna worked as a specialist included – loving, friendly, caring, fun, on most levels.” He also was part of the Emergency Service. anaesthetist at North Shore Hospital in supportive, brave, kind, compassionate, team that spent eight weeks in Singapore He received training in general rescue, Auckland for 12 years. Her particular open, honest, happy, bright, concerned in 1967 setting up an open heart unit. road crash rescue, storm and fl ood rescue area of interest was obstetrics and for others, great teacher, wicked sense of Dick Connock died peacefully in his Dick and Val had three children; Linda and Chainsaw use. He was soon elevated It is with great sadness that we gynaecology. She is remembered as a humour, mischievous grin. Many people Drysdale garden on October 26 last year. in 1956, Richard in 1958, and Patricia to training offi cer, and really enjoyed acknowledge our friend and colleague, doctor who genuinely cared. She was told of how she supported and helped He was a superb and very accomplished (Trish) in 1960. The family settled in facilitating the training of others. He and Anna Lynda Illingsworth, who passed always compassionate with patients. Her them when they were going through anaesthetist who had a long, Canterbury and, in addition to being Faye joined the Peninsula Players Drama away on July 5, 2018 at her home in skill was in making distressed and fearful tough times. Almost all of the messages distinguished, successful and infl uential mum, Val processed and dealt with all of group. Faye became one of their most Nelson, New Zealand. people who are in a vulnerable position made mention of how much she loved her career in both the private and public Dick’s private accounts. Their children versatile actors and Dick stage managed Anna was born in South Shields, feel safe and cared for. Anna also looked boys and how proud she was of them. spheres in Melbourne. He was active remember them as having the happiest of and built sets. He became a volunteer County Durham, England on April 22, after the welfare of many others in the That is the Anna that I will remember. continuously in Melbourne anaesthesia marriages with never a cross word. Dick at Queenscliff ’s “Cottage by the Sea”, a 1969. Her beloved grandmother helped theatre suite. She would actively seek out Anna will be profoundly missed by from 1958 until his retirement in 1998. was totally devastated by Val’s premature charity giving underprivileged children care for her in her early years while and talk to expectant mothers. She will her children, Max and Bob, her parents, In every fi eld of human endeavour death from ovarian cancer in 1986. the chance to have a seaside holiday. Anna’s mother, Lynda, worked. In 1970 be remembered for ensuring that they Lynda and Jim, her brother, Paul, and her there are those few individuals who Dick was a tireless and diligent He was nominated for the 2014 Pride of Lynda met and married Jim Illingsworth had the support they needed and would many friends and colleagues. appear to every trainee or apprentice contributor to both the ASA and the Australia awards in the category of care and Jim adopted Anna. Anna’s brother, help them with the sometimes diffi cult to display such calm and easy mastery Faculty of Anaesthetists RACS, continuing and compassion. Dick really enjoyed his Paul, was born in 1973. transition from full-time work to the Dr Karen Pedersen MBBCh, FANZCA of their specialty that they readily lend with ANZCA after 1990. One simply years in Drysdale. He attended a function In 1974 the family moved to South stressors of being a mother and working Anaesthetist, Auckland Hospital, themselves to become one’s guiding could not do justice to every aspect of his held at ANZCA House in July 2008 to light and role model. Dick was one such. Africa where, other than a brief return to as well. New Zealand contribution, however three things stand celebrate 50 years of our anaesthetic Outside work the most important thing Hugely experienced, knowledgeable, out. His role as a fellowship examiner group and looked like a man years the UK in 1983, Anna spent her childhood. in Anna’s life was her family. She met Dr professional in every way and above all from 1978 to 1989, his achievements as younger. Although still retiring in manner She attended Grosvenor Girls High School John Foy in 1999 and they had two sons, the much admired “Ice man” in a real safety offi cer on the Victorian Regional he relished the opportunity to reconnect. in Durban and was encouraged by the crisis. He made the bar seem too high to Committee of the faculty, and his Dick Connock was a remarkable family GP, Dr Mima Verster, to follow her Maxwell and Robert. She was immensely be really achievable, and he did it easily. appointment to the Consultative Council anaesthetist but moreover a remarkable dream and apply for medical school. proud of Max and Bob and loved nothing Richard Connock was born in on Anaesthetic Mortality and Morbidity, man. He was not an angel and could Anna was just 17 when she travelled more than spending time with them, Maracaibo, Venezuela to English parents. occasional from 1984 and as a full be caustically sarcastic, especially to from Durban to Johannesburg by bus to supporting them through challenges and His father, also Richard, was a mining member from 1990 until his retirement. fools that he suffered poorly. He was start her studies at the University of the celebrating their achievements. engineer from Helston in Cornwall and Many of the early policy documents of however the sort of anaesthetist that Witwatersrand. Anna graduated from his mother, Grace, was from Oxford. He the faculty (later adopted and updated for you hope to become when you start Medical School in 1992 and left South started schooling in Barbados then moved the college) were authored by Dick. These training, and moreover the sort of man Africa soon after that as the interest on with the family to the Cameron Highlands include hazards of electrosurgical units, that most men want to be. Quiet, humble, her student loan was higher than the in Malaya, fi nally fi nishing at Scots protocol for checking an anaesthetic self deprecating but with a noticeable salary she received as a junior doctor. College Sydney and The Armidale School machine, the anaesthetic record, re-use of physical presence and just so capable. in NSW. After school Dick continued to disposable equipment, and any number of Very defi nitely a man made of the right live in Armidale and started science at the hazard alerts. stuff. He was much loved by Faye, Linda, University of New England , subsequently All of this work was in addition to a Richard and Trish. He is much missed by moving to Sydney University to pursue busy and successful private and public them and also by the greater anaesthetic medicine, residing at St Paul’s College. practice including weekly on-call nights community who owe him a debt of His heart however remained in Armidale at both Box Hill Hospital and The Alfred, gratitude for his quiet but very substantial where he had met Valerie McLaughlin, the each for more than 30 years. Dick was contribution to our specialty. girl who would go on to become his true an intensely private man who couldn’t soul mate, a now much overused term bear any fuss, especially if it was about Dr Mark Langley that in this instance is entirely fi tting. him. It made him visibly uncomfortable. Nineteen fi fty-fi ve was a big year for Dick Chairman Victorian Anaesthetic Group Above: Dr Anna Illingsworth with her boys Max (left) and Bob.

100 ANZCA Bulletin December 2018 101 Obituary Obituary Dr Graham Lindsey Dale, FANZCA Dr Darcy Price, FANZCA 1950-2018 1966-2018

Graham was an intellectually gifted Almost always he was accompanied fi eld of 1000 competitors to hand the fi nal An intellectual and well-read man, person and a gifted anaesthetist. He was by his wife, Lynne. They enjoyed 45 leg to his team mate in fi rst place. This Darcy was always generous with his time always abreast of the medical literature years of marriage and were very devoted was a remarkable feat, given it was his and knowledge, educating and supporting and regularly introduced new systems to each other as well as to their three fi rst time in a river kayak. all medical colleagues, including into our hospitals. He was the person that children, Greg, Kate and Caroline and fi ve Darcy used his considerable experience lecturing regularly on the anaesthesia less senior anaesthetists would approach grandchildren. and infl uence in kayaking to develop Part One and Part Two courses. He was for advice and assistance. He was cool In recent years, all of us who crossed the sport in New Zealand and contribute the fi rst Supervisor of Training and went under pressure and often the fi rst choice his path noticed how cheerful and back to the kayaking community. He on to establish a fellowship position anaesthetist for medical families in physically fi t he was. It was an absolute established the inaugural King of the in regional anaesthesia at North Shore Bunbury. He was selfl ess in giving up his tragedy that he died in a cycling accident Harbour surf ski race in Auckland in Hospital. professional time and could always be on the morning of November 6, 2018. 2001 and was integral in giving the event Darcy generated and enjoyed a relaxed relied upon to attend for emergencies, day He is sadly missed by his family and a strong profi le, attracting TV coverage atmosphere in the operating theatre or night, whether he was rostered on duty a wide circle of friends and colleagues. and a number of sponsors. The King of where the music was always just right. or not. His entertaining conversation and the Harbour continues today as the main “Reggae Friday” was a prerequisite to Graham also became involved with extraordinary wit will live in our event on the New Zealand long distance help ease into the weekend. This calm anaesthesia administration, hospital memories. surf ski calendar, attracting many demeanour helped him expertly treat planning and teaching. He was the international paddlers from around the life-threatening emergencies including obvious choice for these roles. For Dr Tom Cottee FRANZCOG world to compete with local athletes. anaphylaxis and an episode of malignant 20 years, he served on the medical When unable to continue racing due hyperthermia, all with excellent outcomes advisory committee of the hospital to injury, Darcy gave his time as the race for the patients. and concurrently acted as head of the commentator, his quirky comical insights Darcy recognised the best in all people. Graham was born in Perth and grew up in anaesthetic department. At meetings, Darcy Price, born in Hawera, New adding fl avour to this gruelling event. He established a scholarship supporting the Perth beachside suburb of Trigg. his opinion was always highly valued. Zealand, was an accomplished Not only did Darcy support the elite year 13 students at Hawera High School, He attended Scarborough High School He had such clarity of thought that sportsman, highly respected anaesthetist, athlete, he recognised the importance of his secondary school, to further their and was a member of The Trigg Island after discussion on complex matters, loyal friend and family man. family events. In Auckland’s North Shore, education. He was also active in Surf Club. the meeting would often turn to him for Following a successful sporting and Darcy established the Takapuna Beach promoting health and wellbeing in his He studied medicine at The University arbitration. academic career at high school, where Series to enable amateur athletes, families local hospital, founding the successful of Western Australia and trained in Graham and I commenced practice he was Head Boy, Darcy left Hawera and children to participate in fun and dragon boating team. anaesthesia at Royal Perth Hospital, in Bunbury at the same time and for 32 to study at Auckland University. After healthy competition over various events First and foremost however, Darcy was Princess Margaret Hospital for Children years, he provided anaesthesia services completing a science degree, majoring in including ocean swimming, running and a family man. He absolutely adored his and at King Edward Memorial Hospital for for all my obstetrical and gynaecological physiology and including an impressive paddling. Now in its 12th year, the event partner, Jane and their two children Rita Women. operating lists, almost exclusively, in both dissertation on Cardiac Loops, he was attracts hundreds of competitors each and Zella and was very proud of all that After four years of private anaesthetic the public and private hospitals. I wonder accepted into Auckland Medical School. week. they did. Not surprisingly, they succeed practice in Perth, he relocated to whether this timespan may be a Western After graduation he chose to specialise Off the water, Darcy was an in their chosen activities and he spoke Bunbury in 1984, where his wife, Lynne, Australian record for an anaesthetist/ in anaesthesia, training in Auckland and exceptional anaesthetist. To many, often of his time on the sporting sidelines had family. He was the fi rst specialist surgeon association. Sydney. In 2000 he took up a position he was a mentor and role model, well supporting them with pride. They have anaesthetist to practice in Bunbury and Graham fl ourished in retirement. He as a specialist at North Shore Hospital, known both locally and internationally lost a selfl ess, generous and kind man was thought to be the fi rst specialist was a humble man and loved the simple Auckland where he excelled clinically in regional anesthesia circles. Darcy who was the epitome of integrity. anaesthetist in Western Australia to things of life, especially outdoor activities and academically. was instrumental in developing, Darcy died on September 29 and will reside and practice outside the Perth and the wonders of nature: camping, Darcy was a very capable and talented researching and educating our specialty be greatly missed. He was an inspiration Metropolitan Area. He served at both boating, fi shing, scuba diving, swimming, sportsman. In his youth, he was a to the benefi ts of the combined to many and each of us has a special Bunbury Regional Hospital and SJOG cycling and travel. representative level football goalkeeper, suprascapular and axillary nerve block memory of him. He was an esteemed Hospital, Bunbury, until retirement in cricketer and fi rst XV rugby fl anker, for shoulder surgery. He developed this colleague and loyal friend; a kind, March 2016. but his real talent was water sports, as an alternative to avoid some of the humble and considerate gentleman specifi cally open water kayaking. complications of the interscalene block. with an engaging sense of humour who He achieved signifi cant personal As a regional enthusiast, he volunteered achieved so much. His legacy will live on success in kayaking, completing the to have this technique performed on in the many contributions he has made to prestigious Molokai Long Distance himself for his own shoulder surgery. medicine and anaesthesia, kayaking and World Surf Ski Championship in Hawaii A pioneer, but also humble, he simply surf lifesaving and most of all, his family. six times (more than any other New named this technique the Shoulder Block. Zealander), with a best placing of eighth Locally, we refer it more appropriately Dr Mark Chaddock in the world. as the “Darcy Block”. He lectured Dr Amitha Abeysekera Darcy also completed, and nearly worldwide and freely offered his expertise specialist anaesthetists, won, the team event of the Coast to Coast in workshop sessions. He also gave his North Shore Hospital challenge, an iconic multisport event time to teach in developing countries, based in the South Island of New Zealand. such as Nepal, where his relaxed, Of note was his extraordinary kayak on personable manner was invaluable in the Waimakariri river passing the entire maintaining team composure in stressful environments.

102 ANZCA Bulletin December 2018 103