Australian and New Zealand College of Anaesthetists Joint Faculty of Intensive Care Medicine Faculty of Pain Medicine

March 2009 The ANZCA Bulletin

EXCLUSIVE REPORT Australia’s looming anaesthetist shortage

2,287 shortfall

2008 2028 1427 20 28

Contents The ANZCA Bulletin Looming Victoria’s bushfi res Environment special The Australian and New Zealand College of anaesthetists The Alfred Hospital’s role in Anaesthesia and the Anaesthetists (ANZCA) is the professional medical body in Australia and New shortage the midst of Victoria’s worst environment – how big is your Zealand that conducts education, training ANZCA and ASA natural disaster. footprint and what can we do? and continuing professional development of anaesthetists, intensive care medicine workforce study. and pain medicine specialists. ANZCA represents more than 5000 Fellows and trainees across Australia and New Zealand 2 President’s message and serves the community by ensuring the highest standards of patient safety. 3 News Editorial 4 Awards Medical Editor Dr Michelle Mulligan 6 People and events Editor 8 Council reports Nigel Henham 12 Health Policy Sub-editor Liane Reynolds 12 – National health reforms Staff writer 13 – Maternity services report: ANZCA’s response Kate Saunders Design Features Pang & Haig Design 14 Workforce study: Australia’s looming anaesthetist shortage Submitting letters and material We encourage the submission of letters, 20 Victoria’s bushfi re crisis – medical response news and feature stories. We prefer letters 24 Profi le: Dr Judith Killen – living and working in rural New South Wales of no more than 500 words and they must indicate your full name and address and a 26 The cool side of medicine – Antarctica daytime telephone number. 28 Environment special feature Advertising inquiries To advertise in The ANZCA Bulletin please 28 – Doctors for the environment contact Marc Wilson, ANZCA advertising sales representative, on 0419 107 143 or 32 – How big is your footprint? email [email protected]. An 35 Operation Open Heart in Papua New Guinea advertising rate card can be found online at www.anzca.edu.au/news/bulletin Fellowship Affairs Contacts Head offi ce 38 CPD Program – your questions answered 630 St Kilda Road 40 The sceptics guide to mentoring Melbourne Victoria 3004 Telephone +61 3 9510 6299 42 FANZCA Module sign-off Facsimile +61 3 9510 6786 [email protected] 43 IMGS: International Medical Graduate Specialists www.anzca.edu.au 44 Pigs, anaesthesia and burns Joint Faculty of Intensive Care Medicine Telephone +61 3 9530 2862 47 Changes to Final Examination jfi [email protected] Faculty of Pain Medicine 51 The ANZCA Foundation Telephone +61 3 8517 5337 52 Trials group [email protected] Copyright 54 Quality and safety news Copyright © 2009 by the Australian and 57 – Report on third National Audit of the Royal College of Anaesthetists New Zealand College of Anaesthetists, all rights reserved. None of the contents of 57 – Malignant Hypothermia this publication may be reproduced, stored in a retrieval system or transmitted in 58 Library update any form, by any means without the prior 62 Regions written permission of the publisher. 70 Joint Faculty of Intensive Care Medicine Cover: Plenary session, Australian 74 Faculty of Pain Medicine and New Zealand College of Anaesthetists Annual Scientifi c 80 Obituaries Meeting, Sydney, 2008. 83 Professional Documents Photo: Jason Bull 86 Future Meetings

The ANZCA Bulletin March 2009 1 President’s message News

ANZCA responds to Health Practitioner National Health and Regulation Agency Hospitals Reform New Chief management Commission report Medical Offi cer committee appointed of workforce would be inaccurate. Having ANZCA believes it can play a leading ANZCA is responding to the interim report Distinguished cancer physician, Professor Michael Gorton, ANZCA’s solicitor, is learned from our experiences in conducting role working proactively in partnership that was released in February, ahead of the Jim Bishop AO, has been appointed one of fi ve committee members on the the study in Australia, ANZCA will be with governments to deliver the best fi nal report due in June this year. Many of Australia’s new Chief Medical Offi cer. management committee of the new proceeding with a similar survey in New surgical outcomes for the community. It is the key reform directions are consistent Professor Bishop is Professor of Cancer Australian Health Practitioner Regulation Zealand this year. important to stress that the College is not with recommendations from our original Medicine at the University of Sydney, is a Agency which will commence operation It is vitally important that ANZCA take a the gatekeeper of numbers of specialist submission. They include the separation Fellow of the Royal Australasian College in March 2009. The appointments were central role in assessing the future demand anaesthetists entering the profession. The of “planned” and “emergency” procedures of Physicians, and a Fellow of the Royal announced by the Australian Health for anaesthesia services and the number of College does not regulate the numbers of performed in public hospitals; the College of Pathologists in haematology. Workforce Ministerial Council on March 5. Dr Leona Wilson anaesthetists required to meet this demand. trainees in the system. That is determined acknowledgement of clinical training and He takes up his appointment after Easter. Other members of the management If we are not there, others will defi ne these by state departments of health / District the need for dedicated teaching time, committee include Peter Allen (Chair), In this Bulletin, we have a summary of the parameters for us. Critical issues such as Health Boards, which fund training and a greater emphasis on rural and ANZCA meets NZ Professor Genevieve Gray, Professor Australian anaesthesia workforce study the proper scope of services provided by positions in hospitals. In Australia, the regional services (see page 12). Health Minister Constantine Michael AO, and Associate “Supply and Demand for Anaesthesia anaesthetists, and the appropriate model College already trains more anaesthetists Professor Merrilyn Walton. Services” undertaken by Access Economics of care, will be defi ned by others who may than the Australian Medical Advisory WA criticises national ANZCA representatives including President, and commissioned jointly by ANZCA and miss out integral parts of our care such as Committee say we should but our position Dr Leona Wilson, Professor Alan Merry, and National Blood Supply the ASA. The study examines factors that pre-anaesthesia assessment. The negative has always been that if state health registration and New Zealand Councillor, Vanessa Beavis, met with the New Zealand Health Minister, Contingency Plan shape the supply of, and demand for, fl ow-on from such omissions could include departments create increased numbers of accreditation scheme anaesthesia services and identifi es gaps under-staffi ng of our public hospitals, training posts, we will provide the training. Tony Ryall recently. Matters discussed The National Blood Supply Contingency Western Australia has left the option open in service provision over the next 20 years. with consequent implications for trainees’ In New Zealand, we have trained more than included the need for a Perioperative Plan (NBSP) was released in November of pulling out of the proposed national While not underestimating the diffi culties supervision and education, patient safety, have been funded by the Clinical Training Mortality Review Committee, protected 2009. The Plan aims to improve awareness registration and accreditation scheme. involved in conducting such a study, this is and decreased funding for training positions. Agency. This study shows that the demand quality assurance activities status for and ensure appropriate planning is in Comments made by the Minister for Health, an excellent piece of work. With the information contained in the for anaesthesia services will continue to activities undertaken as part of the CPD place for dealing with the impact of blood Kim Hames, are signifi cant because it is The study was overseen by a joint workforce study, ANZCA will be able to take grow and that governments need to take program, and workforce issues (see crisis in the health sector. The Plan covers the fi rst time that a state signatory to the working group comprising Dr Richard a leading role in the development of public action now to address a projected shortage page 65). three levels of accountability: national, Council of Australian Government (COAG) Waldron, Dr Richard Grutzner, Dr Richard policy with regard to anaesthesia workload in 2028. operational and clinical. In this edition agreement has publicly expressed concerns Clarke, Professor Barry Baker, Dr Mike and workforce. We have various bodies in The College will periodically review Maternity services of the Bulletin, Professor Garry Phillips with the scheme. Dr Hames said unless the Richards, Mr Peter Lawrence, and Mr the two countries interested in workforce: our workforce requirements, modifying reviews the contingency plan (see page 52). government’s concerns over bureaucratic report Ian Collens. Dr Andrew Mulcahy also in Australia, these include the Medical assumptions in response to changing A copy of the plan can be downloaded via and political interference in training provided considerable input in refi ning Training Review Panel, and the Australian demographic and economic factors, as well Following the release of the Federal the National Blood Authority’s website – standards were addressed “we’ll have to and interpreting the Medicare and DVA Consumer and Competition Commission, as government policy. For example, the Government’s maternity services report http://www.nba.gov.au consider whether we want to be part of data, and his knowledge and expertise the Australian Medical Workforce demand for anaesthesia services may be after a review of maternity services, ANZCA the national system”. Dr Hames said that was greatly appreciated. I would also Committee; in New Zealand these include affected by technological advances, changes is preparing a further submission to Western Australia would put a compromise like to thank Mr Michael Douglass for his the Clinical Training Agency, District Health in income, or changes in government government to ensure it is appropriately proposal to a meeting of health ministers. assistance in putting the Workforce Boards New Zealand, and the Medical policy towards such items as waiting lists included in the Steering Group which is The proposal retains the Australian Medical Survey online. Training Board. or accessibility of services in rural areas. examining core competencies and the Council beyond the fi rst three years of Having practicing anaesthetists With recent increases in medical Supply can be affected by changes in the educational framework for maternity the scheme and the composition of state in the working group has meant that graduate places in universities in both age of retirement, pattern of work, and services. See “Maternity services report medical boards would be unchanged with inaccuracies and gaps in data provided countries, medical workforce has become a gender balance of the workforce. The model silent on analgesic and anaesthetic services, representatives fi lling the new national have been detected, estimates have been major focus of government. The (Australian) used in the study can be adapted to allow high-risk pregnancy and critical care” (see registration boards. arrived at where no data is available, and National Health and Hospitals Reform for these changed circumstances, allowing page 13). assumptions underlying the methodology Commission, for example, has developed us to identify the impact on workforce/ have been examined rigorously. key reform directions that contain implicit workload and to implement strategies to Governor-General Damning audit I am very grateful to the committee for workforce issues, such as: address these shortfalls. supports ANZCA report on NSW health their work and enthusiasm in producing • Ensuring timely access and safe care in This is an important body of work that this study which will be of considerable hospitals. This focuses on improving will underpin our forward planning, and is Foundation fi nances an example of some excellent collaboration benefi t to us in our interactions with our access to emergency care, (access to) Her Excellency Ms Quentin Bryce AC The NSW Auditor-General has given New between the College and the Societies governments and other stakeholders. I am elective procedures and treatment, and Governor General of the Commonwealth South Wales’ state health system a damning of Anaesthesia. also grateful to our Fellows and Trainees better hospital planning. of Australia has accepted the College’s report card: “They are not paying their bills who participated in the survey. While I • Working for us: a sustainable health invitation to become the Patron of the on time, they’re not managing their budgets Dr Leona Wilson recognise that we may all be suffering from workforce for the future. The challenges ANZCA Foundation. ANZCA Foundation properly, they didn’t get their annual ‘survey-itis’, there are some data that can identifi ed are health professional President Director, Ian Higgins, recently visited statements in on time and they are using only be provided by you. For example, shortages and unbalanced geographical Government House in Canberra to meet trust fund money for reasons that were without knowing current and anticipated distribution, predicted increased health with key staff to introduce the Foundation not intended”. future average hours worked per week per needs of the community and professional and to outline ANZCA’s plans to raise anaesthetist, our projections on the patterns boundaries. ongoing funds for medical research.

2 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 3 AWARDS Dr Frank Brigadier Pezzutti Professor Alan Merry Junius

On his election to ANZCA Council, In the 2009 Australia Day Honours List, Brigadier Pezzutti worked for four because of his interest and skills in quality Brigadier the Hon Brian Pezzutti CSC RFD years as Assistant Surgeon-General assurance, Alan was made the inaugural was awarded the Conspicuous Service Cross in the Army. In that role he worked to Chair of the (ANZCA) Quality and Safety ‘for outstanding achievement as a specialist improve Defence capability by improving Committee. As one of his fi rst actions as anaesthetist and advisor to the Defence recruitment of, and conditions of service Chair, he subsequently set up a tripartite Health Service Division’. for, specialist health offi cers in the committee with the New Zealand Society Brigadier Pezzutti has served with the Australian Defence Force. He was a member of Anaesthetists and the Australian Society Australian Defence Force as a specialist of the Legislative Council of NSW from 1988 of Anaesthetists to gather data required for anaesthetist in troubled regions around the to 2003 and was Parliamentary Secretary

improving the safety of anaesthesia care. / Sara Nixon © Newspix Photo world including Rwanda, Bougainville, Iraq, for Health from 1993 to 1995. He has been in This allowed ANZCA to further develop Fiji and East Timor on numerous occasions. anaesthetic practice in Lismore since 1976 Dr Frank Junius was awarded in the its focus on maintaining the quality of He has been a member of the Army Reserve and was Director of Intensive Care there Australia Day Honours List for service to anaesthesia care for patients in New since 1968. He also worked as a civilian from 1978 to 1988. medicine. Brigadier Pezzutti with an Iraqi child, his Zealand and Australia. volunteer as part of the Australian/NSW Dr Junius, an anaesthetist, devoted his father and a US army nurse in the US Military In New Zealand he is working with the Health surgical team in Banda Aceh after career to cardiopulmonary perfusion. He Hospital in Iraq in December 2005. ANZCA President, Dr Leona Wilson, the the earthquake and tsunami devastated recognised that this area of work involved Chair of the New Zealand National the area in 2005. high-risk procedures with possible serious Committee, Dr Vanessa Beavis, and Ministry complications, but also that it was largely of Health offi cials to establish a National neglected by practicing clinicians. Perioperative Mortality Review Committee. While working at St Vincent’s Hospital Professor Alan Merry was recognised in Alan’s interest in quality and safety has in Sydney during the 1970s, Dr Junius was the New Zealand 2009 New Year Honours. been recognised with his chairmanship very critical of how a potentially damaging Alan Merry was appointed as an Offi cer of of the World Federation of Societies of procedure was managed. As a result, he the New Zealand Order of Merit (ONZM). Anaesthetists Safety and Quality Assurance spent his career trying to advance the The award is in recognition for services to Committee. study of cardiopulmonary perfusion with medicine, in particular anaesthesia. In 2007, the then New Zealand Minister a particular emphasis on research and Alan has been a leader in anaesthesia of Health appointed Alan to the statutory practical clinical innovations. and medicine in New Zealand and the body, the National Quality Improvement Dr Junius’ investigations into the side world, especially in the area of quality Committee. effects of heart-lung machines found 30 to improvement of medical services. Alan has published widely, including 40 per cent of patients undergoing heart Alan was fi rst elected to the New Zealand a book written with Bill Runciman and surgery were suffering problems with National Committee of the Australian and Merrilyn Walton, ‘Safety and Ethics in their brain. These problems included poor New Zealand College of Anaesthetists Health Care: A Guide to Getting It Right’. (ANZCA) in 1990, and served for 12 years memory and concentration, depression, until 2002 on that committee. He was the irritability and personality change. Through Chair of the Committee from 1996 – 1999. his work, Dr Junius was able to optimise the He was then elected to the Council of parameters to virtually eradicate these ANZCA in 2005. side effects. One of the highlights of Alan’s service Dr Junius aimed to be present at all to ANZCA has been his leadership of the profusion procedures undertaken at the campaign to amend the law regarding the hospital, either as the principal operator or conviction for manslaughter of those who in the role of supervisor. With St Vincent’s owe a special duty of care, such as doctors. heavy cardiac surgery load, he was virtually His efforts meant that the standard for on call 24 hours a day. conviction in New Zealand came into line While setting high technical standards with that in other similar jurisdictions. In for the specialty, Dr Junius also established this campaign he led a pan professional an extensive clinical database to ensure group, and worked tirelessly to convince his patients received the best medical care. Members of Parliament and others of the He kept extensive personal notes on all of need for the law change. his patients, consisting of comprehensive preoperative and postoperative assessments and extended follow-up surveys aimed at detecting any long term problems. This information was carefully audited and used as the basis of innovative changes in his practice.

4 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 5 People & Obstetric Anaesthesia

Special Interest Group 1. Dr Michele Moore, Dr Vicky Volkova (and Events partner Craig behind), Dr Tim Parris- Conference Piper, Dr Julian Fuller, Dr Jenny Fabling and Dr Michaela Hamschmidt. SA/NT ANZCA and Combined TAS ANZCA/ASA Combined 2020 – A Vision of the 2. Dr Graham Sharpe, Wellington Hospital, NZ (left) and Prof Warwick Ngan Kee, SA/NT RANZCOG ANZCA/ASA Annual CME Committee of Future for Obstetric Prince of Wales Hospital, Hong Kong. joint event Scientifi c Meeting Queensland Anaesthesia 3. Dr Julian Fuller, North Shore Hospital, NZ.

1 1 1 1

2 2

2 3

Twelve registrars presented their Formal A joint ANZCA and Royal Australian and The combined ANZCA/ASA Annual 2 Projects at the 12th Annual Queensland New Zealand College of Obstetricians and Scientifi c Meeting in Hobart from February Registrars Meeting on February 28 at the Gynaecologists (RANZCOG) meeting was 20–22 attracted 65 registrants and was ANZCA Queensland offi ce, with a diverse held in Adelaide on Saturday, February sponsored by 11 trade companies. The range of subjects being covered. The state’s 28, 2009. The topic was ‘The Role of meeting commenced with a registrars workshop conducted by Mary Lawson hospitals were well represented with Critical Care in Contemporary Obstetrics & Blenheim, New Zealand from our obstetric colleagues via Dean (Director of Education, ANZCA), and was presenters travelling from as far as Cairns Gynaecology – Is It Really Critical?’. 15–17 October Maharaj and a midwifery view from Robyn followed by welcome drinks at Hadleys and Rockhampton. Critical care is an embracing term for Maude were also greatly appreciated. It was Hotel on Friday evening. The venue was Three prizes were awarded: the Tess The Obstetric Anaesthesia SIG satellite intensive care, high dependency care and also the offi cial launch of what is hoped to particularly auspicious as this was the 75th Cramond Prize of $500, The Axxon Health meeting of the 2008 ASA/NZSA Combined emergency care and its application to be the ongoing development of the web- birthday of the ASA and its fi rst meeting Prize of $350, this year named in honour Scientifi c Congress was held on October obstetric and gynaecological care is rapidly based clinical practice evidence base. was held at Hadleys. of Dr Diana Khursandi, and a new prize 15–17 2008. Following the success of the developing worldwide to counter the Slides from the presentations are The weekend sessions addressed the offered by the ASA, the ‘ASA Chairman’s 2004 meeting, the meeting returned to continuing morbidity and mortality available on the ANZCA website via the theme of the meeting ‘What’s Up Doc – Choice’ prize of $500. This was the last the striking backdrop of the Blenheim of women. 3 Obstetric SIG webpage. Anaesthetic implications of new techniques offi cial engagement for Dr Tess Cramond countryside, at Montana Brancott Winery, This joint meeting of obstetricians I would like to thank all speakers for and procedures’. Topics included bariatric who retired on 1 March. It was a timely and Marlborough, New Zealand. and gynaecologists, anaesthetists and donating their time and expertise to make surgery, cardiology update, endovascular signifi cant event in what has been a long With 150 delegates in attendance, a wide intensivists with visiting and local speakers this meeting a great success and the health surgery update and gastrointestional and outstanding career. array of local and international speakers served to reinforce the required nexus care industry for their generous support. between the two specialities to effectively developments and were delivered by 1. Dr Matthew Bryant, Dr Michael Steyn, including Steve Yentis, Michael Paech and implement critical care. The day was well anaesthetists, surgeons, and physicians. Warwick Ngan Kee gave presentations on Dr Di Khursandi, Dr Tess Cramond and Dr Scott Simmons supported by Fellows and trainees from Mary Lawson also hosted a concurrent Dr Chris Bryant. evidenced based medicine and clinical Convenor both colleges and was oversubscribed. clinical teaching workshop. 2. Dr Paul Suter, Dr David McCormack, audit and the likely developments in Guest speakers, ANZCA President Dr Dr John Archdeacon, Dr Mark Gibbs and clinical practice in the decade to come. 1. Professor John Svigos, Leona Wilson and ASA President Dr Liz Dr Matthew Bryant. There was also a broad coverage on the Dr Scott Simmons and Dr Kym Osborn. Feeney, addressed the Annual General 1. Dr Agata Ancypa and Dr Mimi Darcey. future of training and simulation and 2. Dr Paul Herreen and Sue Imgraben. Meeting on Saturday afternoon. 2. Dr Gabe Shuster, Dr Emily Lee and Dr communication skills from Allan Cyna, Wendy Falloon. Alicia Dennis, Suyin Tan and Lara Hopley 3. Dr Deborah Wilson, Dr Mark Reeves as well as a perspective on Asia-Pacifi c and Dr Christopher Wilde. practice from Stephen Gatt. Contributions

6 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 7 ANZCA Council Meeting report

February 2009 Quality and Safety Fellowship Affairs Workplace Based Assessment Subcommittee Australian and New Zealand College of Council approved a new application fee Q&S Editorial Advisory Body (EAB) Annual Scientifi c Meeting as ex-offi cio members. Perfusionists (ANZCP) of $1000 to cover the associated Report following the Council Meeting The Quality and Safety Committee established Council supported the initiative that each Regulation 16 – Trainee Committee The ANZCP has advised of recent revisions administrative costs. of the Australian and New Zealand a communications and liaison portfolio, member of the ASM Regional Organising to the Constitution of the Australasian College of Anaesthetists held on This Regulation was amended as a result chaired by Dr Patricia Mackay. The initial Committee be awarded an ASM Certifi cate Board of Cardiovascular Perfusionists, and Dr Leona Wilson 28 February 2009. of deliberations by the Trainee Committee. activity involved the provision of a special in recognition of their contribution to the that as a result, ANZCA is no longer required President The revisions were designed to emphasise to appoint two anaesthetists to serve on the Death of Fellows section of the Bulletin devoted to safety and meeting. The certifi cates will be presented by the relationship between the ANZCA Board. Drs Paul Forrest and Andrew Stewart A/Prof Kate Leslie Council noted with regret the death of the quality issues. It was always recognised the President at the College Dinner. Trainee Committee and the Regional/ were long-standing College representatives Vice-President following Fellows: that with the development of the College New Fellows’ Conference National Trainee Committees, while on the ABCP, and have been thanked for website, this would be an important medium This year’s NFC will be held at Thala Beach Dr Lim Say Wan (Malaysia), FFARACS 1974, strengthening the communication between their input over the years by the President. FANZCA 1992 for such communication. In addition, the Resort, Port Douglas from 29 April to 1 May. these committees. The updated Regulation College has developed a regular e-newsletter Council ratifi ed ANZCA nominations to attend appears on the College website. National Registration and Accreditation Dr Brian Donald McKie (VIC), FFARACS 1968, to Fellows and trainees. As a result of these the Conference as follows: Scheme (NRAS) for Australia Professional FANZCA 1992 developments, Council has approved the Dr David Bramley, Vic The College has provided a submission Professional Documents on arrangements for specialist registration Dr Carlos Parsloe (Brazil), Honorary Fellow, establishment of an informal editorial Dr Alexandra Douglas, Qld Withdrawal of PS48 – Statement on within the NRAS, highlighting the FFARACS 1989, FANZCA 1992 advisory group to provide advice on all Q&S issues to be published via all three mediums. Dr Bruce Hammonds, Qld Clinical Principles for Procedural Sedation following points: Dr Nalin Rohitha Wijeyesekera (NZ), FFARACS In conjunction with the Director of Dr Tomoko Hara, NZ PS48 was promulgated in February • Support for a national registration 1984, FANZCA 1992 Communications, the EAB will review all Dr Mohua Jain, NZ 2003 and was due for review in 2008. scheme for the health professions. Honours and Awards Q&S issues for the Bulletin, website and Dr Kwok Yee Patricia Kam, HK On review, it was considered that PS48 • Support for a separate specialist register. e-newsletter, and will determine the type of is less defi nitive than the new PS9 – Prof Alan Merry (NZ) was awarded the Dr Irina Kurowski, WA • Entry to that specialist register being information and priorities for each medium Guidelines on Sedation and/or Analgesia New Zealand Order of Merit (ONZM) in the limited to practitioners with specialist Dr Irene Ng, Vic for Diagnostic and Interventional Medical New Year’s Honours List in recognition to avoid unnecessary duplication. qualifi cations on advice from the Dr Timothy Porter, SA/NT or Surgical Procedures, has no evidence- of services to medicine, in particular relevant accreditation body. For medical World Health Organisation – based references, and does not adequately anaesthesia. Dr Tanya Selak, NSW practitioners, this is the AMC acting on Safe Surgery Checklist address many sedation issues such as Dr Alice Summons, NSW the advice for the Medical Colleges. Dr Frank Junius was awarded the Medal of ‘Safe Surgery Saves Lives’ is part of the staffi ng, monitoring, medication, training the Order of Australia (OAM) in the Australia Second Global Challenge for Patient Safety Dr Michael Thumm, SA/NT and accreditation. There are also some • Support for independence of any Day Honours List. This award recognises his of the World Health Organisation. One of Dr Andrew Watson, ACT contradictions generated because of these accreditation processes. the initiatives resulting from this project led service to medicine over a long period of time, Dr Diana Webster, Qld differences between PS9 and PS48. • Support for a name change from and in particular cardiopulmonary perfusion. to the development of a three-phase WHO As a result, Council agreed to ‘continuing competence’ to ‘continuing Dr Sarah Wyatt, WA checklist (the Checklist) for use before the withdraw PS48. professional development’. Dr Brian Pezzutti (NSW) was awarded the induction of anaesthesia (sign in), before Dr Genevieve Goulding has been appointed • Concerns about the proposed powers of Conspicuous Service Cross (CSC RFD) in Process for review of the surgical incision (time out) and at the Councillor in Residence to the Conference. the Ministerial Council. ANZCA considers the Australia Day Honours List for Professional Documents end of the procedure (sign out). Following It has been agreed that the New Fellow that Government should set legislation, outstanding achievement as a specialist A draft process for the review of College the evaluation of a study comparing 4000 Councillor will attend the NFC in addition to and independent statutory bodies should anaesthetist and advisor to the Defence Professional Documents was supported patients undergoing surgery over eight sites the Councillor in Residence. be responsible for its implementation. Health Service Division. around the world prior to the introduction of by Council and is to be circulated to the Internal Affairs Regional/National Committees for input. International Medical A number of Fellows have been recognised the Checklist with those in 4000 patients after its introduction, mortality and morbidity were Resignation from Council Graduate Specialists by the New Zealand Society of Anaesthetists Australian Day Surgery Council substantially and signifi cantly reduced. Dr Margaret Cowling has tendered her The IMGS Assessment Process was with the award of Life Membership: Council has now formally ratifi ed the In an effort to encourage wide adoption resignation from Council, effective from introduced, and Regulation 23 updated Drs Bob Boas, Mack Holmes and Hugh revised ADSC Charter and will meet the of the Checklist, ANZCA, in conjunction 1 May. Dr Cowling’s contributions to Council from 1 January 2009 for the assessment of Spencer. Immediate Past President of ANZCA, funding request of $1500 for 2009. with RACS, will develop and promulgate since her election in 2004 were recognised IMGS via the AMC process. Some Partially Dr Walter Thompson, was awarded Honorary ANZCA is currently represented on the a suitably modifi ed version as a College by the President. Comparable applicants have sought to have Life Membership of the Society. ADSC by Dr Anthony Bergin. The revised their pre-2009 requirements ‘reconsidered’ Professional Document, indicating those Regulations Charter provides for ANZCA and the ASA under the new rules. Dr Michelle Mulligan was admitted to elements they consider essential in Regulation 2.7 – Education and to have two representatives each, and the Following receipt of legal advice, it has Fellowship of the Australian Institute of Australia and New Zealand. In addition, Training Committee College and Society will confer about the been clarifi ed that applicants assessed Company Directors (FAICD). the College has agreed to work with RACS This Regulation was amended to include nomination of further representatives to under the pre-2009 Regulations may towards establishing the universal adoption the Chair of Examinations and the Chairs Election of President the ADSC. not be ‘reconsidered’ under Regulation Dr Leona Wilson has been elected President of the Checklist in Australia and New of the Primary Examination Subcommittee, 30 – Reconsideration and Review, but for a second term to May 2010. Zealand, with support and input from the the Final Examination Subcommittee, rather, should be invited to submit a new ASA and NZSA. the Assessments Subcommittee and the application. As a result of this advice,

8 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 9 ANZCA Council Meeting report 2

December 2008 developing a series of online materials for appropriately and registration brochures will Internal Affairs to Professor Michael Cousins (NSW) in delivery via the ANZCA website. The rationale be circulated early in the new year. New Zealand Resuscitation Council recognition of his outstanding contributions Report following the Council Meeting behind the project is that rural trainees Dr Malcolm Stuart has been nominated as over many years to anaesthesia and pain of the Australian and New Zealand Continuing Professional Development may not have access to the range of training ANZCA representative to the New Zealand medicine research, to clinical practice in College of Anaesthetists held on Mandation of CPD Program activities and resources that may be available Resuscitation Council. pain medicine, the establishment of the 13 December 2008 in metropolitan settings. To this end, an Information is being provided to Fellows via Faculty of Pain Medicine, to the College as the Bulletin, website and letter reminding Regulation 6 – Admission to Fellowship Death of Fellow Online Learning Working Group has an examiner and Committee member, and them of Council’s decision in October 2007 of the College Council noted with regret the death of the been established. as President from 2004 to 2006. to mandate participation in a ‘formal CPD Council suspended parts of Regulation following Fellows: Dr Ray Hader Trainee Award program’ effective from January 2009. 6.3.1 (Election to Fellowship) in February The Medal will be presented to Professor Dr John Martin Rutherford Bruner FFARACS for Compassion 2008, pending review and formalisation Cousins by the President at the Annual 1985, FANZCA 1992. This award was established to recognise International Medical Graduate Scientifi c Meeting in Cairns in 2009. Specialists (IMGS) of the IMGS Assessment Process. As the Dr Russell Geoffrey Cole (Vic), FFARACS 1956, Trainees or Fellows within three years of new process has now been approved An attachment on ‘Regulation 6 – IMGS Assessment Process FANZCA 1992. admission to Fellowship by Examination who for commencement on 1 January 2009, Admission to Fellowship of the College’ can In April 2006, Council resolved that Specialist have made a signifi cant contribution to the appropriate changes to the Regulations be found at www.anzca.edu.au in the News Dr John B McCarthy (Qld) FFARACS 1984, Anaesthetists with Fellowship of the RCoA welfare of an individual, a group or a system governing Election and Admission to section under Council Reports. FANZCA 1992, FJFICM 2002. or CARCSI by training and examination with that promotes welfare and compassion. The Fellowship have been approved and appear CCT, recency of practice and participation Honours and Awards award of $2000 per annum for fi ve years has on the College website. Dr Leona Wilson Dr Phoebe Mainland has been awarded been donated by Dr Brandon Carp. in CPD, after six months in Australia or New President Fellowship of the Australian College of Legal Zealand would be granted recommendation Research The inaugural award was made to Dr Amanda Medicine (FACLM). ANZCA CEO, Dr Mike for specialist recognition. After a further six Lennard Travers and Douglas Young (Vic), and was presented to her by A/Prof Kate Leslie Richards, recently gained Fellowship of the months’ practice in Australia or New Zealand Joseph Professorships – Deadline for Dr Carp at a function hosted by the President Vice-President Australian Institute of Management (FAIM). together with a pass in the Final Examination Applications at ANZCA House on 12th December. or the OTS Performance Assessment, they To bring the timing of the Lennard Travers Education and Training Finance were eligible to apply for FANZCA. and Douglas Joseph Professorships into line Clinical Teaching Workshops Annual Subscription and Fees for 2009 The OTS Committee was given until December with other research awards, the submission Council supported the concept of expanding Council approved the 2009 budget and 2008 to recommend a new process for IMGS, date for each has been amended from the provision of CTC workshops to include the following fees were set for the coming based on AMC requirements, taking into 1 March to 1 April. The Regulations Malaysia and Singapore. As a result, face- year. The table of fees can be found at account New Zealand requirements, and pertaining to these Professorships have to-face workshops have been budgeted to be guided by initial documents prepared by Prof been amended accordingly. convened in these regions in 2009. www.anzca.edu.au in the News section under Teik Oh. As a result, the following resolutions Council Reports. New Programs Committee Curriculum Review and Development were passed by Council: Establishment of Regulation 2.17 – Royal Hobart Diving and Hyperbaric At the fi rst meeting of the Curriculum Review 1. That the criteria for Advanced Standing Investment Committee Medicine Unit Working Group (CRWG) held in August, it was towards Substantial Comparability, As the Investment Committee reports This unit has been accredited for training agreed to adopt the CanMEDS framework Partially Comparable and Non- regularly to Council with updates on the towards the ANZCA Certifi cate in Diving and for the revision of the training curriculum. Comparable IMGS be accepted. performance of the Investment Portfolio, it Hyperbaric Medicine for a further period of Invitations have been sent to key stakeholders 2.That the “Workplace Based Assessment” to provide input to the review process. has been agreed to formalise its functions fi ve years. in the College Regulations with the process and form be accepted. Christchurch Hyperbaric Medicine Unit Formal Project Offi cers promulgation of Regulation 2.17. 3. That those UK and Irish Fellows Following review in February, it has been The requirement for increased support to recommended for Specialist Recognition Membership of the Committee includes the confi rmed that the Hyperbaric Medicine Formal Project Offi cers (FPOs) has been between April 2006 and December 2008 raised, along with issues such as the need President, the Honorary Treasurer, the CEO be advised that in order to be eligible to Unit at Christchurch Hospital is accredited for standardisation of project submissions, and the Director of Finance. In addition, apply for Fellowship, they must either for training towards the ANZCA Certifi cate assessment between the regions, and Council may co-opt members who have high pass an examination, or undergo a in Diving and Hyperbaric Medicine for six development of quality assurance processes. levels of fi nancial literacy and are not Fellows Workplace Based Assessment. months of the 12 months required in an As a result, it has been agreed that the of the College. The Committee is responsible ANZCA-approved unit. for developing and reviewing investment 4. That those OTS previously assessed as Deputy Chair of the Education and Training Partially Comparable be advised of the College Award Committee will conduct regular meetings with strategies regarding the Investment Portfolio new IMGS process. Orton Medal the FPOs. This arrangement will be reviewed for approval by Council, and reviewing and 5. That the new IMGS process be The Orton Medal was established in 1967 by at the time of implementation of the outcomes reporting to Council on the performance of implemented from 1 January 2009 and the Faculty of Anaesthetists, RACS and is of the current curriculum review process. the Investment Portfolio. evaluated once fully implemented for the highest award the College can bestow Final Examination Lecture Series Fellowship Affairs two years. on one of its Fellows, the sole criterion This initiative is aimed at meeting the needs Annual Scientifi c Meeting – Cairns 2009 being distinguished service to Anaesthesia. of advanced trainees in rural settings by Organisation of the ASM is progressing Council has awarded an Orton Medal

10 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 11 HEALTH POLICY HEALTH POLICY ANZCA responds to National Maternity services report silent Health and Hospitals Reform on analgesic and anaesthetic Commission (NHHRC) services, high-risk pregnancy and critical care Interim Report Mike Paech

The NHHRC recently released its interim to explore the demand/supply and that the separation of the costs of In the previous issue of the ANZCA received little or no attention. The important report after more than 500 submissions suitable models for locum support for training from service provision is not Bulletin (December 2008) key points made role of the anaesthetist, chronic pain Maternity services and countless consultations across the GP anaesthetists, which should also be an exact science. Also, another layer of in ANZCA’s submission to the federal management services, multi-disciplinary country. ANZCA contributed a 35-page extended to other health professionals bureaucracy would need to be funded Government’s Maternity Services Review team training to optimise safety standards, report submission to the Commission with a list including specialists. We also are running at taxpayer’s expense. Discussion Paper were highlighted. The and the issues related to public hospitals The Federal Government’s Maternity of 22 recommendations covering the health another project funded by the Rural report of the Maternity Services in Australia delivering maternity services, all failed to Services report was released on service system, education and training Advanced Specialist Trainee Scheme Review has recently been released and receive mention. February 21. The report followed National Health and Hospitals in relation to the health workforce, and from DoHA which is looking at improved presumably establishes a blueprint for The Report made repeated mention of a review led by Chief Nurse and Reform Commission – Interim rural health. The fi nal report is due for distance education facilities through use possible reforms and priorities in the the need to support procedural rural GP Midwifery Offi cer Rosemary Bryant. Report – Key points development of a national maternity anaesthetists, but was silent about rural completion by the end of June 2009. of the web and video conferencing. ANZCA The report focuses on the need to services plan. So does the report address specialist anaesthetists. In relation to ANZCA congratulates the NHHRC also actively supports the Support Scheme • Acknowledgement of access to improve the choices available to any of the key points made by the College? the pressure on the maternity workforce on the interim report that outlines a for Rural Specialists. universal health care pregnant women, access to high quality Many people will have seen media and the need to attract and retain health comprehensive suite of mainly sensible Strengthening the governance of • Establishing a national health maternity services, and support for comment on the report, which focused on professionals, specialist anaesthetists were reform directions. ANZCA is preparing a health and health care promotion and prevention agency to the maternity services workforce. recommendations to expand choice and the not mentioned. For those anaesthetists follow up submission. As discussed in our original submission, improve community health and The review received more than 900 availability of models of maternity care, with involved in maternity services, one Ensuring timely access and safe care ANZCA is concerned about the well-being submissions. an expanded role for midwives. Pleasingly, recommendation that may affect you in hospitals fragmentation of health care and the need • Safe and timely access to hospitals three important components of the ANZCA is the responsibility of ‘professional Summary of fi ndings and In our earlier submission we recommended for a better-integrated and coordinated • Universal dental care (Denticare submission in relation to quality and safety bodies’ to ensure that all staff involved in recommendations special arrangements for emergency surgery system. Our preference is for Option A Australia) of care appear to have been well supported delivery maternity services receive cultural • Australia remains one of the safest to improve patient throughput and safety in the interim report – continued shared by the report. awareness training. countries in the world in which to and prevent “bed-block” of inpatient beds. responsibility between governments, • Commonwealth assuming First, there are recommendations While no-one would dispute the value of give birth It is pleasing to see acknowledgement of with clearer accountability and more responsibility for all primary health to develop national cross-professional a recommendation to improve information this serious issue and the recommendation direct Commonwealth involvement. This care policy and funding • In 2006, 277,436 women gave birth best practice guidelines to support available to Australian women (an area in that consideration be given to separate proposal is less ambitious and therefore to 282,169 babies in Australia – the • Reshaping hospital roles (greater multidisciplinary care and to improve which Fellows are also active), a key remit “planned” procedures from “emergency” less disruptive than the other two and highest number of births since 1971 delineation such as separating national data collection and targeted of the report was to consider quality and procedures by ensuring dedicated much more realistic as it streamlines • Over 60 per cent of births take place planned and emergency services) research. The Obstetric Anaesthesia Special safety. From my perspective, the report is planned procedure units are established in public hospitals accountabilities under the umbrella of a and refl ecting this in the use of Interest Group scientifi c evidence guidelines striking for the total absence of reference to as separate facilities. This also has the • Improving choice for Australian national health strategy. It retains both local activity-based funding for private and now available on the ANZCA website are analgesic and anaesthetic services, high-risk added advantage, if properly planned, of women by supporting an expanded state/territory and national federal control, public hospitals an example of a suitable resource that pregnancy, tertiary and critical care services. improving clinical training and supervision. role for midwives allowing the states/territories to retain • Establishment of Comprehensive we have already developed. Second, as a This seems a serious omission. The report We concur with the need for greater support local level control which is usually their Primary Health Care Centres member of the National Advisory Committee acknowledged the excellent safety record of • Consideration of the expansion of for teaching. However, we do have concerns overwhelming preference. on Maternal Mortality, representing the obstetric care in Australia and the fact that access to Medicare and the PBS for about centralising all clinical placements at • Prioritising and investing in sub- Working for us: a sustainable health College, I have been acutely aware of the 85% of the population is delivered in public midwives – but only if accompanied a national level. acute services workforce for the future current defi ciencies in state-based mortality and hospitals and by private obstetricians, by stringent professional • National Access Guarantees and Delivering better health outcomes for ANZCA favours a team-based approach reporting and the need to introduce with the current caesarean section rate requirements for midwives Targets for hospitals remote and rural communities to care. Anaesthetists have been at the national serious morbidity reporting in (more than 30%), not surprisingly, receiving • Consideration of support for ANZCA endorses the directions for rural forefront in utilising nurses as assistants • Remote and rural health – equitable some form. It is therefore most welcome to some attention. Perhaps we can assume professional indemnity insurance and remote health, in particular improved as part of the anaesthesia health care and fl exible funding, innovative see a recommendation that the Australian that obstetric anaesthetic services are so for midwives access to care, including specialist health team. There may be roles, and reference workforce models (including government, in consultation with states good that they do not need to be changed or • The development of new national care that is often hard to reach by these is made to the scarcity of workers in rural allowing appropriately trained nurse and territories, implement arrangements improved? The College was represented at a cross-professional guidelines communities. ANZCA has direct experience and regional areas, which anesthetists feel practitioners and other registered for comprehensive national data collection, round table forum on this topic, but it is not to support collaborative through its Fellows of the diffi culties faced are appropriate for delegation to others. health professionals to order monitoring and review of maternal and clear to me whether the discussions there multidisciplinary care in line with by these communities and supports calls However, the composition of any team, and diagnostic tests and make specialist perinatal morbidity and mortality. Third, a will have any impact on the fi nal national best practice referrals covered by Medicare for improvement to distance learning their specifi c roles, should be applicable recommendation to support collaborative plan. It remains important that ANZCA • Consideration of the establishment opportunities and continuous professional to the Australian context, especially with • New educational framework care, especially in rural and remote areas continues to participate in the process of a single integrated pregnancy- development for practitioners. These are of consideration of workforce projections consisting of a competency-based (where maternal mortality is higher), of developing this plan, and that we as a related telephone support line direct relevance to anaesthesia trainees as for all healthcare workers, and must be of including targeting retention of GP profession do not remain a highly effective approach • Improved data collection and well as specialist anaesthetists who need proven benefi t. The current pilots in Victoria anaesthetists, also fi ts well with ANZCA’s but inadequately acknowledged health care • National Indigenous Health Authority analysis, and further research to access educational support, as well as and Queensland on nurse clinicians and policy of enhanced specialist back-up and provider. locum relief. physician assistants will provide valuable • National registration of increased education and training for all • Providing increased support for the To demonstrate its commitment ANZCA guidance on some of these alternative roles. health professions local rural anaesthetists. Many Fellows are Professor Mike Paech maternity workforce, particularly in rural Australia has recently been directly involved in a The establishment of a National Clinical • Three options for governance already involved in such initiatives and this King Edward Memorial Hospital for • National Maternity Services Plan to feasibility project funded by the Department Education and Training Agency while role may expand in future. Women, Perth of Health and Ageing (DoHA) and led by perhaps superfi cially attractive is not Nevertheless, a number of the be developed the Australian Society of Anaesthetists proven in practice. A key consideration is suggestions made in the ANZCA submission

12 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 13 SPECIAL FEATURE

Australia’s looming anaesthetist ‘In the base case, the projections suggest a Key fi ndings shortage: ANZCA and ASA combined widening gap between demand and supply, workforce study rising from a very small shortage of four FTE There are considerable problems With the issue of medical workforce a major focus for government and policy makers, Australia and New Zealand’s anaesthetists in 2008 to in Utilisation in 2006-07 medical colleges have a central role to play in ensuring the community has a well-trained highly skilled workforce undertaking medical workforce studies, Existing data sources indicated that close 2287 in 2028.’ in particular accessing robust, up-to-date to 5.5 million anaesthesia services were available into the future. Rather than leave this important work to others, ANZCA and the Australian Society of and consistent data on which to build provided to Australians within a twelve- Anaesthetists decided to commission an independent workforce study on the likely future demand and supply for projections. month period in 2006–07. The bulk of these Australian anaesthesia services which will continue to underpin modern surgery. Access Economics developed a model services were provided under Medicare split into two modules: and to public in-patients. Some 450,000 services were provided to Department of This feature contains the key results ‘The results also — a demand module, refl ecting the use of for examination. The ANZCA Final the Australian workforce’s characteristics. anaesthesia services and Veterans Affairs (DVA) patients, as well as of the fi rst joint ANZCA/ASA Australian Examination to be held early this year has In addition, Access Economics were also indicated a signifi cant for intensive care, pain management and — a supply module refl ecting the capacity Workforce study “Supply and Demand a record 220 candidates presenting. This is asked to develop a model that could be used hyperbaric services. These are conservative maldistribution of FTE of the workforce to provide anaesthesia for Anaesthesia Services”. The study was the fi rst of two such exams which will be to conduct future surveys in Australia and estimates as the services provided to public services. undertaken by Access Economics who not held this year. New Zealand. anaesthetists between in-patients are likely to be understated only assessed the numbers of anaesthetists, What is the ideal number of anaesthetists I would encourage all Fellows and urban and rural areas. The latter was informed by a survey of owing to data limitations. and their participation, in the workforce to meet the demand for anaesthesia Trainees of ANZCA and members of the anaesthetists conducted in October 2007. Converting the number of anaesthesia (i.e., the supply side of the workforce), but services? Early attempts looked at the ASA to take the opportunity to read the They revealed a current In addition, a Working Group of ANZCA and services used to hours, around fi ve million also the demand for anaesthesia services. Specialist Anaesthetist to Population ratio summary report which is available on the shortage in rural areas ASA members provided guidance on the hours would be required – an average of Access Economics were also asked to make (SPR). In 1995, the SPR was about 1:10,000. ANZCA website. Although there were many project. 55 minutes per service. Dividing by clinical 20-year projections (to 2028) regarding By way of comparison, Canada in 1996 had diffi culties in gathering accurate data, and and an oversupply in The methodology involved four stages hours per FTE (1176 hours per year) suggests probable future trends, based on current an SPR 1:13,583. However, according to the several key assumptions had to be made (Box 1). that in 2006-07 there was a requirement for modelling. 2004 Medical Workforce Survey of Victoria, based on the experience and knowledge urban areas.’ 4286 FTE anaesthetists. Anaesthetists in Australia are only there were 17 Specialist Anaesthetists per of Working Group’s members and scanty Box 1 Methodology too aware of statements made about the 100,000 population or a SPR of 1:5,882 information, the report nonetheless clearly Demand Projections adequacy of numbers of anaesthetists. (note that AMWAC 2001 stated that South identifi es the disparate growth in demand Stage 1: Demand projections of Demand projections of anaesthetists, Some reports in the media often refer to Australia had the highest SPR of 1:7,290 and supply of anaesthesia services over the anaesthesia services based on: age including a split by urban and rural the lack of anaesthetists in the Australian and the Northern Territory has lowest at next 20 years, and makes use of various ‘By 2028 shortages, and gender of population, region, prices areas, are presented in Table 1. The urban workforce and cite this scarcity as one 1:20,470). scenarios to identify potential strategies under the base case of services infl uenced by public/private population share used in the study was reason for the lengthy surgical waiting lists. The above data is obviously incomplete. and will be of considerable use in future split, bulk billing rates, private health based on 2006 census data and Access Since the mid-1990s, ANZCA has been The ANZCA data only contains information workforce planning. scenario, are predicted insurance and rebate levels, patients’ Economics’ estimates, and held constant surveying its Fellows regarding workforce about Fellows of ANZCA. Other providers in both urban and income and technology and for the projected timeframe. The number participation on a roughly triennial basis. of anaesthesia not included in the ANZCA References patient expectations. of FTE anaesthetists required was forecast The information gathered from these fi gures include some members of the ASA, 1. “The Specialist Anaesthesia Workforce in rural areas. The to nearly double from 4437 to 8599 in the Stage 2: Supply projections of full-time surveys has been used by ANZCA to respond GP Anaesthetists, some International Australia – An Update: 2001-2011” AMWAC 20 years to 2028, representing an average equivalent (FTE) anaesthetists based to enquiries from various government Medical Graduate Specialists (IMGS), and Report 2001.5 (September 2001). This projected workforce of increase of 208 FTEs per annum. Nearly on: age and gender of the workforce, bodies, particularly the Medical Training doctors working in Area of Need (AON) document can be downloaded from http:// half of the expected increase in demand anaesthetists in 2028 average hours worked, number of Review Panel (MTRP), the Australian locations. Similarly, the Australian Institute www.health.nsw.gov.au/amwac/amwac/pdf/ can be attributed to demographic change, anaesthesia20015.pdf new trainees entering the workforce, Medical Council (AMC) and most notably of Health & Welfare (AIHW) has incomplete should reach 6312 FTEs, including ageing of the population. remuneration, net overseas migration, the two Australian Medical Workforce data as their information relies on a re- 2. “Medical Workforce Survey of Victoria The balance can be largely attributed 2000-2004” published by the Victorian compared to a demand retirements/deaths, temporary Advisory Committee (AMWAC) review registration census-type process. to rising incomes and raised Government Department of Human Services movements in and out of the workforce, reports of 1996 and 2001. Thus, international medical graduates for 8599 FTEs – a total community expectations. 2006. This document can be downloaded from substitution between specialist The 2001 AMWAC report noted that there who work for less than 12 months are not The base case results refl ect a number of www.health.vic.gov.au/workforce/medical.htm. potential gap of 2287 anaesthetists and other service were 369 specialist anaesthesia training captured. Also, they do not necessarily assumptions (e.g., no net effect on demand 3. “Medical Labour Force 2003” National Health providers, and employment status (e.g., from advances in medical technology, a positions in 1995. It identifi ed the need for catch all GP anaesthetists in their data. Labour Force Series (Number 32) published FTE anaesthetists.’ major settings including public/private). 1 512 trainees by 2003 in order to maintain With the above in mind, a joint working by the Australian Institute of Health and public patient complexity factor of 1.3 , 2 adequate numbers of anaesthetists in the group was established between ANZCA and Welfare (Canberra) 2005. This document Stage 3: Gap analysis involving a income elasticity of demand of 1 and 80 per workforce (on the assumption of a 2.1% the ASA co-chaired by myself and can be downloaded from www.aihw.gov.au/ comparison of the demand and supply cent of clinical time captured by Medicare growth in demand for anaesthesia services). Dr Richard Grutzner. The Workforce labourforce/medical.cfm. projections of FTE anaesthetists for the data). Alternative scenarios were also In 2003, the Australian Institute of Working Group also comprised both ANZCA 4. Baker, AB (1997), Anaesthesia workforce in period 2008-28. Gap estimates were also modelled and found to be most sensitive to Health & Welfare (AIHW) Medical Labour and ASA Presidents and CEOs, Professor AB Australia and New Zealand, Anaesthesia and made for urban and regional areas to the assumptions regarding income elasticity Force Survey 2003 revealed that there were Baker and Mr Ian Collens, ANZCA Director Intensive Care, 25 (10): 60-7 identify any geographic imbalances in of demand and technological change. 763 anaesthesia trainees that year with a of Strategy & Operations. Dr Andrew service provision. 1. The public patient complexity factor was applied to Medicare T10 data to allow for the greater time further 67 trainees classifi ed as intensive Mulcahy also provided considerable input Dr Richard Waldron Stage 4: Scenario analysis care trainees. This was 50% more than in refi ning and interpreting the Medicare of various associated with the more complex care generally Co-Chair, Combined ANZCA/ASA Workforce policy options to remedy imbalances. required of public patients. recommended by the AMWAC report of and DVA data. It was agreed that a joint Working Group 2. The income elasticity of demand measures the relative 2001. ANZCA is currently experiencing survey (distributed in October 2007) should responsiveness of demand (in this case for anaesthesia signifi cant growth in candidates presenting be undertaken to provide a “snapshot” of services) to a change in consumer income.

14 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 15 SPECIAL FEATURE: AUSTRALIA’S LOOMING ANAESTHETIST SHORTAGE Key fi ndings Continued

Table 1 Demand Projections for FTE Table 2 Base Case Projections of Supply (FTEs) Table 3 Alternative Supply Scenarios The results are also sensitive to the assumption regarding technological Anaesthetists to 2028 Total Anaesthetist GP Anaesthetists* Non-Fellows* Scenario Description Percent Increase Projected FTE change. Technological advances could Year Urban Rural Total Fellows and in FTEs (2008–28) Supply Gap (2028) infl uence the future practice of medicine Trainees* 2008 3242 1195 4437 Base case 42% 2287 signifi cantly and, as a result, surgical and 2028 6261 2388 8599 2008 4,433 4,063 118 252 Scenario 1 Training completions grow 4.4% pa 74% 883 anaesthetic practices, both directly and Average annual 2028 6,312 5,786 168 358 (historical trend) indirectly. On balance the overall impact increase of FTEs Growth 42% Scenario 2 Increase feminisation 41% 2338 of technological change is uncertain and from 2008 151 57 208 (33% in 2008 to 40% in 2028) needs to be monitored. * These numbers vary from the headcount numbers given earlier being This study assumed no changes in estimates of full-time equivalent positions. Scenario 3 Net migration infl ow of 60 p.a. 50% 1875 government policy, but it is reasonable to Scenario 4 Later retirement 55% 1522 assume that over a 20-year period there could be signifi cant changes at both Estimate of Current Supply Scenario 5 Increase in real remuneration 61% 1466 Figure 1 Growing Shortage of FTE Anaesthetists Commonwealth and State levels that could ANZCA headcount data in 2007 recorded by 20% in 2010 9,000 affect both the demand and supply sides. 2963 active Fellows and 1084 Trainees. Data Total supply (base case) Meanwhile the supply scenarios from the ASA and the Joint Consultative to the assumptions used. Similarly the 8,500 Conclusions tested indicated that the projected supply Committee on Anaesthesia (JCCA) application of alternative scenarios on both Demand (base case) The study projections indicated that gap could be reduced by introducing suggested a further 564 non-Fellows 8,000 the demand and supply sides produced a signifi cant shortage in anaesthetists one of a number of initiatives, such as and 460 GP anaesthetists. Medicare markedly different outcomes. The choice could occur by 2028. This result refl ects maintaining training completions at data indicated that GP anaesthetists 7,500 of assumptions can have opposing effects pressures on both the demand and supply recent trend levels, increasing fi nancial tend to work in rural areas and provide on the gap. For example, using actual sides, resulting from a growing and ageing incentives, or increasing the net migration approximately 2.7 per cent of anaesthesia 7,000 utilisation in 2006–07 as a proxy for population, higher income levels, and a fl ow. Introducing a combination of such services overall. Trainees tend to be located workforce whose average age is increasing demand would underestimate the projected 6,500 measures could serve to meet the future in public hospitals in urban areas. as specialists retire. gap given the current level of unmet demand for elective surgery in the demands for anaesthesia services. Based on headcounts of anaesthetists 6,000 Questions arise as to how ‘real’ these and an estimated average clinical time of expected shortages are. Sensitivity analysis public sector.

1176 hours per year, the model suggested FTE Anaethetists 5,500 indicated that the results can be sensitive that in 2008 there were 4433 FTE anaesthetists in Australia. Over 90% of 5,000 these were ANZCA Fellows and Trainees. 4,500 Supply Projections Survey results The number of FTE anaesthetists working 4,000 in Australia was projected to increase by 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 42% to 6312 by 2028 (Table 2). Again, the base case applied a number Comparing Supply and Demand Table 3 shows the impact on the supply/ A key part of the ANZCA/ASA joint All ANZCA Fellows Survey Sample of assumptions (e.g., net migration In the base case, the projections suggest a demand gap of implementing a range workforce study, was a survey that covered Male Female Male Female infl ow of 40 FTEs per annum, 33 per cent widening gap between demand and supply, of initiatives to increase supply. It also both qualitative and quantitative aspects of Average Age 51.6 46.6 51.4 48.8 female trainee completions, constant real rising from a very small shortage of four FTE shows the potential impact of increasing the work environment. remuneration, 1.9 per cent per annum anaesthetists in 2008 to 2287 in 2028 feminisation of the anaesthesia workforce. A total of 1,368 responses were received, growth in new Fellows). Several alternative (Figure 1). of which 75% were current anaesthesia Age and Gender supply scenarios were also modelled service providers, 17% were in training and The results also indicated a signifi cant The average age of respondents to the (Table 3). the remainder had not provided anaesthesia maldistribution of FTE anaesthetists survey was 51.4 years for men and 48.8 services in the last month. The response between urban and rural areas. They years for women. This was not too different represented approximately one quarter of revealed a current shortage in rural areas from the current age distribution of total potential respondents. and an oversupply in urban areas. Australian-based Fellows which is 51.6 for By 2028 shortages, under the base men and 46.6 for women. case scenario, are predicted in both urban and rural areas. The projected workforce of anaesthetists in 2028 should reach 6312 FTEs, compared to a demand for 8599 FTEs – a total potential gap of 2287 FTE anaesthetists (i.e., there will be a requirement for 36 per cent more anaesthetists).

16 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 17 SPECIAL FEATURE: AUSTRALIA’S LOOMING ANAESTHETIST SHORTAGE Males Males Survey results Average hours worked per week Females Weeks worked per year Females 50 47

Continued 45 46.5 40 46 35 45.5 30

25 45

20 44.5 Distribution of Australian FANZCA by age and gender 15 44 100 hours per week Average Males 10 number of weeks Average Females 43.5 90 5 0 43 80 35–39 40–44 45–49 50–54 55–59 56–64 65–69 35–39 40–44 45–49 50–54 55–59 56–64 65+

70 Age Cohort Age Cohort

60

50 average proportion of anaesthetists who private medical facilities. About half of Duration of Work trained in the UK, Europe, South Africa and respondents (55%) thought the number of Number Survey respondents worked an average of 40 Ireland and India worked in regional anaesthetists adequate, and the remainder, 41.7 hours a week, 38.2 hours of which were and rural areas. just over a third (38%) thought there was 30 spent in direct contact with patients. Of a shortage. this, an average of 12.1 hours per week was Determining Factors in The top recurring areas in which gaps 20 spent on call, but not providing services. were thought to exist were: In general, women worked fewer hours Practice Location • Country or rural regions (18.1%) 10 then men (36.0 hours per week compared to Respondents were asked to weight the top 43.8 hours). Both sexes worked a little over three factors they would take into account • Emergency and ICU (6.8%), and 0 45 weeks per year. when deciding to move from their current • Obstetrics (4.9%). 30 35 40 45 50 55 60 65 70 75 80 85 90 Hours worked per week were relatively practice location to a rural location. The Age Cohort constant over age groups, but began to six leading factors in descending order of Summary fall at aged 60 and over as anaesthetists importance were: While the survey results in themselves approached retirement. 1. Locality/lifestyle preferences are of interest, their main value from a A chart of the distribution of current Years Female Male Total Percent Fellows (including those who have retired) 2. Family Issues – Children strategic perspective lies in the qualitative Time Spent in Private and and quantitative insights they provide by Age and Gender, shows the population to Founding 142 710 852 17% 3. Family Issues – Partner be a relatively young one with the majority to the Workforce Model. Survey input Members Public Hospitals 4. Remuneration of Fellows lying between the ages of 38 provides critical demographic data that Survey respondents who were Fellows of the and 54. Less than 104 555 659 16% 5. Professional development/educational facilitates cross-tabulation analysis and College spent approximately 45% of time in While women make up 28% of the total 17 years opportunities provides estimates of parameters for use in Public Hospitals caring for ‘public’ patients, current workforce, the average percentage the Workforce Model, e.g. working hours, 16 15 63 78 19% and a further 5% caring for ‘private’ 6. Access to high-quality hospitals/prestige of women Fellows in the last fi ve years elasticity of workforce supply. 15 20 54 74 27% patients. The remaining 50% of the time of appointment has been approximately 33% of total new The experience gained in the process, was spent in private practice. The top three factors were nominated Fellows. The Workforce Model assumes 14 24 67 91 26% and the careful scrutiny and analysis of The four main reasons listed by by far greater numbers than the fi nal three this percentage of women will enter the 13 14 62 76 18% data, will allow the College to further refi ne anaesthetists for preferring the private factors in the above list. Signifi cantly, all profession in future years, and explores the the model in future years, and provide 12 15 68 83 18% system were (in decreasing order of three reasons for choice of practice location scenario where this percentage increases to valuable input into developing strategies 11 28 80 108 26% are factors that cannot be altered by policy importance): that can be used by the College to address 40% in the next 20 years. incentives. The fourth and fi fth reasons, 10 32 87 119 27% • Remuneration future needs of the profession. while appealing to a signifi cantly smaller Years as a Fellow 9 31 89 120 26% • Greater control over time number, provide possible incentives to Ian D Collens The table to the right shows the distribution 8 45 83 128 35% • Surgeon/anaesthetist relationship encourage a subset of anaesthetists to of FANZCA by Gender and Years since 7 28 73 101 28% • Ability of institution to provide a practice in rural locations. Director, Strategy and Operations ANZCA qualifying as a Fellow of the College. While 6 46 115 161 29% pleasant working environment the proportion of women entering the 5 54 115 169 32% Levels of Adequacy of profession fl uctuates each year, over the Specialisation and past fi ve years, 33% of all Fellows have been 4 63 111 174 36% Service Provision women (288 of 880 new Fellows). 3 63 101 164 38% Country of Training Survey respondents were asked to describe Access Economics study This ‘feminisation’ of the anaesthesia 2 55 123 178 31% Over 85% of survey respondents had the general level of adequacy of the The Access Economics’ workforce workforce has small but important completed their anaesthesia training study monograph “Supply and 1 53 142 195 27% anaesthesia workforce in meeting current implications for the future supply in Australia. Of the remaining 15% of demand for anaesthesia services. Only 7% Demand for Anaesthesia Services” is of services. Sub-totals 832 2698 3530 24% respondents trained overseas, most came of respondents thought that supply was available on ANZCA’s website from the United Kingdom, followed by more than adequate, with a large portion www.anzca.edu.au New Zealand and Europe. A higher-than- of these responses from anaesthetists in

18 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 19 FEATURE 3 Australia’s worst bushfi re disaster: the medical response on Victoria’s Black Saturday

The worst bushfi res in Australia’s history occurred on Saturday, February 7, 2009 in Victoria. More than 1. Dr John Moloney, Head of Trauma 210 people were killed, 30 people are still missing, hundreds were injured and whole communities Anaesthesia at the Alfred Hospital. 2. A slide from Dr John Moloney’s were destroyed. We spoke with Dr John Moloney, Head of Trauma Anaesthesia, at The Alfred Hospital presentation to colleagues at the Alfred and some of his colleagues in Melbourne where all the major adult burns victims received their Hospital on the bushfi res. defi nitive care following Black Saturday. 3. Doctors from the Alfred Hospital who worked over the weekend of Black Saturday: Back row – Dr John Moloney, Dr Alex Konstantatos, Dr Sarah McLeod, Dr South-eastern Australia is one of the “The conditions look set to be the worst home to the State’s adult burns centre. Carolyn Arnold, Dr Joel Symons, Dr Hugh most bushfi re prone areas in the world. in Victoria’s history”. The following day, Together with the Royal Children’s Anderson. Front row – Dr Wai Tam and Wet winters, long dry summers and the Premier added: “It’s just going to be Hospital they took 24 patients, including Dr Cong Choong Tang. eucalyptus-based bush make fi re a part of probably by a long way the worst day the most severely burnt victims. the natural landscape. Previous disastrous ever in the history of the state in terms of Over the ensuing hours, days and fi res occurred in 1939 (Black Friday, with temperature and winds.” weeks, Fellows and trainees of the 71 deaths) and 1983 (Ash Wednesday, 75 On Saturday morning, 107 fi res were College have been involved in their ‘The sheer volume deaths). still burning across the state. Record care. Initially this included pre-hospital of patients was The summer of 2008-9 was particularly temperatures, up to 49 C, extremely low triage and emergency department hot. In the last week of January, land humidity and hot gale force northerly airway management and resuscitation. overwhelming and we surface temperatures in Victoria and winds set the stage for what was to follow. Operative management and intensive were stretched to our South Australia were well above recent Townships were razed and many lives care are obvious sequelae. Less obvious summer averages. Melbourne had three were lost when bushfi res on a scale never was the ongoing need for anaesthesia for limits but what came consecutive days with temperatures above before seen tore through many areas burns dressings and the signifi cant pain through was extraordinary 43 degrees, South Australia had four. of Victoria. Townships like Marysville, management issues, made more diffi cult Tasmania broke temperature records on Kinglake and Flowerdale almost ceased by complex psychosocial issues. teamwork between two consecutive days. to exist. The current death toll is 210, with With the Alfred on ambulance bypass anaesthetists, intensivists, In the days leading up to what has 30 people still missing. Forensic teams are for everything except burns, other become known as Black Saturday still searching for human remains in some hospitals in Melbourne took on additional pain specialists and the (February 7, 2009), meteorologists and townships a month later, such was the patient loads. politicians were warning of major bushfi re extent of the destruction. burns department.’ threats. The Premier, John Brumby, said: The Alfred Hospital in Melbourne is Dr Kerry Thompson, Pain Medicine registrar, The Alfred Hospital.

Dr Moloney fi rst heard about the fi res the hills by police, ambulance or private to Whittlesea. We arrived there at then ran one burns theatre for the rest of the mid-afternoon on Saturday when he was 1 2 vehicles, being assessed, treated as needed around 1:40am.’ week. Normally we would have one burns coordinating for Adult Retrieval Victoria and then transferred to appropriate The Alfred didn’t have any information theatre running for less than three half days (ARV). He was asked by Hamilton Hospital hospitals,’ Dr Moloney said. on how many burns patients would be a week,’ he said. in western Victoria to move a patient who “As I was driving up to Diamond Creek, I transported to them, so the plan was to ‘We put 10 burns patients through the suffered 50 per cent burns, having been rang the anaesthetic consultant on duty at accept all patients with more than 30 ICU and another 10 into the burns ward. By caught in a fi re in his shorts and t-shirt. ARV The Alfred and said ‘this is going to be bad, percent burns and other patients with less Monday morning we were able to accept was involved in another incident around you’d best fi nd out who’s around town’.” severe burns were to be sent to one of the other patients into ICU. Within 36 hours, 7pm. Dr Moloney was on the phone to The FEMO Program mobilised six other major hospitals in Melbourne. The despite the infl ux of major burns patients, Bendigo Hospital and heard the bushfi res specialists with experience in emergency potential Victorian burns capacity was also we were able to take ‘normal’ ICU patients, were two kilometers away from the hospital. and disaster medicine. Dr Moloney and expanded by arranging for the intensive which astounded me. Soon after, he received a text message the team at the Casualty Collecting Post care unit at the Royal Melbourne Hospital ‘The Burns Unit managed its staff better asking him to contact the Field Emergency saw about a dozen patients. One was dead to be able to accommodate up to four major than we did after the Bali bombings. We Medical Coordinator from the Field on arrival. There were also numerous burns patients. paced ourselves a bit more so we didn’t run Emergency Medical Offi cer (FEMO) patients with minor injuries such as smoke Dr Moloney believes The Alfred Hospital ourselves into the ground. Everyone was Program, a component of the State Health inhalation and minor burns who were sent staff coped well with the burns patient load. willing to help. Every department went out Emergency Response Plan. to Box Hill Hospital, in order to take the ‘Additional anaesthetic staff were of its way to work well together and show ‘I was requested to proceed to Diamond pressure off the hospitals closest to the fi res. called in during the early hours of Sunday good will.’ Creek where they were setting up a Casualty ‘It later became obvious that where we morning so that instead of having only one On Monday, February 9, Dr Moloney Collecting Post at the combined Country were stationed wasn’t where the majority of consultant in the hospital we had four. was the anaesthetist for a burns list at The Fire Authority/ Ambulance headquarters. patients were coming to, so our convoy of We ran two burns theatres all day on the Alfred and anaesthetised two of the severely People were being brought down from more than seven vehicles moved up following Sunday, Monday and Tuesday and burnt ICU patients.

20 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 21 FEATURE Australia’s worst bushfi re disaster: The toll: the medical response on Victoria’s 210 lives lost Black Saturday 2,029 properties destroyed 78 townships affected Continued 400,000+ hectares burnt 500+ incidents responded to

12

1. Dr Joel Symons, an anaesthetist, at work at ‘The bushfi re patients were badly burnt, to assist relief and recovery. A week later, response (disaster medicine) we had to running again, getting tourists in to system to deal with fi ve, 10, 50 or 100. That’s the Alfred Hospital. but their burns were comparable to a house he was asked to undertake a tour of the manage initially with limited information, spend some money will really help the the challenge and my area of interest. 2. A slide from Dr John Moloney’s fi re, a motor vehicle or industrial burns. bushfi re sites to assess further health needs. which in this instance was related to recovery process. ‘Black Saturday was worse than anyone presentation to colleagues at the Alfred Their burns and injuries were less severe Doctors and nurses had been organised the speed of the fi res. However, years of ‘From a medical point of view, I would could imagine.’ Hospital on the bushfi res. than the survivors of the Bali bombings. to support many communities including planning, training and exercising paid off,’ suggest having an awareness of disaster ‘The cooperation was Some of the bushfi re burns patients Kinglake, Alexandra, Eildon, Flowerdale, he said. medicine and the principles around it suffered from being stuck in dams (severe Buxton and Narbethong. The Department Dr Moloney says some aspects of the would also help because one never knows exceptional on Saturday night infection) and experienced delayed fl uid of Human Services (DHS) facilitated the extended response weren’t anticipated. what’s going to happen and where,’ he said. and Sunday. Administration resuscitation,’ he said. placement of GPs utilising the Rural ‘If there was a need it was met, but some Dr Moloney says Black Saturday wasn’t asked what we needed and Dr Moloney says it’s the psychological Workforce Agency Victoria, and similarly of it wasn’t explicitly planned for. There specifi cally a burns response but a mass ‘There were many component that makes this burns crisis utilised Royal District Nursing Service to has been discussion in the past about casualty incident with multiple victims that generous offers from did as we asked; this meant different from others he’s seen during supply nurses. how to support isolated communities but needed health and recovery personnel with no bed block so that there was his career. In addition, medical staff and nurses support for maintaining primary care and expertise and experience in dealing with other anaesthetists, smooth transition between ‘If someone’s in a car crash and gets were drawn from the Royal Melbourne, St. the business continuity of small hospitals multiple patients. The Alfred and Royal including VMOs, full-time resuscitation of patients in the burnt (or even some of their family members Vincent’s, the Austin, the Western, Ballarat, on the periphery of Victoria’s urban Children’s Hospital treated most of the have been killed or hurt as well), they still Maroondah and Bendigo Hospitals, forming conurbations had not previously been patients with major burns but many other staff, trainees, and other emergency department and have a house and family to come home Victorian Medical Assistance Teams required,’ he said. hospitals in Melbourne and the rest non-Alfred anaesthetists admission to ICU or operating to, friends and next-door neighbours. The (VMAT). ‘To have so many people affected and of Victoria also treated victims of theatre and then again back bushfi re patients may have lost everything,’ ‘I visited Alexandra Hospital and met the destruction of infrastructure over such a the bushfi res. in Melbourne and he said. with the administrator on-call about the large area was unimaginable. For example, Black Saturday was a ‘super fi re’. The to ICU. Surgeons operated in There are approximately 15 burns medical and nursing support that DHS and the general practice in Marysville was burnt heat energy was unprecedented because of interstate, to assist in the emergency department, ICU patients still being treated at The Alfred and the FEMO Program were facilitating, and out and the whole town was inaccessible. the extremely dry conditions, low humidity, management of the burns and OR. Anesthetists and the severe ones in intensive care will need to establish how best to provide ongoing The pharmacist in Yea was busy defending record temperatures and strong winds. victims.’ intensivists did what was further surgery over the coming weeks, support. Supporting the business continuity his house and in Alexandra, one of the GPs ‘People were injured from 200 meters months and, potentially, years. of small GP-dependant hospitals was defending his house while another was away from the fl ames (compared to normal Dr Hugh Anderson, anaesthetist, The required for optimal patient ‘Two or three years ago I re- becomes unsustainable in the long-term missing for a period of time.’ fi res – 50 meters away) and there Alfred Hospital care. Theatre sterilized ICU anaesthetised one of the Bali bombing without separate identifi able funding,’ Dr Moloney says the best way of assisting were embers the size of forearms,’ bronchoscopes, without delay.’ patients and that tragedy was six and a half Dr Moloney said. the communities affected by the bushfi res Dr Moloney said. years ago,’ Dr Moloney said. Overall, Dr Moloney believes the acute is by making a donation through the Red ‘Most anaesthetists would be able to Associate Professor Warwick Butt, On the Monday following the fi res, health response worked well. Cross or by supporting the local economies. deal with one of these burns patients. intensivist, The Alfred Hospital Dr Moloney also visited Kinglake as a FEMO ‘As is frequently the case in emergency Once the towns are eventually up and The question is how you best organise the

22 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 23 PROFILE

Judith Killen: Living and working in rural New South Wales

After a morning working on an eye list bases decisions on frequent measurements (one baby and fi ve patients over 80), then of other parameters, such as oxygen levels, an afternoon of endoscopies, Wagga Wagga heart rate, blood pressure, gas exchange…” anaesthetist Dr Judith Killen is sitting in “Management of Type 1 Diabetes has her garden looking across 100 acres that changed enormously in the past decade. include a soccer fi eld and a small orchard. When my son was fi rst diagnosed, we tried This is the lifestyle that Dr Killen wants to minimise the number of needles. This anaesthetists and trainees to know about: meant guessing what a toddler might eat for the combination of rewarding and varied the day, and giving this amount of insulin. work with a great family lifestyle. I remember one weekend in Sydney when Although Dr Killen’s training was in he refused to eat until I had to let him have Sydney, based at St Vincent’s, Darlinghurst, chips and doughnuts. Now the insulin is with secondments to St George Hospital, given as “basal and bolus”, with mealtime St Margaret’s and the Royal Alexandria insulin matched to the food eaten. Insulin Hospital for Children, she always wanted may be given by an insulin pump – my son to end up in a regional setting. After her has had a pump for the past 18 months training fi nished in 1986, she moved to and loves it. There are many new insulins Wagga Wagga. “I was born in the Riverina being used. However, there have been very and I always wanted to go into rural few updates in the anaesthetic literature practice. When I fi rst started medicine, I on managing diabetic patients, and the assumed that I’d be a general practitioner, Having said that, we all enjoyed the video Diabetes when he was three. This has been potential of the emerging technology.” but quickly decided that wasn’t for me conferences available a few years ago – this a huge focus for her family since then – they “Within the next decade, there will be and developed an interest in anaesthesia. gave us access to mid-week city meetings have an annual fi reworks display on the continuous glucose monitors, so diabetic I did an anaesthetic term as a resident in and weekend ones when we had family June long weekend which has raised over patients will have a continual display of Wagga; also an emergency and a surgical commitments near home.” $100,000 over the years for research into their blood sugar, right by the oximetry term. I really liked the range of work that “Modern communications have Type 1 Diabetes. Dr Killen has also had her and end tidal CO2 ,” Dr Killen says. was available. You don’t get stuck in a transformed rural practice. There is no need garden on display as part of the Australian subspeciality.” to feel isolated or unable to get support. The Open Garden Scheme, with proceeds going “I do a lot of intensive care. While I hospitals have quick dials to all the major to research into diabetes. didn’t particularly enjoy intensive care Sydney hospitals. The internet gives us the Dr Killen’s experience with a child with during my training in Sydney, when I came ability to access information quickly and Type 1 Diabetes has impacted on her clinical ‘I was born in the Riverina to Wagga the intensive care unit was run apparent during the 1990s and have been They have vibrant communities with good sites such as CIAP and the College website life. “During the late 1990s, I realised and I always wanted to go by anaesthetists and they asked me to at crisis point this century. There are 14 educational, cultural and sporting facilities. are great sources. Many senior consultants in-hospital management of diabetes was participate in this. My interest gradually anaesthetists based in Wagga Wagga, three There are rural clinical schools so clinicians are happy to be emailed with particular appalling, particularly in Intensive Care. into rural practice. When increased – I think we had younger patients of whom cover Intensive Care. There is a can follow up interests in education and clinical issues – two outstanding examples Very few people understood the duration of I fi rst started medicine, I and I could see their progress over time. need for about 20, and the shortfall is made research,” she says. would be Dr Andrew Ross in Melbourne action of the various insulin preparations. assumed that I’d be a I’m now somewhat of a dinosaur, as I’m the up with locums. Not all anaesthetists are Dr Killen says ongoing professional and Dr Stephen Katz in Sydney, who are I did introduce the use of longer acting only consultant in our unit who does not suited to rural locum work. They need to development is essential. “We are big unfailingly courteous and helpful with insulins in our ICU, particularly for patients general practitioner, but have a dual fellowship. I’m very conscious be confi dent anaesthetising the extremes enough to have regular sessions, hopefully obstetric anaesthetic issues.” on total parenteral nutrition, but we were quickly decided that wasn’t of this and always consult a colleague if of age, obstetric patients, trauma, often on topics identifi ed as of interest to “Such professional support is two-way. still failing to treat high blood glucose for me and developed an I have any doubts. I have very supportive with unfamiliar equipment and without the everyone. Recent topics have included Once a fortnight, I visit one of the smaller levels effectively.” colleagues, so this is a very rewarding part luxury of knowing the staff’s strengths and Diabetes and Anaesthesia, Anticoagulants hospitals in the area health service, Tumut. “Then in 2001, I was at the World interest in anaesthesia. I of my practice. I do roughly every fourth weaknesses. “A lot of new Fellows aren’t very and Eye Blocks, Regional Anaesthesia, I’m the only specialist anaesthetist going Congress of ICU in Sydney. There was a did an anaesthetic term as week in ICU, and all my on-call is for happy anaesthetising small children, but in a Anaesthesia for Radical Prostatectomy and there and can give advice on standards and seminal paper on tight glycaemic control a resident in Wagga; also an intensive care.” rural area we can’t send off every three-year- the next will be on Major Haemorrhage. education. My support there allows them in Intensive Care units. It transformed our emergency and a surgical “My regular lists include paediatrics, old with a broken arm,” Dr Killen says. We occasionally have visiting speakers to continue an obstetric service – they have management practices worldwide virtually O&G, urology and colorectal surgery. Wagga “The College has responded to this – for instance A/Prof David Baines from around 150 deliveries there per year, and the overnight. We changed from intermittent term. I really liked the range is unique in rural areas in having a fully situation by increasing trainee numbers Westmead Children’s came down to speak alternative is travelling to the overstretched injections to insulin infusions, with specifi c of work that was available. equipped ICU in both the public and private and the Federal Government has increased on Paediatric Adenotonsillectomy and service in Wagga Wagga. It’s good for glycaemic targets. This made me think You don’t get stuck in a hospitals, so we can feel comfortable medical student numbers. In the next Obstructive sleep apnoea, and Dr Cliff Peady patients and the community,” Dr Killen says. about management of diabetic patients in anaesthetising the frail and elderly in decade, more anaesthetists will be trained, from Canberra on Fascia Iliacus Blocks.” A new direction for Dr Killen is other wards, and undergoing anaesthesia. subspeciality.’ both locations.” but they need to realise that much of the “However, we also have very regular involvement in writing a paper. This is on We do not measure the blood glucose level Dr Killen has long been interested in available work is in the large regional fl ights to Sydney and Melbourne and are Type 1 Diabetes and Anaesthesia. Dr Killen’s often enough in hospitals, including in the issue of rural workforce shortages. centres. This is varied and rewarding work. only two-and-a-half hours from Canberra. interest in writing on diabetes is personal: the theatre setting in most cases. This is The increasing problems became very “Such centres are good places to live. Thus, weekend meetings are easy to attend. her younger son, now 17, developed Type 1 particularly troubling in a speciality that

24 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 25 FEATURE: IN THE FIELD 1 2 3

The cool side of medicine

1. Adelie Penguins. Mawson station 4 2. Dr Jo Melick doing some minor dentistry work in Antarctica. 3. Dr Jo Melick. 4. Emperor Penguin rookery.

the following year plus also checking the quality of the drinking water every month. As it is such a small community, there are numerous other jobs that need to be performed – my main job was looking after hydroponics, which was situated in its own building, and a wonderful source of vegetables and herbs and warmth and light. It provided a nice change from the inevitable frozen or dried produce. There were so many incredible experiences. The highlights for me were the wildlife – Emperor penguins, Adelie penguins, seals and sea birds. All of the Australian bases are close to Adelie penguin Antarctica is a fascinating place for the doctor, major problems rarely occur plus have a good grounding in medicine are at their largest – anywhere from 30 to the year I was down there – one broken rookeries, but Mawson is the only one that and somewhere that I had always wanted (whereas the mechanic isn’t quite and surgery. 70 people. When they leave, there remains ankle and a fractured humerus. Both were is close to an Emperor penguin rookery. to visit. My opportunity came in 2006 so fortunate!). Other training required was provided by a core group which are mostly involved treated conservatively, as we had no other The rookeries are usually on sea-ice, and 2007, when I was employed as the Thus, to fulfi l the criteria for the the AAD, based in Hobart, and it was great with maintenance of the stations, and the treatment available. About every 10 years in areas that are protected by ice-bergs, Expedition Medical Offi cer for Mawson position, both my employers and I had fun. “How to do dentistry” took eight days numbers drop dramatically. At Mawson in someone has an appendicectomy – my so both the scenery and the colonies are Station, with a contract lasting 18 months. to be happy that I could deal with any at the Dental Hospital in Melbourne, and my year, there were only 14 winterers, most predecessor performed this surgery on spectacular. Since the birds start their Both of my brothers had worked “down contingencies. My main concern was was incredibly useful as that is one of the of whom are tradesmen. the ship on the way3. down to the surgery. nesting in winter when the sea-ice is fi rm, south” in the 1990s, one as a biologist and surgery, so I used my contacts among major workloads. Other parts of the training Like all things, working in Antarctica Luckily, on the ship there are usually a lot of there were many trips over the dark months the other as the Station Leader, so I thought obliging surgeons at my hospital base to included “do-it-yourself” haematology, had its highs and lows. Everyone has useful people around – other doctors, vets, to visit these superb creatures. To my that I had some idea as to what would be do some surgical assisting. It was fun to biochemistry, radiology, microbiology, different experiences, but for me the good nurses, so there is help. His patient did so surprise, I really enjoyed the winter, not only in store. I certainly knew that it was not all be on the other side of the “blood-brain” sterilisation and others. Although this certainly outweighed the bad. Medically, well that she recovered quickly and went because we could visit the penguin colonies, a bed of roses. The job consisted of several barrier, and my surgical colleagues were sounds daunting, they were just guidelines. fortunately it was pretty mundane, with back to work within days. There have been but also seeing the incredible colours of months of training, a long ship journey extremely helpful and encouraging. When we needed to do things at the bases, minor musculoskeletal complaints being some major traumas – the last was about the twilight, with regular viewings of the through the infamous southern seas, Another requirement for the wintering there were plenty of guides that could the main problems, though the odd dental 10 years ago, when an expeditioner was extraordinary aurora australis. followed by 12 months at the station. doctor is that they must have had an be followed or advice obtained over the issue also raised its ugly head. I really crushed by her quad bike as it fell through a A year such is this is not one that is The position of medical offi cer with appendicectomy before going down, so I phone or the internet. Also, the equipment enjoyed doing some minor dentistry. The crevasse. She sustained abdominal trauma, easily forgotten. Each base has its own the Antarctic Division (AAD) is essentially dutifully had this performed. The theory provided was generally excellent, with isolation can be very hard, and that tends to requiring several returns to theatre both magic, every year its own experiences. I that of a solo practice general practitioner. behind this is that appendicitis is still the a fully functional theatre including cause the most troublesome medical issues, in Antarctica and also once we returned think these challenges need to be taken up Australia has three stations on the Antarctic most common surgical emergency, and it anaesthetic machine and ventilator, with somatisation of stress being a common to Australia. Let me stress, however, these occasionally, as they are rarely regretted. continent: Davis, Casey and Mawson. All would be rather diffi cult for the doctor to diathermy, and a dedicated scrubbing problem, and very hard to treat. This tends incidents are rare, and most doctors have Will I go down again? Not this year, but who these bases are very isolated: over the do an appendicectomy on themselves. Mind area. There was also Antarctic training – to become more of a problem in the winter, nothing more exciting happen than losing knows what the future will bring? summer, it may take weeks to evacuate a you – it has been done, unsurprisingly by including navigation, survival in the cold as it becomes colder and, of course, darker a fi lling. And as it is such an isolated patient, whereas over the winter (which a Russian doctor, using local anaesthetic, and basic rock-climbing to name a few. Part so there is less inclination to spend environment, over the winter, expeditioners Dr Jo Melick lasts from March to November), there is no mirrors and vodka. of my training including gaining a forklift time outside. do not even get the common cold, as there possibility of external assistance, for the There are a variety of doctors that are licence, although I am not sure that my The equipment at the base was really is no exposure to any new viruses. However, Dr Jo Melick is originally from Melbourne, bases are thousands of kilometres away employed by the AAD. Classically, it was skills were quite up to scratch! Fire training good, and generally we had everything that soon changes once the summer arrives starting her anaesthetics training in North Wales but fi nished it based at The Alfred in Melbourne, from any cities, and it is far too dangerous the rural GP, who could turn their hand was essential for the whole community, that we could possibly need in case of and the viruses are brought in with the gaining her FANZCA in 1998. Originally she and costly to try to reach them at this to anything. This individual is becoming as fi re remains one of the real problems emergencies, from obstetric forceps and next crew! worked at Dandenong, but moved to Adelaide time of year. Thus, all bases need to be harder to fi nd, so the doctors now have in Antarctic – though cold, it is a very dry neonatal incubator (luckily they have As all expeditioners should be fi t and in 2004, where she remains – working at the self-suffi cient, which also means that all a diverse background, with emergency place, and fi res are not uncommon. never been needed), to craniotomy or rigid healthy, there is often not a lot for the doctor Repatriation General Hospital. Since she has expeditioners must be able to handle their physicians, surgeons and anaesthetists The main activity of the station is bronchoscopy instruments. There have been to do. We do have other responsibilities, been a consultant, she has spent two weeks most area of expertise, whether it is the doctor now also often being employed. I think that over the summer, which lasts from late some major incidents, though only rarely. such as maintaining all our equipment years in Vanuatu, with the Pacifi c Island Project, treating appendicitis or the diesel mechanic anaesthetists have a valuable role to play. November until late February, and the The commonest major injury is broken (each base effectively has a mini hospital!), with an orthopaedic team. handling a generator malfunction. Luckily They are used to dealing with emergencies, numbers at the stations during this period limbs – there were a couple of fractures stocktaking all items and reordering for

26 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 27 FEATURE Personal experience: Initiating operating theatre plastic recycling programs Doctors for the By Forbes McGain Environment Australia

Doctors for the Environment Australia 1. Proportion of (DEA) is a voluntary organisation of medical Forbes McGain and Eugenie Kayak 1. 2. products recycled doctors and students. It was formed in 2001 in Case 1. as a branch of the Swiss-based International 2. PVC products Society of Doctors for the Environment being recycled in (ISDE), a group that has had signifi cant Case 2. achievements in Europe. Climate change is a priority for DEA because we recognise its major health impacts and its overwhelming threat to humanity.1 DEA aims to educate and inform policy makers, industry, colleagues and the public about the health and humanity implications resulting from green house gas emissions and environmental degradation. Members are supported by a scientifi c committee comprised of renowned international leaders and pioneers in research and After reading Dr Rod Westhorpe’s to focus on waste management initially warming blankets and wraps, syringes, medicine, including Sir Gustav Nossal, “Letter from the editor: Agents of because energy and water issues, while intravenous cannula covers, suckers Professor Peter Doherty, Professor Fiona change”, ANZCA Bulletin, March 2007, integral, would involve an initial outlay and surgical wraps (polypropylene and Stanley and Professor Tony McMichael. The I was motivated to investigate and of fi nances. polyethylene types). quantify what our individual effect of We are now recycling about 200kg per present Chair of DEA is Professor Michael Case 1 using N O on greenhouse gas emissions week of plastic products in a cost-negative Kidd, past President of the RACGP. 2 The Williamstown Hospital operating is. As Dr Westhorpe states in his article exercise from the operating theatres at DEA has developed policies, suite already had successful recycling of N O contributes about 5% to the total Williamstown Hospital. comprehensive reports and supported 2 cardboard, paper and most plastic bottles, on the issues of renewable energy and the of sustainable practices among College greenhouse gas effect. Although medical recent initiatives such as Green Clinic2, however the theatre staff were keen to Case 2 Carbon Pollution Reduction Scheme. staff. Some of the initiatives undertaken use is a minimal producer of greenhouse Bike Doctor3 and a Green Hospitals group. do more. It was readily apparent that the At the Western Hospital, we have Health professionals have a proud by ANZCA include the installation of water gases, relative to release from fossil fuel Policy documents include the topics of major recyclable material heading into the embarked on a pilot project to recycle history of service to the community and tanks, drip fed irrigation, recycling and burning and farming, Dr Westhorpe climate change, energy production, public waste bin was plastic. polyvinylchloride (PVC) plastic only. PVC have been instrumental in encouraging energy conservation practices. Energy questions whether using low-fl ow closed- transport and forests (www.dea.org.au). Firstly, we needed to determine the forms about 25% of all operating suite policy development to improve the health conservation measures have led to circuit anaesthetic delivery systems is “Climate Change Health Check 2020” is a types of plastics in our operating theatre and intensive care plastic. This recycling of present and future generations. This decreases of up to 10% in electricity usage adequate or whether Fellows of ANZCA report prepared by members for the Climate rubbish. These plastics are often not project is converting oxygen masks, is evident with tobacco legislation and by the College. should consider phasing out N O (and Institute of Australia in relation to World 2 labeled, unlike the plastics that we use at oxygen tubing, intravenous fl uid bags and various road trauma initiatives (seat belts, Australia is an affl uent, secure country volatile anaesthetic agents)? My research Health Day 2008 for which the WHO’s home. A laborious process, which involved giving sets and suction tubing into PVC blood alcohol levels, speed limits). DEA that should be showing leadership in astounded me: you are likely to be theme was ‘Protecting Health from Climate contacting all the manufacturers of the pipes. Thus far, the trial is performing now builds on this foundation of service by abating greenhouse gas emissions, emitting far more greenhouse gas Change’1. The report outlines and quantifi es medical plastic products, was undertaken.4 well and we are in communication with addressing the global health implications of rather than waiting for countries with administering a 30-minute 1 l/min N O the direct effects of climate change on 2 Secondly, an appropriate recycler various medical PVC recyclers to expand our lifestyle. millions of people living below the anaesthetic than driving to and from health, including heat stress and related needed to be found. Limitations were the program beyond the pilot stage. Fellows of our College are ideally placed poverty line to act fi rst. Per capita we are work (1 min of 0.5 l/min N O is equivalent deaths, trauma from extreme weather 2 soon discovered upon contacting possible Change is required and we as to alter the environmental impact of our the highest greenhouse gas emitters in to driving an average car 1 km)1. events, increases in allergic symptoms, recyclers i.e. volume was not considered doctors should be leaders in advocating operating theatres and intensive care units the world. The Australian government This initial research lead me to respiratory problems, mental illness, to be large enough for the big recyclers, for sustainable practices within our – some of the highest energy-consuming recently acknowledged the adverse health consider other questions concerning the post-traumatic stress disorders, infectious several recyclers would only take hospitals. Anaesthetists are ideally placed waste-producing areas in hospitals. We consequences of climate change with their sustainability of our practice e.g. total diseases and changes to the distribution compacted material (smaller hospitals to make changes, particularly within are also well placed, as a core group of allocation of $10 million into researching carbon footprint of disposable vs. reusable of mosquito-transmitted diseases. DEA tend not to have compacters), other our theatres. Some practical measure senior clinicians, to encourage sustainable the health implications of climate change.5 trays. It also gave me added motivation has also developed a range of educational recyclers would only accept certain types are detailed in Table 1. Researching the practices throughout our hospitals. The United Nations Secretary-General to initiate what changes I could within material including pamphlets and posters. of plastics (made by companies with whom sustainability of our practice is no less The Australian Medical Association has Ban Ki-moon has recently stated that my current work places to improve their Medical doctors are in a unique position they had contractual arrangements). important than other areas of medical recently updated their position statement climate change is the “one true existential carbon footprints. to promote the need for action concerning Fortunately, Thermoplastics Recyclers, a research, indeed one could argue that it is on climate change and DEA encourages and threat to the planet” even in today’s We formed a hospital environmental our environment. We are well positioned 4 local Melbourne company was happy to of utmost importance. supports all Colleges to do the same. Our current of multiple crises. He has called committee at Western Health with a strong professionally and in society to be heard take as much plastic as possible from the College has taken the initiative and formed for a positive outcome in the Copenhagen theatre presence, inviting members of and help infl uence others. Politicians operating suite. Products recycled by this the ANZCA “Green Committee” to encourage Climate Conference and emphasised that the environmental services, engineering, have shown a willingness to listen to DEA company into plastic wrap for fl ooring and promote sustainable practices within “climate change threatens all our goals for infection control and clinical staff to members. The organisation actively engages include: saline and water ampoules, ANZCA House. The committee has been development and social progress”.6 become involved. The committee decided politicians on both sides of politics, recently running for more than a year and have been intravenous fl uid bag wraps, disposable Continued on page 30 writing to all federal members and senators active in promoting increased awareness Continued on page 30

28 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 29 FEATURE Personal experience: Doctors for the Initiating operating theatre Environment plastic recycling programs Australia Continued from page 28 Continued from page 28 ANZCA Green Committee

As medical professionals we understand Table 1. Practical steps towards • Form / join a Theatre/Hospital that “prevention is better than cure”, A Green Committee was established sustainability for the anaesthetist Environment Committee. Theatre as anaesthetists and intensivists we are at ANZCA House in November 2007 to produces anywhere between 5–20% of trained to pre-empt and avert potential • Alter your gases! Stop using Nitrous promote and support the development all hospital waste. disasters in our daily practices. Now is the Oxide. For every minute of 0.5L/min. of a range of initiatives that encourage time to advocate for the mitigation of green N2O you’ve driven the equivalent of • Minimise lighting costs with timers and environmentally sustainable practices house gas emissions and environmental 1km in an average car.1 energy effi cient fl uorescent lamps. across the national and regional offi ces degradation, pre-empting and averting a • Conserve your gases! Use low • Turn off the theatre ventilation and air of the College. truly global disaster that will affect us and fl ow anaesthesia (sevofl urane conditioning when not in use, with The principles of the committee are: future generations. Now is the time to refl ect nephrotoxicity in humans has been hospital engineering invovement.5 • To take greater care of our 2,3 on how we can alter our personal and work shown not to occur at low fl ows). • On your bike! If ever there was environment for current and future practices for a lower carbon footprint. Now • Reduce. Are two disposable a medical profession that was generations by reducing the College’s is the time to join an organization, such anaesthetic trays per patient sartorially suited to lycra and blues consumption of energy and other as DEA, empowering them with numbers necessary? it’s anaesthesia! Facilitate bike use by consumables. and contributing as much or as little as • Re-use. Disposables routinely use advocating for bike parking and form • To ensure all staff (including you wish. If nothing else, now is the time more energy and water to produce a BUG (bicycle users’ group). regions) are involved and committed to seek us out at the next Annual Scientifi c than re-usables. Re-usable plastic • Advocate for the environment. by promoting enthusiasm and Meeting in Cairns. DEA will have a display drug trays require around 1/3 the Join DEA (Doctors for the education. area and welcomes delegates to come and energy and 1/10 the water to reprocess Environment Australia). • Promote sustainable cultural change discuss environmental issues globally, in compared with similar disposable via management and from the our hospitals and within anaesthetics. Useful links: plastic trays (unpublished research ground up. References: by author). www.dea.org.au • Be seen as a leader in environmental 1. Horton G. and T McMichael DEA. Climate (Doctors for the Environment), Change Health Check 2020. April 2008. • Recycle. Twenty fi ve per cent of theatre sustainable practices. Prepared for the Climate Institute of Australia. waste is of anaesthetic origin (paper www.ihea.org.au • Ensure short-term and longer-term www.climateinstitiue.org.au submitted for publication). More (Institute of Hospital Engineers of actions are implemented with clear 2. www.actonline.org.au/greenclinic than 40% of all anaesthetic waste is Australia), deliverables. recyclable, mostly plastic. Recyclable 3. www.dea.org.au/bikedoctor/index.html www.ecobuy.org.au The committee meets monthly and medical plastics are referenced.4 4. Australian Medicine: February 16, 2009. (for more sustainable procurement), comprises members from ANZCA 5. Australian Federal Government Media Release: • Procure more sustainable products. www.corporatecitizen.nhs.uk/index.html management, administration, and January 27, 2009. $10 million for Research into Fifty per cent recycled paper is a start. (NHS sustainable website), Council, including A/Prof Kate Leslie. Health and Climate Change. Senator the Hon So far the Green Committee has: Penny Wong, The Hon Nicola Roxon MP and www.gghc.org Senator the Hon Kim Carr. (green guide for health care). • Reduced electricity usage by 10% (via 6. United Nations Secretary-General Ban the “switch off lights” campaign). Ki-moon. Plenary Speech at World Economic • Installed water tanks and drip References: 4. McGain F, Williams A, Clarke M, Wardlaw E. Forum on “The Global Compact: Creating feed irrigation. Sustainable Markets”. Davos (Switzerland), 1. McGain F. Why anaesthetists should no Recycling plastics from the operating suite. January 29, 2009. longer use Nitrous Oxide. An Int Care, 2007; An Int Care, 2008; 36 (6); 913-914. • Improved recycling of glass, plastics, 35: 5: 808-9. 5. Dettenkofer M, Scherrer M, Hoch V et al. and other recyclables. Dr Eugenie Kayak 2. Kharasch ED, Frink EJ, Artru A et al. Long- Shutting down operating theatre ventilation • Begun composting food materials. Visiting Anaesthetist duration low-fl ow sevofl urane and isofl urane when the theater is not in use: infection control and environmental aspects. Inf Cont • Reduced paper usage by Council and The Alfred & Austin Hospitals, Melbourne effects on postoperative renal and hepatic increased the use of electronic means function. Anesth Analg , 2001; 93 (6): 1511-20. Hosp Epi 2003; 24(8): 596-600. Dr Forbes McGain to access documents. 3. Story DA, Poustie S, Liu G, McNicol PL. Staff Anaesthetist and Intensivist Changes in plasma creatinine concentration • Reduced paper usage by ANZCA Western Health, Melbourne after cardiac anesthesia with isofl urane, staff and priority given to double- propofol or sevofl urane: a randomized sided copies. clinical trial. Anesth 2001; 95(4): 842-8. To join Doctors for the • Explored the use of solar power Environment Australia installation and the option of Visit www.dea.org.au and follow switching to renewable energy. the links. Or contact David Sherman, • Increased awareness by staff Honourary Secretary for Doctors for of environmentally sustainable the Environment Australia, via email: practices. [email protected]

30 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 31 FEATURE Dr Stephen Lightfoot

Anaesthesia and the environment: How big is our footprint?

Since September last year, the media, considerable quantities of waste. The resources into waste faster than nature can smaller impact and if we act alone we will politicians and the public have been operating theatre setting multiplies these turn the waste back into resources2. Using be unable to save the planet. obsessed with the global fi nancial crisis impacts. The need for sterility, safety and a fi nancial analogy, rather than living off However, there are many reasons we (GFC). Unfortunately this has diverted their infection control has seen the development the interest from our bank account with should act to reduce our footprint. First, we collective attentions from a crisis of equal, of copious amounts of packaging and a nature, we are making withdrawals that are have to start somewhere. If all industries and I would argue greater, long-term gravity myriad of single-use items that are made eating into our fi nancial capital. Our and individuals took the attitude that they that has been brewing since the industrial from both plastics and metal. The cleaning account balance at the “Ecobank” is couldn’t make a difference then nothing revolution. This is what I call the global of equipment and linen requires electricity, going backwards. would ever change. Second, as Paul Kelly environmental crisis (GEC) and just because water and sometimes toxic chemicals. The WWF estimates that we currently has famously sung “from little things, big it is no longer centre stage doesn’t mean the Biological and chemical waste must be need about 1.3 earths to supply the things grow”5. If anaesthetists can reduce crisis is over. disposed of in ways that do not endanger resources for our current lifestyles and at their ecological footprint, other groups Sustainability current or future generations. Theatre the existing rate of consumption we will may take note and either be shamed or The GEC is a crisis of sustainability. air-conditioning and ventilation consume need two earths to sustain us by about challenged into action. Much like a single Sustainability refers to an economic and massive amounts of energy. Further, a 20303. In other words we will soon be bacteria ballooning into a large colony on social way of life that can be continued ad hospital itself is like any other business. Its looking for another planet to provide the a plate of agar, action by anaesthetists has infi nitum without degrading ecological commercial activities consume resources resources we require. the potential to rapidly spread throughout systems and thereby compromising the and create greenhouse gases. So how does the provision of health care the health care sector. ability of future generations to meet Quantifi able impacts fi t into this picture? The Material Health I am advocating that instead of their needs. For the specifi c practice of anaesthesia there Report found that the NHS in England and despairing and continuing with the status In short, it is about the Earth’s capacity is currently not enough published data Wales has a footprint of 4.9 million global quo, we should act now and begin to reduce to cope with our way of life and it is available to make a meaningful estimate of hectares (gha) where one global hectare is the boot size of our anaesthetic footprint. one hectare of biologically productive space becoming increasingly clear that the human our impact on the environment. The overall References: race is living beyond the Earth’s means. impact of the health care sector is similarly on earth. To put this into perspective, the UK has a total footprint of 317 million gha, 1. Royal Society for Nature Conservation, 2004, The evidence is undeniable. Issues such as diffi cult to estimate accurately. Material Health. A mass balance and ecological peak oil, climate change, rising food prices, Most of the information about the Australia 157 million gha and the US 2,803 footprint analysis of the NHS in England and 2 and the collapse of entire ecosystems health care sector’s impact is not peer million gha . Wales, Jenkin, N (ed), Best Foot Forward Ltd, such as the Murray-Darling basin are reviewed or referenced. Some comes from If you divide the total biologically Oxford, United Kingdom just a few of the obvious symptoms of companies complete with commercial bias, productive area of the earth by the world 2. WWF, 2008, Living Planet Report 2008, Hails, the GEC. The continuing rapid growth of the units used vary between metric and population you get 2.1 gha available for C (ed), Gland, Switzerland the world’s population, combined with imperial, and the units themselves vary each person alive in 20054. In comparison, 3. WWF, 2008, Living Planet Report 2008, Hails, the industrialisation of the world’s most between volumes and weights, the way of the NHS uses 0.09 gha per-capita, England C (ed), Gland, Switzerland pg 3 populous nations, means that the GEC is determining “per patient” fi gures varies and Wales 5.39 gha, Australia 7.8 gha and 4. WWF, 2008, Living Planet Report 2008, Hails, only going to get worse. and the case load of individual hospitals is the US 9.4 gha. For a stark contrast, China C (ed), Gland, Switzerland pg 14 4 Climate change is, in essence, a rarely discussed. Further, the data is often only uses 2.1 gha per-capita . 5. Kelly, P, 1991 “From little things, big things sustainability problem. It is caused by based on information from the last century Thus, the NHS per-capita footprint uses grow”, Comedy, Mushroom records, Australia the unsustainable use of fossil fuels and that, given the rapid changes in health care 4.3% of the global available footprint per unsustainable land use practices. It is a delivery systems in the last 10 to 20 years, is person and its total impact contributes 1.7% Dr Stephen Lightfoot, FANZCA problem that requires urgent attention. unlikely to be accurate today. to the UK’s global footprint. Given that the So who cares about healthy functioning The best current estimate of the overall proportion of GDP spent on health care in Master of Environmental Management ecosystems anyway? We all should. We impact the health care sector has on the Australia is similar to the UK (just under (MEM) from the UNSW. need a healthy environment to sustain our environment comes from the 2004 Material 10%) and that our standard of patient care NSW Councillor on the Federal Council way of life. We need the fresh water, the Health report1. It examined in depth the is also similar, it is likely that our health of the Australian Conservation fresh clean air and the productive soils a ecological footprint of the National Health care system makes a similar contribution of Foundation (ACF). healthy environment supplies. We need the Service (NHS) in England and Wales. around 2% to Australia’s global footprint. wood that grows in healthy forests and the Ecological Footprint Our footprint and the future food that the ocean provides year after To determine exactly what impacts humans The Earth is beginning to struggle under year. Life as we know it depends on are imposing on the environment, the the weight of the impacts of our current these ecosystems. concept of the ecological footprint has been way of life. The human ecological footprint Anaesthesia and the environment developed. It measures the area of has already exceeded what is available on How are we, in our professional lives as biologically productive land and sea our planet and unless either our lifestyles anaesthetists, contributing to this GEC? required to provide the resources we use change or population growth ceases the It is apparent that we do have an impact and to absorb the waste we create. Using Earth’s prognosis looks grim. because the practice of anaesthesia is this concept, the World Wide Fund for The health care sector makes a small by necessity an activity that consumes Nature (WWF) Living Planet Report 2008 but signifi cant contribution to the GEC. large amounts of resources and produces shows that we are currently turning Obviously we as anaesthetists make an even

32 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 33 ADVERTISEMENT

FEATURE: IN THE FIELD Right: Darren Wolfers with a satisfi ed customer, taken day two post-VSD repair in Port Moresby General Hospital. Honours for Operation Open Heart in Papua New Guinea

Operation Open Heart was established in 1986 by the Seventh Day Adventist Hospital Left: Matthew Crawford in Wahroonga NSW, to deliver open heart with Papua New Guinea Prime Minister surgical procedures for populations in Sir Michael Somare and the South Pacifi c. The teams comprise one of the ICU nurses, cardiology, cardiothoracic surgical, Margaret Bresnahan perfusion, anaesthetic and nursing from Sydney Children’s personnel as well as a post-operative Hospital. recovery team. Some larger teams have biomedical, physiotherapy, radiology and pathology support. Most of these areas receive service provision, with minimal educational training for the local anaesthetists perform most of the closed country that is struggling to meet basic medical personnel. procedures such as PDAs. We help them for health care needs, is a waste of precious Funding for the projects is derived from shunts and coarctations and pacemaker resources, and that was certainly much of multiple sources, including AusAid, host insertions. The Australian team mainly the criticism that was levelled at the project country governments, Australian and local performs open heart surgical cases, for the in the early days. The spin offs, however, donors, including Rotary, airlines and other most part ASDs, VSDs, Fallot’s tetralogy, have been one of the main benefi ts to transport organisations, medical suppliers Anomalous Pulmonary veins and valve PNG. These have included a development and the Seventh Day Adventist Hospital. All reconstructions or valvotomies. Most of an ICU service, with nurses trained in team members take leave from work and patients are children or young adults mechanical ventilation, dramatic changes pay their own airfare, but they are provided with children. We do not do any “lifestyle to blood bank screening and supply of with meals and accommodation. diseases” such as coronary artery grafting. factors, improvements on pathology, In 1993, a decision was made to include Selection for the program involves radiology, computing, air conditioning, gas Papua New Guinea as a destination, as it working closely with the local medical supplies and electricity supplies, as well as was felt that of all the sites visited, PNG teams, both adult and paediatric. A the retention of key staff members within National Scientific Congress of the would be the most likely to be able to cardiologist visits PNG one week before the public sector, that will continue to Australian Society of Anaesthetists develop its own program, with the support the main team and ECHOs about 200–250 develop health care in PNG long after of the strong local medical school. The patients and selects 50–60 patients for us we are gone. emphasis of this program has always been to evaluate. Cases are chosen on the basis This year a number of long-term education. After some initial indifference that they will spend one day in the ICU, members of the PNG Operation Open from the PNG government and the refusal thus not blocking another patient from their Heart team, including two anaesthetists, of the health department to provide us operation, have a “low mortality” risk, be were awarded Independence Day Honours with the same health care workers we had able to live a normal or markedly improved awards by the PNG Governor General. already trained in surgery, anaesthesia lifestyle afterwards, and be a valuable They were Matthew Crawford, Insignia of and post-operative care, a dramatic change resource for their family and the PNG the Member of the Order of Logohu (“ML”) 5th-8th September 2009 occurred when the government was unable population as a whole. Repeat operations for 15 years of service and Darren Wolfers, to provide even minimal support for the are generally not offered unless there has Insignia of the National Logohu Medal project. At that stage the Director of the previously been an unsatisfactory result. (“LM”) for nine years of service. Darwin Convention Centre Port Moresby General Hospital went on PNG is the only project site that has This has certainly been one of the most national TV and radio and appealed to the managed to train a group of medical and challenging and rewarding experience of local community, as well as the corporate nursing staff to be able to perform cardiac our time in medical practice, and we would For the latest information on the NSC 2009 in Darwin, please visit sector, for funding. The response was surgery by themselves. With their ability urge others to become involved in these amazing, with more money being donated to perform closed work, they can deal with outreach projects. Being able to work in www.asa2009.com to the project within 48 hours than the half of the surgical load required. This year a situation where everyone has the same government had in the previous fi ve years. we have managed to have the surgical and goal, no clipboards, minimal if any hospital Since then the project has taken on a anaesthetic staff spend one year in Chennai, politics, and being able to sit down at night life of its own, and has become India, undertaking continued training in with your work mates for dinner, a beer or important politically. “open heart” surgical procedures. Our focus glass of wine, has much to recommend it. Keynote Speakers This year marked the 15th year of the will now be on further training them in project in PNG. Over 550 cases have been bypass surgical techniques with the hope Matthew Crawford Prof. John Sear Prof. Mark Warner Dr. Archie Brain performed, with a mortality rate of less that one day they will be able to master this Director of Anaesthesia & Surgery, Nuffield Dept. of Anaesthetics, Mayo Clinic College of Medicine, FFARCSI, FRCA (Hon), FANZCA (Hon), than 1.9%. The last three years have been process by themselves. Sydney Children’s Hospital University of Oxford, Oxford, UK Rochester, Minnesota, USA Seychelles mortality free, with an average of 60 cases One can argue that developing highly FANZCA, FJFICM, FFPMANZCA being done each week. Local surgeons and complex surgical services in a Third World Dr. Orlando Hung A/Prof. Pam Macintyre Dr. John Loadsman Dalhousie34 The ANZCA University, Bulletin Halifax,March 2009 Canada Royal Adelaide Hospital, Adelaide, SA Royal Prince Alfred Hospital, Sydney, NSW The ANZCA Bulletin March 2009 35 FELLOWSHIP AFFAIRS The CPD Program CPD Program Flowchart Your questions answered

Participation in a CPD program has now could assist the private practitioner in been mandated by ANZCA from January gaining important quality assurance Application Enrolment Start of Participation 2009 for all practising Fellows. The new activities and credits. Not necessary for Fellows

38 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 39 FELLOWSHIP AFFAIRS – OPINION The sceptics guide to mentoring

Dr Greg Downey

There is a strong push in our medical work; skill rehearsal; improved ability to fraternity, and others, to foster communicate and career development. So what is it? professionalism among our trainees. But can mentoring actually achieve all Classically, it refers to personal and Concepts such as honesty and integrity, this? The evidence is not strong, and most professional development by a wise and practicing ethically and dutifully, positive studies are poorly designed. trusted guide. There are multiple roles communicating effectively and A systematic review in JAMA of 39 papers3, ascribed to mentors such as advisor, coach, empathically are being advocated in order many of which had methodological teacher, listener, counselor, resource to produce responsible, accountable, caring limitations, revealed the following facilitator, etc. But essentially mentoring individuals who are able to contribute as advantages attributed to mentoring: has two major functions: provision of role well as benefi t from their roles in medicine. • Greater career satisfaction than those models and perspective. Producing anaesthetists with the above without a mentor. A role model is simply a person we look up to, someone whose thoughts and attributes sounds like a tall order, but • Greater satisfaction with training. the implementation of techniques such actions we admire and wish to emulate. • Important in career advancement. as mentoring may go some way towards Identifi cation of, and with role models is promoting these issues in addition to • Likelihood of promotion. a natural process, something that occurs providing support for our trainees. Mentoring has also been shown to throughout life and that infl uences, not For some of us, the concept of mentoring infl uence: only our approach to life, but in fact how we may seem like a good idea. But for many, • Selection of a speciality4. develop as a society or organization7. it can appear foreign and an unnecessary • Interest in academic medicine5,6. Perspective: there are multiple situations indulgence. Most senior anaesthetists will A survey of registrars in our institution in life and work where we are stressed, have had little, if any, experience of it, (all of whom are mentored) was unable angry, confused or frustrated. In such and could perhaps be excused for having to demonstrate improvements in specifi c situations it’s diffi cult to see the wood It is interesting to note that in general, or house. However, it may be desirable 6. Steiner JF, Curtis P, Lanphear BP, Vu KO, Main opinions such as: skills such as problem solving, judgment, for the trees. The mentor can provide the the mentors chosen are the “likely in order to produce individuals who act DS. Assessing the role of infl uential mentors • “We didn’t need it in my day”. management of error, confl ict resolution, environment in which to step back and take candidates” – consultants with an outgoing professionally, who have a rewarding in the research development of primary care a considered look at the situation with a fellows. Acad Med. 2004;79(9):865–872. • “Surely trainees can manage their stress management and interest in personality, interest in others and with career and who are making a contribution view to its resolution. 7. Hazzard WJ. Mentoring across the professional own affairs”. research, among others. However, there a proven track record of success in their to the community. These are blatantly old- was overwhelming support for the careers and personal lives. Instruction is fashioned notions. But, if we look around us lifespan in academic geriatrics. J Am Geriatr • “Why can’t we stick to the hard facts of Soc 1999;47:1466–1470. program in terms of its ability to support How can it be put given on how a mentoring relationship is set at those who have the most fulfi lling lives in education instead of this touchy-feely and encourage, manage transition, job into practice? up, how to conduct meetings and regular our fraternity, it may be that these and other nonsense?”. Dr Greg Downey satisfaction and career development. In In our institution, a department meeting handouts on topics of interest. No formal ‘noble’ attributes underpin that fulfi llment. So, if we and our predecessors didn’t need addition, there have been a number of training is given and mentors are expected In addition, personal experience and simple Anaesthetist, it, then why is it becoming popular now? determined that there was a need to teach instances where the mentor has been able professionalism and that mentoring to rely on their own abilities to foster the observation tell us that these are the very Westmead Hospital, There are a number of possible to step in and help to manage confl ict, relationship, something made somewhat characteristics that our patients value in us. New South Wales explanations: could be an effi cient way to achieve this. stress or breakdown. A coordinator was given responsibility easier by the fact that trainees choose If a mentoring relationship can contribute • Mentoring has become commonplace in The lack of adequate evidence for its for the program and a committee was them as role models. Nonetheless, the to this, it may be of signifi cant value. the business world as a means of nurturing effectiveness might make one wonder why relationship between mentor and trainee set up incorporating people who had References and supporting potential protégés. bother. But perhaps mentoring does not demonstrated an interest in personal and does not happen overnight. It requires at lend itself well to academic study. Our least a moderate amount of time and effort. 1. (Dickson DE. Stress. Anaesthesia 1996; 51: • There is strong intuitive appeal in terms professional development. All members 523–4.) of support for our colleagues and the trainees say that the mentoring program To be effective, a bond of trust between of the department were asked about their 2. (Seeley HF. The practice of anaesthesia – a organisation and promoting self-respect provides acknowledgment, back-up and, willingness to participate as mentors and, mentor and trainee needs to develop, just more importantly, the assurance that there as in any relationship. Once that bond is stressor for the middle aged? Anaesthesia 1996; and personal fulfi llment. surprisingly, none declined. Information 51: 571–4.) is someone at a senior level that has their established, a long term association of • Management of stress. Trainee was provided by the coordinator to mentors interests at heart. Just as in any relationship, benefi t to both parties results. 3. Sambunjak D, Straus SE, Marusic A. Mentoring anaesthetists have been identifi ed as and trainees at the outset and continuously in academic medicine: a systematic review. these are diffi cult concepts to study. a group that are regularly exposed to regarding the functions and logistics of JAMA. 2006;296(9):1103–1115. Can we be sure that mentoring, as Conclusion stressful situations1 and should have a an effective mentoring relationship. The 4. Medina-Walpole A, Barker WH, Katz PR et compared to other forms of personal A mentor is not a prerequisite for system of support2. committee decided that all trainees were al. The current state of geriatric medicine: development, is the best method of to take part in the program and they were advancement or success, and mentors do A national survey of fellowship trained Supporters in the medical fraternity supporting our trainees? Mentoring, in fact, asked to choose three consultants who not have any magic powers to fashion great geriatricians, 1990–1998. J Am Geriatr Soc suggest a multitude of advantages such is only part of the overall development of they looked to as role models. Most were individuals. But they are concerned with 2002;50:949–955. as: improved emotional literacy; better the individual, which is based on multiple given their fi rst choice. Each consultant making the most of human potential and 5. Riechelmann, Rachel P.*; Townsley, Carol A. handling of confl ict and the consequences inputs, good and bad. What it does provide was limited to no more than two trainees. with aiding trainees to be successful in MD, MSc*; Pond, Gregory R.†; Siu, Lillian L. of error and mishap; better integration into perhaps, is “at the coal face” management The participants are asked to meet at least their own right MD The Infl uence of Mentorship on Research the medical community; better handling of evolving issues, which any number of monthly in order to establish a relationship In truth, nobody actually needs to be Productivity in Oncology. Am J Clinical of the frustration, disorientation and Oncology. Volume 30(5), October 2007, preemptive courses and disciplines may such that when needed, the mentor is the mentored, just as nobody really needs disillusionment that can confound medical pp 549-555 prove inadequate for. one to turn to. This happens in most cases. that extra slice of pie or that expensive car

40 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 41 FANZCA Module Sign-Off International Medical ANZCA’s Education and Training Committee reiterates how Modules should be signed off, particularly if a Module is done at more than one hospital. Graduate Specialists This information is aimed at Module Supervisors and Supervisors of Training as well as trainees.

The ANZCA training program currently Apart from the fact that modules 1-3 this with the trainee, the module supervisor The introduction of ANZCA’s new moves towards national registration comprises fi ve years of approved must be completed during basic training, can do a partial sign-off, that is, he or she International Medical Graduate Specialists in Australia. supervised clinical training, (Basic the modules do not have to be completed can sign and date a page of the portfolio, (IMGS) process from January 2009 follows A number of new documents have been followed by Advanced), Primary and Final sequentially, neither were they designed to together with the hospital and dates of the an extensive review over the past two years. posted on the ANZCA IMGS website. Minor Examinations, an EMST or EMAC course be done as dedicated rotations (except for term, documenting that some of the module The new process is aimed at being more but important changes have been made to and a program of twelve modules. The ICU Module 9, which requires minimum one requirements have been met. defi nitive, with introduction of a workplace- the IMGS documents already on the website. modules form the syllabus. month blocks). It is possible to complete based assessment in lieu of an examination The new process clarifi es IMGS entering Module sign-off on completion a module over several terms in more than for some candidates, taking into account temporary Area of Need positions or Once a trainee feels they have fulfi lled the one training site. This allows fl exibility trends internationally, nationally in both entering the IMGS process directly. Module 1 Introduction to Anaesthesia requirements for completion of a module, for the trainee as well as departments. Australia and New Zealand, including and Pain Management they should seek out the relevant module ANZCA accredited departments should supervisor, with their learning portfolio, Module 2 Professional Attributes have a module supervisor appointed for any and spend some time together reviewing it. module for which it is possible for a trainee Key points • “Partially Comparable” are people who Module 3 Anaesthesia for Major and The trainee needs to be able to validate to gain experience. At the start of a rotation, • To be considered “Substantially are recognised as IMGS, but judged Emergency Surgery that they have completed the specifi c the trainee should seek out the relevant Comparable” to FANZCA, an IMGS must to need up to 24 months of additional clinical experience, have self-assessed that have had substantially comparable supervised training, plus examination, Module 4 Obstetric Anaesthesia module supervisors, meet with them and they have achieved the core aims (and their training and assessment to FANZCA. The and workplace-based assessment in and Analgesia discuss what the trainee’s clinical and own goals as set out in their learning plan) educational needs are in order to meet some curriculum must be comparable to that order to achieve recommendation for Module 5 and that they have completed any module- Anaesthesia for Cardiac, or all of the core objectives for the modules of ANZCA, carried out in institutions specialist recognition and eligibility to specifi c assessments. Once satisfi ed that Thoracic and Vascular Surgery for which they are seeking experience. which meet standards set by the apply for FANZCA. the trainee has confi rmed all these with accrediting body, following two years Module 6 Neuroanaesthesia The module supervisor should assist the • Defi nition of IMGS is a medically qualifi ed the module supervisor, they both sign the of post MBBS Prevocational Medical trainee in setting some realistic goals within person who has undergone specialist Module 7 Anaesthesia for ENT, Eye, Module Completion Form K. This must also Education and Training (PMET). The a specifi ed time-frame and oversee their anaesthesia training in their own country, Dental and Maxillofacial Surgery be countersigned by the Supervisor duration of anaesthesia training must be progress. A learning plan should then be graduated, and become eligible to work as of Training. at least fi ve years of structured training Module 8 documented in the learning portfolio. a specialist in that country. Paediatric Anaesthesia A module supervisor can recognise leading to a qualifi cation recognised Module 9 Intensive Care Progressing through a module prior module experience from another term by national government agencies as • Continuing Professional Development The trainee has to record their clinical or rotation, provided there is suffi cient qualifying the individual for specialist Module 10 (CPD), (with satisfactory evidence), Pain Medicine – experience in their learning portfolio. This evidence of such in the portfolio and the anaesthesia practice. Assessments is a requirement for consideration of Advanced Module is not just the number of lists or sessions other module supervisor has signed it. must include regular in-training classifi cation of both substantially Module 11 Education and (some modules specify a minimum Overall, however, module sign-off is not formative assessments, and summative comparable and partially comparable. number of clinical sessions). Ideally, just about completing a number of sessions examinations in both basic sciences Scientifi c Enquiry • Those IMGS who have received two years the trainee will have entered case mix, or cases, it is a demonstration by the trainee and clinical/professional practice. All Module 12 of post MBBS Prevocational Medical Professional Practice degree of supervision, skills learned, and that they have been exposed to a suffi cient candidates require 12 months of Clinical Education and Training and completed any signifi cant learning points, and then depth and breadth of clinical experience in Practice Assessment under oversight a three- or four-year specialist qualifying relate this range of experience to the core a particular area, that signifi cant learning and a workplace-based assessment The College Professional Document program in their country of origin may trainee aims of the module. In addition, has occurred, that knowledge has been to be eligible for recommendation for pertaining to the modules is TE2 – Policy have considered by the Interview Panel their learning plans, refl ection on their acquired and skills have been gained. specialist recognition and ability to on Vocational Training Modules and one year of additional post-specialist experiences and some evidence of self- Evidence of refl ective practice is a sign apply for FANZCA. Module Supervision. Some modules are assessment is desirable. of development of a professional attitude qualifi cation training under supervision specialty specifi c, others comprise a that needs to occur throughout one’s career • “Not Comparable” is the classifi cation in a tertiary/academic institution. number of subspecialties. Each module Partial module completion for those IMGS not meeting the criteria as a specialist. • Assessors for workplace-based groups learning objectives with learning At the end of the rotation, the trainee in the fi rst point who are judged on assessment, Areas of Need on-site experiences such as clinical exposure and should once again meet with the module paper assessment, or by the IMGS Dr Genevieve Goulding assessment and Clinical Practice requisite knowledge, skills and attitudes. supervisor. The experience gained during Interview Panel as being unable to Assessment visits may claim credits Modules 2 and 12 are assessed online. the term may or may not be suffi cient ANZCA Councillor achieve the standard required of a under the ANZCA CPD program. Module 11 requires completion of a Formal to complete the module. There may be College Fellow within two years. These Project, signed off by a Formal Project insuffi cient sessions (if a minimum number IMGS still have the ability to seek to Enquiries regarding the IMGS process Offi cer, under the terms of TE11, Policy on has been specifi ed), the core aims may satisfy AMC requirements, to enter the should be directed to Jill Humphreys or the Formal Project. Trainees may be eligible not have been met, the planned goals may ANZCA training program, and to request Renee McNamara at jhumphreys@anzca. for an exemption from the Formal Project not have been achieved, or the amount of recognition of prior learning. edu.au or [email protected] after as per TE11. This requires an application experience may just not be enough to satisfy visiting the College website www.anzca. in writing to the Director of Professional all the objectives (knowledge, skills and edu.au/imgs-aon/ Affairs Assessor. All other modules are attitudes) necessary for completion. If this signed off by a module supervisor. is the case, having reviewed the contents of Professor Garry Phillips the learning portfolio, and having discussed Chair, IMGS Committee

42 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 43 FELLOWSHIP AFFAIRS – FEATURE Pigs, burns and curly tails

In the early 1970s, the Burns Unit at the • A clear airway may be diffi cult to maintain The only possibility was to somehow uneventfully back into the panel van and Royal Children’s Hospital in Melbourne in a pig. Manoeuvres such as chin-lift get the pig to turn round and present his home to Werribee. was suddenly faced with the management and jaw-thrust are problematic, and buttocks to me at the open window at the Flushed with success and now armed of a number of children presenting with endotracheal intubation is made diffi cult back of the panel van. Sweet talking and with a proven approach, we prepared for extensive full-thickness burn injuries. This by the airway taking an acute, almost 90° cajoling failed, but shoving and prodding the next pig to arrive the following week. prompted a renewal of interest in the use turn just beyond the vocal cords. fi nally got the buttocks within range and On its arrival in the back of the panel van, of fresh pigskin as a temporary cover for There was limited information on how I prepared for action. Using a stabbing I was confronted with a new pig and a new burn wounds. pigs react to anaesthetic agents commonly motion, reserved for intramuscular problem relayed to me by the lone driver. While early debridement and split skin used in humans. Two points were of injections into violent and uncooperative En route to the hospital from Werribee autografts offer the best form of wound concern: adults, I plunged a hypodermic needle and passing through Footscray, the driver’s coverage, this approach is limited in deep into the nearest buttock and emptied assistant noted that the pig was trying to • Pigs are susceptible to malignant massive burns by the lack of donor sites my preloaded syringe of 1 g ketamine — climb out of the open window at the back of hyperthermia, not only in association available to obtain split skin for grafting. hopefully into a gluteal muscle — before the panel van. The van was stopped and the the ears was easy and endotracheal with anaesthetic agents but even with make unruly behaviour even less likely. The aim of temporary cover of burns quickly moving to a safe distance away. driver and his assistant attempted to push intubation diffi cult. signifi cant exercise and stress. Landrace Droperidol was in fact given on only one sites with pigskin is to reduce excessive The pig was angered by this assault, but the now almost fully extruded pig back into I anaesthetised 10 piglets in total, with pigs are particularly susceptible to occasion: 10mg intramuscularly 30 minutes fl uid loss, act as a barrier against burns the ketamine soon took effect and he fell on the panel van. only one untoward event: one piglet had a stress, and risk becoming “roast pork” if before departure to the hospital. The pig wound sepsis, protect the wound from his side, adopting an air of sweet repose, Unfortunately, the pig fell out onto the short episode of profound hypoxaemia and suffi ciently stressed. arrived calm and awake, even tranquil. We, mechanical trauma, and help control pain. although snoring loudly, indicating some ground, injuring the leg of the assistant however, remained apprehensive, being appeared to have a somewhat “cerebral” Plans to obtain pigskin were made with • Pigs are much more sensitive than degree of airway obstruction. driver, and then escaped into suburban unsure what this pig was really thinking. grunt for the fi rst 24 hours after surgery, but some degree of urgency. The State Research humans to non-depolarising muscle- Much haste was now required. Four able Footscray. The assistant was taken to a local We anaesthetised three pigs in total and then reverted to behaving in a normal Farm at Werribee agreed to supply a pig relaxant drugs. These drugs need to be bodies, myself included, quickly lifted the hospital while the driver, with help from the harvested skin was used as temporary piggy way. to the hospital, on a weekly basis, for titrated carefully to avoid the need for unconscious pig out of the panel van and some local council workers, eventually got skin cover to good effect. It was said that the The research study on the piglets harvesting of a large split skin graft taken prolonged positive-pressure ventilation. placed him on a sheet on the ground. He the pig back into the van and fi nally to children’s appetites improved, even to the did not produce any breakthroughs in from one side of its body. This would be Armed with this knowledge, I prepared was then rapidly hosed down before being my care. extent that one child reportedly “would now surgical practice, but did demonstrate performed under anaesthesia by a member an anaesthetic machine, some intravenous transferred to a clean sheet. By lifting the In response to this incident, the State eat almost anything”. This is, of course, that pericardium is probably not a suitable of the surgical staff. We were also informed equipment, drugs, masks and intubating sheet at each corner, we carried our snoring Research Farm sternly warned us they purely anecdotal and I fi nd it diffi cult to material to bridge the gap in that these were valuable “pathogen free” equipment in the animal laboratory pig hurriedly into the hospital. The noisy, would send no more pigs unless we sedated attribute this observation to the nature of the oesophagus when repairing pigs and were to be returned alive and operating room. This room was on the fi rst obstructed, breathing pattern intensifi ed them before departure to ensure the health the temporary skin cover used. oesophageal atresia. intact (minus, of course, the split skin fl oor at the rear of the hospital and it was as we ascended the stairs to the animal and safety of the driver, his assistant, the Soon after these three successful There was very little science in my pig from their side) to the research farm after here, on the fi rst morning, that I nervously laboratory. Appalled at the thought of panel van and the pig. anaesthetics, a Surgical Research anaesthesia experience either, except the procedure. awaited the arrival of the attendants with having to assist breathing en route with How best to sedate a pig for a journey Fellow arrived at the hospital keen to for one important observation that All that was needed to complete the plan my fi rst “patient’’. mouth-to-snout ventilation, we quickened across Melbourne in a panel van? Clinical start a research project on oesophageal sadly remains little known even today. was an anaesthetist. I was selected for the When they failed to arrive in the our pace. I was greatly relieved to fi nally pharmacology was in its infancy in the atresia, using piglets as an animal model I discovered that when piglets were task not on the basis of any experience, operating room and I was called to go to the get the pig onto the operating table, where 1970s, and conclusions drawn from human Unfortunately, being now regarded as the adequately anaesthetised (ie, did not skill or knowledge, but primarily because goods delivery laneway at the back of the I was able to deliver 100% oxygen via a studies and applied to animals were risky. pig anaesthesia expert in the hospital, I respond to surgical stimulation), their of my junior status within the Department hospital, it suddenly became apparent to conical face mask, suction the nose and What was needed was a drug that would once again found myself seconded to the curled tails became straight. I took it on of Anaesthesia. In addition, it seemed that me that my role was to be larger than I pharynx, and thus restore a clear airway. calm the pig and take away its desire animal laboratory to anaesthetise pigs. myself to call this the “Mullins sign”, with all the other members of the Department had anticipated. I deepened the anaesthesia by adding to escape but not sedate excessively. These, however, were piglets, weighing only the hope of making a name for myself in the had suddenly developed an intense interest In the laneway was a panel van and halothane to the oxygen delivered from the At that time there was much interest in about 8 kg each, and were much less of a paediatric porcine anaesthesia literature. in vegetarianism, animal rights, Judaism or beside it were the driver and his assistant, anaesthetic machine and then placed a the anaesthetic literature in the drug challenge. In fact, it soon became almost a But despite quite brazen self-promotion of any other cause they could fi nd that would both anxious to get my signature for the large intravenous cannula into one of the droperidol. pleasure to anaesthetise these happy little this sign over the past 30 years, the Mullins preclude them being selected. delivery of a pig. I peered into the back of pig’s superb ear veins. I then attempted Droperidol had been used to treat severe piglets. They were small enough for me to sign has failed to receive due recognition. Having no knowledge of pig anaesthesia, the panel van and was confronted by my to intubate the trachea. This proved very agitation in psychotic patients. It was said carry to the operating theatre in my arms. With the acceptance of this article for I consulted what literature I could fi nd on fi rst view of my patient — a snorting, smelly, diffi cult, and after multiple attempts I to produce marked tranquillisation and If they squealed or struggled, which usually publication by the MJA, I can now say with the subject and gleaned the following: very grubby pig with an excess of oral and fi nally succeeded by using a malleable wire sedation, allay apprehension and provide a occurred only when I started to anaesthetise a mixture of pride and humility that the • Pigs can never be considered fully fasted nasal secretions and weighing about and then passing a cuffed endotracheal state of mental detachment and indifference them, they would immediately become Mullins sign is fi nally “in the literature”. for anaesthesia. They always have a 100 kg. His aggressive stance and demeanour tube over the wire. while maintaining a state of refl ex alertness. quiet if, with one hand, I held them upside Geoffrey C Mullins, MBBS, FANZCA, potentially “full stomach”, with its indicated clearly that there would be no My greatest fear throughout the Just what we wanted in our pigs! However, down by their hind legs. Then with my attendant risk of vomiting and aspiration cooperation with any medical procedure. procedure was that the pig would develop there had been some disturbing reports other hand I would place the anaesthetic Perth, WA. under anaesthesia. If fasted in an My approach to pig anaesthesia required malignant hyperthermia. The thought of of the drug causing a state likened to a mask over their snout and anaesthesia Mullins Geoffrey C. Pigs, burns and curly tails. enclosure, they will eat their faeces if a hurried revision. There was no way this pig my patient becoming roast pork kept me “locked-in syndrome”, with marked inner induction would take place calmly. The MJA 2008; 189 (11/12): 666-667. ©Copyright 2008. hungry. After all, they are pigs. was going to proffer me one of his ears, with nervously vigilant. turmoil experienced by the patient despite induction was so calm and smooth I have at The Medical Journal of Australia – reproduced The skin harvesting went well, and after the external appearance of calm. There was with permission. • Pigs have excellent veins in their ears, its excellent veins, and allow me to establish times been tempted to try this technique on emergence from anaesthesia the pig was no time for trials, and we reasoned that, if suitable for cannulation and intravenous intravenous access and then administer uncooperative small children. As with adult transferred, in a somewhat dazed state, the pig did indeed feel locked in, this would induction of anaesthesia. drugs to render him more compliant. pigs, intravenous cannula placement in

44 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 45 Quality & Safety

for and mitigation of a crisis; and response basis over the next two years. The regulators 35 Figure 1 and Bruce Corkill QC regularly advise the PICC lines re-visited – at all levels. used on the current large cylinders will not College on legal matters in Australia and Episode 3 An appendix (page 29) lists patient fi t the new pin indexed cylinders and must 30 New Zealand, and in conjunction with the categories to assist in prioritisation of red be changed. members of the ANZCA Quality and Safety In response to concerns related to PICC blood cell transfusions. 25 Committee they have very kindly prepared lines (expressed by Queensland Health It is recommended that every Two annexes deal with: two documents advising on the relevant as well as being highlighted by Dr Philip Anaesthetic Department and Intensive 20 legislative issues. These can be seen on the Ragg in The ANZCA Bulletin, March 2007 A. Red Blood Cell Response, and Care Unit request that the gas supplier Quality and Safety section of the ANZCA and December 2008), a letter from the B. Plasma Products Response: plasma- for their hospital contact them a week 15 website, under Legal Matters. Therapeutic Goods Administration (TGA) derived and recombinant product before their conversion date so that they The ANZTADC program has been was received by Professor Barry Baker on response plan can be prepared and cooperate with the 10 registered as a protected Quality Assurance

19 December 2008, outlining results of change-over. patients Injuries / 10,000 The plan is well worth reading, Activity in Australia and New Zealand, and investigation into reports of adverse events. 5 especially noting the levels of alert for appropriate ethics committee approvals are The outcome is a planned improvement clinicians and the actions they should Hospitals with bioengineering being sought. In New Zealand there will of manufacturers’ instructions about the 0 take or be involved in (white alert / yellow departments should also ensure that All <70 >70 MF M<70 F>70 be one application nationally (and this is use of PICC lines as well as advice on the activate / red activate / green deactivate) bioengineering are notifi ed of the Patient Group in progress). In Australia, ethics approval risks of trimming PICC lines. To view the and the guidance for prioritisation of (red changeover plans. is not required for an approved quality letter in full (Alert: Result of the Therapeutic blood cell) transfusions (priority 1 includes Problems Cardiac and Thoracic Surgeons database assurance activity but may be required Goods Administration (TGA) investigation resuscitation, emergency and urgent Failure to convert free-standing D, E, F or between 2001 and 2007, we sought to defi ne for national publication of the results. into adverse event reports about PICC surgical support, and non-surgical anaemia G cylinders used around the wards and on the local incidence and outcome from ANZTADC is in the process of applying guidewires) please go to the ANZCA link: which must be treated). mobile ventilators may jeopardize patients TOE-related complications, and assess any for ethics approval at the pilot test sites. www.anzca.edu.au/news/announcements See www.nba.gov.au/nbscp who require oxygen. possible risk factors, such as age or sex. The situation will become clearer when A review process of the Contingency Plan Small pipelines supplied from cylinder Figure 1 summarises the key fi ndings. the responses of the ethics committees National Blood is already underway. banks may lose supply if the changeover is Overall, the incidence of TOE-related and hospital administrations at the pilot Supply Contingency not coordinated. complications was higher, at 9 per 10,000, sites are known. This quality assurance Garry Phillips Backup cylinder banks with AS240 Type with a mortality rate of 2 per 10,000. protection for ANZTADC incident reporting Plan – 2008 South Australia 10 connections used with liquid oxygen Patients aged over 70 years had a relative in both countries prevents the disclosure In December 2008, the National Blood supplies may not be replaceable if there is risk of 3.7 compared to those under 70 (95% of any information that would identify an Authority released its National Blood Changes to Medical a failure. CI 1.2-11.7). Women had a relative risk of 6.5 individual practitioner or patient. This also Supply Contingency Plan, approved by compared to men (95% CI 2.0-21.1). Females applies to court proceedings. In exceptional Australian Health Ministers. It states that Oxygen Connections John Russell over 70 had a relative risk of 22 compared to cases, the health minister may overrule the ‘National Blood Authority (NBA), is Background South Australia men under 70 (95%CI 2-182). the legislation but this would not normally responsible for ensuring that Australians Until now, large medical oxygen cylinders, We concluded that older women apply to legal action against an individual have an adequate, safe, secure and i.e. size D, E, F and G have been supplied The Incidence of have a substantially greater risk for practitioner. The ANZTADC process will affordable blood supply.’ with a screw-thread connection (AS240 TOE-related injury. have considerable protection and also be anonymous, so even for more serious events The plan outlines the risk management Type 10). This connection is also used Transoesophageal Reference: approach taken to assessing the possible on nitrogen, industrial air and argon the legal risk will be low. Nevertheless, the Piercy M, McNicol L, Dinh DT, Story DA, cylinders and occasionally has resulted Echocardiography – decision to report an incident lies with problems, governance arrangements and Smith JA. Major complications related to the use the broad overarching strategies in place in misconnections. Until about 10 years each individual. Related Complications of transesophageal echocardiography in cardiac It should be noted that the ANZTADC to mitigate a supply or demand crisis. It ago, large medical air cylinders were surgery J Cardiothorac Vasc Anesth, 23:62–65 2009. enunciates three levels of accountability: also supplied with an AS240 Type 10 in Victorian Cardiac incident recording and reporting activity screw connection. Mix-ups between air Mathew Piercy is completely separate from local hospital • National incident recording systems and also and oxygen occurred. This problem was Surgery Centres Victoria • Operational solved by providing all sizes of medical air Over the past decade, the Victorian separate to open disclosure requirements of • Clinical – ‘the role of clinicians and cylinders with a pin-indexed connection. Consultative Council on Anaesthetic the state or country in which you practice. pathology providers in managing However, the problem of possible Mortality and Morbidity has received Legislation in relation The ANZTADC program will place demand through strong triage and vetting misconnection of large oxygen cylinders to a small number of case reports of to incident reporting considerable emphasis on analysis of the processes based on clinical needs.’ complications related to the use of reports and on feedback. We hope that nitrogen, industrial air or argon lines and The Australia and New Zealand Tripartite transoesophageal echocardiography (TOE) the majority of anaesthetists will report Each institution is required to have in cylinders with those gases connected to Anaesthetic Data Committee (ANZTADC) in cardiac surgery (perforations or tears of regularly, so that we can all learn from one place an emergency blood management plan oxygen lines remains. is making great progress in setting up the oesophagus or upper stomach). Several each other’s experience and improve to assist all players when supply is short. The Solution a specialty specifi c incident reporting international studies had estimated the patient safety. This is an excellent document which All medical oxygen cylinders will be pin system for use by anaesthetists throughout incidence of TOE-related complications deals with the normal blood sector indexed in accordance with the recent Australia and New Zealand. Many as very low, of the order of 3-4 per 10,000 Alan Merry, arrangements; blood and blood product AS2473.3 amendment. The conversion will anaesthetists have asked about the legal New Zealand cases. Using the Australian Society of Martin Culwick, management; crisis planning; preparation be done by all suppliers on a State by State implications of this activity. Michael Gorton Queensland

54 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 55 QUALITY & SAFETY MHANZ (Malignant Short course in Perioperative Medicine Major complications of central Hyperthermia Group Convenor: Dr Joel Symons neuraxial block: report on of Australia and Date: 21 July–6 October, 2009 (Tuesday) New Zealand) Time: 6pm–9pm the Third National Audit Project Venue: ICU Seminar Room – 1st Floor, Alfred Hospital, Commercial Road, Melbourne, VIC 3004 and the MH Fee: $2400.00 (excl GST) of the Royal College resource kit Suitable for: Medical Practitioners (Anaesthetists, Intensivists, Physicians, Surgeons, Pain Specialists,

Emergency Physicians, General Practitioners) of Anaesthetists Overview: This short course will cover many aspects of perioperative management. Some of the topics will include: Coronary artery disease One of the great frustrations when trying case. The incidence of death or paraplegia MHANZ1 was offi cially formed in November and hypertension, The Cardiac patient for noncardiac surgery, Perioperative cardiac risk assessment & testing, Heart failure, to interpret the reported incidence of was 1.8 or 0.7 per 100,000 respectively. 2004 as a fundraising group for malignant Arrhythmias, Pacemakers and AICDs, Anticoagulants, Antiplatelets & Thromboprophylaxis, Blood Transfusion Medicine, Airway a complication in our speciality is the Further, two-thirds of the injuries hyperthermia (MH) research and testing management, Sleep apnoea, Pulmonary disease, Endocrine disorders, Obesity, Allergies & anaphylaxis quality of the basic data. The numerator resolved fully. throughout Australia and New Zealand. is often derived from voluntary reporting, ‘Mining the data’ reveals further The group collaborates in many areas of Why you should participate: retrospective surveys or analysis of information. CNB includes epidurals research and meets once a year to review Surgical patients are getting older and sicker. Many Clinicians caring for surgical patients are challenged by the growing closed claims data. The denominator and spinals as well as combined spinal- the latest clinical and diagnostic advances complexity of these patients, particularly their perioperative management. Pre-admission clinics are responding, and is often a ‘best guess’ derived from epidurals (CSE) and caudals in the in this specialised fi eld. perioperative medicine is becoming an emerging fi eld. This course will address defi ciencies in this area. the funding statistics of hospitals perioperative, obstetric and chronic pain All members are directly involved in This course will be conducted by Monash University (School of Public Health and Preventative Medicine), in conjunction with the and insurers. These limitations are situations. Perioperative epidurals were research and in-vitro contracture testing Alfred Hospital’s Department of Anaesthesia and Perioperative Medicine (Director Prof Paul Myles). accentuated when the incidents being associated with a higher incidence of for MH. Anaesthetic members of MHANZ For further information please refer to http://www.med.monash.edu.au/epidemiology/shortcrs/2009. studied occur less frequently as is the complications (8 and 17 per 100,000, best include Robyn Gillies (Vic), Elaine Langton case with serious complications following and worst case, respectively) and CSE (NZ), Philip Nelson (WA), Neil Pollock (NZ), central neuraxial blockade (CNB). To this techniques accounted for 13% of permanent Margaret Perry (NSW), Neil Street (NSW), statistical uncertainty is added a ‘clinical injuries and deaths yet were only 6% of Mark Waddington (NZ) and Rob Whitta (NZ). uncertainty’ in the interpretation of case CNB performed. Although obviously the MHANZ has developed the MH resource reports for a procedure as complex as use of these techniques in this situation kit with the help of expert opinion, epidural anaesthesia, which integrates may simply refl ect an older, higher-risk literature review and international individual judgement and skills, intricate population than, for example, the obstetric guidelines. The crisis task cards for the delivery systems and an interaction with patients. Sub group comparisons must be kit were the original idea of the Southern broader hospital systems. A failure of any made with caution and may not be valid. Health Simulation and Skills centre2. These component or combination of components The article and an accompanying have been modifi ed after simulation testing may result in patient injury and ascribing editorial2 make very informative reading. by the MHANZ. The Australian and New ANZCA Education Innovation Funding 2010 causation can be extremely diffi cult if However, the Clinical Reviews of the project Zealand College of Anaesthetists endorsed not impossible. published online by the Royal College of the resource kit in 2008. Request for Proposals • The track record of the investigators, in particular the ability to Against this background, the Third Anaesthetists are even better.3 The clinical The resource kit is designed as a guide The ANZCA Education and Training Committee has established deliver high quality work according to specifi ed timeframes. National UK Audit Project of the Royal aspects of the project are reviewed by and a practical memory aid and it has been Education Innovation Funding to support small workplace- • Value for money to the College. College of Anaesthetists on Major complication type and indication, with prepared for a typical MH case. It is still the based projects with modest budgets that are directly relevant to Complications of CNB is an extraordinary individual case studies and quantitative responsibility of the practitioner to look at the ANZCA Training Program. • Quality of the evaluation plan. achievement.1 This is the largest ever analysis as well as expert comment. The the circumstances of each case and whether A request for proposals is now being made for projects Proposals must be received in electronic format (MS Word or reported prospective audit of complications learning points are then highlighted. the application of all or some of the advice investigating education innovation within the ANZCA Training PDF) as an email attachment, including signatures by all named following CNB with a unique and ‘robust’ The individual risk-benefi t analysis, in the kit is appropriate. The resource kit Program by Departments of Anaesthesia, Fellows and/or researchers by 5pm AEST on 1 June 2009. Late or incomplete data base. The denominator data were which underpins clinical decision making can be downloaded from the website www. registered Trainees of ANZCA. The total quantum of funding for applications will not be accepted. obtained from a census, which achieved a and subsequent informed consent, is malignanthyperthermia.com.au or from the always going to be complicated and diffi cult college website www.anzca.edu.au (search 2010 is $40,000AUD. Proposals will be reviewed, in de-identifi ed format, by two remarkable 100% return rate from all NHS where CNB is involved. We are well assisted, term – malignant hyperthermia). reviewers selected by the Education Innovation panel. Funding hospitals in the UK! Closing date for proposals: 1 June 2009 at 5pm. however, by reliable resources such as this will be made available on 1 January 2010, with a fi nal project The numerator was derived from a 1. Address for correspondence: quite awesome project from the UK and The 2010 funding priorities are: report due by 1 February 2011. comprehensive audit of major reported MHANZ Group, complications over a 12-month period led its report. • Workplace based assessment for ANZCA Trainees. c/o Dr Robyn Gillies, Successful proposals will be subject to a formal project by a network of local reporters in every Department of Anaesthesia and Pain • ANZCA clinical teacher support and agreement which will include funding and reporting timelines; hospital, supplemented by reports from Patrick Hughes Management, Royal Melbourne Hospital, development initiatives. and Intellectual Property (IP) rights. Potential applicants should Grattan Street, Parkville 3050. other specialties such as radiology and Victoria note that the College will be required to retain IP for any project A detailed proposal and a letter of support from any involved neuro- and spinal surgery. This was further Phone: +61 3 9342 7540 results relevant to the ANZCA Training Program. Researchers Departments should be submitted. Each proposal must include cross referenced against litigation and References: [email protected] may present their results or offer them for peer reviewed www.malignanthyperthermia.com.au a detailed project plan, budget and a statement that ethics indemnity fund databases supplemented by 1. Major complications of central neuraxial block: publication, with appropriate acknowledgement and the committee approval will be sought. The proposal should also literature and internet searches. report on the Third National Audit Project of 2. Southern Health Simulation and prior permission of the Chair of the Education and cover the following selection criteria: Refl ecting the uncertainty and ambiguity the Royal College of Anaesthetists Skills Centre, Training Committee. inherent in assessing some of the case T. M. Cook, D. Counsell, J. A. W. Wildsmith, and Moorabbin campus, • Relevance and other benefi ts to the ANZCA Training Program, Please submit enquiries and proposals to: reports, the results are reported both on behalf of The Royal College of Anaesthetists Monash Medical Centre, particularly in the identifi ed priority areas. Third National Audit Project Centre Road, The Education Development Unit ‘pessimistically’ and ‘optimistically’, but in BJA 2009 102: 179-190. East Bentleigh, Victoria 3165. • Originality of the innovation. Australian and New Zealand College of Anaesthetists either case are generally very reassuring. 2. Central neuraxial block: defi ning risk more 630 St Kilda Road, Melbourne Victoria 2004 With a denominator of over 700,000 cases Phone: +61 3 99288314 • Appropriateness and feasibility of the project methodology. clearly D. J. Buggy BJA 2009 102: 151-153. T: +61 3 8517 5361 the incidence of permanent injury following brendan.fl [email protected] E: [email protected] CNB was 4.2 per 100,000 cases in the worst- 3. Available from http://www.rcoa.co.uk/ www.southernhealth.org.au/simcentre/ case scenario or 2.0 per 100,000 in the best

56 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 57 LIBRARY UPDATE Library update International news and resources

Clinical pain management: Cancer pain / A Surgical Safety Checklist to Reduce General anaesthesia versus local 3. Patient safety initiatives ECRI Institute notices Sykes, Nigel [ed]; Bennett, Michael I [ed]; Morbidity and Mortality in a Global anaesthesia for carotid surgery (GALA): 4. Enhancing physician involvement The ANZCA Library subscribes to ECRI Yuan, Chun-Su [ed]. – 2nd ed – London: Population / NEJM a multicentre, randomised controlled in quality and safety improvement publications on Operating Room Risk Hodder Arnold, 2008. Implementation of the checklist was trial / Lancet 2009; 372: 2132-42 initiatives Management and Health Device alerts and associated with concomitant reductions in Conclusion: There was no defi nite Clinical pain management: Chronic Available online at: information. Check this space regularly for the rates of death and complications among difference between general anaesthesia and http:// pain / Wilson, Peter R [ed]; Watson, Paul updates on the latest information produced patients at least 16 years of age who were local anaesthesia for carotid surgery, with www.jointcommission.org/ J [ed]; Haythornthwaite, Jennifer A [ed]; by ECRI. undergoing noncardiac surgery in a diverse decisions to be made on an individual basis. NR/rdonlyres/433B9886-F95E- Jensen, Troels S [ed]. – 2nd ed – London: 40B8-B25A-FE521D34E936/0/ Recent notices include: group of hospitals. Available online Hodder Arnold, 2008. via the ANZCA Library PhysiciansandTheJointCommission.pdf • Device alerts on various anaesthesia kits, Available online at: http://content.nejm. Journal List anaesthesia units, and breathing circuits Clinical pain management: practice org/cgi/content/full/NEJMsa0810119 Value-Based Anesthesia / Cyberchondria: Studies of the Escalation in anaesthesia. and procedures / Breivik, Harald [ed]; Anesthesiology Clinics, Vol. 26, No. 4, of Medical Concerns in Web Search / Book donations • Executive Summary on warming cabinets. Campbell, William [ed]; Nicholas, Michael International Anesthesia Research Dec 2008 Thanks to Dr David Brown and the K [ed]. – 2nd ed – London: Hodder Arnold, Society (IARS) 2009 Annual Meeting Ryen White; Eric Horvitz Contact the ANZCA Library for Articles include: Royal Hobart Hospital Department of 2008. Registrations are now open: http://www. Cyberchondria encompasses symptoms further information. • Is it possible to measure and improve Anaesthetics, and Dr George Waters for iars.org/congress/annualmeeting.asp of non-medically trained people using the Cousin & Bridenbaugh’s neural patient satisfaction with anesthesia? recent signifi cant book donations to the World Wide Web to fi nd health information blockade: in clinical anesthesia and ANZCA Library. New technologies and FDA Alerts Public about Danger of Skin and self-diagnose, thereby increasing • How much work is enough work? Results pain medicine / Cousins, Michael J [ed]; Numbing Products anxiety. from a survey of US and Australian Carr, Daniel B [ed]; Horlocker, Terese T online tools The U.S. Food and Drug Administration has Available online at: Anesthesiologists’ perceptions of part- [ed]; Bridenbaugh, Phillip O [ed]. – 4th ed http://research. Evidence-based Anesthesia case log tracking issued a Public Health Advisory alert about time practice and part-time training – Philadelphia: Wolters Kluwer / Lippincott microsoft.com/research/pubs/view. made easy potentially serious and life-threatening practice corner aspx?type=Technical%20Report&id=1595 Available in hardcopy Williams & Wilkins, 2009. side effects from the improper use of skin at the Clinical Practice Guideline Handbooks iPhone or iPod Touch users can now use an application for anaesthesia case log Essentials of neuroanesthesia and numbing products. Transformation of the Intensive Care ANZCA Library. The Library has collated a list of handbooks Unit (TICU) Measures [Collection] / tracking. iAnesthesia: Case Logs was neurointensive care / Gupta, Arun K; Available online at: http://www.fda.gov/ on developing clinical guidelines. ANZCA VHA Inc designed by anaesthetists and allows the Gelb, Adrian W. – Philadelphia, PA: Elsevier bbs/topics/NEWS/2009/NEW01947.html Notice to New Zealand Library staff are always happy to assist with Care and Communication Quality evidence-based practice and development user to track case information such as Saunders, 2008. Fellows and trainees patients and equipment. Major complications of central neuraxial Measures [Set] of clinical guidelines. Obstetric anesthesia and uncommon A core collection of anaesthetic textbooks Available online at: http://www.caselogs. block: report on the Third National Available online at: http://www.anzca. disorders / Gambling, David R [ed]; Sepsis Quality Indicators [Set] is available for loan from the New Zealand org/index.php/iphone-app/ Audit Project of the Royal College of edu.au/resources/library/research-tools.html Douglas, M Joanne [ed]; McKay, Robert S http://www.qualitymeasures.ahrq.gov/ offi ce of the College. Please check the library Anaesthetists WinkingSkull.com F [ed]. – 2nd ed – Cambridge: Cambridge Browse/DisplayOrganization.aspx?org_ catalogue via the ANZCA Library website. Cochrane Library Training Dates T. M. Cook, D. Counsell, and J. A. W. WinkingSkull.com is an interactive study University Press, 2008. id=1896&doc=9953 for 2009 Wildsmith on behalf of The Royal College aid on human anatomy. Sign up today for The Cochrane Collaboration/Australasian Oh’s intensive care manual / Bersten, of Anaesthetists Third National Audit Analgesia and anesthesia for the free access to material on all areas including Cochrane Centre offers workshops on topics Andrew D [ed]; Soni, Neil [ed]. – 6th ed Project. British Journal of Anaesthesia 2009 breastfeeding mother / Breastfeed Med the upper and lower limbs, neuroanatomy, such as developing a protocol, diagnostic – Edinburgh: Butterworth-Heinemann 102(2):179-190. 2006 Winter;1(4):271-7 (Guideline) head, neck and back. Available online at: accuracy and analysis in capital cities Elsevier, 2009. Major recommendations cover: http://www.winkingskull.com/ Available online via the ANZCA Journal list around Australia. • Analgesia and anaesthesia for labour Timetable available online at: http:// Ultrasound guidance for nerve blocks: principles and practical Interventional procedure overview of • Postpartum anaesthesia www.cochrane.org.au/training/timetable.php New titles ultrasound-guided regional nerve block / implementation / Marhofer, Peter. – • Anaesthesia for surgery in Anaesthesia and intensive care A-Z: Oxford: Oxford University Press, 2008. NICE Available online at: breastfeeding mothers New databases an encyclopaedia of principles and http://www.nice.org. Westmead anaesthetic manual / Padley, uk/nicemedia/pdf/661_Ultrasound-guided_ • Specifi c agents used for anaesthesia CareSearch is an online resource that can practice / Yentis, Steven M; Hirsch, Anthony. – 3rd ed – North Ryde, NSW: regional_nerve_block_for_web_230708.pdf and analgesia help clinicians fi nd relevant evidence about Nicholas P; Smith, Gary B. – 4th ed – Contact details for the New Zealand Edinburgh: Churchill-Livingstone, 2009. McGraw-Hill, 2009. Available online at: http://www.guideline. palliative care and trustworthy resources WHO Guidelines for Safe Surgery offi ce are as follows: gov/summary/summary.aspx?view_ Available online at: http://www. Board stiff three: Preparing for the Available online at: http://www.who.int/ New Zealand National Committee caresearch.com.au id=1&doc_id=11232 (ANZCA) anesthesia orals / Gallagher, Christopher J. Contact the library patientsafety/safesurgery/knowledge_base/ PO Box 7451 PROQOLID – Patient-Reported Outcome – 3rd ed – Philadelphia, PA: Butterworth Web www.anzca.edu.au/resources/ WHO_Guidelines_Safe_Surgery_ Physicians and the Joint Commission – Wellington South and Quality of Life Instruments Database Heinemann Elsevier, 2009. (Book; DVD) library fi nalJun08.pdf The Patient Safety Partnership Available online at: 1. The role of the physician in New Zealand Clinical pain management: Acute pain / Phone +61 3 8517 5305 http://www.proqolid.org/ The Joint Commission Phone (04) 385 8556 Macintyre, Pamela E [ed]; Walker, Suellen Fax +61 3 8517 5381 M [ed]; Rowbotham, David J [ed]. – 2nd ed – 2. Focus on patient safety – accreditation Fax (04) 385 3950 London: Hodder Arnold, 2008. Email [email protected] process, standards and performance Email [email protected] measurement

58 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 59 Supervisors of training and trainees 1 at an Orientation to Anaesthesia, Regions held on Friday, February 27 2009 at the College. 1. Dr Abhay Umranikar, Dr Michael Shaw and Dr Tony Leaver. 2. Dr Rachel Shanks, Dr Liam Broad, Dr Auday Hasan and Dr Ravi Ramadas. 3. Dr Rick Horton and Dr Maggie Wong. Australian Capital Territory Tasmania Victoria New ANZCA offi ce ANZCA will have new headquarters in the 2 3 Australian Capital Territory (ACT) with the opening of an offi ce at 6/14 Napier Close in Deakin. A new Regional Coordinator has also been appointed. Vena Murray commenced working with ANZCA on March 10. Vena was formerly the CEO of Swimming Australia. Conferences Two conferences are being held in Canberra this year: the very popular Floriade Conference in September and the SPANZA ASM to be held at the end of October. The theme is ‘New Frontiers in Paediatric Anaesthesia’. More details about both of these conferences will be distributed in the coming months. South Australia / Northern Territory Clinical teaching workshop Joint ANZCA/ASA Committee and Presidents: The new year commenced with the fi nal Trainees Dr Damian Castanelli An all-day workshop was conducted as Back row from left: Dr Mark Reeves (Chair, full-time course for advanced trainees. The Obstetrics and Paediatric Anaesthesia Supervisor of Training The 25th short course on intensive care part of the Tasmanian Regional Committee ANZCA Tas.), Dr David Brown (Treasurer course was well attended and included Training Scheme (OPATS) 2010 Department of Anaesthesia medicine was held on February 25–27 at (TRC) combined ANZCA / ASA Annual ANZCA/ASA Tas.), Dr Richard Waldron trainees from around Australia. Applications are invited for a position in the Monash Medical Centre Ayers House in Adelaide. Fifty-two intensive Scientifi c Meeting. Mary Lawson (Director (Treasurer ANZCA), Dr Stuart Day (Chair, above training scheme which is coordinated Phone: 9594 6666. care trainees attended. The course is aimed of Education at ANZCA) gave a series of ASA Tas.) Dr Stephen Reid (Director of Key event dates: through The Royal Women’s Hospital, Anaesthesia, Royal Hobart Hospital), Dr Chris Email: Damian.Castanelli@southernhealth. at trainees who are preparing for the JFICM practical teaching workshops. The theme Courses Monash Medical Centre and The Royal Wilde (Chair, Trainee Committee Tas.). org.au Fellowship Examination and includes of the meeting was effective feedback and April 6, 8, 15, 20: Primary Trial Orals Children’s Hospital. Applicants should Front row from left: Dr Susannah Sherlock tutorials and sessions on the written assessment. It complimented a dedicated May 11, 13, 18, 20: Final Trial Orals have completed 24 months of accredited Important Dates for Obstetrics and (ANZCA Committee), Dr Leona Wilson examination, vivas and hot cases. Despite registrar workshop on effective feedback May 11–22: Primary Full-time Course anaesthesia training and hold their Paediatric Anaesthesia Training Scheme increasing the number of places available, (President of ANZCA), Dr Liz Feeney (OPATS) 2010 held two days previously as part of the (President of the ASA), Dr Lia Freestone Continuing Medical Education (CME) Part 1 FANZCA. this course continues to remain heavily same ASM. The timely combination of Applications open: May 30 2009 (Secretary of ANZCA/ASA Tas.), Dr Andrew and events This training scheme is aimed at providing oversubscribed. these workshops will be very useful for Mulcahy (ASA Vice-President). April 29: Matthew Chan (ANZCA House) – sub-specialty training experience in Applications close: July 3 2009 translating some of what was learnt into A Continuing Medical Education (CME) Topic: ‘Hot Air – Full Steam Ahead’ obstetric and paediatric anaesthesia for everyday clinical and teaching practice. Interview (to be held at ANCZA House): meeting was held on February 18 at the trainees in their third or fourth year of Departmental directors, supervisors of May 16: Airway Workshop for Fellows and July 30 2009 Women’s and Children’s Hospital (WCH) in accredited anaesthesia training. All posts training and interested clinical teachers trainees (ANZCA House) Adelaide. The title of the meeting was ‘An are accredited with ANZCA. Email applicants interim selection results: attended the workshop. Anaesthetic Sojourn’. The guest speaker was July 25: ASA/ANZCA Combined Meeting August 6 2009 The next clinical teaching workshop is Dr Haydn Perndt and Dr Steve Kinnear (Sofi tel, Melbourne) – Topic: ‘Anaesthesia OPATS positions for 2010 will not be scheduled for mid-year in Launceston. was presented with the Gilbert Brown Right Now – A Clinical Update’ advertised in the newspaper in 2009. For Email applicants fi nal rotations: information about selection for the 2010 September 18 2009 Award from the Australian Society of Registrars workshop September 25: Anaesthetic Registrars program and/or an application form (once Anaesthetists (ASA). As part of the February ANZCA/ASA Victorian Trainee Committee Scientifi c Meeting (ANZCA House) applications open), please contact: Combined ASM, Tasmanian trainees were A new committee was created in February invited to participate in a half-day seminar Details and registration forms can be found Dr. Maggie Wong and it is organising a mentor or buddy with the ANZCA’s Director of Education, at www.vic.anzca.edu.au/training Supervisor of Training system to promote the welfare of trainees. Mary Lawson. A good-humoured afternoon Department of Anaesthesia An orientation to anaesthesia was held on session concentrated on trainees receiving The Royal Women’s Hospital 27 February at the College. The event was feedback and actively seeking feedback Phone: 8345 2000 well attended by trainees and supervisors from supervisors. Trainees were also Email: [email protected] of training. updated on the current projects of the Education Development Unit and had an opportunity to ask questions about the College.

62 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 63 Regions Continued

Dr Jodi Graham with Anaesthetic Trainees Queensland New South Wales Western Australia during Part Zero Course. Part Zero Course – ‘Zero to Hero’, an Humphreys, Executive Offi cer of IMGS Professor Garry Phillips visited the ANZCA introduction to anaesthesia Accreditation at ANZCA, were on hand to Sydney offi ce in early February to conduct The Part Zero Course is held annually for liaise with delegates. The meeting also a Workplace Based Assessment workshop. trainees. This year’s course convenor, Dr gave delegates the opportunity to meet and Dr Leonie Watterson assisted Prof Phillips Chris Breen, brought together a varied discuss issues with others facing similar explain the new program to the NSW program covering ten topics, presented by a circumstances. Regional Committee. devoted and willing group of anaesthetists. OTSAN endeavour to hold three A Clinical Teaching Course workshop Topis covered included: the role of ANZCA, ‘education meetings’ annually. The next “Teaching in Small Groups” will be run the Australian Society of Anaesthetists meeting will be held in Brisbane on the in the Crows Nest offi ce in late March. (ASA), QARTS, the training program and weekend of July 18–19. The September This full-day workshop will explore ways modules, passing the primary exam, welfare venue is yet to be confi rmed. in which small groups can be used as of anaesthetists, managing consultants, If you would like further information a method of teaching anaesthesia. The formal projects, surviving ICU and exam regarding OTSAN, please contact Dr Rajesh activities and discussion will focus on preparation courses. Brijball at [email protected] developing understanding of small group Thanks to all the presenters for their dynamics and strategies to promote contribution: Dr Jeremy Brammer, Dr Anton ANZCA/ASA Combined CME Committee maximum participation of all group Loewenthal, Dr Tim Wong, Dr Mark Gibbs, of Queensland – 12th Annual Queensland members. Dr Genevieve Goulding, Dr David Belavy, Registrars Meeting The Part II Refresher Course In Dr Joe Power, Dr George Pang, Dr Gamini Twelve registrars presented their Formal Anaesthesia was conducted at Royal Prince Projects at the 12th Annual Queensland Wijerathne and Dr Chris Breen. Alfred Hospital from February 9–20. The WA Part Zero Course Registrars Meeting held on Saturday, Dr Chris Breen has produced an two-week full time course was run for those The 2009 Part Zero Course, convened by February 28 at the ANZCA Queensland information booklet of the day. If you would trainees presenting for their Final Fellowship the Group of ASA Anaesthesia Clinical offi ce. A diverse range of subjects like a copy, please contact Linda Cuffe at Examinations this year. The course was Trainees (GASACT) Senior Representative were covered. the ANZCA Queensland Offi ce: qldevents@ fully subscribed to, culminating on the fi nal Dr Ana Licina, was held at the Western Dr Matthew Bryant and Dr David anzca.edu.au day of the course with an anatomy day at Australian offi ce on Thursday, January 29. McCormack were announced as the winners Sydney University. Courses planned for the Coinciding with their orientation week, Overseas Trained Specialist of the Tess Cramond Prize. Dr Cramond remainder of this year include: 15 fi rst-year trainees attended the course. Anaesthetists Network (OTSAN) made a speech (her last offi cial engagement May 4–15: Primary Refresher Course In The aim of the course was to provide OTSAN is an organisation formed by as she retired on March 1, 2009) and Anaesthesia (Royal Prince Alfred Hospital) trainees with an introduction to the Overseas Trained Specialist Anaesthetists presented the doctors with their certifi cates. anaesthetic program – where to start, in 2006 as a non-profi t, self-help group, Dr Mark Gibbs, the Regional Education October 12–23: Primary Refresher Course In what to expect and a few hints on fi nding aiming to facilitate professional and social Offi cer and Director of Anaesthesia Anaesthesia (Royal Prince Alfred Hospital) their feet. integration in Australia. The aim is to at Ipswich Hospital, organised a new Date to be advised for the Part Zero Sponsored by Schering-Plough, the assist in the areas of the FANZCA exam, perpetual plaque with the title of ‘Introduction to Anaesthesia’ Course afternoon began with lunch and was immigration and visas, jobs and industrial ‘Supporting Hospital of the Tess Cramond followed by an introduction by Dr Licina relations, liaison with local and national Prize Winner’. The plaque was presented to This year the NSW ACE Committee is and the ANZCA WA Trainee Committee bodies, integration and social networking. the Cairns Hospital this year. planning two major education meetings. Deputy Chair, Dr Emelyn Lee. OTSAN met on February 21 and 22 at Dr Diana Khursandi presented the Axxon On August 8 at the Sydney Hilton Hotel we Thanks to Dr Suzanne Bertrand, Dr Rob ANZCA House in Melbourne. Delegates Health Prize to Dr Marc Maguire. The ‘ASA will be hosting a day meeting on “Oxygen”. Edeson, Dr Lindy Roberts, Dr Jodi Graham, from South Australia, Northern Territory, Chairman’s Choice Prize’ was awarded to Dr This will encompass everything about Dr Daniel Ellyard and Dr Kevin Hartley for Tasmania, Victoria, New South Wales and Marc Maguire and Dr Nick Hutton. oxygen from its storage and delivery in the GASACT Chair Dr Ana Licina with their participation. Queensland attended, making this OTSAN’s Dr Sarah Greenwood received a special hospital to the mitochondria in cells where Part Zero Sponsor Barry Weinmann from Schering-Plough. tenth education meeting and its most mention for her interesting presentation it gets used and all the potential problems successful yet. on communicating with the deaf. Dr with delivery inside and outside the body Dr Sanjay Sharma, based at Ballarat Andrew Jorgensen presented his projects as on the way. Later in the year, on November Hospital, convened the meeting and Principal House Offi cer and also received 14–15, we will be hosting our fi rst weekend organised a contingent of capable speakers a special mention. Presentations were also meeting in Wollongong. In conjunction with to present a broad base of educational made to Drs Petra Millar and Mark Dilda, a committed group of local anaesthetists, topics over the two days. Dr Rajesh Brijball, Merit Winners of 2008. we will be running the weekend meeting on president of OTSAN, and Dr Sanjiv Sawhney preoperative assessment, a subject that has were also involved with the organisation relevance to all anaesthetists whatever their of the meeting remotely from Queensland. fi eld of practice. We are also investigating Dr Michael Steyn, originally from Scotland the feasibility of one or two evening and Director of Anaesthesia at the Royal meetings throughout the year, with the Brisbane and Women’s Hospital, and Jill dates, venues and topics yet to be decided.

64 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 65

Regions

Continued

College representatives in Wellington for a meeting with the new Minister of Health, Hon Tony Ryall. Professor Alan Merry (ANZCA Councillor) Dr Leona Wilson (ANZCA President) and Dr Vanessa Beavis (Chair of New Zealand the ANZCA New Zealand National Committee). ‘GUMNUTS AND JOEYS’ Delivering Anaesthesia in the Bush important issues regarding this proposal and these have been submitted to MCNZ. 23 – 25 July 2009 Hunter Valley Submissions and consultations

NZNC has been involved in the following Following on from the success of the Rural Special Interest Groups Inaugural Conference ‘the Accidental Intensivist’, it is consultations and submissions this year. with pleasure I wish to announce the 2nd Annual Rural SIG Conference to be held at the Crowne Plaza, Hunter Valley. • Medical Training Board discussion papers

The meeting will provide an update for all doctors (Specialists and GP's) providing anaesthetic services for obstetric • PHARMAC (Crown pharmaceutical management agency): Proposal to patients outside metropolitan areas. The program will include best practice updates for routine patients as well as amend restrictions on musculoskeletal reviewing management of the more common obstetric emergencies (including the obstetric perspective) and a neonatal pharmaceuticals and to reduce the resus workshop. subsidy for EC aspirin

• Ministry of Health (MoH): nominations So mark the dates in your diary as it would be unfortunate to miss this invaluable opportunity to network with your fellow and or applications for the Perinatal and rural practitioners in this magnificent location with all it has to offer. Maternal Mortality Review Committee for the one vacancy for a member with I look forward to seeing you there. knowledge of Pacifi c Island health. David Rowe, Convenor • Ministry of Health (MoH) Maternity Action Plan 2008–2012 Matters raised with the New Zealand Medical Council of New Zealand (MCNZ) REGISTRATIONS ARE NOW OPEN! Minister for Health, Hon. Tony Ryall – meeting with the MCNZ CEO and staff • Medical Council of New Zealand (MCNZ) The President of ANZCA, Dr Leona Wilson, involved in IMGS assessment consultation: Draft statement for doctors on the subject of advertising For further information please contact Marta Dziedzicki e [email protected] Professor Alan Merry, New Zealand and supervision Councillor, Dr Vanessa Beavis, Chair of On February 13, the ANZCA President, Dr • Clinical Training Agency: Purchase t +613 9510 6299 or visit www.anzca.edu.au/fellows/sig/rural-sig/2009-rural-sig-conference NZNC, and Heather Ann Moodie, New Leona Wilson, the Director of Professional Intentions 2009/10 Zealand Executive Offi cer, met with the Affairs, Professor Garry Phillips and • PHARMAC consultation document: Minister for Health on February 17. members of NZNC and staff held a meeting “Relevant Practitioner” Pharmaceutical THE RURAL SPECIAL INTEREST GROUP with the Medical Council CEO and staff Perioperative Mortality Schedule defi nition in the New Zealand offi ce to discuss the Australian and New Zealand College of Anaesthetists Review Committee • PHARMAC: Request for nominations for new ANZCA process for International Australian Society of Anaesthetists ANZCA has been working with the Ministry clinical advisors on volatile Anaesthetics Medical Graduate Specialists (IMGS) New Zealand Society of Anaesthetists of Health, RACS, RANZCOG and JFICM for assessment, including the workplace-based • MoH Report on the HPCA Act Review a number of years to have a perioperative assessment. ANZCA is keen to ensure that • MCNZ consultation document: The mortality review committee established. The Rural Special Interest Group Conference this new process can fi t in with MCNZ IMGS proposed use of practice visits (periodic ANZCA strongly urged the Minister to ‘Gumnuts and Joeys’ Delivering Anaesthesia in the Bush assessment processes. assessment of performance) as part support this important initiative. The meeting was very constructive and a of CPD Protected Quality Assurance number of issues were clarifi ed. Supervision • MCNZ: Proposed new framework for the - CHANGE OF VENUE NOTICE - Activities (PQAA) arrangements for IMGS were also discussed. supervision of international medical Last year NZNC applied to the Ministry Supervision of IMGS graduates (IMGs) of Health for PQAA status for activities The Medical Council is seeking ANZCA’s • Health & Disability Commissioner (HDC) Please note that that due to recent flight cancellations to and from Norfolk Island, the Venue for the 2009 undertaken as part of the ANZCA CPD opinions on the supervision process for Review of the Act and Code Rural Special Interest Group conference has changed. The meeting will now be held at the Crowne Program. Approval was delayed because of IMGS who are going through the vocational the Ministry’s review of the HPCA Act and a • New Zealand National Safe Medication Plaza in the Hunter Valley, NSW. The meeting will still be held from the 23-25 July, 2009. registration process in New Zealand, change of government. Approval has been Management programme: electronic especially where the doctor is practising in given for protection of the Australian and prescribing – speciality requirements the more isolated and small centres in The Hunter Valley is one of Australia's premier wine growing districts and also a varied and interesting New Zealand Tripartite Anaesthesia Data • District Health Board NZ (DHBNZ) New Zealand. tourist region in New South Wales. Whether you're a lover of wine and great food, an enthusiast of natural Committee (ANZTADC) which has now Workforce forecasting for anaesthetists beauty and wildlife, or a keen golfer, the Hunter Valley has it all. Less than two hours drive from Sydney been gazetted. The proposed use of practice visits • NQIP Draft Guidance Document: Central (Periodic Assessment of Performance) and 45 minutes from Newcastle Airport, the destination is easily accessible. Workforce issues Venous Catheter-related Bloodstream for all vocationally registered specialists ANZCA briefed the Minister on its current Infections The MCNZ is currently consulting on its demand and supply of anaesthetists If any Fellows would like to read any of Surrounded by picturesque vineyards and its own golf course, the Crowne Plaza offers deluxe hotel and proposal to introduce periodic assessment workforce study in Australia and the discussion documents or the NZNC villa style accommodation and boasts the only full-time, purpose-built supervised space for children of any of performance (PAP) as part of the CPD and foreshadowed a similar study in New submissions, please contact Heather Ann recertifi cation requirements. The ANZCA accommodation in the region, offering indoor and outdoor play equipment, evening cinema and supervised Zealand in 2009. Moodie at the ANZCA New Zealand offi ce CPD Committee and NZNC have raised many activities. via email [email protected].

66 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 67 JOINT FACULTY OF INTENSIVE CARE MEDICINE JOINT FACULTY OF INTENSIVE CARE MEDICINE Intensive Care Dean’s Message Foundation update

It is with great pleasure that I report on the be put in place and also practically, as the from 12–14 June 2009. The title of the The February meeting of the Board of the The ASM will be preceded by the second Intensive Care Appeal 2009 progress made towards the establishment JFICM books are run on a calendar (and ASM is “Energy Crises Large and Small. Joint Faculty of Intensive Care Medicine JFICM New Fellows Conference, which The Intensive Care Appeal will be held of the College of Intensive Care Medicine of not a “fi nancial”) year, it will allow for Metabolism, Microbiology and Sepsis.” was held in the Ulimaroa Boardroom on will be held at Coolum from June 10–11. from April 14–27 with Intensive Care Day Australia and New Zealand (CICM). What clear delineation between JFICM/ANZCA The meeting promises to offer an excellent Thursday, February 26. Dr Leona Wilson, Immediately following the conclusion of taking place on Friday, April 24. The theme follows will, I believe, show that the Board fi nances and those of CICM. Subscription programme of speakers and all the benefi ts President of ANZCA and Dr Peter Hicks, the ASM, on Sunday afternoon (June 14) a for this year’s Appeal is ‘I thank you’ and and staff of JFICM have taken very seriously notices sent to Fellows at the end of 2009 of networking with other Fellows and President of ANZICS, attended the meeting. Supervisors of Training workshop will be gives Australians and New Zealanders the the mandate of the Fellowship to establish will therefore be for CICM’s account, as Trainees. held at the conference venue. opportunity to say thank you to those ICU Admissions to Fellowship CICM within a reasonable timeframe and will any other potential fi nancial call on I warmly invite you all to join us in teams who have saved their lives or that of The Board approved admission of 19 New in a responsible way. Before reporting Fellows to fund CICM. The actual fi nancial Brisbane in June and I look forward to JFICM Medal a loved one. This year merchandise boxes Fellows to the Joint Faculty, including will contain pens only, with key tags and on progress, it needs to be clearly stated requirements to commence operations seeing you there. The Joint Faculty of Intensive Care Medal two who were admitted as Fellows by wristbands available upon request. Pens will that the progress made so far has only are being determined and will inform the is awarded to recognise an outstanding examination in Paediatric Intensive contribution to the specialty of intensive be priced at $3 per item. been possible with the great goodwill and quantum of the 2010 subscriptions and Prof. P.V. van Heerden Care Medicine. All ICUs are encouraged to celebrate the support of both ANZCA and the RACP. the need for a fi nancial call on Fellows. care medicine. The Board enthusiastically Dean, JFICM supported the proposal to award the JFICM Appeal to help raise funds to ensure the Hopefully this will be clearer by the time of Financial Results for 2008 Progress President, CICM Medal for 2009 to Dr Felicity Hawker, who Foundation can continue to fund research the AGM held in Brisbane in June this year. Jess McKay, the ANZCA Director of Finance, As previously reported, the CICM has was the inaugural Dean of the Joint Faculty. well into the future. informed the Board that the fi nal fi gures been incorporated as a body limited by CICM symbols Dr Hawker will be presented with the award If you like further information please for the Joint Faculty’s fi nances for 2008 guarantee, with a robust constitution, The JFICM staff are putting a lot of energy at the ASM dinner. contact Hayley on +61 3 9340 3444 or via should end up being close to budget, which which will serve it well in the future. On into developing a suitable coat of arms [email protected] is an operating surplus of around $85,000. February 27 the current JFICM Board was and a crest for CICM. Once ideas have 2010 Annual Scientifi c Meeting Annual ICU Donation Income for the year was down on budget appointed as the Interim Board of CICM. been developed, then a few designs will Planning is underway for next year’s All ICU Directors across Australia and due to a lower than anticipated income from This will allow both Boards to operate in be presented to the Fellows and Trainees ASM, which is to be held in Sydney from New Zealand will have received a letter examination fees, however this was offset parallel, with gradual transfer of functions to vote on. It is also planned to have a 4–6 June. Dr Deepak Bhonagiri is the encouraging their ICU to make an annual by savings in a number of areas, including from the JFICM Board to the CICM Board competition for the best motto for the scientifi c convener. donation of $1,000 to the Intensive Care staffi ng costs, travel and accommodation. Ms Foundation. This donation will go directly to over the coming months, so that a smooth new College. Upcoming Examinations McKay stressed that at this stage the results research in intensive care. transition is effected. The offi ce bearers Forty-six candidates have entered for the Hong Kong Committee were provisional and subject to audit. This initiative has been brought about due of the CICM Board are P.V. van Heerden, The election of Prof. G. Joynt, from Hong fi rst Fellowship Examination for 2009, to the overwhelming number of requests for President, J.M. Myburgh, Vice-President 2009 Annual Scientifi c Meeting Kong to the Board of JFICM, and now CICM, which will be held in Brisbane, 28–29 May funding received every year. With your help and B. Venkatesh, Treasurer. The new Board Planning for the JFICM 2009 ASM, to be has already paid dividends in that a new (Oral section). The written section will be the Foundation will be able to fund more members have had initial instruction in held in Brisbane from June 12–14 is well Hong Kong Committee has been established held at various locations on 3 April. projects in Australian and New Zealand, their duties, responsibilities and liabilities underway, with registration brochures to foster the interests of Fellows and Ten candidates have entered for the projects that your hospital or colleagues will as directors of CICM and are ready to about to be posted. The theme of the Trainees in Hong Kong. We look forward to fi rst Primary Examination for 2009, which be involved in. take on the challenges that face any meeting is to be ‘Energy Crises Large and the further development of this committee will be held in Melbourne on 1 May (Oral Thank you to those ICUs who have new enterprise. Small’ with a focus on showcasing local for the benefi t of JFICM/CICM in Hong Kong. section). The written section was held already begun supporting this initiative – and international research into metabolism Timelines on 2 March. your donations and commitment are much Trainee Committee and endocrine function as they relate With the above in place, there is now appreciated. For those wishing to fi nd out On a slightly less positive note, the Board to the critically ill. The local organising Honorary Fellowship more, please contact Tracy on +61 3 9340 3444 much hard work to be done to make sure is very concerned about the degree of committee, led by Scientifi c Convener The Board received a proposal to make the or [email protected] the systems that support CICM functions apathy among trainees with regard to Professor Rob Boots, has done an excellent award of Honorary Fellowship to Professor are put into place over the coming 2010 research grants being involved with the Trainee Committee job of assembling an impressive array of Napier (‘Nip’) Thomson in recognition of months – e.g. IT systems, website, human Applications for 2010 Foundation grants (TC). The TC is very important to the speakers, including international keynote his contribution both to the development resources. A suitable site must be found to opened at the end of January with Board, as this is the mechanism by which speakers Professor Djillali Annane, of the Joint Faculty and also to the fi eld of accommodate the new College and be fi tted submissions due Friday 29 May 2009. the Board is kept informed of matters of Dr Frank Martin Brunkhorst and Professor renal and transplant medicine. The Board Application forms and guidelines are out to a suitable standard. Whether to rent interest and concern to trainees. Clearly the Marin Kollef. voted unanimously in support of this available on the Foundation’s website at or buy premises is still under discussion Board can set up the structure for trainee A highlight of the JFICM ASM is the proposal. Professor Thomson will receive www.intensivecareappeal.com and will clearly depend on the resources representation, but is somewhat powerless conference dinner, which includes the his Fellowship at the conference dinner at available to CICM when operations Critical Splash to coerce trainees to take advantage of the graduation ceremony for new JFICM the ASM. commence. All the documents to allow Dr Stuart Lane, Intensive Care Specialist at opportunity to express their views. Trainees Fellows and the presentation of awards. functioning of CICM are being put in place the Nepean Hospital and Senior Lecturer in are invited to discuss any matters that may This year the G A (Don) Harrison medal Critical Care at the University of Sydney, will e.g. regulations, policy documents. There improve the lure of serving on the TC with for the best performing candidate at the be undertaking the “Everest of open-water are many other details which the JFICM any member of the Board or with the JFICM Fellowship Examination will be presented swims”, The English Channel, in August this staff are working hard at getting ready for staff on +61 3 9530 2861. to Dr Edward Litton (May exam) and Dr year to raise funds for the Foundation. when CICM commences operations. It is Sara Allen (October exam). The Oration at To support Stuart visit envisaged that CICM will commence full ASM June 2009 the Graduation Ceremony this year will be www.intensivecareappeal.com to fi nd out how functioning on 1 January, 2010. This date Plans have been fi nalised for the JFICM delivered by Dr Carole Foot. you can help raise much needed funds for has been chosen to allow all procedures to 2009 ASM and AGM to be held in Brisbane intensive care research.

70 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 71 FACULTY OF PAIN MEDICINE Dean’s Message

After diffi cult economic times in 2008, Dr Penelope Briscoe Ten years since the Faculty was formed, applications from many people for I would like to take this opportunity to people were looking forward to the new we have come a long way and this has been Fellowship either by election or through the acknowledge the retirement of Professor year of 2009, but that has been marred in due to the hard work of our Board, and I training program. Two years ago, we added Tess Cramond who has contributed to Australia, once again, with Mother Nature would like to acknowledge in particular, both the Royal Australian College of General Pain Medicine practice for over 40 years. controlling the forces of this massive Roger Goucke and Milton Cohen who Practitioners and the Royal New Zealand Those of us involved in Pain Medicine in country. The fi res in Victoria have been have decided after 10 years on the Board College of General Practitioners to specialty Australasia have all been aware of Tess’s devastating and the fl oods in the north that they need to retire to allow new groups who could apply to do training, enthusiasm and her great success in have also created widespread heartache. young blood to come on and also to allow and once they have passed the process encouraging young doctors in Queensland Attending the College in Victoria during succession planning to occur. I thank go on and be awarded Fellowship. We to undertake Pain Medicine training February, one could tell from the smell of them for their contribution which has currently have three general practitioners through her unit. We wish her all the very smoke in the air, the haze and the red moon been immense and although they are both training. We have also had a number of best in her well-deserved retirement. that things were still not under control. To retiring from the Board I know they are enquiries from other specialty groups and I would also like to acknowledge the all those people who have lost loved ones going to be continuing to contribute to the our regulations state that people who have hard work of all Fellows who contribute to or other precious things, our thoughts are Faculty in a number of ways. an Australasian specialist qualifi cation the Faculty in so many ways. We are a small with you all. As medical practitioners we It is also my pleasure to announce acceptable to the Board can enter training. Faculty and we do need the support of all need to give in whatever way we can to that we had six nominations for the six In addition, for people who have been our Fellows and so, if currently you are not support those affected, be that time, effort vacancies on the Board this year and in practice for a while and do hold an contributing to the Fellowship, please feel or economically. therefore do not have to go to election. The Australasian specialist qualifi cation, we free to contact myself or Helen Morris and With the week of intense heat in South two new Board Members are Raymond have now introduced a new pathway by we will be able to utilise you in some role Australia, and temperatures hitting 47 their training program is also not as Garrick from Sydney, who has been on which they can be granted Fellowship. This for our Faculty. degrees, I was lucky enough to be away in structured as ours and does vary across the Examination Panel for a number involves the candidate applying for election Hawaii attending the American Academy North America, and so I think we, as a small of years and for the last 12 months has via the normal process (see Regulation 3.2). Penelope Briscoe Faculty, can be incredibly proud of the of Pain Medicine (AAPM) Meeting. Seven been the Chair of Examinations, and Guy The Board can decide, after having viewed Dean Fellows from Australia attended their training and assessment process that we Bashford from Wollongong, who has been a the information provided by the candidate, meeting and were all made to feel incredibly have developed for our young doctors. contributor to Pain Medicine in Australasia to elect them directly to Fellowship or to welcome. The AAPM awarded Roger Goucke As part of the meeting there was a Pacifi c for many years. Ray and Guy are both offer them the process by which they can a Presidential Commendation recognising Rim dinner attended by Roger and myself, Fellows of the Royal Australasian College register with the Faculty for six months, leadership in establishing cross cultural several other FPM Fellows and members of Physicians; Ray is a neurologist and be provided with the usual training connections between FPM and the AAPM. of the AAPM and a number of doctors from Guy through the Rehabilitation Faculty, documentation and then, upon completion Nik Bogduk received a Founder’s Award for mainland China, including Professor Han and I think this is extremely timely as we of the examination process and case report outstanding contributions to the science or from Beijing. The aim of this dinner was to as a specialty need to involve our parent process, be granted Fellowship without practice of Pain Medicine. encourage two-way communication so that colleges more. I’m hoping that Ray and Guy, further training. Roger and I were invited to attend the we can all work together to promote the with input from Carolyn Arnold (who was This pathway is to encourage people, AAPM and ABPM Board Meetings and also speciality of Pain Medicine in our countries. re-elected to the Board), can work with the who perhaps have been in clinical Pain their Examination Committee Meeting, and In mainland China, Pain Medicine is now RACP to raise our profi le and to encourage Medicine practise equivalent to at least Colin Goodchild and Roger attended the recognised as a speciality (as in Australia) its younger Fellows to get involved with three years FTE and are unable to go back Editorial Board Meeting. The Faculty started and any teaching hospital over a certain the Faculty. and enter a training program, that they can liaison with the American Academy and the size must have a pain clinic within it. They Leigh Atkinson has been working apply for and be awarded Fellowship by American Board of Pain Medicine (ABPM) have also recently run their fi rst exam and diligently with the Royal Australasian completing the above requirements. As a in 2000 through our journal Pain Medicine. had 600 candidates. However, the pass rate College of Surgeons and, in fact, has Board, we feel we should encourage people The impact factor of this journal has risen for that exam was approximately 30%. negotiated a memorandum of understanding who would like to gain Fellowship, to assess from .68 in 2003 to 2.741 in 2007. North America is yet to have Pain to the sum of $23,500 over the 2009-2011 whether or not they meet our requirements Michel Dubois, the President of the Medicine recognised as a specialty and triennium for a Pain Medicine Program as and then to apply for election with a ABPM attended our examination at St so they are organising a national summit part of their Annual Scientifi c Congress detailed CV and confi rmation of their Pain Vincent’s Hospital in Sydney in November under the guidance of the American Medical This year, the FPM ASM Visitor for Medicine experience and then the Board of last year and was very impressed with the Association, to push the cause of Pain Cairns, Dr Andrew Rice, will be fl ying to can make the decision. whole process and the time and dedication Medicine in the United States. Once again Brisbane to present at the RACS meeting, The examination is a rigorous process put in by all examiners. At this point the Australia can be justifi ably proud of the as will several other Fellows of our Faculty. and does encompass the practise of ABPM believe the cost of transporting that fact that, with the hard work of a number RACS has also linked their website to ours acute, cancer and persistent pain, but the process to North America to be prohibitive. of our Board Members and Garry Phillips so that their Fellows can access a number feedback we have from the candidates who Interestingly, they have approximately 200 (ANZCA Director of Professional Affairs), we of our professional and educational have sat the exam is that they do believe Fellows attending their examination each have been able to attain Australian Medical documents and I would therefore like to that it is fair (but rigorous), and so this year and their examination comprises two, Council recognition of Pain Medicine as a thank Leigh for his tireless efforts in raising new pathway may encourage practitioners three-hour multiple choice question papers. specialty in Australia. We are now working our profi le with the College of Surgeons. who have not met the criteria for election It became obvious in discussion that on the same process for New Zealand. The Board continues to receive previously to reapply.

74 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 75 FACULTY OF PAIN MEDICINE FACULTY OF PAIN MEDICINE News Continued Report from the Board Meeting held on 16 February 2009

likewise admitted as an honourary Fellow Faculties: Rehabilitation Medicine; Public of the Australian Chapter of Palliative Refresher Course Day – Spring Meeting in NSW Regional Faculty Board Health Medicine; Occupational and Medicine (RACP) for her contribution to May 1 2009 Melbourne Committee Faculty of Dr Penelope Briscoe was re-elected as Dean Environmental Medicine; Sexual Health the development of palliative medicine. for a second year. Medicine The Faculty will hold its seventh annual Plans are underway for the Faculty’s Throughout her illustrious career, she Following a recent call for nominations Refresher Course Day in Cairns preceding 2009 Spring Meeting in Melbourne. Pain Medicine Chapters: Addiction Medicine; has been honoured by many bodies in for the Faculty Board, there were six the ANZCA ASM. The meeting theme The theme will be ‘Duelling with Pain’, The NSW Regional Committee Faculty of Palliative Medicine recognition of her contributions to both the nominations for the six vacancies, therefore is ‘Unravelling the Chaos of Pain’. The aiming to strengthen the ties and improve Pain Medicine, having been constituted anaesthetic community and the general a ballot will not be required. The New Liaisons with Colleges program is headlined by international communication between the groups as last year, held its fi rst meeting in February community. The College/Faculty honoured Board will take offi ce following the Annual Professor Michael Murphy, President of the guests, Professors Andrew Rice, Steven we learn to better manage challenging 2009. Issues of importance to trainees and Prof Cramond with the Gilbert Brown Prize General Meeting in May and will comprise: Neurosurgical Society of Australasia, met Passik and Rollin Gallagher, and patients. Contact Marta Dziedzicki, Meeting fellows are being identifi ed. We aim to hold in 1967 and the Robert Orton Medal in with the Board to discuss opportunities for complemented by national leaders in Coordinator via email: mdziedzicki@anzca. a dinner social function for our Fellows * Carolyn Ann ARNOLD, FAFRM RACP, 1987. The Orton Medal is the highest award dialogue and collaboration between the two neuroradiology, pain and addiction edu.au or on +61 3 8517 5308 for more possibly in July which would allow Fellows Victoria the Faculty can bestow on a practicing organisations. Four neurosurgeons have medicine. The registration brochure is information. and trainees to meet in an informal setting * Rupert Leigh ATKINSON, FRACS, Fellow. At a government level, she has now completed training in Pain Medicine available online or by contacting the and discuss FPM issues and understand Queensland been honoured with an Order of the British the role of the committee. An educational and there was discussion about how the Faculty offi ce. * Penelope Anne BRISCOE, FANZCA, Empire (OBE) in 1977, Offi cer of the Order of session is being planned later in the year. A Faculty might become more relevant to South Australia Australia (AO) in 1991 and a Centenary communication bulletin “The Algometer” all neurosurgeons. Federation Medal in 2003. will be published three times a year to keep Christopher HAYES, FANZCA, RACS have included a link to the Faculty Fellows abreast of recent developments. New South Wales and FPM Resources in their recently The committee will also participate in the * David JONES, FANZCA, New Zealand re-launched website. Communications coming AMA Careers Day in conjunction are ongoing to coordinate the FPM ASM Brendan Joseph MOORE, FANZCA, Visitor’s participation in the RACS ASC with Anaesthesia and we hope to raise Queensland the profi le of Pain Medicine and attract in Brisbane. Frank James NEW, FRANZCP, Queensland recruits to the speciality in time to come. The Faculty is developing a document Pain medicine tutorials geared towards the Edward Archibald SHIPTON, FANZCA, in conjunction with RANZCOG promoting fellowship exams under the guidance of New Zealand the value of interdisciplinary and multidisciplinary pain clinics as being best Dr Paul Wigley will commence shortly in ** Guy Michael BASHFORD, FAFRM RACP, practice for the management of pelvic pain. Royal North Shore Hospitals and all New South Wales trainees are encouraged to attend. The working paper on Prescription Opioid ** Raymond GARRICK, RACP, Policy: Improving management of chronic New South Wales non-malignant pain and prevention of * Re-elected unopposed problems associated with prescription opioid ** Elected unopposed use, developed by the Australasian Chapter Dr Roger Goucke and A/Prof Milton of Addiction Medicine with FPM input, has Cohen did not seek re-election and will been published and is about to be launched. retire from the Board in May. The Faculty has provided support to Regions are to be encouraged to form Canadian-based Fellows in their efforts to a Regional Committee and if they are not establish Pain Medicine as a recognised represented on the Board, the Chair of that specialty in Canada. Committee can be invited to attend. Relationships Portfolio Trainee Affairs Physician representation on the Board Portfolio To refl ect the recent reorganisation of the International Medical Graduates Royal Australian College of Physicians and Following advice from the Chair, ANZCA the fact that the predominant physician IMGS Committee, the Faculty has been group in the FPM is rehabilitation medicine, informed that trainees with a UK or it was resolved to revise Regulation 1.1.3 Irish anaesthesia Fellowship who would pertaining to representation on the Board be assessed at interview as having to read: “At least two shall be Fellows of a “Advanced Standing towards Substantially Division or a Faculty or a Chapter of Comparability” to FANZCA may, having the Royal Australasian College of completed at least 12 months training in Physicians (RACP).” a Faculty-accredited training unit within Divisions: Adult Medicine; Paediatrics and Australasia, satisfactory In-Training Child Health Assessments, examination and Case Report

76 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 77 FACULTY OF PAIN MEDICINE Report from the Board Meeting held on 16 February 2009 Continued

requirements, be awarded FFPMANZCA. Alternative Pathway or “Pain Medicine Physician” and this will 2009 Spring Meeting paying subscriptions to both the Faculty However, these candidates will be advised Further to earlier advice that the Board was be explored further as part of a brief on Planning for the Faculty’s Spring Meeting Resources Portfolio and their primary specialty. that they cannot practice anaesthesia exploring reestablishment of the Alternative promoting the Faculty. at the Sofi tel Melbourne, 16–18 October Finance At the February Board Meeting, the within Australasia without meeting the Pathway for applicants for Election to 2009 are well underway. The International The Board met by teleconference on 3 Financial Reports to 31 December 2008 were Research requirements of the ANZCA IMGS process. Fellowship who have been working in Pain Visitor will be Dr Roman Jovey MD, Medical December to ratify the 2009 Budget and accepted. The Board noted that the higher Standardised Outcome Measures in ANZCA Curriculum Review Medicine, have a qualifi cation acceptable Program Director CPM Centres for Pain subscription and fee structure. It was than budgeted surplus was a result of Persistent Pain The Dean had made a submission to the to the Board, but whose knowledge base is Management, Immediate Past-President resolved that the FPM Subscriptions for the high level of attendance at Faculty Alfred Health (Victoria) and Hunter ANZCA Curriculum Review on behalf of the not clearly known to the Board, Regulation of the Canadian Pain Society, Ontario, 2009 be increased by 7.5% but with an CME events and a successful cost Integrated Pain Service (NSW) and a Faculty after consultation with a number 3 has now been amended. Applicants Canada. The meeting theme will be increase of 5% for Fellows who pay within reduction program. number of centres around the county will of FANZCA FFPMANZCAs. Submissions are invited to apply for election by the “Duelling with Pain” with sessions focused four weeks of the due date of 1 January proceed with a pilot core outcomes database from the Acute Pain SIG and other normal process under Regulation 3.2. The on capturing the interest of pain physicians, 2009. It was also resolved that the FPM project. A number of database issues are Faculty Fellows were also among the 121 Board may then either award Fellowship anaesthetists and addiction medicine Examination fee be increased by 7.5% and currently being addressed. Further details submissions received from a wide range of directly (Regulation 3.2.1) or following specialists. that other FPM Fees be increased by half will be published in Synapse in due course. groups and highlighted the key challenges satisfactory completion of examination and 2010 Spring Meeting of the percentage increase agreed upon for which need to be addressed. case report requirements without further Professional It was resolved that the 2010 meeting will ANZCA fees. ANZCA Council had agreed training (Regulation 3.2.2). Applicants to the Faculty raising its subscription and Recognition of Pain Medicine as a be held in the Hunter Valley with Dr Chris Training Unit Accreditation will be considered through the Election to fees by half of the percentage increase Specialty – New Zealand Hayes as Convenor. Royal Melbourne Hospital (Vic) and Fellowship application process. agreed upon for ANZCA taking into account Concord Repatriation Hospital (NSW) were The application is now in the fi nal stages the Faculty’s concerns that its Fellows are re-accredited for a further three-year period. Honours and Appointments of drafting with the support of Dr Steuart The Royal Children’s Hospital, Melbourne The Board acknowledged and congratulated Henderson, ANZCA Director of Professional was re-accredited for a period of 12 months the following recipients: Affairs, and is being progressed as a matter followed by a paper review. • Professor Alan Forbes Merry – appointed of urgency. During a review of chronic pain as an Offi cer of the New Zealand Order of National Pain Summit management services in Victoria it has Merit (ONZM) in recognition of services to A number of Board Members will participate become evident that funding for chronic medicine, in particular anaesthesia. in a Pain Summit Committee which will pain is a real concern in creating positions • Professor Michael J Cousins – awarded also include APS, MDF and nursing for pain specialists. Funding arrangements the Orton Medal by ANZCA Council for representation. The National Summit, within the state vary signifi cantly and the distinguished services to anaesthesia being organised by the Pain Management government has expressed reluctance to which will be conferred during the Research Institute in partnership with increase available funds. The Department Cairns ASM. the MBF Foundation, will now proceed in of Human Services has engaged Aspex 2010, however a date and venue have yet Consulting to undertake this review and the • Dr Roger Goucke was awarded a to be confi rmed. Involvement of physicians Dean and several Victorian Fellows have Presidential Commendation by the AAPM, and surgeons and the Faculty Regional provided input. A report is pending. recognising leadership in establishing cross cultural connections between FPM Committees will be sought. Examination and the AAPM. The 2009 Examination venue was confi rmed AMC Good Medical Practice: as Royal North Shore Hospital on 25–27 • Professor Nikolai Bogduk – AAPM Code of Conduct November. The Pre-Examination Short Founders Award for outstanding The AMC are currently analysing Course program at the Royal Adelaide contributions to the science or practice of submissions and the results of the Hospital will now run over two-and-a-half pain medicine. consultations but have not nominated a specifi c date for the release of a further days. Dates for 2009 have been confi rmed Pain Medicine Specialist draft at this stage. The latest information is as 9–11 September. The Board discussed the issue of non- available at http://goodmedicalpractice.org. Fellows using the term “Pain Medicine au/consultation/ Fellowship Affairs Specialist” and this was highlighted as an issue requiring vigilance with concerns Continuing Education & Quality Portfolio about confusing the public. It was agreed Assurance Fellowship that the Faculty should be proactive and Scientifi c Meetings notify registration bodies in Australia and New Admissions 2009 ASM New Zealand that FFPMANZCA is a rigorous Six new Fellows were admitted to Registration brochures for the Refresher qualifi cation and that those without it Fellowship taking the number of Fellows Course “Unravelling the Chaos of Pain” should not be permitted to advertise admitted to 260. have been circulated and registrations have themselves as pain specialists. There was commenced. Dr James Seymour has been discussion of using an alternative title such invited to speak on Irukandji at the 2009 as “Consultant Physician in Pain Medicine” Faculty Dinner.

78 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 79

Untitled-1 1 9/2/09 9:19:36 AM OBITUARY Photo: The Royal OBITUARY Melbourne Hospital Dr Russell Geoffrey Cole Archives Dr Nalin Rohitha 1920–2008 Wijeyesekera 1943–2008

Russell Geoffrey Cole, who died on start of his long and happy association with Visiting Professor at the South Western Dr Nalin (Wijey) Wijeyesekera was born Wijey’s high level of skill, experience November 2, 2008, was born in Melbourne St Thomas’ Hospital where he later worked Medical School in Dallas, TX, and he in Colombo, Sri Lanka (then Ceylon) in and his calm and patient nature endeared on October 28, 1920. He was educated for two six-month sabbatical periods and delivered popular lectures on chronic 1943. He was the fourth son of Nicodemus him to all of his anaesthetic, surgical, at Scotch College and subsequently at renewed treasured friendships. pain management in many centres in Wijeyesekera, a prominent public health nursing and technical colleagues and also the University of Melbourne. He is well- Upon his return to Melbourne in 1952, he South Africa and South East Asia. He specialist. Sadly, his much loved father to generations of Wellington anaesthetic remembered by fellow medical students readily obtained the DA of the University also provided anaesthetic support for died when he was 11 years old. Nicodemus trainees. Wijey was of the school of as an engaging, extroverted and of Melbourne and became a Fellow eye surgery on indigenous patients in the Wijeyesekera was keen that his sons anaesthesia where unless you looked convivial companion. of the Faculty of Anaesthetists, Royal Northern Territory, Australia. become doctors also and this paternal wish carefully you would never be aware of his He graduated as MBBS in 1944 and Australasian College of Surgeons in 1956 Russell Cole’s committee activities infl uenced the young Wijey. He studied actions; he was the antithesis of anaesthetic forthwith elected to serve the country in the and subsequently a Fellow of the Australian included membership in 1956 of the medicine in the Faculty of Medicine, fl amboyance. This did not mean that his Royal Australian Navy as medical offi cer and New Zealand College of Anaesthetists Victorian Regional Committee of the Faculty University of Ceylon (Colombo) from 1963 to skills were not of the highest order, quite in MAS Bataan until 1948 and became a in 1992. of Anaesthetists, anaesthetic advisor to 1968, graduating MB.BS. in 1969. He began the contrary. In his last 10 years of practice, Surgeon Lieutenant. Throughout his career, In 1952, he entered part-time practice the Standards Association of Australia, his anaesthesia training in Colombo and Wijey divided his time between Wellington Russell Cole maintained his association with the Melbourne Anaesthetic Group, and a representative for Australia on the passed the London primary FFARCS. In Hospital and private anaesthesia practice. with the Royal Australian Navy (RAN) a group of private anaesthetists. After Australian-Asian Committee of the World 1971, he passed the ECFMG and in that same He continued in private practice after his after being appointed Senior Anaesthetic becoming an assistant honorary Society of Anaesthesiologists. He was an year he became aware that the UK was to retirement and was still working clinically Specialist to the RAN in Victoria, and was a anaesthetist at the Royal Melbourne extremely social person who attracted the change its immigration laws meaning that until a few months before his fi nal illness. member of the Volunteer Reserve with the Hospital, he was promoted to full honorary friendship of anaesthetists and surgeons subjects of former British colonies would Going to work as an anaesthetist was rank of Surgeon Lieutenant Commander. In status in 1954 and also held appointments alike in his sphere. Indeed, as well as no longer have entry rights. Wijey wished a pleasure to Wijey, and he took genuine 1964 he was awarded the Volunteer Reserve at the Footscray and District Hospital his procedural skills, this was the to continue his anaesthesia training in the pleasure from the daily badinage that is Offi cers Decoration, RAN and in 2000 the (now Western General Hospital) and the foundation of his successful tenure as UK so at some personal cost immediately part of hospital life. Sadly, he was Australian Service Medal 1945–75. Repatriation General Hospital and in 1953 Departmental Director. left Ceylon for London and obtained full predeceased by his adored wife Deepti who During the Vietnam War, he further became Acting Director of Anaesthetics at Physically, Russell Cole was an extremely registration with the GMC in 1972. The desire died three years before his illness. Her loss served for a period on secondment from the Royal Women’s Hospital. Just as the robust individual who strongly believed in to further his training in the UK and the deeply affected Wijey, although of course the navy to the army in Vietnam where he management of cancer pain was pioneered the benefi ts of physical exercise. He was pending immigration law changes meant that would not have been obvious except worked as an anaesthetist at the Vung Tau in Sydney by Brian Dwyer, Russell Cole never to be seen catching a lift, despite that his newly-formed family was separated to those who knew him well. Wijey was a Hospital in Vietnam and participated in became his counterpart in Melbourne, the location of the operating theatres for a while. His wife, Deepti, was not to join great traveller and intensely interested in many hair-raising episodes of helicopter having had a long interest in the anatomical on the ninth fl oor of the hospital. His him in London until 1973 and their three- what was happening in other countries. He retrieval of injured soldiers. basis of nerve blocks and having published numerous sporting activities included year-old daughter, Shamila, joined them tended to couple his travelling with work as In 1949 he returned to Melbourne and informative articles on the relief of tennis, skiing and golf, all undertaken in 1974. His fi rst anaesthetic job in the UK an anaesthetist and would use his annual was appointed a demonstrator in anatomy intractable pain by nerve block. at a high level of skill. Although always was as a registrar in Whittington Hospital, leave to do locums in other countries, doing at the University of Melbourne and clinical In 1962, he decided to change direction. courteous and accommodating and easy to London. Wijey obtained his Final FFARCSI this work in Canada, the Netherlands, supervisor at The Alfred Hospital. Soon He ceased private anaesthetic practice, communicate with, he did not compromise in 1978. In 1980, following a brief stint in the Sweden, Australia and Saudi Arabia. In his after, in 1950, he commenced his long and was appointed a full-time executive on his Wednesday afternoon appointment USA, Wijey was appointed as a consultant younger days he was a keen track athlete association with the Royal Melbourne medical assistant at the Peter MacCallum at Kooyong Tennis Club, whatever the anaesthetist in Wellington Hospital, New and maintained a lifelong interest in cricket. Hospital up to his retirement in 1987. At Cancer Hospital with duties that included rostering policies might dictate. Zealand. He was awarded FFARACS in Wijey was the embodiment of his that time Russell Cole, along with the late supervision of the Consultant Pain Relief It was therefore a sad blow that on 1984 (FANZCA in 1992). He continued Buddhist faith in his gentle and dignifi ed Dr Alfred Nathan, were appointed as the Clinic, in which he maintained a deep the golf course in 2000 he suffered a in anaesthesia practice in Wellington manner. Never was this more evident than fi rst anaesthetic registrars in the newly interest until his retirement. cerebrovascular event that left him with until 2008. in his fi nal illness which he accepted with a established Department of Anaesthesia, the In 1965, Russell Cole was appointed a physical infi rmity which he endured for Wijey’s special interest was calmness, serenity and an utter lack of self- fi rst in Victoria under a full-time director. Director of Anaesthetics at the Royal his fi nal eight years. To his great credit he neuroanaesthesia and he formed a close pity that was truly remarkable. This department was initiated with the Melbourne Hospital, succeeding the adjusted to his incapacity and continued partnership with prominent Wellington He is survived by his much-loved recognition that the existing staffi ng by legendary Norman James, a post which he to interact with his many friends and neurosurgeon Balakrishnan that lasted daughter Shamila and two grandsons visiting anaesthetists could no longer held until 1980. Thereafter he remained colleagues and continued traveling abroad. a practicing lifetime. He enthusiastically Solomon Nalin Gurr and Jai Lamont Gurr. cope with the increasing demands and as a senior staff specialist until his formal His wife, Tup, was devotedly supportive volunteered his skills for the newly formed complexities of contemporary surgery, retirement in 1985, after which he was in his latter years and she and her neurovascular and craniofacial unit Phil Thomas particularly the expansion of thoracic appointed a Consultant Anaesthetist daughters, Rowena and Victoria, have with David Glasson and Balakrishnan. FANZCA surgery and neurosurgery. to the Hospital. He continued medical our deepest sympathy. His calmness and close contact with February 2009 In 1951, Russell Cole traveled to activities for a further several years, the neurosurgeons while performing London and worked as an anaesthetic including medical offi cer to Pentrige Prison, Dr Patricia Mackay complex neurosurgery, especially registrar at St Thomas’ Hospital where endoscopy lists and surgical assistance. December 2008 surgery in sitting position, made all the he obtained the Diploma of Anaesthetics Russell Cole was an inveterate traveller. surgeons feel very comfortable working (DA) and subsequently in 1954 attained the In addition to his time at St Thomas’ with him. His reputation and techniques Fellowship of the Faculty of Anaesthetists of Hospital, he held appointments as a Fellow for neuroanaesthesia in the sitting the Royal College of Surgeons. This was the at the Mayo Clinic, Rochester NY, as a position were widely recognised in other neurosurgical units in New Zealand.

80 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 81 OBITUARY FELLOWSHIP AFFAIRS Dr Brian Donald McKie Professional documents 1939–2009

Brian McKie passed away on January 18, He contributed, with Anne Thorp, the Following the normal review process Australian and New Zealand College a fortnight before his 70th birthday. Brian only paper published for about 30 years on by Council, the following Professional was born in Poona, India, where his parents awareness during anaesthesia in children. Document has recently been withdrawn: of Anaesthetists were missionaries. He was educated at It was probably the fi rst such study. ABN 82 055 042 852 PS48 – Statement on Clinical Principles for Trinity and Carey Grammar Schools in Brian was very musical and was able Procedural Sedation Professional documents Melbourne and graduated from Melbourne to play the organ by ear. He also sang, P = Professional University in Medicine in 1962. including several performances of the T = Technical After his resident jobs undertaken in Messiah in the Town Hall, and wrote a EX = Examinations Geelong, he went to New Guinea where pantomime. He also enjoyed a game PS = Professional standards he worked for two years. On his return, of squash. TE = Training and Educational he undertook his anaesthetic training in I had the pleasure of travelling to Melbourne gaining his FFARACS in 1968. He several conferences with Brian. In 1970 was appointed to an Uncle Bobs fellowship on the way to Canberra for the third Asian TE1 (2008) Recommendations for Hospitals Seeking College Approval for Vocational in the Anaesthetic Department at the Royal Australasian Congress in a VW beetle we Training in Anae sthesia Children’s Hospital in 1969. He participated had two windscreens broken on one day. TE2 (2006) Policy on Vocational Training Modules and Module Supervision in intensive care and in anaesthesia and It poured rain after the second one which (interim review) became one of the cardiac team. After four added to our discomfort. In 1973 we went to TE3 (2006) Policy on Supervision of Clinical Experience for Vocational Trainees years, he decided to move to private practice a meeting in Malaysia followed by a Faculty in Anaesthesia in Geelong. He continued on the sessional of Anaesthetists conference in Singapore. TE4 (2003) Policy on Duties of Regional Education Offi cers in Anaesthesia staff at the Royal Children’s Hospital for It was another trip with many interesting 29 years, even after he changed course in episodes, including Devonshire tea at TE5 (2003) Policy for Supervisors of Training in Anaesthesia midlife and went into the church. Cameron Highlands! In 1976 we drove to TE6 (2006) Guidelines on the Duties of an Anaesthetist He graduated B. Theology in 1993 and Surfers Paradise for the ASA meeting and TE7 (2005) Guidelines for Secretarial and Support Services to Departments was then ordained into the Baptist Church. were apprehensive about running out of of Anaesthesia He was involved with Belmont Church in petrol between Jerilderee and Narrandera Geelong, then Traralgon before returning to – places named on the map where we TE8 (2003) Guidelines for the Learning Portfolio for Trainees in Anaesthesia Aberdeen Street Baptist Church in Geelong hoped to obtain petrol didn’t seem to exist. TE9 (2005) Guidelines on Quality Assurance in Anaesthesia until his retirement. In retirement he Travelling with someone for days generates TE10 (2003) Recommendations for Vocational Training Programs continued to work part time and made a big a deeper understanding between people TE11 (2008) Formal Project Guidelines (interim review) impact on the Euroa Church while fi lling and these travels enhanced our friendship. in there. With the passing of Brian McKie, many TE13 (2003) Guidelines for the Provisional Fellowship Program Brian was a quiet, unassuming man who of us have lost a good friend. Our sincere TE14 (2007) Policy for the In-Training Assessment of Trainees in Anaesthesia had a deep commitment to both his careers. sympathy is extended to his wife, Dorothy, TE17 (2003) Policy on Advisors of Candidates for Anaesthesia Training He played an important role as conciliator and their children, Cathy, Jenny, Barbara TE18 (2005) Guidelines for Assisting Trainees with Diffi culties on several committees at Geelong Hospital and Andrew. The blessing at the conclusion and elsewhere. Brian’s concern for the of his funeral, written by himself, had some EX1 (2006) Policy on Examination Candidates Suffering from Illness, Accident wellbeing of people and his wise counsel valuable messages. “Go in peace. Don’t or Disability helped many of his parishioners and be sad but share God’s joy with others. Be T1 (2008) Recommendations on Minimum Facilities for Safe Administration of reassured many of his patients. He was kind to each other – life is too short to do Anaesthesia in Operating Suites and Other Anaesthetising Locations a mentor to young people and provided otherwise. Life is a precious gift – live it (interim review) foster care to several children. Brian had a to the full while you can. God be with T3 (2008) Minimum Safety Requirements for Anaesthetic Machines for Clinical Practice concern for many social issues and was a you. Amen.” PS1 (2002) Recommendations on Essential Training for Rural General Practitioners in member of the interchurch gambling Australia Proposing to Administer Anaesthesia task force. Dr Kester Brown PS2 (2006) Statement on Credentialling and Defi ning the Scope of Clinical Practice FANZCA in Anaesthesia February 2009 PS3 (2003) Guidelines for the Management of Major Regional Analgesia PS4 (2006) Recommendations for the Post-Anaesthesia Recovery Room PS6 (2006) The Anaesthesia Record. Recommendations on the Recording of an Episode of Anaesthesia Care PS7 (2008) Recommendations on the Pre-Anaesthesia Consultation PS8 (2008) Guidelines on the Assistant for the Anaesthetist PS9 (2008) Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical or Surgical Procedures

82 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 83 FELLOWSHIP AFFAIRS Professional documents Professional documents P = Professional P = Professional Professional T = Technical T = Technical EX = Examinations EX = Examinations documents PS = Professional standards PS = Professional standards TE = Training and Educational TE = Training and Educational Continued

PS10 (2004) Handover of Responsibility During an Anaesthetic Australian and New Zealand College Australian and New Zealand College College Professional Documents adopted by the Faculty: PS12 (2007) Statement on Smoking as Related to the Perioperative Period of Anaesthetists of Anaesthetists PS4 (2006) Recommendations for the Post-Anaesthesia Recovery Room ( Adopted February 2001) PS15 (2006) Recommendations for the Perioperative Care of and and Patients Selected for Day Care Surgery PS7 (2008) Recommendations for the Pre-Anaesthesia Joint Faculty of Intensive Care Faculty of Pain Medicine Consultation (Adopted November 2003) PS16 (2008) Statement on the Standards of Practice of a ABN Specialist Anaesthetist Medicine 82 055 042 852 PS8 (2008) Guidelines on the Assistant for the Anaesthetist PS18 (2008) Recommendations on Monitoring During Anaesthesia ABN 82 055 042 852 (Adopted November 2003) Professional documents PS19 (2006) Recommendations on Monitored Care by PS9 (2008) Guidelines on Sedation and/or Analgesia for an Anaesthetist Professional documents PM2 (2005) Guidelines for Units Offering Training in Diagnostic and Interventional Medical or Surgical PS20 (2006) Recommendations on Responsibilities of the Multidisciplinary Pain Medicine Procedures (Adopted 2008) IC-1 (2003) Minimum Standards for Intensive Care Units Anaesthetist in the Post-Anaesthesia Period PM3 (2002) Lumbar Epidural Administration of Corticosteroids IC-2 (2005) Intensive Care Specialist Practice in Hospitals PS10 (2004) The Handover of Responsibility During an PS21 (2003) Guidelines on Conscious Sedation for Anaesthetic (Adopted February 2001) Dental Procedures Accredited for Training in Intensive Care Medicine PM4 (2005) Guidelines for Patient Assessment and Implantation of Intrathecal Catheters, Ports and Pumps for PS26 (2005) Guidelines on Consent for Anaesthesia or Sedation IC-3 (2008) Guidelines for Intensive Care Units seeking PS15 (2006) Recommendations for the Perioperative Care of Accreditation for Training in Intensive Care Medicine Intrathecal Therapy PS27 (2004) Guidelines for Fellows who Practice Major Patients Selected for Day Care Surgery (Adopted Extracorporeal Perfusion IC-4 (2006) The Supervision of Vocational Trainees in PM5 (2006) Policy for Supervisors of Training in Pain Medicine February 2001) Intensive Care PS28 (2005) Guidelines on Infection Control in Anaesthesia PM6 (2007) Guidelines for Longterm Intrathecal Infusions PS18 (2008) Recommendations on Monitoring During PS29 (2008) Statement on Anaesthesia Care of Children in IC-6 (2002) The Role of Supervisors of Training in Intensive (Analgesics/Adjuvants/Antispasmodics) Anaesthesia (Adopted February 2001) Healthcare Facilities without Dedicated Paediatric Care Medicine PS3 (2003) Guidelines for the Management of Major PS20 (2006) Recommendations on Responsibilities of the Facilities (reissue) IC-7 (2006) Secretarial Services to Intensive Care Units Regional Analgesia Anaesthetist in the Post-Anaesthesia Period PS31 (2003) Recommendations on Checking Anaesthesia IC-8 (2000) Quality Assurance (Adopted February 2001) PS38 (2004) Statement Relating to the Relief of Pain and Delivery Systems IC -9 (2002) Statement on the Ethical Practice of Intensive PS31 (2003) Recommendations on Checking Anaesthesia PS37 (2004) Regional Anaesthesia and Allied Health Suffering and End of Life Decisions Care Medicine Delivery Systems (Adopted July 2003) Practitioners IC-10 (2003) Minimum Standards for Transport of the Critically Ill PS39 (2003) Minimum Standards for Intrahospital Transport of PS38 (2004) Statement Relating to the Relief of Pain and Critically Ill Patients T1 (2008) Recommendations on Minimum Facilities for Safe IC-11 (2003) Guidelines for the In-Training Assessment of Suffering and End of Life Decisions Administration of Anaesthesia in Operating Suites Trainees in Intensive Care Medicine PS40 (2005) Guidelines for the Relationship Between Fellows and PS39 (2003) Minimum Standards for Intrahospital Transport of and other Anaesthetising Locations (Adopted the Healthcare Industry Critically Ill Patients IC-12 (2001) Examination Candidates Suffering from Illness, May 2006) Accident or Disability PS40 (2005) Guidelines for the Relationship Between Fellows and PS41 (2007) Guidelines on Acute Pain Management February 2009 the Healthcare Industry IC-13 (2008) Recommendations on Standards for High Dependency Units Seeking Accreditation for PS45 (2008) Statement on Patients’ Rights to Pain Management PS41 (2007) Guidelines on Acute Pain Management Training in Intensive Care Medicine and Associated Responsibilities PS42 (2006) Recommendations for Staffi ng of Departments PS49 (2008) Guidelines on the Health of Specialists and Trainees of Anaesthesia IC-14 (2004) Statement on Withholding and Withdrawing Treatment PS43 (2007) Statement on Fatigue and the Anaesthetist IC-15 (2004) Recommendations of Practice Re-entry for an PS44 (2006) Guidelines to Fellows Acting on Appointments Committees for Senior Staff in Anaesthesia Intensive Care Specialist PS45 (2008) Statement on Patients’ Rights to Pain Management February 2009 and associated responsibilities PS46 (2004) Recommendations for Training and Practice of Diagnostic Perioperative Transoesophageal Echocardiography in Adults PS47 (2008) Guidelines for Hospitals Seeking College Approval of Posts for Vocational Training in Diving and Hyperbaric Medicine PS49 (2008) Guidelines on the Health of Specialists and Trainees PS50 (2004) Recommendations on Practice Re-entry for a Specialist Anaesthetist February 2009

84 The ANZCA Bulletin March 2009 The ANZCA Bulletin March 2009 85