JUNE 2018 BULLETIN ANZCA Slow-release opioids: Leadership changes: Follow-up to Meet our new our statement president and dean

on a successful SYDNEY ASM Contents 4 President’s message 30 Slow release opioids: 5 Professor David A Scott leaves Follow-up to our statement strong legacy 34 The reality of humanitarian work in Iraq 6 Changes to council 36 Reflecting on a successful Sydney ASM 8 Chief executive officer’s message 45 Emerging leaders working together Slow-release opioids update 9 Queen’s Birthday honours 48 ANZCA Clinical Trials Network news The ANZCA/FPM recent position statement on slow-release opioids for 9 Letter to the editor 49 ANZCA Research Foundation update 30 acute pain is explained in more detail 10 ANZCA staff awards 51 Faculty of Pain Medicine as not all opioids are the same. 12 ANZCA and FPM in the news: 52 Dr Chris Hayes – a dean who built Opioids, women in anaesthesia and strong relationships chronic pain hot topics for media 54 FPM: Endometriosis – time for action Lesson from the heart for doctors’ 14 ANZCA and government: 57 FPM: Refresher Course Day My Health Record expands wellbeing 58 Anaesthetic history: Women Dr Kate Harding writes from the UK about the suicide 16 ANZCA’s professional documents: anaesthetists in Australia and of her husband Richard, an intensive care consultant, 22 What would you do? New Zealand following his months of anxiety and powerlessness. 18 Can trainees’ (and fellows’ and other 62 What’s new in the library CPD participants’) personal reflections 67 Conversations to enhance learning be used in court? 70 Successful candidates 20 CPD: Meeting practice evaluation activities in private practice 72 Diploma of Advanced Diving and Hyperbaric Medicine High-flying fellow 21 CPD: Medical Board of Australia’s Wing Commander Dr Alex Douglas, Professional Performance Framework 74 A VAST improvement for a recipient of the Medal for Gallantry, resource-limited settings gives a candid account of her service 22 Doctors’ welfare: Learning from 26 Richard’s death 78 Special interest group events in the Australian Defence Force. 25 Have your say...Doctors’ Health and 80 New Zealand news Wellbeing Draft Interim Framework 83 Australian news 26 Fellow profile: Wing commander flies 89 Obituaries Reflecting on the ASM high with Defence medical teams 91 Future meetings More than 2400 ANZCA delegates attended the annual scientific meeting 28 Safety and quality news 36 in Sydney. Some of the program’s scientific and social sessions were organised jointly with the Royal Australasian College of Surgeons. ANZCA Bulletin Submitting letters and other Copyright The Australian and New Zealand material ANZCA may promote articles College of Anaesthetists (ANZCA) We encourage the submission of that appear in the Bulletin in is the professional medical body letters, news and feature stories. other forums such as the ANZCA in Australia and New Zealand Please contact ANZCA Bulletin website and ANZCA social media that conducts education, training Editor, Clea Hincks at chincks@ platforms. and continuing professional anzca.edu.au if you would like to Copyright © 2018 by the Australian development of anaesthetists contribute. Letters should be no and New Zealand College of and specialist pain medicine more that 300 words and must Anaesthetists, all rights reserved. physicians. ANZCA comprises contain your full name, address None of the contents of this about 6700 fellows and 1500 and a daytime telephone number. publication may be reproduced, trainees mainly in Australia They may be edited for clarity stored in a retrieval system or and New Zealand. It serves the and length. transmitted in any form, by any community by upholding the means without the prior written highest standards of patient safety. Advertising inquiries permission of the publisher. To advertise in the ANZCA Cover: Waiting for the 2018 College Please note that any views Ceremony to begin at the 2018 Bulletin please contact [email protected]. or opinions expressed in this ANZCA Annual Scientific Meeting publication are solely those of in Sydney. Contacts the author and do not necessarily represent those of ANZCA. Medical editor: ANZCA Dr Nigel Robertson 630 St Kilda Road, Melbourne ISSN: Victoria 3004, Australia 1038-0981 (print) Editor: Telephone +61 3 9510 6299 2206-5423 (online) Clea Hincks Facsimile +61 3 9510 6786 Art direction and design: [email protected] Action on Fellow in Iraq Christian Langstone www.anzca.edu.au endometriosis Dr Mathew Zacharias Production editor: Faculty of Pain Medicine Until now the condition has been writes about his harrowing Liane Reynolds Telephone +61 3 8517 5337 [email protected] under-diagnosed and poorly but rewarding experience Advertising manager: 54 34 www.fpm.anzca.edu.au treated but a new federal action working with Medecins Vivienne Forbes plan provides funding and hope Sans Frontieres in Iraq. for change, writes FPM Dean Dr Meredith Craigie.

2 ANZCA Bulletin June 2018 3 President’s message Professor David A Scott leaves strong legacy

• We will all be perioperative Number one. When I left Adelaide to “He is a deeply thoughtful and practitioners, but some of us will return to Alice Springs I was concerned be “perioperative specialists”, who, about professional isolation, and about considerate person, of true integrity similarly to how pain specialists lead closing doors professionally. Professor pain medicine – will lead the education, Don Moyes, the Director of Anaesthesia and who is always prepared to listen.” training, professional standards and at the Queen Elizabeth Hospital, told me research into perioperative medicine “I think it’s great you’re going to Alice. that will benefit us all. Let me offer you a 0.1 FTE which you can The list of ANZCA’s achievements over the past two years is • Perioperative medicine will be led take as a one month block each year, to reconnect with your colleagues. You’ve substantial, but a number of them directly reflect David’s energy (but not owned) by anaesthetists, and vision. Research funding to support our fellows reached because we are best placed to provide got my phone number, if ever you need $1.74 million in 2017, and we have seen the establishment of an the necessary co-ordination, logistical some advice, and whenever you do return Emerging Investigators Sub-Committee, the latter support, vision and energy for this there will be a job here for you”. of which is to support the next generation of researchers. collaboration. So the whole process of going out bush was framed as a positive and supported The college developed a first-ever Joint Position Paper on The second issue I want to discuss is how experience, with no worrying concerns Day Surgery in Australia with the Royal Australasian College we need to address all of the six domains that I would be “forgotten”. The message of Surgeons and the Australian Society of Plastic Surgeons, of healthcare delivery – safe, timely, is that we can all be more encouraging, initiated discussions about whether we want to present ourselves I come into this role with a somewhat effective, efficient, equitable, patient- reassuring and supportive of young different background to my predecessors. as anaesthesiologists or anaesthetists, progressed the evolution focused (STEEP). people who are prepared to go and do a I work in Adelaide, in intensive care of perioperative medicine, strengthened international relations Equity of healthcare relates to access, stint in the bush. and anaesthesia, primarily in the outer with our sister colleges overseas, and developed five-year treatment, and outcomes. Number two. Minority groups are more suburbs, in public and private. strategic plans for overseas aid work and Indigenous health. We have achieved absolute world- likely to engage with a workforce whose I previously spent the best part of Of particular note has been David’s stewardship of the class excellence in delivering safe and diversity includes representation from a decade in central Australia, mainly development of a strategic framework to address bullying, high quality clinical care. Our ongoing their community. In addition, the M ori with the Royal Flying Doctor Service, ă discrimination and sexual harassment, and the Doctors’ challenge is to ensure that everyone in the pain medicine specialist in New Zealand, in Indigenous primary health care Support Program. community benefits from that care. There or the Aboriginal anaesthetist in northern and retrieval medicine, and later as As a leader he has fostered, and represented a strong are three distinct groups who don’t enjoy Australia provide valuable role models. the director of anaesthesia at the Alice culture of professionalism. David has achieved a national and equity of that care. Put very simply, it Through encouragement and support of Springs Hospital. international reputation for clinical and academic excellence, doesn’t matter how good our care is if it’s aspiring young anaesthetists and pain I have been lucky to have married and it is perhaps easy for these accolades to overshadow the not reaching people. specialists, we can facilitate this diversity. David A Scott enjoys widely recognised expertise such a wonderful woman, Sue, and to important facts that he is a deeply thoughtful and considerate The first group are our rural Number three. Let me make a pitch for have four really great kids. Daryl Catt, in research, safety and quality, pain medicine, person, of true integrity and who is always prepared to listen. communities, who are subject to the the WFSA’s “Fund a Fellow” program, the anaesthetist at Alice Springs hospital It is these attributes that have driven him to work so tirelessly as ongoing mal-distribution of specialist which is addressing the global shortage of medical leadership, and cardio-thoracic when I was a young fella, wisely told our president to ensure he has done all he can for his colleagues, anaesthetists, and the challenges of anaesthetists. We can all work to support me that the grass will always be greener anaesthesia, and our college has been fortunate to and for our patients. distance. this, as individuals, as departments and where I water it, and I’ve tried really hard have the opportunity to benefit from his leadership The second group are those as private groups. Thank you David. to remember that. And just so you know, marginalised members of our community, And finally, we need to recognise and over the last two years. having had the privilege of working as particularly our Indigenous peoples, and address unconscious biases, at both an Dr Rod Mitchell a primary health physician, a retrieval David will be quick to acknowledge that the many and varied recent migrants. individual and institutional level. Of ANZCA President doctor, an intensivist, an anaesthetist, achievements of our college more accurately reflect the collective The final group are the five billion course, we also need to call out blatant and a councillor, the thing that’s brought people globally who lack ready access to discrimination, which still occurs. wisdom and energy of our membership, but nonetheless his me the most happiness, and that I’m most Above: President Dr Rod Mitchell with Immediate Past President anaesthesia care. In closing, let me just say I am leadership has clearly contributed to ANZCA’s vision and proud of, is just being a dad. Professor David A Scott at the ANZCA president handover and closing Addressing inequity does involve incredibly humbled to be the president successes, and to ensuring the efficient governance of our So, two issues I would like to discuss address at the ASM. stepping outside our comfort zone. of our college. I’m really looking forward college as a bi-national, bi-specialty entity representing over are perioperative medicine, and equity. However, when I was in Alice Springs, to working with the ANZCA Council, 8000 fellows and trainees. There’s been much discussion about doing my very best to deliver high quality the FPM Board, and with you all. I’m perioperative medicine – with claims that anaesthesia care, I realised that if I didn’t particularly aware that we’re a very it will significantly change our scope of address why Aboriginal people presented high-performing college, and that’s due practice. However, I sense some confusion so late and self-discharged so early, why to the enormous talent and hard work of about what that means in practical terms, Anaesthesiology plebiscite change is being contemplated, and whether a change of name there were no Aboriginal doctors in my all our fellows, and in no small part to so I would suggest the three following The proposed change of name to our speciality was a favourite justifies the significant costs involved. As such, the college, theatre, and why I was the only FANZCA the enormous talent and hard work of our features will be apparent five years topic of discussion for many at the 2018 ASM in Sydney. The the Australian Society of Anaesthetists and the New Zealand working there, that I was failing, as a extraordinary staff. from now: great debate held on the final day of the meeting saw an Society of Anaesthetists have agreed it seems sensible to delay perioperative practitioner, to address Thank you. engaged audience hear the cases for and against the proposed the proposed plebiscite, initially scheduled for later this year, to • Widespread recognition that patient- important issues that contribute to change, and polling with delegates both on site and on social allow for the provision of further discussion and consideration. focused, multidisciplinary, evidence- perioperative outcomes. Dr Rod Mitchell media show that each side of the argument enjoys considerable based perioperative care improves Addressing inequity is very ANZCA President support. Informal conversations also showed that many people Dr Rod Mitchell surgical outcomes. challenging, but there are things we can feel they still need more information as to the “on the ground” do, and I’d like to outline four of them. ANZCA President implications of a name change, the reasons behind why a

4 ANZCA Bulletin June 2018 5 Changes to council

There are two new faces on ANZCA Council with new FPM Dean Dr Meredith Introducing our new councillors Craigie replacing Dr Chris Hayes and Dr Christine Vien replacing Dr Scott Ma as new fellow councillor. Dr Meredith Dr Christine Vien Dr Craigie focuses on adult pain Craigie Dr Christine medicine in the Central Adelaide LHN Dr Meredith Craigie Vien underwent Pain Management Unit at the Queen is the dean of the anaesthetic training Elizabeth Hospital. Her interests include Faculty of Pain in Victoria, and now holds a full-time pain in childhood, pain education and Medicine. Her public position at St the wellbeing of colleagues. interest in pain Vincent’s Hospital Dr Vien, whose interests include medicine grew Melbourne. She has regional and paediatric anaesthesia, from requests to see children with particular interests is based at St Vincent’s Hospital in in regional and paediatric anaesthesia, Melbourne. burns and persistent pain while she was a paediatric anaesthetist. Dr Craigie having completed sub-specialty There have also been some changes transitioned four years ago to working fellowships in regional anaesthesia at to ANZCA committees following the solely in adult pain medicine in the St Vincent’s Hospital and paediatric changeover of presidents. Immediate Central Adelaide LHN Pain Management anaesthesia at the Royal Children’s Past President Professor David A Scott Unit at the Queen Elizabeth Hospital. Hospital in Melbourne. Aside from has been appointed chair of the ANZCA Meredith enjoys working in the team clinical roles, her experiences extend Research Committee, replacing Professor environment at work and with FPM to medical management – having been Alan Merry. colleagues on faculty committees and a member of, and chairing a number Associate Professor Leonie Watterson, projects. Her interests include pain in of committees at Monash Health and Director of the Sydney Clinical Skills childhood, pain education and wellbeing ANZCA during her specialist training, and Simulation Centre at Royal North of colleagues. Her personal pain relief focusing on the welfare and training Shore Hospital replaces new ANZCA strategies include exercise, gardening of junior doctors. President Dr Rod Mitchell as chair of the and travel. Professional Affairs Executive Committee. See Dr Craigie’s first dean’s message Dr Nigel Robertson replaces Dr Rowan on page 51. Thomas as medical editor. Dr Vanessa Beavis is the new vice- president of ANZCA and Dr Michael Vagg has been appointed vice-dean of FPM. For the full list of ANZCA Council office bearers go to www.anzca.edu.au/about- The FPM Board has a new member with anzca/. The list of FPM office bearers and a list of FPM appointments to ANZCA FANZCA and FFPMANZCA Dr Susie Lord committees can be found at www.fpm.anzca.edu.au/about-fpm/structure-and- replacing Associate Professor Ray Garrick. governance and www.fpm.anzca.edu.au/about-fpm/committees. Dr Lord, Clinical Lead at the Children’s Complex Pain Service in Newcastle, is a member of several expert advisory and working groups and was lead author of the Better Pain Management Pain in Children module.

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6 ANZCA Bulletin June 2018 7 Chief executive Queen’s Birthday honours Officer (AO) in the general division of Dr Michael Gerrard Cooper, NSW officer’s message the Order of Australia For significant service to medicine in the Dr David Charles Pescod, Vic field of anaesthesia as a clinician, teacher, For distinguished service to medicine, mentor and historian. and to Australia Mongolia relations, Associate Professor Charles Roger particularly through the provision of Goucke, WA • Training. A continuing professional development A key component of addressing surgical and anaesthetic care, and to For significant service to medicine in the (CPD) advisory group is being established inequities in Indigenous health is to health education and standards. • New specialist. field of pain management as a clinician, to provide advice on matters related improve Indigenous representation in the • Mid-career. Member (AM) in the general division academic and mentor, and to professional to “strengthened CPD requirements”. health workforce. Naturally this is an area • Retirement. of the Order of Australia societies. This includes advice on changes to the where specialist medical colleges have the Dr David Russell Hillman, WA • Return to work (which spans all of registration standard for CPD and “CPD potential to make a meaningful impact, Medal (OAM) in the general division For significant service to medicine as of the Order of Australia the above transition points). homes”. Professor Kate Leslie has agreed through initiatives such as supporting an anaesthesiologist and physician, to to chair this group. the training of Indigenous doctors. Dr Mary Felicity Sutherland, SA The consultation will be open until medical research into sleep disorders, and As the board progresses its work However workforce development For service to medicine, and to the mid-July. to professional organisations. on peer review and health checks for involves more than the recruitment and community. ANZCA launched its doctors’ support Associate Professor Geoffrey David practitioners aged 70 years and older, support of Indigenous doctors. It also Dr Stephen Bryce Kinnear, SA program last November. It is a telephone Champion, NSW it will establish an older practitioners’ involves ensuring that non-Indigenous For service to medicine, particularly to counselling service which is available free For significant service to medicine in the reference group to provide feedback to practitioners are equipped to practise anaesthesiology. of charge to fellows, trainees, specialist field of paediatric rheumatology, and the board on relevant matters. in a culturally responsive manner and international medical graduates and their to medical research and treatment of improving the ability of mainstream immediate families. ANZCA’s role in improving Indigenous musculoskeletal pain. health services to meet the needs of In the first quarter of 2018 there were health outcomes Indigenous people. Doctors’ health 34 new referrals to the service. The top In Australia, Closing the Gap is a We have committed to working closely I have reported in this column in previous five primary work related issues during commitment made by all governments with governments and Indigenous issues the direction that ANZCA is taking the period were: to achieve Aboriginal and Torres Strait health organisations to play our part with regard to promoting and supporting Islander health equality by 2030. It aims • Work behaviours (27 per cent). in achieving these goals. Several ANZCA’s fund-a-fellow doctors’ health and wellbeing. We have to reduce disadvantage with respect to life • Work practices (18 per cent). organisations have developed cultural now published a draft framework for expectancy, child mortality, educational competence programs that we may wish consultation at www.anzca.edu.au/ • Work related incidents (18 per cent). achievement, and employment outcomes. to access to assist members accessing campaign donation resources/doctors-welfare. If you have • Career adjustment (18 per cent). The National Aboriginal and Torres Strait college education and training resources. something to contribute to this important Islander Health Plan 2013-2023 supports The World Federation of Societies of 500 fellows and reach over one million • Work change (9 per cent). Pain medicine and perioperative work, we would love to hear from you. the strategy, and aims for a health system Anaesthesiologists’ (WFSA) has thanked patients by 2020, plays an essential medicine have been flagged as possible We are seeking your views on for The top personal related issues emerging that is free of racism and inequality, and ANZCA’s Overseas Aid Committee for role in meeting the shortfall in skilled areas for collaboration between the its $A5000 gift to the Fund a Fellow anaesthesiologists in low and middle example, the three integrated action this period were: enables Aboriginal and Torres Strait college and indigenous health services. campaign. income countries by ensuring they have areas: Islander people to have access to effective, • Health and wellbeing (47 per cent). Essential Pain Medicine (EPM) in The CEO of the federation Julian Gore- access to quality specialised training. • Promotion: Promoting health and high quality, appropriate and affordable • Personal relationships (42 per cent). particular was identified as a tool for Booth said the donation would help WFSA For more information on the program wellbeing by developing the positive health services. • Adjustment/grief and loss (5 per cent). training Indigenous health workers in support more fellows this year than ever go to: www.wfsahq.org/get-involved/ aspects of being in the profession as The Treaty of Waitangi is New Indigenous communities. This presents an before. The program, which aims to train fundafellow well as the importance of self-care in Zealand’s founding document, and was Of the 32 new referrals, 37 per cent were opportunity for the college to potentially the role of doctor. Promoting research. signed in 1840 between representatives work-related and 63 per cent personal. design and establish an EPM pilot for of the British Crown and a number of • Protection: Protecting health and The industry benchmark for the same Indigenous Australians and M ori. M ori chiefs. It allowed government ă wellbeing of doctors through advocacy period was 56 per cent work and 44 per ă We are expecting that once adopted, to be established in New Zealand and with employers to reduce profession- cent personal. It should be noted that 32 the Indigenous health strategy will assist migration to New Zealand to continue. Letter to the editor related risk factors for health and referrals is a relatively small number and us to play a meaningful part in improving it may be another six months before any The treaty is fundamental in guiding wellbeing and increasing protective the health of Indigenous New Zealanders Assisted dying In my view, the ANZCA leadership trends may be meaningful. the relationship between the crown and strategies. and Australians. The recent death of 104-year old should be dissociating itself and our The referral service is confidential Măori, and its intent and principles are a • Support: Providing effective and Australian Professor David Goodall fine college from the actions of the Swiss and ANZCA receives only statistical core consideration in government policy. accessible services and programs to John Ilott by self-injection of a lethal dose of doctor and his clinic. That case and the information. Health strategies frame commitment to support doctors’ health and wellbeing. Chief Executive Officer, ANZCA barbiturate – in a Swiss clinic for legal new Victorian legislation on euthanasia the treaty under three key principles: Encouraging those who need treatment; Professional performance framework reasons – carried an ominous message for – compounded a totally inadequate, even partnership, participation and protection. de-stigmatising mental illness; and (revalidation) Australian anaesthetists. supine response to the Victorian Act by These core government commitments promoting inclusion. For prominent in the media report of ANZCA and a state committee of the RACS The Medical Board of Australia is in both Australia and New Zealand are the continuing its work on the professional the case was the “specialist” who aided do not bode well. The consultation document proposes that guiding principles underpinning ANZCA’s This is a serious issue that could cause performance framework, and intends to Professor Goodall kill himself was the we focus on doctors’ career life cycle. Indigenous health strategy. word “anaesthesiologist”. The simple a schism within the college. Silence will establish a number of groups to progress In other words, it intends to reflect the message imparted to millions of people not suffice. implementation. An implementation importance of the transition across a was “anaesthesiologists help to kill working group is being established, doctor’s career stages where uncommonly people”. Dr Jim Wilkinson OAM MHL FANZCA chaired by the chair of the medical high levels of stress are experienced: Queensland board to provide overall direction of the implementation of the framework. Letters on slow-release opioids are on page 31.

8 ANZCA Bulletin June 2018 9 ANZCA and FPM in the news Opioids, women in anaesthesia and chronic pain hot topics for media

Coverage of the Sydney annual scientific The Tasmanian annual scientific FPM’s Immediate Past Dean Dr Chris meeting (ASM) dominated our media meeting attracted media interest Hayes, new Dean Dr Meredith Craigie Since the March 2018 edition of the ANZCA Bulletin, ANZCA and FPM coverage since the last ANZCA Bulletin with delegate Dr Lizzie Elliott being and new Vice-Dean Dr Mick Vagg were have featured in: (see page 42 for full report) with 670 interviewed about her experience working featured in television news and radio online, print and broadcast reports in in Antarctica as part of an expert diving segments and online and print articles. • 71 print reports. • 210 radio reports. Australian and New Zealand media and hyperbaric medical team. Dr Elliott Dr Vagg was interviewed by the Medical • 554 online reports. • Two TV reports. outlets. was featured in an article in the Sunday Republic about the slow-release opioid In addition to the ASM reports media Tasmanian and interviewed by ABC Radio statement and Dr Hayes was interviewed covered a diverse mix of issues and Hobart and Launceston FM. by Channel Nine News in Sydney about Media releases since the previous Bulletin: topics including the debate around the The Rare Privilege of Medicine the shortage of pain medicine physicians. Follow us on terminology of anaesthesiology versus exhibition was profiled on ABC Radio Dr Vagg was also interviewed by AAP Friday May 11: Tuesday May 8: anaesthesia, slow-release opioids, National’s breakfast program by host Fran about a new study on hypnosis as a Medical emergencies occur during Does anaesthesia affect my baby’s Twitter for all the shortage of pain medicine physicians, Kelly who interviewed curator Monica treatment for chronic back pain. Dr Vagg one in 400 flights, says new study brain? management of chronic pain, and the Cronin and in an article on Melbourne cautioned patients against rushing out Two new leaders for ANZCA Doctor stress, burnout and hospital latest ANZCA Rare Privilege of Medicine exhibition at anaesthetist Dr Lucky De Silva for the to be hypnotised saying the jury was still and FPM rosters on agenda of key medical the Geoffrey Kaye Museum of Anaesthetic Herald Sun International Women’s Day out on the practice for managing chronic conference in Sydney news and events. History. edition. These two items attracted a pain. This article was syndicated to Thursday May 10: Monday May 7: @ANZCA ANZCA’s Immediate Past President combined audience and readership of sbs.com.au, yahoo news Australia and Australian-led global study unlocks Professor David A Scott and the Chair 550,000 people. New Zealand and the Daily Telegraph and the secret of IV fluid treatment for Space exploration or catching a of the Safety and Quality Committee Dr In New Zealand a 760-word opinion Courier Mail and attracted a combined millions of patients wave: Kids taking charge of virtual reality in hospitals Phillipa Hore were interviewed by The piece written by FPM fellow Dr Paul audience of 700,000 people. Needle phobias a real pain for many Age medical writer Aisha Dow about Vroegop calling for more pain medicine Dr Craigie was interviewed by ABC Sunday May 6: the anaesthesiology versus anaesthesia resources ran in The Dominion Post and Radio Adelaide’s breakfast program Surgeon league tables under the microscope at scientific meeting Breakthrough blood test reveals debate as covered in the December issue stuff.co.nz with an audience of 460,000. for a four minute segment on chronic colour of chronic pain of the ANZCA Bulletin. The Age article ANZCA and FPM’s joint statement and pain management and an article for ANZCA joins global patient safety was syndicated to other Fairfax Media accompanying media release on slow- The Age on pharmaceutical companies’ foundation Saturday May 5: advertisements for strong painkillers. Headaches affect one in 150 women platforms The Sydney Morning Herald, release opioids attracted strong media Wednesday May 9: The Canberra Times, the Brisbane Times interest in Australia. Professor Scott was The debate on the effect of anaesthetic after they have been given epidurals Specialist reveals challenges of and WA Today and attracted a readership interviewed by Australian Associated on children’s brains continued with treating Australia’s most obese Press and this story was syndicated to 50 fellows Professor Paul Myles and of 500,000 people. Professor Scott was patients also interviewed by Melbourne radio outlets across Australia with an audience Professor Andrew Davidson being drive program hosts Raf Epstein on ABC of over 1 million readers. Professor interviewed by Fairfax Media’s science A full list of media releases can be found at www.anzca.edu.au/communications/media Radio Melbourne and Tom Elliott on Scott was also interviewed for news editor Liam Mannix. The Sunday Age story 3AW. The issue was also followed up segments on 2GB and 3AW and these were was also syndicated to The Sun Herald by Australian Doctor and the Wake Up syndicated to radio stations in Brisbane and the Canberra Times. Australia program on 2GB in Sydney. In and Perth. New Zealand Professor Alan Merry was The joint statement was also included Carolyn Jones interviewed on the issue for The Listener in a 2300 word opioids investigation Media Manager, ANZCA by Ruth Nichol for a 1000-word article story in the June edition of the Australian that reached an audience of 200,000 Women’s Weekly. Professor Scott was people. interviewed by writer Ingrid Pyne for the article “One Little Pill.” The magazine has a monthly circulation of 375,000 readers.

12 ANZCA Bulletin June 2018 13 ANZCA and government: Building relationships My Health Record expands

The minister was interested to hear that Health Select Committee. ANZCA and FPM Australia New Zealand pain medicine focuses on rehabilitation supported this stance, in a submission to Australia prepares for expansion of Meeting with the Minister of Health and returning people to work, and that the Health Select Committee. My Health Record ANZCA and FPM opened up channels of investing in pain services has potential to Government meetings The Australian Digital Health Agency communication with the new New Zealand save costs across the social development government when Dr Jennifer Woods, sector. He also encouraged ANZCA The ANZCA NZNC invited the Medical (ADHA) recently announced a significant Director of PHARMAC, Dr John Wyeth, expansion of My Health Record – the Professor Ted Shipton and Dr Paul Vroegop and FPM to provide feedback to the met with the Minister of Health, Dr David government inquiry into mental health and the Chief Medical Officer of the secure online summary of key health Ministry of Health, Dr Andrew Simpson, information for Australians. To date, more Clark, on March 29. and addiction. In the open and free-ranging The minister asked about ANZCA’s to its March meeting. The NZNC took than one in five Australians have elected the opportunity to discuss with Dr to register for a My Health Record however discussion, the minister outlined his and FPM’s views on medicinal cannabis. priorities of inequality, mental health and Professor Shipton, Dr Vroegop and Dr Wyeth PHARMAC’s work developing the ADHA recently announced that the primary health – and he asked for free and Woods explained that there is no evidence national contracts for anaesthesia small current “opt-in” participation model frank advice. for the efficacy of cannabis for chronic equipment and consumable products, will change to an opt-out arrangement. Dr Woods, chair of the New Zealand pain, and further research is needed. and to recommend PHARMAC set up This means that by the end of 2018, a My National Committee (NZNC), spoke of Medicines in general are just a small an anaesthesia clinical advisory group Health Record will be created for every provide program updates and exchange Choosing Wisely meeting inequity as a leading issue for ANZCA too component of the options for treating to ensure appropriate products are Australian with a Medicare or Department information between participants about and outlined the draft Indigenous health chronic pain, and better access to pain contracted for. of Veterans’ Affairs card unless they the roll-out of new funding agreements strategy working towards redressing medicine services may mitigate public The NZNC heard from Dr Simpson that choose to opt out. and a revised operational framework that inequitable health outcomes between demand for cannabis to treat unrelieved the ministry is looking at developing ANZCA has been engaging with came into effect in 2018. The event also M ori and non-M ori, recognising that pain. The minister understood that new health targets for the minister, and ă ă that work is still progressing to develop the ADHA to assist in making health provided the department the opportunity inequity is a safety and quality issue. evidence for using cannabis-based a national electronic health record. Dr practitioners aware of this change and to deliver an information and training Professor Shipton, chair of the FPM NZNC, products for chronic pain was lacking, Simpson also provided updates on the what it might mean for them. The ADHA session on a new online reporting portal and Dr Vroegop talked about the burden of and explained this was behind his that will be implemented in the latter part chronic pain in New Zealand, inequitable decision not to widen access to cannabis mental health review and medicinal has created a number of resources for cannabis legislation. both health professionals and patients of 2018. Attendees also took part in guided access to pain medicine services across to those with chronic pain in the Misuse which are available. Resources tailored tours of the Geoffrey Kaye Museum and its the country, and the bi-directional of Drugs (Medicinal Cannabis and other specifically for specialists are available on new “Rare Privilege of Medicine: Women relationship between chronic pain and matters) Amendment Bill before the mental health and addiction issues. the myhealthrecord.gov.au website. These anaesthetists in Australia and New Zealand” exhibition. include how to view and upload clinical NPS MedicineWise hosted the second A feature of the event was a workshop information, help sheets for a range of annual Choosing Wisely Australia on expanding regional and rural training Australia New Zealand clinical software, webinars and brochures capacity. Colleges identified a number of National Meeting in Canberra on May 30. Submissions for patients. issues including: Led by Australia’s medical colleges and • Therapeutic Goods Administration – • Justice Select Committee – End of Further, to ensure that My Health professional societies and facilitated by ANZCA prepares submissions and Consultation on prescription strong Life Choice Bill. • Trainee welfare and feelings of makes representations to government Record fulfils its aims for healthcare NPS MedicineWise, the Choosing Wisely (Schedule 8) opioid use and misuse professional isolation. and other stakeholders on a range of in Australia – options for a regulatory • Health Select Committee – Misuse of professionals of improving timely access initiative is now in its third year and policy initiatives and inquiries, many response. Drugs (Medicinal Cannabis and other to relevant patient information and • Providing suitable supervision. is challenging the way we think about of these in response to requests for • Therapeutic Goods Administration matters) Amendment Bill. • Meeting accreditation requirements. supporting clinical decision-making, healthcare. college feedback and input. ANZCA’s – Consultation on management and • Health Select Committee – Health ANZCA has undertaken to provide • Ensuring trainees have access to diverse There was an emphasis on the submissions to public inquiries are communication of medicine shortages in practitioners Competence Assurance the ADHA with relevant feedback cases and adequate patient loads. recognition and reduction of low-value available on the ANZCA website Australia – a new protocol. Amendment Bill. and suggestions from our fellows • Infrastructure deficiencies. healthcare, in terms of low yield tests and following the inquiry closing date. • Therapeutic Goods Administration and trainees. The college will keep procedures, and also on decreasing risk Note that some inquiries and requests – Consultation on labelling of • Health Quality and Safety Several strategies to address these issues its members updated with relevant and harm to the patient. for college input are confidential. For neuromuscular blocking agents. Commission – Maternity vital signs were explored by participants however it information in future communications, Dr Kim Hattingh, the Faculty of Pain a listing of recent submissions visit • Medical Board of Australia – chart. however should you have any feedback was clear that many of them will require Medicine representative on ANZCA’s www.anzca.edu.au/communications/ Consultation on draft revised guidelines on My Health Record or queries about locally developed solutions given the Safety and Quality Committee presented a advocacy/submissions. “sexual boundaries in the doctor-patient • Perioperative Mortality Review the significant expansion of the program complexity and diversity of both regional poster highlighting the joint FPM/ANZCA relationship”. Committee – 2018 draft annual in 2018, please contact the Policy unit at and rural communities and specialist Statement on the Use of Slow-Release • Committee on the Health Care report recommendations. medical training requirements. [email protected]. Opioid Preparations in the Treatment Complaints Commission (NSW) – ANZCA’s Specialist Training Program of Acute Pain and discussed the Handling of complaints about cosmetic health services providers in New South Working to enhance rural training team will continue to work closely with relevant college staff and committees to recommendation with participants from a Wales. On May 2-3 ANZCA hosted the first of two range of organisations. enhance the college’s ability to identify • Department of Health and Human inter-college network meetings planned opportunities to expand regional training The keynote address for the meeting Service (Victoria) – Draft amendments for 2018 (top right). Attended by the capacity in the coming years. For was given by Mr Daniel Wolfson (above), to the Health Services (Private Department of Health and all colleges further information please contact Executive Vice President and Chief Hospitals and Day Procedures Centres) participating in the Specialist Training the Specialist Training Program team Operating Officer of the ABIM Foundation, Regulations 2013. Program and the associated Integrated at [email protected]. a not-for-profit foundation focused on • Royal Australasian College of Physicians Rural Training Pipeline initiative, advancing medical professionalism and – Consultation on position statement and the purpose of the meeting was to physician leadership to improve the evidence review on obesity. healthcare system.

14 ANZCA Bulletin June 2018 15 ANZCA’s professional documents

Dr Peter Roessler explains ANZCA’s professional documents using practical examples.

Picture the scenario where a surgical concern in the absence of evidence of in question, and how would you proceed? participation is likely to raise alarm bells knowledge”. When clinical performance colleague comes to you and expresses clinical underperformance or relevant Using the ANZCA roles as a basis, the with the regulatory authorities. Indeed, becomes the subject of concern as a their concern about an anaesthetist, not health issues. Nevertheless, participation guide identifies behaviours that may reductions in scopes of practice are strong result of ageing, the opportunity should because there have been any issues, but in continuing professional development be used to evaluate/support clinical reasons for adherence to the mandatory be seized to capture and utilise the simply because they are concerned about is a necessary component as inadequate performance, whether it be our own or our practice evaluation and emergency resources deposited over the years by the anaesthetist’s advanced age. activity is linked to increased risk of colleagues. responses sections, as they provide the redirecting the wealth of knowledge underperformance. The above resources may be helpful opportunity to maintain skills, as well and experience to safety and quality, What would you do? In guiding our approach to addressing in identifying the relevant standards as confirmation of performance at the and professionalism, via non-clinical While I appreciate that there may be a the surgeon’s concern, it may be helpful as well as the value of compassion and expected level. conduits. temptation on the part of some, to dismiss to refer to the ANZCA professional understanding. This is encompassed very In conclusion, would you dismiss your this concern purely because it was raised documents, the ANZCA Supporting nicely in the Promoting good practice surgical colleague’s concern because Dr Peter Roessler by a surgeon, the question remains, is Anaesthetists’ Professionalism and and managing poor performance in there have been no reports suggesting Director of Professional Affairs, Policy their concern warranted? How would you Performance: A guide for clinicians anaesthesia and pain medicine guideline underperformance, or would you thank respond? booklet, and the codes of conduct of the containing sections on identifying poor them for their concern and for bringing Ageing (this) gracefully Despite financial pressures and relevant authorities in Australia and performance as well as appropriate steps the matter to your attention and then use The topic of retirement is a perennial competition for lists, my experience New Zealand, as well as the very well- that a colleague may take to explore the abovementioned resources to follow one that appears to generate a spectrum has been that fellows’ primary regard considered ANZCA document available allegations of poor performance. This through? I know what I would like if I of emotions ranging from fear to is patient safety and the wellbeing on the website under doctors’ welfare, can be accessed at www.anzca.edu.au/ was the subject of concern (and maybe anticipation. At the centre of retirement is of colleagues rather than any Promoting good practice and managing resources/doctors-welfare/managing- I am). I have discovered that in my case the issue of ageing, although discussions opportunistic or selfish exploitation of the poor performance in anaesthesia and pain poor-performance-in-anaesthesia-and- the ageing process is unkind to memory, frequently heard in hospitals and at circumstances. This typifies collegiality, medicine. pain. This resource may be most helpful especially with names, which is why I conferences involve fellows of all ages. which is appropriate in this scenario as Taking some of the concerns in turn, in differentiating concerns about age from prefer to wear my name tag upside-down, What expertise do I possess regarding the concern was based on advancing age fatigue and ability to cope with fatigue concerns about performance. so that I can read it should I forget my ageing? In my early years as a consultant rather than actual clinical performance. as well as the impact on vigilance are With the often-observed voluntary name. I was invited to lecture on the physiology With regard to ageing, there is addressed in PS43 Statement on Fatigue narrowing of case-mix and limitations on The price of experience is time, which of ageing at the short course run by the continuing emergence of research and the Anaesthetist. Health issues should hours worked, CPD becomes increasingly is accompanied by the accumulation Victorian Regional Committee. Mind highlighting specific neurological be guided by the recommendations important as any reduction in CPD of “intellectual property and corporate you, I was intrigued as to why a neonatal changes accompanying ageing that contained in PS49 Guidelines on the anaesthetist would be invited to present affect the “fast” and “slow” neurological Health of Specialists and Trainees. PS50 on ageing. I discovered the wisdom of that responses. Automated responses based on Guidelines on Return to Anaesthesia selection in due course as I presented on experience remain rapid, however, those Practice for Anaesthetists provides this topic for almost two decades, during that require processing and evaluation guidance in cases where there has been which time, yes, I had aged. Also, my tend to slow down, resulting in a a significant absence from work for scope of practice at that time included decreased ability to effectively respond to health or other reasons. Contracture the whole age range from neonatal to “new” clinical presentations. of some of the duties contained within Professional documents – update geriatric. It is said that with ageing comes In subtle ways this possibly accounts PS57 Statement on Duties of Specialist insight and wisdom. It has also been said for the shifts in clinical practice observed Anaesthetists may need to be considered; that my case is exceptional, although I with ageing, which include a reduced however, there can be no compromise on The professional documents of ANZCA and FPM are an • PS63 Guidelines for Safe Care for Patients Sedated in Health still wonder about the interpretation of workload – initially after-hours and then the need to undertake relevant quality important resource for promoting the quality and safety of Care Facilities for Acute Behavioural Disturbance (approved exceptional in this instance. also during hours; and a narrowing of assurance as stated in PS58 Guidelines patient care. They provide guidance to trainees and fellows for pilot at the April 2018 council meeting.) This document In this edition I propose to consider case-mix – voluntary limitation in scope on Quality Assurance and Quality on standards of clinical care, define policies, and serve other is co-badged with the Australasian College for Emergency the issues associated with the ageing of practice. Improvement in Anaesthesia. purposes that the college deems appropriate. Government Medicine and the College of Intensive Care Medicine of anaesthetist, and this is timely given the Although age has been identified Some of these aspects are emphasised and other bodies refer to ANZCA’s professional documents as Australia and New Zealand. an indicator of expected standards, including in regards to prominence of the topic of ageing during by the Medical Board of Australia as with examples of good and poor All comments and queries regarding professional documents accreditation of healthcare facilities. Professional documents National Anaesthesia Day in October a risk factor for clinical performance, behaviour reflecting clinical performance can be sent to [email protected]. last year. Although the focus was on the the vexing question that needs to be in the handbook Supporting Anaesthetists’ are subject to regular review and are amended in accordance ageing patient the processes of ageing answered is at what age does this apply Professionalism and Performance: A guide with changes in knowledge, practice and technology. All ANZCA professional documents are available via the does not differentiate between patient or to any individual. Given the spectrum for clinicians. For example, at what point Recent releases ANZCA website – www.anzca.edu.au/resources/professional- documents. practitioner, and no one is immune from of performance at any specified age would you raise this with the anaesthetist • PS58 Guidelines on Quality Assurance and Quality this terminal condition. the application of a rigid age limit is of Improvement in Anaesthesia (final version). FPM professional documents can be accessed via the FPM In pilot website – www.fpm.anzca.edu.au/resources/professional- documents. • PS64 Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice (in pilot until February 2019).

16 ANZCA Bulletin June 2018 17 Can trainees’ (and fellows’ and other CPD participants’) personal reflections be used in court?

The recent case in the UK of Dr Hadiza The General Medical Council, considering the decision of Bawa-Garba has raised concerns in Australia and the tribunal, felt it was inadequate and appealed the tribunal’s decision arguing that in the case of a serious criminal conviction New Zealand for young doctors and trainees. of this nature, that de-registration should automatically apply. Many medical colleges require their trainees, and some fellows The case of Dr Bawa-Garba is not over. Most recently, she and other CPD participants, to undertake consideration of their has obtained the right to further appeal this decision. Her practice, reflect on their own performance and give a frank de-registration is therefore subject to further review and the assessment of their actions and performance in particular areas. outcome will be of great interest. Obviously the information can be quite personal and sensitive, The case of Dr Bawa-Garba involved a relatively junior doctor and may admit some error, or identify areas for improvement. in circumstances of an extraordinarily busy time in the hospital, There is now concern that information might be “used a lack of adequate staffing, substantial overload of her work, against them” should medico-legal action arise or in other missing clinical information and delayed test results. In the administrative processes. midst of all of this it was alleged that Dr Bawa-Garba also was While the outcome in the case affecting Dr Bawa-Garba negligent, to the extent that a court concluded that she was is concerning, with her ultimate de-registration as a medical criminally negligent. As a consequence the General Medical practitioner, there are also strong views that the same situation Council in the UK sought and ultimately obtained her de- could not arise in Australia or New Zealand. There is also the registration. There are a number of reasons why this is unlikely myth that, in the Dr Bawa-Garba case, her reflective notes were to be repeated in Australia and New Zealand: used against her in the proceedings by which she was convicted 1.The factual circumstances affecting Dr Bawa-Garba and her criminally and ultimately de-registered. In fact it was clear that performance in the hospital at that time while negligent, her reflective notes were not used, and were not permissible as would not ordinarily meet the Australian and New Zealand evidence. requirements for criminal negligence. Well intentioned Dr Bawa-Garba was a registrar at the Leicester Royal doctors can make mistakes. These can lead to negligence Infirmary in the Paediatric Unit. The relevant case involved a claims. However a conviction for criminal negligence requires six-year-old boy presenting at hospital with dehydration and that the negligent act or omission should be of such order and other symptoms. He was initially treated for gastroenteritis magnitude that it amounts to the criminal standard equivalent Perhaps most reassuringly of all to trainees, fellows and other and dehydration. Other tests were requested. Radiography to manslaughter. Australia and New Zealand cases in relation CPD participants in Australia and New Zealand is the fact Summary of protections available under Qualified indicated pneumonia and antibiotics were administered. to this issue have set a higher bar than would appear to have that ANZCA has obtained appropriate legislative protection Privilege (Australia)/Protected Quality Assurance Activity (New Zealand) legislation Delayed blood test results were received later. There was some been the case in this instance in the UK, especially given that for the reflective notes and reflective parts of their training miscommunication between Dr Bawa-Garba, nursing staff and this was a jury trial. This is especially so in New Zealand since program (training portfolio system cases and procedures) and Protection IS available for (in both countries unless ultimately the consultant. A serious infection had not been the change in the law in the 1990s, in response to a campaign CPD program (practice evaluation)2 such that the information otherwise stated): identified, and the child suffered septic shock. It was suggested led by Professor Alan Merry. protected cannot be revealed beyond the process for which 1. Training portfolio system (TPS) it was intended (training and CPD). To reveal any identifying that the delayed response to the underlying infection was a. New Zealand: “ANZCA trainee portfolio system: Cases 2.The Medical Board of Australia (MBA) and the Medical information that is documented in these sections of the TPS directly relevant to the child’s death. Other “system” errors and procedures section” (which includes the reflective Council of New Zealand (MCNZ) are unlikely to adopt the and CPD portfolio, including identifying the trainee or fellow, within the hospital contributed to this unfortunate event. same rigid stance of the General Medical Council, in seeking notes within). Dr Bawa-Garba and a nurse faced criminal charges for gross beyond that process would constitute a criminal offence. automatic de-registration. In the circumstances of misconduct b. Australia: “Reflective self-audit on cases and procedures negligence, equivalent to manslaughter. This required more Apart from the fact that the reflective notes of Dr Bawa-Garba in both Australia and New Zealand, both the MBA and MCNZ were not used in the relevant court case, trainees, fellows within the ANZCA training program”. than mere negligence, and required proof beyond reasonable would look at the individual circumstances of each case, and doubt that the circumstances were so bad and so exceptional and other CPD participants in Australia and New Zealand 2.CPD Program seek to understand better the nature of the charges, the details can be assured that the college has had, for some time, legal that it amounted to a criminal act and would be a breach of of the misconduct and the surrounding circumstances and the a. New Zealand: “ANZCA CPD Program” (no exclusions). criminal law. It is significant, perhaps, that the trial involved a 1 protection in relation to any right of access to the reflective and implications of the conviction for fitness for medical practice . b. Australia: “ANZCA CPD Program – Practice Evaluation jury, and that they were persuaded that in all of these difficult personal notes of trainees and fellows in relation to the training It is unlikely that the MBA and the MCNZ would have a Section” (which includes the practice evaluation circumstances, the conduct was of a criminal nature. As a program (TPS cases and procedures) and CPD program (practice position that circumstances of this nature must automatically evaluation part) of the college. mandatory activities). consequence Dr Bawa-Garba (and the nurse) were convicted involve de-registration. of gross negligence, and although sentenced to two years 3. WebAIRS: All information submitted. imprisonment, it was wholly suspended for two years. Michael Gorton AM LLB. B.Comm. FRACS (Hon) FANZCA (Hon) In relation to the subsequent professional action taken Principal – Russell Kennedy Lawyers Protection is NOT available for: against Dr Bawa-Garba before the Medical Practitioners’ 1. TPS – rest of the documentation apart from the cases and Tribunal, the tribunal accepted that there was professional 1. Health Practitioners Competence Assurance Act 2003 S 100 (1) c procedures section as noted above. misconduct and it imposed 12 months’ suspension, subject to http://www.legislation.govt.nz/act/public/2003/0048/latest/ review. It explicitly rejected de-registration as an appropriate DLM204310.html 2. CPD Program response. a. Australia: The rest of the program (knowledge and 2. See table summarising details of protections available for skills, emergency responses, CPD plan and evaluation). documented reflections. b. New Zealand: Nil (all covered). 3. WebAIRS: Any data forwarded to local systems or any pages printed out from WebAIRS submitted data.

18 ANZCA Bulletin June 2018 19 Continuing Professional Development Meeting practice evaluation Medical Board of Australia’s Professional activities in private practice Performance Framework

The recent fellowship survey included Released in late 2017, the Medical Regulation Agency, the Australian FPM CPD Program complies with all some encouraging insight into how the Board of Australia’s (MBA) Professional Medical Council, the Australian Medical aspects of the framework in 2019, with ANZCA and FPM CPD Program was being Performance Framework provides the Association, specialist colleges, health the vision of delivering an updated CPD received with 85 per cent of respondents foundation for a new national perspective complaints commissioners, government Standard and Program in 2020. indicating that they felt the continuing on continuing professional development representatives and medical indemnity The CPD Committee are keen to professional development (CPD) portfolio (CPD) and ensures that medical insurers to discuss any issues or concerns maintain transparent communications was easy or very easy to use. practitioners in Australia practice safely these stakeholders had with the structure with the ANZCA and FPM fellowships, The survey also showed that the and with competence throughout their or implementation of the framework. and will provide regular updates as fellowship would like more information professional lives. ANZCA Immediate Past President new information is available via the about how to complete their practice The framework is intended to build Professor David A Scott, President Dr ANZCA Bulletin, ANZCA E-Newsletter, evaluation requirements, particularly on existing initiatives and the ANZCA Rod Mitchell, CEO Mr John Ilott, CPD Synapse and other ANZCA and FPM from those in private practice. and FPM CPD Program is already in Committee Chair Dr Nigel Robertson communication platforms. The CPD Committee and CPD team good standing, as we include many of and Director, Education, Mr Olly Jones Further information about the will endeavour to share more information the items that will now become an MBA all attended the workshop. Finalising professional performance framework about how those in private practice can requirement such as practice evaluation the framework is intended to be a can be found on the Medical Board fulfil these requirements, including and knowledge and skills activities, the collaborative exercise and further of Australia’s website: insights from private practitioners CPD plan and triennial evaluation and the information is expected to be provided by www.medicalboard.gov.au/ themselves in future editions of the CPD portfolio. the Medical Board at another workshop Registration/Professional- Bulletin. The MBA hosted a workshop in due to be held in August 2018. Performance-Framework.aspx There is a misconception that February, hosting representatives from ANZCA expects to begin any work participants cannot meet the practice the Australian Health Practitioner required to ensure that the ANZCA and evaluation requirements if they cannot complete a peer review of practice or a multi-source feedback (MSF) activity; this This activity is worth 20 credits. including and implementing changes as a is not the case. Completing this process twice within result of the audit conducted and for time There are four mandatory activities in the triennium would satisfy the practice devoted to presenting the audit findings the practice evaluation category: evaluation requirement of two mandatory locally or at a meeting/conference. • Patient experience survey. activities per triennium. Completing this process twice within the triennium would satisfy the practice • Multi-source feedback (MSF). Clinical audit of your own practice or evaluation requirement of two mandatory • Peer review of practice. significant input into a group audit of practice activities per triennium. • Clinical audit of individual or group Completing a clinical audit of your own Get in touch practice. practice is another of the four mandatory If you are in private practice and feel Participants may choose any two (or activities and can be completed by an that you are having difficulty meeting complete the same activity twice) per CPD individual without needing to rely on the the practice evaluation requirements, we triennium as a minimum requirement to assistance of other colleagues. encourage you to contact the CPD team achieve the CPD standard. There are 14 sample audits on the for advice, or contact the CPD Committee A patient survey and an audit are ANZCA website, and links to the Royal for guidance on how to complete practice equally valuable and may be more College of Anaesthesia’s Audit Recipe evaluation activities within your specific achievable in certain circumstances. Book. practice settings. The ANZCA and FPM CPD Committee Patient experience surveys +61 3 9510 6299 aims to develop further clinical audit Patient experience surveys can be [email protected] samples each year to expand the available administered and the results collated selection. by a co-worker or an assistant. Dr Nigel Robertson FANZCA The clinical audit is worth 20 credits A trusted colleague or feedback CPD Committee Chair within the practice evaluation category. provider should then have a 20-30 minute As well as claiming the actual audit, two conversation with you summarising the credits per hour can also be claimed in results of each item and discuss any practice evaluation for the time spent issues that arise form the results. documenting the clinical audit results,

20 ANZCA Bulletin June 2018 21 Doctors’ welfare Learning from Richard’s death

Opposite page from left: Headland Farm Park, Tamaterau, Whangarei; Dr Richard Harding and Dr Kate Harding in NZ; their last photo together taken in Melbourne in October 2017.

“ He was three days away “ He began worrying from his first appointment about cases that with a psychiatrist when previously would he took his own life.” have caused him no concern.”

I have recently been catapulted back to the UK Unfortunately, the effects of a complaint – even one At home, however, it was clear to us both that his mood was him away, knowing that I would never see him again. Fielding the statistically highly likely to be found in the doctor’s favour, as in slipping downwards, and it seemed that the long months of policemen’s questions, thanking the neighbours for their help, from New Zealand in the wake of my intensive care Richard’s case – last far longer than the period of investigation. anxiety and powerlessness in the face of the GMC complaints shutting the door on them and at the same time on our old life, consultant husband’s death. My children and I are Richard did a lot of soul-searching during those months. He procedure, coupled with a move across the globe, were catching unable to imagine how our new life could possibly take shape still reeling from Richard’s suicide, which took had always been known for his sound clinical judgment and for up with him. without him. Suffice to say that we did – somehow – survive those his decisiveness at work, for his steadiness under pressure, for Richard did well on antidepressants and weaned himself early days, and that our new life is unfolding without him, though place six months ago, at home, while my daughter his relaxed and calm manner and his sense of fun – he loved to off them after six months, with his doctor’s blessing. He threw it still seems incredible sometimes that such a thing should be and I were walking the dog. banter with the nurses and doctors he worked with and had an himself into our new coastal lifestyle: running, cycling, diving possible, or even allowed. open and forthright manner with everyone he met. and fishing. He frequently had his morning coffee in the sun We have returned to the UK, to the security that comes Richard and I met as junior doctors in Brisbane, and have also This sense of having been born to do the work that he did was while gazing at our astonishing view, which took in the gleaming from living near family and old, dear friends, though I have worked in Perth, Dunedin and, latterly, Whangarei, after 10 years something he exuded effortlessly, and I envied him this, having blue of the harbour waters, Mount Manaia in the distance and the made friends for life in New Zealand and will never forget their back in Herefordshire, England. We shared a deep love of both always questioned my own place within medicine and my choice shimmering greens for which New Zealand is famous. He deeply kindness in the aftermath of Rich’s death. We are adapting to Australia and New Zealand, and chose to return to the latter of general practice as a career. loved his new environment, and we often walked on the beach life as a unit of three, rather than four. I have returned to work, in 2016. It had been increasingly difficult for British doctors to In the aftermath of the complaint, however, he talked to me together, marvelling at our good fortune in having landed in a compelled to do so as soon as possible by my new status as sole find intensive care consultant posts in either country in recent much more about the ethical dilemmas he faced at work, all of place so heart-stoppingly beautiful. breadwinner, and by the absence of any life insurance pay-out. I years, and when a job came up in Northland, New Zealand, and which cropped up in intensive care, rather than during the course The illness then recurred some six months later, slowly am taken out of myself and my troubles by my hospice work, and we became aware of the area’s incredible natural attributes, of his anaesthetic work, which continued to come easily and taking hold, fuelled by his on-call rota and the associated sleep am well supported by my work colleagues, many of whom are including the world-renowned Tutukaka coast, Richard felt naturally to him. He began to question his decision making. He disturbance that, constitutionally, he had always found difficult, close friends. compelled to apply. began worrying about cases that previously would have caused but which this time took a disproportionate toll on his mental Richard’s mental health troubles were, in comparison with Just as we prepared to make the journey across the globe, him no concern. He brought his work home in a way that I hadn’t health. He went back on to his medication, but this time, agitation those of other doctors who have taken their own life, short-lived including packing up our possessions into a shipping container, seen him do before. was an increasingly prominent feature of his illness, and it and intense. He had had one previous episode of depression making arrangements for our two dogs to fly out to join us and By this time, he had settled into his new role at Whangarei became clear to us both that he was on the wrong drug; that, this in his early s; there was no recurrence for 23 years, until the selling our house, Richard received the letter all doctors dread – 20 Hospital and was enjoying getting to grips with a new system, time, he needed something different. He was three days away period following his GMC complaint and our emigration. He notification that a complaint had been made against him to the despite the challenges of adapting to a new country and different from his first appointment with a psychiatrist when he took his was open about being investigated (probably in part because General Medical Council (GMC). ways of working. He was popular with his colleagues, and his own life. he was confident that he would not be found guilty of poor This effectively put our plans on hold indefinitely and caused direct communication style went down well with his patients, I have written elsewhere (www.theguardian.com/ clinical judgement, on which count he was correct) and found his us months of stress. Camped out in a holiday cottage, living out who appreciated his warmth and his honesty. He enjoyed lifeandstyle/2018/feb/24/went-walk-returned-husband-suicide- colleagues to be uniformly supportive and reassuring. He still died. of suitcases, we sent our children back to the school they thought learning about the M ori culture, and would give me and the depression) about finding Richard dead, trying to resuscitate they had left for good, and returned to the jobs we had resigned ă children impromptu tutorials on M ori word pronunciation, him while knowing it was entirely futile to do so, helping the (continued next page) from. Finally, the complaint resolved in Richard’s favour, we left ă having been inspired to make headway in this area by some children to say goodbye to him, watching the paramedics drive the UK, assuming that our emigration would be permanent, and powerful and thought-provoking cultural awareness teaching we were determined to put the GMC investigation and all the at the hospital. associated anxiety and uncertainty behind us.

22 ANZCA Bulletin June 2018 23 Doctors’ welfare Learning from Richard’s death Have your say...Doctors’ Health and (continued) Wellbeing Draft Interim Framework

It is hard to predict who will succumb to suicidal thoughts If this article has raised concerns for you, please ANZCA is committed to developing a health and 3. A respectful, positive approach to creating a safe and both during and after an investigation. He would not have been supportive culture: Reflecting our ability to provide on anyone’s “one to watch” list. It is debatable how much of a contact the ANZCA Doctor’s Support Program. wellbeing framework that supports our members, leadership and advocacy in the profession, supporting a factor the GMC investigation was in causing his death, since at every stage of their career, and provides guiding culture which positively embraces the importance of doctors’ his suicide occurred 22 months after first receiving the “letter principles for future initiatives in this area. Part health and wellbeing. of doom”, as we called it. I personally feel that its effects were of this process is seeking your thoughts, on what 4. An accessible, integrated, holistic approach: Reflecting insidious, that a complaint, however minor, has deep and long- our ability to provide integrated strategies that consider work lasting ramifications for doctors, who tend to be sensitive to any matters most to you. An online response form is environment, personality factors, home and personal life, and suggestion that they are not looking after their patients properly. available for all fellows, trainees and specialist the potential stigma associated with seeking help. Of course we make mistakes. Some of us even commit crimes. The vast majority of us are just trying to do our best, however. international medical graduates to provide We genuinely want to help our patients, do some good in this comment on the framework until July 15. troubled world, go home to our families feeling that we made In February 2018, a group of trainees, fellows, councillors, staff, a difference – however small, however temporary. and representatives from our sister colleges and societies met Risk and protective Here in the UK, I am working with the Association of with the college to support the development of our proposed new Anaesthetists of Great Britain and Ireland, which is looking into approach to doctors’ health and wellbeing. strategies the suicide rate among anaesthetists. This is well known to be The proposed framework intends to guide the college’s higher than average, due in large part to their easy access to prioritised efforts on doctors’ health and wellbeing strategically n Pr Collaborative approachio o lethal injectable drugs. Of course, many suicides have nothing to t te over the coming years. This will govern the planning and o c • Willingness to respond t m i do with complaints. Some are substance misuse-related, others o o delivery of both actions deemed to be directly within r Better health n associated with long-term chronic health conditions, physical the college’s control and those that are best achieved in P as well as mental (although the distinction between the two is • Wellness collaboration with other stakeholders. •Wellbeing artificial and not always helpful). The following framework has been adapted to the college's Accessible integrated One of the goals of this work is to put in place ways of trying needs from beyondblue's “First responders” good practice model holistic approach S to reduce the risk of suicide for individual doctors, while for mental health and wellbeing” because of the similarities in upport equipping hospital departments to offer better support to those its principles, action-orientated approach and the people it aims affected by such tragedies when they do occur. Colleagues are to support. hit hard by the loss of a doctor in their midst to suicide, and Respectful positive approach the remorse and guilt that I feel as Richard’s wife are felt by his The overarching intent • Safe and supportive culture friends and workmates too. The overarching intent of this framework – better health and I am no expert in the field of doctor wellbeing, and am wellbeing – encompasses the holistic health and wellbeing of learning as I go along. I am grateful to those who are teaching our doctors. me, and allowing me to play my own tiny part in the work that is being undertaken in this area. Richard’s death was simply Three integrated action areas unimaginable to me, knowing as I did – do! – how much he loved Career life cycle his family. I have to live with the consequences of this failure of 1.Promotion: Promoting the positive aspects of being in the This reflects the importance of the transition across the imagination every day, as do my children and everyone else who profession as well as the importance of self-care in the role following stages to a doctor's career: training; new specialist; has been affected by his death. of doctor. Promoting research. mid-career; retirement; and return to work. And that this should I miss him desperately. I miss our life in New Zealand, our 2.Protection: Advocating to reduce profession-related risk be considered in relation to the framework intent, actions areas enchanting peninsula, the greens and the blues. I long to go factors for health and wellbeing and increasing protective and principles. back, but, for now, I belong here in Britain, lashed by rain, Brexit strategies. Training New specialist Mid-career Retirement a constant background rumble of discontent. Richie is with me 3. Support: Providing effective and accessible services wherever I am, as is the grief – a deep, dark central weight within. and programs to support doctors’ health and wellbeing. Not for one moment do I doubt how much we were loved by him, Encouraging those who need treatment; de-stigmatising Return to work not for one moment do I think that he knew what he was doing to mental illness; and promoting inclusion. us by leaving us. Sometimes that helps; more often, it doesn’t. What happens next? Four key principles Dr Kate Harding Responses from this consultation will be used to further develop There are four key principles that will guide the implementation of the draft framework. Updates will be provided via the ANZCA Dr Kate Harding is a hospice doctor and part-time GP now working all health and wellbeing actions in alignment with this framework. website and through other college communications. Further in Herefordshire, UK, following the death of her husband Richard. 1.A collaborative approach and a willingness to respond: consultation is anticipated to occur to map current ANZCA She lives with her two children and her cavalier King Charles Reflecting the collective effort considered essential to doctors’ health and wellbeing initiatives against the framework spaniel, Mo. She can be found on Twitter at @KateJH1970. achieve the overarching intent. We are all part of shifting the over the coming months. professional paradigm to one that considers the health and wellbeing of our doctors a priority. Have your say 2.Risk and protective strategies: Reflecting our ability to For further information and to provide feedback go to promote strategies to modify the risks to our doctors through www.anzca.edu.au/resources/doctors-welfare. This article was originally published in MJA InSight education, policies and other areas of influence in employer www.doctorportal.com.au/mjainsight/2018/18/doctors- organisations. wellbeing-learning-from-richards-death/

24 ANZCA Bulletin June 2018 25 Fellow profile Wing commander flies high with Defence medical teams

Extract from the Medal for Gallantry citation awarded to Major Vaughan-Evans (now Douglas) in 1996: “Her gallant performance of duty, distinguished leadership and tireless and selfless efforts, often under fire and always under appalling conditions, Major Vaughan-Evans was directly responsible for saving the lives of many Rwandan people. Her calmness in this life threatening situation and her ability to make clear and accurate medical assessments under pressure were of the highest order. In addition, her compassion and dedication to those she was treating, ability to improvise when supplies ran low, and outstanding medical expertise were the finest traditions of the Royal Australian Army Medical Corps. Her acts of gallantry and leadership whilst under fire were an inspiration to all members of the Australian Medical Support Force Team at Kibeho.”

“ It is an adjustment. I can be at the In addition to the Medal for Gallantry Wing Commander Douglas has received: Gold Coast University Hospital and • Australian Active Service Medal with clasps for International then a week later I’m in full uniform Coalition Against Terrorism, East Timor and Rwanda. • International Force East Timor Medal. armed to the teeth.” • Australian Campaign Medal for Afghanistan. • Australian Service Medal with clasps for Counter Terrorism/ Anaesthetist Dr Alex Douglas, the recipient of an I enjoyed my military training and responsibilities and It is an adjustment. I can be at the Gold Coast University Special Recovery, Timor Leste, Special Operations and Iraq. revelled in the work. In 1995 as an Army Captain with nearly Hospital and then a week later I’m in full uniform armed to the • Operational Service Medal. Australian Medal for Gallantry, writes about how teeth. I don’t feel like I am going to do anything differently but three years’ experience I was deployed to Rwanda. My unit was • Australian Defence Force Medal. her experiences growing up in South Africa and her based at Kibeho (a refugee camp) where more than 5000 people it is a bizarre thing to be walking along and being mindful of • UN Rwanda Medal. Australian Defence Force deployments in Rwanda, were massacred. The Royal Australian Army Medical Corps improvised explosive devices and the like while a week before saved many lives in Kibeho and I was awarded the Medal for I was worried about whether I would be hit by a car crossing • NATO medal with International Security Assistance Force East Timor and the Middle East have shaped her Gallantry in 1996. the road. clasp. approach to the specialty. I then went on to be the first female doctor to work at the It makes you incredibly grateful when you ask for something Special Air Service Regiment (SASR). I have since served on and it’s available and you don’t suddenly have to change or Born in 1967 in Johannesburg as Carol Louise Vaughan-Evans adjust your thinking to adjust or make a contingency plan on many overseas deployments. my early years were spent with extended family in Zimbabwe the back foot. If you are suddenly presented with a child in the After my posting to the SASR I decided to resign from where safety and security were paramount. civilian sector and you weren’t expecting it you just go and get a full-time service and start training as a specialist in both At the age of 11 or 12 I was at a gathering with family and friends paediatric pack whereas in the military if you weren’t expecting anaesthesia and intensive care. To help alleviate the pressure without my parents when there was a terrorist attack. This a child there’s some serious adapting that’s required. I experienced with post-traumatic stress that went untreated became a solidifying moment in my life – the army came and Specialists who have worked in Defence are flexible but I changed my name to Alexandra Evan Douglas. rescued those being held hostage. I vowed then that I would very determined. You do develop a bit of a spine. Having completed my training and gaining a position as do the same thing one day as a doctor. A lot of the technical developments we now use in trauma a consultant specialist I moved into a full time role with the My parents, concerned for their three daughters, sought a medicine comes from the military domain such as the Royal Australian Air Force and I’m now a Wing Commander new life that was far less dangerous. We emigrated to Australia reintroduction of tourniquets. The combat experience is really based with the Headquarters Health Services Wing in Amberley, in 1982, first to the Hunter Valley in New South Wales and then about trauma care and anaesthesia has been a step for me to get Queensland. I’ve been deployed many times overseas including Tasmania. My sporting passions included karate and hockey to ICU. I am very passionate about trauma. It really is a disease five months in the Middle East. To maintain my medical skills and a strong sense of fitness as I was determined to serve in for me and I believe there is much more we can do. I work at the Gold Coast University Hospital with the intensive the military. care unit. I gained my Bachelor of Medicine and Bachelor of Medical I’ve handled the transition from resource-poor field work Science in 1992 from the University of Tasmania and soon after Opposite page: Wing Commander Alex Douglas with the Australian to modern clinical environments in Australian hospitals As Dr Douglas was preparing her story for the Bulletin she was I began my studies I joined the Australian Defence Force. During just days away from participating in her first “half Ironman” Specialist Health Group in Kandahar Airfield's Role 3 medical facility, relatively easily. checks equipment. Source: Australian Defence Force. my holidays and spare time I began my military training and event – the Tweed Coast Euro – which included a 1.9 kilometre worked for Tasmania’s 10th Field Ambulance. On graduation swim, a 90 kilometre cycle and a half marathon. Her results were This page: Aeromedical Evacuation Liaison Officer Wing Commander I went straight into a full time medical role as an Officer of the impressive – of the 21 men and women who were competing for the Alex Douglas prepares a wounded soldier for his journey home from Royal Australian Army. first time in the competition she came sixth with a time of 6:09:16. Afghanistan. Source: Australian Defence Force.

26 ANZCA Bulletin June 2018 27 Safety and quality News

elective. There did not appear to be a October will feature a session on the webAIRS reliable predictor of aspiration with a importance of incident reporting with Respiratory aspiration incidents history of reflux reported in only one in presentation of airway specific data reported to webAIRS seven of cases. It is also interesting to note analysis. webAIRS reporting provides a unique that aspiration occurred during a rapid opportunity to analyse various themes of sequence induction in 15 per cent of the Dr Martin Culwick, Dr Michal Kluger, anaesthesia incidents for the purpose of webAIRS reports. Sarah Walker and Dr Pieter Peach quality improvement. It was respiratory In terms of outcome, almost 60 per aspiration data that was given recent cent of patients experienced a prolonged Reference: focus at ANZCA’s 2018 ASM. length of stay or unplanned admission to 1. Medelson CL. The aspiration of stomach contents into the lungs during obstetric Since Mendelson’s publication in intensive care. Death occurred in 6.6 per anaesthesia. AM J Obstet Gynecol. 1946; 1946, there have been numerous journal cent of the incidents of aspiration reported 52: 191-205. articles relating to acid aspiration of to webAIRS. gastric contents1. The presentation of The full analysis of the aspiration data webAIRS data at the ASM reconfirmed will be published in a scientific journal. that aspiration remains an important What the current findings highlight is the complication of anaesthesia despite need for vigilance around aspiration even high awareness of risk and management in the absence of perceived high risk. Safety alerts techniques. While prevention is often The second half of 2018 will see Safety alerts are distributed in the cited as the mainstay in avoiding further themed analysis and conference “Safety and quality” section of the incidents of aspiration, the analysis of presentation of webAIRS data. The monthly ANZCA E-Newsletter. A full list the webAIRS incident data revealed that Publications Group led research will can be found on the ANZCA website: approximately 40 per cent of affected examine causal and management factors www.anzca.edu.au/fellows/safety patients were considered to be of no as well as outcomes. The ASA NSC in -and-quality/safety-alerts. risk, and approximately 50 per cent were

28 ANZCA Bulletin June 2018

14361 Palexia IR ASA Advert FPC 210x285_FA.indd 1 1/03/2018 10:07 AM Slow release opioids: Message from the Fellows respond president and dean to the statement been prescribing SR opioids for closely We acknowledge that any comment The release of our “Position monitored acute pain management, the college makes in the public arena Anaesthetists have a long and excellent record in I am writing to condemn the college and FPM’s statement on the use of slow- with no apparent morbidity. It is also will be interpreted as an expression patient safety, making Australia and New Zealand endorsement of this “position statement”. release opioid preparations in recognised however that the management of expectation relating to professional two of the safest countries to have an anaesthetic in. This is independent of any debate about the advisability of the practice of “experts” often drive practice, As such, any contribution made As we continue to work in acute pain management and move use of SR opioids in perioperative pain management. It is also the treatment of acute pain” has management protocols more broadly, by the college to public discussion is further into perioperative medicine we bring the attributes independent of any discussion about solutions to the problem and are seen as role-models for evidence- always carefully considered. created welcome and energetic and skills around patient safety to areas beyond the operating of abuse of prescription opioids in our communities. based best-practice. Our concern is that In this case, the proposal for a discussion among ANZCA and theatre. We wrote as a department, to the college and FPM, unlicensed and unconsidered practices statement and the statement itself was The ANZCA/FPM position statement and supporting expressing our concerns about the document on two counts: FPM fellows. are creeping into everyday “normal” discussed at several FPM Board meetings, comment from Dr Kim Hattingh, Professor Pamela Macintyre, There was no consultation process with the wider membership Many have applauded it and cite changes acute pain management regimes. and ANZCA Safety and Quality Committee of either professional body; there is no evidence provided to to practice already implemented as Professor Stephan Schug, Dr Meredith Craigie and Dr Phillipa The realities are that many meetings over a six-month period. The support the recommendations in the statement. a result, both by individuals and by Hore (March 2018 ANZCA Bulletin) is a document that represents experienced acute pain management latter 18-member committee has broad In response to our letter, the college and FPM replied that a hospitals across Australia and New an important resource to assist in reducing opioid-related harm practitioners achieve adequate results representation including anaesthesia lesser standard is required for an endorsed position statement Zealand. Others have expressed concern and deaths on the wards and after discharge. I congratulate without using SR opioids, that SR opioids and pain fellows, from public and private than for other professional documents. Any other professional with the content of the statement, and/ Dr Hattingh and her colleagues on the production of this (long have been associated with significant practices and metropolitan and semi-rural body, and any lawyer, might be forgiven for misunderstanding or the implications that such a college desired) local statement. morbidity (and mortality) when used for areas, as well as community and policy the subtle distinction. Ask any lawyer what they understand by publication has for independency of I understand some of my medical and nursing colleagues management of acute pain, and that many representation. There is wide geographic the term “college-endorsed position statement”. practice (see page 31). find the statement a challenge and are concerned that it would patients commenced on SR opioids for distribution from WA to NZ. My straw poll in recent Australasian scientific meetings It is clearly evident that inappropriate post-operative acute pain management We thank the faculty board members require an unmanageable change in their practice, resulting slow release (SR) opioid use is causing in patients being in uncontrolled pain. Yet as-needed dosing of suggests that the prescription of SR opioids for perioperative remain on them, inappropriately, for and the Safety and Quality Committee pain is widespread. There is much concern that the college serious harm within our community. The months afterwards. The consequences for their important contribution to this immediate release opioids is certainly compatible with staffing has made this practice medico-legally difficult. This might be United States is in an even more difficult of this can be tragic, and we all need to significant community health issue. levels on general wards in our public hospitals. Additionally appropriate if there was overwhelming or even convincing situation. It is beholden upon ANZCA, consider our role in addressing this. good patient safety practice means being willing to change our evidence to support the college’s position. There is not. including the Faculty of Pain Medicine The SR opioid document is a position practice to safer alternatives, even if we do not have first hand Dr Rod Mitchell We have read through the references provided in the (FPM), to give due consideration to our statement from the college. As such, it is experience of the complications. ANZCA President statement. They do not contain scientific evidence to support role in addressing this dilemma. a point of view on practice expectations, As someone who has been gravely concerned about the the statements or recommendations. As such, the faculty and the ANZCA albeit at a high level. The statement is Dr Meredith Craigie escalating use of non-titratable formulations of these drugs Promoting, publishing and endorsing an unsubstantiated Safety and Quality Committee have neither a mandate nor intended to dictate FPM Dean with highly variable (both within individuals over time and worked together to develop and publish the practice of experienced specialist across the population) therapeutic indices, I am pleased to now opinion piece as a position statement is an embarrassing and an evidence-based position statement, anaesthetists and pain medicine have documented support from my college and faculty to assist unscientific way of “generating discussion”. with the intention of conveying the specialists. “Position statement on the use of in continuing to raise this issue one-on-one with colleagues, The college has declined to publish our full letter in the key message that SR opioids are not However, the position statement slow-release opioid preparations in and more broadly within the organisation that I work in. It Bulletin, requiring 300 words only. Our full letter and the recommended for use in the management does unashamedly encourage us all to the treatment of acute pain” can be has already helped prompt change in approaches to pain college’s response are available at this download: of patients with acute pain. Importantly, re-evaluate the role of SR opioids in our found via www.anzca.edu.au/front- management practices on our rehabilitation ward. https://app.box.com/s/98va7sxcvj1x2g10beqk8ishzcre707h this message is being promoted to reach acute pain management practice. Of note, page-news/position-statement-on- We continue to demand that the college and FPM withdraw this document, until such time as a full, evidence-based debate all opioid prescribers. we need to at least be aware that these slow-release-opioids. Dr Suzanne Cartwright FANZCA FFPMANZCA It should be noted that the discussion agents are not licensed for such use, Tamworth, NSW can be had within our community. Until then, we should not relating to SR opioids was clearly stated and to give due consideration that many tolerate this paternalistic attempt to control our practice. to be regarding their use in opioid- experienced colleagues achieve safe and naive patients. It is acknowledged that effective acute pain control using readily Dr Tim Skinner, MB BCh, FANZCA, FRCA, Dip IMC RCSE many experienced practitioners and titratable, multi-modal analgesia regimes. Consultant Anaesthetist pain management teams have long For the Women’s Health Pain Team Women’s Health Anaesthesia Auckland City Hospital

“We need to at least be aware that these agents are not licensed for such use.”

30 ANZCA Bulletin June 2018 31 Not all opioids are the same

In a direct comparison of opioids with Overall, a differentiation between 5. Tarkkila P, Tuominen M, Lindgren L. The ANZCA/FPM “Position regard to mortality and serious adverse conventional and atypical opioids is a Comparison of respiratory effects of statement on the use of slow- effects, captured by the Researched clinically useful approach in view of the tramadol and oxycodone. J Clin Anesth. 1997;9(7):582-5. release opioid preparations in Abuse, Diversion and Addiction-Related different mechanisms of actions, side Surveillance (RADARS®) System Poison effect profiles, and abuse potentials of 6. Tarkkila P, Tuominen M, Lindgren L. the treatment of acute pain” Comparison of respiratory effects of Center Program in the US, tramadol the latter compounds. Atypical opioids tramadol and pethidine. Eur J Anaesthesiol. has engendered much healthy showed lower mortality, lower serious may therefore play an increasing role 1998;15(1):64-8. adverse effects and lower rates of conversation, but frequently for patients in the acute pain setting as 7. Orliaguet G, Hamza J, Couloigner V, hospitalisation than all other opioids they fulfil the criteria for less sedative/ Denoyelle F, Loriot MA, Broly F, et al. A the question has been asked; except tapentadol9. Furthermore, the risk respiratory depressant opioids. In case of respiratory depression in a child “Which opioids are the less of abuse10 is low and diversion rates are addition, the less sedating effects and with ultrarapid CYP2D6 metabolism after sedating ones referred to in the similar to tapentadol and lower than all their lower potential for abuse and tramadol. Pediatrics. 2015;135(3):e753–55. conventional opioids11. diversion might make them preferable 8. Stamer UM, Stuber F, Muders T, Musshoff statement (with “less sedating” The analgesic effect of tapentadol is as discharge medications in view of the F. Respiratory depression with tramadol inferring less risk of respiratory based on a synergistic combination of concerns about conventional opioids in in a patient with renal impairment and low µ-opioid receptor agonist activity this setting15. CYP2D6 gene duplication. Anesth Analg. depression)?” 2008;107(3):926-9. with neuronal norepinephrine-reuptake It should again be noted that In our modern armamentarium of inhibition without a relevant effect on monitoring for opioid-induced respiratory 9. Murphy DL, Lebin JA, Severtson SG, Olsen analgesics, we have a large number HA, Dasgupta N, Dart RC. Comparative serotonin. This explains the extremely depression, using an appropriate sedation Rates of Mortality and Serious Adverse of “opioids”. The term opioid in this low risk of respiratory depression; scoring system, and adjustment of the Effects Among Commonly Prescribed Opioid context covers a wide range of analgesic in the above-mentioned US Poison dose as required, remains essential for Analgesics. Drug Saf. 2018. compounds, which can be very different Center Program there was no recorded the safe prescription of opioids. Acute 10. Radbruch L, Glaeske G, Grond S, in their effects and adverse effects. It has mortality from tapentadol and all other Pain Services, anaesthetists and pain Munchberg F, Scherbaum N, Storz E, et al. been stated that “the categorisation of serious adverse effects occurred at the medicine physicians should lead the way Topical review on the abuse and misuse all analgesics that have any component lowest rates of all opioid analgesics in the education and promotion of safety potential of tramadol and tilidine in of opioid mechanism of action into the investigated9; in network meta-analysis concepts relating to safe use of opioids as Germany. Subst Abus. 2013;34(3):313–20. same class is anachronistic”1 and that of opioids in the chronic pain setting, part of our role in opioid stewardship. 11. Vosburg SK, Severtson SG, Dart RC, Cicero the importance of multi-mechanisms of tapentadol was ranked the most tolerable TJ, Kurtz SP, Parrino MW, et al. Assessment of Tapentadol API Abuse Liability With action of some modern opioid analgesics one [Meng, 2017 #23332]. Similar findings Professor Stephan Schug, Professor should be emphasised with separation of the Researched Abuse, Diversion and are reported for rates of abuse and Pamela Macintyre, Dr Kim Hattingh Addiction-Related Surveillance System. J tramadol, tapentadol and buprenorphine diversion11. Pain. 2018;19(4):439-53. from “conventional” opioids, which are Buprenorphine binds with very high References: 12. Hans G, Robert D. Transdermal relying nearly exclusively on agonism at affinity at µ-opioid receptors, but with 1. Raffa RB. On subclasses of opioid analgesics. buprenorphine - a critical appraisal of its the µ-receptor. lower affinity and intrinsic activity at Curr Med Res Opin. 2014;30(12):2579-84. role in pain management. Journal of pain The common term used to describe the K- and ƣ-receptors, the nociceptin 2. Schug SA. The role of tramadol in current research. 2009;2:117-34. these medications is “atypical opioids”, receptor (NOP/ORL-1 mediated effects) treatment strategies for musculoskeletal 13. Davis MP. Twelve reasons for considering although there are other proposals and possibly a further not yet defined pain. Therapeutics and clinical risk buprenorphine as a frontline analgesic in including “atypical centrally acting receptor system1,12,13. There appears to be management. 2007;3(5):717-23. the management of pain. J Support Oncol. analgesics”2. The discussion on the no ceiling effect for analgesia, and a lower 3. Häuser W, Schug S, Furlan AD. The opioid 2012;10(6):209-19. need of a new terminology to separate risk of respiratory depression although epidemic and national guidelines for opioid 14. Richards S, Torre L, Lawther B. these atypical opioids from conventional case reports of respiratory depression for therapy for chronic noncancer pain: a Buprenorphine-related complications in perspective from different continents. elderly hospitalised patients: a case series. opioids has been ignited in particular the sublingual preparation do exist14. The These “atypical” opioids also show The mechanism of action of tramadol PAIN Reports. 2017;2(3):e599. Anaesth Intensive Care. 2017;45(2):256-61. by the “opioid epidemic” in the US and a long time to analgesic effect (12-24 hours) 3 properties which qualify them as combines a relatively weak µ-opioid 4. Raffa RB, Friderichs E, Reimann W, 15. Macintyre PE, Huxtable CA, Flint SL, number of other countries , as the former and steady-state plasma concentration “opioids with the least sedative (and receptor agonist (primarily mediated Shank RP, Codd EE, Vaught JL. Opioid and Dobbin MD. Costs and consequences: a show different side effect profiles and a (72 hours) limits the usefulness of therefore respiratory depressant) effects” via an active metabolite M1) with a nonopioid components independently review of discharge opioid prescribing lower abuse potential than conventional transdermal buprenorphine in the mentioned in the statement. While neither monoaminergic reuptake inhibition, contribute to the mechanism of action of for ongoing management of acute pain. opioids. acute setting12. tramadol, an 'atypical' opioid analgesic. Anaesth Intensive Care. 2014;42(5):558–74. slow-release tramadol and tapentadol, nor namely of serotonin (5-HT) and 4 Journal of Pharmacology & Experimental transdermal buprenorphine preparations noradrenaline reuptake . It is thereby the Therapeutics. 1992;260(1):275-85. are Therapeutic Goods Administration prototype of an atypical opioid with a low (TGA)-approved for the treatment of risk of respiratory depression compared acute pain, they are worth considering to conventional opioids5,6. However, rare if slow-release preparations are deemed cases of respiratory depression have necessary. been described in CYP2D6 ultrarapid metabolisers, either in children7 or in adults with renal impairment leading to retention of the active metabolite M18.

32 ANZCA Bulletin June 2018 33 The reality of humanitarian work in Iraq

Our hospital has an unusually large input of children of all ages and everyone “ There is nothing like is very proud of their ability to save majority of them from both medical and a compassionate surgical ailments. Attempts to save little children, many hug from someone, with severe infections, burns or major particularly a doctor, accidents, fail in spite all our best efforts and this is the most upsetting time for to let them express people. Watching the anxiety, concern, disappointment, tears and heartbreak on their grief in full.” the faces of waiting parents, particularly young mothers, can be a daunting task: one often has to hold back the tears and Even though we had one of the finest pretend to be brave. I can vividly recall field anaesthesia machines in Glostavent a young mother of a one-year-old child, helix in the OT, plenty of spinal needles, carrying her dead daughter in her arms, access to an ultrasound machine to do only to be told that the accident had nerve blocks, and a Monnal T50 ventilator already killed her. The mother’s anguish, in the ICU and ample supply of oxygen intense grief, helplessness and loud concentrators all around the place, there sobbing, remains with me as one of my are limitations to the variety of drugs and saddest memories. equipment. However it is our fair share of We often long for an extra bit I consider myself to be brave, probably because successful management of the critically of something for our patient: an ill that really justifies our time spent in investigation, a piece of equipment, a I am 73 (not out) in my life’s innings. But this Daily anaesthesia work consists places like this. One quietly wonders how drug but you know what, we get through mostly of dealing with effects of burns morning at work I got a nasty bouncer – I a reasonably well-to-do country like Iraq, with none of those extras. In fact, we are and blast injuries. These need regular witnessed a child crying in utter anguish clinging with a relatively strong health service overjoyed that the patient is doing well in dressing, debridement or skin grafting. infrastructure, ended up like this within a spite of lack of items you might consider on to the feet of her dying father who was brought There is no doubt ketamine is a great few short years, having to depend on aid a necessity to our routine practice in drug for majority of these patients. There in collapsed and unable to be resuscitated. Yet organisations for basic health needs. Australia and New Zealand. is a scatter of other cases including another young child was left fatherless in an I discovered that it is one of the There is a vast and unfamiliar world gunshot wounds, road traffic accidents, hardest, but most rewarding experience, out there for those anaesthetists who seek already troubled country. blast injuries and severe burns. We offer to simply comfort the male members of a new challenge. It is a worthy adventure. I am on my ninth overseas humanitarian mission, currently in occasional elective surgeries, particularly the family of the deceased. That is the northern Iraq with Médecins Sans Frontières/Doctors Without for the internally displaced people from time even the bravest looking man needs nearby camps. Dr Mathew Zacharias, Borders (MSF). A number of anaesthetists from Australia, and support, even from a stranger. There is Dunedin anaesthetist a few from New Zealand, are doing similar kind of work as I Mass casualties do occur at varying nothing like a compassionate hug from frequency. The team deals with them as do. This is working in countries with ongoing conflicts or its someone, particularly a doctor, to let Dr Zacharias who has been working on consequences, in makeshift hospitals with very limited facilities Only the other morning, while walking the short distance efficiently as possible with some amount them express their grief in full and a few of insouciance to the ongoing chaos and a field assignment with Médecins Sans and taking care of the sick and vulnerable people, who wouldn’t from our residence to the hospital, the sun just peeping through minutes spent is worth a lifetime to that Frontières in Iraq. otherwise receive any medical care. some of the totally destroyed houses on to almost empty and following our mass casualty plan. The individual. Cultural rules of Iraq prevent Many of my anaesthetist colleagues might be shocked to learn well-littered streets, I was recalling the busy last few weeks. largest number during my time was eight men from being too close to women that the only readily available investigations to manage major The work starts the usual way every day as we all assemble adults following a road traffic accident, outside their own families. For more information about joining surgical and obstetric emergencies are bedside haemoglobin in the emergency room for the morning ward rounds, almost though this could increase considerably Apart from basic human emotions like Médecins Sans Frontières, visit and blood sugar monitors, and urine dipstick. One depends on always led by the expatriate surgeon. Last week we welcomed during times of conflicts. compassion and concern, we also see www.msf.org.au or www.msf.org.nz. basic clinical skills and an understanding of the functioning our new surgeon from Portugal, who thought that Ronaldo We transfer some of them away to evidence of cruelty of humans against of the human body to do the rest. It is really remarkable what a was definitely a better player than Messi in every aspect of the other larger hospitals for CT scans, each other. Conflicts in most countries surgeon, an anaesthetist and a couple of enthusiastic nurses can beautiful game (by the way, no one agreed with him). neurosurgical input or major orthopaedic are generated and supported by rich and achieve with limited resources, bringing comfort and solace to During typical ward rounds the group consisting of the work. Serious burns over 40 per cent are powerful countries for spurious reasons, the people. surgical team, local doctors, nurses and translators. We all also transferred to specialist hospitals but the civilian population is left with march through the emergency room, ICU, male and female after overnight stabilisation. For practical death, destruction and total anarchy with wards, often accompanied by a posse of flies which increase reasons, patients are transferred mostly often unresolved and ongoing conflicts. in numbers as the rounds progress. We finish the round in a during daytime. These are just clinical ward where men with chronic ulcers and malnourishment with realities and are taken in their stride. From left: Buildings destroyed and unoccupied scabies are housed. litter the landscape near the hospital; Dr Mathew Zacharias at work; Though short of equipment, the hospital does have one of the finest field anaesthesia machines, the Glostavent helix.

34 ANZCA Bulletin June 2018 35 Reflecting on the ASM

This was the first ANZCA Annual Several combined sessions with RACS Snapshot Scientific Meeting (ASM) held in the were dedicated to issues of global and Delegates 2404 beautiful new Sydney International Indigenous health and, following the Speakers and facilitators 500 Convention Centre (ICC). Perhaps it footsteps of last year’s Brisbane ASM, Plenary sessions was the lure of this impressive venue, we were able to support safe surgery 6 perhaps it was sparkling Sydney itself, in developing countries by making a Concurrent sessions 42 perhaps it was the outstanding workshop donation to Lifebox. This donation was Workshops and SGDs 150 and scientific program, or perhaps it was on behalf of all those who generously Focus sessions 10 the prospect of another collaborative gave their expertise and time to e-posters 170 meeting with the Royal Australasian present or chair workshops, lectures Combined sessions with RACS 25 College of Surgeons? Whatever the and other sessions at the ASM. Also, reasons, this ASM attracted a record one of our workshop convenors, Dr number of registrations and it is our hope Andrew Lansdown, put much effort into every single delegate, and every invited organising the first ASM Charity Fun Unfortunately, we underestimated their speaker, found the conference a valuable Run. More than 60 delegates gathered popularity and the badges ran out – and enjoyable experience. before sunrise to jog around the harbour “Coffee Addict” and “Wine Lover” went first. On a more serious note, we also As always, the ASM week was extremely foreshore, under the Harbour Bridge, and around the Sydney Opera House. used the ASM as a platform for promotion busy and included several events of improved access to help for the outside the meeting itself. Prior to the The chosen charity for this event was the Indigenous Marathon Foundation, concerning proportion of our colleagues ASM, a highly successful Emerging with serious mental health issues. Leaders Conference was held in the Blue which promotes a healthy, active lifestyle Mountains, inland from Sydney, which in Aboriginal and Torres Strait Islander The ASM social program was, as usual, brought together future leaders in both youth. a raging success. We opened the week with a welcome reception in the anaesthesia and surgery. Over the same Because the environment also really Powerhouse Museum with its eclectic on weekend, two extremely well subscribed matters, we attempted to limit the ASM collection of fascinating artefacts. If you meetings were held in the ICC – the footprint. Each year ANZCA explores weren’t there, you should find someone Obstetric Anaesthesia Special Interest more ways to reduce printed material Group satellite meeting and the FPM who was to ask them about the amazing for the ASM, and increase the usability dessert! The grand finale of the social Refresher Course Day. The ASM then of the electronic program. We sourced launched on the Monday with a massive program was the Gala Dinner held jointly recyclable take-away coffee cups and with the surgeons. More than 1200 day of workshops which saw delegates the ANZCA Geoffrey Kaye Museum scattered across multiple rooms and guests enjoyed a beautiful meal and provided keep-cups to anyone who great dancing. Those who preferred to then multiple locations across the city. could pass a quick historical quiz. It is a successful It was truly a wonder to behold the move away from the music were treated well-recognised that reducing excessive to cocktails and harbour views. complexity of the workshop day rolling on meat consumption will be essential for without a hitch! The College Ceremony global sustainability, therefore we served The ASM is a flagship event for was held that evening with an inspiring exclusively vegetarian food for one whole ANZCA and an increasingly complex oration by Raelene Castle, the first day of the ASM. Fortunately, the meals undertaking, requiring more than two female CEO of a national football league, were so good that few omnivores even years of planning. Our organising who brought a fascinating perspective noticed! committee took on the challenge and as a powerful woman in what was once responsibility with some trepidation a man’s world. A record number of new Another feature of the ASM that really but, with the support of the college fellows presented at the ceremony, matters is the opportunity to catch up events team and the wider anaesthesia which was streamed live and, amazingly, with colleagues from around the region community, we found the experience viewed nearly four thousand times from and around the world. Our ASM is world- enormously rewarding. We wish future SYDNEY locations all over the world. renowned for its friendly atmosphere organising committees all the best and and great social program. To stimulate Given the theme of the meeting, very much look forward to enjoying the conversation and to acknowledge “Reflecting on what really matters”, we fruits of their efforts. that we are more than just our jobs, made efforts to reflect not just on what we decided to provide free badges Dr Tim McCulloch matters clinically and scientifically but displaying our extra-curricular interests. ASM Convenor also to reflect on broader issues such as health equity, the global environment, Dr Veronica Payne and physician well-being. ASM Deputy Convenor

36 ASMANZCA Bulletin June 2018 37 Scientific program Workshops and small group discussions The scientific program was designed but maybe related to your surgeon. Dr The task of bringing together the scientific around the theme to “reflect on what really Bronwyn King gave a very inspiring and program was made easier by the fantastic matters” to our specialty. This included popular talk on her journey to set up help of all the presenters and facilitators. both refreshers and the latest scientific "tobacco-free portfolios" after realising her It is humbling to be involved in a specialty and research outcomes and how they super was invested in tobacco companies. where people are happy to give up their mattered for all anaesthetists on a time to prepare and give fantastic talks daily basis. We also had the great advantage of and workshops and I thank everyone combining with RACS for the Sydney involved in the program for their help. I The opening plenary discussed the difficult conference, which gave us a wealth of hope all the attendees had a great time ethical and moral arguments involved in cross-specialty knowledge and allowed at the conference and found the scientific surgery in the elderly and sick patient. candidates to visit either "combined", content educational, confronting and It involved excellent talks by Dr Linda “surgical” or “anaesthetic” sessions. Some enjoyable. Sheahan, a palliative care physician and of the more popular combined sessions ethicist and Dr Ken Hilman, an intensivist looked at data of the safety of general Dr Ben Olesnicky with an interest in end-of-life interventions. anaesthesia in children as well as what ASM Scientific Convenor A great panel discussion then followed mattered to families of children undergoing based around common clinical scenarios. operations, the shared airway in head and Our invited international visitors Dr Richard neck surgery and the management of the With more than 130 workshop and small echocardiography, neuroanaesthesia, skills, and friendship made orchestrating Dutton, Professor Karen Domino, Dr Fiona bleeding trauma patient and of the mass group discussion sessions, this year’s intraoperative neuromonitoring, one-lung this huge workshop and small group Keirnan and Professor Jenny Weller spoke casualty event. program aimed to provide a mix of anaesthesia, ECMO, pre-hospital trauma discussion program a breeze for us. We about pay-for-performance measures emergency response activities, technical management); employing old and new can’t thank Fran and the rest of the events in anaesthesia, communication with our The final combined plenary session and non-technical skills as well as tips and technology (ventilators, ultrasound and team enough for the mammoth effort patients and among operating theatre explored the issues of physician burnout tricks for anaesthesia practice and for life. echocardiography, endoscopy, THRIVE, undertaken to bring the workshop and "teams" and behavioural economics in and doctors’ welfare and told us to both Drawing from the expertise and generosity ROTEM/TEG, apps and virtual reality); small group discussion program to life. healthcare. They also delivered a number look after ourselves, and to look after each of our facilitators and teachers, the trying a cadaveric or animal carcass other. Professor Dan Sessler delivered a program provided a comprehensive and session (anatomy for anaesthetists, A program of this scope and breadth of high quality talks throughout the was only possible due to the incredible scientific program. fantastic closing session, imploring us as exciting range of sessions, with something ophthalmic anaesthesia, various regional a specialty to really reflect and challenge for everyone. anaesthesia catheter workshops, and talent, generosity, and passion of all our The other plenary sessions across the information that we use to inform our trauma skills sessions); as well as facilitators and teachers. Local national the week were delivered by a number practice. There were too many highlights A major aim of the program was to provide reflecting on their communication and and international demonstrators including of international experts on topics as in the concurrent sessions to mention, as many emergency response workshops mindfulness skills. Our anaesthetist anaesthetists and other doctors, allied broad as communication, standardised but included sessions on patient safety, as possible to ensure better access for teachers even had delegates trying health staff, medical students, and outcome measurements, the importance obesity anaesthesia, and practice in a delegates. To this end, in addition to the their hand at yoga and photography. representatives from the healthcare comprehensive program of emergency industry all came together to provide their of worldwide access to safe anaesthetic rural setting, perioperative medicine and response activities held on the Monday The lunchtime small group discussion time and expertise to contribute to the services and why perioperative mortality obstetrics. All of the sessions are available workshop day, our facilitators and teachers sessions were extremely popular, and workshops and small group discussions. was not linked to your anaesthetist, for fellows to view on the virtual ASM in provided CICO and ALS workshops daily covered a broad range of topics from All of the facilitators and teachers invested their own time. throughout the rest of the week. Most managing issues that arise in clinical a significant amount of time and effort into of these extra sessions were scheduled anaesthesia practice, through to producing some truly fabulous workshops, during the lunch break, meaning that maintaining volume and currency in rural often forgoing their own chance to attend delegates did not have to miss any of anaesthesia, and also how to prepare for the ASM sessions to teach. We would like the excellent scientific program sessions retirement. They allowed for open and to wholeheartedly thank everyone who on offer. lively discussion between delegates and worked on the workshop and small group facilitators, encouraging the sharing of discussion sessions for the role they each New workshops were offered, and ideas and experience. played in helping us all to reflect upon others were given an innovative what really matters. spin – a reflection of the ingenuity Coordinating all these sessions were of the facilitators. The program saw the wonderful ANZCA events team, and Dr Shanel Cameron delegates engaging in simulation chiefly Fran Lalor, Senior Events Officer. Dr Andrew Lansdown activities (obstetric emergencies, Fran’s professionalism, organisational ASM Workshop Co-convenors

From everyone at Lifebox to everyone at ANZCA – thank you! Your generous donation will make a life-changing difference to colleagues and their patients, helping Lifebox make anaesthesia and surgery safer on a global scale.

During the ASM, ANZCA presented a $A10,000 cheque to Lifebox on behalf of all ASM speakers, presenters, facilitators and contributors in lieu of the usual gifts.

38 ANZCA Bulletin June 2018 39 FPM wrap up Prizes Keynote presentations Gilbert Brown Prize ANZCA ASM Visitor Ellis Gillespie Lecture Dr Rani Chahal for “STEP: Surgical Thrombo-Embolism Professor Karen B Domino, “Communicating with patients Prevention Protocol: Post-Implementation Re-audit – Impact of – what matters”. a newly developed risk stratification model and a smartphone APP on venous thromboembolism”. FPM ASM Visitor Michael Cousins Lecture Professor Oscar de Leon-Casasola, “The neurobiology of acute Trainee Academic Prize postoperative pain and the translation to post-surgical pain Dr Rebekah Potter for “Rationalising group and screen testing management guidelines”. in adult elective surgical patients” and Dr Nathalie Gomes for "Simulation to assess latent safety threats and operational ANZCA Australasian Visitor Mary Burnell Lecture preparedness within anaesthetic locations in a new children’s Professor Jennifer Weller, “Tribes, teams and trust.” hospital”. ANZCA NSW Visitor’s Lecture Open ePoster Prize Dr Richard P Dutton, “Pay-for-performance: How do we make Dr Julie Lee for “Rotational thromboelastometry (ROTEM®) the measures relevant?” in obstetrics: baseline parameters in uncomplicated and This, the last pain Refresher Course Day The cadaveric workshops were complicated pregnancies. A prospective observational study FPM NSW Visitor’s Lecture (RCD) under the current name, drew the oversubscribed and very well received on parturients”. Professor Tor Wager, “Why do some of my patients have so largest ever number of registrations. In however they will not be offered in Kuala Name change for FPM’s much more pain than I think they should?” recognition of how the content of the day Lumpur in 2019 for logistical reasons. Refresher Course Day Trainee ePoster Prize has outgrown the fairly restrictive title, it Their possible role, context and content Dr David Shan for “The effect of a pulmonary bundle of care on Organising Committee Visitor's Lecture will be called the Annual Pain Medicine for future ASM inclusion is likely to be The FPM Refresher Course Day has postoperative pulmonary complications: A quality improvement Dr Fiona Kiernan, “Organising Committee Visitor: Behavioural Symposium from the 2019 Kuala Lumpur addressed by the new Procedures been renamed as the FPM Annual Pain project”. economics in healthcare”. meeting onwards. Working Group within FPM. Medicine Symposium in time for the 2019 Annual Scientific Meeting in Kuala Lumpur. As part of the RCD Professor Mark The ASM program was well supported FPM Dean’s Prize Hutchinson managed to be a media and and featured many of our own fellows, The new name, which was approved by Dr Luke Arthur for “Erythromelalgia in children: Presentation, audience darling with his research on including Dr Stephen Gibson on the faculty’s Professional Affairs Executive genotype, and treatment response”. colour mapping of pain. Our wonderfully his experience with percutaneous Committee, better reflects the high quality warm and friendly FPM NSW Visitor was cordotomies, Professor Paul Glare on content and structure of the event, which FPM Best Free Paper Award Professor Tor Wager, who explained his pain in survivors of cancer, Dr Marc Russo attracts leading local and international Dr Daniel Chiang for “The prevalence and risk factors research on the neuro-circuitry of fear on CRPS, and our perennial favourites pain medicine speakers and researchers. associated with persistent pain after breast cancer treatment”. avoidance and the central role it plays Professor Pamela Macintyre and Professor The 2018 FPM Refresher Course in the establishment of chronic pain. Stephan Schug with the latest in acute Day attracted 400 delegates, several and transitional pain. Our FPM ASM international speakers and featured a The presentations on currently available Visitor, Professor Oscar de Leon-Casasola broad range of presentations on issues and tested online pain programs and proved to be a font of wisdom on almost such as opioids, medicinal cannabis, how to adapt pain programs to patients every clinical pain topic, a truly delightful blood tests for chronic pain, pain from different cultural backgrounds were individual, and a modern-day Fred Astaire management in the elderly and the immensely practical. They have already on the dance floor…a high bar for future Kings Cross safe injecting room. prompted me to write my first prescriptions international visitors. for an online program for patients waiting for chronic pain clinic appointments. I would like to thank Dr James Yu, Dr Martine O’Neill and Dr Andrew Patterson The risky prescribing session saw the for their able assistance in putting the forensic and addiction communities program together, and the amazing staff at encouraging pain clinicians to utilise ANZCA and FPM who were encouraging naloxone prescribing and opioid guides through the process. An extra substitution therapy more frequently mention goes to the ANZCA design team in pain practice. They also spoke for a who made me want to frame the RCD dissolution of the porous and fairly artificial abstract book and the Communications distinction between prescription and illicit unit who were still working when we harmful drug use. These ideas should help were onto the champagne at conference inform the FPM opioid forum in June. end. The ANZCA Regional Organising The highlight of the FPM dinner at the Committee were a pleasure to work, put lovely Ivy Ballroom was the perfectly together a fantastic program, and in quiet pitched after-dinner address by Catherine moments taught me how to use Twitter. Keenan from the Sydney Story Factory. Having been given a preview of the Both funny and moving Catherine excellent program for next year’s FPM reminded us how much of a human need meeting I am already looking forward to it is to tell our story and know that it has seeing you all in Kuala Lumpur in 2019. been heard and that it is worth telling. Dr Jennifer Stevens FPM Scientific Convenor

40 ANZCA Bulletin June 2018 41 Raising our profile Steuart Henderson Award Newspapers, radio, TV results. Both Dr Beit and Professor So thank you to everyone who “joined the She obtained a Masters in Clinical The recent award of a multi-million dollar Myles were interviewed on radio about conversation”, and, in particular, to our top- Education in 2002 and an MD in 2006. grant for a national patient safety program The Sydney ASM received widespread their presentations and research. Other 10 tweeters. Between them, Dr Katie Ben, She first became involved with educational for every operating theatre in New Zealand coverage across Australia and New popular topics were burnout among Dr Scott Ma, Dr Tracey Tay, Dr Eric Levi, Dr matters in the college in 1999. Her current is one example of her ongoing interest, Zealand with 670 online, print and anaesthetists and other specialists (The Tanya Selak, Dr Rhys Thomas, Dr Minh Le roles include the chair of the Education commitment, leadership, and success in broadcast reports. According to media Herald Sun page 2, syndicated to the Cong, and Dr Anthony Herbert clocked up Special Interest Group, a member of simulation and multidisciplinary teamwork monitoring service iSentia the ASM Geelong Advertiser, the Courier Mail and more than 1700 tweets. Two of them weren’t the Education Development Training training. Her influence in the research coverage reached a combined audience the Adelaide Advertiser) opioid prescribing physically at the ASM. And one of them was Committee, the Curriculum Evolution behind and implementation of workplace- of 7.8 million people and would have cost (The Age page 3, syndicated to the a surgeon. Which really demonstrates the Working Group, and the Research based assessments within the college $A1.5 million if bought as paid advertising. Canberra Times, the Sydney Morning power of Twitter as a tool for collaboration Committee. She has recently finished her cannot be over-stated. The list of research Herald and brisbanetimes.com.au) and and crowd-sourced education. 12 years as a final examiner and chaired publications, conference presentations, Highlights included a Channel Nine futile medical treatment. a number of other education-related book chapters, and media reports is Sydney news report on FPM Refresher Our Twitter poll (a first for us) to support committees. extensive. Course Day speaker Professor Mark ANZCA distributed 11 media releases on the Great Debate on the final day of Hutchinson and his Adelaide team’s a range of topics and issues including the ASM attracted 264 votes which was Professor Weller extensively meets every Professor Weller has received 30 grants revolutionary blood test to detect chronic obesity, mental health, in-flight medical encouraging. criteria for this award. Her contributions to mainly for educational projects over the pain, and Sydney anaesthetist Dr Andrew emergencies, surgeons’ league Professor Jennifer Mary Weller teaching and learning are overwhelming. past 25 years. She was recently appointed On Facebook, our posts were engaged with Weatherall’s interview with Radio National tables, hypnosis and virtual reality, She established a new post-graduate as the ANZCA representative on the (liked, shared or commented on) 25,250 Professor Jennifer Weller has been Breakfast host Fran Kelly on how virtual anaesthesia and children and ANZCA’s education centre in clinical education at International Collaboration of Colleges times and our broadcast of the College awarded the ANZCA Steuart Henderson reality can be used to calm children before new partnership with the Patient Safety the University of Auckland over 10 years of Anaesthesia working on competency- Ceremony via Facebook Live was seen by Award for fellows who have demonstrated their operation. These two segments had Movement. excellence and provided outstanding ago, in which she has employed staff, based medical education in anaesthesia a combined audience of nearly 600,000 nearly 4000 people from as far afield as mentored more than 200 students, and globally. Her list of awards is impressive, Four journalists attended this year’s ASM as Canada, India, Ireland and the UK. contribution, scholarship, and mentorship people. to medical education in the field of produced an impressive research output. with the most recent being the Douglas guests of ANZCA: Rachel Thomas, health She has been an enormous influence Joseph Professorship awarded by ANZCA Other highlights included page one This year, we streamed 13 sessions on anaesthesia and/or pain medicine. reporter for New Zealand’s The Dominion on the development of simulation-based in 2016, and a lectureship awarded by the articles in New Zealand’s Dominion Post Periscope (with permission from the Post, Grant McArthur, the medical editor Professor Weller obtained her medical training throughout Australia and New Royal College of Anaesthetists in 2017. newspaper (surgeon league tables as presenters), almost double the number of the Herald Sun, The Age health reporter degree from the University of Adelaide. She Zealand. She was the main driving force explored by Dr Andrew Klein in his plenary last year. The total audience was more Aisha Dow and Sarah Wiedersehn of became a member of the Royal College behind the establishment of ANZCA’s Professor Weller’s contribution to these address) and the Brisbane Courier Mail than 1800 people, with the most popular Australian Associated Press. of Anaesthetists in 1981 and a fellow of Effective Management of Anaesthetic numerous and diverse fields of medical (mental health and burnout.) These two session Dr Fiona Kiernan’s on behavioural education is nothing short of extraordinary. economics. ANZCA in 1995. She worked in Wellington, Crises course. topics attracted a combined 150 reports New Zealand, for 10 years before moving across Australia and New Zealand. Social media From the citation by Dr Natalie Smith at Our videos of interviews with keynote to Auckland in 2004, from which time she the College Ceremony during the 2018 Some of the more popular topics for With more than 9500 tweets, 1600 speakers and college leaders on YouTube became increasingly involved in medical ANZCA Annual Scientific Meeting in media were Toowoomba anaesthetist participants, and 22.8 million impressions have already been watched nearly 7000 education in a growing number of areas. Sydney. Dr Jamie Beit’s presentation on obesity #ASM18SYD was the best-performing times. ASM hashtag to date. It also dramatically and Professor Paul Myles’ RELIEF study Clea Hincks, General Manager, out-performed #RACS18. Communications

#ASM18SYD #RACS18 #ASM17BRIS

To see all the photos, interviews, e-newsletters and media coverage go to asm.anzca.edu.au/asm-photos- interviews-e-newsletters-media.

42 ANZCA Bulletin June 2018 43 Robert Orton Medal Emerging leaders working together The Robert Orton Medal is ANZCA’s most prestigious award and is made at the discretion of ANZCA Council, the sole criterion being distinguished service to anaesthesia, preoperative medicine and/or pain medicine. The award was established by the Faculty of Anaesthetists, Royal Australasian College of Surgeons, in 1967.

Associate Professor Australian Society of Anaesthetists Professor Walsh has also contributed to The 2018 Emerging Leaders Conference A team building “Licence to spy” exercise with a combined session “Pathways to (ASA), the World Federation of Societies the regulation of the profession through (formerly the New Fellows Conference) was held on site at the hotel. This was well leadership” featuring Dr Scott Ma, Dr Harry Richard George Walsh of Anaesthesiologists (WFSA) and the the Medical Council of NSW since 2002 was held from May 4-6 at the Hydro received by delegates and a great way Eeman (New Fellow Board Member, FPM) NSW Medical Council. He served on the and he is currently the deputy president. Majestic Hotel in the Blue Mountains, for anaesthetists and surgeons to interact and Dr Andrew MacCormick (Younger Richard Walsh graduated with MBBS NSW Regional Committee and Panel of He has been awarded many honours NSW. It was the first time the meeting before dinner and a fiercely-contested Fellows Chair, RACS). The highlight of the from the University of Sydney in 1974. He Examiners (1986-1992) and in 1988 was including honorary fellowships of the (#ELC18) had been combined with trivia quiz. dinner at Parklands Country Garden and completed his internship, residency and elected to the board of the faculty. He had College of Anaesthetists, Royal College RACS’s Younger Fellows Forum. Lodges were the speeches made by both anaesthetic training at Royal Prince Alfred numerous roles on the board including of Surgeons in Ireland and the Academy The second day of the conference began ANZCA President Professor David A Scott Hospital (RPAH) and gained his FFARACS overseeing the transition from the faculty of Medicine, Singapore. Other awards The “Working together” meeting welcomed with an ANZCA-only session hosted by and RACS President Mr John Batten. in 1980. He was then appointed a Visiting to the college and was on the first ANZCA include the ASA’s Gilbert Brown Award 20 delegates who had been selected New Fellow Councillor Dr Scott Ma and the Medical Officer at RPAH with a major Council until 2000. He was elected ANZCA in 1996, the Pask Certificate of Honour by their respective regional committees college’s Digital Communications Manager On the final morning, the day began with a interest in cardiothoracic anaesthesia President in 1998. from the Association of Anaesthetists of in New Zealand, Malaysia, Papua New Al Dicks who introduced delegates to the combined session introducing delegates and perfusion. He has continued this Great Britain and Ireland in 1997 and the He has also served on ASA’s federal Guinea and Hong Kong. A similar number pros and cons of social media platforms. to the science and art of mindfulness appointment, along with appointments Centenary Medal of Australia in 2002. of delegates from the nine subspecialties Delegates were encouraged to join Twitter from Mr Anthony Dunin (FRACS). This at Strathfield Private Hospital and executive committee (1982-1987) and was honorary federal secretary during He has been and remains an enormous within RACS also attended. after being shown the basics of the was followed by an ANZCA-only panel Macquarie University Hospital. He has communication tool and help build the discussion where delegates were invited been an Adjunct Associate Professor at that time. Following on from these roles contributor to the profession and a very The meeting opened with a combined Twitter army ahead of the Annual Scientific to ask questions from the leadership team the University of Sydney since 2001 and Professor Walsh became chair of the deserving recipient of the Robert Orton plenary lecture on gender diversity and Meeting in Sydney. including President Professor David A in 2011 was appointed Clinical Associate World Congress of Anaesthesiologists’ Medal. inclusion presented by Australian business organising committee and president of Scott, Dr Scott Ma, Dr Harry Eeman and Professor at Macquarie University. leader and mentor Diana Ryall. This The meeting then reconvened with RACS the World Congress of Anaesthesiologists From the citation by Dr Patrick Farrell at the Councillor-in-residence Dr Michael Jones. Professor Walsh’s contribution to our meeting in Sydney in 1996. He then College Ceremony during the 2018 ANZCA thought-provoking and engaging session when a session on doctors’ mental After morning tea a challenging session profession has been outstanding continued his global interests serving on Annual Scientific Meeting in Sydney. examined an important and contemporary health was tabled. Dr Marion Andrew on the ethics and legal implications of with significant involvement with the the WFSA executive committee from 1998 issue in both colleges and in the wider (FANZCA), chair of the Welfare Special futile treatment was hosted by Dr Margot Faculty of Anaesthesia, ANZCA, the to 2008 including eight years as treasurer. community. Interest Group, combined with Dr Sally Heaney (FANZCA). Langley (FRACS) to address “Self-care This was followed by another combined for a successful team”. This was followed A final session that explored the past, and interactive session “What makes by Professor Michael Baigent (FRANZCP) present and future of leadership and a good operating theatre medical who presented “A healthy team requires a mentoring was hosted by Dr Robert Michael Cousins portrait unveiled team?” presented by Dr Stuart Marshall healthy team member”. Buckland (FANZCA). The meeting was (FANZCA). The opposing view, highlighting then closed and delegates bussed to the A portrait of Professor Michael Cousins, Smeeth was the winner of the Packing the medical and legal implications of what Dr Tracey Tay (FANZCA) and health Sydney International Convention Centre AO, AM, a world expert in pain medicine, Room Prize at the 2017 Archibald Portrait happens when teams do not work well research economist Penny Reeves for the ASM. was unveiled at the annual scientific Prize at the Art Gallery of New South Wales together, was presented by Dr Joseph presented a detailed and informative meeting’s 2018 ANZCA Research and has been a finalist in several major art Lizzio (FRACS). introduction into health economics, Dr Craig Coghlan Foundation cocktail party. prizes including the Doug Moran National “Making choices in healthcare”, in an Emerging Leaders Conference Convenor Portrait Prize and the Blake Prize. Professor Cousins, a former ANZCA ANZCA-only session. The day ended president and FPM dean was the first chair Professor Cousins had several sittings with of the foundation and a special guest at Smeeth including photographic shoots. the cocktail party with his wife Michele. The portrait was commissioned in 2017 Clockwise from left: The emerging leaders The portrait was painted by award-winning but completed this year. at the Three Sisters lookout; Saturday night artist and former GP Peter Smeeth who dinner at Parklands; team building activity – became a full-time artist in 2008 after 34 Right: Professor Michael Cousins with his wife Licence to Spy. years practising medicine. Michele after the unveiling of his portrait.

44 ANZCA Bulletin June 2018 45 Here is what some of the delegates at this year’s Emerging Leaders Conference had to say about the meeting.

Dr Candice Peters FANZCA Dr Nirooshan Rooban FANZCA Dr Paul Vroegop FFPMANZCA, FRANZCP “If somebody offers you an amazing It was my pleasure to attend the 2018 I was really inspired by Diana Ryall, opportunity and you’re not sure you can do Emerging Leaders Conference (ELC) executive, previous CEO for Apple Australia it, say yes and learn how to do it later”. “Working Together” in the Blue Mountains. and founder of “Xplore for Success” which Save the date! Gaining insight into the values of the offers services to organisations to support That’s a quote from Sir Richard Branson many leaders on show, difficult choices professionals to achieve personal success. that a colleague shared with me a few years in healthcare and where some of the new She spoke passionately about gender, 2019 Emerging Leaders Conference ago in an effort to inspire me to do things challenges to our specialty lie were among privilege, bias and inclusion/exclusion, and April 26-28 I thought I had no business doing. It turns the benefits of this combined meeting with equality and equity, and challenged us to out she attended what was then the New the younger fellows of RACS. recognise our own biases and how to change the behavior of “Leaders without borders” Fellows Conference and serendipitously this quote came up ourselves and the organisations we are involved with. at the ELC. I have never really considered myself an emerging Things I took away are: leader, but when I was nudged by one of our SOTs to apply, The discussion on leadership by Dr Rob Buckland, who focused The Saujana Hotel, Kuala Lumpur I figured there was no harm in trying (and in the era of Trump, 1. Social media is something to be embraced as an educational on leadership styles, leadership competencies and leading absolutely anything is possible: insert smirking emoji here!). tool. change, with an emphasis on knowing yourself to optimise For further information, please 2. The earlier we educate people about burnout, resilience and health outcomes by promoting effective leadership, clinical contact Kate Galloway at The theme “Working Together” encompassed the unique governance and sustainability. This was followed by Dr Scott nature of this year’s conference as participants working in mental health, the more chance of preventing issues before they occur. Ma’s entertaining lessons to lead by; “Pathways to leadership [email protected] anaesthesia and pain medicine from across Australia, New – lessons from a goose”, which I took to heart. Zealand, Hong Kong and Malaysia joined forces with younger 3. The importance of hearing the vision of leaders – the chair Applications open soon. fellows from the Royal Australasian College of Surgeons for panel discussion with ANZCA councillors was particularly Lastly, but not least, Dr Tracey Tay and Penny Reeves’ crash the first time with a joint agenda. This was certainly one of the illuminating. course in health economics introduced me to a number of highlights for me: meeting new fellows from these disciplines, frameworks for looking at improving population health outcomes sharing the highs and lows, discussing common gripes (let’s For people thinking about attending, I would say go for it. It that I have already been utilising in my clinical roles, and opened call them challenges) and actually learning from one another’s definitely allows you to see the varying leadership styles, you my eyes to learning a new language… perspectives, which doesn’t happen easily during our day-to- make some great connections and you learn a bit more about day work, particularly with the increasing performance pressure yourself. Thank you to the ANZCA crew and co-convenors for The ELC was most importantly an opportunity for networking, facing us all in a stretched healthcare system. putting on a very worthwhile meeting. discussions and connecting the dots with an inspiring and entertaining group of like minded colleagues, incredibly The opening session on gender diversity by the inspirational encouraging when we can often feel as though we are working and aspirational Diana Ryall AM, a former high school teacher in isolation. and managing director of Apple Australia from 1997-2001, opened my eyes to unconscious bias and privilege (including my own) and what inclusion truly means (“Diversity is being Dr Rochelle Barron FANZCA invited to the ball, inclusion is being asked to dance”). She was I attended the recent Emerging Leaders so on point for what is as relevant to the corporate world as it Conference (ELC) in the Blue Mountains is to modern medicine by asking some very thought-provoking and would really encourage anyone questions: “If you were told the most important person was who is interested to apply for next year – about to walk into the room, how many of you would imagine especially any women who are looking for a man?” and inspired my very first tweet: “Only when we opportunities. Don’t put it in the “too hard” have as many incompetent women in positions of power as basket!! And don’t feel you need to have incompetent men will we truly have achieved equality”. Think a lot of experience or fit the typical profile about it. of an outspoken confident leader; it was an awesome inclusive weekend that played to many different strengths. Dr Harry Eeman, FPM Board Member and Rehabilitation Physician gave a riveting, yet sobering account of his journey to There was a lot of excellent discussion about team work, fellowship and pathway to leadership, a significant proportion communication, and preventing burnout. We had interactive of which was spent as a patient after being struck-down with sessions on the use of social media (I’m still not convinced on severe GBS during an overseas holiday. He taught me that we Twitter, sorry guys), mindfulness and mentoring. I especially all are disabled in one way or another, only some of us have enjoyed the “Pathways to leadership” talks from our own new insight into it! fellow board members – an excellent demonstration of different types of people getting involved in their own way and in their own style. Inspirational.

46 ANZCA Bulletin June 2018 47 ANZCA Clinical Trials Network ANZCA Research Foundation Restrictive versus liberal fluid Foundation update therapy in major abdominal Research update Professor Merry thanked CSL Behring for its award to Dr Julie surgery RELIEF trial success Applications for the 2019 grant round closed on April 3, with a Lee’s ROTEM platelet study, Dr Peter Lowe for his generous record 61 applications received compared to 55 in the previous grants especially the inaugural ANZCA Melbourne Emerging administration is restricted it is likely that hypotension needs year. The number of first time foundation grant applicants Anaesthesia Scholarship (AMERS; awarded to Dr Jai Darvall of to be treated with vasopressors. Vasopressors may impair organ increased from 14 in 2017 to 25 in 2018. Royal Melbourne Hospital), and all other donors and patrons. perfusion, threaten local tissues at the site of IV administration, Applications from female principal investigators increased Finally, he encouraged people to support similar scholarships, cause arrhythmias, and be mistakenly used when hypovolaemia from 17 in 2017 to 26 in 2018. for the Australian and New Zealand researchers of the future. is the underlying cause. On the other hand, excess IV fluid New research committee chair Joan Sheales Staff Education Award administration causes tissue oedema, with increased pulmonary This award, designed to support ANZCA staff to contribute to morbidity, impaired coagulation, and poor wound healing. Most Professor Alan Merry has stepped down as chair of the ANZCA ANZCA’s mission was made possible by a generous donation in recent guidelines, particularly those focussing on enhanced Research Committee after 10 years in the role. The foundation recovery after surgery, have recommended limiting IV fluid acknowledges and thanks Professor Merry for the important 2014 from Professor Barry Baker in honour of ANZCA’s first CEO, administration, aiming for a zero-balance. work he has done in guiding the college's research grant Joan Sheales. The 2018 winner, Hannah Sinclair, Membership The RELIEF trial was a pragmatic, multicentre, randomised, program to its strength and transparency. While Professor Merry Manager, in the Fellowship Affairs unit, will use the prize to trial conducted in 47 hospitals across seven countries. A total has stepped down as chair, we are pleased that he has decided visit the Royal College of Physicians and Surgeons of Canada of 3000 patients were enrolled and randomly assigned to a to remain a member of the committee. At the May 11 new council and study their approach to continuous improvement in member restrictive or liberal IV fluid regimen. The study population meeting, Immediate Past President Professor David A Scott was services. The foundation congratulates Hannah and thanks consisted of at-risk patients undergoing planned major appointed as the new chair. The foundation looks forward to Professor Baker, for his wonderful support for the development working closely with Professor Scott in implementing research of ANZCA staff. Results of the RELIEF (restrictive versus liberal fluid therapy abdominal or pelvic surgery with an expected operative duration in major abdominal surgery) trial were presented to a packed of at least two hours. The primary endpoint was disability-free strategies within the college's 2018-2022 strategic plan. Leadership Circle lunch audience at this year’s scientific meeting in Sydney, and results survival, a novel patient-centred outcome measure. Secondary Second term for foundation chair The second lunch was hosted at the college in April, with chair published in the prestigious New England Journal of Medicine. outcomes included 30-day acute kidney injury, a composite of Past ANZCA president Dr Genevieve Goulding was appointed to Mr Ken Harrison, then ANZCA President Professor David A The RELIEF trial was the first large randomised trial evaluating septic complications, surgical site infection or death, and 90-day continue for another two-year term as chair of the foundation, Scott, and ANZCA CEO Mr John Ilott. Keynote speaker Professor renal replacement therapy. perioperative IV fluid volumes, and was funded by the ANZCA which is looking forward to continuing to work with Dr Goulding Kate Leslie AO, past ANZCA president and eminent anaesthesia The findings of the study surprised many: although the two Research Foundation and NHMRC. to further build the foundation. researcher, explored research in anaesthesia and pain medicine Each year at least 310 million people undergo major surgery groups of patients had similar disability-free survival at one year, including the important areas of anaesthetic depth and Successful foundation reception at the ASM worldwide. All receive intravenous (IV) fluids. Clinicians have those in the restrictive group had a higher risk of acute kidney postoperative cognitive deficit. injury, surgical site infection, and need for renal replacement traditionally administered generous amounts of IV fluids Guests expressed amazement at the complexity of therapy after surgery. Accordingly, the authors recommended perioperatively, to correct for preoperative fasting, blood loss and anaesthesia. Representatives from the Cancer Council of that a moderately liberal approach to perioperative IV fluid other fluid deficits. But the optimal IV fluid regimen for patients Victoria, Medibank Better Health Foundation, Idapt consulting, therapy for patients undergoing major abdominal surgery. undergoing major abdominal surgery was unclear. If fluid Development Impacts, Normanby Capital, Minter Ellison, CSL Behring, and the Bennet Group attended, as well as individual foundation donors. The foundation is following up with those interested in potential future support. Member Advantage The Member Advantage program has been launched to provide a range of purchasing benefits for fellows, trainees, SIMGs, ANZCA CPD participants and staff. The program provides a new sustainable, source of funding for the foundation’s research grants program. The level of funding will depend heavily on The Sydney ASM included the foundation’s reception, the most members’ usage. Funding comes from commissionable products, successful to date with approximately 130 attending. The new such as financial services, cards, insurances and motor vehicles. Andrew Couch Prize for the Trainee Academic Session was It is a great way to save money while supporting the announced by Dr David Elliot, chair of the NSW Anaesthesia foundation. All members should have received a welcome email Continuing Education Committee. Dr Couch, a NSW trainee, and instructions, and can log in via the ANZCA website. For passed away last year. The foundation is honoured to have been queries contact Anna Smeele at [email protected]. involved in announcing this ongoing tribute to Dr Couch. It was also an honour to host a moving tribute by Professor Thank you foundation donors Scott to Professor Michael Cousins, acknowledging his extensive The foundation again warmly thanks all its generous donors and formative contributions to the college, foundation, FPM, and for their ongoing support. the fields of pain medicine and related research. Professor Merry inspired guests with achievements of Rob Packer foundation-supported research including the Australian General Manager, Clinical Trials Alliance’s Trial of the Year 2017 award to ATACAS. ANZCA Research Foundation

“Saving lives, improving life”

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

48 ANZCA Bulletin June 2018 49 Faculty of Pain Medicine

Dean’s message

level, I enjoyed being involved in many fruitful discourse with discussions conversations connecting with colleagues last year around medicinal cannabis around shared interests. Dialogue with and the rescheduling of codeine. The our partners from the Hong Kong College next conversation was at the TGA’s of Anaesthesiologists and Board of Pain Opioid Forum on June 1 considering Medicine and separately with the RACS the regulator’s role in addressing the Pain Section will facilitate stronger challenges around opioid use. I spoke working relationships of mutual benefit, about the faculty’s position statements. especially around pain education and The conversation around opioids will training. remain high on the faculty’s agenda as As we look to the future, the 2018- the pendulum swings away from long- 22 strategic plan will guide the many term opioid use recognising the less than conversations needed to fulfil the optimal outcomes and harms experienced faculty’s vision “to reduce the burden by patients. The faculty held its own of pain on society through education, forum on opioids and pain on June 16. advocacy, training and research”. Again, this forum will be informed Conversations connect us and help us to Priority areas include discussions around with talks from experts sharing their make sense of the world. opioids in chronic non-cancer pain and knowledge from multiple perspectives The recent ANZCA Annual Scientific procedures in pain medicine; working followed by small group discussions Meeting theme of “Reflecting on what with our partners, Painaustralia and the ending with innovative solutions to take really matters” prompted some deep Australian Pain Society on advocacy for us forward. thinking. It seems to me that listening pain services; and last but by no means Finally, we need conversations and being heard are what really matters. least, conversations around the health looking inward, recognising our shared Therefore, the highlight of the ASM for and wellbeing of fellows and trainees. humanity. We allocate time every day me was the many varied conversations I The faculty’s world-class educational to speak with patients and hear their noticed happening throughout our week offerings will be enhanced by a six- stories of conversations gone wrong or together. The FPM Refresher Course Day month training option currently under never had or lost opportunities. These are program set the tone. discussion, addressing strategic goal four. difficult conversations. Added to other More than 220 participants heard Pursing strategic goal two of life events, they can impact on the health multiple outstanding presentations that positioning the faculty as the trusted and wellbeing of fellows and trainees. led to animated conversations at the source of expertise in pain medicine We need to take a little time out in our breaks. Some were sharing the latest led to a meeting with Australian health busy days to check in with our colleagues scientific research or lessons from the minister, Mr Greg Hunt, in September and ourselves. There are resources to clinical world. last year and will be followed up with a assist whether issues are professional or Others were personal stories often second conversation in July. Promotion personal. All assistance is confidential. I tragic and painful about the experiences of an overarching, government encourage you all to make this a priority of refugees, the challenges of inadvertent endorsed National Pain Strategy and in your working week. opioid dependence or the struggles of consideration of chronic pain within As I look to the next two years as your the elderly. The joint programs with our the National Strategic Framework for dean, I feel excited about the future. I ANZCA and Royal Australasian College Chronic Conditions will be high on the plan to visit all Australian states and of Surgeons colleagues were of a similar agenda. Review of funding models for New Zealand over this time. In last high standard; facilitating discussions pain medicine so that patients can access year’s fellowship surveys, many fellows across the artificial boundaries of the multidisciplinary care they need is indicated their enthusiasm for engaging specialist practice that often inhibit another key discussion point focussing more with faculty activities. I look conversation. on strategic goal one. Continuing forward to meeting and chatting with as The discourse on Indigenous health dialogue with Australian Department of many of you as possible. was one standout for me. I left the session Health officials around funding for pain inspired by some of the innovative medicine training positions and research Dr Meredith Craigie strategies connecting clinicians with will also be pursued. Dean, Faculty of Pain Medicine Indigenous patients yet dismayed at the The faculty’s engagement with the paucity of Indigenous specialist pain Therapeutic Goods Administration medicine physicians. On a personal (TGA) has been another avenue of

50 ANZCA Bulletin June 2018 51 SampleFaculty of Pain heading Medicine Sample heading (continued)

Dr Chris Hayes – a dean who built strong relationships News

It is my pleasure on behalf of the Society and Painaustralia. Chris has New fellows New board member fellowship, the board, the general been a very strong advocate of the need We congratulate the following doctors manager and faculty staff to thank Dr to longitudinally assess patient outcomes on their admission to Faculty of Pain Dr Susan (Susie) Lord is from New South Wales and Chris Hayes for his dedication, hard work from pain management programs to Medicine fellowship. obtained FANZCA and FFPMANZCA in 2004. She has been Clinical Lead, Children’s Complex Pain and leadership of the Faculty of Pain inform the evolution of clinical practice. By completion of the training program: Medicine at the completion in May of his He will continue to provide leadership Service, Newcastle since 2013 and was Staff Specialist, Dr Jason Siauw Wei Chow, FRANZCOG, busy two years as on the Electronic Persistent Pain Department of Anaesthesia, Intensive Care & Pain FFPMANZCA (NSW). Management, John Hunter & John Hunter Children’s the dean. Outcomes Collaboration management Hospitals, Newcastle from 2004-2013. From 2004 she Chris’s inclusive, reflective style has and scientific committee and has renewed Dr Alireza Feizerfan, FRCA, FANZCA, is also Conjoint Senior Lecturer, School of Medicine been the hallmark of his leadership of the conversation around outcome FFPMANZCA (WA). and Public Health (Newcastle). Her interests include the faculty. His search for synergies with monitoring of devices in procedural pain Dr Gunjeet Singh Minhas, FAFRM (RACP), procedural interventions (now non-procedural FFPMANZCA (Queensland). others underpins his ability to nurture management. so no conflict of interest), pain in childhood and important relationships. Behind his Chris has skilfully steered the faculty Dr Alan Nazha, FANZCA, FFPMANZCA adolescence, remotely supported care for people in gentle, personable approach, though, is a board through a complete committee (NSW). regional, rural, and remote locations and closing the quiet determination and persistence that restructure, the development of an Dr Michelle Ann O'Brien, FANZCA, gap in access and outcomes for Indigenous people gets results. Chris is courteous and fair ambitious strategic plan for 2018-22 and a FFPMANZCA (Queensland). with pain. in his discussions with everyone be they range of challenging discussions. Every Dr John Alexander Prickett, FANZCA, fellows, trainees or those from outside the board member has appreciated the way FFPMANZCA (NSW). faculty. The faculty staff have appreciated Chris enables everyone to express their his calm, thoughtful approach and views while quietly remaining in control Dr Jane Catherine Standen, FANZCA, FFPMANZCA (NSW). especially the alacrity with which he of the discussion, drawing it to a close in Chris’s wise counsel is sought after far FPM office bearers as elected at the new board meeting on May 9 responded to their requests. a timely manner with an insightful outside the faculty. The recent invitation Dean Dr Meredith Craigie By invitation (honorary Fellow): The faculty has flourished under summary and action plan. He has been from Professor Bruce Robinson, Chair of Professor Fiona Mary Blyth, AM (NSW). Vice-Dean Dr Michael Vagg Chris’s leadership. Stronger engagement a strong voice for the faculty as its the Medicare Benefits Schedule Review with government through representations representative Assessor Dr Dilip Kapur Taskforce, to chair the committee tasked This takes the number of fellows admitted at state and federal level, including a on the ANZCA Council as well. Assistant Assessor Associate Professor Paul Gray with reviewing item numbers related to to 470. meeting with Federal Health Minister Chris has led closer engagement pain medicine exemplifies the high regard Chair, Examinations Committee Dr Eric Visser Greg Hunt, has raised the profile of with the fellowship through the topical in which Chris is held. Chair, Learning and Development Committee Dr Aston Wan the faculty as a valued advisor, a key forums held late last year as a way of I am delighted that Chris will serve on Training unit accreditation Chair, Professional Affairs Executive Committee Dr Michael Vagg strategic goal. Chris has also led faculty encouraging wide-ranging conversations the faculty board for another year and The following hospitals have been interactions with government agencies, on some of the more controversial issues will provide leadership for the faculty in accredited for pain medicine training: Chair, Professional Standards Committee Dr Melissa Viney especially with the Therapeutic Goods in contemporary pain medicine, namely other capacities into the future. • Fiona Stanley Fremantle Hospitals Chair, Research and Innovation Dr Chris Hayes Administration on key issues around medicinal cannabis and procedures in Group, WA. Chair, Scientific Meetings Committee Dr Jennifer Stevens medicinal cannabis and the re-scheduling pain medicine. These robust discussions Dr Meredith Craigie • Pain Matrix Geelong, Victoria. Chair, Training and Assessment Executive Committee Dr Kieran Davis of codeine. have informed the revision of the Dean, Faculty of Pain Medicine He has strengthened the faculty’s faculty’s position statement on medicinal • Pain Science Joondalup, WA. Chair, Training Unit Accreditation Committee Dr Kieran Davis already close relationships with key cannabis, and the faculty’s new working • Precision Health, Victoria. Senior Editor Pain Medicine Journal Professor Milton Cohen strategic partners, the Australian Pain group on procedures in pain medicine. • Royal Adelaide, SA. Co-opted Council Member (appointed by council) Dr Vanessa Beavis

The FPM Executive Committee comprises: Dr Meredith Craigie (Dean) Dr Michael Vagg (Vice-Dean, Chair Professional Affairs Executive Committee) Dr Kieran Davis (Chair Training and Assessment Executive Committee) Ms Helen Morris (GM FPM)

52 ANZCA Bulletin June 2018 53 SampleFaculty of Pain heading Medicine (continued)

Endometriosis – time for action

“To spend years living in chronic pain with no diagnosis, being labelled drug seekers, losing jobs, enduring repeated surgeries and not being believed, suddenly here we are in Parliament House. Our voices are finally being heard.” – Sylvia Freedman of EndoActive

December 5 last year was a big day for Federal Minister for Health, Mr Greg extend to the intermenstrual period so in endometriosis lesions, stimulation of Unfortunately, although the New people living with endometriosis. Federal Hunt and Labor Shadow Minister for that many women are experiencing pain inflammatory processes, peripheral and Zealand Pain Society has representation Fast facts about endometriosis politicians Ms Nicolle Flint MP and Ms Gai Health, Ms Catherine King, attended on most days of the month that is the central sensitisation and inadvertent nerve on the New Zealand Task Force, both • Affects one in 10 women of Brodtmann MP launched the nonpartisan the launch along with other members progression to chronic pelvic pain. Also, injury from surgical excision of lesions. the Australian National Action Plan and reproductive age regardless of age, Parliamentary Friends of Endometriosis of parliament. The women’s harrowing it is not uncommon for women to struggle the New Zealand Task Force have not How can we help? background or lifestyle. Awareness with a formal event at descriptions of their experiences and with other visceral pain conditions like included ANZCA and the Faculty of Pain It is time to change outmoded attitudes • Cause remains unclear. Parliament House1. For those who may that of Ms Nola Merino MP who shared irritable bowel syndrome6 and pelvic Medicine as partners which seems to be a and beliefs in the community and the • Seven to 10 times more likely if a close not be aware, parliamentary friendship her daughter’s story of life-threatening muscle spasm and bladder symptoms. It lost opportunity. Specialist pain medicine health sector. Minister Hunt has followed relative has endometriosis. groups are groups formally recognised by endometriosis surgery visibly moved has serious deleterious effects on their physicians (SPMPs) and anaesthetists can up on his promise. A roundtable to the presiding officers of the parliament them both. sleep, mental health and social wellbeing. play a significant role at a critical time by • Delay in diagnosis on average seven develop the National Action Plan for to 12 years. which last for the term of the parliament2. Minister Hunt offered an apology, Historically an under-recognised improving perioperative care for these Endometriosis was held in February. The They provide a non-partisan forum for saying “The time is long overdue to bring condition both by the community and the women. They can be patient advocates, • One in three will experience fertility tight three-month timeline has produced politicians to meet and interact with this condition out of the dark… On behalf medical profession, endometriosis has asking the hard questions about whether problems. an action plan aligned with the goals stakeholder groups on issues relating to a of all of those in parliament and all of been under-diagnosed and poorly treated. surgery is necessary and will it treat the • Absenteeism and presenteeism of the National Strategic Framework for specific area of concern. those who have been responsible for our To this day, many women experience pain. The evidence suggests that repeated common in the workplace. Chronic Conditions (AHMAC 2017) as the The launch was an opportunity for medical system, I apologise.” He promised confronting and unhelpful interactions surgery may not be beneficial and, in • Costs of healthcare, lost jobs, impact first step7. In addition, the May federal women to share their stories of life with that the Turnbull Government would with the healthcare system. They are fact, may contribute to worsening pain. on productivity and social costs in budget allocated one million dollars endometriosis, heart-wrenching litanies create the first National Action Plan for often perceived to be exaggerating Anaesthetists have a prime opportunity the billions of dollars. to educate healthcare practitioners of pain and loss. Courageous partners Endometriosis to provide women and their their pain severity, attention seeking or to influence the pain experience in the about endometriosis8. In New Zealand, also spoke of the shared devastation families with the support they deserve3. drug dependent1. Key drivers of these perioperative setting. This can be a Endometriosis NZ has been influential experienced by families as the women attitudes are the social taboos around very frightening time for these girls and Why all the fuss? in the NZ Ministry of Health establishing they love struggle on a daily basis with menstruation, beliefs about “the right women; a lot is at stake. They deserve to Endometriosis is a chronic progressive their Task Force to improve diagnosis and this frequently hidden condition. They amount of pain” for the condition, the be treated with dignity and compassion. disease estimated to affect around 700,000 management of endometriosis and pelvic were supported by speakers from the lack of objective measures of pain, and Anaesthetists and SPMPs also act as role women and girls in Australia, 120,000 in pain9. The Endometriosis NZ “me™” newly formed Australian Coalition for the poor correlation between the extent models for the junior medical staff and New Zealand and 176 million world-wide4 program has been teaching menstrual Endometriosis (ACE), a collaboration of of the pathology seen on laparoscopy play a pivotal role in teaching modern pain and the costs are high5. Endometriosis health in New Zealand schools for more awareness groups, patients, clinicians and reported pain experiences. The management strategies. can be well managed, but it becomes a than 25 years10. A pilot project of this and researchers including the Pelvic Pain pathophysiology of endometriosis problem for many because of the often program in Adelaide last year was rated Opposite page: Sylvia Freedman and her Foundation of Australia, Endometriosis encompasses a range of nervous system (continued next page) debilitating pain experienced by many very highly by the participants with mother Lesley. Australia, EndoActive, QENDO and the changes including new nerve growth sufferers. Over time, pain episodes can requests to continue the program this year University of Queensland. This page from left: Federal Minister for and beyond. Health, Mr Greg Hunt; Ms Nicolle Flint MP with Ms Nola Merino MP.

54 ANZCA Bulletin June 2018 55 Faculty of Pain Medicine (continued)

An increasing number of women are 3. http://health.gov.au/internet/ministers/ being referred to pain management clinics publishing.nsf/Content/health-mediarel- Refresher Course Day yr2017-hunt171205.htm accessed May 21, Objectives of the Parliamentary as chronic pelvic pain is recognised 2018. Friends Group include: more frequently. SPMPs are trained to 4. Simeons et al. The burden of endometriosis: 1.To raise awareness of endometriosis manage these patients in the context of a cost and quality of life of women with endometriosis and treated in referral centres. as a reproductive and chronic pain multidisciplinary approach, best teamed Human Reproduction 2012; 27.5:1292-9. condition affecting many women with a specialist pelvic physiotherapist 5. Bush D, S Evans & T Vancaillie, The $6 throughout Australia. and pain psychologist as a start. The Billion Woman and the $600 Million Girl: 2.To inform members and senators FPM Board is working towards a closer The Pelvic Pain Report, 2011 http://fpm. anzca.edu.au/documents/pelvic_pain_ of the plight of sufferers of partnership with the Royal Australian report_rfs. endometriosis with a view to and New Zealand College of Obstetricians 6. Moore J et al. Endometriosis in patient securing funding for further medical and Gynaecologists aiming to identify with irritable bowel syndrome: specific research and awareness raising. synergies for sharing knowledge and symptomatic and demographic profile, and response to the low FODMAP diet. A N Z J 3. To facilitate a forum whereby skills. Obstet Gynaecol 2017 https://doi-org.ezproxy. organisations already working Whether they are consciously aware of flinders.edu.au/10.1111/ajo.12594. on endometriosis research and it or not, most anaesthetists and SPMPs 7. http://www.health.gov.au/internet/ ministers/publishing.nsf/Content/ awareness raising can come together will know at least one woman with health-mediarel-yr2018-hunt054. to coordinate their activities. endometriosis and chronic pelvic pain. htm?OpenDocument&yr=2018&mth=05 They are our sisters, mothers, friends and accessed May 21, 2018. work colleagues. Recent events are giving 8. http://www.health.gov.au/internet/budget/ publishing.nsf/Content/budget2018- women living with endometriosis some factsheet44.htm accessed May 21, 2018. hope now. 9. https://nzendo.org.nz/endo-news/enz- working-with-the-nz-government/ accessed Dr Meredith Craigie May 21, 2018. 10. Bush, D et al. Endometriosis education in FPM Dean schools: A New Zealand model examining the impact of an education program in References: schools on early recognition of symptoms 1. https://vimeo.com/246652420 accessed suggesting endometriosis. A N Z J Obstet May 21, 2018. Gynaecol 2017; 57:452-457. 2. www.aph.gov.au/About_Parliament/ Parliamentary_Friendship accessed May 20, 2018. The faculty’s Refresher Course Day and annual scientific meeting (ASM) programs were a tremendous success and a tribute to the hard work of the faculty’s Refresher Course Day and FPM ASM Scientific Convenor, Dr Jennifer Stevens. The Refresher Course Day attracted 224 delegates and received strong support from the healthcare industry with our major sponsor Seqirus and three exhibitors present. The program, “Pain: The dark side of the mind”, explored the darkness that can be experienced living with pain, brain damage, emotional and physical aspects of pain Prize winners and anxiety beyond the confines of the hospital. Also covered was implications of ANZCA trainee Dr Luke Arthur from South prescribing pain medication and challenges of pain in the elderly population. Australia, is this year’s winner of the The keynote speakers Professor Oscar de Leon-Casasola and Professor Tor Wager Dean’s Prize, awarded at the Faculty of provided excellent, thought-provoking presentations that created much discussion. The Pain Medicine’s annual general meeting academic sessions were followed by a dinner at The Establishment Ballroom, which in May. Dr Arthur won the award for his included an inspirational after-dinner talk by Catherine Keenan, founder and executive paper titled “Erythromelalgia in children: director of The Sydney Story Factory. Presentation, genotype, and treatment response”. Name change for Refresher Course Day Dr Daniel Chang, from New Zealand, The FPM Refresher Course Day has been renamed as the FPM Annual Pain Medicine won the Best Free Paper Award at the Symposium in time for the 2019 Annual Scientific Meeting in Kuala Lumpur. The new 2018 FPM free paper session at the name, which was approved by the faculty’s Professional Affairs Executive Committee, annual scientific meeting. His paper was better reflects the high quality content and structure of the event. titled “The prevalance and risk factors associated with persistent pain after Clockwise from above left: FPM Dean Dr Chris Hayes with FPM ASM Visitor Professor Oscar de breast cancer treatment”. Leon-Casasola; Dr Kieran Davis, Dr Vanessa Beavis and Dr Kushlin Higgie after the morning session; Ms Bernadette Brady presenting on multicultural pain management programs; FPM NSW Visitor Professor Tor Wager with Dr Hayes.

56 ANZCA Bulletin June 2018 57 Anaesthetic history The Rare Privilege of Medicine: Women Anaesthetists in Australia and New Zealand

The Rare Privilege of Medicine FPM history project

Each year the Geoffrey Kaye Museum of Anaesthetic History This year we also launched an online history project for the develops a temporary exhibition to expand the awareness and Faculty of Pain Medicine, looking at the development of the research on the history of anaesthesia and pain medicine in faculty from the earliest days of the college. We were privileged Australia and New Zealand. On International Women’s Day, to work with Professor Michael Cousins in the lead up to the March 8, 2018, the museum launched its new online exhibition launch. The online history project is now available for viewing, "The Rare Privilege of Medicine: Women anaesthetists in along with three new versions of the Lives of the Fellows project. Australia and New Zealand". The physical exhibition was To view the FPM history project go to launched on April 18, to coincide with the Australian Heritage www.geoffreykayemuseum.org.au/faculty-of-pain-medicine- Festival. history/. The exhibition investigates the professional lives of 10 women To view the Lives of the Fellows project go to http://anzca. anaesthetists, ranging in date from 1896 to the present. These online-exhibition.net/fellows/. women came to medicine through very different paths, and the trajectories of their careers were also markedly different. With these women’s stories, the museum hopes to inspire other Medical History Masterclass women but also to challenge other researchers to find women’s PREDICTABLE. COMPLETE. RAPID. stories in medical history, and bring them into the public domain. Medical The exhibition was also promoted at the ANZCA annual scientific meeting with an exhibition booklet and keepcup. To History get a keepcup, fellows needed to be able to provide the name of Masterclass at least one woman anaesthetist from before 1950. Fortunately, it was an open book question, The Georey Kaye Museum of all the answers were inside the exhibition booklet, and there Anaesthetic History is running was a 100 per cent success rate. an all-day masterclass to help To view the online version of the exhibition, go to medical professionals and members of the public develop https://geoffreykayemuseum.org.au/rareprivilege/. and fine-tune their historical research skills.

Saturday August 4, 2018 | $160

This year, we will once again be running the Medical History Masterclass, facilitated by Monash University’s Associate Professor Paula Michaels. The masterclass will be on August 4, 2018, and registrations are now open. Participants in the ANZCA Continuing Professional Development program can claim attendance under the knowledge and skills category “short courses, workshops” for two credit points per hour. For more information, or to register, go to the museum page on the college website: www.anzca.edu.au/about-anzca/ Above: Dr Winnie Hong, one of the first women to sit for fellowship with geoffrey-kaye-museum. ANZCA’s Faculty of Pain Medicine with her keepcup at the Sydney ASM.

58 ANZCA Bulletin June 2018 59 Library update What’s new in the library

Key points: Calling all ANZCA and FPM • Now live (beta-testing): http://airr.anzca.edu.au. ANZCA Library at the ASM Referencing and citation help researchers – promote your • All ANZCA and FPM-related research and publication output is being brought together in the one spot. research and publications! • Content is now discoverable via Google and Trove thereby increasing visibility of ANZCA and FPM-related research and publications. The library has developed a new library • Researchers can register to self-submit content, guide to highlight the various reference/ ANZCA Library – in association with the ANZCA Research as well as create an author profile. citation manager tools available. The Foundation – are excited to announce the launch of the Access the new AIRR Library Guide: guide has information and links to the ANZCA Institutional Research Repository (AIRR). http://libguides.anzca.edu.au/research/airr. various support resources and output Launched at the ANZCA ASM in Sydney in May, AIRR is styles available for many of the more an institutional repository that identifies, captures, stores popular tools including EndNote, RefWorks, Zotero and and facilitates retrieval of the research and publication Mendeley. output of ANZCA and FPM fellows, trainees and staff for Access the new referencing library guide here: the collaborative benefit of local and global clinicians, http://libguides.anzca.edu.au/referencing. researchers and health educators. Do you publish or present papers? The ANZCA Library maintains a number of library guides We are seeking researchers and authors who would like to that are designed to bring together key resources to support register and start contributing their publications particular aspects of pain medicine. via self-submission; set-up an author profile; or There are guides are based around: provide comment/feedback. • Particular specialist/subject areas – for example: Airway Content you can contribute: management, paediatric pain, and many more. • ANZCA and FPM fellow research grants (publications and • Guidance on searching specific databases – for example: outcomes). Ovid MEDLINE and PubMed. • ANZCA and FPM fellow publications (not related to • Supporting the growing number of ANZCA-subscribed research grants, for example: journal articles, theses, apps including Read by QxMD, ClinicalKey, BrowZine book chapters). and Audio-Digest. • ANZCA and FPM trainee research (published and The ANZCA Library ran two workshops – “Beyond The ANZCA library guides can be accessed at: unpublished). Google: An introduction to the ANZCA Library” and http://libguides.anzca.edu.au/. “The Undiscovered Country: Advanced searching using MEDLINE” during the 2018 ANZCA Annual Scientific Meeting in Sydney. The two sessions provided attendees with an opportunity to meet directly with library staff and to learn more about the library and how to utilise its services. By the end of New journals the second workshop, attendees who wanted to undertake Follow the #ANZCALibrary on their own literature searches learnt how to build better New England Journal of Medicine • The Clinical Journal of Pain. Twitter searches in Ovid Medline and PubMed. Both sessions were (NEJM) • Journal of Graduate Medical Education (JGME). enthusiastically received and will be offered to delegates Want to stay up to date with the latest news and resources The New England Journal of Medicine from the ANZCA Library? Follow @ANZCA on Twitter and Fellows and trainees can find these and many other again at the 2018 ASM in Kuala Lumpur. (NEJM) is a weekly general medical you will see weekly updates from the library using the recent anaesthesia and pain medicine titles on the Library staff were also on hand to meet with fellows and journal that publishes new medical trainees at the ANZCA Lounge. #ANZCALibrary tag. research and review articles, and ANZCA Library’s latest titles list: http://libguides. anzca.edu.au/news/titles. The library spotlights online resources, editorial opinion on a wide variety of topics of importance new books and articles of particular to biomedical science and clinical practice. Access The above titles are also available via the library journals Above from top: Kieran Matharu and Megan DeGuerre from interest as soon as they hit the collection. NEJM through the following link: www.nejm.org.ezproxy. page (www.anzca.edu.au/resources/library/journals) and Elsevier with ANZCA Manager, Knowledge Resources, Laura Foley; anzca.edu.au/. via BrowZine (http://browzine.com/libraries/1231). an@tomedia developer Norm Eizenberg with RACS Library Manager, Graham Spooner and ANZCA Library Manager, John Other recent new journals include: Prentice. • Aerospace Medicine and Human Performance (AMHP). • Pain.

62 ANZCA Bulletin June 2018 63 Library update Books for loan

Critical care sedation Hung's difficult and failed airway New eBooks De Gaudio, Angelo Raffaele [ed]; Romagnoli, management eBooks can be accessed via Stefano [ed] – Cham: Springer International Hung, Orlando R [ed]; Murphy, Michael F [ed]. Publishing AG, 2018. – 3rd ed – New York: McGraw-Hill Education, the ANZCA Library website: Essentials of anesthesia for infants 2018. www.anzca.edu.au/resources/ and neonates Management lessons from Mayo library/ebooks McCann, M [ed], Greco, C [ed], Matthes, K [ed] – Clinic: inside one of the world's most Cambridge: Cambridge University Press, 2018. admired service organizations Anesthesia for congenital heart Essentials of neuroanesthesia Berry, Leonard L.; Seltman, Kent D. – New York: disease McGraw-Hill, [2017]. Andropoulos, Dean B [ed]; Stayer, Stephen A Prabhakar, Hemanshu [ed]. – London, England: [ed]; Mossad, Emad B [ed]; Miller-Hance, Wanda Academic Press, 2017. Manual of clinical anesthesiology C [ed].– Hoboken, NJ: John Wiley & Sons, 2015. Essentials of interventional Chu, Larry [ed], Fuller, Andrea [ed] - Philadelphia, PA: Wolters Kluwer Health/ Anesthesiology techniques in managing chronic pain Lippincott Williams & Wilkins, [c2012]. Talley & O'Connor's clinical 9th International Symposium on the Longnecker, David E [ed.]; Newman, Mark F; Manchikanti, Laxmaiah.[Ed in chief]; Kaye, New books for loan Brown, David L; Zapol, Warren M. - 3rd ed - Alan D.[ed]; Falco, Frank J. E.[ed]; Hirsch, Monitoring mechanical ventilation examination. Volume 1: a systematic History of Anesthesia [program]: Joshua A.[ed]. – Cham: Springer International guide to physical diagnosis Boston ISHA-9 2017 New York: McGraw-Hill, 2018. using ventilator waveforms Books can be borrowed via the Publishing AG, 2018. Arnal, Jean-Michel. – Cham, Switzerland: Talley, Nicholas J and O'Connor, Simon. – 8th ed Desai, M. and Desai, S. [Program directors] – ANZCA Library catalogue: Atlas of sonoanatomy for regional Springer, 2018. – Chatswood, NSW: Elsevier Australia, 2018. Boston, Mass.: ISHA, 2017. anesthesia and pain medicine Essentials of regional anesthesia www.anzca.edu.au/resources/ Kindly donated by Dr John Crowhurst. Kamakar, Manoj K [ed.]; Soh, Edmund [ed.]; Kaye, Alan David [ed]; Urman, Richard D. [ed]; Oxford textbook of anaesthesia Talley & O'Connor's clinical Vadivelu, Nalini[ed]. – Cham, Switzerland: library/book-catalogue.html Experience anesthesia history in Chee, Victor [ed.]; Sheah, Kenneth [ed.]. Hardman, Jonathan G [ed], Hopkins, Philip M examination. Volume 2: a guide to – New York: McGraw-Hill, [2018]. Springer, 2018. [ed], Struys, Michel MRF [ed] – Oxford: Oxford specialty examinations New England University Press, 2017. Talley, Nicholas J and O'Connor, Simon. – 8th ed [Place of publication not identified]: [publisher Basic and clinical pharmacology Ganong’s physiology examination and – Chatswood, NSW: Elsevier Australia, 2018. not identified], c 2017. Katzung, Bertram G. [ed] -14th ed. – New York: board review Principles and practice of pain Kindly donated by Dr John Crowhurst. McGraw-Hill, 2018. Barrett, Kim E.; Barman, Susan M.; Boitano, medicine Hyperbaric medicine practice Scott; Reckelhoff, Jane. – New York: McGraw- Explain pain Wootton, R Joshua [ed]; Warfield, Carol A [ed]. Kindwall, Eric P [ed]; Whelan, Harry T [ed]. The Basics of anesthesiology: a Hill Education, 2017. – 3rd ed – New York: McGraw-Hill Education, Butler, David S.; Moseley, Lorimer. – 2nd ed. – – 4th ed. – Flagstaff, AZ: Best Publishing primer for medical students 2017. Company, 2017. Adelaide, SA: Noigroup Publications, 2013. Patel, Gaurav. – New York: McGraw Hill, [2016]. Hadzic's textbook of regional anesthesia and acute pain Turn the ship around: a true story of Understanding patient safety A Circuitous history of anaesthesia Central pain syndrome management Wachter, Robert; Gupta, Kiran. – 3rd ed. and analgesia in Cairns to 2017 turning followers into leaders Canavero, Sergio; Bonicalzi, Vincenzo. – 3rd ed. Hadzic, Admir [ed]. – 2nd ed – New York: – New York: McGraw-Hill, 2018. Grace, R. [self-published] – c 2017. Marquet, L. David. – New York: Portfolio, 2015. – Cham, Switzerland: Springer, 2018. McGraw-Hill Education, 2017. Kindly donated by the author Dr Robert Grace. Vander's renal physiology Complications in neuroanesthesia Harrison's principles of internal Eaton, Douglas C; Pooler, John P. – 9th ed Prabhakar, Hemanshu [ed] – London: Academic medicine – New York: McGraw-Hill, 2018. Press, 2016. Contact the ANZCA Library Kasper, Dennis L. [ed]; Fauci, Anthony S. [ed]; Cote and Lerman's a practice of Hauser, Stephen L. [ed]; Longo, Dan L. [ed]; www.anzca.edu.au/resources/library Jameson, J. Larry [ed]; Loscalzo, Joseph [ed]; Phone: +61 3 9093 4967 anesthesia for infants and children Hauser SL [ed]. – 20th ed – New York: McGraw- Fax: +61 3 8517 5381 Cote, Charles J [ed]; Lerman, Jerrold [ed]; Hill Education, 2018. Anderson, Brian J.[ed]. – 6th ed – Philadelphia: Email: [email protected] Saunders Elsevier, 2018.

64 ANZCA Bulletin June 2018 65 Conversations to enhance learning

Anaesthesia is primarily taught as an apprenticeship Structure for learning and teaching model. As supervisors when we arrive at work Table 1. we have multiple agendas including providing Set the scene safe, high-quality patient care, perhaps reviewing • Learning needs assessment conversation. patients from a previous list, completing non- • Agree learning objectives with the trainee. clinical work-and providing an environment • Outline the approach the learning and teaching will take. which facilitates learning. • Discuss relevance of what will be covered with the trainee. ANZCA places the responsibility for learning with the trainee1, Body and the role of the supervisor is to support lifelong learning. It • Consider content or skills you will include specific to the is important the supervisor encourages this philosophy with the agreed learning objectives. trainee. Questions often arise as to how to do this in a structured • Consider how learning will be facilitated. Possibilities way. There are several factors that evidence demonstrates are include: necessary for learning, and this article will focus on three: - Use of questions. Setting goals, providing feedback and promoting reflection. - Tools: SNAPPS, One minute preceptor. Elements of a learning and teaching experience • Review of learning. Six elements to consider when facilitating a learning and Closure teaching experience. This is a continuous cycle of learning. • Summarise the key points. Establishing psychological safety is imperative. Planning involves the use of “Set, body and closure” (see figure 1). • Feedback conversation. • Evaluate. Figure 1.

Where do I start? Early in medical school we hear the maxim that “more is missed by not looking than not knowing”. This is true of teaching and learning as well – if we “teach” something the learner has no interest in, how much learning occurs? As supervisors, if we can identify the trainees perceived learning needs and align our teaching to make this both relevant and practical2 we may facilitate knowledge retention and learning more effectively. It’s important to remember that even at similar stages of training, trainees may have diverse interests and learning needs. The clinical environment is a rich learning space enabling application of theory into practice, development and refinement of skills and opportunity to problem solve in real time. To capitalise on these opportunities, a conversation to plan the list and potential learning is beneficial. Taking a few minutes to determine the trainee’s learning needs enables you to tailor the teaching and learning episode and when relevant include your “pet topics”. Be mindful with pet topics as trainees may find this frustrating if these topics are Why have a conversation about learning? not aligned with their individual needs or a repeat of a previous Teaching has been referred to as “A mysterious process by interaction. Next you can establish a short plan to effectively means of which the contents of the notebook of the professor deliver the teaching itself or “body” then evaluate the teaching are transferred to the notebook of the student without passing during the “closure” (see Table 1). through the mind of either.” -att. Edwin Emery Slosson. Phrases that may be useful to begin this conversation How can we prevent this? may include: Inherently we know if we set goals we are more likely to achieve • “What would you like to learn today (get out of this list)?” them, so engaging with the trainee to identify their learning • “Is there anything you are working on (from previous goals is a good place to start. feedback) that you would like to try and build on during this list?” • “What is one thing you would like to take away from today?” Take home points: • “What would you like feedback on today?” • A learning conversation is a dialogue, not a one-way This conversation may assist the supervisor to gain insight transfer of information from the supervisor to the trainee. into the trainee’s current knowledge and skills as well as assist • Start with goal setting – focus on specifically identifying the trainee to identify specific learning needs not previously what the trainee wants to learn. considered. As with other new skills or approaches this • End with guidance for further learning. conversation may feel awkward at the start. (continued next page)

66 ANZCA Bulletin June 2018 67 Conversations to enhance learning (continued)

Barriers to the conversation trainee may prioritise viva practice over presence in a list and What about afterwards? Conclusion Supervisors often have several reactions to the suggestions this may be appropriate for a period. However, utilising the The feedback conversation is an opportunity for purposeful The clinical environment provides many opportunities for they should start the list by asking the trainee what they time in theatre to underline the principles of the exam (for dialogue between the trainee and the supervisor to share learning. Maximising these with conversations designed to want to learn: example, pharmacology in action) is an opportunity to reinforce perspectives related to performance and assist the learner to plan, implement and benefit from these opportunities is highly knowledge and evidence suggests application of knowledge identify goals and actions for ongoing development. Feedback satisfying for both supervisors and trainees. “We won’t have time, there’s too much work pressure.” results in long-term behaviour change. A useful approach is to conversations after working with multiple supervisors over For more information: ANZCA educators program Planning at the start of the list (or before) allows time to make explicit your thinking and make explicit why you do what time provide an opportunity for the trainee to gain information www.anzca.edu.au/resources/learning/anzca-educators-program assemble equipment or call for patients early to allow extra time you do. through a variety of lenses enabling strengths and gaps in to focus on teaching. Additionally, it creates an environment knowledge, skills and professional behaviours to be identified “It’s exhausting to be teaching all the time.” Dr Kara Allen expecting learning to take place. This approach capitalises on and discussion regarding ongoing improvement. This is a common statement from participants in the ANZCA Supervisor of Training, Royal Melbourne Hospital, opportunity, and even in high turnover situations trainees can The feedback conversation focuses on reflection (self- educators program! Yes, it is exhausting – which is why few of Mecical Lead, Monash Simulation, identify learning opportunities. assessment), and involves an exploration of things that worked us explicitly teach throughout an entire list. In any list there will ANZCA Education Program Facilitator well and areas for ongoing development. An important final step “What if they don’t come up with anything?” be teaching moments – some planned (aim for at least one at is for the trainee to take responsibility for creating an action plan Mr Maurice Hennessy It might be the first time a trainee has been asked what they the start of the list), others opportunistic as well, and learning towards improvement. Learning and development facilitator, ANZCA want to learn! To start the discussion, try presenting two or three moments where the trainee can benefit from guided self-directed learning opportunities related to the list and ask them to choose learning3. Role modelling is a valuable tool to promote learning A typical feedback conversation may include phrases such as: References: one to start a conversation. Once the trainee knows you’re and can be supported by a reflective learning conversation. “Tell me what you think worked well today.” 1. Australian and New Zealand College of Anaesthetists. ANZCA serious about meeting their needs, they are often quite happy to In my (Kara's) experience, trainees usually have highly Anaesthesia training program curriculum. 2016 [cited 2018 May 15]. discuss where the gaps are, or ask questions. “Is there anything you would do differently or will continue Available from: http://www.anzca.edu.au/documents/anaesthesia- practical, achievable aims for learning on a list. These include to consider after today?” training-program-curriculum.pdf. performing a WBA, practicing a technique, discussing why I do “I don’t want to teach what they want to learn.” “Was there anything you would do differently next time?” 2. Knowles MS, Holton III EF, Swanson RA. The adult learner: This can be a challenge particularly with trainees who may things the way that I do, talking about a difficult case, or career Routledge; 2012. wish to learn something outside the scope of the list. The onus planning. Allowing the trainee to take the lead in establishing “What feedback do you have for me as a supervisor?” 3. Kirschner PA, Sweller J, Clark RE. Why minimal guidance during is therefore on the supervisor and trainee to work together the agenda has opened conversations that are fascinating and The Fundamentals of Feedback modules in Networks instruction does not work: An analysis of the failure of constructivist, to find relevant learning opportunities! The exam-focused rewarding for both the trainee and for me. Don’t underestimate is a valuable resource to advance your skills in feedback: discovery, problem-based, experiential, and inquiry-based teaching. a trainee’s ability to recognise your strengths and play to them! https://networks.anzca.edu.au/d2l/home/7108. Educational psychologist. 2006;41(2):75-86.

68 ANZCA Bulletin June 2018 69 Training Successful candidates

Tasmania David John Hargreaves Victoria Brian Nee Hou Chee Asha Simon d'Arville Alexandra Lee Hill Luxmana Sean Jeganathan Vivian Liang Ainsley Christina Lorych Li Yong Ng Western Australia Louisa Ann Corr Alicia Louise Cullingford Shilpa Desai Owen Patrick Gray Court of Examiners for 2018.1 Final Exam. Court of Examiners for 2018.1 Primary Exam. Xiao Liang Mateusz Piotr Lisik Adrian Pregelj Queensland Sneha Neppalli Final fellowship Ray Paramalingam Leela Manik Patrick James Rubie Primary fellowship Catherine Jane Bella Darren Paul Sherwin examination Jessie Kowhai Maulder Lilyana Putri Satiowijaya examination Matthew Jacob Black Luke John McConnell Thomas John Shepherd Matthew Jonathan Bolland March/May 2018 Joel Brian Menzies Christopher John Slattery February/April 2018 James Edward Lloyd Booth NEW ZEALAND Jonathan David Moore Iain Cameron Walker-Brown David John Burgess James Edward Bickley One hundred and fifty seven candidates Jessica Nghiem Ninety-four candidates successfully Michael John Busser Karen Mu-Hsuan Chiu successfully completed the final Graham Collin O'Connor South Australia completed the primary fellowship Joshua Cher Jin Chew Carole Ann Gillespie fellowship examination at this Gabrielle Papeix Nicole Diakomichalis examination: Larissa Maree Cowley Matthew Hart presentation and are listed below: Dana Michael Perrignon Roth Anisha Kulkarni Rian James Crandon Amiria Isabelle Taylor Howie Kate Smith Kylie Musgrave AUSTRALIA Jason Chiong-Hui Tiong Marthinus Vermeulen Emmanuel Dhoss Renee Clair Hope AUSTRALIA Australian Capital Territory Nilru Priyanka Vitharana Elena Clare Vowels Nicholas John Egerton Matthew Jeremy Lowe Australian Capital Territory Nicole Elizabeth Somi Aleksandar Vukomanovic Samuel Jeremy Whitehouse Karl Alexander Eisner Anna Jan Mearns Martin Michael Dempsey Bridget Irene McKenzie New South Wales Nicole Elise Galletly New South Wales Queensland Tasmania Courtney Lee Hawthorne Keryn Dale McLeay Benjamin James Bartlett Caroline Ban Rafal Bacajewski Nathaniel Guy Jackson Anna Julia Pozaroszczyk Kathryn Marie Brooker Jane Caroline Leadbeater Christopher John Bell Tamsin Catherine Barratt Harry Arthur Laughlin Mark Elie Chemali Andrew Gregory Little Christopher Peter Burnett Shaw Mitchell David Blake Cameron Morton Bell Peter Michael Mulcahy Tejas Chikkerur Jun How Low John Edward Shepherd Kate Elizabeth Blatchford Rachel Claire Bourke Kate Howson Antimony Ashley Mar Peter Yang Xiang Samuel John Boyers Andrew Charles Bower Victoria Gregory Kalogeropoulos Rajesh Pachchigar Nicholas Casimir Zichy Woinarski Oliver Mark Carson Hanna Denise Burton Sarah Jane Ashcroft Adam Michael Kelly Emma Elaine Paver Supriya Chowdhury Rebecca Kathleen Caragata Jonathan Li Wern Au Melissa Xiao-Ming Kuo Romitha Vidushan Ranasinghe Phillip Wayne Collins Gillian Hilda Cook Nicholas John Cameron Jaroslaw Jerzy Latanik Thomas Benjamin Roberts Renton Prize Timothy David Cooper Corey James Dore Isabelle Laura Cooper Jonathon Paul Fanning Andrew William Maccioni Danielle Rebecca Scott The Court of Examiners recommended Tara Kristen Dalby Henry James Davidson Benjamin Ross McAlpin Nevin Mark Fernandez Jacqueline Anne Seebold that the Renton Prize at this sitting of Zoe Daskalopoulos Tabara Dione Briana Loloma Miller Nathan Bruce Flint Jai Sharma the primary examination David Richard Denman Kathryn Anne Donaghy William Cobley Moor Thomas Egan Nicholas James Gerbanas Erin Mary Nelson Yi Ching Siah be awarded to: Alice Hazel Gynther Julia Alexandra Dubowitz Carling Ann Tills Simmons Andrew Herbert Emanuel Cameron Gibson Galbraith Nikhil Subhaschandra Patel Brian Nee Hou Chee, Victoria Daniel Fletcher Jessica Anne Hegedus Catherine Stephanie Stirzaker Andrew John Goldberg Lauren Deborah Paton Damitha Viraj Anton Fonseka Yena Hwang Daphne Subarna Premnath Zach Daniel Tappenden Michael Adam Ginsburg Lee Nicholas Imeson Jina Hanna Anthony Anis Almendra Qureshi Leigh David White Merit certificate Daniel David Gorman Behruz Mohammad Jamshidi Jackson Thomas Hawkes-Sutton Richard Pieter Ruberti Ashton Jeffery Timothy Boh Chu Ho The Court of Examiners recommended John Paul Harper Michael John Scerri South Australia Juan Sebastian Lopera Alvarez Zacchary James Ivey that merit certificates were awarded to: Nathan Andrew Hewitt Patrick Vincent Sheehan Shaun Peter Campbell Dinushka Iroshima Devi Kariyawasam Thar Nyan Lwin Patricia Ky Samuel Weka Stewart Paul Timothy MacLure Michael John Busser, Queensland (Pakiarajah) Claire Jane Maxwell Sophie Ann Lee Brendon Jonathan So Alicia May Paterson Swaetha Koneru Tony James Miller-Greenman Yasmin Safia Lennie Michael Tyrrell Taylor Charlotte Naomi Wade Bianca Gkin-Hui Lan Martin Misevski Bianca Antoinette Macula Stephen James Naughtin Simon Tiew Fong Ting Timothy James Wonders Andrew Peter Lindberg Nirnitha Manivasagan Rheily Paige Ward Luke Bradley Nottingham Samuel Charles Wotherspoon

70 ANZCA Bulletin June 2018 71 Training Successful candidatescandidates (continued)

Matthew David Mathieson NEW ZEALAND Alexander John McCann SIMG examination Charlotte Emily Adamson Therese Rose Nigro Siva Sundari Arumugam Six candidates successfully completed the Georgia Catherine Preece Specialist International Medical Graduate Michael Johan Barlev Ramanan Rajendram Exam at this presentation and are listed Lisa Marion Barneto Dashiell Trinity Reed below: Jane Christy Carter Andrew Leslie Simons Thida Evennett Akhilesh Kumar Tiwari, Queensland Yuet-Ching Sing David Choi Josko Zaja, Queensland Harridharshan Janahan Sivakumar Yanyi Chuah Leandro Cardoso, Western Australia Liam George Twycross Nicola Anne Delany Esha Sethi Chaudhary, Western Australia Alice Elizabeth White Nicholas Charles William Eaddy Patricia Eveline Nientiedt, Western Peter Daniel Williams Mehreen Maqsood Farrow Australia Luke William Willshire Nicholas Stephen Harrison Evelina Shepherd, Western Australia Elliot Lachlan Wilson Victoria Anne Lyon Zi Yang Aaron James Macdonald Western Australia Fynn Maguire Natalie Akl Leesa Jane Morton Cecil Gray Prize Lisa Mariana Parisouk Alarcon Hye-Won Karen Park The Court of Examiners recommended Vincent Bryan Anderson Matthew Byron Rowe that the Cecil Gray Prize for the half year Simon Peter Bradbeer Charlotte Louise Smith ended 30 June 2018, be awarded to: Matthew James Sumner Suze Dominique Bruins Alice Hazel Gynther, Queensland Maya Calvert Nicole Kyla Vogts Peter Benjamin James Garnett Arihia Elizabeth Te Mare Waaka Maya Williams Merit certificates Jodie Lisa Jamieson Merit certificates were awarded to: Ryan Maslen Michael Tak Kwan Miu HONG KONG Jessica Anne Hegedus, Queensland Simon Don Papaelias SeleenKa Chung Cheah Shek Harry Arthur Laughlin, Tasmania James Franklin Preuss KaShuk Chung Wah ShekTse Zacchary James Ivey, Victoria Craig Melville Rainbird Shuk Wah Tse Craig Melville Rainbird, Western Scott Cameron Sargant MALAYSIA Australia Archana Chandrashekar Shrivathsa Bojana Stepanovic Seleen Cheah Syed Muhammad Syed Abdul Hamid

Diploma of AdvancedAdvanced DivingDiving and Hyperbaric MedicineMedicine

ANZCA congratulates the following Dr Susannah Sherlock, FANZCA, doctors on their award of the Diploma FCICM (Qld) of Advanced Diving and Hyperbaric Dr Paul David Cooper, FANZCA, Medicine: Correction FCICM (Tas) In the March 2018 edition of the Professor Michael Bennett, Dr Elizabeth Jane Elliot, FRACGP (Tas) ANZCA Bulletin, an article by Dr FANZCA FRCSI (NSW) Dr Rod Franks, FACEM (Tas) Richard Seglenieks had an incorrect Dr Glen Campbell Hawkins, Clinical Professor David Smart, sign off. FANZCA (NSW) FACEM (Tas) It should have read: Dr Jan Peters Lehm, FAZNCA (NSW) Dr Andrew William Harold Fock, Dr Richard Seglenieks Dr Barbara Elise Trytko, FANZCA, FANZCA (Vic) Chair, ASA Trainee Members FCICM (NSW) Dr Ian Christopher Gawthhrope, Committee Dr Robert Turner, FANZCA (NSW) FACEM (WA) We apologise to Dr Seglenieks. Dr Kenneth Robert Thistlethwaite, FRACGP (Qld)

72 ANZCA Bulletin June 2018 73 A VAST improvement for resource-limited settings

As of July 2017, I have been In low- and middle-income countries VAST is grounded upon a longstanding Course evaluations were universally anaesthesia trainees in Rwanda. We References: (LMICs) resource limitations, severe association among the anaesthesia positive. The pilot courses provided great also are planning to conduct a formal 1. Vo D, Cherian MN, Bianchi S et al. Anesthesia undertaking a global health workforce shortages and scarce capacity in 22 low and middle income departments at Dalhousie University, insight into the feasibility of conducting assessment of the program, in terms countries. J Anesth Clin Res. 2012; 3:4. and anaesthesia fellowship at professional development opportunities University of Rwanda and the Canadian a three-day simulation-based course in of ability for knowledge translation of 2. Enright A. Review article. Safety aspects of Dalhousie University, Halifax, pose significant challenges to the Anesthesiologists’ Society International a resource-limited setting on a modest non-technical skills and for efficacy of anesthesia in under-resourced locations. provision of safe anaesthesia1,2. The Education Foundation (CASIEF). budget. From the perspective of course facilitator training. Following delivery Can J Aneth. 2013; 60: 152-158. Nova Scotia, Canada. Armed content of the VAST Course was Extensive foundational work has already design, the lessons learnt will be used to of the pilot courses, the overwhelming 3. Mock CN, Donkor P, Gawande A, Jamison DT, with the luxury of time, flexibility specifically designed to reflect the case been conducted in Rwanda in both refine the course prior to future delivery. impression amongst the project leads and Kruk ME, Debas HT. Essential surgery: key mix encountered in district hospitals, medical education and simulation6-8. With hindsight and time, I cannot help reflected from participants, is that VAST messages from Disease Control Priorities, in expected output and a strong 3rd edition. Lancet 2015; 385:2209-2219. a level in the health system of LMICs I have had the pleasure of VAST co- but reflect on the pilot courses as a great has potential value across a wide range of collaborative partnership 4. Henry JA, Bem C, Grimes C et al. Essential recognised as a pivotal target for quality authorship with Dr Livingston (Dalhousie success. However, in the moment, there resource-limited settings. I look forward surgery: the way forward. World J Surg. 2015; between Dalhousie University improvement initiatives3,4. The course University, Halifax, Canada) and Dr were multiple obstacles to overcome. to ongoing partnership with the WFSA 39: 822-832. focuses on anaesthesia and resuscitation Mukwesi (Rwanda Military Hospital, The most notable challenge was trying and am hopeful that with the support of 5. Livingston P, Evans F, Nsereko E et al. Safer and the University of Rwanda, I for obstetric, paediatric and trauma Kigali, Rwanda), who were both central to meaningfully conduct and debrief ANZCA and ASA we will be able to explore obstetric anesthesia through education have focussed my fellowship on care as well as safe general surgery and to this foundational work. Collaboration simulation scenarios with a diverse group avenues for trial of the VAST course closer and mentorship: a model for knowledge translation in Rwanda. Can J Anesth. developing and piloting the Vital pain management. Beyond the clinical with the Scottish Centre for Simulation of participants, who often switched to home. 2014; 61: 1028-1039. material, VAST utilises simulation and Clinical Human Factors provided a between three languages. While English I sincerely thank the ANZCA Overseas 6. Livingston P, Zolpys L, Mukwesi C et al. Anaesthesia Simulation Training and reflective learning (debriefing) to robust framework for simulation design has replaced French as the official Aid Committee for awarding me the Non-technical skills of anaesthesia providers (VAST) Course. The VAST Course highlight the role of anaesthestists’ and debriefing, which we have adapted language, French and the ubiquitous Overseas Aid Trainee Scholarship. in Rwanda: an ethnography. Pan Afr Med J. 2014: 19-97. is a novel, three-day simulation non-technical skills. VAST creates an for suitability in resource-limited settings. Kinyarwanda are often deferred to. Overseas work in a resource-limited immersive simulation environment VAST has been developed in consultation Additionally, the stakes were raised setting has provided me not only a 7. Livingston P, Bailey J, Ntakiyiruta G et al. based program centred on core Development of a simulation and skills without reliance on advanced or with the World Federation of Societies when the Minister of State in charge of rewarding personal experience, but an centre in East Africa: a Rwandan-Canadian clinical and non-technical skills, expensive simulation technology. This of Anaesthesiologists (WFSA), who have Public Health and the Commandant of the avenue to harness fortune and privilege partnership. Pan Afr Med J. 2014; 17: 315. is achieved through the combination endorsed the pilot courses. Additionally, Rwanda Military Hospital joined us for in an attempt to give back to the global 8. Skelton T, Nshimyumuremyi I, Mukwesi C et promoting safe anaesthesia and of basic task trainers, iPads using I am grateful to CASIEF and Dalhousie a demonstration scenario and certificate community. I have been able to hone al. Low-cost simulation to teach anesthetists’ perioperative care in resource- SimMon software, simple props (for University for their financial support. presentations at the end of the second my teaching abilities and meaningfully non-technical skills in Rwanda. Anaes Anal. 2016; 123: 474-480. limited settings. example, airway equipment, syringes, The VAST Course was conducted course. Their evaluation and ongoing apply the skills and knowledge developed drapes), representative documentation, three times during January 2018, in endorsement of VAST are central to a during ANZCA training. Further, the photographs of pathology and briefing Kigali, Rwanda. In total, 40 participants locally-driven and meaningful future process of designing and delivering the cards to prepare participants for their role completed the training. More than 50 rollout of VAST in Rwanda. VAST Course has driven me to explore during scenarios. per cent were non-physician anaesthesia Stemming from the pilots, we have what underpins effective medical providers. We also delivered two VAST secured the endorsement of Ministry of education. Facilitator Courses, mentoring 12 trainee- Health to promote dissemination of the facilitators. The goal of the facilitator VAST Course in Rwanda. Additionally, Opposite page from left: Certificate Dr Adam Mossenson presentation and the end of the inaugural VAST course is to develop a network of local we are working with the University ANZCA Provisional Fellow, MPH Course; Debriefing; Without needing to rely on VAST facilitators who will promulgate the of Rwanda to extrapolate VAST into a Assistant Professor and Global Health expensive technology and complex equipment, course and promote sustainable delivery. longitudinal simulation curriculum for Fellow, Dalhousie University, psychological fidelity and “buy in” can be Halifax, Nova Scotia, Canada achieved; Demonstration scenario for the Commandant, Minister of State and entourage.

7482 ANZCA Bulletin June 2018 7583 New ACE Special interest group SampleSpecial headinginterest group Twitter events events account You can now follow ACE on Twitter at @ACE_ACECC for updates on all the latest SIG and CME activities.

Obstetric anaesthesia – delivering what matters

The 2018 Obstetric Anaesthesia SIG meeting “Obstetric In addition to the four emergency response workshops held anaesthesia – delivering what matters” was held at the on the Saturday afternoon we were able to offer for the first International Convention Centre in Sydney as a satellite meeting time emergency response sessions covering the four topics in to the ASM. It was wonderful to see the ongoing interest in obstetric scenarios at the Westmead and Royal North Shore obstetric anaesthesia with more than 400 delegates attending. Simulation Centres. These proved very popular and engaging. The aim of the meeting was a broad ranging update in We were thrilled with the response to the inaugural Micheal obstetric anaesthesia best practice. We welcomed three Paech Prize for Research in Obstetric Anaesthesia. Following international invited speakers, Professor Richard Smiley, three excellent presentations the prize was awarded to Dr Professor Marc Van de Velde and Professor Warwick Ngan Kee, Patrick Tan for “High flow humidified nasal pre-oxygenation two of whom had not spoken in Australia before, and provided in pregnant women – The HINOP1 Study”. interesting perspectives on what’s new and the future of We would like to especially thank Sarah Chezan, Hannah obstetric anaesthesia. We were left in no doubt as to the Belgian Sinclair and the team from the college for all their fantastic view of remifentanil with the declaration that Professor Van de help in making both the meeting and social program a success. Velde hates this drug on birth unit. The Saturday evening harbour boat ride to dinner was a Particularly well received were the talks from non- special highlight. Finally a huge thank you to all the fantastic anaesthetists in the program, in keeping with obstetric presenters and workshop instructors who gave their time and anaesthesia as a team sport. These included the role of efforts and made it all possible. interventional radiology in managing placental abnormalities from Dr Tim Harrington, the concerning trend towards earlier Dr Jane Brown and Dr Surbhi Malhotra delivery from Professor Jonathan Morris and a very interesting Obstetric Anaesthesia SIG Convenors discussion of the incidence of post-partum post-traumatic stress disorder from psychiatrist Professor Philip Boyce. A particular Clockwise from top left: Professor Warwick Ngan Kee, Professor mention also to Dr Edith Waugh, a Darwin anaesthetist, who Marc Van de Velde, Dr Surbhi Malhotra, Associate Professor Victoria presented an insightful and moving talk on the issues around Eley, Dr Jane Brown and Professor Richard Smiley; Professor Michael caring for Indigenous parturients. Paech presenting the winner of the inaugural Michael Paech Prize for Research in Obstetric Anaesthesia, Dr Patrick Tan; Delegates during a break viewing the e-posters on display; Professor Marc Van de Velde and Associate Professor Alicia Dennis during question and answer time.

78 ANZCA Bulletin June 2018 79 New Zealand news

• ANZCA and FPM do not take a stance on Laws on medicinal the issue of decriminalisation of personal cannabis and end of life use of cannabis preparations. • There is little evidence for the efficacy of New Zealand is facing debates at the cannabinoids in chronic non-cancer pain highest level about issues that have situations. been exercising our friends across the Tasman for some time – what we do • ANZCA and FPM do not recognise a need about medically-assisted dying and what for greater availability of medicines in is our stance on the growing demand general and in particular do not endorse for medicinal cannabis that is driving the use of cannabinoids in chronic non- changes in the law? cancer pain until such time as a clear The ANZCA New Zealand National evidence-based therapeutic role for them Committee has submitted on both is identified in the scientific literature. using the experience from what has • Substances intended for therapeutic happened in the Australian jurisdiction, purposes should be fully characterised the environment in New Zealand and chemically, pharmacologically and the specific aspects of the legislation toxicologically. proposed. • ANZCA and FPM are concerned about the So what are the issues? adverse effect profile in cannabis users, The debate about the use of medicinal including impaired respiratory function, cannabis reached the New Zealand psychotic symptoms and disorders, and Tena koutou katoa – let’s talk about equity parliament late last year. cognitive impairment, particularly in the There were two bills vying for oxygen, Quality assurance coordinators (QAC) from hospitals all over New Zealand were developing (including adolescent and challenged to think about what equity looked like in their workplace when they attended with a more liberal private member’s young adult) brain. cannabis bill failing at first reading. This their meeting in Wellington in April. one, proposed by a Green MP, would have The End of Life Choice Bill passed its QAC was addressed by the group manager Kiri Rikihana whose job, among other allowed the terminally ill and debilitated first reading in December and is now things, is supporting the implementation of Te Whai Oranga, the Health Safety and to legally grow cannabis if prescribed by being considered by the Justice Select Quality Commission’s Măori advancement framework. their doctor. Committee. The bill gives people with Her first task was to show how equity The government’s Misuse of Drugs a terminal illness or grievous and differs from equality using the illustration (Medicinal Cannabis and other matters) irremediable medical condition the option (right) and discussion after. Amendment Bill was introduced to of requesting assisting dying. Kiri Rikihana explained that equity the House in December and passed Some of the main points in the New means “everyone has the same outcomes – its first reading late January. It is now Zealand National Committee submission whatever it takes”. being considered by the Health Select included questioning the clarity of the She says for too long Indigenous groups Committee. definition of assisted dying, that medical have been blamed for their health problems. Research workshop – opening avenues The bill introduces an exception and practitioner or health service participation Yet the weighted statistics illustrate Măori in assisted dying should be voluntary with have been the canary in the health system Whether you want to do a small research project or get on board with a huge trial, the statutory defence for terminally ill people no need for an objection to be qualified, indicating where the major issues are going ANZCA research workshop provided a taste of all that’s available for trainees and fellows to possess and use illicit cannabis and to and that there should be guidelines on to appear in the population. when it ran on March 23 in Auckland. possess a cannabis utensil. It also enables what information a medical practitioner Kiri Rikihana spoke about how we can Topics from both national and international speakers ranged from how to do a pilot the setting of standards that products must provide. The submission also design health systems differently to attain study to the ins and outs of airways research. manufactured, imported and supplied emphasised that quality palliative care equity but it takes leadership, strategy, The “Young and the Restless” section was three presentations looking at the good, the under licence must meet, and amends services must be accessible across New capacity, good measurement, accountability bad and the ugly in diploma, masters and PhD study. Dr Daniel Chiang, who is a recipient Schedule 2 of the Act so that cannabidiol Zealand, and research and investment and vision. of an ANZCA Foundation grant for his gene research into post-surgery pain in breast products are no longer classed as into palliative care must be prioritised. The Health Quality and Safety Commission has developed an Equity Explorer cancer patients, says being knocked back on ten previous grant applications made him controlled drugs. Assisted dying legislation must not become which provides information on how health and health care varies between groups of successfully hone back his proposal. On the benefits of research, he says, “I feel I’m a Key points from ANZCA’s and FPM’s a substitute for good palliative care. people, and between district health board (DHB) areas of Aotearoa New Zealand. Two better doctor with a wider clinical and academic understanding of our profession”. position on medicinal cannabis, with Submissions on both these bills can types of group are compared: ethnic groups and groups based on socioeconomic status Dr Carolyn Deng and Dr Nicola Broadbent both had a public health lens on their post particular reference to its use in the be found on the ANZCA website. (deprivation). graduate research emphasising how understanding the complex environment patients management of patients with chronic non-cancer pain, are as follows: www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/atlas-of- come from affects outcomes. healthcare-variation/equity-explorer/. Once you have finished your research, do you start thinking of publishing? Another Kiri Rikihana challenged anaesthetists to ask what are some of the biggest barriers to speaker, editor of the Canadian Journal of Anesthesia Dr Hilary Grocott says no. He addressing equity in their workplace, what would help overcome them and what is their emphasises you need to be thinking about publishing right from the design phase. sphere of influence? He said editors look for whether the research is new, important and well done.

Above from top: Health Quality and Safety Commission Group Manager, Kiri Rikihana; Above from top: The Young and the Restless from left: Dr Nicola Broadbent, Dr Carolyn Deng and Illustration of Interaction Institute for Social Change by artist Angus Maguire. Dr Daniel Chiang; Dr Hilary Grocott and ANZCA Research Workshop organiser, Dr Tom Fernandez.

80 ANZCA Bulletin June 2018 81 Australian news

Australian Capital Territory

Scan and Ski Workshop After the immense success of our inaugural Scan and Ski Workshop in July 2016 we are delighted to announce that we will be running the event again in 2018. The workshop will be held Art of anaesthesia – A game of risk? from Friday July 13 to Saturday July 14 at the Thredbo Alpine On behalf of the ACT Regional Committees of ANZCA and the Hotel in the Kosciuszko National Park. Dr Ross Peake will ASA, we invite you to attend the Combined Art of Anaesthesia again convene the workshop, together with world-renowned meeting to be held in Canberra over the weekend of September ultrasound specialists Dr Alwin Chuan, Dr Peter Hebbard, 15 and 16, 2018. Dr Andrew Lansdown, Dr Brad Lawther, Dr Harmeet Aneja This year the meeting will be held at the National Museum of and Dr Sam Sha. Australia, overlooking the picturesque Lake Burley Griffin and The workshop will run over two days, using the morning only a short distance to the Floriade festival, Australia's premier and evening sessions for hands-on ultrasound scanning and flower show, which is held annually at Commonwealth Park. instruction, and leaving the middle of each day free for skiing This year our theme is "A game of risk?” Risk is increasingly or sightseeing in the beautiful NSW Snowy Mountains. The something we all have to deal with on various levels. This year's workshop will cover upper limb blocks, lower limb blocks, program not only hopes to explore risk from a clinical context trunk and spinal blocks, among other topics. (namely assessment and minimisation) but also through Online registration is now open via the ANZCA ACT exploring risk from different perspectives, namely the patient, website or if you would like to find out more please email Kym the trainee, the workforce, and historical perspectives to see Buckley in the ACT office [email protected] or phone whether we have actually learned from past mistakes. +61 2 6221 6003. Places will be limited to 35 participants so Our lecture series will run on Saturday September 15. don’t delay. Leading the exploration of this theme will be Professor Francesco (Franco) Carli from McGill University, Canada, as our invited international speaker. Professor Carli will focus ACT Regional Committee update on prehabilitation as a means to risk attenuation along with We welcome three new members to the ACT Regional Committee providing guidance on how to formulate ERAS packages for for 2018-2020 – Dr Manasi Rai, Dr Monika Tecsy and Dr Bibhuti smaller hospitals. He will be complemented by our interstate Thakur. Our new members are joined by existing members speakers – Dr Jai Darvall, Dr Lachlan Miles, Dr Stephen Bolsin, Professor Thomas Bruessel, Dr Natalie Marshall, Dr Girish Dr Martin Culwick, and Ms Kate Cole-Adams who, along with Palnitkar and Dr David Reiner to round out our full complement our local speakers, will demystify the risks that we face on a of seven elected members. We would like to sincerely thank day-to-day basis and provide strategies on how to deal with Dr Andrew Hehir who has sadly stepped down from the such challenges. committee for his tireless efforts as ACT Regional Chair over On Sunday September 16, we will run the mandatory the period 2014-2017. CPD workshops Can't Intubate, Can't Oxygenate (CICO) and Anaphylaxis. In addition, Professor Carli will run a Prehabilitation Workshop which will complement his talk given a day earlier. September is a wonderful time to visit Canberra – particularly with the opening weekend of Canberra’s Floriade flower festival. Bring the family, stay for the weekend and enjoy a unique and thought provoking scientific meeting along with experiencing the best of spring in the nation’s capital.

82 ANZCA Bulletin June 2018 83 Australian news (continued)

Victoria Queensland

A CME evening with a difference Faculty of Pain Medicine CME Following on from the art and mindfulness workshop held at the Queensland Art Gallery (QAGOMA) in Brisbane as part of the 2017 evening ANZCA ASM, several workshops have been held for registrars The first Queensland FPM CME evening of 2018, “Opiate in Brisbane to help alleviate stress during peak exam time. It stewardship: Let’s make it happen” was held on March 6. Guest has not taken long for consultants to ask “what about us?” so speakers Benita Suckling, Acute Pain Pharmacist at Redcliffe for our first CME lecture evening of the year we arranged for it Hospital, and Dr Joann Rotherham, Director of the Acute Pain to be held at QAGOMA. On March 27, 33 delegates arrived for a Service at the Princess Alexandra Hospital, gave an informative cocktail reception in the gallery itself, of which we had sole use, presentation on the opiate stewardship program. Delegates were followed by the workshop. At first there was a brief introduction provided an overview of analgesic stewardship measures here by Dr Anna Hallett, who has been facilitating these workshops and abroad, the evidence for positive change and a practical and Susan Rothnie, one of Queensland Art Gallery’s educators. The topic of mindfulness was introduced together with how the guide to help healthcare providers implement these changes. appreciation of art can be used as a mindfulness exercise. The evening was well received and attended. FPM VRC CME Evening Meeting We were then taken into the gallery as four groups by The Faculty of Pain Medicine VRC held their first CME evening volunteer guides from QAGOMA. Each group spent the best meeting for the year on Wednesday May 23. Dr Martyn Lloyd- part of an hour looking in detail at and discussing two works of Jones (Addiction Medicine Specialist, St Vincent’s Hospital) and art, both modern and traditional. After our exclusive use of the Ms Maureen Chesler (Pharmacotherapy Development Officer, gallery we returned to the lecture theatre where we were able to Department of Health and Human Services) presented on "High discuss the role of mindfulness in our lives, together with general Quality assurance meetings welfare topics. As with the registrar workshops, several learning dose Buprenorphine/Naloxone for the treatment of opioid points came out of the workshop. Most notable was the fact that Convened by Dr Dean Dimovski, the first of a series of two dependent pain patients". It was a successful event with quality assurance meetings was held on Saturday May 26 at the since the workshop was a CME event worthy of CPD points, it 35 registrations and was sponsored by Indivior. gave delegates permission to take time out for themselves and it college. The presentations included “Obstetric haemorrhage” was observed how important that simple fact was. Also, delegates delivered by Dr Andrew Buettner, and “Management of the found it very interesting hearing how differently their colleagues suboptimal obstetric spinal/epidural block” presented by Dr Annual combined CME meeting and saw and interpreted a work of art, illustrating the fact that often Maggie Wong. As with all our quality assurance meetings, circumstances at work and at home are open to individual following the presentations the groups split to have small group emergency response workshops interpretation without there necessarily being a correct or discussions on cases and then they come together again to give incorrect approach. The annual combined ANZCA/ASA CME meeting will be held on summaries from their groups. The meeting was well attended Finally the workshop concluded with five minutes of Courses Saturday July 28, and emergency response workshops on Sunday with 49 registered and very positive feedback was received. mindfulness and the delegates left the gallery feeling relaxed July 29 at the Sofitel on Collins in Melbourne. This year’s meeting The focus in Queensland over the past few months has been The second quality assurance meeting is scheduled to be after their evening of art appreciation. The feedback from the theme is “Rising temperatures, the heat is on” and along with the primary and final practice vivas. On Tuesday March 20 and held on Saturday October 13 – save the date! delegates was very positive with comments that the content of the Wednesday April 4, Dr Ed Pilling convened the primary practice the additional workshops being held the next day, there is also workshops was excellent and that the evening was an enjoyable viva evenings, and Dr Jesse Gilson convened final practice viva an optional audit component which can attract an additional 20 unique experience. We will continue to hold registrar art and evenings on Thursday April 26 and Wednesday May 2. These CPD points. To date these have all been very well received and mindfulness workshops at exam time and there was one held at the Museum of Contemporary Art in Sydney at this year’s ASM. courses will be repeated again on Wednesday September 5 we are expecting to have a good turnout on the day. and Thursday September 13, and final practice on Thursday Dr Anna Hallett, Convenor September 27 and Wednesday October 3, 2018. Trainees should register for the vivas by emailing [email protected]. If you are interested in being an examiner for these evening Above clockwise from left: Attendees enjoying the workshop at the courses please e-mail [email protected]. Queensland Art Gallery; Ms Benita Suckling and Dr Joann Rotherham; Primary practice viva evening on April 4.

84 ANZCA Bulletin June 2018 85 Australian news (continued)

South Australia and Tasmania Northern Territory

Tasmanian midwinter Part one course It was great to see so many new faces at the first part one meeting session for 2018. The weekly tutorial is held over the entire year You are invited to book now for the Encouraging students FPM meeting and is open to introductory and basic trainees in independent Tasmanian Midwinter Meeting which Dr Nina Loughman and Dr Harry Laughlin The first SA FPM CME meeting was held and rotational accredited training positions and RMOs with an will occur on Saturday August 25, 2018. provided an educative and entertaining at the college on February 26. Dr Penny interest in anaesthetic training. All participants are required to The organising committee look forward presentation at the recent careers expo Briscoe gave an update on the recent present up to three primary topics per year. Staff and trainees to you joining us to discuss “Traps and organised by the Tasmania University are extremely grateful to Dr Agnieszka Szremska, the course hazards”, both in anaesthesia practice move of the Central Adelaide Local Health Medical Students’ Society at the Medical facilitator, as well as the numerous consultants who assist the and on the fairways, at Barnbougle Network (CALHN) Pain Medicine Unit trainees in their presentations. – one of Australia’s top five rated golf Science Precinct in Hobart on Thursday from the Royal Adelaide Hospital to the courses. Three highly knowledgable May 2, 2018. Queen Elizabeth Hospital. Dr Sharon and experienced interstate speakers More than 130 medical students Keripin provided members with the will present on airway mangement, attended ranging from eager first year to progression of regulations on medicinal hepatobilary surgery and regional fifth year students. ANZCA also provided a cannabis and codeine prescribing. The anaesthesia, in addition to a range of stand manned during the break by Dr Mike June CME will be a joint meeting with the high quality local speakers. You can Challis, Dr Nina Loughman and Dr Harry addiction medicine specialists. also gain important emergency response Laughlin to answer any questions that the CPD points by attending a breakfast students may have regarding anaesthesia anaphylaxis workshop while not missing or pain as a career. A lot of interest was out on the presentations. shown by the students, who had a lot of At the end of the day, enjoy pre- questions for the doctors. dinner drinks as you watch the sun set over beautiful Bass Strait, followed by a three-course sit-down dinner, all included in your conference package. Relax further on the Sunday morning by joining an organised golf round with your colleagues. Emergency response and airway Experience a part of Tasmania that President visit to SA many Tasmanians have not, the stunning ultrasound workshops ANZCA Immediate Past President Professor David A Scott and barely touched north-eastern The SA/NT CME Committee held a series of emergency response visited the South Australian regional office in April for the coastline. You may also want to visit one and airway ultrasound workshops in Adelaide in March 2018. SA/NT Regional Committee Meeting which was also attended of Launceston's Tamar Valley wineries Delegates were able to complete their emergency response by ANZCA President Dr Rod Mitchell from South Australia. workshop requirements in one afternoon by attending both before you head home. CV and interview skills Members discussed regional as well as topical issues including Can’t Intubate Can’t Oxygenate (CICO) and Anaphylaxis This is the second time the meeting has evening workshops. Two hands on Airway Ultrasound workshops were the specialist training program, international rural training been held at Barnbougle and has proved also offered to delegates. program and the welfare and trainee survey. to be a very popular destination, Dr Julia Cox and Dr Munib Kiani recently The CME Committee acknowledges the hard work and so book now! represented ANZCA at the AMA(SA)’s commitment of facilitators Dr Paul McAleer, Dr Richard Walsh, Visit ww.tas.anzca.edu.au. This page clockwise from above: Dr Harry CV and interview skills evening. The Dr Nagesh Nanjappa, Dr Alison Brereton, Dr Christie Lang, Dr Left from top: Emergency response and airway ultrasound workshops. Laughlin, Dr Nina Loughman and Dr Mike education event was held for medical Faith Crichton, Dr Zoe Lagana, Dr Nikki Dyson, Dr Kate France, Above from top: Part one course participants; Dr Thien LeCong, Dr Karl Gadd Challis; Dr Sharon Keripin and Dr Penny students and young doctors to assist with Dr Donna Willmot and Dr Joey Ng who dedicated their valuable Professor David A Scott, Dr Scott Ma, Dr Gurunath Murthy and Convenor, August Mid Winter Meeting Briscoe; Dr Julia Cox. getting into a training program. time to ensure the workshops were a success. Dr Rod Mitchell.

86 ANZCA Bulletin June 2018 87 Obituary Australian news (continued) Dr Bruce Marks, FANZCA 1962-2018

Bruce conducted a successful practice as an anaesthetist. I worked together with Western Australia New South Wales Bruce every Friday afternoon at Bethesda Hospital for many years. He entertained all of us in theatre, while giving anaesthetic sedations for my patients NSW trainees’ Facebook group having pain interventions. He was The NSW trainee committee has set up the NSW Anaesthetic extremely comfortable with both patients Registrars' Facebook group as a way of improving interaction and theatre staff. His innate abilities between ANZCA registrars across the state, and as part of our and skills, including his commonsense efforts to improve trainee welfare. We will also use this group to approach, made working with him a promote trainee-related educational and social events. Please pleasure. note that this is a closed group, so you need to be added or Bruce left medicine in 2007 to follow approved following a request to be added. his passion for sport and travel. He did For further information about NSW courses, and the this over the next decade, accumulating NSW trainee social networks and social events please email [email protected]. enviable experiences and wonderful friends. Bruce was a person who enjoyed life and lived it to the full. By the age of New South Wales 56 he had already experienced several Primary refresher Part Two refresher lifetimes of adventure. course in anaesthesia course in anaesthesia His memory will be remembered It is with great sadness that we on the Western Australian coast, the This is a full-time revision course, The course is a full-time acknowledge our friend and colleague, world’s oceans, and on the mountain run on a lecture/ interactive revision course, run on a Bruce Marks, 56, of Perth, WA, who ranges where he rode the thermals. tutorial basis and is most suitable lecture/interactive tutorial passed away on March 4, 2018, at his His large circle of paragliding friends, for candidates presenting for basis and is open to candidates who responded to his charisma and their primary examination in presenting for their final home in Cottesloe. the first part of 2019. fellowship examination in 2019. Bruce Marks was born in Melbourne, thoughtfulness, will no doubt miss him. Bruce’s intelligent, sensitive side Date: Monday December 3 – Friday Date: Monday December 10 to Ann and Brian Marks on March 3, 1962. December 7, 2018 – Friday December 14, 2018 He was the youngest of six children. He made him extremely likeable. His friends Venue: ANZCA New South Wales Venue: ANZCA New South Wales went to Melbourne Grammar, where he will remember him as a kind and gentle Regional Office, 117 Alexander Regional Office, 117 Alexander excelled academically. His headmaster soul with a love for nature. He was also Street, Crows Nest Autumn Scientific meeting a great Street, Crows Nest wrote that Bruce will have a brilliant pragmatic, quirky, absolutely unique, a success Fee: $A330 (including GST) Fee: $A363 (including GST) career. He was right. He graduated in total riot, and always ready with a huge Applications close on Monday Applications close on Monday medicine at Melbourne University in 1985, smile. The Autumn Scientific Meeting was held at Joondalup Resort November 19, 2018 November 26, 2018 completing his anaesthetic training in He will be profoundly missed by his on April 7 and the theme was “We are all in this together – (if not already filled). (if not already filled). 1995 when he moved to Perth. wife, Carla, and his five siblings, Andrew, Volunteerism, self-care and responsible anaesthesia”. The The number of participants for the courses will be limited. Preference I first met him in the mid-1990s John, Jenny, David, and Michael. delegates consisted of 117 anaesthetists and 30 anaesthetic will be given to those candidates who will be sitting the primary or final when we were senior registrars at technicians who enjoyed the sunny surroundings of the examination. Late applications will be considered only if vacancies exist. Royal Perth Hospital. Our friendship Dr Stephanie Davies MBBS FANZCA beautiful lecture theatre. The autumn meeting was held For information contact Tina Lyroid via [email protected] or developed around windsurfing and then FFPMANZCA for the first time at the new venue which was received well +61 2 9966 9085. kiteboarding on the beautiful blue waters Painless Clinic by the delegates. The presentations included lectures on of Cottesloe and Gnaraloo. Perth, Western Australia sustainability, practical aspects of volunteering with the Red Cross; the Bunny Wilson Lecture was presented by Dr David New South Wales Perlman and was a highlight for the delegates. The fully subscribed workshops included “Can’t intubate, Part Zero Course can’t oxygenate”, facilitated by Dr Scott Douglas, “How to write, “About to start training in Program highlights run and mark a mock viva” by Dr Prani Shrivastava and team, anaesthesia?” CV, interview, selection – how and a “SafeTALK: suicide prevention training workshop” by ANZCA welcomes you to the Part to get on training?; anaesthesia Ms Lorna Hirsh. The feedback has been positive and we thank Zero Course on Saturday November training – what is ahead for you the presenters, lecturers and sponsors who contributed to the 3, 2018 from 10am to 4pm at the and your family?; top training success of the conference. ANZCA NSW Office, 117 Alexander tips – curriculum/TPS/WBAs Street, Crows Nest. made easy; how to study and In 2018 the WA CME Committee will hold the Country PASS the primary exam; FANZCA Conference from October 26-28, 2018 at the Pullman Resort in Who is it for? career options; trainee welfare and Bunker Bay. It is convened by Dr Nirooshan Rooban and Dr • New anaesthetic trainees and mentorship; meet and greet fellow Trevelyan Edwards, and a program and registration will be partners (Partners are also trainees, SOTs and HODs. available shortly. welcome to attend the final RSVP session at 2.20pm). All committee meeting dates for 2018 and committee Tina Lyroid via nswcourses@anzca. • Supervisors of training. edu.au by Friday October 26, 2018. members are on the ANZCA WA website for future reference. • Head of departments.

88 ANZCA Bulletin June 2018 89 Obituary Dr Donald Stenhouse, FANZCA 1936-2018

Donald’s PhD (ANU, 1968) in Donald set up a clinic for patients with neurophysiology was supervised by ischaemic leg pain, and established his John Eccles. Ted Hughes recounts own chemical sympathectomy list (under asking Donald a clinical question that image intensification). He subsequently he answered using the Nernst Equation taught this skill to several colleagues, completely "off-the-cuff". Despite his including me. For some years he worked obvious talent for this field, it seems closely with Sir Brian Barrett Boyes, and that the attraction of the increasingly also Alan Kerr, on complex paediatric mathematical research of his ANU group cardiac cases. began to pale, and Donald decided to The culture of the department at Green return to clinical work. Basil suggested he Lane Hospital, led by Eve Seelye at that come to Auckland (where Basil was now time, was strongly oriented to full time based) to do anaesthesia. Interestingly, public practice. In 1987 Donald, John Donald seemed to show no interest in McDougall, and I simultaneously dropped pursuing further research. Perhaps the three tenths each to become part-time and standard of the science he had been enter private practice. I would certainly pursuing was so high (Eccles shared not have felt able to undertake this radical the 1963 Nobel Prize for Medicine and move without the support of Donald and Physiology) that anything less seemed John. Donald worked in private for many trivial. years, primarily at the Mercy Hospital On the other hand, he was a hugely with Clive Robinson and then with Ken Donald Stenhouse was born in valued mentor to me in my own early Graham, while continuing at Green Lane Stonehaven, Scotland and grew up clinical research. Notably, he put many for most of his career. He was closely in Dars-Es-Salaam, Tanganyika (now painstaking hours into extracting data involved with the early heart transplants Tanzania) where his father was a from medical records, and then helping and with many other cutting-edge district officer. Donald said that he me write the manuscript of Merry… … advances to patient care at Green Lane. was "imprinted" as a child with life in Stenhouse… et al (1992). First-time Donald was a Quaker for much of his Tanganyika, and "home" was always a coronary artery bypass grafting: The life, but in his latter years gave up all plain that was hot and dry with head-high anaesthetist as a risk factor. British religion. Understandably, Donald found grass. Journal of Anaesthesia, 68, 6-12. Donald’s the social norms of the society in which Donald was sent to school in encouragement and guidance was pivotal he spent the first two thirds of his life Stonehaven. He found Scotland bitterly to this work and to the direction of my very difficult. He combined scrupulous cold, grey and perpetually raining. own career. intellectual honesty with great kindness Nevertheless, he stayed on to study Donald trained in anaesthesia in and humanity. I have heard from many medicine and graduated MB ChB Auckland, won the Cecil Gray Prize for of his friends about his supportiveness (Aberdeen) in 1961. the 1974 final examination, becoming during challenging times. Douglas Taylor, a former lecturer in FFARACS and then FANZCA in 1992. He Diana and Basil visited Donald's Aberdeen, suggested to Donald that was appointed to a consultant position at mother in Stonehaven in 1985 and were he come and spend a year at Otago Green Lane Hospital, where he practised able to tell her of her elder son's success University in the Physiology Department, cardiac anaesthesia with considerable and their friendship with him. Donald in 1964, as a junior lecturer. Basil distinction. At that time, cardiac also had a sister, who died in a car Hutchinson was in Dunedin that year anaesthetists’ responsibilities extended accident some years ago. He was very demonstrating in physiology. He and into postoperative intensive care, often for close to Bill Pearson (1922-2002) and his wife Diana got to know Donald well, days or even weeks after surgery. Donald subsequently to Jim Courtney. He was and this important friendship continued had a deep understanding of physiology, always a supportive and true friend to the following year when Donald won a and was also technically gifted, and me and many others. fellowship to do a PhD at the Australian very compassionate. Donald’s surgical National University (ANU) in Canberra, colleagues trusted him completely and Professor Alan Merry ONZM, FANZCA, in neurophysiology and the Hutchinsons he had a wonderfully calming influence FFPMANZCA, FRCA, FRSNZ moved to Melbourne for Basil to complete when situations became tense. At Auckland, New Zealand his fellowship. the request of the vascular surgeons,

90 ANZCA Bulletin June 2018 91