Australian and New Zealand College of Anaesthetists Joint Faculty of Intensive Care Medicine Faculty of Pain Medicine ANZCA December 2009 Bulletin
Special Report: ANZCA speaks to HEALTH MINISTER, nicola roxon Plus: ANZCA MEDICAL RESEARCH GRANTS NATIONAL PAIN STRATEGY SEXUAL HALLUCINATIONS AND ANAESTHESIA MERCY SHIPS – MAKING A DIFFERENCE COLLEGE OF INTENSIVE CARE MEDICINE ANZCA Bulletin The Australian and New Zealand 14 ANZCA speaks to 35 Mercy Ships College of Anaesthetists (ANZCA) is the Health Minister How a hospital ship is making a professional medical body in Australia difference in Africa – one Australian and New Zealand that conducts Australian Health Minister, Nicola education, training and continuing Roxon, discusses priorities and anaesthetist’s experience professional development of challenges in the health portfolio anaesthetists, intensive care medicine and pain medicine specialists. ANZCA represents more than 5000 Fellows and trainees across Australia and New Zealand and serves the community by ensuring the highest standards of patient safety. Editorial Medical Editor Dr Michelle Mulligan Editor Nigel Henham Sub-editors Clea Hincks & Liane Reynolds Design Christian Langstone Submitting letters and material We encourage the submission of letters, news and feature stories. Sexual Hallucinations ANZCA Medical We prefer letters of no more than 500 28 61 words and they must indicate your and Anaesthesia Research Grants full name and address and a daytime Anaesthetists warned over patients ANZCA announces $600,000 telephone number. and sexual hallucinations funding for medical research Advertising inquiries To advertise in the ANZCA Bulletin please contact Marc Wilson, ANZCA advertising sales representative, on 0419 107 143 or e-mail marc@ gypsymedia.com.au. An advertising rate card can be found online at Contents www.anzca.edu.au/news/bulletin. Contacts 2 President’s message 46 ANZCA teachers: what’s new in 2010? Head office 3 News 47 ANZCA Curriculum Review: 630 St Kilda Road latest update Melbourne Victoria 3004 4 People & events Australia 12 Letters to the editor 48 Cha nges to the ANZCA in-training Telephone +61 3 9510 6299 assessment process 13 Awards Facsimile +61 3 9510 6786 50 Quality & safety [email protected] 14 ANZCA speaks to Australian www.anzca.edu.au Health Minister, Nicola Roxon 56 Managing acute pain safely Joint Faculty of Intensive Care 61 Medical research boosted by $600,000 Medicine 25 Dr Steven Cook: Operation Samoa Telephone +61 3 9530 2862 – Tsunami aftermath 66 The ANZCA Foundation [email protected] 28 Anaesthetists warned over patients and 68 ANZCA in the news Faculty of Pain Medicine sexual hallucinations 71 Library update Telephone +61 3 8517 5337 [email protected] 30 Anaesthesia training in the private sector 74 Regions Copyright 35 Dr Harry Venema: Mercy Ships 78 New Zealand news – making a difference Copyright © 2009 by the Australian 80 New College of Intensive Care Medicine and New Zealand College of 39 ANZCA Trials Group Anaesthetists, all rights reserved. 87 Faculty of Pain Medicine 41 National registration and None of the contents of this publication 93 Obituaries may be reproduced, stored in a accreditation scheme retrieval system or transmitted in any 98 ANZCA Council meeting reports form, by any means without the prior 42 Dr Jamin Mulvey: Philippines floods written permission of the publisher. – lending a hand 104 Professional documents 106 Future meetings Cover: Australian Health Minister 45 Podcasts – a new age of learning Nicola Roxon and ANZCA President Dr Leona Wilson at The Alfred Hospital, Melbourne. Photo: Sarah Wood
ANZCA Bulletin December 2009 1 President’s message
2009, of course, is a watershed for the some of the topics that have grabbed College as we are farewelling the Joint the media’s attention and resulted in Faculty of Intensive Care. We respect the extensive interviews and media coverage. right of JFICM Fellows to make a decision Increasing our profile is important in to pursue the path of independence — just terms of communicating the critical as anaesthetists did when we separated role anaesthetists, intensivists and pain from the College of Surgeons 18 years ago. medicine specialists play in modern Importantly, the change has occurred medicine, educating the community in a spirit of goodwill. We wish the and governments. There is a thirst for new College of Intensive Care Medicine information and I would encourage well and we look forward to our good Fellows to contact our communications relationship continuing. department if you think there is a story This is the last message for this year, and This is a time of potentially significant which may be of wider interest. so I would like to extend to all of you, your changes in the training of health Wishing you a safe and Happy Christmas families, whanau and friends the season’s professionals and in healthcare delivery and a productive 2010. greetings, and hope that many of you in our two countries. It is important that will have a break and return re-energised we maintain our place in the conversation for the new year. For those of you who with government, so that we can bring Dr Leona Wilson are working over this time to allow your our profession’s knowledge and expertise President colleagues their breaks, I would like to bear on the questions facing them. In to thank you for continuing to serve this issue, we speak with the Australian our community so that they may have Federal Minister for Health, Nicola Roxon, constant access to safe and high quality on a range of issues affecting both our health care. specialty and, more broadly, the medical I would also like to thank all of our profession. It is two years since the Fellows and trainees who have worked Minister was appointed and her responses tirelessly to support the activities of our make interesting reading. In the March College. Our College depends on your issue of the ANZCA Bulletin we hope support, and the skill and expertise that to speak with Tony Ryall, Minister for you bring to bear on all that you do for Health, in New Zealand. the College. This includes the members 2010 will see the commencement of of the ANZCA and National and Regional the national registration and accreditation Trainee Committees; the examiners for scheme in Australia. It is pleasing our examinations; those who have been that following representations from involved with educating and training ANZCA and other medical colleges our trainees including the supervisors and organisations that the Australian of training, module supervisors, Government listened to the genuine specialists and provisional Fellows who concerns expressed by the medical have provided clinical supervision and profession surrounding the initial draft examination revision; members of the legislation. The scheme does have National and Regional Committees and important implications for anaesthetists their sub committees; research grant including mandated continuing reviewers; those who assess international professional development and I would medical graduates specialists; those who urge Fellows and affiliates of the College have represented us on countless external to reconsider your CPD standing now committees of government and other and register for the program. organisations and who have assisted More recently, Fellows and trainees with submissions to those bodies; those would have noticed that we have taken who organise and present at our CME steps to increase the profile and visibility meetings; and members of the Council of our profession in the media and wider and Council Committees, sub committees community. Propofol, prescription drug and working groups. In all of this we abuse, allergic reactions, pain, conjoined have been very ably supported by CEO twins, and some of our colleagues’ Mike Richards and ANZCA staff who have fantastic volunteering work in disaster worked enthusiastically and tirelessly. zones and the Third World, are just
2 ANZCA Bulletin December 2009 People & events
JFICM farewell dinner A veritable who’s who from the worlds of anaesthesia, intensive care medicine and pain medicine gathered at ANZCA House on Saturday, November 21 for the official farewell dinner of the Joint Faculty of Intensive Care Medicine, as they become the new College of Intensive Care Medicine in 2010. In addition to the ANZCA Council and the boards of both faculties, previous Presidents, Deans and Heads of Section and other guests celebrated a historic occasion. The President of ANZCA, Dr Leona Wilson, proposed the toast to the new College and introduced many of the past luminaries in the history of ANZCA. Professor Vernon van Heerden, the President of the new College responded by describing the events over the last 18 months that had culminated in this occasion, and thanked the ANZCA Council, in particular Dr Wilson and Associate Professor Kate Leslie for their part in the negotiations that had taken place. Excerpts of the speeches appear on pages 80-83. One hundred guests enjoyed a wonderful evening and a fitting occasion to wish the new College of Intensive Care Medicine well for the future and an ongoing close relationship with ANZCA.
Top from left: ANZCA House foyer set for dinner; Professor Vernon van Heerden addresses the dinner guests; pre-dinner drinks in the marquee; CICM Vice President Professor John Myburgh makes a presentation to Associate Professor Kate Leslie; guests at pre-dinner drinks; guests at dinner; Dr Leona Wilson addresses dinner guests.
4 ANZCA Bulletin December 2009 ANZCA Bulletin December 2009 5 People & events continued
Byron Combined SIG Meeting 2009 What would you expect of a meeting held in Byron Bay in October? Great weather? Great social life? Great meeting? While we had no control over the weather, the combined special interest group meeting held in Byron Bay from October 9-11 was a great success as both a meeting and networking opportunity. This meeting is always well attended by enthusiastic participants, but this year saw us achieve one of the largest numbers of attendees to date. Was it the location? We suspect so, but it was certainly aided by some very interesting and capable speakers and an exciting program. There were lively sessions including “Selection of anaesthesia trainees”, the “ANZCA curriculum review” and “Depression” amongst many others. The quality of the speakers was very high including Professor Gordon Parker, The Black Dog Institute, Dr Jillann Farmer, Queensland Health, Associate Professor Sandy Garden and ANZCA’s Mary Lawson and Claire Byrne. Some of the presentations from the meeting are available on the medical education SIG website. There are plans afoot for Port Douglas next year with bigger and better ideas coming from the SIG members. We look forward to seeing you there in 2010.
Dr Jodi Graham Chair, Combined SIG Convenor From top left: Healthcare industry exhibition area; Dr Kim Jamieson, Dr Debbie Goodall, Dr Karen Smith, Dr Nicole O’Brien, Dr Annick Depuydt; Laerdal team – Mr John McMurray, Mr Phil White, Ms Carylin Lenehan; Dr Amrat Chowdhary and his wife, Mrs Kulwant Chowdhary, Greg Baldwin and Dr Alka Singh; Dr Daryl Williams, Dr Michele Moore, Dr Vanessa Beavis and Dr Tracey Tay.
6 ANZCA Bulletin December 2009 CVP SIG conference The biennial Cardiothoracic, Vascular and Perfusion SIG conference was held at the Sheraton Noosa from October 4-7. The invited overseas speaker was Professor David Reich, Chairman of the Department of Anesthesiology at the Mt Sinai School of Medicine in New York. Professor Reich gave excellent talks on management of cerebral protection during aortic surgery as well as transoesophageal echocardiography of the mitral valve. The meeting also had a strong line-up of Australian and New Zealand speakers and feedback from the meeting was extremely positive with the session on adult congenital heart disease particularly well received. Edwards, a major sponsor, kindly donated an audience response system that was very popular, permitting an exchange of ideas and knowledge of each other’s clinical practice. The conference social functions were well attended including the conference dinner at Bernardo’s. The weather was balmy and the conference venue a popular one with delegates and their families taking advantage of the beaches, restaurants and shops that Noosa has to offer. There were 190 registered delegates, a record number for a special interest group meeting. Thanks go to the speakers, the CVP SIG executive who arranged the program and Kate Briggs, the ANZCA SIG Coordinator.
Top from left: Welcome reception poolside at the Sheraton Noosa; Dr Justin Wong, Dr Warren Pavey and Dr Khairul Amir Zainuddin; Delegates enjoying morning tea with the healthcare industry; Dr Steve Same and Mrs Terri Same; Dr Mark Hurley, Ms Robyn Sutton and Dr Damon Sutton; “Anaesthesia in the cath lab” presented by Dr John Leyden.
ANZCA Bulletin December 2009 7 People & events continued
Annual ANZCA/ ASA Combined CME Meeting of ACT The 2009 Canberra Floriade “The Art of Anaesthesia” Meeting was held from September 19-20. The meeting was very lucky with beautiful Spring weather and the organisers are sure at least some of our delegates managed to get out and about and enjoy all that Canberra has to offer. There were many distinguished speakers, and thanks go especially to those who travelled from overseas and interstate in order to make a presentation on our theme of Organ Protection and Immune System Modulation. It was an honour to have the President of ANZCA, Dr Leona Wilson and the President of the ASA, Dr Elizabeth Feeney open the meeting and welcome delegates. The Vice President of ANZCA, Associate Professor Kate Leslie also gave a presentation. Feedback received from this event has been tremendous, with many delegates remarking on the relevance and interest of the program. The Finkel Theatre at the John Curtin School of Medical Research was an excellent venue.
From top left: Inside the Finkel Theatre; Delegates visiting healthcare industry sponsors; Dr Stephen Brazenor; Professor Patrick Wouters discussing “Cardiac protection, volatiles and opioids”; Dr Pal Sivalingam making his presentation on “Starch and renal function”; Professor Thomas Bruessel; Delegates in the foyer of the John Curtin School of Medical Research.
8 ANZCA Bulletin December 2009 National Pain Strategy launch The launch of the initial draft of the National Pain Strategy was held on Sunday, October 18 to coincide with the final day of the Faculty of Pain Medicine’s “Duelling with pain” Spring Meeting in Melbourne. Speaking at the media conference were Professor Michael Cousins (Chair, National Pain Summit steering committee), Dr Penelope Briscoe (Deputy Chair, NPS and Dean, Faculty of Pain Medicine), Ms Coralie Wales (President, Chronic Pain Australia) and Professor Stephen Gibson (President, Australian Pain Society). The strategy launch resulted in some 40 radio interviews, talkback calls and news items, 18 newspaper articles and three television reports. The strategy, which can be found on the National Pain Summit website – www.painsummit.org.au – is being regularly updated with feedback. It will be finalised at the National Pain Summit being held at Parliament House, Canberra on Thursday, March 11.
From top left: Professor Michael Cousins, right, and Professor Stephen Gibson at the media conference to launch the National Pain Stratgey; Mr Rob Baveystock and Dr Stephen Leow; Dr Stephen Jensen and Dr Victor Wilk; Dr Penelope Briscoe, Professor Stephen Gibson, Professor Cousins, Ms Coralie Wales; Professor Cousins gives a television interview; Ms Wales speaks at the media conference; Dr Humphry and Professor Tess Cramond and Professor Julia Fleming at the National Pain Strategy launch.
ANZCA Bulletin December 2009 9 People & events continued
10 ANZCA Bulletin December 2009 The smaller, problem-based learning FPM Spring Meeting sessions were interesting and practical. “Duelling with pain” Feedback suggests the faculty should do more of these in future meetings. Delegates attending the FPM Spring The social program was excellent. Meeting “Duelling with pain” in October Proud Melburnians were able to show off at the Sofitel in Melbourne enjoyed a their “foodie” reputation with a delicious stimulating scientific program as well dinner in elegant surroundings at The as practical sessions of relevance to the Italian restaurant on Saturday evening. daily practice of pain medicine in acute, Informal networking with colleagues chronic and cancer pain settings. was a valuable part of the meeting. Such The diversity of the sessions was a opportunities allowed our clinicians, highlight of the meeting. They included who often work in challenging settings, the pharmacology of methadone, to share their experiences and give (Professor Andrew Somogyi, Adelaide), clearer identity to their work treating and spinal magic bullets (Professor Colin researching in pain medicine and Goodchild, Melbourne) and addiction related fields. controversies (Professor Jon Currie, Thank you to everyone involved – Melbourne). speakers, health industry supporters, Dr Roman Jovey from Canada was a attendees, my committee and ANZCA wonderful teacher, sharing his practical and FPM staff for their contributions to insights (for example, what to say in a successful meeting. Thank you, and consultations) regarding the management please consider coming to Newcastle of opioid use in chronic pain. Dr Suellen in 2010. Walker (a locally born London expat!) spoke about research into spinal analgesics in babies and in laboratory Dr Carolyn Arnold research, giving glimpses of developing Convenor analgesic research. There was opportunity to discuss and debate management with many From top left: Dr Peter Cox, Dr Rebecca experts, experienced clinicians Martin and Dr Duncan Wood; Ms Julia Barton, and young clinicians. The audience Professor Ted Shipton and Dr Frances included representatives from nursing Beswick; Dr Graham Rice and Associate Professor Leigh Atkinson; Dr Roman Jovey; and allied health, addiction medicine, Professor Colin Goodchild, Dr Julia Fleming rehabilitation medicine, psychiatry, and Dr Jovey; Dr Charles Brooker, Dr Suellen anaesthesia, geriatric medicine and Walker and Dr Chris Hayes; Professor Andrew general practice, reflecting the potential Somogyi; Dr Graham Rice, Dr David Gronow for multidisciplinary approaches to pain and Dr Bruce Rounsfell; Dr Kerry Thomas and management. Dr David Lindholm; Dr Penelope Briscoe and Dr Carolyn Arnold; Dr Arnold; Mr Damien Finniss; Dr Paul Glover, Dr Nanda Bellum and Ms Claire Atkins; Dr Martine Holford and Dr Lewis Holford.
ANZCA Bulletin December 2009 11 Letters to the editor
Specialists were involved in nine cases, insufficient data on which SCIDUA can make although in four of these SCIDUA could not a decision. find any aspect of management that could SCIDUA believes that irrespective of ASA have delivered a more favourable outcome. status or severity of illness for which the Training non-anaesthetist sedation practitioners Non-anaesthetists were involved in four cases, procedure is being carried out, a patient’s – living with PS9 in all of which SCIDUA criticised management best chance of survival is at the hands of
Introduction Gastrointestinal endoscopy is one of the most commonly performed medical issues, whilst in the one case involving a an appropriately qualified and experienced procedures in Australia and New Zealand, and the number of procedures is growing rapidly. Much of the sedation for endoscopy is administered by anaesthetists, but when access to trainee, lack of appropriate supervision was specialist. It is therefore unfortunate that anaesthetists is limited, other medical practitioners are called upon to provide sedation. In this article, we will discuss recent initiatives by the College to a factor. many departments of anaesthesia will not, or improve the quality of endoscopy sedation and ensure safe practice wherever endoscopy is performed. Background From a situation 20 years ago in which cannot, provide a service to endoscopy suites Access to specialist anaesthesia services for endoscopy patients in NSW public hospitals has been a longstanding problem. The issue was highlighted who are suitable for conscious sedation. refer to an anaesthetist), pharmacology by the Greater Metropolitan Clinical The document requires non-anaesthetist (particularly the sedation continuum), few, if any, deaths occurred with procedures or radiology departments, irrespective of the Taskforce (GMCT) in 2006 and a medical practitioners who wish to monitoring (including sedation depth), working party was established which administer sedation to acquire airway management of complications, advanced included representation from the NSW and resuscitation skills and to undertake life support (including airway and Regional Committee of ANZCA. The training in sedation. ventilation skills), recovery and discharge 9 working party agreed that the “gold criteria, and quality assurance. PS such as the above, to one in which 10 per cent seriousness of the patient’s condition. To their The Sedation Training Working Group was used to underpin all curriculum standard” for endoscopy sedation was After the revised PS9 was promulgated, objectives. The working group was an anaesthetist-based service, and that the core representatives of the GMCT- supported in this endeavour by the that such simulation-based training sedation practitioners. Other implications From left: Day 1 – course participants involved propofol-based sedation resulted in based working party and the tripartite in problem-based learning discussion based governing bodies of each member of for sedation should be a core part of of PS9 are yet to be addressed, improved patient comfort, safety and group formed a working group to on sedation complications; Course participant the tripartite group and the GMCT who gastroenterologyor training inmore the future. particularly of the need reported to train non-medical cases are now the norm great credit, a number of departments do, and efficiency. It was also acknowledged that investigate the training requirements for Dr Cameron Bell with Dr Cate McIntosh; provided administrative assistance personnel who are assisting in the ACLS – “hands on” team training. some gastroenterologists and surgeons non-anaesthetists who wished to provide Post-course oversight and sign-off and a seeding grant. provision and monitoring of sedation. on the working party had considerable sedation (including the use of propofol). After completion of the pilot course, the ANZCA Council is aware of other experience in endoscopy sedation, This working group was chaired by The sedation course for “grandfathers” “grandfather” gastroenterologists agreed areas where non-anaesthetist medical including the use of propofol, and that Professor Barry Baker (ANZCA Director The inaugural two-day pilot course to participate inindicates a process of oversight practitioners area administering level sedation of associated mortality which if they can, the rest could if they tried. endoscopist-administered propofol-based of Professional Affairs) and included was held at the Hunter New England by the departments of anaesthesia and Council delegates are in discussion sedation was common in the US Associate Professor Kate Leslie (ANZCA Simulation and Skills Centre (HNESSC) within their own hospitals. A mini-CEX with other groups with the aim of setting and Europe. Vice President), Drs Joanna Sutherland in May 2009, under the direction of assessment tool was developed, based a uniform standard for safe and high At the same time, ANZCA, the and Tracey Tay (ANZCA NSW Regional Dr Cate Mcintosh. Nine experienced on PS9, allowingis for assessment considerable. by more quality sedation for all patients. It is Even though the denominator Training non-anaesthetists may be the Gastroenterological Society of Australia Committee members) and representatives gastroenterologists from six metropolitan than one observer, and on a number of anticipated that PS9 will ultimately (GESA) and the Royal Australasian from GESA and RACS. Sydney teaching hospitals attended the occasions. By August 2009, at least four of underpin all sedation practice, and that College of Surgeons (RACS) (the The working group decided to course. The course included background the “grandfather” gastroenterologists had anaesthetists, through ANZCA, will I read with interest“tripartite group”) were collaboratingthe articleconcentrate its initial efforts “Trainingon those reading relating to basic pharmacology, non- commenced the final process of oversight, provide leadership through training in a review of ANZCA Professional endoscopists who had administered airway management, oxygen therapy, leading to assessmentis andunknown, sign-off. and oversight for this activity. it is fair to assume that the next best thing but it remains second best. Document PS9: “Guidelines on Sedation sedation to at least 1000 patients (so- pulse oximetry and advanced life The future and/or Analgesia for Diagnostic and called “grandfathers”). Over a series of support, and two days of intensive A second training course at the HNESSC Dr Joanna Sutherland Interventional Medical or Surgical anaesthetist sedation practitionersmeetings and after review of the available problem-based – learningliving and “hands-on” is scheduled for September 2009, and Coffs Harbour Health Campus Procedures”. The revised document was literature for such training processes, training in a simulated environment. eight gastroenterologists have enrolled. promulgated in February 2008. The numberDr Cate McIntoshof such procedures does not amount The College would do well to encourage the working group agreed on the course On day two, the gastroenterologists It is anticipated that there will be ongoing document recognises the reality that John Hunter Hospital, curriculum, identified available training were joined by their nursing demand for similar courses in NSW, for practitioners with diverse qualifications Newcastle resources, described appropriate colleagues to participate in immersive trainees in gastroenterology and possibly with PS 9” (ANZCAand training are administering Bulletin a variety practical experience, Septemberand supervision, simulation-based team training, 2009). which 1. ANZCA Professional Document PS9: surgery. ANZCA Council will shortly of medications, including propofol, to Guidelines on Sedation and/or Analgesia and devised a method of “sign-off” for focused on the management of the review the governanceto arrangement more than 10% per cent of the total number departments which it approves for training facilitate endoscopy. The document limits for Diagnostic and Interventional Medical these practitioners. Curriculum criteria complications of sedation (as specified for curriculum development and the use of propofol by non-anaesthetist 9 or Surgical Procedures: www.anzca.edu. that were identified as essential included: in PS ). The feedback from the course delivery, clinical practice oversight and au/resources/professional-documents/ medical practitioners to ASA 1-3 patients patient assessment (particularly when to was overwhelmingly positive: the It raises a number of issues and it would be of supervision, assessment and continuing professional-standards/ps9.html participating gastroenterologists believed professional developmentof anaestheticscriteria for for surgical operations. to provide a service in this sometimes help if the historical16 The ANZCA Bulletin September 2009situation was reviewed. Under-reporting The ANZCA of Bulletin September deaths 2009 17 following neglected area. Prior to 1990, there were no reports to the sedation at the hands of non-anaesthetists NSW Special Committee Investigating Deaths is a problem, as is the fact that even when Professor R. Holland Under Anaesthesia (SCIDUA) of mortality reported, follow-up sometimes yields Former chairman, SCIDUA associated with endoscopic diagnostic procedures, with the sole exception of bronchoscopy. Since then, a gradual increase Table 1 has occurred, until deaths associated with Procedure ASA class GA/sedation Anaesthetist Classification Factors/Suffix endoscopy either under general anaesthesia Gastroscopy unknown Sedation Other 3 Ai,ii,Bi.ii,iv or “sedation” now constitute more than 10% Cii,Fii,iii of notifications. Many of these deaths go unreported Gastroscopy 4E Sedation Specialist 3 GH because the Coroners Act does not include Gastroscopy 4 GA Specialist 2 GH the term “sedation” in that section requiring and banding deaths occurring within 24 hours of Gastroscopy 3 Sedation Other 1 Ai.Bii anaesthesia for a procedure. Those in which Gastroscopy 4E GA Specialist 3 Biv the person administering sedation is neither qualified as, nor training to become, a Colonoscopy 4E Sedation Specialist 3 Ci,ii,H specialist anaesthetist are especially difficult Colonoscopy 3 GA Specialist 2 GH to investigate. Colonoscopy 3 GA Specialist 3 Ai,Bi,Cii,Fiii Nevertheless, the table (right) shows ERCP 4 GA Specialist 2 GH results for cases classified as categories 1, 2 or 3 from 2005 through 2008, the last being that ERCP 4E GA Trainee 3 Ai,iiFi,ii,iii H year for which data are complete. Bronchoscopy unknown Sedation Other 3 Ai,Ci,Fiii Summarising the above, there were Bronchoscopy 3 Sedation Specialist 3 GH five gastroscopies, three colonoscopies, Oesophagoscopy 4 GA Specialist 1 Biv,Cii two ERCPs, two bronchoscopies, one oesophagoscopy and one PEG insertion PEG Insertion 4 Sedation Other 1 Ai,Bii,Fiii for a total of 14 deaths in four years.
I would like to reply to the letter from Fellows, departments of anaesthesia and the Dr Guy Buchanan in the recent ANZCA general public. Bulletin. The loss of the name anaesthetist for our I am opposed to a change in name of the specialty would leave this name free for any specialty and those practicing anaesthesia. In non-medical group that is allowed to practice this country the expression “ology” is reserved some form of anaesthesia. for sub-specialties such as neurology, urology, Although close to retirement I will continue cardiology, etc. Anaesthetists are not a to call myself an anaesthetist or retired sub-specialty of any other group. anaesthetist, as the case may be. The word anaesthesiologist has seventeen letters whereas anaesthetist has twelve letters. Dr Ian Rechtman I believe a change would create enormous FANZCA confusion between the College, the ASA, our
12 ANZCA Bulletin December 2009 Awards
Orton Medal Council changes Professor Peter Kam (NSW) has been Following the resignations from Council of Drs Richard Waldron and Peter Cook (as awarded an Orton Medal. This is the highest form of recognition the College outlined in the report of ANZCA Council meeting on October 10 on page 100), casual can give one of its Fellows, and the award vacancies have been filled by Dr Mark Reeves and Dr Patrick Farrell respectively. of the Orton Medal to Professor Kam is in Dr Reeves and Dr Farrell have joined Council as co-opted members for an initial recognition of his immense contribution period to May 2010. to training and education across Australia, New Zealand and South East Asia over many years. ANZCA Medal Dr Robert Wong (WA) has been awarded an ANZCA Medal in recognition of his contribution to diving and hyperbaric medicine, his initiation of the formal qualification in this area in 2003, and his ongoing work to maintain the program at the highest possible standard. Dr Diana Khursandi (Qld) has been awarded an ANZCA Medal in recognition of her long-term contribution to the specialty of anaesthesia. Dr Khursandi has made a significant and sustained contribution in a diverse number of areas including rural and regional practice, anaesthesia workforce challenges, gender Dr Mark Reeves was elected Chair of the Dr Patrick Farrell is Director of issues in medicine, clinical indicators, Tasmania Regional Committee in 2004 Anaesthesia of the Newcastle anaesthesia CPD, education and training, and the and has held this position since then. service based at John Hunter Hospital. He health and welfare of doctors. He gained his medical degree in London is a graduate of University of New South Professor Kam, Dr Wong and Dr in 1989 before migrating to Australia for Wales. He commenced his anaesthetic Khursandi will be invited to receive marriage and anaesthesia training. training at the Royal Berkshire Hospital their medals at the College Ceremony Dr Reeves gained Fellowship in 1999 in Reading, UK and completed his in Christchurch next year. and moved to northern Tasmania for the Fellowship in Sydney in 1986. His clinical lifestyle and the weather. He works in interests include paediatric and neonatal both public and private practice in Burnie. anaesthesia and he has contributed a He is also the supervisor of training, a chapter on paediatric thoracic anaesthesia primary examiner and an enthusiastic to Hatch and Sumner’s Textbook of research Fellow with the University Paediatric Anaesthesia. He was a final of Tasmania. examiner for 12 years and a member of the Final Exam Committee. He is a past president of SPANZA. Patrick is married, has four children and enjoys cycling and living near the Hunter Valley.
ANZCA Bulletin December 2009 13 Special Report: ANZCA speaks to Health Minister, Nicola Roxon
14 ANZCA Bulletin December 2009 Australian health reform – issues and challenges The past 12 months have been marked by a number of extensive reviews into Australia’s healthcare system. It is expected that the Federal Government will announce its proposed changes to healthcare in the first half of 2010. Health Minister, Nicola Roxon, has been responsible for the health portfolio since December 2007. ANZCA spoke to the Minister at a recent consultative forum at The Alfred Hospital in Melbourne and sought some answers to key questions facing anaesthetists, intensivists, pain medicine specialists and the wider medical profession.
Since being appointed as Minister for Before we started, we expected many “...there have also been Health what has surprised you most different topics would be raised – and this about the portfolio or the health sector, has happened – but there have also been strong common and more broadly – and what do you see as strong common and consistent themes consistent themes your biggest challenge? such as the importance of primary healthcare, preventative health, e-health such as the importance We are about to embark on the biggest reform and how we can take pressure reforms of our health system since the of primary health care, off our hospitals. introduction of Medicare – that’s quite preventative health, a challenge! We welcome everyone’s feedback – and readers can find out more about it at ehealth reform and how Reform agenda www.yourhealth.gov.au. we can take pressure You have consulted widely following the release of the Health and Hospitals When do you propose announcing off our hospitals.” Reform Commission Report with more the reforms ? Nicola Roxon, than 70 forums around the country. A meeting of COAG this month will Minister for Health Is there anything arising from these provide a forum to discuss health forums that you think deserves greater reform with the states and territories. attention than you might otherwise The Commonwealth will put forward its have thought before you commenced the National Health Reform Plan in the first consultations? What issues have varied part of 2010. the most between the consultation sites? The National Health and Hospitals Where do you see the private health Reform Commission report made care system in 10 years, particularly its recommendations for system-wide reform relationship with the public hospital of the health system – and the Prime sector? Can the two systems work more Minister, myself and other Ministers have collaboratively and what is the role held 76 consultations with health workers of the states/territories in the funding in communities across Australia. of specialist training posts in private settings? Most consultations discussed health care reform in general, but we have also I see an integrated healthcare system held consultations on specific reform in Australia with the private and public areas, such as indigenous health, rural systems working collaboratively to health, mental health, aged care, and achieve optimal patient outcomes. The preventative health. Rudd Government believes in a strong private and strong public system that work cooperatively.
ANZCA Bulletin December 2009 15 “The Government is Collaborative arrangements will become The development of a national e-health a necessity in the coming years to cope system holds revolutionary potential – well aware that medical with increasing demand for services – and will help empower consumers by specialist training and to ensure there is an adequate supply providing access to patient-controlled of trained health professionals in the information about their health. numbers will have to system into the future. Trainee positions increase to ensure that The Rudd Government’s $171 million – public and private Australians will continue Specialist Training Program is aimed at working with the state and territory Output from medical schools will to enjoy world class governments and the private sector soon double. Our College’s workforce health care in the future.” to boost and target trainee places in study shows that we need to produce expanded settings – the majority of more specialists for our growing and Nicola Roxon, which are in the private sector. Access ageing population. (In fact, the study Minister for Health to training in the private sector provides undertaken for us by Access Economics trainees with a broad range of experience. shows that – on current projections of This can only occur with strong support supply and demand – there will be a and commitment from both the state shortfall of 2287 anaesthetists by the year and territory governments and the 2028.) Our Fellows are willing and able private sector. to train more junior doctors. The missing link is funded positions for interns, We are seeing greater consumer prevocational doctors and specialist representation and engagement in health trainees in our public and private issues, which we fully support. Do you hospitals. think the level of engagement is sufficient Accepting that funding training positions and how can the colleges assist? Do in the hospital system has historically you see consumers and community been within the gift of state government representatives as being more involved in departments of health, and having decisions about healthcare interventions regard to the COAG process, what is the in the future? Commonwealth Government’s proposed Consumer representation and solution to this issue? engagement in healthcare is essential The Government recognises that the and the effort made by the colleges to provision of intern, pre-vocational and address this is a positive step forward. vocational training places is critical to There are a number of ways to help the training pathway of doctors. empower consumers, including through providing information and changing the way information is accessed.
16 ANZCA Bulletin December 2009 The Government will continue to work for patients to be charged only for The Government’s Specialist Training with the states and territories to increase procedures that have been directly Program will help to expand medical medical training capacity. Australia carried out by the specialist (except for specialist training into non-traditional is experiencing an unprecedented surgical procedures by trainee surgeons training settings. However this significant increase in the number of Australian and who have a special exemption). Would investment will only be successful if international medical school graduates the Government consider correcting this it is matched by states and territories and managing this effectively will be a anomaly, which will prevent meaningful increasing the number of public sector significant challenge for all governments. experience for all other trainees, and training posts and by medical specialist therefore inhibit the uptake of training colleges agreeing to increase the number In regard to intern training places, at the in the private sphere ? of medical graduates entering medical July 2006 COAG meeting, the states and specialist training programs each year. territories gave a guarantee to provide In the new environment, Australia high quality medical intern training may be less reliant on international Rural/remote health places for Commonwealth-funded medical graduates (IMGs). What is medical graduates. This commitment the Commonwealth Government’s We understand there is a maldistribution is critical to ensuring the training of longer term plan with respect to the of specialists between metropolitan Australia’s medical workforce. The immigration of medical practitioners? and regional and rual areas and allocation process for intern placements acknowledge there is a need to address The Government is well aware that is the responsibility of state and territory this issue. Would the Government be in medical specialist training numbers governments. As the major employer favour of creating special short-term will have to increase to ensure that in the sector, the states and territories rotational positions (3-6 months) in Australians continue to enjoy determine how that process is managed. linkage with a teaching hospital to world-class healthcare in the future. enable senior trainees to rotate to rural/ I recently wrote to state and territory Australia aims to be self-sufficient in remote or Area of Need (AON) regions health ministers seeking advice on their the long term. However, in the short where there is a need for specialists, planning for increasing intern training to medium term, increases in student but none are available? Such a scheme capacity and confirming their 2006 numbers will not meet increasing would allow these senior trainees to gain COAG commitments. demand. Other approaches, such as valuable independent experience, and increased international recruitment, also provide the community with medical There will need to be an expansion of improving retention rates and workforce cover by a practitioner who was close specialist training positions into the reform will also need to form part of any to full qualification as a specialist. By private sector to accommodate the national and jurisdictional response. linking to a teaching hospital this would increased numbers of trainees coming enable effective distant supervision to through the system and the changing As I’ve said previously, I am committed be provided. Are there any other options nature of practice where some medical to working with state and territory that the Government is considering that procedures are increasingly only governments through the COAG process, aim to improve recruitment and retention performed in the private sector. A barrier specialist medical colleges and the for the rural and remote specialist to the implementation of full experience Australian Medical Council (AMC) to workforce? in the private sector is the requirement boost specialist trainee numbers.
ANZCA Bulletin December 2009 17 The Rudd Government knows that The Government is interested in attracting and keeping doctors in rural considering any proposals that would and remote areas is about more than just increase specialist training outside our overseas recruitment. That’s why the major metropolitan centres and would Rudd Government has developed a $134.4 welcome leadership from the colleges million package of measures to attract on this issue. This will be a vital part of and reward doctors who practice in rural providing the increased training capacity and remote Australia. as well as providing much-needed services to those communities. The package’s initiatives include: • Higher relocation grants – for example, Supporting education a doctor relocating from a major city to and training a regional centre will receive a $15,000 grant, while a doctor relocating to a very Does the Government support protected remote area would receive $120,000. educational and administrative time for clinical supervisors of training and • Adjusting the rate of reimbursement clinical teachers to carry out educational of HECS payments to give more credit activities in clinical medicine? according to the remoteness of the location; In the new environment of an increased • Providing locum relief for doctors number of medical graduates and patient working in difficult locations to enable concerns about being “experimented rural GPs to take a holiday or undertake on” by trainee doctors, we may rely more further education and training; and on medical simulation to prepare young doctors for emergency situations and to • Allowing more than 150 urban assess their progress. Do you see support doctors to be up-skilled in exchange for the development and maintenance for undertaking four-week locum of simulation centres as one way of placements in rural and remote addressing the issue of increased communities. numbers of medical graduates where This package also includes some changes there are insufficient clinical training “The Government is to the ten-year restriction on overseas opportunities? interested in considering trained doctors, reducing it in the most The Government is strongly committed any proposals that remote areas of Australia to five years. The to ensuring that clinical teaching and ten-year restriction will also be reduced training is a key part of our future would increase specialist to seven years in places like Cairns workforce planning. and Townsville, six years in Burke and training outside of our Cooktown and five years in Longreach That is why the November 2008 COAG major metropolitan and Tennant Creek. package included the biggest investment in workforce made by any Government – centres and would The Government also aims to strengthen a $1.6 billion partnership. This includes welcome leadership Australian’s investment in rural training $1 billion for clinical training. through the Rural Health Continuing from the colleges Education Sub-Program. A $175 million investment in capital infrastructure will support the training on this issue.” This program was announced in the of the future medical workforce including 2009-10 Budget and is an amalgamation funding for the simulated learning Nicola Roxon, of three existing programs. The bringing Minister for Health environments and an additional together of these programs will encourage $28 million will train and skill up increased collaboration between supervisors across the disciplines. stakeholder groups with the intent that this will foster multidisciplinary team The Commonwealth is working with based-training. The program will also all jurisdictions, the universities and provide a coordinated approach to issues private hospital sector to implement this of professional isolation and access to component of the COAG health workforce continuing professional development reform package. Simulated learning for health professionals in rural and will enhance the training experience remote areas. across and within all disciplines, without compromise to patient safety or privacy. These measures underline the Rudd This will allow students to work in Government’s ongoing determination scenarios that they would otherwise to properly address the rural workforce receive little or no exposure. shortages so Australians can access appropriate and timely healthcare when and where they need it.
18 ANZCA Bulletin December 2009 ANZCA is undertaking a comprehensive through the work of the Expanded is important that the Commonwealth, review of its curriculum to ensure it is Medical Education Advisory Committee, states and territories and all education best practice and meets the needs of is also aware of the importance of and training providers work together to the health system and the population it matching education and training address these important issues. serves in the 21st century. In addition, with contemporary models of some time ago we mandated continuing healthcare delivery. One of the more unfortunate events professional development for all Fellows. in Australia’s health care system’s In your view, what key elements does Role of medical colleges history was the Patel case where a state the new curriculum need to address in health department employed someone shaping the new training program ? Australia’s medical colleges such as ANZCA – which is self-funded with without conducting due diligence With medical students, trainees and virtually no recourse to the taxpayer, and regarding Patel’s qualifications and specialists dispersed across the country which relies predominantly on pro bono experience under the “area of need” in the public and private sectors, we will work by clinicians such as supervisors program. The department effectively be more reliant on distance education of training – have played an important, bypassed well-established protocols and web-based learning. Does the cost-effective role in educating and involving Australia’s medical colleges, Commonwealth Government have training medical specialists ensuring which demand the highest clinical a clear plan to support these high clinical standards in Australian standards. What are your views on educational activities? healthcare. Where do you see the medical these certification processes and are The Rudd Government is strongly colleges in your future plans for the you confident that these processes will supportive of continuing professional health system, the future of specialist minimise the risk of such cases development. This will be a requirement medicine and the increased demand being repeated? across all professions covered by for high-end services as the population A uniform national process for assessing the National Registration and gets older? Accreditation Scheme. International Medical Graduates (IMGs) The Commonwealth acknowledges that was phased in across all jurisdictions The Government supports education professional medical specialist Colleges from July 2008 to ensure that all IMGs that will encourage best practice and provide an important role and function meet the same minimum standards of quality care. in vocational training in Australia medical education and clinical practice The Government is aware of the College and appreciates the time dedicated by as Australian trained doctors. The new accreditation processes undertaken by many professionals to training the next pathways are intended to reduce the the AMC, in particular the assessment generation. As healthcare needs change possibilities for assessment error. The of standards that address curriculum over time – and the need for increased assessment pathways rely on the medical content and delivery. My department, vocational training places grows – it boards and colleges as essential elements in the assessment process.
ANZCA Bulletin December 2009 19 As part of these new standards all Australia has been at the forefront applicants have their qualifications of utilising nurses as assistants as independently verified, and in the case part of the anaesthesia care team – of specialists, the assessment process is in the operating theatre and recovery administered by the Australian Medical room with more recent involvement Council. Currently, state and territory in pre-anaesthesia clinics and medical boards have the legislative acute pain services in the wards. responsibility to ensure that a medical Australian anaesthetists have also led practitioner is fit to practice. In the case of investigations into the use of physician doctors recruited to hospital positions, the assistants within the anaesthesia care medical board must be satisfied that the team. With Australia having one of the applicant has been adequately assessed world’s best safety records in this area, and is suitable for the position. what changes, if any, do you envisage for the anaesthesia workforce? Further, the Commonwealth is acting with all states and territories to introduce a Australia should be proud of its nurses. National Registration and Accreditation Often the skills and expertise of nurses Scheme that will improve safety of our go unrecognised, and the ability of many medical systems for the community. highly trained nurses makes them quite capable of taking on responsibilities such Workforce as those you’ve highlighted. The National Health Workforce The Government acknowledges and Agency will be responsible for the supports a team-based healthcare planning, coordinating and funding model as practiced in anaesthesia. of pre-professional entry clinical The Commonwealth will continue training, workforce planning and policy to engage heavily with key health development. How do you see this agency professional stakeholders to assist in working and what are the implications developing high quality and sustainable for medical colleges’ training programs? workforce models of healthcare delivery. How can the medical colleges best work “Pain management is with the National Health Workforce Pain Agency to ensure that in the future, one of a broad range It is estimated that chronic pain (that is, the Australian public is served by constant daily pain for a period of three of issues raised in the a healthcare team of the same high months or more) costs the Australian standards as they are now? current consultation economy around $34 billion per annum process on national In November 2008, COAG agreed to a with 36.5 million working days lost – a significant package of health workforce huge productivity loss. Yet pain services health system reform initiatives through its $1.6 billion seem to be unevenly spread with a small and I look forward to commitment to the health workforce. number of multidisciplinary pain clinics The aim of that commitment is to improve and only 26 funded specialist training considering innovative health workforce capability and supply, places Australia-wide as well as a major proposals that are recognising that against the backdrop of shortage of trained GPs and other allied an ageing population and rising chronic health professionals in this area. Do you being developed.” disease, the already significant pressures see addressing the issue of pain as an on our existing health workforce will important element in the government’s Nicola Roxon, continue to increase. health reforms and do you believe that Minister for Health the Commonwealth should be taking a The establishment of Health Workforce lead role? Would the Commonwealth Australia will allow more effective, support an increase in funded positions integrated clinical training arrangements for training in pain medicine? and support the workforce policy and planning initiatives announced by COAG. The Government is aware of the Health Workforce Australia will be significant burden on the community responsible for administering the majority from acute and chronic pain, and has of health workforce initiatives announced moved to address this issue through a by COAG. range of national programs including the Pharmaceutical Benefits Scheme, the Medicare Benefits Schedule, the National Palliative Care Program and, through the National Health and Medical Research Council, research and acute pain guidelines.
20 ANZCA Bulletin December 2009 The Government also acknowledges A landmark $64 billion healthcare What would you like Australia’s health the work done within your College to agreement was made to ease pressure system to look like five years from now? address this particular area of health on the health and hospital system – The Rudd Government wants health need. The Commonwealth through its a funding increase of 50% on the reform to ensure Australians have access Specialist Training Program will continue last agreement. to healthcare they can rely on – this to work closely with training providers This includes $750 million for emergency means the right service in the right place and Colleges to assist in producing a departments, $500 million for sub- at the right time – with the patient as the specialist workforce that meets emerging acute care and the biggest investment focus of the system. community’s health needs. in preventative health made by any We are at an exciting time in the health Pain management is one of a broad government of $872 million and $1.6 debate. Rarely does it happen that the range of issues raised in the current billion on a workforce package. urgent need for reform coincides with consultation process on national health The foundations for long term health a Government determined to implement it. system reform and I look forward to reform are in place with the release considering innovative proposals that In five years these major reforms will be of the comprehensive Health and are being developed. well under way to ensuring we have a Hospitals Reform Commission Report, strong, agile and self-improving system the Preventative Health Taskforce and a Conclusion for generations to come. draft of Australia’s first National Primary What is your proudest achievement, Health Care Strategy. or a decision to date, relating to our health system, that has given you But it is many of the smaller, practical most satisfaction since being elected? initiatives that are also satisfying to see when they take off – our GO Superclinics The Rudd Government is taking concrete opening, breast care nurses taking up steps to improve Australia’s health system their positions and kitchen gardens after 12 years of neglect. rolling into our primary schools, I am very proud that upon coming into to name some examples. office two years ago, the Government took swift action to deal with key pressure points in the health system and lay the foundations for longer term reform.
ANZCA Bulletin December 2009 21 Dr Steven Cook: Operation Samoa – Tsunami aftermath
From left: Dr Steve Cook with then Prime Steven Cook’s original plan had been to become a surgeon. Minister, John Howard receiving the But it was while on deployment to East Timor in 2000 Conspicuous Service Cross; Dr Cook on arrival in Darwin on the first C-130 from Bali with the Royal Australian Air Force – which had awarded with a severely injured burns patient in 2002. Dr Cook an undergraduate scholarship that had helped him through medical school – that his career plans took a marked turn.
“You’re flying around in a helicopter Kuta in which 202 people (including 88 He recruited Australian surfers as bringing in burnt kids (from falling into Australians) died. The second attack in stretcher bearers, some holidaying oil cooking fires) and you realise how 2005 involved a series of three explosions Australian nurses pitched in and helped important retrieval and resuscitation in restaurants in which 26 people (four and South African helicopter pilots were skills are – I wanted to become a Australians) died. used as medics. competent retrievalist,” said Dr Cook, In 2002, Dr Cook had been on-call in Dr Cook was awarded a Conspicuous an anaesthetist now based at the Royal Sydney when initial reports indicated five Service Cross which “recognises Brisbane and Women’s Hospital and also people needed to be evacuated to Darwin. outstanding commitment to duty or working in private practice. When he reached Darwin, the evacuation outstanding application of exceptional After seven months in East Timor, number had climbed to 40 and it rose skills” for his efforts in 2002. Dr Cook served for four months in Iraq again to about 80 by the time he landed “We learned a lot of lessons after in 2003 before he left the military and amongst the chaos in Bali. 2002,” Dr Cook said. “We upgraded our started his anaesthesia training in “I was involved in the initial equipment and policies which meant the Sydney. He finished his training last year response,” Dr Cook said. “When we rolled response to the second bombings in 2005 in Queensland. up 16 hours post the blast they were very was pretty slick.” In Iraq, Dr Cook was largely involved much untreated, un-triaged patients. In late September, Dr Cook was part in transporting severely injured military “We set up a field hospital at the of the rapid response team that went casualties to Kuwait on C-130 transport airport in Denpasar and our job was to Samoa following the tsunami in an planes. the initial resuscitation – checking operation coordinated by Queensland “We were working pretty closely with circulation, intubating patients, putting Health. the Americans and they were pretty in drips, setting up monitoring - and then Dr Cook left for Samoa with just two amazing – I’m still using some of the rapidly transferring them back to Darwin hours notice, arriving the day after stuff I saw back then, like their massive for definitive treatment.” the tsunami. transfusion protocols that are still being In all, 66 patients with major burns, “My wife’s very supportive and at least introduced here,” he said. traumatic amputations and severe burns this one wasn’t dangerous. She’s had lots Dr Cook is also a veteran of both Bali were evacuated, with Dr Cook in charge of phone calls like that,” Dr Cook said of bombings – the first in October 2002 at of the first and third evacuations.
ANZCA Bulletin December 2009 25 Dr Steven Cook: Operation Samoa – Tsunami aftermath continued
“The whole Samoan trip was great because we had Samoan surgeons and Australian surgeons and Samoan anaesthetists and Australian anaesthetists working side by side,” he said. “You’re working as a team and sharing the skills.”
his wife, Nina, a psychiatrist who has had the need for expensive equipment. “I Dr Cook is keen to see more anaesthetists 10 years’ experience of her husband being think a lot of anaesthetists rely on their working overseas in difficult conditions called away at short notice. The couple machines too much and don’t want to - in January he will be travelling with has a three-year-old daughter Madeline work without them - but it can be done Interplast as part of a plastic and and a one-and-a-half year old son, Alex. and done safely,” said Dr Cook, who is reconstructive surgical team to work in “The whole Samoan trip was great an Officer in Charge for FAST (Fly Away Papua New Guinea. because we had Samoan surgeons Surgical Team) and an Early Management He has absolutely no regrets about and Australian surgeons and of Severe Trauma (EMST) instructor. the career he chose. “I love it,” he said. Samoan anaesthetists and Australian He is one of two Dr Cooks in the anaesthetists working side by side,” he specialist reserve in Queensland – Steve said. “Your’re working as a team and Cook is a squadron leader and his uncle sharing the skills and experience.” Peter Cook, a former ANZCA councilor, Most of the work in Samoa was on is a wing commander. adult patients. Sadly, many of the dead Last year he was involved in were children – “they couldn’t swim” – establishing the Trauma Service at the and he described the injuries they saw Royal Brisbane hospital (Queensland’s as being like what would happen if your first) which manages trauma cases in a patients had been “tossed around in a multi-disciplinary team. Anaesthetists giant washing machine”. Many patients can make an enormous contribution in had severe limb injuries with infected the management of trauma patients - from wounds and fractures. initial resuscitation of critically injured The teams were forced to rediscover the patients through the operating theatre “lost art” of anaesthetising patients using and intensive care and in acute and cronic Above: Dr Cook, left, with a patient who ketamine, a drug that can be used without pain management in the rehabilitation is undergoing hand surgery after being anaesthetised with ketamine. phase, he said.
26 ANZCA Bulletin December 2009 Anaesthetists warned over patients and sexual hallucinations
Medical boards have reported an increasing number of complaints against anaesthetists concerning inappropriate sexual activity during or around the time of anaesthesia or sedation, particularly when propofol has been used. This article aims to alert anaesthetists to this potential problem that may lead to embarrassing legal investigations. The proceduralist may also be implicated, particularly if the procedure involves the pelvic or perineal regions.
Medical boards have reported an associated with anaesthesia but very compared with propofol induction increasing number of complaints against little about hallucinations associated and isoflurane anaesthesia or with anaesthetists concerning inappropriate with anaesthesia where experience has thiopentone induction and isoflurane sexual activity during or around the time mainly arisen from anecdotal reports or anaethesia. There were, however, 19 of anaesthesia or sedation, particularly complaints. patients of a total 119 patients (17%) who when propofol has been used. This There are a number of randomised reported sexual emotions although only article aims to alert anaesthetists to trials investigating dreaming five patients had sexual dreams – only this potential problem that may lead to during anaesthesia, with a recent one of which was serious (level 4 out of 6 embarrassing legal investigations. The comprehensive review from Australia on the Ben-Horin overt sexuality scale). proceduralist may also be implicated, by Leslie and Skrzpek (1). Patients This type of dreaming or personal particularly if the procedure involves rarely spontaneously report dreams of experience of a sexual nature with the pelvic or perineal regions. a sexual nature. A study by Brandner anaesthetic drugs such as propofol may Some definitions may be helpful. et al. in 1997(2) appears to be the only be more likely to occur in situations Patients who report hallucinations one that has specifically sought these where the anaesthesia is “lighter”, or usually believe they were awake during sexual aspects in dreams or recall with “conscious” or “deep” sedation the experience or at least aware of actual following anaesthesia. There have, (12) and when the procedure is oral, events occurring, and not in natural however, been a number of anecdotal gynaecological or urological. This sleep or under anaesthesia or sedation. reports of sexual dreams or recall in raises the distinct possibility of an In contrast, patients who report the literature concerning propofol (3-8), increasing incidence of such dreams dreaming usually believe that they were midazolam and other benzodiazepines or hallucinations, as propofol is asleep and that the events were fanciful (9, 10), thiopentone (and in former times increasingly used for sedation in a and not real. methohexitone), and nitrous oxide wide variety of settings. Dreams and/ However, patients and anaesthetists when used as an analgesic and sedative or hallucinations with propofol appear often confuse these phenomena. (11). None of these anecdotal reports or to be equally common in males and In addition, patients may start out research studies has included the more females (13), but the complaints of sexual believing they were dreaming, but florid recall which tends to be reported assault or indiscretion are much more change their minds when, for example, in complaints. common from females. Practitioners who surgical or anaesthetic procedures have With regard to anaesthetic agents, appear to be particularly at risk from left bruising and/or swelling or there is Brandner et al. (2) did not find any complaints are dentists, anaesthetists pain or stiffness in certain anatomical statistically significant difference and male recovery nurses. The incidence areas such as perineum or mouth. There when propofol-based anaesthesia was of sexual dreams or recall varies from has been some research on dreaming
28 ANZCA Bulletin December 2009 “Patients who report hallucinations usually believe they were awake during the experience or at least aware of actual events occurring, and not in natural sleep or under anaesthesia or sedation.”
43% (5) which reduced to 10% on References 11. Jastek JT, Malamed SF. Nitrous oxide later questioning, down to 0% (1). The 1. Leslie K, Skrzypek H Paech M, Kurowski I, sedation and sexual phenomena. Dental incidence of “complaints” is not recorded Whybro T. Dreaming during anaesthesia Anaesthesia & Sedation 1984; 13: 70-73 in any study. and anaesthetic depth in elective surgery 12. Thompson KD, Knight AB. Hallucinations The only strategy that has been patients: a prospective cohort study. after propofol. Anaesthesia 1988; Anesthesiology 2007; 106: 33-42 43: 170-171 reported to reduce the incidence 2. Brandner B, Blagrove M, McCallum 13. Play ford RJ. Allegation of sexual assault of dreaming during anaesthesia is G, Bromley LM. Dreams, images and following midazolam sedation in a man. intramuscular scopolamine (14). emotions associated with propofol Anaesthesia 1992; 47: 818 Scopolamine is also well known to be a anaesthesia. Anaesthesia 1997; 52: 750-755 14. Toscano A, Pancaro C, Peduto VA. good amnesic agent, which also may be 3. Hunter DN, Thornily A, Whitburn R. Scopolamine prevents dreams during useful at times of stressful procedures, Arousal from propofol. Anaesthesia 1987; general anaesthesia. Anesthesiology though its main drawback for patients is 42: 1128-1129 2007; 106: 952-955 a very dry mouth and rather prolonged 4. Young PN. Hallucinations after propofol. 15. Bohe imer NO, Thomas JS. Amorous sedation effects. Scopolamine is Anaesthesia 1988; 43: 170 behaviour and sexual fantasy following therefore not advocated for routine 5. Smyth DG, Collins-Howgill PJ. anaesthesia or sedation. Anaesthesia use to prevent dreaming. Opinion is Hallucinations after propofol. 1990; 45: 699 divided as to whether warning patients Anaesthesia 1988; 43: 170 16. Brah ams D. Benzodiazepine sedation and preoperatively of the possibility of 6. Schaefer HG, Marsch SCU. An unusual allegations of sexual assault. Lancet 1989; emergence after total intravenous 1: 1339-1340 sexual dreams would limit (7, 10, 15) anaesthesia. Anaesthesia 1989; 17. Scha efer HG, Marsch SCU. An unusual or exacerbate (2) the incidence of 44: 928_929 emergence after total intravenous these dreams. 7. Bricker SRW. Hallucinations after anaesthesia. Anaesthesia 1989; In conclusion, it would appear that propofol. Anaesthesia 1988; 43: 171 44: 928-929 protection is best achieved for both 8. Kent EA, Bacon DR, Harrison P, Lema MJ. practitioners and patients if staff of Sexual illusions and propofol sedation. both genders are present, to provide Anesthesiology 1992; 77: 1037-1038 witness, whilst the patient is sedated or 9. Dundee JW Unpleasant sequelae of anaesthetised (7, 11, 16, 17). benzodiazepine sedation. Anaesthesia 1990; 45: 336 Professor Barry Baker, 10. Dundee JW. Fantasies during MB BS DPhil FANZCA FJFICM FRCA DHSA benzodiazepine sedation in women. British Journal clinical Pharmacology Executive Director of Professional Affairs 1990; 30: 311P
ANZCA Bulletin December 2009 29 Anaesthesia training in the private sector
Images of Noosa Private Hospital courtesy of Woods Bagot architects.
ANZCA has responded to calls from public and private hospitals, from universities and from government, by accrediting a range of private hospitals for training in clinical anaesthesia.
Feedback from trainees and their of some urgency. Much of the surgical Finally, private hospitals provide supervisors has generally been positive, workload in Australia and New Zealand a valuable source of sub-specialty although some teething problems and is undertaken in the private hospitals surgery such as cardiothoracic surgery, cultural barriers have been encountered. and already medical students, junior neurosurgery and paediatric surgery. As In this article, we would like to highlight doctors and trainees of other medical there is significant demand for experience some of the advantages of training in colleges are receiving valuable training for these modules, many rotations are private, outline some of the challenges from enthusiastic teachers in this sector. seeking to include in their schemes that lie ahead and provide an example The private sector is a valuable source of private hospitals with high volumes of one of the many successful public- training sites for ANZCA as well. of these cases. private collaborations in our region In addition, the private sector provides The process of accreditation (table 1). The College is undertaking a a training experience that is not available The process for accreditation of private survey of training in private which will in the public sector. For example, trainees hospitals is the same as the process for be published in a future edition of the can be exposed to cases that are hard to public hospitals, and is supervised by ANZCA Bulletin. find in the public sector but are the “bread the ANZCA Training Accreditation and butter” of many specialists in private The need to train anaesthetists in the Committee (TAC). practice (such as ophthalmic surgery, private sector The department head at the private major joint surgery, endoscopic knee With the increased number of medical hospital completes detailed paperwork surgery and plastic/cosmetic surgery). graduates and demand for specialist about the case-load, facilities, specialist They can also get experience and anaesthesia services predicted for staffing and qualifications, the CPD and knowledge in the workings of a private the next decade (“Australia’s looming QA activities at the hospital and the plans hospital and the life of a private anaesthetist shortage”, ANZCA Bulletin, for the education and clinical supervision practice anaesthetist. March 2009), ANZCA needs to find of the trainees. TAC seeks the support additional training sites as a matter of the regional or national committee in the region before organising an on-site inspection.
30 ANZCA Bulletin December 2009 Table 1: Accredited Private Hospitals “Trainees can be exposed Private Hospital Rotational Training Scheme to cases that are hard Noosa Private (Qld) Queensland Anaesthesia Rotational Training Scheme Mater Private Townsville (Qld) Queensland Anaesthesia Rotational Training Scheme to find in the public Mater Private Brisbane (Qld) Queensland Anaesthesia Rotational Training Scheme sector but are the Westmead Private (NSW) Westmead Rotation “bread and butter” Brisbane Waters Private (NSW) Newcastle Rotation of many specialists North Gosford Private (NSW) Newcastle Rotation in private practice.” Sydney Adventist (NSW) Nepean Rotation St Vincent’s Private (Vic) St Vincent’s Rotation Central Victorian Anaesthetic Service (Vic) Stand alone (PF only) Flinders Private (SA) South Australian Rotational Training Scheme Calvary-Wakefield (SA) South Australian Rotational Training Scheme Memorial (SA) South Australian Rotational Training Scheme
During the visit, the inspectors are are very accepting of trainees - and the these problems in order to provide more particularly keen to determine the result has been happy trainees receiving surety to specialists and trainees who amount of “hands-on” clinical work outstanding training. participate in training in private. that will be possible, how the formal However, some significant and Through frequent feedback, iterative education and examination preparation understandable hurdles to acceptance changes and advocacy, the College of the trainees will be arranged, how the of trainees in private hospitals exist hopes to demonstrate to specialists who rotation to the hospital will work (daily including: participate in the training in private allocation or more extended placements) • The concept of a private patient programs the benefits to their patients, and the arrangements for indemnity and “paying” for higher expertise but being to themselves and to the trainees. pay. The inspectors’ report is considered “exposed” to trainees. Training in private has the potential to by TAC with the final recommendations provide high quality training for trainees, • Concern about indemnity of the requiring the approval of ANZCA continuing education opportunities for specialist and trainee in the event Council. specialists and improvements in patient of a mishap. care that is too good to miss. The challenges of training in private • Concern about the ability of specialists While training in private hospitals to bill for procedures that are performed Associate Professor Kate Leslie has been firmly established in other under their supervision. Chair, ANZCA Training countries and other specialties for many • The possibility that the presence of a and Accreditation Committee years, the concept is relatively new to the trainee may slow down “turnover”. College and its Fellows and trainees. Some private hospitals and their • The desire of specialists to “do their specialist anaesthetists have embraced own thing” when working away from training in private with enthusiasm. The the public hospital. specialists have reported that sharing The College is working with trainees, techniques and ideas with the trainees SOTs, private and public hospital is mutually beneficial and that patients specialists, hospitals management, the Australian Society of Anaesthetists and government to understand and address
ANZCA Bulletin December 2009 31 Anaesthesia training in the private sector continued
Benefit To Consultants • There is always an extra pair of hands to assist with difficult cases and unexpected emergencies. • Someone who can open a theatre for emergency obstetric cases until a consultant becomes available to take over. • A trainee who can review post-operative patients with pain issues, as currently there is no acute pain service at the hospital. • Opportunity to teach in a non teaching hospital setting. The Westmead private experience has been very positive for both trainees and consultants. Some of the key aspects of the trainee. The Westmead Private that seem to be important in making The private experience rotation has proven to be a fantastic this collaboration successful include way for trainees to complete their Training at Westmead Private Hospital the following: Westmead Private Hospital is a 140 cardiothoracic and neurosurgery modules • A large enough overlap of specialists bed private hospital located a few and to find out more about private who work in both the co-located private hundred metres from its larger sibling, practice anaesthesia. and public facilities, but enough “new Westmead public. Despite a few early concerns about blood” to give trainees exposure to A wide range of surgical, obstetric and non-specialists “taking over” established different ways of approaching clinical medical services is provided, including areas of practice, in the seven years that situations. all the major surgical specialties bar the program has been running, there has • A Department of Anaesthesia at the transplant surgery. There is a 12 bed been almost universal acceptance and private hospital that embraces the ICU which has 24-hour medical cover enthusiasm from consultant anaesthetists concept of teaching in the private sector. including an on-site consultant during the at the hospital. • A management team at the private day. The obstetric unit is responsible for A recent trainee was asked for hospital who value the collaboration about 1500 deliveries each year. feedback for this article and wrote the beyond a mere service function. The hospital was accredited by ANZCA following summary: • Management at both the private and for training in 2003 and is affiliated with Benefit to Registrars public hospitals who work to overcome the University of Sydney medical school. • It is a great opportunity to see cases the administrative issues associated One trainee from the Westmead that you would not normally see in with pay and medical indemnity. rotational program is allocated to the public or you would have minimal Westmead private for a three-month exposure to due to reduced number of In summary, the Westmead private period. The trainee is rostered to work cases and increased number of trainees. rotation is an integral part of the at the hospital during the day only with • Specific examples of the lists that greatly Westmead rotational program and their overtime commitments and formal benefit the trainees are: the laser ENT provides benefits to the trainees, educational activities undertaken at the list, cardiac and neurosurgical lists, the anaesthetists and the patients public facility. vascular list and the paediatric ENT list. at Westmead Private Hospital. Although the supervisor of training • It is a good opportunity to use the (SOT) keeps a watching brief, the trainees ultrasound for blocks as there are some Dr David Elliott allocate their own time to the consultants consultants in the private hospital with Staff Specialist, Westmead Hospital or lists of most interest to their training a particular interest in that area who needs or where a specific list requires a are happy to teach trainees. Dr Nicole Phillips “second pair of hands”. • It provides the opportunity to see New Fellow, ANZCA Council Occasionally the trainee is called upon private practice and how it functions Supervisor of Training, Westmead to provide epidural analgesia for women and the professional relationships with Hospital in labour. This only occurs when no patients. This will be an integral part consultant is available within reasonable of our practice when we finish. time, the woman declines the option of • There are smaller trainee-to-consultant alternative analgesia until a consultant ratios and better bedside teaching can come in and accepts the services Above: Dr David Elliot, Specialist Anaesthetist opportunity. and Dr Lindy Lowenstein, ATY1 trainee.
32 ANZCA Bulletin December 2009 Dr Harry Venema: Mercy Ships – making a difference
Imagine a work environment where the prevailing You may say I’m a dreamer (with apologies…) but this is exactly the atmosphere is one of cooperation rather than of situation one experiences when competing agendas and where everyone is an volunteering for the global Christian charity Mercy Ships, which operates the enthusiastic, unpaid volunteer. largest non-government hospital ship in the world, the MV Africa Mercy. This ship Imagine an anaesthetics department that includes has ward beds for 80 surgical patients medical specialists from all over the world, in addition and has six operating theatres. It is based to nurse anaesthetists from the US, but that generally in West Africa, moored in the port of a different country for 10 months of each has no dedicated anaesthetic assistants. year. The organisation’s stated aim is to provide “hope and healing to the world’s Imagine a week where one would expect to deal with forgotten poorest”, and it does this by the several difficult airways (as a result of gross third-world provision of free medical care irrespective pathology). of tribe or religion. The ship is staffed by more than 400 Imagine a hospital where there is no “luxury” surgery, volunteers at any particular time. This revolving crew includes people involved and where the patients think nothing of having to gain with the running of the ship (by necessity access via a protective UN security cordon. a self-contained community), and those who specialise in shore-based community Imagine a work environment in which prayer is development projects in addition to the commonplace, divine assistance expected, but the majority medical personnel. Volunteers serve for as little as two weeks or for surgeon does not believe that he is God! as long as two decades.
ANZCA Bulletin December 2009 35 Dr Harry Venema: Mercy Ships – making a difference continued
In 2007-8 I volunteered for two with malignancy (who are excluded emotional disability, who are offered rotations of about one month each, from surgery). Rather, the ship’s hospital restorative surgery by Mercy Ships, whilst the ship was in Liberia, a country is geared towards the provision of involving specialists in maxillo-facial brutalised by civil war, systemic poverty specialised elective surgery for conditions and plastic surgery, some of whom have and government corruption (and by such as head and neck tumours vast experience gained over decades slavery in the more distant past). The (non-malignant but often slowly with this condition. The surgery often experience for me was essentially one progressive and obstructing), clefts, stretches over multiple stages involving of first-world hospital care transported goitres, meningo-encephaloceles, various full-thickness skin flaps and to patients with extreme third-world cataracts, vesico-vaginal fistulas, bony reconstructions. It is not unusual for pathology. The hospital is well equipped burns contractures, club feet and several of these episodes to begin with the with modern drugs, anaesthetic machines, other bony malformations. securing of a difficult airway when there fiberoptic scopes, a CT scanner and four One of the most interesting conditions is not already a tracheostomy in place. ventilated beds. encountered is Noma (“to devour”) or Another condition with similar The organisation attempts to Cancrum Oris. It is an opportunistic, surgical ramifications and anaesthetic complement rather than duplicate what necrotising, ulcerative stomatitis. challenges is that of Ameloblastoma, an is already available in the host country It progresses rapidly from an acute epithelial tumour of dental enamel origin, in terms of their own health system (often gingivitis to a catastrophic oro-facial which, although benign, is nevertheless minimal and devastated by civil war) or gangrene, involving both soft and hard locally invasive into mandible and that provided by other excellent NGOs tissues. It is a disease of children living in maxilla and can lead to slow obstructive (such as Red Cross and Medicins Sans extreme poverty, probably bacterial, often death by suffocation and/or starvation. Frontieres). To this end, there is little with underlying malnutrition, poor oral It was a humbling experience to see acute or primary health care provided hygiene and an inter-current infection the dedication and extraordinary skill though there are exceptions - for example, such as measles. The “fresh” phase of some of these surgeons who have the surgical drainage of Ludwig’s angina carries with it a 70-90% mortality. given up many years of Western private as a life-saving measure (an anaesthetic Those who survive undergo a “healing” practice, but it was even more of a challenge) or at the other end of the phase that can leave behind severe highlight to witness the emotional and scale, the provision of a shore-based deformity. It is these survivors, often spiritual transformation of these kids over palliative care service to those patients with severe physical, social and a few weeks. A similar transformation is
36 ANZCA Bulletin December 2009 undergone by the women having repairs conditions that led to their ostracism and Previous page: Dockside, West Africa; UK and of their chronic vesico-vaginal fistulas. exclusion from African society, and even Korean anaesthetists waiting for an infant to I can honestly say that my interest in their own families as a result (in part) awake after repair of meningo-encephalocele. volunteering was not a purely altruistic of animistic religious values. Opposite page: This ship represents hope to thousands of West Africans; A case of one, since there was much to be gained Since Liberia, the ship has been meningo-encephalocele. personally! I found the experience in Benin (for 2009) and is expected to This page: Slums; A roadside billboard; valuable for its many challenges and operate in Togo for 2010, where I hope Presentation of benign facial tumour rewards. I enjoyed the high paediatric to join it for a further short tour of duty. at screening. case-load and frequent (anticipated) I would highly recommend Mercy Ships difficult airways. It was probably “good to any anaesthetist who is at consultant or for the soul” to learn to cope without the senior registrar level, with a flexible work help of dedicated anaesthetic assistants, attitude being the key attribute, I believe. and it made me return to Australia with Finally, my experience in this multi- a new appreciation for our own system national setting has made me appreciate in terms of ease and safety. that the training I have received in the It was refreshing to work in a multi- Australasian setting is second to none. national, multi-lingual environment of To find out more about volunteering extraordinary unity of purpose. And it opportunities with Mercy Ships visit was a novel experience to work with www.mercyships.org.au other independent anaesthesia providers who were not medical practitioners. It was immensely satisfying to be involved with surgery that was, in almost all cases, life-saving, if not literally, then certainly in social and emotional terms, because most patients had
ANZCA Bulletin December 2009 37 ANZCA Trials Group – Strategic Directions Workshop
The future of research by ANZCA • Deep anaesthesia and long-term Experts meet to Fellows looks bright. Any interested mortality. discuss research Fellows are encouraged to contact the • Incidence and risk factors for Trials Group Research Co-ordinator, priorities persistent post-operative pain. Stephanie Poustie, via e-mail ([email protected]). One of the key aims of the ANZCA Trials • Teaching and learning Group is to develop new multi-centre interdisciplinary teamwork. Attendees at ANZCA Trials Group trials to solve important problems in • Aspirin/clonidine to prevent Strategic Workshop perioperative cardiac morbidity. anaesthesia, perioperative medicine and D Bramley (VIC) pain medicine. • Optimal sedation for colonoscopy. T Brussell (ACT) To this end, the trials group held its • Echocardiography and perioperative D Campbell (NZ) inaugural Strategic Directions Workshop mortality in #NOF. D Canty (TAS) on October 9, 2009 at the College’s headquarters in Melbourne. The • Low versus high volume fluid M Chan (Hong Kong) workshop was attended by researchers management. A Davidson (VIC) who are already collaborating in the • Restrictive or liberal blood transfusion E Hessian (VIC) group’s multi-centre trials and Fellows and mortality (two proposals). A Jeffries (VIC) who are interested in contributing • Dexamethasone for antiemesis and S Jenkins (SA) in the future. postoperative infection. R Kerridge (NSW) The workshop was led by David Story K Leslie (VIC) • Predicting difficult intubation. (Chair, Trials Group Executive) and was T McCulloch (NSW) co-ordinated by Stephanie Poustie • TAP blocks and pain outcomes after P Myles (VIC) (Trials Group Research Co-ordinator). abdominal surgery. T Painter (SA) The workshop included presentations • Anaesthesia technique and outcomes P Peyton (VIC) from Associate Professor Kate Leslie on from ERCP. D Potgieter (ACT) research at ANZCA, Associate Professor • Postoperative surveillance and B Silbert (VIC) David Story and Professor Paul Myles on intervention. P Sivalingam (QLD) the current multicentre trials (ENIGMA- • Preoperative nutrition. F Stapelberg (NZ) II, ATACAS) and audits (REASON) and D Story (VIC) Ms Jill Humphreys (Executive Officer, Subsequently, the proposed trials will S Walker (NZ) ANZCA Foundation) on research funding be ranked in order of priority, detailed L Weinberg (VIC) opportunities. protocols will be developed and high- However, most of the day was spent SJ Yap (NSW) level funding will be sought. The Trials discussing a series of proposed ANZCA D Hannah (NSW) Group plans to conduct annual workshops Trials Group research projects that came to evaluate the progress of trials and to from established and new researchers develop new projects. alike. Each project was presented and The workshop proved to be an then vigorously discussed. Topics for exciting and productive day. It was a new trials included: great opportunity for old collaborators to meet up and for new collaborations to be fostered.
Top, from left: Douglas Campbell, Matthew Chan and Pal Sivalingum; Su Jen Yap, David Bramley and Elizabeth Hessian; David Canty and workshop participants.
ANZCA Bulletin December 2009 39 National registration and accreditation scheme – time to consider your CPD standing
CPD requirements for medical practitioners will be set by the relevant national board. Registered health practitioners (not students) will be required to demonstrate that they have participated in a CPD program as determined by their national board when they renew their registration annually. A health practitioner granted non- practising registration will not be subject to CPD requirements, as it is a standard condition that he/she not practise the profession. With this scheme being introduced in July 2010, the College is encouraging all Fellows and affiliates of the College to reconsider their CPD standing now and register for the program either online or offline to meet the mandatory requirements needed for next year. There are many benefits of the new CPD program and one is that you are able to access your online portfolio, add your CPD plan and activities then print off your own statement of participation whenever A national scheme for the regulation of The ANZCA CPD program was you need it. If you are participating offline health practitioners within Australia is mandated from January 2009 for the you can still access an annual summary to be introduced from July 1, 2010. The following reasons: form online, complete it and send to the scheme will incorporate a public national • an ongoing need to demonstrate to College for your statement or again print register for each medical profession government, key stakeholders and it yourself. and national boards have been set up the community that anaesthetists are The CPD unit is able to help and to exercise regulatory functions, with serious about maintaining the highest advise you on the CPD program and help the structure supported by state and clinical standards and providing the you enrol as soon as possible. The CPD territory boards. best outcomes for patients. Co-ordinator, Sara Habib can be contacted Legislation to enable the • a mandatory CPD program is at the College at [email protected] or implementation of the national scheme an important expression of that on +61 3 9510 6299. (Bill B) has been drafted and is being commitment to high standards. For further information on the National introduced for consideration into state • national registration being introduced Registration and Accreditation Scheme and territory parliaments. Some of the in Australia, and participation in a visit www.nhwt.gov.au/natreg.asp. key features of the scheme are mandatory formal CPD program being a compulsory reporting, criminal history and element of registration. Dr Frank Moloney identity checks, simplified complaints • the need to place ANZCA on the Chair, ANZCA CPD Committee arrangements, independent accreditation same level as other medical Colleges, processes, privacy protections for professional organisations and practitioners and consumers, and countries that have mandated mandatory continuing professional continuing professional development development. programs. In 2007, the ANZCA Council decided to replace the Maintenance of Professional Standards (MOPS) program with an updated Continuing Professional Development (CPD) program that would better reflect best practice in professional education.
ANZCA Bulletin December 2009 41 Dr Jamin Mulvey: Philippines floods – lending a hand
It was a week of unprecedented disaster in South-East Asia and the Pacific. On Saturday September 26, 2009, Typhoon Ketsana battered the coastline of the Philippines causing devastating flooding around Manila and killing about 200 people. Three days later, on Tuesday September 29, a tsunami destroyed countless villages and killed about 140 people in Samoa. Then the next day the Indonesian island of Sumatra was struck by earthquakes, killing more than 1100 people.
With such widespread destruction, It wasn’t long before I received my first Our area of response was about 50km it would take an unprecedented relief phone call. The Samoan tsunami had hit from the outskirts of Manila around effort from volunteers and aid agencies the day before, and Queensland Health Lake Laguna, the second-largest lake in to provide assistance to the people of was preparing an aid response. South-East Asia, where the shoreline had these countries. With my anaesthesia training and shifted inland about 500m to 1km. As a My understanding of such disasters – work commitments, I’m not usually in consequence, with dense populations the destruction that goes hand in hand, a situation to be readily deployed for living around the lake, 125,000 families and the international relief effort that aid work and you can’t exactly arrange were displaced and the lack of clean follows – has increased dramatically holidays in advance for these things. water, sanitation, food supplies and since I first became involved in aid However, after talking to Dr Peter Moran, electricity was having a huge impact. work in 2005. At that time, working the Director of Anaesthesia at Princess We started clinics in the evacuation for Australian Aid International Alexandra Hospital (who was incidentally centres around Lake Laguna at San (www.aai.org.au) a non-government, on standby for deployment to Samoa) Pedro, seeing about 400 people a day. volunteer-based, relief organisation, he kindly organised leave for the Our response team consisted of two AAI I was deployed to Pakistani Kashmir Philippines response. doctors, two AAI nurses, one local doctor for two months after earthquakes killed Arriving in Manila a few days later, and three local midwives. more than 80,000 people and injured I hit the ground running. Due to the nature of this disaster more than 100,000. The initial Disaster Assessment (compared with earthquakes and This time, watching news reports Response Team (DART) of AAI had tsunamis which have high trauma loads) about the flooding and displacement of arrived three days earlier; securing my anaesthesia skills were not required. about 750,000 people in the Philippines - supplies, meeting governmental health However, my general medicine, primary prior to the Samoan and Indonesian crises officials, performing needs assessments, healthcare, paediatric and infectious - I was wondering whether AAI (for which and devising a health care strategy in disease knowledge and skills were I am on the volunteers list) would be conjunction with the United Nations and heavily tested. involved in the humanitarian relief effort. World Health Organisation (WHO).
42 ANZCA Bulletin December 2009 Fearing outbreaks of infectious AAI and other aid organisations are “Fearing outbreaks disease, we recorded all cases seen at the continuing their work in the Philippines, clinic, reporting back to WHO on a daily now focusing on medium- to long-term of infectious disease, basis. With these disease surveillance health care issues. As with all non- we recorded all cases methods, we were able to identify governmental aid agencies, they can only seen at the clinic, outbreaks of Leptospirosis-related continue their work through donations acute gastroenteritis in our region. This and volunteer assistance. reporting back to WHO enabled specific treatment and prevention Always challenging and rewarding, on a daily basis.” programs to start, aiming to reduce I would encourage ANZCA trainees and morbidity and mortality. Fellows to enlist as volunteers for such Unfortunately, with flood waters relief missions. not likely to subside for three months, AAI has programs in Timor, Indonesia, outbreaks of vector-bourne diseases, Philippines, and Burma; but keep your such as malaria and dengue, are almost passport ready, as you never know where unavoidable as mosquitoes re-establish disaster will strike next. themselves after the flooding. Returning back to Australia after only Dr Jamin Mulvey, nine days, I felt as though relatively little MBBS(Hons) BSc(Hons) was achieved. It’s easy to be overwhelmed Advanced Anaesthesia Trainee in these mass disasters, but every little Department of Anaesthesia, Princess From left: The medical relief team with bit helps. It’s not the individual effort that Alexandra Hospital, Brisbane members from AAI, the United Nations and local health officers; Extensive flooding to counts, but the combined, organised, communities from typhoon Ketsana; Dr Jamin collaborative effort of many that makes Mulvey reviewing patients at temporary the difference. clinics; Local children at San Pablo district evacuation centre.
ANZCA Bulletin December 2009 43 Education ANZCA teachers: what’s new in 2010?
WHY review and re-design the 1. ANZCA Teacher Course – WHO is the ANZCA Teacher Course clinical teacher support and Foundation Level – Advanced Level suitable for? training activities? In 2010 the ANZCA Teacher Course - Fellows who have attended CTC The College is reviewing and redesigning Foundation Level will be piloted in three Workshops previously, those who hold the way in which it provides support and locations - Victoria, New South Wales and a formal ANZCA position of teaching training for those involved in the delivery New Zealand. The ANZCA Teacher Course responsibility, or anyone involved of clinical teaching to ANZCA trainees. - Foundation Level will be a 2 ½ day in teaching ANZCA trainees. This review is in parallel with the ANZCA course and will equip participants with NB: The ANZCA Teacher Course – Curriculum Review which is described on the fundamental skills, knowledge and Advanced Level will supersede the the following page. professional behaviours to teach ANZCA current Clinical Teaching Course trainees effectively. WHO is conducting the review (CTC) workshops. and re-design process? WHO is the ANZCA Teacher Course – HOW can I find out more or register A Clinical Teacher Development Working Foundation Level suitable for? my interest? Group (CTDWG) has been appointed Anyone involved in teaching ANZCA For a full summary and up-to-date to oversee the review process and this trainees, in particular those who have information visit the clinical teacher group reports directly to the Education received little or no formal training in review homepage: and Training Committee (ETC) of ANZCA teaching in the clinical environment. www.anzca.edu.au/edu/projects/ Council. Chairing of the CTDWG and Note: As 2010 will be a pilot year, numbers teaching-review/clinical-teacher- coordination of the overall review will be strictly limited. Regions will be development-anzca-training- process is the responsibility of the ANZCA asked to nominate a specified number programme.html Education Development Unit (EDU). of interested Fellows to attend. For ANZCA teacher course dates, locations WHERE is the review up to? 2. ANZCA Teacher Course and to register your interest visit: www. The CTDWG has provided the input and – Advanced Level anzca.edu.au/edu/teacher-programme/ direction for the development of the new Two new Advanced Level options will be teacher-course/anzca-clinical-teacher- ANZCA Teacher Course to be delivered offered in 2010 in addition to the current course.html in 2010 throughout all ANZCA regions suite of topics. The ANZCA Teacher Course For further information, e-mail the and nations. This exciting initiative will – Advanced Level will be delivered Education Training and Development comprise two components: face-to-face as a one-day workshop in all Manager, Felicity Hutton: ANZCA regions, New Zealand, Malaysia, [email protected] Singapore and Hong Kong.
46 ANZCA Bulletin December 2009 Education ANZCA Curriculum Review: latest update
WHY is there a review? such as other colleges, anaesthetic WHAT will happen next? The College initiated the review of associations, and various government/ The next meeting of the CRWG was in the ANZCA training program in 2008, regulatory bodies. November 2009, to analyse the survey to ensure the curriculum remains The second meeting of the CRWG responses and begin drafting outcomes of contemporary, and that ANZCA trainees was held in March 2009, where analysis the review. The official dissemination of are experiencing the highest quality of the submissions commenced. The the ANZCA curriculum review outcomes teaching and learning opportunities. submissions were then made publically will take place at the 2010 ANZCA Annual available on the ANZCA website in July Scientific Meeting. The outcomes of this WHO is conducting this review? 2009, to stimulate discussion and debate review are anticipated to include: a new A Curriculum Review Working Group on the training program within the ANZCA Curriculum Framework, and a (CRWG) was appointed to oversee the Fellowship and trainee body. set of recommendations for change to review process and this group reports the ANZCA Training Program. Following directly to the Education and Training The Survey the conclusion of the review, a process Committee (ETC) of ANZCA Council. The analysis of the submissions, and of redevelopment and implementation Chairing of the CRWG and coordination input from related subcommittees and will need to be undertaken, with the of the overall review process is the working groups of the ANZCA ETC, were future ANZCA training program expected responsibility of the ANZCA Education then used to create the ANZCA Curriculum to be launched in 2012; coinciding with Development Unit (EDU). Review Survey; which was designed as a an expected significant increase in further opportunity for ANZCA Fellows WHERE is the review up to? vocational trainees. and Trainees to voice their opinion on the The Submissions future of anaesthesia training. The survey HOW can I find out more? The CRWG had their first meeting in was open for six week (from September 21 For a full summary and up-to-date August 2008, where principles and until October 31, 2009) and was available information on the curriculum review plans for the review process were online and in hard-copy. ANZCA Fellows project, visit: established. The ANZCA Curriculum and trainees received the survey via www.anzca.edu.au/edu/projects/ Review Submissions Process was then post and e-mail, and the survey was also curriculum-review undertaken by the CRWG from October promoted through all College media (i.e. For further information, e-mail 2008 to January 2009 (inclusive), with ANZCA Bulletin, E-Newsletter, Trainee the Education Development Unit invitations sent to key stakeholders. Newsletter and on the ANZCA website [email protected] The CRWG was pleased to receive a homepage). More than 2000 survey total of 132 submissions from a diverse responses were received, representing range of stakeholders, including ANZCA an overall response rate of over committees, Fellows, trainees and staff; 35 percent. and a broad set of external stakeholders,
Message from the President
ANZCA Curriculum Review Survey
• Current Trainees and Teaching/Supervising Fellows: of you who are actively involved in the current ANZCA TrainingFor those Programme (e.g. current trainees, supervisors, and other active teachers), we call on your first-hand experience and expertise to Demographic Information comment on the existing training programme and to also make Please complete questions 1 - 11 (as appropriate) to provide contextual information for your survey responses. ANZCA Curriculum recommendations for improvements. 1. Sex: Male Female 2. Age (in years, at 31 Oct 2009): ______• Non-Teaching Fellows: For those of you either not actively 3. Fellow or Trainee: Review Survey involved with the training programme, or working in settings Fellow (go to Question 4) Trainee (go to Question 7) which have not traditionally included trainees (e.g. private Dear ANZCA Fellows and Trainees, practice, VMOs etc.), we call on you to provide your opinions Fellows Only and suggestions on improvements to our training programme; For ANZCA Fellows and Trainees Only As a member of the College I am calling on you to help us achieve 4. Formal ANZCA Supervisory Roles: particularly those that would allow feasible expansion into Also available online at: www.anzca.websurvey.net.au one of our key objectives, to cultivate and maintain the highest such settings. Please indicate your current and previous formal ANZCA Supervisory Roles, if any. Closing date: 31 October 2009 principles and standards in Anaesthesia training. The ANZCA
Curriculum Review Survey represents another opportunity for • Other Fellows: For those of you that have been involved with our Regional/National Formal Project Rotational Supervisor Module Primary
you to make an active contribution to the shape of our training training programme in the past (e.g. retired Fellows), we would Education Officer Officer Supervisor of Training Supervisor Examiner Examiner programme for future generations of Anaesthetists. highly value the insights from your previous experience, including Current the many changes and advances in our specialty in recent times. Final In the near future our College will need to successfully contend Previous and compete with a number of major issues facing the medical Please take the time to complete this survey regarding the systems in which we work and train. In particular, we will need future of the ANZCA Training Programme, it is our collective 5. Current Fellowship Status: to be prepared for the increased number of junior doctors seeking professional responsibility to ensure we maintain a high Currently in clinical practice a place in vocational training from 2012, due to the increased standard of training for future Anaesthetists which will ensure 6. Interaction with ANZCA Trainees: Currently on extended leave (e.g. maternity, sabbatical, etc.) (except retired Fellows) number of medical student places offered by both the Australian our continuing reputation for providing safe and effective care There are usually no ANZCA Trainees in my current workplace. Retired (go to Question 10) and New Zealand governments in recent times. Similarly, we will for our patients. There are ANZCA Trainees in my current workplace. need to be able to respond effectively to government calls for us to Other, please describe: ______When trainees are in my workplace, I: further expand our range of training settings; into the private sector
and rural areas, for example. ______do not teach or supervise. occasionally teach and/or supervise Whilst I realise that this survey is a lengthy one, it is necessarily Dr Leona Wilson so, as the questions asked cover an array of complex issues that ANZCA President Trainees Only usually teach and/or supervise surround our training programme. confidently into the future we needTo move our ourmembers training (both programme Fellows 7. ANZCA Trainee Status: Registered, but not commenced ANZCA Training and Trainees) to provide us with a consensus view and 8. ANZCA Supervision Level: a clear mandate regarding these issues. BTY1 (Basic Trainee, Year 1) Passed a formal assessment to move beyond of recommendations that are both comprehensive To produce and relevant, a set BTY2 (Basic Trainee, Year 2) ‘Level 1 Supervision’ (i.e. one-to-one supervision) we need to ensure the input comes from a wide and representative ATY1 (Advanced Trainee, Year 1) sample of our College body: Have moved beyond ‘Level 1 Supervision’, ATY2 (Advanced Trainee, Year 2) without a formal assessment process ATY3/PF (Advanced Trainee, Year 3 /Provisional Fellow) Not yet moved beyond ‘Level 1 Supervision’ Other, please specify:______Don’t Know / Unsure 9. ANZCA Examination Status: Instructions Passed Not Passed Exempt Please complete the following survey to help the ANZCA Primary Examination College shape the future ANZCA Training Programme! ANZCA Final Examination What is the participation prize? Both Fellows and Trainees Can I complete this survey online? Encourage your peers to complete the survey too! On reaching 10. ANZCA Nation/Region: Yes, you can complete the survey online at: a final response rate of 40% a complementary registration to the Please indicate your current work or training location (or last work/training location if not currently working or training). www.anzca.websurvey.net.au ANZCA 2010 Annual Scientific Meeting will be drawn. One prize Please Note. You will require your College ID and Surname each for a Fellow and a Trainee will be on offer. Fill in your contact Australia – Australian Capital Territory to login to the online version. details on the last page to be included in the draw! Australia – Northern Territory Australia – New South Wales How will my confidentiality be assured? Australia – South Australia Who can complete this survey? Australia – Queensland ANZCA Fellows and Trainees only. An external contractor (Strategic Data Pty. Ltd.) has been Australia – Victoria Australia – Tasmania Please Note. Earlier stages of the review process have included employed to manage all data collection for this survey (both Hong Kong Australia – Western Australia external stakeholder input. For details, see the ANZCA online and hard-copy). To protect your anonymity, any identifying New Zealand Malaysia Curriculum Review Homepage: www.anzca.edu.au/edu/projects/ information supplied by you (e.g. for login to the online version Other, please specify: ______curriculum-review and/or contact details for the participation prize) will be removed Singapore from the survey database by the external contractor, prior to the 11. Current Employment Details: (except retired Fellows) How much of the survey do I need to complete? data being made accessible to the College. a. Sector: The more questions you answer the better! The survey allows you
to comment on all aspects of the programme, but remember, How do I return this survey? Public Only b. Status: you do not need to answer every question to make a valuable Simply return your completed survey by 31 October 2009, Private Only Full-time contribution. in the reply-paid envelope provided. Both Public and Private Please estimate % in Public: ______Part-time Can I claim ANZCA CPD points? Otherwise you can complete this survey by 31 October 2009 Please specify ~ days/week: ______Yes, you can claim ANZCA CPD points for completing this survey. online at: www.anzca.websurvey.net.au c. Hospital - Location: ANZCA CPD Programme (approval number 1577); Metropolitan (Inner) d. Department - Number of ANZCA Trainees: Category 3/Level 1, 2 credits per hour. Metropolitan (Outer) 0 Regional 1-9 Rural 10-19 20+
Please turn over ANZCA Curriculum Review Survey 01
ANZCA Bulletin December 2009 47 Education Changes to the ANZCA in-training assessment (ITA) process in 2010
The purpose of the ANZCA in-training - Documentation of the initial, mid- • During 2010, the College will also assessment (ITA) process is to help term (where required) and end-of-term develop an on-line process for completing trainees to continue to learn effectively interviews with prompts for the SOT (e.g. and submitting the ITA Form. and progress successfully through their modules completed/planned). What is not changing? training program. It is intended to be a - A global assessment of trainee negotiated process in which the trainee • The current end of term assessments performance to indicate whether they (polling of three senior staff or a and supervisor of training (SOT) agree are performing at a level consistent with consensus meeting of senior staff) will goals or steps that are appropriate to the their stage of training. continue. In addition, individual SOTs trainee’s particular level of achievement. Feedback from SOTs indicates that the and departments may, if they wish, The goals of the ITA have been areas listed in the ITA Form are too select additional methods for assessing summarised as follows: “blunt” to provide a helpful description of trainees. This is in recognition that • Discuss and set appropriate educational trainee performance (particularly in non- many SOTs already use tools like the and clinical goals for the training term; technical areas such as communication Mini-Clinical Evaluation Exercise (Mini- • Assess trainee progress towards and teamwork). The descriptors have been CEX) or forms they have developed obtaining these goals and assist the improved to make them more useful in themselves. The College will provide trainee in achieving these objectives; describing trainee performance; hence examples of such forms and toolkits with • Provide the trainee with regular allowing SOTs to give more helpful practical information about how to use feedback; and feedback to assist trainees to develop them. Ongoing educational development • Develop any remedial activities that and improve. work will continue in 2010 and 2011 to may be required. As the new curriculum will be based investigate and agree a set of observation on the CanMEDS framework2, the tools which will, in the future, be The College is engaged in a curriculum recommended for use for all trainees. 1 descriptors in the new ITA Form are review project and recommendations from • TE18 Guidelines for Assisting Trainees based on the CanMEDS roles. These the review are being formulated. A revised with Difficulties3 and the trainee roles have been developed into a revised training program will be implemented performance Review4 Processes will curriculum framework that is tailored to from 2012. In the interim, a review of the remain unchanged. the contemporary practice of anaesthesia. ITA process has been conducted. The goal • Other aspects of the ITA Process will This is a first opportunity to apply this of this ITA review is to lay the foundation also remain unchanged. for further curriculum change, particularly framework in a meaningful way. in relation to ANZCA’s curriculum • The ITA-1 Form has been redesigned More information about the changes framework and the implementation and is now called the ITA-Short Form will be posted on the College website, of a formal suite of workplace-based (ITA-SF). along with the new forms, frequently asked questions and toolkits for SOTs assessment tools. • The use of the ITA Form for trainee with practical tips to assist them with The ITA review was initiated in self-assessment is no longer mandatory. the revised process. Personalised response to feedback from SOTs and The College supports the idea of communication will also be sent to all trainees. The planned changes have trainees reflecting on and assessing SOTs and trainees outlining the changes. been developed by the Workplace-Based their own performance. However, the Feedback is welcome and further Assessment Subcommittee (WBASC) implementation of this process has been information can also be provided on request whose members include SOTs, a regional variable and is not regarded as useful by by contacting either Dr Lindy Roberts or education officer (REO), and a trainee, in many SOTs and trainees. addition to other Fellows and College staff. Greg Pain at [email protected]. • The College will provide greater support What is changing? for Supervisors of Training and regional/ • The Approved Vocational Training (AVT) national education officers in the case Lindy Roberts and ITA-2 Forms are being amalgamated of an unsatisfactory performance in Chair, ANZCA Workplace Based into a single form (the ITA Form). This the ITA process. The global assessment Assessment Subcommittee will reduce duplication for supervisors allows the SOT to indicate to the trainee Greg Pain and trainees. The ITA Form will now whether his/her performance is at the ANZCA Director, Training and Assessments include details of the trainee’s training level expected for the stage of training. If Mary Lawson and thus must be submitted to the the answer is “no” or “borderline” then ANZCA Director of Education College so that this time can be counted this acts as a trigger to ensure that the towards training. trainee’s performance is being managed 1. Lawson M & Byrne C. ANZCA Curriculum according to the TE18 Guidelines for Review: Your questions answered. ANZCA • The content of the ITA Form has been Assisting Trainees with Difficulties3 Bulletin September 2009, pp 54 - 56 revised to include: 2. What is meant by CanMEDS? G Goulding. process. The Training and Assessments ANZCA Bulletin June 2009, pp 56 - 57 - A criteria that allows a more Unit at the College will also monitor this 3. College Professional Document TE18 comprehensive description of trainee global assessment and, if the trainee is Guidelines for Assisting Trainees with performance. These have been designed not performing at the level expected, Difficulties www.anzca.edu.au/resources/ to allow SOTs to provide more specific will contact the SOT and the REO/NEO professional-documents/training- and detailed feedback to trainees on all to provide support to them in undertaking educational/te18.html areas of their clinical practice. 4. College Regulation 33 Trainee Performance a remediation process to help the Review www.anzca.edu.au/resources/ trainee improve. regulations/regulation-33.html
48 ANZCA Bulletin December 2009 Quality & safety
This system has proven to be very Using an incident successful with a completion rate of reporting system to 94% and a sensitivity/specificity for intraoperative incidents of 80% and improve anaesthetic 91%, respectively.3 It has allowed the investigation of several important clinical care: a study on issues 4-8 and more particularly the study of the impact on patient safety of introducing undesirable events new trainees in hospitals at the beginning at the beginning of of the academic year.9 Common wisdom suggests an increase a new year in the rate of undesirable events at the Patient safety is the avoidance, prevention, beginning of the academic year for anaes- amelioration of adverse outcomes or thesia trainees in teaching hospitals. This injuries stemming from the processes of phenomenon is commonly termed the July health care.1 However, one can only manage phenomenon in the United States and the what one can measure. The speciality “killing season” in the United Kingdom 1,11. Professor Paul Myles and Dr Guy Haller of anaesthesia has been at the forefront However, available data regarding this of many developments in patient safety phenomenon have been equivocal.12-14 measurement and particularly in the use of We recently published a study on this incident reporting systems, an achievement subject in the British Medical Journal,9 originally developed in Australia 2. These utilising our existing QA database. We systems are widely used by anaesthesia compared the rate of undesirable events departments around the world. during or after procedures performed The Alfred Hospital (Melbourne, by new trainees at the beginning of the Australia) anaesthesia department academic year with the rest of the year. This developed a computerised reporting system was a retrospective cohort study of 19,560 as part of an ongoing quality assurance patients over a five-year period. All patients (QA) program in 1993. The system includes having an anaesthetic procedure carried not only intraoperative incidents but out by first to fifth year trainees starting all other patient information such as work for the first time at the Alfred Hospital demographic characteristics, past medical were assessed. history, current health status, medication We found that the rate of undesirable usage, ASA score; type of procedure, events was higher at the beginning of the timing, duration, and emergency status; as academic year compared with the rest of well as information on staff characteristics the year (absolute event rate 137 v 107 per and level of supervision. A follow-up at 24 1000 patient hours, relative rate reduction hours is routinely done for most inpatients 28%, P<0.001). The overall adjusted rate and complication and patient satisfaction ratio for undesirable events was increased information are collected. by 40%:
Rate ratios of undesirable events Rate/1000 patient hours with first period compared with (no. of events) rest of year Training year First period Rest of year Adjusted rate ratio† (95% CI) year 1 130 (288) 108 (1130) 1.31 (1.11 to 1.55) year 2 134 (35) 89 (46) 1.69 (0.94 to 3.04) year 3 198 (13) 168 (71) 1.19 (0.53 to 2.71) year 4 128 (89) 111 (467) 1.25 (0.92 to 1.68) year 5 152 (168) 92 (365) 1.78 (1.39 to 2.29) All years 137 (593) 107 (2079) 1.40 (1.24 to 1.58) †Adjusted for case mix of patients (age, sex, ASA physical status score, comorbidities), type of surgery, and characteristics of anaesthetic procedure (type, duration, emergency status, time of day, and mode of supervision)
50 ANZCA Bulletin December 2009 This excess risk was seen for all levels Indeed, since the study data were 6. Myles PS, Williams DL, Hendrata M, et al. of training (p<0.03). The excess risk collected, the Alfred hospital’s Department Patient satisfaction after anaesthesia and decreased progressively after the first of Anaesthesia and Perioperative Medicine surgery: results of a prospective survey of month, and the trend disappeared fully has made several changes to improve 10,811 patients. Br J Anaesth 2000;84:6-10. after the fourth month of the year: orientation and supervision of its new 7. Myles PS, Reeves M, Anderson, Weeks AM. trainees. We provide 24 hour in-house Measurement of quality of recovery in 5672 patients after anaesthesia and surgery. consultant cover at all times, and minimise Anaesth Intensive Care 2000;28:276-9. consultant leave through February. All 8. Haller G, Myles PS, Wolfe R, et al J. Validity incoming trainees are provided with a full- of uplanned admission to an intensive care day orientation program before starting unit as a measure of patient safety in surgical their clinical work. Trainees also are patients. Anesthesiology 2005;103:1121-9. given information about intranet-based 9. Haller G, Myles PS, Taffé P, Perneger TV, Wu protocols and guidelines, and important CL. Rate of undesirable events at beginning of procedures as to what they should do in academic year: retrospective cohort study. BMJ case of any emergency. Airway workshops 2009 Oct 13;339:b3974. and other high-fidelity simulation days are 10. Aylin P, Majeed FA. The killing season-fact or offered early in the academic year. Further fiction? BMJ 1994;309(6970):1690. studies are planned to assess the overall 11. Claridge JA, Schulman AM, Sawyer RG, et impact of these initiatives. al. The “July phenomenon” and the care of It should be emphasised that some of the severely injured patient: fact or fiction? Surgery 2001;130:346-53. the reported undesirable incidents were Guy Haller near misses or otherwise well-managed by Consultant Anaesthetist, Department 12. Shulkin DJ. The July phenomenon revisited: trainees or their supervising consultants, of Anaesthesia, Pharmacology and are hospital complications associated with new house staff? Am J Med Qual 1995;10:14-17. and so did not result in patient harm. This Intensive Care; and Division of Clinical does not however detract from the key Epidemiology, Geneva University Hospital 13. Rich EC, Gifford G, Luxenberg M, Dowd B. The relationship of house staff experience to findings of the study. and University of Geneva, Geneva, the cost and quality of inpatient care. JAMA Not only was the suspected increased Switzerland 1990;263:953-7. rate of undesirable events at the beginning Paul Myles 14. Englesbe MJ, Pelletier SJ, Magee JC, et al. of the academic year confirmed, but it Professor/Director, Department of Seasonal variation in surgical outcomes was also found that the phenomenon was Anaesthesia and Perioperative Medicine, as measured by the American College present regardless of trainees’ level of Alfred Hospital and Monash University, of Surgeons-National Surgical Quality clinical experience. This challenges the Improvement Program (ACS-NSQIP). Ann Melbourne, Australia common view that professional expertise Surg 2007;246:456-62. relies solely on medical knowledge, 15. Cruess SR, Johnston S, Cruess RL. References technical skills, and clinical judgment.15 “Profession”: a working definition for medical Adequate (new) staff orientation, 1. Cooper JB, Gaba DM, Liang B, Woods D, Blum educators. Teach Learn Med 2004;16:74-6. knowledge of the specifics of the working LN. The National Patient Safety Foundation 16. Haller G, Garnerin P, Morales MA, et al. Effect agenda for research and development in of crew resource management training in a environment, and awareness of teamwork- patient safety. Med Gen Med 2000;2:38. related factors may also contribute multidisciplinary obstetrical setting. Int J Qual 2. Webb RK, Currie M, Morgan CA, et al. The Health Care 2008;20:254-63. strongly to trainee performance and Australian Incident Monitoring Study: an patient outcome. 17. Helmreich RL. On error management: lessons analysis of 2000 incident reports. Anaesth from aviation. BMJ 2000;320:781-5. These results imply that improving Intensive Care 1993; 21:520-8. 18. Dunn EJ, Mills PD, Neily J, et al. Medical team trainees’ orientation and integration, 3. Haller G, Myles PS, Stoelwinder J, et al. regardless of their level of clinical training: applying crew resource management Integrating incident reporting into an in the Veterans Health Administration. Jt expertise, during their first weeks of electronic patient record system. J Am Med Comm J Qual Patient Saf 2007;33:317-25. employment is crucial. Advanced trainees Inform Assoc 2007;14:175-81. should benefit from the same level of close 4. Myles PS, Hunt JO, Moloney J. Do women have supervision (1:1) usually reserved for first more “minor” complications after surgery? year trainees. Crew resource management Anaesthesia 1997;52:300-6. programs such as those developed in 5. Reeves MD, Myles PS. Does anaesthetic aviation could also be used to improve technique affect outcome after transurethral team coordination and interprofessional resection of the prostrate? Br J Urology collaboration early in the academic year.16- 1999;83:982-6. 18 Simulator training may also enhance improvements in junior trainees’ technical and teamwork skills.
ANZCA Bulletin December 2009 51 Quality & safety continued
over the easy access. Consideration is The propofol being given to applying the same level of ECRI Alerts controversy control as with opiates. Paul E Wischmeyer October – Normal Priority et al 3 undertook a survey of 126 academic Physio-Control-LIFEPAK 15 Biphasic Since the untimely death of Michael anaesthesiology training programs in the Monitor/Defibrillator Jackson, the use, as a sedative, of the US and found a fivefold increase in propofol A recent alert from the ECRI Institute anaesthetic agent propofol with its narrow abuse over previous surveys. Trainees were (www.ecri.org/Pages/default.aspx) therapeutic margin of safety is being the most vulnerable and one explanation concerns the Physio-Control-LIFEPAK 15 reviewed, certainly in the USA. It is agreed may be (as with Michael Jackson) that, for a Biphasic Monitor/Defibrillators where that specialist anaesthetists are unable person under stress, an apparently normal the non invasive blood pressure may be to service the large volume of endoscopic sleep can be rapidly induced along with an disabled if there is bumping or squeezing procedures and that other members of the awakening relatively devoid of after effects. of the cuff resulting in a display of XXX medical workforce need to be trained to Restriction of the use of propofol is instead of a valid reading of the NIBP. In ensure proper assessment, safe clinical not suggested but all procedeural areas this situation the device must be powered practice and the ability to handle crises. including endoscopy suites with their rapid off and back on. The problem does not An article in the recent ANZCA Bulletin, turnover will increasingly need to have in affect defibrillation or other functions of “Training non-anaesthetist sedation place adequate strategies for the control of the monitor. Physio-Control have upgraded practitioners-living with PS9” by Joanna the drug, particularly in view of the now all units in the US but it is not clear whether Sutherland and Cate McIntosh1 describe extensive use by non anaesthetists. this has yet occurred in Australia or New a program undertaken to address these Zealand. issues. Although it is specifically stated in the College document that the proceduralist Dr Patricia Mackay November 6 – Critical Priority Victoria must not also administer the sedative BD/Acacia—Q-Syte Luer Access drugs, what is not clarified is whether these References Split-Septum Needleless Intravenous “grandfather” gastroenterologists are in Connectors: May Allow Air Bubbles 1. ANZCA Bulletin, September 2009 fact “operator anaesthetists’’ when propofol to Enter Infusion System, Potentially 2. Charatan F. Propofol among US healthcare is employed, irrespective of whether Resulting in Air Embolism “conscious sedation” can ever be assured professionals. BMJ 2009;339:b2673 with this drug. 3. Paul E Wischmeyer et al. A Survey of Propofol This alert concerns the BD/Acacia-Q- In the news section of the British Medical Abuse in Academic Anaesthesia Programs. Syte Luer Access split-septum needleless Journal2 Fred Charatan of Florida raises the Anesthesia and Analgesia 2007: 105; 1066-71 intravenous connectors. BD states that issue of the increase in propofol addiction it has received complaints of air bubbles leaking into the infusion system through among health professionals associated with its wide use in “sedation’’ as well the above connectors. This problem may as anaesthesia; this point is supported result in an air embolism in a patient with a by the American Association of Nurse central venous catheter. The manufacturer Anaesthetists who have raised concerns has not confirmed the geographic
52 ANZCA Bulletin December 2009 distribution of the affected product. ECRI are attached to or removed from the the increased failure rate of the affected Institute recommends that you check monitors, potentially interrupting patient vaporisers. MHRA also recommends that your inventory for this product regardless monitoring. In some facilities, such you have procedures in place to ensure of where you are located, and isolate the damage is frequent. Philips has indicated that the vaporiser’s performance is closely affected product from your inventory. its intention to implement design changes monitored, the vaporiser is replaced to reduce the likelihood of such damage. immediately if any problem is suspected, November 13 – High priority In the meantime, if clinicians experience and that the vaporiser’s performance is ZOLL—M Series Defibrillators: Unsecure problems such as a lack of or intermittent checked regularly. Connection between Paddles and Cables communication between the MMS and To view ECRI’s full alerts please contact the May Delay Therapy monitor, facilities should examine ANZCA library at [email protected] This alert concerns the Zoll-M series connectors for damage and immediately defibrillators. In rare cases, Zoll-M Series replace them if required. multifunction cable (MFC) connectors may GE/Baxter—Tec 6 Plus Desflurane fail to securely attach to M Series external Vaporizers: Internal Rotary Valve May Fail defibrillator paddles, potentially permitting Prematurely, Potentially Causing Over- or inadvertent disconnections that could Underdelivery of Anaesthesia delay treatment. Currently, ECRI Institute has no reason to believe that that this is a This alert concerns the Philips the GE/ widespread problem. Nevertheless, given Baxter—Tec 6 Plus Desflurane Vaporizers. the risk that the problem may go unnoticed The UK Medicines and Healthcare Products before clinical use, ECRI Institute believes Regulatory Agency (MHRA) has issued that users should verify proper connections a Medical Device Alert (MDA/2009/072) between cables and paddles during the warning healthcare workers that the manufacturer-recommended shift check. internal rotary valve of the above vaporisers may fail prematurely. While the failure rate Philips—IntelliVue Monitors and Multi- is low, it is higher compared to other types Measurement Server (MMS) Monitoring of vaporisers. MHRA states that because Modules: Module to Monitor Connector many perceive that anaesthetic vaporisers Damage May Impede Monitoring are extremely reliable, anaesthetists may This alert concerns the Philips—IntelliVue mistakenly believe that the anaesthetic Monitors and Multi-Measurement Server agent monitor failed and continue to use (MMS) Monitoring Modules. The connector faulty vaporisers. This problem may result pins of Philips multi-measurement in over- or under-delivery of anaesthetic server (MMS) monitoring modules or agents. MHRA recommends that you Philips IntelliVue physiologic monitors identify any affected vaporisers in your may become bent when the modules inventory. Ensure that users are aware of
ANZCA Bulletin December 2009 53 Managing acute pain safely Part 1: Opioid-induced respiratory depression
The first in a two-part series, Opioid-induced central nervous and ventilation in non-ventilated patients Associate Professor Pam Macintyre system depression receiving PCA, neuraxial opioids or serial and Associate Professor David Scott Opioids administered by any route have doses of parenteral opioids”.3 discuss how to manage acute central nervous system depressant An editorial in a more recent APSF pain safely. effects as well as analgesic effects. The newsletter by Stoelting & Weinger, 20094 focus of attention has tended to be on reiterated the APSF stance and stated Surveys published over the last few respiratory depression (altered response that continuous use of pulse oximetry decades have consistently shown of the respiratory centre to carbon should be “the routine rather than the that acute pain management is often dioxide) although as is discussed below, exception”. suboptimal. the effects on conscious state are tightly They suggested this only for patients This has led to an increasing use linked to this and are equally important. receiving PCA or neuraxial opioids. of more sophisticated methods of pain There remains significant confusion However, there is no evidence to suggest relief in general hospital wards and about the best method of monitoring that respiratory depression following in ambulatory settings, as well as an for respiratory depression related these methods of opioid administration is increasing emphasis placed on the to administration of opioids. While any greater than following opioids given need to assess pain on a regular basis. 5 measurement of arterial PCO2 levels is by other routes of administration . Assessment of pain as the “fifth vital the most sensitive and accurate, it is not sign”1 has been promoted as an essential Reliability of oxygen saturation possible in most patients, particularly on component of acute pain management monitoring a regular basis. and one that should be routinely recorded But just how reliable is oxygen saturation Over recent years, the question of in conjunction with measurements of (as measured by pulse oximetry) as an how best to monitor for opioid-induced respiratory rate, blood pressure, pulse indicator of respiratory depression? respiratory depression has been debated and temperature. Although it is an easy and non-invasive in a number of publications including Much less emphasis, however, has measure of blood oxygen levels, care in newsletters of the Anesthesia Patient been placed on the need to monitor for must be taken in the interpretation of Safety Foundation (APSF) from the US. the early onset of significant side effects any readings because these may not related to treatment – in particular, Detecting respiratory depression reflect respiratory drive. If the patient opioid-induced respiratory depression. One article3 summarised the conclusions is receiving supplemental oxygen, the Without such monitoring, safe of a workshop convened by the APSF added oxygen may mask deterioration management of acute pain using opioids to look at improved recognition of in respiratory function (i.e. “normal” is not possible. Use of an unbalanced postoperative opioid-induced respiratory oxygen saturation levels may still be strategy for pain management, which depression. seen in the presence of significant emphasises the need for better pain Included was a summary of the respiratory depression). However, if management and lower pain scores sensitivity, specificity, reliability, supplemental oxygen is not used, is it without stressing the need for appropriate response times and costs of a number of any more reliable? The answer may be patient monitoring, can and will lead to methods of monitoring ventilation and/ “no” as there can be reasons other than an increase in adverse events2. or oxygenation: respiratory rate, tidal opioids for hypoxaemia, especially in the As well as appropriate monitoring, volume, continuous measurement of postoperative setting6. there must also be suitable lines of oxygen saturation and end-tidal CO2, Cashman and Dolin reviewed communication whereby nursing staff can blood gas analysis, minute ventilation published cohort studies, case-controlled relay their concerns, as well as proper and and chest wall impedance. studies and audit reports as well as timely responses to any abnormalities Despite recognising the limitations randomised-controlled trials and used detected. of available monitors, and despite the the data to compare patient-controlled If problems are detected at an early low sensitivity of continuous pulse analgesia (PCA), epidural analgesia and stage it will increase the chance of oximetry in patients given supplemental intramuscular (IM) opioid analgesia in avoiding significant and permanent oxygen (common in many countries), terms of pain relief 7, nausea, vomiting, patient harm. The information below the recommendation of the APSF was sedation, pruritus, and urinary retention8 therefore aims to summarise current for “the use of continuous monitoring of and respiratory and haemodynamic knowledge relating to the assessment of oxygenation (generally pulse oximetry) effects5. opioid-induced respiratory depression.
56 ANZCA Bulletin December 2009 In the latter paper, the incidence of pain management at home. False positive guided by a patient’s numerical (0 to respiratory depression for the various alarms from overuse would also decrease 10) pain score. As a consequence of this techniques was reported using a variety confidence in the technique. push for lower pain scores, there was a of measures – as used by the authors of It is possible that transcutaneous doubling in the incidence of over-sedation the studies included in the review. These CO2 measurement may become more or respiratory failure – which was not measures were a decrease in respiratory common9, 10 but the same problems that usually accompanied by a decrease in rate, elevated PaCO2 levels, the need for would arise from a requirement for respiratory rate. administration of naloxone, or decreases routine use in every patient, including Of the 29 patients who developed in oxygen saturation. patients at home, would remain. respiratory depression (either before or There appeared to be little difference Therefore, reliance must be placed on after the introduction of the NPTA), only between the analgesic techniques other clinical measures. three had recorded respiratory rates of unless pulse oximetry was used - a far less than 12 breaths/min; however 27 were Respiratory rate or level of sedation? greater proportion of patients given IM noted to have a decrease in their level of CNS depression from opioids can lead opioids were reported to have low oxygen consciousness during the 12 hours before to respiratory depression, for which saturation levels – 37% of patients the event. respiratory rate can be an unreliable given IM opioids compared with 11.5% The authors concluded that there was guide, as well as a decreased conscious in patients with PCA. Could IM opioid not a predictable decrease in respiratory state manifest by drowsiness, loss of analgesia really be more likely than PCA rate associated with respiratory airway tone and ultimately upper to cause respiratory depression? depression and also noted “an inherent airway obstruction. If the data from the paper on patient safety concern when titrating In 1988, Ready et al11 published their effectiveness of pain relief using these opioid analgesia to a one-dimensional landmark paper on the development of techniques is examined7, it can be seen pain rating scale”. an anaesthesiology-based Acute Pain that patients given IM opioids reported In another paper reporting on an Service (APS). In the text of that article significantly more pain (moderate- audit of patients given PCA for pain relief was a description of four patients who severe pain in 67.2% and severe pain after surgery, respiratory depression was developed respiratory depression after in 29.1% compared with 35.8% and defined as a respiratory rate of less than administration of epidural morphine. 10.4% respectively in PCA patients), 10 breaths/min and/or a sedation score Two patients were noted to have “marked suggesting that these patients may have of two (defined as “asleep but easily sedation”; their PCO2 levels were 63 received much lower doses of opioids. It roused”) or more. and 66 mm Hg and the lowest recorded is therefore probably unlikely that these Of the 13 patients who developed respiratory rates were 11 and 8 breaths/ patients would have a greater risk of respiratory depression, 11 had sedation min respectively. respiratory depression than patients scores of two or more. In contrast to The other two patients were using PCA. the study by Vila et al above, all were unconscious; PCO2 levels were 85 and Could hypoxia therefore have arisen reported to have respiratory rates of less 95 mm Hg and their respective lowest for other reasons such as an inability to than 10 breaths/min12. recorded respiratory rates were eight and cough or take deep breaths after surgery, There are other examples of cases 12 breaths/min. Note that the patient with obesity, or fluid overload? Patients can where an over-reliance on the use the highest PCO2 also had the highest be hypoxaemic and in pain without of respiratory rate as an indicator of respiratory rate! Thus their APS developed significant respiratory depression6. respiratory depression may have led to and used sedation scores (similar to So, despite APSF recommendations problems and where increasing sedation the table below) to routinely monitor all that have been made suggesting that may have been missed. patients given opioids. the use of oxygen saturation monitoring Reports of life threatening respiratory The importance of increasing sedation should be mandatory in all patients depression have been published following as a clinical sign of early respiratory given opioids, it may not always be a opioid administration via a number of depression was also highlighted by good or reliable indicator of respiratory routes (but especially using IV PCA) Vila et al2. depression. and are often used to “demonstrate” the This group reported on the Furthermore, it is unlikely that potential danger of opioid administration introduction and use of a numerical continuous pulse oximetry would be in patients with obstructive sleep pain treatment algorithm (NPTA) which made available (too costly) to all patients apnoea (OSA). aimed to improve pain scores in cancer receiving opioids – neither as inpatients patients – opioid administration was nor when opioids are required for acute
ANZCA Bulletin December 2009 57 Managing acute pain safely Part 1: Opioid-induced respiratory depression continued
Four of these reports involved the In the cases mentioned above, would Patient tolerance, expense and use of PCA: one patient given PCA set to the same outcomes have been seen reliability beyond a research environment deliver (inappropriately) a background had sedation been monitored and had limit their utility. Transcutaneous infusion of morphine of 2mg/hr was found excessive sedation (a sedation score of carbon-dioxide measurements are also 13 unconscious with a PaCO2 of 94 mm Hg; two – see below) triggered some action? not in widespread use and are generally another was ‘found to be unrousable’ with not suited for long-term application. 14 Sedation scores a PaCO2 of 76 mm Hg ; and yet another A number of different sedation scoring Summary was “heavily sedated and hypercapnic”15. systems are available. Whichever In summary, when clinical indicators Respiratory arrest leading to the death is used, it must represent a sensible are used to monitor for opioid-induced of three patients receiving postoperative progression – that is, increasing sedation respiratory depression, increasing bupivacaine and fentanyl epidural (i.e. decreasing rousability) and not sedation is a more reliable indicator than infusions has also been reported16. The necessarily things such as cognitive a decrease in respiratory rate – although “usual” sign of respiratory depression was function (e.g. whether or not the patient both should be measured. stated, in the discussion, to be a decrease is confused). It is recognised that, as with the in ventilatory frequency. In another One common sedation scoring system other potential monitors of respiratory report a patient died after being given IM used is that in Table 1. Note that it depression discussed by the APSF above, morphine; over the two hours after IM indicates patients should be roused to increasing sedation suffers from a lack of injection he was noted to be “sleeping” assess their level of sedation. If this is specificity and sensitivity. However, is it and then “unresponsive”, and an order not done, the early onset of respiratory any worse than the other suggestions? was given to continue monitoring of depression can be missed, sometimes Monitoring for opioid-induced “vital signs”17. with fatal results19. Anecdotally, when respiratory depression needs to be Checking a patient’s level of sedation arterial PCO2 measurements have been available to all patients receiving opioids was considered by the American Society done on patients with a sedation score of by any route and in all acute pain of Anesthesiologists (ASA) Task Force 2 (as defined in Table 1), the levels tend to settings in both hospitals and at home. on Neuraxial Opioids to be important in be higher than 55mm Hg. Clinical practice would suggest that, in the detection of respiratory depression Furthermore, the assessment the absence of better clinical monitor, in patients given neuraxial opioids, of patients at night when they are sedation should become the “sixth as well as assessments of adequacy of “asleep” should be undertaken by vital sign”. ventilation and oxygenation18. However, simply evaluating their ability to “stir” It is recognised that there may be a it was noted only that “in cases with in response to mild stimulation (e.g. number of other reasons for sedation – other concerning signs, it is acceptable to taking a pulse or blood pressure reading) including administration of sedatives awaken a sleeping patient to assess level rather than vigorously waking them up such as benzodiazepines and some of consciousness”. (which leads to sleep deprivation and antihistamines (e.g. promethazine). It If a patient is not woken, it would dissatisfaction). follows that concurrent administration be possible for increasing sedation and of sedatives will interfere with the use respiratory depression to be missed Other monitors of sedation scoring as an indicator of unless the patient was at least roused Bedside capnometry devices are available respiratory depression but, as they – see below. This paper also stated, in but not in widespread use. They generally also increase the risk of respiratory contrast to the APSF position, that both work by sampling expired carbon- depression, they should be avoided the taskforce members and consultants dioxide through modified nasal prongs where possible. “disagree that pulse oximetry is more and may be used whilst administering likely to detect respiratory depression supplemental oxygen. than are clinical signs”.
58 ANZCA Bulletin December 2009 If a sedation score of two of more is 5. Cashman JN & Dolin SJ (2004) Respiratory 16. Ostermeier AM, Roizen MF, Hautkappe M reported, a reduction in opioid dose is and haemodynamic effects of acute et al (1997) Three sudden postoperative mandated, regardless of the patient’s pain postoperative pain management: evidence respiratory arrests associated with epidural from published data. Br J Anaesth 93(2): score. If the patient is uncomfortable, opioids in patients with sleep apnea. Anesth 212-23. Analg 85(2): 452-60. alternative and less sedating forms of 6. Larson MD, Itkin A & Severinghaus JW 17. Cullen DJ (2001) Obstructive sleep apnea pain relief will need to be added to the (2007) Postop hypoxia multifactorial and and postoperative analgesia--a potentially analgesic regimen. should be treated with supplemental dangerous combination. J Clin Anesth 13(2): oxygen. APSF Newsletter 22: 39. 83-5. Table 1: Sedation Scores 7. Dol in SJ, Cashman JN & Bland JM (2002) 18. Horlocker TT, Burton AW, Connis RT 0 awake, alert Effectiveness of acute postoperative pain et al (2009) Practice guidelines for the management: I. Evidence from published prevention, detection, and management 1 mild sedation, easy to rouse data. Br J Anaesth 89(3): 409-23. of respiratory depression associated 1s* asleep, easy to rouse 8. Dolin SJ & Cashman JN (2005) Tolerability with neuraxial opioid administration. 2 moderate sedation, easy to rouse, of acute postoperative pain management: Anesthesiology 110(2): 218-30. unable to remain awake nausea, vomiting, sedation, pruritus, and 19. Peady C (2007) Unauthorised access to the urinary retention. Evidence from published 3 difficult to rouse contents of a Graseby 3300 PCA pump. data. Br J Anaesth 95(5): 584-91. Anaesthesia 62(1): 98-9. * may not be used in some centres where a 9. Kopka A, Wallace E, Reilly G et al (2007) score of 1 is used whether or not the patient Observational study of perioperative is asleep PtcCO2 and SpO2 in non-ventilated patients receiving epidural infusion or patient- controlled analgesia using a single earlobe Associate Professor Pamela E Macintyre monitor (TOSCA). Br J Anaesth 99(4): 567-71. Royal Adelaide Hospital 10. McCormack JG & Kelly KP (2007) and Transcutaneous carbon dioxide monitoring. Associate Professor David A Scott Anaesthesia 62(8): 850-1. St Vincent’s Hospital, Melbourne 11. Ready LB, Oden R, Chadwick HS et al (1988) Development of an anesthesiology-based postoperative pain management service. References: Anesthesiology 68: 100-06. 1. Veterans Health Administration (2000) Pain as the 5th Vital Sign Toolkit. http://www1. 12. Shapiro A, Zohar E, Zaslansky R et al (2005) va.gov/pain_management/docs/TOOLKIT. The frequency and timing of respiratory pdf. Accessed November 2009 depression in 1524 postoperative patients treated with systemic or neuraxial 2. Vila H, Jr., Smith RA, Augustyniak MJ morphine. J Clin Anesth 17(7): 537-42. et al (2005) The efficacy and safety of pain management before and after 13. VanDercar DH, Martinez AP & De Lisser EA implementation of hospital-wide pain (1991) Sleep apnea syndromes: a potential management standards: is patient safety contraindication for patient-controlled compromised by treatment based solely on analgesia. Anesthesiology 74(3): 623-4. numerical pain ratings? Anesth Analg 101(2): 14. Etches RC (1994) Respiratory depression 474-80. associated with patient controlled 3. Weinger MB (2006-2007) Dangers of analgesia: a review of eight cases. Canadian postoperative opioids. APSF Newsletter 21: Journal of Anaesthesia 41: 125-32. 61-7. 15. Parikh SN, Stuchin SA, Maca C et al 4. Stoelting RK & Weinger MB (2009) Dangers (2002) Sleep apnea syndrome in patients of postoperative opioids - is there a cure? undergoing total joint arthroplasty. J APSF Newsletter 24: 25-32. Arthroplasty 17(5): 635-42.
ANZCA Bulletin December 2009 59 Medical research boosted by $600,000
ANZCA has allocated more than $600,000 to important and Project Grants exciting research initiatives to commence in 2010. It is hoped that A reappraisal of the sniffing position these projects will lead to significant improvements in patient and the Three Axes Alignment Theory safety and contribute to medical research worldwide. More than for direct laryngoscopy What is the best position for the head and neck 40 applications were received from Australia, New Zealand, to manage a patient’s airway? Anaesthetists Hong Kong, Singapore and Malaysia, and ANZCA was especially commonly use the “sniffing position” for tracheal intubation which aligns the oral, pleased to support a Scholarship Grant for a PhD student among pharyngeal and laryngeal axes and produces the 16 successful applications. Two continuing PhD students were a line of sight from the anaesthetist’s eye to the patient’s vocal cords. This position has also supported. ANZCA acknowledges and appreciates the many been taught and written in textbooks since generous contributions made to the ANZCA Foundation that its proposal by Magill in 1936 yet there has facilitate this important process. been little research since to support its current usage until it was contested by Adnet and co-workers in 2001, who concluded using an MRI study that alignment of the three axes was impossible. The current study will repeat Research award recommendations Adnet’s paper but substitute two curves – 1) The Harry Daly Research Award was awarded to Professor Matthew Chan for primary curve which is formed when the his project “Re-defining the Warning Criteria for Intraoperative Neurophysiologic previously described oral and pharyngeal Monitoring”. axes are joined and 2) the secondary curve which is produced from the pharyngeal and The Mundipharma ANZCA Research Fellowship was awarded to Dr Paul Wrigley laryngeal axes. The researchers expect that for his project “Regional changes in cerebral perfusion associated with persistent the radius of curvatures will increase with the spinal cord injury neuropathic pain”. sniffing position and therefore show that there is alignment of these curves with the line of The Pfizer ANZCA Research Fellowship was awarded to Professor Alan Merry for sight proving the sniffing position actually his project “Validation of the ‘WHO Surgical Safety Checklist’ to reduce postoperative works. morbidity and mortality – The Check WHO Study”. Dr Keith Greenland, Dr Michael Edwards, Royal Brisbane and Women’s Hospital, The ANS ANZCA Research Fellowship was awarded to Professor James Sleigh for his Australia. project “The genetics of the analgesic response to opioids in the post anaesthesia care unit”. $15,000 The JB Craig Research Award was awarded to Dr Phillip Finch for his project “Adrenergic receptor involvement in an animal model of complex regional pain Above from left: Professor Jamie Sleigh; syndrome type I”. Dr Philip Finch; Dr Keith Greenland.
ANZCA Bulletin December 2009 61 Medical research boosted by $600,000 continued
The genetics of the analgesic response Evaluation of exercise rehabilitation Determination of equivalent dose rates to opioids in the post anaesthesia for survivors of intensive care of metaraminol and phenylephrine to care unit Patients who survive ICU commonly prevent hypotension during elective After surgery: (i) some patients have little suffer from weakness and debilitation. Caesarean section under spinal pain, (ii) some patients have a lot of pain International literature has reported that anaesthesia but analgesic drugs work well to reduce these patients have reduced physical Vasopressors are frequently given to the pain, and (iii) some patients have a lot function and a poor quality of life up to six maintain maternal blood pressure during of pain but the analgesic drugs don’t work years following discharge. In this study, caesarean section under spinal anaesthesia. very well. Whilst some of this variation all ICU survivors with >5 days ICU stay will Two vasopressors, phenylephrine and can be explained by clinical factors, it be randomised to either a comprehensive metaraminol, are considered the most is likely a significant proportion of the physiotherapy rehabilitation program or suitable and effective drugs for maintaining variation is caused by intrinsic genetic standard care. Physical outcome measures the blood pressure in this setting, however factors. In this study, the researchers will along with validated quality of life we do not know which is more effective or determine whether or not EEG monitoring questionnaires will be used to evaluate even by how much exactly their potency can predict the requirements for analgesics the rehabilitation program at baseline, differs. In this study, the investigators will in the early post-operative period. They are three, six and 12 months post discharge randomly assign women to receive either collecting a large quantity of clinical data from ICU. Cost utility and cost effectiveness phenylephrine or metaraminol infusion about pain scores and the effect of drug of providing a rehabilitation program to during planned caesarean section. By treatment as well as samples for genetic survivors of ICU also will be assessed. It is varying the concentrations given during an analysis. Previous work shows that a hoped the introduction of a rehabilitation infusion over a fixed period, and measuring particular genetic variant of the morphine program will improve function and quality the effectiveness in maintaining normal receptor (A118G) occurs in about 16% of of life. This will potentially reduce the maternal blood pressure, dose rates of the population and is probably associated burden to patients, their family/carers and equivalent potency will be determined. This with the poor response to morphine. Using the community, allowing better utilisation information is required before a larger well- the results from this study, the researchers of resources and an improved quality of life. controlled comparison of the two drugs, would hope to pursue pre-operative genetic Dr Stephen Warrillow, Associate Professor powered to detect differences in important tests to predict exactly who is likely to Linda Denehy, Ms Sue Berney, Austin clinical outcomes, can be conducted. experience severe – or alternatively little – Health, Melbourne, Australia. postoperative pain. Dr Nolan McDonnell, Professor Mike Paech, University of WA, Perth, Australia. Professor James Sleigh, University of $20,000 Waitkaito, Hamilton, New Zealand. $10,000 $50,000
Above from left: Professor Paul Myles; Professor Matthew Chan.
62 ANZCA Bulletin December 2009 Regional changes in cerebral Validation of the “WHO Surgical Safety The Australian and New Zealand perfusion associated with persistent Checklist” to reduce postoperative Registry of Regional Anaesthesia spinal cord injury neuropathic pain morbidity and mortality - The Check (AURORA Study) (PhD Fellowship) Around 50% of patients with spinal cord WHO Study Many anaesthetists are now undertaking injury continue to suffer from persistent pain The World Health Organization (WHO) has peripheral nerve blocks guided by that cannot be relieved by currently available developed a checklist to make surgery safer ultrasound. Identifying problems after treatments. Improvements in treatment by reducing errors and improving team regional anesthesia is challenging because continue to be held back by our lack of work. A study from eight centres world-wide they occur rarely and identifying the root understanding as to why some people with showed that the checklist reduced patient cause of a complication can be difficult. spinal cord injury develop pain and others do harm and actually saved lives. Auckland Because ultrasound imaging allows the not. Recent research suggests that changes City Hospital was one of the centres, but only anaesthetist to image the needle, nerve and in the brain are crucial to the problem. This four operating rooms were involved, so there surrounding structures it is possible that it study will examine the long-term changes were not enough patients to see a significant may both improve the safety and quality of occurring in the brains of those people that benefit locally. Furthermore the standard regional anaesthesia. To determine if this develop neuropathic pain following spinal of medical care in New Zealand is already is true, the investigators will collect crucial cord injury. The study will involve 70 people higher than in some of the centres in the information describing contemporary and use a new brain imaging technique WHO study. This new study, using the same practice from a very large number of patients. called quantitative arterial spin labelling measures as before, will compare patient The internet will be used to facilitate this (QASL) to measure brain blood flow as an outcomes for 2006-2007 (before the checklist with an online interface (www. Regional. indicator of brain function. People with was introduced) with those in 2009-2010 anaesthsia.org.au) used to collect data into spinal cord injury and no pain, spinal cord (after its modification and adoption) at the a central database. The investigators plan to determine accurately risks associated with injury and neuropathic pain and people Auckland City Hospital. The research will nerve blocks and also factors that influence without spinal cord injury or pain will include enough patients to see whether the an individual patient having a complication. undergo a single brain scanning session and benefits of in the international WHO study Such information has hitherto not been comparisons will be made between the three can in fact be gained with the modified checklist in New Zealand. available and will critically inform clinical groups to determine differences in long-term practice in addition to having public health Professor Alan Merry, Dr Simon Mitchell, brain function. and health policy relevance. Dr Paul Wrigley, Dr Luke Henderson, Associate Professor Papaarangi Reid, University of Auckland, New Zealand. Dr Michael Barrington, Associate Clinical Assoc Prof Philip Siddall, Pain Professor Danny Liew, Dr Rowan Management Research Institute, Royal $51,751 Thomas, St Vincent’s Hospital, North Shore Hospital, Sydney, Australia. Melbourne, Australia. $45,645 Adrenergic receptor involvement in an animal model of complex regional $70,000 per annum for three years pain syndrome type I ENIGMA-II trial long-term Re-defining the warning criteria for follow-up study Complex regional pain syndrome (CRPS) starts after various types of injury, intraoperative neurophysiologic Nitrous oxide is very widely used sometimes quite minor, with or without monitoring internationally. The ENIGMA-II trial is a obvious injury to nerves. One explanation Spinal cord monitoring is an established five-year study of 7000 patients in about 40 for the persistence of CRPS is that an technique to provide real time information hospitals around the world, and is already abnormal connection develops between the on the functional status of the nervous underway. Patients are randomly allocated pain processing system and the sympathetic system during spine surgery. This to one or two routinely used anaesthetics: nervous system. Indeed, research findings monitoring can detect impending injury either (i) general anaesthesia that includes support the idea that sympathetic nerves so that timely intervention can be applied nitrous oxide, or (ii) general anaesthesia contribute to pain after peripheral nerve before permanent damage occurs. Clearly, that does not include nitrous oxide. The injury, has shown that pain-signalling this requires early recognition of the nerves contain adrenergic receptors, and aim of the follow-up study is to investigate “warning signals”. Unfortunately, the that the density of these receptors increases the long term effects of nitrous oxide in current recommendation for these critical greatly after peripheral nerve injury. The thresholds has not been validated. The these patients. Six thousand patients who investigators wish to determine whether researchers plan to perform a systematic are participating in the ENIGMA-II trial the density of adrenergic receptors also study to determine the threshold will be followed up at 12 months after increases after injuries that spare major changes of monitoring signals, beyond surgery, to compare the incidence of cardiac peripheral nerves and will collaborate which neurologic deficit occurs in a pig complications (including myocardial with researchers from Stanford University model of spinal cord injury. Appropriate infarction) and death in those who did and to test their hypothesis using an animal interpretation of these signals will be did not receive nitrous oxide as part of the model. This research may explain why so important to avoid inadvertent spinal anaesthetic. many different forms of environmental cord injury. The impact on patients, their stimulation aggravate pain and distress in families, and the society as a whole in terms Prof Paul Myles, Alfred Hospital, patients with CRPS, and why current forms of decreasing the number of patients who Melbourne, Australia; Associate of treatment are often ineffective. become paraplegic after spine surgery will Professor Kate Leslie, Royal Melbourne be socially and economically significant. Hospital, Melbourne, Australia; Dr Philip Finch, Professor Peter Professor Matthew Chan, Chinese Drummond, Professor Jacqueline Professor Matthew Chan, Professor University of Hong Kong, PRC. Phillips, Murdoch University, WA, Tony Gin, Chinese University of Australia. Hong Kong, PRC. $60,000 $47,000 $59,438
ANZCA Bulletin December 2009 63 Medical research boosted by $600,000 continued
Perfusion levels and correlation of pain processing regions in the brains of chronic pain patients and healthy people People with chronic pain can experience low mood and are less active. This study will use magnetic resonance imaging (MRI) to look for brain regions that are involved in emotional and behavioural responses to pain. The objective of the study is to identify new options for the management of the negative impact of pain. The project is a collaboration between Melbourne Health, the University of Melbourne and the Florey Neuroscience Institutes. Dr Malcolm Hogg, Dr Michael Farrell The Royal Melbourne Hospital, Australia. $40,000
Does remote ischemic post- Comparison of oesophageal doppler conditioning reduce ischaemia Novice investigator with arterial pressure waveform reperfusion injury in patients derived cardiac output and stroke undergoing lung transplantation? grants volume variation Lung transplantation is the treatment The use of mechanically skinned The aim of this project is to compare of choice for a number of incurable lung muscle fibres for the diagnosis devices that can measure cardiac output diseases, but after new lungs are implanted, of MH: a pilot study non-invasively (the CardioQ ™ device from a significant number of these lungs will Deltex Medical, the Edwards Lifesciences experience primary graft dysfunction Malignant hyperthermia (MH) is an inherited disease that can be triggered by FloTrac/Vigeleo ™ system and the (PGD). PGD is caused by a number of factors LidcoRapid system). In the past, cardiac including the period when the donor lungs common anaesthetics. It can potentially be fatal and it is therefore important to output could only be measured invasively are ischaemic and the unstable period using a pulmonary artery catheter (PAC). when the new lungs are first reperfused. diagnose the disease in patients who are at risk. Current testing involves taking This device had some potentially serious The aim of this study is to discover if short adverse effects. A new generation of periods of ischaemia to muscle using a thigh a sample of muscle from the outer thigh of a patient and exposing that tissue to non-invasive cardiac output monitors tourniquet before lung transplantation is emerging in clinical medicine that protects the new lungs from injury and anaesthetic agents which trigger an MH episode. The sample of muscle taken is are safe and can be used routinely. This improves lung function. This phenomenon study is primarily aimed at comparing is called remote ischaemic preconditioning. approximately 4cm by 3cm and recovery can be painful. This study will look at a new how consistently the devices demonstrate The investigators will randomly assign changes in cardiac output during surgery. To patients requiring lung transplantation to test to see whether the muscle sample can be smaller and therefore less painful for do this, the study plans to monitor patients receive 3 short periods of thigh ischaemia having major surgery using both devices at or no treatment before the new lungs are patients being tested. We need to make sure that the new test is as accurate and reliable the same time by accurately recording the implanted and perfused with blood again. times and the events that affect the heart Oxygen levels and oxygen requirement will as the original one and we are trying to establish this with our study. and circulation. The investigators will also be measured at various time points in both evaluate each device’s ease of use and check groups to see if our simple intervention Dr Brad Hockey, Supervisor: Dr Robyn their accuracy by comparing them with the improves the function of transplanted lungs. Gillies, Royal Melbourne Hospital, more invasive PAC device in a smaller group Dr Enjarn Lin, The Alfred Hospital, Australia. of patients, who already require this for Melbourne, Australia. $18,570 their operation. $20,000 Dr Tuong Phan, Supervisor: Dr Roman Kluger, St Vincent’s Hospital, Melbourne, Australia. $15,000
Above from left: Dr Enjarn Lin and Dr Silvana Marasco.
64 ANZCA Bulletin December 2009 The process is rigorous and transparent. Conflicts of interest are recorded and Simulation/ committee members are excluded from consideration of any grants for which they have conflicts. An independent community representative, Dr Angela Watt, has education grant been appointed to the Research Committee to contribute to the impartiality and Training for debriefing after appropriateness of the process. simulation of anaesthetic crises: current practices The Research Committee Associate Professor Dr Imogen Mitchell members are: Marianne Chapman A program of research in Australia and New Dr Simon Mitchell Zealand is currently examining the key role Professor Alan Merry, Chair Dr Jeremy Cooper of debriefing after simulation experiences Dr Richard Morris that have been designed to increase Associate Professor Kate Professor Michael Cousins Leslie, Deputy Chair Dr Sheila Muldoon anaesthetist’s skills in crisis management. Dr Dean Cowie Existing research, with professionals Professor Andrew Bersten Dr Toby Newton-John such as doctors and pilots, indicates that Dr Andrew Davidson Dr Irene Ng the debriefing discussion that follows a Associate Professor David Dr Andrew Davies simulation is a key element for learning. Cottee Professor Warwick Ngan Kee Effective debriefing enables trainees to Professor Tony Gin Professor Doug Elliott investigate and reflect on their actions Dr Alistair Nichol Dr Michael Fink and the actions of others, integrating their Dr Chris Hayes Dr Michael O’Leary current knowledge and beliefs with the Mr Ian Higgins, Director, Dr Steven Fowler perspectives of expert professionals and Dr David Olive ANZCA Foundation Dr Michael Fredrickson with theories of best practice. This study Dr Neil Orford will investigate what happens during the Professor Paul Myles Dr Craig French debriefing that follows simulated crises Professor Harry Owen Professor Mike Paech Associate Professor Sandy that are managed by trainee anaesthetists. Dr Donald Oxorn The results of this study will be used to Associate Professor Tony Garden help with the future design of simulation- Quail Dr David Gattas Dr Margaret Perry based training, particularly the training Professor Stephan Schug Dr Philip Peyton of instructors. Dr Neville Gibbs Associate Professor Sandy Garden, Dr Associate Professor David Dr Michael Gillham Dr Neil Pollock Deidre Le Fevre, Associate Professor Scott Dr Genevieve Goulding Dr Richard Riley Jenny Weller, Massey University, Associate Professor Tim Wellington. Short Dr Paul Gray Associate Professor Colin Royse $32,226 Associate Professor Phil Dr Peter Harrigan Siddall Professor Bill Runciman Dr William Harrop-Griffiths Associate Professor Dave Associate Professor John Dr Peter Hebbard Grant review process Story Santamaria Dr Luke Henderson Each year many willing members of the Dr Angela Watt, Community Dr Andreas Schibler ANZCA community invaluably contribute representative Dr Robert Henderson Dr Ian Seppelt to the process of selecting the best research grants for support by thoroughly Dr Steve Webb Dr Graham Hocking Dr Yahya Shehabi reviewing and rating each grant Dr Dan Wheeler application. The process is dependent Dr Malcolm Hogg Dr David Sidebotham upon this support. Each application Dr Daryl Jones Dr Brendan Silbert is reviewed by three independent Grant reviewers for the reviewers who are carefully chosen for 2010 grant round Associate Professor Robert Associate Professor Scott Kennedy their relevance to the particular grant Dr Christopher Acott Simmons application. The table below lists this Dr Ross Kerridge Professor Jamie Sleigh year’s reviewers for the 2010 grant round. Dr Leanne Aitken Dr Michal Kluger ANZCA is sincerely grateful to these Associate Professor David Dr Paul Soeding reviewers for their assistance. Many of Baines Mary Lawson Professor Andrew Somogyi the reviewers review many more than one grant. Dr Paul Baker Dr Thomas Ledowski Dr David Sturgess The ANZCA Research Committee Dr Michael Barrington Professor Guy Ludbrook Dr Lawrence Tsen members each read all of the grants, Professor Rinaldo Bellomo Associate Professor Ross Professor Bala Venkatesh select the reviewers, read the reviews, MacPherson collate the information and act as Professor Duncan Blake Dr Suellen Walker Professor Mervyn Maze overall spokesperson for each grant, Dr Simon Body Associate Professor Jenny and attend meetings at which the final Dr Timothy McCulloch Weller recommendations to Council are made. Associate Professor Robert They also contribute as reviewers Boots Professor Elspeth Dr Dan Wheeler McLachlan of grants. Dr Andrew Buettner
ANZCA Bulletin December 2009 65 Philanthropy The ANZCA Foundation An initiative of the Australian and New Zealand College of Anaesthetists
Back row from left: Associate Professor Kate Leslie, Mr Kieren Perkins, Mr John Astbury, Mr Neil Batt Centre row from left: Mr James Strong, Professor Michael Cousins, Mr Geoff Linton, Mr Michael Gorton Front: Professor Alan Merry Absent: Dr Leona Wilson and Ms Yvonne Kenny.
Mr Neil Batt, AO, is Executive Director of Mr James Strong, AO, is the Chairman Meet the ANZCA the Australian Centre for Health Research of Insurance Australia Group (IAG), Foundation board Limited. He had a substantial career in Woolworths Limited, the Australia Council politics having held Tasmanian ministerial for the Arts and Kathmandu. He is also a Mr Michael Gorton, AM, is a principal with portfolios for transport, education, director of Qantas Airways Limited and the solicitors Russell Kennedy with experience economic development and forestry Australian Grand Prix Corporation. James in corporate and commercial law and and concluding his political career as was the chief executive and managing a special interest in health law. He has Tasmanian Deputy Premier and Treasurer. director of Qantas Airways Limited from qualifications in law and commerce and has In addition, he was the national President 1993 to 2001. James has been admitted as an extensive background in the community of the Australian Labor Party. Neil has been a barrister and/or solicitor in various state sector. Michael has honorary fellowships active in charitable activities including jurisdictions in Australia. In 2006, James with the Royal Australasian College of Chair of the International Diabetes Institute. was made an Officer of the Order Surgeons and ANZCA. Mr John Astbury is a director of of Australia. Mr Geoff Linton was an audit partner with Woolworths and is a member of the Associate Professor Kate Leslie, FANZCA, Ernst & Young in the financial services Audit, Risk Management and Compliance FAICD, is the vice-president of ANZCA and industry for 25 years. Upon his retirement Committee and the Corporate Governance Chair of the College’s Training Accreditation from Ernst & Young he became secretary of Committee. He was previously a director of Committee. She has served as Chair of the Collier Charitable Fund. He is a company AMP and of Insurance Australia Group (IAG). the College’s Annual Scientific Meeting director and Audit Committee member. Previous roles include Finance Director of Committee (2002-2004) the Communications Lend Lease Corporation and chief general and Fellowship Affairs Committee (2002- manager, National Australian Bank. 2004) the Research Committee (2004-2008) and was the Honorary Treasurer for four years (2004-2008).
66 ANZCA Bulletin December 2009 The Foundation is grateful to the Sponsors Dr M P Jaimon Dr R K Boyle Dr M L Soh following people and organisations who Pfizer Australia Dr P J Houlton Dr S D Newell Dr M V Tuck have supported our programs in 2009: St Jude Medical Dr P J Lawrence South Australia Dr M Wallace The Patrons Program Mundipharma Dr P Liston Dr A Flabouris Dr N J Colin-Thome Governor Dr JB Craig WA Schering-Plough Dr R C Perera Dr I Augstkalns Dr R Kishen Life Patrons Dr William Howard VIC Dr R S Schumacher Dr R M Orme 2009 Donors Dr J K Somfleth Associate Professor Dr S M Barratt Dr R M Voselis Australia Dr J L Moran John Rigg WA Professor R B Holland Dr S D Reilly ACT Professor A D Bersten Patrons On Call Locums NSW Dr M P Burt Queensland Professor J Russell Western Australia Dr Richard Vaughan WA Dr A E Bruce Dr H B Hamzah New South Wales Tasmania Dr George Boffa and Dr C A Johnston Dr P G Beahan Assoc Prof S R Sundaraj Dr A R Beswick Mrs Laura Boffa NSW Dr D Berens Dr R J Vaughan Dr A J MacLennan Dr D Pereira Dr Bernard Cook NSW Dr D H McConnel Dr W R Thompson Dr A R Singh Dr D W Wilson Dr John Gray VIC Dr D J Berge Dr A V Jaumees Dr J S Henshaw Overseas Dr Tim Allen SA Dr D S Ho Dr A Yusuf Dr M Martyn Hong Kong Mr Gordon Moffatt VIC Dr G E Power Dr C J Lowry Victoria Dr C C Li Associate Professor Dr G I Rice Dr C M Kane Assoc Prof Kate Leslie Dr J C Lui Kate Leslie VIC Dr J D O’Reilly Dr C T Lamond Dr A J Penberthy Dr K S Cheung Professor Tess Cramond QLD Dr J M McLean Dr D W Collins Dr A S Gunatunga Dr L L Lau Dr Ying Hung Mok HK Dr J R Bellapart Dr F M Re Dr B J Peers South Africa Dr M D Cobcroft The John Snow Society Dr G C Lindsay Dr D A Cowie Dr D A Roux Dr M E O’Loughlin Dr Leona Wilson NZ Dr G Thanakrishnan Dr E Rubinstein Dr M K Duncan Switzerland Associate Professor Kate Leslie VIC Dr I B Dugan Dr G E Littlejohn Dr M M Tol Dr E Parisod Professor Michael Cousins Dr J D Chee Dr G Liu Dr M Pabari United Kingdom and Mrs Michelle Cousins NSW Dr L J McBride Dr I Rechtman Dr M Vellaichamy Dr J R Lo Dr Elaine Kluver QLD Dr M A Lovell Dr I S Smith Dr N Crimmins Dr R M Mayall Dr Murray and Mrs Adeline Taverner VIC Dr M C Kilminster Dr J F Oswald Dr P K Lane Dr Cedric Hoskins and Dr M J Pink Dr L J O’Halloran Dr P T Tran Mrs Doreen Hoskins NZ Dr M K Saxena Dr M B Suss Dr R J Geytenbeek Mr Ian Higgins VIC
Dr Leona Wilson, FANZCA, FAICD, is the Professor Alan Merry, ONZM, FANZCA, Ms Yvonne Kenny AM is one of the most President of ANZCA. As a Fellow of the FFPMANZCA, FRCA, is head of the distinguished sopranos of her generation. College and a member of Council, Dr Wilson Department of Anaesthesiology, University She was born in Sydney and after achieving has contributed to a wide range of College of Auckland, an ANZCA councillor and a BSC in Biochemistry, went to London to activities including Chair of the Education Chair of the College’s Quality and Safety and study voice. She made her operatic debut in and Training Committee and the Hospital Research Committee. He is also Chair of the 1975 after which she joined the Royal Opera Accreditation Committee. Dr Wilson is Quality and Safety of Practice Committee House, Covent Garden where she remained a the first female anaesthetist to be elected of the World Federation of Societies of member of the company until 1994. She was President of ANZCA and the first New Anaesthesiologists. Professor Merry is made a Member of the Order of Australia in Zealander to hold the position. co-author of the publication Errors, 1989 for services to music and also conferred an Honorary Doctorate in Music by the Mr Kieren Perkins, OAM, is a former Medicine and the Law (CUP, 2001). University of Sydney in 1999. professional swimmer. One of the world’s Professor Michael Cousins, AM, best long distance swimmers, he won two FANZCA, FFPMANZCA, is a past president Olympic gold medals in 1992 and 1996, and of the College and is Chair of the ANZCA To make a bequest, become a patron a silver medal in 1992 and 2000. Since his Foundation. He was the founding dean and for all other inquiries please contact: retirement from professional swimming he of the Faculty of Pain Medicine and has Ian Higgins has worked in the broadcast media. He is a also served as Chair of the Committee of Director, the ANZCA Foundation board member of Swimming Australia and Presidents of Medical Colleges. He is a ANZCA House the Starlight Foundation. In the Australia councillor of the Australian Medical Council 630 St Kilda Road Day Honours of 1992 he was awarded the and is Chair of the Steering Committee Melbourne VIC 3004 Medal of the Order of Australia (OAM). He is of the National Pain Summit. Tel: +61 3 9093 4900 an Australian Living Treasure. Fax: +61 3 9510 6786 E-mail: [email protected]
ANZCA Bulletin December 2009 67 ANZCA in the news
Herald Sun Brief: RANZCA Tuesday 8/9/2009 Page: 18 Section: General News Region: Melbourne Circulation: 518,000 Type: Capital City Daily Size: 73.62 sq.cms. Published: MTWTFS-
“When the tidal wave struck they obviously got thrown around like in a washing machine and so there were a lot of limb fractures and severe cuts.” Brisbane anaesthetist Steve Wood tells ABC radio about his experiences as part of New Zealand Herald Brief: RANZCA the rapid response teamTuesday that 22/9/2009 went to Samoa after the Page: 3 tsunami struck on SeptemberSection: General 29. News Region: Auckland Circulation: 180,939 Type: Metro Size: 145.60 sq.cms. Published: MTWTF--
Pain, Propofol and an ex-PM. These are just three of the diverse subjects involving anaesthetists, pain medicine specialists and intensivists that have drawn media attention in recent months.
The launch of the National Pain Strategy Another very big story in recent weeks guests including Associate Professor on Sunday, October 18 generated more has been the separation of conjoined David Scott on her two-hour program than 40 interviews, talkback calls and Bangladeshi twins Trishna and Krishna from the Department of Anaesthesia at news reports on radio and resulted in at Melbourne’s Royal Children’s Hospital. Melbourne’s St Vincent’s Hospital. PMCA licensed copy. You may not further copy, reproduce, record, retransmit, sell, publish, distribute, share or 18 newspaper articles and three The hospital’s head of anaesthesia,store thisDr information Ian without the Aprior Media written consent Contacts of the Print Media Guide Copyright Agency. that Ph lists +64-4-498-4488 Ref: 57352725 television reports. McKenzie, played a major role in orkeeping email [email protected] forFellows further information. with expertise in particular areas Also popular was the report by Dr an enthralled public up to date with the is being prepared and the search for good Penelope Briscoe (Dean, Faculty of Pain twins’ progress. stories is ongoing – generally, there is Medicine) in the September ANZCA Also part of a major news event were a thirst for health-related issues. Bulletin that discussed the growing Brisbane’s Steven Cook and Adelaide’s The communications unit can prescription drug abuse problem. The Gerry Neumeister who went to Samoa approach the media and also advise references to celebrity (Heath Ledger and soon after the tsunami and told their Fellows on what to expect when they Michael Jackson) in Dr Briscoe’s article stories on local radio on return. are to be interviewed. helped spark media attention. ANZCA put out a statement when a Similarly, former Prime Minister, British Medical Journal published a study John Howard’s anaphylactic reaction to in October that showed a spike in adverse anaesthesia and Michael Jackson’s death events when trainees begin their hospital linked to Propofol abuse were taken rotations and a media release to announce up by the media. In both cases, ANZCA the launch of the Surgical Safety Checklist spokespeopleCopyright were Agency able Limited to reassure (CAL) licenced the copyin Australia and NewRef: Zealand 56707711 in August. public of their safety when in the hands In November, 3AW’s Talking Health of qualified anaesthetists. presenter, Dr Sally Cockburn, had three
68 ANZCA Bulletin December 2009 NZPA Newswire Brief: RANZCA Thursday 27/8/2009 Section: National Region: NZ National Type: National Published: MTWTFSS
SURGERY CHECKLIST TO HELP PREVENT INJURY IN HOSPITALS EMBARGOED TO 10.30AM Wellington, Aug 27 NZPA - A surgery checklist to help ensure doctors operate on the correct part of the right person was announced today. Every hospital in New Zealand and Australia will be receive the checklist, part of a World Health Organisation initiative to reduce mortality rates and complications during surgery. The 21-item checklist will take just two minutes to complete and will be done in three phases -- before, during and after surgery. It will include checking the patient's identity, operation site, availability of equipment and labelling specimens for testing. Speaking at its launch, Health Minister Tony Ryall said while "most" patients received good care a Ministerial Review Group report found 44,000 people suffered unintended injury in hospital caused by the management of their injury. Healthcare workers "suffer perpetual information overload" and it was hard for one person to remember everything. The checklist was a "simple improvement, yet it has such a significant effect", Mr Ryall said. "I strongly encourage all clinicians with the support of their managers to adopt the Surgical Safety Checklist in their hospitals." The Royal Australasian College of Surgeons censor in chief Ian Civil said the list had "real potential to save lives, reduce operating room errors, and improve patient safety". "We want to see it displayed in every operating theatre in every hospital in New Zealand and Australia." The Australian and New Zealand College of Anaesthetists Quality and Safety Committee chairman Professor Alan Merry said the checklist involved no additional expense to the hospital or patient. A global trial of the list, part of which was carried out in Auckland, found death rates for surgical patients fell from 1.5 percent to 0.8 percent after its introduction. Inpatient complications fell from 11 percent to 7 percent. Prof Merry, who was the principal investigator at Auckland City Hospital for the trial, said the checklist was a very simple clinical tool that would have an enormous impact on preventing mishaps and associated complications. NZPA PAR kc kn 27/08/09 09-42NZ
Australian Brief: RANZCA Monday 19/10/2009 Page: 7 Section: General News Region: Australia Circulation: 138,765 Type: National Size: 122.96 sq.cms. Published: MTWTF
PMCA licensed copy. You may not further copy, reproduce, record, retransmit, sell, publish, distribute, share or store this information without the prior written consent of the Print Media Copyright Agency. Ph +64-4-498-4488 Ref: 56195476 or email [email protected] for further information.
Media releases distributed by ANZCA Since August, ANZCA (August – November) has generated…
“World-first National Pain Strategy launched” (Sunday October 18, 2009) 77 print and online stories “Leading pain specialists gather for Melbourne meeting” 83 radio interviews (Friday October 16, 2009) 19 radio news stories “College welcomes study on trainee doctors” (Wednesday October 14, 2009) 5 television reports “Rural lives saved by new mobile heart-lung machine service”
(Monday October 5, 2009) Copyright Agency Limited (CAL) licenced copy Ref: 58613227 Anaesthetists Steve Cook, Gerry Neumeister in Samoa (Monday October 5, 2009 and Tuesday October 6) “Bulletin: New registry providing vital flu information” (Tuesday September 22, 2009 in New Zealand) “ANZCA Bulletin out today: Australia’s prescription drug abuse problem/ New registry providing vital flu information” (Monday September 21, 2009) “John Howard story: anaphylactic shock and anaesthesia” (Monday September 7, 2009) ANZCA’s communications unit is always looking for good news or “Surgical Safety Checklist will save lives” general interest stories that can (Thursday August 27, 2009 in New Zealand) be promoted in the media. If you have an idea, please contact media “Michael Jackson story – use of Propofol” (Tuesday August 25, 2009) manager, Clea Hincks, at ANZCA via “Simple tool will save lives” (Wednesday August 19, 2009 in Australia) e-mail [email protected] or by phone (03) 9093 4917 or 0418 583 276.
ANZCA Bulletin December 2009 69 Library update
“Anaesthesia for fast track cardiac Health and safety New EBP website surgery” alerts - ECRI Institute launched Varadarajan B. NHS Evidence - surgery, anaesthesia, perioperative and critical notices Centre For Evidence Based care (published September 2009; Practice Australasia downloaded 19 November 2009). The (virtual) Centre for Evidence Based Practice Australasia (CEBPA) is not a Available from: http://www.library. typical website but an evolving “cloud” nhs.uk/theatres/viewResource. (or collection) of EBP resources from aspx?resid=324726 across Australia and New Zealand, with “Anticoagulants and antiplatelet agents: particular emphasis on Australasian regional anaesthesia” content. http://www.cebpa.info/ The ANZCA Library subscribes to ECRI Available from: http://www.library. publications on operating room risk New research in anaesthesia, pain nhs.uk/theatres/viewResource. management and health device alerts and medicine and intensive care medicine aspx?resid=320359&code=04c3c8 information. Check this space regularly Recent Cochrane Library Reviews 08065251347f5b4c578182427f for updates on the latest information The Cochrane Pain, Palliative and “Does regional anaesthesia improve produced by ECRI. Supportive Care Group has recently outcome after total hip arthroplasty? Recent notices include: published a number of systematic reviews A systematic review” Top 10 technology hazards for 2010 on interventions for acute postoperative Macfarlane AJ, et al British Journal of pain in adults. Browse by review group The top five are: Anaesthesia Vol. 103, Issue 3, Pages in the Cochrane Library to view the new 335-45, 2009 1. Cross-contamination from flexible publications. endoscopes “Perioperative peripheral nerve injuries: http://www.mrw.interscience.wiley.com/ 2. Alarm hazards a retrospective study of 380,680 cases cochrane/cochrane_clsysrev_crglist_ during a 10-year period at a single 3. Surgical fires fs.html institution” 4. CT radiation dose “Hypothermia for neuroprotection Welch, MB., et al. Anesthesiology. 5. Retained devices and unretrieved in adults after cardiopulmonary Volume 111, Issue 3, Pages 490-497, 2009 fragments resuscitation” “Should dosing of rocuronium in obese Health Devices, Vol. 38, No. 9, Arrich J, Holzer M, Herkner H, Müllner M. patients be based on ideal or corrected September 2009 Cochrane Database of Systematic Reviews body weight?” 2009, Issue 4. Art. No.: CD004128. DOI: - Real-time locating systems 10.1002/14651858.CD004128.pub2. Meyhoff, Christian S., et al. Anesthesia - The Basics of benchmarking & Analgesia, Volume 109, Issue 3, Pages Health Devices, Vol. 38, No. 10, “Local anaesthetic wound infiltration 787-792, 2009 October 2009 and abdominal nerves block during caesarean section for postoperative pain “Anaesthesia and deep brain - Surgical fire prevention guide relief” stimulation” - Integrating your OR for less Dobbs, P., Hoyle, J and Rowe, J. Bamigboye AA, Hofmeyr GJ. Cochrane Continuing Education in Anaesthesia, Operating Room Risk Management Database of Systematic Reviews 2009, Critical Care & Pain, Volume 9, Issue 5, Executive Summaries Issue 3. Art. No.: CD006954. DOI: Pages 157-161, 2009 - Obstetric liability: an overview 10.1002/14651858.CD006954.pub2. - Event reporting http://mrw.interscience.wiley.com/ “Safe Management of Anaesthetic Related Equipment” - Use of reprocessed single-use cochrane/clsysrev/articles/CD006954/ New AAGBI Guideline medical devices. frame.html “Non-pharmacological interventions for http://www.aagbi.org/publications/ Pain medicine assisting the induction of anaesthesia in guidelines/docs/safe_management_ children” 2009.pdf book collection Yip P, Middleton P, Cyna AM, Carlyle AV. The ANZCA Library has created a direct Cochrane Database of Systematic Reviews link to pain-related books held in the 2009, Issue 3. Art. No.: CD006447. DOI: collection via the library catalogue. 10.1002/14651858.CD006447.pub2. Log-in to the ANZCA/FPM website and http://mrw.interscience.wiley.com/ link to the library catalogue to view the cochrane/clsysrev/articles/CD006447/ large range of books in the pain area. frame.html http://www.anzca.edu.au/resources/ library/book-catalogue.html
ANZCA Bulletin December 2009 71 Library update continued
New Titles Manage your pain: Practical and Safer surgery: analysing behaviour in positive ways of adapting to chronic the operating theatre Flin, Rhona (ed); Chronic pain for dummies Kassan, pain Nicolas, M; Molloy, A; Tonkin, L; Mitchell, Lucy (ed). (Surrey, England: Stuart S; Vierck, Charles J; Vierck, Beeston, L. (Australian Broadcasting Ashgate, 2009). Elizabeth. (Hoboken, NJ: Wiley, 2008). Corporation - Sydney, Australia:
HarperCollins Publishers, Inc, 2006).
War surgery in Afghanistan and Iraq: Diagnostic imaging in critical care: a series of cases, 2003-2007 Woodruff, a problem based approach Joyce, Chris; Bob (foreword by). (Falls Church, Va.: Saad, Nivene; Kruger, Peter; Foot, Carole; Manual of intensive care medicine Office of the Surgeon General, United Blackwell, Nicki. (Sydney: Churchill Irwin, Richard S (ed); Rippe, James M (ed). States Army, 2008). Livingstone Elsevier, 2010). (5th ed - Baltimore: Lippincott Williams and Wilkins, 2010).
Effective writing for health Books can be requested via the professional: A practical guide Physical diagnosis of pain: an atlas of ANZCA Library catalogue to getting published Johnstone, signs and symptoms Waldman, Steven www.anzca.edu.au/resources/library/ Megan-Jane. (Crows Nest, NSW: D. (2nd ed - Philadelphia, PA: Saunders book-catalogue.html Allen & Unwin, 2004). Elsevier, 2010). ANZCA members can borrow a maximum of five books at once from the ANZCA Library. Loans are for three weeks and can be renewed on request.
Members can also reserve items that are out on loan. Melbourne-based members are encouraged to visit the ANZCA Library to collect requested books. Items will be sent to other library users within Australia. A core collection of the anaesthetic syllabus textbooks is available A practical guide for medical teachers Ganong’s review of medical physiology for loan from the New Zealand office of Barrett, Kim E. (ed); Barman, Susan M. Dent, JA (ed); Harden, RM (ed) (3rd ed - the College. A list of the New Zealand (ed); Boitano, Scott (ed); Brooks, Heddwen Edinburgh: Churchill Livingstone, 2009). books can be accessed by selecting “New L. (ed); Ganong, WF (23rd ed New York: Zealand” from the “Location” drop-down McGraw-Hill Medical, 2010). box of the catalogue. When requesting an item from the catalogue,
please remember to include your name, ID number and postal address to ensure prompt delivery.
Contact the Library www.anzca.edu.au/resources/library Phone: +61 3 8517 5305 Fax: +61 3 8517 5381 E-mail: [email protected]
72 ANZCA Bulletin December 2009 Regions
New South Queensland Wales
There have been two combined ANZCA/ ASA Continuing Medical Education dinner meetings in the past three months. Dr Mark Warner spoke in September on the topic of “How new technologies and practices will influence perioperative safety”. Dr Warner is the Professor of Anesthesiology at the Mayo Clinic College of Medicine. The second meeting was held in November at Victoria Park Golf Course. Professor André Van Zundert, M.D., Ph.D., F.R.C.A. spoke on “Videolaryngoscopy – the end of the classic laryngoscope” which The Novotel Wollongong hosted the was followed by a practical workshop spring CME in November on the theme in videolaryngoscopy for participants. of “Risky business”, looking at aspects Professor Van Zundert is from the of risk management and mitigation in Department of Anaesthesiology, ICU & contemporary anaesthetic practice. Pain Therapy at the Catharina Hospital- The lectures, small group discussions Brabant Medical School, Eindhoven, and workshops to tailor CPD needs Netherlands. were attended by 130 delegates. The A Faculty of Pain Medicine dinner meeting started with a keynote talk by meeting was held in October. Dr Suellen Professor Ross Kerridge on what and how Walker, a senior clinical lecturer and preoperative assessments should be done. consultant in paediatric anaesthesia and This was complemented by Roger Traill pain management at UCL Institute of Child and John Ellingham talking about how Health and Great Ormond Street Hospital, they do it in the public and the private London, UK, joined us and spoke on the systems. The weekend heard from invited topic “Pain in children”. obstetricians, cardiologists, respiratory Queensland has almost completed physicians, intensivists, endocrinologists, the primary lecture program for semester radiologists and anaesthetists, and then two which has been held on the second there was time to swim, exercise or just Saturday of each month. We’ve also held relax. Positive feedback was received on the primary practice and the final practice the theme, the talks, the format and the vivas evenings. Thank you to all Fellows venue, and we look forward to doing it all for their support and, in particular, again next year in Port Macquarie. lecturers: Dr Paul Frank, Dr Ros Purcell, Dr Matt Kelso, Dr Gamini Wijerathne, Dr David Trappett, Dr Bruce Hammonds, Above: Delegates from the NSW CME Dr Peter Watt, Dr Mark Lai, Dr Cameron participating in a workshop. Hastie, Dr Kim Vidhani, Dr Justine Right from top: Delegates in a workshop; Dr Alan Rubinstein with the “Harvey” McCarthy and Dr Gabe Mar Fan. simulator; Dr Richard Connolly and Dr Ross Kerridge at dinner.
74 ANZCA Bulletin December 2009 Australian Victoria Capital Territory
The Victorian Regional Committee primary full-time course was held from November 16-27 at ANZCA House. The course was essentially for trainees preparing to sit the primary examination early in 2010. A record number of 61 attendees were registered and included trainees from interstate and New Zealand. The course was very successful and this was due to the valuable time and hard work of the lecturers and mock examiners, and the organisational skills of the course coordinator. The final session was comprised of 2009 Canberra Floriade Meeting mock viva examinations. This year, 17 The ACT ANZCA/ASA Combined CME Fellows attended the College to give the Meeting was held in September. The candidates a mixture of examination meeting was well supported with more practice, top tips and reassurance. than 120 local, interstate and overseas delegates and 22 healthcare industry From top right: Interstate trainees; mock representatives attending. The two-day viva examiners; Dr Fred Rosewarne (right), event included international speakers, a foundation lecturer of the primary full-time Professor Patrick Wouters of the University course presented “Physics for Anaesthetists” Hospital Ghent, Belgium, who gave a with one of the participants of the course; Dr Ian McKenzie (second from the right) presentation on “Cardiac protection, with trainees. volatiles and opioids” and Dr Matthias Jacob of the Ludwig-Maximilians University Munich, Germany who presented the topic “Protection of the vascular barrier”. Professor Thomas Bruessel did an outstanding job in organising this meeting. (See People & events on page 8 for photos).
ANZCA ACT Regional Committee AGM The ACT Regional Committee held its annual general meeting in the ACT regional offices on November 12. Local issues discussed included progress on work being done by an ACT Mortality and Morbidity Committee, the development of an ACT regional committee orientation manual, how the relationship with local Fellows was progressing and how the ACT was benefiting from improved relations with various health groups.
ANZCA Bulletin December 2009 75 Regions continued
Western Australia
Updates in Anaesthesia meeting Dr Rob Radici, a retrieval specialist with focus on aortic injury; Dr Harmeet Aneja In early November, Western Australia held the Royal Flying Doctors Service in WA, discussed some of the common extremity its annual Country Meeting at the Quay presented a trauma case of a difficult trauma scenarios faced by the modern West Resort Bunker Bay which is about airway encountered in a rural location and anaesthetist and the pros and cons of a three-hour drive south of Perth. The Dr Andy Heard presented an algorithm using regional anaesthesia in these weekend began with a welcome BBQ for the management of a crisis situation situations; and Professor Stephan Schug and drinks for sponsors, delegates and where a patient cannot be intubated spoke about pain management for the their families. or ventilated. trauma patient. The annual Updates in Anaesthesia On Saturday afternoon the airway Thanks go to the invited speakers meeting attended by 116 delegates was workshops and PBLDs were offered Professor Ross Baker and Dr Lucy entitled “Trauma and the anaesthetist”. concurrently. The demonstrated Kilshaw, the sponsors, presenters and The academic program opened with the techniques in the airway workshops were the organising committee from Royal invited speaker, Professor Ross Baker who a sample of the adaptations of advanced Perth Hospital including the convenors, is Director of the Haemophilia Centre of skills which are being taught in the “wet” Associate Professor Tomas Corcoran Western Australia, giving an informative and “dry” lab unique airway teaching and Dr Denise Yim who put together an presentation on coagulation and trauma program at Royal Perth Hospital. The interesting scientific program and an including bleeding and clotting and workshop presenters were Drs Catherine enjoyable weekend in the south-west everything in between. Dr Lucy Kilshaw, Fuller, Shannon Matzelle, Patrick Eakins, of Western Australia which included an a consultant geriatrician and the second Jim English, Andy Heard, Nick Brown and excellent social program and a fantastic invited speaker then gave an excellent Gavin Teague. The airway PBLDs were evening at Vasse Felix Winery. presentation on the peri-operative care presented by Dr Roger Browning, Dr Alex of ortho-geriatric patients. Swann, Dr Claire McTernan and Dr Wim Dr Alex Swann spoke about the Smithies. anaesthetists’ role and principles of The Sunday morning session included management in major trauma and presentations from Dr Lars Wang on disasters in remote and rural Australia; anaesthesia for the head-injured patient; Dr Chris Cokis spoke about anaesthesia for patients with thoracic trauma with a
76 ANZCA Bulletin December 2009 South Australia/ Northern Territory
The South Australia/Northern Territory Regional Committee had its local CME meeting on December 2 at the Women’s and Children’s Hospital in Adelaide. The meeting, sponsored by the ASA, was teleconferenced to both Darwin and Alice Springs. ASA President, Dr Liz Feeney, gave an introductory talk on the ASA. The College CME committee would like to thank the ASA for their continued support of academic meetings. The guest speaker was Professor Annette Braunack- Mayer, an associate professor in ethics who is involved in the department of health sciences. Professor Braunack- Mayer presented two clinical scenarios involving various ethical issues that involved anaesthesia and the relationship with surgeons. A very valuable interactive session followed.
Photographs from the “Updates in anaesthesia” WA Part III Course meeting from Bunker Bay, clockwise from left: The 2009 Part III Course entitled “Life Tasmania Bunker Bay, Western Australia; Dr Lucy Kilshaw; Dr Alex Swann, Mrs O’Loughlin and Dr Ed Beyond Training – Making the Transition” O’Loughlin; Delegates at the meeting; Dr Leigh was held on Saturday, November 14 at Coombs and Professor Ross Baker; Dr Mark the University Club of Western Australia. Williams (back), from left: Associate Professor The course was convened by the GASACT Tomas Corcoran, Dr Denise Yim, Ms Sandra Box, Senior Chair, Dr Ana Licina. Ms Bree Toussaint; Dinner at the Vasse The Tasmanian combined ASA/ANZCA Felix Winery. The course was aimed at fourth and meeting will be held from February 19-21, fifth year anaesthetic registrars who will 2010 at The Old Woolstore in Hobart. soon be completing their training and The theme is “A disaster of a conference” obtaining their FANZCA. Topics included: and the invited speaker is Dr Robyn “Starting out in private practice”, Gilles (Head of Malignant Hyperthermia “Paperwork and practicalities of the Diagnostic Unit, Royal Melbourne transition”, “Life as a new consultant in Hospital). The meeting will look at various public practice”, “Insurance and medico- emergency and difficult situations ranging legal matters”, “Getting paid – billing 101”, from difficult airways, trauma, obstetrics, “Full-time public and private practice and as well as malignant hyperthermia. There a combination of both”. will also be a workshop on ultrasound Thank you to Dr Sharon Smedley, and regional anaesthesia of the upper Dr Markus Schmidt, Dr Angela Palumbo, and lower limbs. Please contact Di Cornish Dr Rob Storer, Dr Jamie Knuckey, in the regional office via e-mail – Dr Ian Forsyth, Dr Alex Swann and [email protected] – for more information. Dr Paul Rodreda for their support.
ANZCA Bulletin December 2009 77 New Zealand news
The New Zealand Anaesthesia NZ Anaesthesia Education Committee (NZAEC) oversees International Medical this joint NZNC/NZSA conference. ASM 2009, Rotorua, Thanks are extended to Dr Brian Lewer, Graduates November 4-7, 2009 the NZAEC Chair who has now completed NZNC vocational registration panel his two years as Chair. Rose Chadwick, The ANZCA New Zealand Panel for The 2009 NZ Anaesthesia ASM (NZA ASM) the NZAEC Administrative Officer Vocational Registration (NZPVR) has organising committee provided a program provided valuable support for the NZA conducted a number of International of great interest and attendee numbers ASM, including organising two NZAEC Medical Graduates (IMGs) preliminary excelled expectations. The keynote meetings at the ASM (for trade personnel assessments and interviews on behalf speakers, Ivan Joubert (Cape Town), Hans- and convenors). The trade meeting was of the medical council over the last Joachim Priebe (Freiberg), Peter Marhofer attended by more than 40 representatives 12 months. (Vienna) and John Barnard (Waikato) won who appreciated the opportunity to accolades for their presentations and for Workplace-based assessments discuss issues of common interest. their participation in all the sessions. for Fellowship The Waikato Hospital Department of Clockwise from top left: Dr Hayley Bennett, An assessors’ workshop and the first Anaesthesia ASM organising committee Dr Hugh Douglas (IV) and Dr Cam Buchanan, assessments in New Zealand occurred is to be congratulated for all the hard convenor of the NZ Anaesthesia ASM; NZ in October. work undertaken to create this successful Anaesthesia ASM conference dinner at the Blue conference. Dr Cam Buchanan was the Baths, Rotorua; workplace-based assessments ANZCA New Zealand Trainees’ convenor and Dr David Kibblewhite, workshop: front row (seated) Dr Richard Willis, Committee Professor Garry Phillips, Dr Leona Wilson, and scientific convenor. Other members of This committee, under the chairmanship Dr Genevieve Goulding; middle row, Dr Vaughan of Dr Kathryn Hagan has been actively the organising committee were Drs Kevin Laurenson, Dr Vanessa Beavis, Dr Paul Smeele, Arthur, Tom Watson, Arthur Rudman, Dr Brian Lewer; back row, Dr David Kibblewhite; developing resources to assist New Lucas Sikiotis, Andrew Miller and Gary Dr Gary Hopgood, Dr Steuart Henderson, Dr Zealand trainees. These include a part Hopgood and Amanda Graham from Six Nigel Robertson, Dr Malcolm Stuart, NZNC; The zero course and a trainees’ handbook. NZ Anaesthesia ASM conference dinner from Hats Conference Management. left: Dr Vanessa Beavis, Mrs Wendy Warmington, Dr Andrew Warmington, Mrs Thompson, Dr Wally Thompson, Dr Leona Wilson.
78 ANZCA Bulletin December 2009 Policy submissions New Zealand National ANZCA/NZSA and representations Committee (NZNC) Workforce Report 2009 There was a 75% response rate to the to government meetings College’s workforce survey to measure The New Zealand National Committee has The New Zealand National Committee the supply and demand for anaesthesia considered a wide range of discussion (NZNC) of ANZCA met on November 20. services (652 out of 873 recipients) documents and requests for nominations A wide variety of issues were discussed, which was a truly exceptional response. from the Ministry of Health and the including the establishment of a New Respondents who completed the survey Medical Council of New Zealand over Zealand Perioperative Mortality Review were entered into a prize draw for a dinner the past few months: Committee by the Minister of Health up to the value of $500. The winner was • The establishment of a New Zealand with an invitation to ANZCA to nominate Dr Pamela Meyer of Rotorua, who shared Perioperative Mortality Review Committee a Fellow to serve on this committee; her prize with colleagues during the NZA and nomination of a Fellow to serve Medical Council of New Zealand (MCNZ) ASM. Results of the survey are being and ANZCA assessment processes on the committee - Minister of Health. analysed. The final report will be made for international medical graduates; available in early 2010. • New Zealand anaesthesia workforce and the interim report to MCNZ for the training including the Government’s reaccreditation of ANZCA as a branch electives initiative – Minister of Health advisory body; New Zealand workforce and Director General of Health. survey and report; acute services in ANZCA New Zealand • ANZCA/RACS WHO Surgical Safety provincial hospitals; Rural Hospital Trainees’ Committee Checklist launch – Minister of Health. Doctors Training Program; and the This committee, under the chairmanship • Acute services in provincial hospitals Faculty of Pain Medicine’s application to of Dr Kathryn Hagan, has been actively roundtable – Ministry of Health. MCNZ for recognition of pain medicine developing resources to help New Zealand • Clinical Training Agency Board as a vocational branch of practice in New Zealand. trainees. These include a part zero course nominations (the one national agency and a trainees’ handbook Anaesthesia for workforce training, funding and Training in NZ made easy. The committee planning) – Ministry of Health. Future CPD events members, who reside in various parts • Use of locum work by District Health of New Zealand, usually meet by Boards – Ministry of Health. in New Zealand teleconference but met for the first time • MCNZ and ANZCA International Medical face-to-face in Wellington on November ANZCA ASM - May 1-5, 2010. Graduates (IMGs) assessment processes 28. The ANZCA President, Dr Leona and the new MCNZ framework for 2011 NZA ASM – Dr Michal Kluger and Wilson, and NZ National Committee Chair, supervision of IMGs – Medical Council the team from Northshore are organizing Dr Vanessa Beavis, joined the meeting. of New Zealand (MCNZ). this conference to tie in with the Rugby • Medical Council periodic assessment World Cup 2011. of performance as part of CPD. International Congress of • The Faculty of Pain Medicine’s Cardiothoracic and Vascular application to MCNZ for recognition of Anaesthesia (ICCVA) 2012 pain medicine as a vocational branch Considerable time, effort and diplomacy of practice in New Zealand. have been directed towards securing • Division of Rural Hospital Doctors and preliminary planning of the ICCVA Board of Studies regarding anaesthesia meeting (under the auspices of the Society training. of Cardiovascular Anesthesiologists from • Accident Compensation Corporation the States). At this stage, it is expected “Evaluation of Treatment Injury that the meeting will run alongside the Legislation”. NZA NZ ASM in Auckland in 2012. The • Nursing Council – Registered Nurse Scope event will be a joint undertaking between of Practice under the Health Practitioners NZSA and ANZCA. Front row from left: Drs Rachel Dempsey, Competence Assurance Act (2003). Nicola Broadbent, Kathryn Hagen (Chair) and Nathan Kershaw (NZSA representative) Back row from left: Dr Leona Wilson (ANZCA President), Juliette Adlam (Administrative Officer, NZ Office), Drs Thimali Rajapaksa, Sheila Hart, Erica Dibb-Fuller, Geoff Long (National Education Officer) and Sabine Pecher.
ANZCA Bulletin December 2009 79 New College of Intensive Care Medicine
Following the vote by the JFICM run in parallel, allowing the transfer of fellowship, the board of the Joint Faculty processes and functions from one to the then entered into negotiations with other. This has been a smooth transition the Council of ANZCA about how to process and we are confident that the bring about the reality of a new College infrastructure and processes to allow of Intensive Care Medicine. With the seamless commencement of activities by support of the ANZCA Council and the CICM on January 1, 2010 are in place. A JFICM Board a working party, consisting new College for a new decade! of Leona Wilson and Kate Leslie from In preparation for January 2010, most ANZCA and John Myburgh and myself foundation Fellows of the new College from the joint faculty, was established were admitted at the November 2009 to steer the process. Negotiations took board meeting of the CICM. New diplomas place under a heads of agreement drawn will be reaching these Fellows shortly. up between JFICM, ANZCA and the It would be remiss of me to neglect RACP. I must pay special tribute to Leona mentioning the proud heritage we take The following are remarks made by Wilson who provided strong guidance to with us to the new College. Intensive care Professor PV van Heerden, Dean of the counterbalance the sometimes unbridled medicine is a relatively new specialty – Joint Faculty of Intensive Care Medicine, enthusiasm of the JFICM approach. As with its genesis in the polio epidemics of at a dinner at ANZCA House, Melbourne, an example, I think we had a six-month the 1950s – a time so well described by Dr on November 21 to celebrate the creation timeline in mind, while Leona promoted Ron Trubuhovich in his historical papers of a new College of Intensive Care a more realistic 12-18 month timeline. published in our journal, Critical Care and Medicine. Somewhat uniquely in these types Resuscitation and elsewhere. The early of negotiations, talks were always 1970s saw the specialty becoming more At this time we celebrate the courteous, and indeed, fruitful. Even organised, resulting in the formation successful culmination of a process the potentially difficult negotiations of the Section of Intensive Care of the commenced some 18 months ago. regarding financial settlement, proved not RACS – an enterprise of some far-sighted ‘‘This process began with a vote by the to be so. Perhaps we all had the advantage people, Barry Baker, Ron Trubuhovich, fellowship of the Joint Faculty of Intensive of having the formation of ANZCA not too Felicity Hawker, David McCleave, Dennis Care Medicine in favour of the formation long ago to look to as an example. Kerr and Ken Hillman. of a separate body for training and A constitution was written for the new The first examination in intensive certification in intensive care medicine in College of Intensive Care Medicine and care medicine was held in 1979 – one Australia and New Zealand. Such a body operations commenced in February 2009, candidate presented. Compare this to the would be the first of its kind in the world when the inaugural board of the CICM more than 100 that present each year now. – this is not unusual, as intensive care was established. These board members At about the same time our physician medicine in Australia and New Zealand were also the first foundation Fellows colleagues started a training scheme for has led the way internationally since of CICM. Since that time the boards intensive care medicine. the 1970s. of the joint faculty and the CICM have The Section of Intensive Care evolved into the Faculty of Intensive Care after the
80 ANZCA Bulletin December 2009 establishment of ANZCA in 1992. There - Secondly, the concept of closed intensive the Faculty of Pain Medicine well and were still two training schemes available care units and general intensive care look forward to watching the evolution of at the time - those run by the Faculty of units has recognised the skills that your speciality over time. Intensive Care and the RACP. A single intensive care physicians bring to training scheme was formalised with the patients – as opposed to open and Professor PV van Heerden formation of the Joint Faculty of Intensive super-specialised units. Dean, JFICM ’’ Care in 2002. The past deans of the faculty - Thirdly, the support of our society, President, CICM and joint faculty read like a “who’s who” ANZICS, has been instrumental in of famous intensive care physicians – enabling long and fruitful careers Clarke, Duncan, Hawker, Matthews, in intensive care medicine for its Havill and Lee. They, the board members practitioners by taking care of industrial who supported them and the excellent matters. executive officers and their staff have - Fourthly, the bi-national nature of our “This has been a smooth made great contributions to the specialty organisations has provided strength and transition process and over the years. diversity to our specialty. we are confident that Special mention should also be made The 18-month process I began describing of representatives on the JFICM board the infrastructure and has seen the new College of Intensive Care from ANZCA and the RACP – in particular Medicine on the threshold of a new era of processes to allow seamless I’d like to thank Professor Nip Thomson intensive care medicine in Australia and and Professor Barry Baker for their commencement of activities New Zealand. It is the leading body of its wise council. by CICM on January 1, type in the world and is proud to oversee At this point I’d also like to point out training in hospitals in Australia, New 2010 are in place.” some of the special and unique strengths Zealand, Hong Kong, Singapore, Canada, of the specialty of intensive care medicine the UK and Ireland and soon in India. We in Australia and New Zealand. These have 700 Fellows and honorary Fellows include – all over the world who take special pride - Firstly, the unity of purpose of intensive in the formation of the new College. care physicians, regardless of primary The new College owes a great debt specialty. We have not seen the bickering of gratitude to all those who have between primary specialities about who Below from left: The presidents and vice contributed to the process in the 30 years “owns” intensive care medicine that has presidents of ANZCA and CICM, Professor leading up to this final 18-month process. Kate Leslie, Professor PV van Heerden, Dr hampered the development and caused May the fact that the new College has Leona Wilson and Professor John Myburgh; the fragmentation of the speciality in been born through a process of evolution, The ANZCA House foyer set for dinner; other countries. Australasian intensive Professor van Heerden with previous JFICM rather than revolution only add to its care medicine has always enjoyed the deans, Dr Geoff Clarke, Dr Alan Duncan, Dr strength in the future. I’d also like to wish support of the primary specialities, Neil Matthews and Dr Jack Havill; Professor van Heerden addresses the guests. particularly anaesthesia and internal medicine.
ANZCA Bulletin December 2009 81 Heading?New College of Intensive Care Medicine continued
people who made and lived this story of “The process of separation the history of our College and intensive care medicine. had the potential to destroy Barry Baker, the obvious first place to start. our good relationship He was the first head of the section of with the new College, and intensive care medicine of the Faculty of instead it’s my view that it’s Anaesthetists, RACS, Australian by birth, New Zealand by adoption, intensivist strengthened it.” and anaesthetist. When we came to the separation of the JFICM from ANZCA, This proceeded very amiably and we had Barry Baker, now a Director of collegially, and served us as a model to Professional Affairs for ANZCA helping follow in our negotiations with JFICM. us. Barry was the Dean of the Faculty of I remember separation being an item The following is an edited excerpt Anaesthetists at the time of negotiation of of discussion through the 1980s, and of remarks made by the President of separation from the college of surgeons, hearing vehement opinions on each side, ANZCA, Dr Leona Wilson, at a dinner on and a font of knowledge on the separation and of course taking part vigorously. Saturday, November 21, at ANZCA House of a faculty from a college and the The main issues were that we were a to celebrate the new College of Intensive establishment of a new college. separate specialty, and thus should Care Medicine of Australia and New Ron Trubohovich worked at DCC in have a separate College. The contrary Zealand. Auckland, the first unit accredited by view was that separation would entail the section for training for intensive care the loss of influence that we would Mr President, Vice-President, CEO medicine in New Zealand (and Australia). sustain by no longer being part of a and Council of CICM, and guests, on And then in 1992 we (the Faculty of College that was perceived as having behalf of ANZCA it is my great pleasure Anaesthetists, RACS) formed the new the ear of governments, and the dangers ‘‘to propose the toast to the new College college of anaesthetists. This is a good of increasing fragmentation of the of Intensive Care Medicine of Australia time to reflect on our formation as a profession. But, the decision to separate and New Zealand and, of course, sadly, to College and our separation from the proceeded, and ANZCA came into being. farewell the JFICM from our College and college of surgeons and we have here Our inaugural scientific meeting as a the RACP. Tonight is a wonderful occasion our surgical representative on Council, College was held in Canberra in 1992. Tess in that we are celebrating the birth of a Graeme Campbell. The RACS provided Cramond proposed the toast to the new new College, but at the same time sad in us with safe conditions for our birth, College of Anaesthetists at the College’s that we are farewelling a faculty. providing us with administrative and inaugural dinner at that meeting. She I would like to welcome our guests to financial infrastructure, so that we were noted the atmosphere of goodwill and this celebratory dinner. Vernon is going able to grow as a specialty and we are continuing support from the President of to tell us about the history of intensive grateful to them for that. We (that is the RACS that attended our separation from care medicine, so I’d like to talk about the Faculty of Anaesthetists, RACS) had to RACS. Peter Livingstone, the last Dean people in this room – here we have the negotiate our separation, especially the of our faculty and the first President of finances, with the College of Surgeons. our College, responded to Tess’s toast at
82 ANZCA Bulletin December 2009 that dinner. He spoke of our 40 years as patients and their families enormously. As “Intensive care medicine a faculty, a long “growing up” period. anaesthetists, pain medicine practitioners Your College, Mr President, has spent (and surgeons) we need to acknowledge has transformed the way in less time as a faculty – as I calculate it, 18 how the standard of intensive care which medicine is practiced years. Michael Davies chaired a scientific medicine has expanded the scope and in the last half of the 20th session opening the ANZCA inaugural complexity of the work we do. This meeting in Canberra. And then, of course, has provided tremendous professional century and the first decade once we became a College in our own satisfaction, personal fulfilment, not to of this century. This has right, then the section of intensive care mention back-up when things do not go became a faculty, with Geoff Clarke, according to plan. benefited our patients and being the first Dean. The faculty then And so, in proposing the toast, I’ll their families enormously. became joint with ANZCA and RACP, use the same words that Tess Cramond As anaesthetists, pain and we have John Wilson representing used in her toast to the new College of Geoffrey Metz, President of RACP. Felicity Anaesthetists: medicine practitioners Hawker was the inaugural Dean of the “the College of Intensive Care Medicine (and surgeons) we need JFICM, and then stayed on the assist the of Australia and New Zealand – may it faculty as the first DPA. We are also joined flourish and extend its influence”. to acknowledge how the by the other Deans, Alan Duncan, Neil standard of intensive care Matthews and Jack Havill. Dr Leona Wilson medicine has expanded The process of separation had the ANZCA President ’’ the scope and complexity potential to destroy our good relationship with the new College, and instead it’s of the work we do. ” my view that it’s strengthened it. The negotiating team from JFICM, Vernon van Heerden, John Myburgh and Phil Hart were absolutely professional in their approach, and made what could have been extremely difficult discussions incredibly collegial. I’m very grateful for that, and the support from ANZCA Below from left: Dr Kerry Brandis, ANZCA Vice President, Kate Leslie, and CEO Councillor and Dr Amod Karnik, CICM Board Mike Richards. member with guests in the marquee; Back- Mr President, intensive care medicine ground music at the dinner was provided has transformed the way in which by the Soundwood Strings; Dr Humphry Cramond, Mrs Elule Goucke, Professor Tess medicine is practiced in the last half of Cramond and Dr Roger Goucke with the Dean the 20th century and the first decade of the Faculty of Pain Medicine, Dr Penelope of this century. This has benefited our Briscoe; Professor John Myburgh, Dr Jane Baker and Professor Barry Baker applaud the President’s speech.
ANZCA Bulletin December 2009 83 News from the College of Intensive Care Medicine
Location of the new Foundation fellowship Support for regional There has been an excellent response to College premises the call for foundation fellowship, with Committees The College has leased office space at over 90% of the joint faculty fellowship The matter of ongoing support to the 168 Greville Street, Prahran, which is now having completed their application regional (and New Zealand national) just over a kilometre from ANZCA House and paid the fee. These foundation committees was discussed at some in Melbourne. The building is the old Fellows were all formally admitted to the length in the board meeting. ANZCA Prahran Post Office, which is being has agreed that their offices in New extensively renovated and converted into College at the board meeting. In addition to the fellowship fee, a number of Fellows Zealand and Queensland will, for a a three storey office building. Building limited period (up to two years), continue works are not yet completed, but all also very generously made additional to provide administrative support to being well the move from ANZCA House voluntary donations to the College. The those CICM regional committees. In the will take place in early January and the certificates of Fellowship will now be College will then be fully operational as prepared, but with more than 600 names other regions it will be necessary for an independent entity. to be written, it will take the calligrapher other arrangements to be put in place. The College’s new website www.cicm. some time to complete his task. Board member Amod Karnik has been org.au will be ready to be launched by the All remaining Fellows of the joint appointed regional officer and given the start of next year and will take over from faculty who have not yet completed their task of liaising with the chairmen of the the temporary web page that is at that application for foundation fellowship are regional committees to ensure that there address. The member database, finance encouraged to do so as soon as possible. is continuity of support in those regions. system, insurance coverage, human After January 1 the joint faculty will cease resources arrangements, etc, are all in the to exist and fellowship of the college Joint training final stages of preparation and will all be (FCICM) will in future be the recognised in place ready for the move. qualification for specialist practice in with RACP intensive care medicine, by both the An education committee has been Associate membership Australian Medical Council and the established to supervise the ongoing joint The College constitution has provision Medical Council of New Zealand. training program between RACP and for a class of membership other than The board recognises the additional the College. The CICM representatives Fellow (and Honorary Fellow). The financial imposition that the fee for on the committee are Peter Morley board discussed whether or not to enact foundation fellowship has meant for and Charlie Corke. The purpose of the this provision and create regulations many Fellows. The money received committee is to ensure that the existing governing admission to the College as will help to ensure that the College has pathway to fellowship for RACP trainees an associate member, to be available to some financial reserve and can begin to who complete all of the requirements medical practitioners who work in the establish an asset base with a view to one for advanced training in intensive care area of intensive care medicine but are not day purchasing a permanent home for medicine remains available. eligible for Fellowship. Following debate over the merits and potential drawbacks the College. of broadening the criteria for membership, Farewell gift the board resolved to not create a category Fees for 2010 from ANZCA of membership for non-Fellows. In considering the fee for the annual The ANZCA Council have generously fellowship subscription for 2010, the decided to give the College a substantial board was mindful of ensuring that and lasting memento. After some the College could meet its financial discussion it was decided that a commitments while at the same time boardroom table and chairs would recognising that foundation fellows had be a much appreciated and practical recently made an additional contribution gift. These are being constructed by a of $1000. It was ultimately decided to Melbourne furniture maker and will keep the annual subscription for 2010 the be ready by the time we move to our same as 2009. The annual subscription new office. notice will be posted to Fellows early in the new year.
ANZCA Bulletin December 2009 85 ReportNews from the JFICM Board Meeting
The final meeting of the JFICM Board was Paediatric intensive care fellowship held on November 5 at ANZCA House, examination Fellowship Affairs with the CICM Board meeting held the The 2009 exam in paediatric intensive Admission to fellowship following day. In attendance were Dr care was held on August 28 (written by examination Michael O’Leary, the new President of component) and October 20 (oral The Board noted admission to fellowship ANZICS and Dr Anthony McLean from the component). Six candidates sat the of the Joint Faculty of Intensive Care JFICM New Zealand National Committee. written component, with five being Medicine by examination: successful and progressing to the oral Organ donation Edward Litton NT component, held at The Children’s Dr Gerry O’Callaghan, National Medical Hospital, Westmead. All five candidates Matthew Holland UK Director of the Australian Organ and were successful. Seamus Crowley WA Tissue Donation and Transplantation Congratulations to all the successful Authority presented to the board a Geoffrey McCracken NZ candidates from both exams, and a huge summary of the work of the authority Gopal Taori VIC vote of thanks to all the examiners who and, in particular, the development of contribute their time and expertise and Vikram Patil NZ a set of clinical triggers for use in all also to the staff for ensuring that the week John McCaffrey UK relevant hospital departments where went so smoothly. consideration of organ and tissue Gordon Flynn NSW donation is appropriate. Intensive care examination dates John Mackle UK for 2010 Rohit D’Costa VIC Education and training Primary examination 1 Nicola Willis QLD Rural training rotations Written component March 1 Andrew Cheng NSW The board approved a proposal to allow a Oral component April 5 three-month rotation to a rural or regional (Melbourne) Grant Cave NZ ICU which has been approved for basic Primary examination 2 Koon Lam HK training, as part of the non-continuous Written component September 13 Sayek Khan NSW year of advanced training in a C12 or C24 Oral component November 12 Poongundran Namachivayam VIC unit. The rotation must be prospectively (Paediatric Intensive Care Medicine) approved by the Censor and will not count (Melbourne) towards the senior registrar time. General fellowship examination 1 Honorary fellowship Written component March 26 A nomination was received for the Examinations Oral component May 27-28 award of honorary fellowship to Dr Sheila Willatts, an eminent (now retired) General intensive care (Melbourne) physician and a pioneer of intensive care fellowship examination General fellowship examination 2 medicine in the UK. The board voted The second General Fellowship Written component August 30 unanimously in favour of the award. Examination for 2009 was held on August Oral component October 28-29 28 (written component) and October 22-23 Fellowship statistics (oral component). Fifty candidates sat (Sydney) At October 14, 2009, the joint faculty had the written exam, with 36 (72%) being Paediatric fellowship examination 688 Fellows. 542 in Australia, 59 in New successful. A further 18 candidates Written component August 30 Zealand, 22 in Hong Kong, 19 in the UK, carried over success at a previous written, Oral component November 5 20 in Ireland and 26 in other countries. so 54 presented for the oral in Sydney. (Auckland) Critical care and resuscitation On day one, the hot cases were held 2009 Annual Scientific Meeting The journal of the joint faculty, Critical at the Prince of Wales, Royal Prince Care and Resuscitation, continues to Alfred, Royal North Shore and St George – Brisbane, June 12-14. The 2009 ASM attracted just over 300 grow and thrive under the leadership hospitals. On day two, the viva section of chief editor Rinaldo Bellomo. Now registrants in total, and with good was held at the Novotel Hotel, Brighton Le in its 10th year, the journal is receiving support from the healthcare industry (two Sands. For the oral section 46 candidates increasing numbers of articles submitted were successful, a pass rate of 85%. major sponsors and 19 trade exhibitors) for publication. Allocation of an impact The year 2009 marks the 30th was able to generate a good surplus. The factor is now an important next step in the anniversary of the first intensive care board is most grateful to the organising journal’s evolution. Publication costs are fellowship examination. To mark the committee, in particular the convener rising steeply and will need to be allowed occasion, a celebratory dinner was held Rob Boots, for the huge amount of time for by the College’s budget. to coincide with the exam in Sydney. The devoted to enduring the success of previous chairmen of the Examination the meeting. Committee were all in attendance and regaled the audience with tales of the early years of the exam.
86 ANZCA Bulletin December 2009 Faculty of Pain Medicine Dean’s Message
These patients respond poorly to I believe anaesthetists are in a unique opioids and are often on high doses position, in that they often see patients when referred. when they present for surgery who may In my centre we still perform coeliac have recently had a diagnosis of cancer. plexus blocks, which give good pain Anaesthetists have the capacity to relief in up to 80% of patients, and enquire about the patient’s pain - not just improve appetite; if that is not available, in the peri-operative period - and make intrathecal pain management strategies recommendations to the patient and the are appropriate. (1) surgeon that the patient may well benefit Pain specialists have for a long time from referral to a pain or palliative care believed that if we give patients with specialist. cancer good pain management they live Anaesthetists should be well aware longer. PS Staats in the Anaesthesiology of the procedures that can assist patients Clinics of North America comments: “… with cancer pain and must also be aware Pain medicine has been receiving untreated pain can take on a life of that patients who present to surgery with a lot of publicity in the last couple of its own. Ongoing pain can increase significant pre-operative pain are at much months with the previous Dean’s report - physically damaging stress and higher risk of having severe pain in the highlighting problems with inappropriate psychologically damaging depression peri-operative period. management of chronic pain in our each of which can, like all negative Therefore, as we are moving towards communities, and then the launch of the emotions, intensify the pain experience”. a pain summit in Canberra in March next National Pain Summit, where more than Clinicians have long understood that year, I would suggest that all practitioners 50 organisations have joined together unremitting pain can shorten life by talk to patients about the pain they aiming to raise the awareness that our causing the patient to choose suicide suffer on an ongoing basis and make patients deserve readily available and (or euthanasia) but we are now beginning the appropriate recommendations appropriate pain management. to realise that, for reasons not yet about referral. I was involved in a number of radio understood, pain can hasten In almost all circumstances talkback shows and was extremely unassisted death.(2) cancer pain can be managed using a disappointed when I spoke with one Thus, we have a situation where we are combination of medication via numerous individual in a major Australian capital trying to raise the profile of pain medicine routes of administration, or therapeutic city where, even in this day and age, he throughout Australasia, while patients nerve blocks and also addressing pain is receiving inappropriate management with cancer are not even being referred management using both psychology and of his cancer pain. The caller had on for opinions and treatment. physiotherapy where appropriate. pancreatic cancer (which is known to be Part of this relates to the ignorance of Patients with pancreatic cancer often a particularly severe form of cancer pain) doctors that cancer pain can be treated have a very short prognosis of months. and was being managed by his GP and successfully in almost all cases. However, However, in my experience, with coeliac gastroenterologist with four oxycodone there is also a belief by both patients plexus blocks these patients can have per day. His pain relief was so inadequate and their doctors that cancer pain is fantastic quality of life. They often come that he was taking far more than inevitable, fear that if strong analgesics back for two or three blocks suggesting prescribed (up to 20 per day). The radio are used now there will be nothing left that their longevity has been prolonged. host “suggested” that this individual was when the disease progresses and that So to all my colleagues who practise exhibiting signs of addiction. This is a using morphine will lead to addiction. medicine in whatever branch, make sure classic case of “pseudo addiction” which There is also lack of understanding that when you are taking a history and is an iatrogenic syndrome resulting from of what is available and accessible. I examining your patient, along with other inadequate pain management. As a result still hear it stated that there is no point vital signs, you always ask about their of this inadequate management, patients referring some patients on to a pain clinic pain, the duration, the intensity and engage in behaviours seeking more as the waiting period is up to 12 months. make appropriate referrals. medication and are often misdiagnosed However, most pain clinics throughout as having addiction problems. Australasia have a triaging system When the World Health Organization Dr Penelope Briscoe where patients with cancer pain are ladder was first published in 1986, it Dean seen quickly. was predicted that over 90% of cancer One of the strategies of the National patients could obtain reasonable relief References: Pain Summit is to chart pain as a fifth 1. Staats PS, Pain: Effects of Alcohol Celiac from their pain by using a combination vital sign in all health facilities in Plexus Blocks, Pain, and Mood on Longevity of opioid and adjuvant medication. In the Australia. Therefore, along with taking of Patients with Unresectible Pancreatic small group that did not respond to either blood pressure, pulse, respiratory rate Cancer, Pain Medicine (2001) Vol 2 No.1 p 28 oral or parenteral medication, invasive 2. Staats PS, The Effect of Pain on Survival, and temperature, the health professional procedures are appropriate. Anaesthesiology Clinics of North America should also ask the patient about Pancreatic cancer is one of those No.21 (2003) 825-833 their pain. conditions where I believe invasive procedures are appropriate.
ANZCA Bulletin December 2009 87 Faculty of Pain Medicine News
New Zealand National Prescribing ANZCA submission: application for Service (NPS) Medical Specialist specialty recognition Acute Post-operative Outreach Assistance An application for specialty recognition in New Zealand has been submitted and Pain (APOP) Toolkit Program-Indigenous the consultation process has commenced The National Prescribing Service (NPS) Chronic Disease with the Medical Council of New Zealand quality improvement toolkit on Acute seeking sector feedback in advance Post-operative Pain (APOP) management Guidelines of the next meeting of their Education is now available. The APOP toolkit The Faculty recently made a submission Committee on January 11, 2010. The two- comprises a downloadable software to the Department of Health and Aging stage application process is expected to application (audit tool) and educational in relation to the Medical Specialist take about 18 months. resources. The APOP toolkit will assist Outreach Assistance Program-Indigenous anaesthetic, surgical and nursing staff Chronic Disease Guidelines. These International Medical in post-operative units and acute pain guidelines will focus on the improving the service teams to conduct reviews of range of health services available to rural Graduates patient care in the area of acute post- and remote indigenous communities. operative pain. The audit tool measures The board has resolved to establish a To read this submission please visit pain assessment and sedation scores, qualification of “Associate Fellowship” as http://www.anzca.edu.au/news/ post-operative analgesic use and safety a form of recognition for those who have submissions-to-government/ of prescribing and administration, completed the training and examination patient perspectives on effective pain requirements of the Faculty of Pain management and adverse effects and ANZCA Library online Medicine but who are not eligible for discharge management. Fellowship as they do not hold Fellowship collection of pain of an approved Australian or New Zealand Access the free toolkit at primary specialty. Associate Fellows http://www.nps.org.au/due_apop medicine books will become eligible for Fellowship The ANZCA Library has created a direct of the Faculty of Pain Medicine Supervisor of training link to pain-related books held in the upon confirmation of “Substantially collection via the library catalogue. Comparability” of their Specialist (SOT) workshop Log in to the ANZCA/FPM website and Qualification by the corresponding FPM supervisors of training met at the link to the Library catalogue to view the Australasian College. Processes are being NSW Regional Office to participate in a large range of books in the pain area. finalised with a view to introduction of workshop facilitated by the Manager, http://www.anzca.edu.au/resources/ this qualification in 2010. ANZCA Education and Development library/book-catalogue.html Unit. The focus of the workshop was on 2010 ASM – assisting trainees in difficulty and nine supervisors of training (SOTs) participated Christchurch enthusiastically. Plans are well advanced for the refresher SOTs explored the types of problems course day and ASM program including that trainees may experience and used Dr Jeffrey Mogil (Canada) as the FPM a framework to analyse and define ASM visitor and Dr Richard Rosenquist these problems. An overview of relevant (US) as the FPM New Zealand visitor. The ANZCA/FPM policies and procedures programs for both the refresher course was provided and participants had the day and ASM are now available on the opportunity to refine their communication website. Registration brochures will be skills through the use of role play. SOTs circulated in January. valued greatly the opportunity to work through problems they commonly faced as a collective group and learn from each other’s experiences. As a result of the workshop, attendees developed a range of remediation strategies to address problems encountered by trainees at a local level. The next workshop is planned in conjunction with the 2010 ASM in Christchurch.
ANZCA Bulletin December 2009 89 Faculty of Pain Medicine News Continued
2009 Faculty of Pain Medicine Admission to Fellowship examinations of the Faculty of Pain The 2009 Faculty of Pain Medicine Medicine examination was held November 25-27 By training and examination: in the Pain Management and Research Dr Donald Johnson UK Centre at the Royal North Shore Hospital. By training and examination: Twenty of the 24 candidates were Dr Stephanie Oak NSW successful, representing a broad range of specialty backgrounds including anaesthesia, surgery and, for the first From top: 2009 Court of Examiners and time, general practice. Merit awards went Observers; from left: Dr Kerry Thompson and to Dr Kerry Thompson (Vic), Dr Clifton Chair of Examiners Dr Ray Garrick; Dr Max Timmins (Qld) and Dr Max Sarma (Tas). Sarma and Dr Ray Garrick; Successful candidates for 2009; Dr Ray Garrick congratulates Dr Clifton Timmins.
90 ANZCA Bulletin December 2009 Faculty of Pain Medicine National Pain Strategy – priorities
The draft National Pain 3 Secure funding and provide resources 3 Develop and standardise education Strategy (NPS) sets out a for existing accredited specialist materials for consumers, health inter-disciplinary pain clinics to professionals, insurers, rehabilitation number of strategies aimed continue to provide care for people providers to improve understanding at minimising the burden of with complex needs, and to support of the nature of chronic pain and health professionals in community best practice management, including pain on individuals, families care settings by providing education, management of pain medicines. training and advice, participating in and the community. clinical networks, and researching 3 Support key consumer groups A key first step will be to have pain and evaluating new treatments. to provide resources, advice and management recognised as a national community-based support for people health priority and recommendations 3 Develop a funding model for with chronic pain. incorporated in to the current health interdisciplinary pain management reform program. The strategy which in the community, including pain 3 Establish a national body with addresses acute, chronic and cancer management Medicare item numbers clinical, consumer and government pain, makes recommendations covering for accredited advanced-skill involvement to identify the improvements in standards and access to practitioners, and funding for self- partnerships, framework and treatment, consumer empowerment and management programs (including resources required to build capacity the need for state of the art research that group programs). and deliver proposed outcomes. translates into the clinical setting. There is an emphasis on strategies aimed at 3 Recognise the critical role of adequate 3 Establish a virtual Centre of Excellence preventing the progression of acute pain management of acute pain to minimise in Pain Medicine to provide clinical, episodes, to chronic pain. Some of the the rate of progression of acute pain to research and education leadership priority strategies are: chronic pain. for Australia and to develop and maintain an accreditation and 3 Implement a strategy of charting pain 3 Develop systems, including e-health quality improvement framework for as the fifth vital sign in all health records, to facilitate improved pain services in collaboration with facilities in the nation. communication and information consumers. sharing between multiple care 3 Recognise chronic pain as a disease providers, and to improve transitions 3 Recognise pain as a discrete research entity with a diagnostic code (as for between care settings. area in NHMRC research categories other chronic diseases) in order to and an NHMRC Research Priority. document its prevalence, outcomes 3 De-stigmatise the predicament of and costs. people with pain, especially chronic The draft National Pain Strategy, aimed non-cancer pain, through development at acute, chronic and cancer-related 3 Develop and evaluate a service of a community awareness campaign pain, is a result of the collaborative delivery model for pain management and training for health professionals work of health professionals and in the community which provides and insurers. consumers. It has been developed in interdisciplinary assessment, the lead-up to the National Pain Summit care and support as a part of 3 Ensure consumers and their carers to be held in March 2010. The National comprehensive primary health care have the knowledge, tools and Pain Summit is led by ANZCA, Faculty centres and services, linked to tertiary confidence to seek appropriate advice, of Pain Medicine, the Australian Pain interdisciplinary pain centres. education and/or treatment to enable Society, and consumer group Chronic them to better manage their pain. Pain Australia, in collaboration with 3 Increase the number of trainee inaugural supporters, MBF Foundation positions in pain medicine to 3 Ensure the social, economic and the Pain Management Research facilitate access to appropriate pain and regulatory environment Institute. management services throughout (i.e. employers, legal systems, Australia, including regional and compensation systems, insurance To read the draft National Pain Strategy remote areas which are currently very bodies, and government agencies) visit www.painsummit.org.au poorly serviced. provides a compassionate, empathic and well-informed framework to support people in pain.
ANZCA Bulletin December 2009 91 Welfare of anaesthetists Depression and suicide: what can you do?
There is no question that anaesthetists, So what can be done to identify Someone must then make the approach like everyone else in society, suffer from depression and prevent suicide, with a firm plan for what to do if the depression. The difference perhaps, particularly by the untrained person refuses or avoids help. It may is that most doctors find it difficult to anaesthetist? The first strategy is that we help if the person who does so is not an disclose the fact to themselves or their all need to take responsibility for our own authority figure or one with implications colleagues, or to seek medical help for health, have our own GP and seek help if for career progression and when the it. It has also been estimated that 10 per we notice signs of depression in ourselves. approach is made, it should be done in a cent of deaths of anaesthetists are due to The next sounds trite, but is timely and sensitive manner. If it doesn’t suicide, yet the cause of these deaths is probably the strongest strategy we work the first time, it should be repeated until it does. And remember, asking rarely acknowledged as such other than have. That is to care for your colleagues someone directly whether he/she feels locally at the time. Many suicide deaths in as conscientiously as you do for your hopeless, depressed or suicidal will not the anaesthetic community are trainees. patients and your families. When the provoke these feelings. Depression may often manifest itself surface is scratched, most communities Finally, if it all fails and someone in a fashion that is insidious, and can of anaesthetists, be they in hospitals, does take his/her own life, we, as be described by the sufferer as stress, private practices, regions, study groups a professional community, have an burnout or anxiety. It may present as or cohorts, actually care deeply about obligation to recognise the grief, guilt and physical symptoms, such as headaches, the well-being of their colleagues and even anger of those left behind and to fatigue and insomnia, and will very often friends. Unfortunately, however, we tend ensure that these people are supported, be denied or trivialised. Depression in to be more vigilant of others’ well-being at either directly or by referral. anesthetists may also be recognised by times of crisis, rather than being proactive colleagues or supervisors as diminished or observing them on a day-to-day basis. Dr Tim Porter performance, mood changes or Once we identify a colleague in trouble, MBBS, BEc, FANZCA withdrawal. what next? Share the concerns with others Depression and suicide may be – they too may have noticed, or wondered Acknowledgements: Welfare of Anaesthetists Special Interest triggered by such incidents as work about the person in question. Consult Group: - RD03 Recognising Depression and problems, adverse events, litigation, an expert; psychiatrists and Doctors’ Anxiety Private communication and editing: substance abuse or relationship problems. Health Advisory Services are the obvious Dr D Khursandi. Suicide may be more common in the places to start. There are also a number of presence of mental illness, medical psychologists in several states who have For help or information, visit illness, and in those who have had a prior active interests in helping doctors pass beyondblue.org.au or spinz.org.nz attempt or verbalised suicidal ideation; exams. The members of the Welfare of or call Lifeline (Australia) on 13 11 14 it may also occur in those who use Anaesthetists Special Interest Group are or Lifeline (New Zealand) psycho-active and/or recreational drugs. not experts but can suggest avenues for on 0800 543 354. Critically, however, even where there are help or referral. Members of the Welfare of “good reasons”, anxiety and depression Anaesthetists Special Interest Group must be identified and treated formally. can be found at www.anzca.edu.au/ fellows/sig/welfare/introduction.html.
92 ANZCA Bulletin December 2009 Obituary Dr Linda Rose Dadds January 23, 1972 – November 11, 2009
She completed her internship and and the ballet. Sport, too, played a huge residency at the Queen Elizabeth Hospital role in her life and included netball, in South Australia, and commenced skiing, badminton, tennis, sailing, table anaesthesia training there in 2004. On tennis, volleyball and, of course, horse the South Australian regional training riding. She was a keen gardener and a scheme she also worked at the Royal loyal friend with an infectious laugh. Adelaide Hospital, Flinders Medical Tragically, Linda took her own life at Centre, Daws Road Repatriation Hospital, Modbury Hospital on Rememberance Day, Women’s and Children’s Hospital and the November 11, 2009. Darwin Hospital. Linda is survived by her parents Rose Linda took a particular interest in and Ken Dadds who were incredibly teaching junior registrars, and as one of and justifiably proud of their daughter, many registrars who struggled with our her brother Andrew, sister-in-law Carol, college exams, she had a special concern beloved nephews Owen and Theodore, for those who, like her, had difficulty and her partner Chris Beamond. They passing them. She was a very giving have kindly agreed and contributed to the person and generous to a fault. When publication of this obituary in the hope friends from her parent’s Barossa Valley that it will lead to a wider recognition community were ill she took time to help of suicide as an issue in our profession, them and their families understand and and possibly help prevent another family cope with the foreign medical world. having to experience a similar Linda Dadds was born on January 23, 1972 Similarly her patients felt that Linda had senseless loss. at Memorial Hospital in Adelaide. She time for them and understood them as Farewell, Linda, you will be deeply was educated at Colonel Light Gardens people rather than just patients. Some missed by many. Primary School and later Kingscote of her patients went so far as to write to Area School on Kangaroo Island, where Linda’s parents after her death to express Dr Kate Drummond and she matriculated in 1988. After leaving their sympathy and their gratitude for Dr Monica Korecki school, she spent a year in Guatemala Linda’s care. on an AFS exchange, during which time While Linda found the ANZCA she became fluent in Spanish. examination process very difficult, she On her return, she completed a had completed the primary exam, all her Bachelor of Medical Laboratory Science modules and training time and was a degree through the University of South highly valued, well-regarded and trusted Australia, graduating with honours senior registrar at Modbury Hospital. after studying the role of blood in Linda was often the most senior doctor rejection after organ transplant. She was in the hospital after hours, and the recognised for her work with a Queen Anaesthetic Department hoped to keep Elizabeth Hospital Research Day Award. her as a consultant as soon as she passed She initially worked as a research the elusive fellowship examination. scientist at Daws Road Repatriation Outside work, Linda was a prolific and Hospital contributing to laboratory work passionate reader and an ardent lover of and papers on the science of bladder animals, particularly cats and horses. tumours, before being accepted in 1998 She rode from the age of five and became into the Flinders University post-graduate a very accomplished rider and show medical degree. As a medical student jumper. She owned two beautiful cats, she rotated to Barmera, Greymouth and had just bought a new puppy. Linda New Zealand, Alice Springs and loved music and was an accomplished Thursday Island. flautist. She also loved going to musicals
ANZCA Bulletin December 2009 93 Obituary Jean Reid Oakes June 16, 1920 – July 28, 2009
established she was an inaugural member and later became a Fellow. Female anaesthetists were a rare species, but she persevered and established herself in solo practice and was later, for a period, a member of the Hobart Anaesthetic Group. From 1976 – 77 she took over the Director of Anaesthetics position at the Royal Hobart Hospital from Michael Hodgson until the arrival of Stewart Lamont. She provided excellent and supportive leadership. She was a visiting medical officer at the Royal Hobart Hospital from 1949 until 1984. Although anaesthesia was her chosen specialty she later moved into community health and general practice. She continued full-time in this role until age 67 and worked part-time until she was 75. She suffered greatly following the death of Henry in 1982 and her son Simon, also a doctor, in 1996, but in true Jean Jean Oakes, who had been a significant Medicine was to become her chosen style, gathered her life together and presence in the Hobart medical community career and in 1944 she qualified in Bristol. moved on. since the 1950s, died suddenly in the This is where she met Henry Oakes, a fellow Her continued interest in all things “good country”, England, aged 89, on her student, whom she married in 1942. medical, her astute observations of life final trip home. Despite serious physical Henry was sent off to India until the and people and her genuine warmth, handicaps as she got older, she was able end of the war in 1945. humour and keen intelligence remained to continue to pursue a wide range of After a period in England following the until her sudden death. She would have interests until her death. war they emigrated to Bothwell, a small enjoyed knowing that England won the Jean Christie was born in Clevedon, town in southern Tasmania, where Henry Ashes. She was alive to know they won Somerset on the west coast of England thought they would find sunshine and the second Test. where her father was a dentist. Her early an opportunity for general practice. Her life was a testimony to her life in England was a happy and privileged Jean by then had two small children. adaptability and good sense – a life truly one. She had a brother Michael and sister She found the isolation of Bothwell well lived. Anne. At 12, she went to a prestigious depressing and at Henry’s suggestion She is survived by her daughter, boarding school, Wycombe Abbey, where returned to England (working as a ship’s Judy, and sons, Anthony and Julian. she learned to work and play hard and surgeon) in 1951. But it was not for long. developed the self discipline which was Her determination to make a new life in Dr Robert Bown to become one of the guiding principles Tasmania saw her return, this time of her life. She excelled in music and her to Hobart. Above: Jean Oakes is on the far right. childhood piano, which was transported She returned to study and qualified to Tasmania, became a source of great as an anaesthetist in the early fifties. relaxation in her always-busy life. When the Faculty of Anaesthetists was
94 ANZCA Bulletin December 2009 Obituary Walter Wyndham Biggs January 7, 1936 – September 24, 2009
Towards the end of his first year as an Walter’s academic interest was soon RMO, he was called to the office of the noticed and he was recruited in 1972 Director General of Health who informed to the Court of Examiners for the final him that next year he was to be sent to FFARACS, then as a member of the Final Longreach as the medical officer (that Examination Committee, and later the is anaesthetist) to the Flying Surgical deputy chair, Court of Examiners, final Service, which was based in Longreach FFARACS 1977-1984. He was also Member and had been established little more than of the Board of the FARACS 1977-1981. a year before. Wally replied to the director During his professional career Walter general that he had never actually gave outstanding service to the Faculty of given an anaesthetic, whereupon, the Anaesthetists and for 30 years as a VMO at director general replied: “It’s easy son, the Royal Brisbane and Royal Children’s you can learn in a fortnight”. Sadly, this Hospital. He was a leader in setting the issue still prevails in the minds of many standards in anaesthesia. administrators. Our specialty has been enriched by Soon after, Wally was sent to the his contributions and is the poorer Walter Wyndham Biggs died on Department of Anaesthesia at the for his loss. September 24, 2009 after a year-long Brisbane General Hospital where the battle with acute myeloid leukemia. wise counsel of the director at the time, Walter - or Wally - as he was known to his Dr Peter Livingstone Dr Ruth Molphy, managed to secure an friends and colleagues had an interesting FANZCA additional four weeks training for him. and broad career in anaesthesia. Walter spent four years in the He graduated MBBS in 1959, from Flying Surgical Service (1961-1965) and the University of Queensland, with experienced a wide range of cases, honours, and elected to do his first year of returning to Brisbane to continue his residency at what was then the Brisbane formal training. After being awarded the General Hospital, a vast conglomerate Renton Prize after passing the primary that included a children’s hospital and a FFARACS, he followed what was then women’s hospital. He had taken up the a familiar path by travelling to the UK, offer of a State Government Fellowship obtaining his FFARCS, then working during his undergraduate course and so at the London Hospital, which at the was “bonded” to the Queensland State time had a very strong connection Health Service for a time after graduation. with Brisbane. Wally always enjoyed recounting In 1968 he returned to Brisbane the story of how he was conscripted and joined the practice now known as into anaesthesia (he had hoped to do Narcosia and passed the final FFARACS. obstetrics and gynaecology).
ANZCA Bulletin December 2009 95 Obituary Dr Wah Kim (Harold) Chan 1931 – 2009
This was a time of great change in To add to the discomfort, when Singapore. Prior to World War II and the they docked in Perth, the city was in Japanese occupation, Singapore had been quarantine due to a polio epidemic under British rule. Negotiations began in and they were unable to disembark. the 1950s for independence and a gradual Eventually the quarantine was lifted and process of elections led ultimately to they travelled by train to Victoria. After effective independence (Kemerdekaan) the jamboree they spent some time in in 1959. As part of this process the health Tasmania. This was a difficult time for service came under local governance Harold as his mother died while he was in the mid 1950s and recruiting in Great away and there was no way for him to Britain for the Colonial Medical Service in return home. Singapore ceased. These were very busy days for the The inevitable result of this process few anaesthetists in Singapore. As an was a shortage of trained personnel. The employee of the government, Harold was Singapore Department of Anaesthesia expected to cover all the hospitals doing was very short staffed and for most of whatever cases were required. Largely the 1950s had no more than two qualified self taught, Harold and his colleagues anaesthetists. The surgical professor, anaesthetised everyone in Singapore, Yeoh Ghim Seng, a visionary surgeon from the very old to the very young. who was to become the Speaker in the “I am sure we must have made a lot of Singapore Parliament and its Acting mistakes,” he would say. President at times, encouraged his In 1959 he travelled to Australia and Harold Chan was born in Singapore trainees to complete twelve months of visited the Melbourne hospitals with in 1931, one of five siblings. The early anaesthesia. This practice was to create anaesthetists such as Bernie Dunn and years of Harold’s life were not easy; he many fine surgeons and was most likely Noel Cass, learning their skills and and his family were forced out of their the reason Harold was encouraged to take preparing for the exams. homes during the Japanese occupation up anaesthesia. However, he remembered He sat and passed the first part of of Singapore and moved to Malacca in that it was a result of failing the first the new Fellowship exam on September Malaysia. There, as a young boy, he met part of the surgical exam and being told 9, 1959 and returned to successfully his wife, Eleanor, whose family was also “you can either choose to work at the complete the final exam in October 1960. suffering considerable hardship as a mental hospital or you could consider The final exam at that time consisted result of the war. With no school to attend anaesthetics – at least then you will be in of two, two-hour papers on one day, and little food, Harold sought work but the operating theatre with the surgeons”! followed by clinicals and vivas the there were few jobs available. Eventually There was no specialist anaesthetic following week. Harold studied very Harold was befriended by a local Japanese training program in Singapore at that hard for the exam but ultimately the final businessman who encouraged him to time but some places were available in fellowship exam was not difficult because learn Japanese and secured him a job as Liverpool with T Cecil Gray. These were he had gained so much experience. an office boy with his company. eagerly sought after and sponsored by the “When I was asked how to manage When the war ended Harold returned Singapore government. Many Australian a bleeding peptic ulcer, I told them to Singapore and completed his schooling. doctors visited Singapore under the everything,” he said. “They asked me how He attended the highly respected Anglo auspices of the Colombo plan and Harold I knew so much. I said in Singapore there Chinese School in Singapore where he learnt much by working with them. Once is no one else, we do them all.” became a King’s Scout in 1945 and was he decided to specialise, he elected to After becoming the first Singaporean dux of the school. His passion was for travel to Melbourne where the Faculty to gain the Australian Fellowship, Harold engineering but he won a scholarship of Anaesthetists had recently been continued working for the Singapore to study medicine. Harold’s medical established at the College of Surgeons. government but also expanded into undergraduate years were spent at the This was not his first trip to Australia. private practice. large and extremely busy “GH” (Singapore In 1948, at the age of 17, Harold attended Some private hospitals had anaesthetic General Hospital) and at “KK” (Kandang the first Pan Pacific Scout Jamboree in machines but he also had his own which Kerbau Women’s Hospital) with 100 Wonga Park in Victoria. He and his fellow he required in some places, especially births each day. One of his important scouts travelled on a boat usually used for dental surgeries. Harold made this mentors at this time was the obstetrics sheep transport and their living quarters machine, mounting various components and gynaecology professor, Benjamin were the sheep pens which had not been such as a circle absorber and ether bottle Sheares, who was to become the second well cleaned. on a metal frame with room for spare President of Singapore. Harold qualified cylinders and a carrying handle. He in 1956 winning the prize for surgery. used this machine throughout his career.
96 ANZCA Bulletin December 2009 Usually there would be someone to help Once back in Singapore, his old friends Footnote: In September 2008, Harold Chan carry the equipment once he arrived at from the scouts and many of his surgical discharged himself from hospital after a the hospital and, although he carried his colleagues rallied around to encourage routine operative procedure to meet Dr Christine Ball in Singapore and tell her the own cylinders, he would also arrange for him and with extraordinary tenacity he story of his life. He was extremely generous oxygen cylinders to be delivered to the eventually returned to work, confining his with both his time and his memories and it site as well. practice to just two hospitals. He was able was a great privilege for Dr Ball to meet him His private practice was not without to drive a car and also returned to playing and his wife, Eleanor. This obituary, although incident and on a particularly memorable golf - “not very good golf mind you…” - compiled by Dr Ball, contains the special memories of his very close friends, Bernie day he was anaesthetising a patient in with the help of a second-hand golf cart. Dunn and Noel Cass. a dental surgery in the Hong Kong and Harold was an expert and enthusiast Shanghai Bank Building in Orchard Road. in many fields. Ultimately he was pleased It was 3.07pm on March 10, 1965 and that he took up medicine rather than Singapore was in the middle of a conflict engineering because it was a career with Indonesia (Konfrontasi). that allowed him to pursue all his other A bomb was detonated in the lift well. interests. He had a ham radio licence Harold and his patient were blown across (call sign 9V1XH), was a wonderful the room, shattered windows covering photographer, grew beautiful orchids and the floor in broken glass. The patient had had the most extraordinary collection been intubated but the tube and circuit of walking sticks, including some with remained by the dental chair and Harold quite dangerous concealed weapons! He had to frantically crawl through the ruins loved gourmet traditional foods and fine of the room to re-intubate this patient. wine and had the command of a number He and the Malay attendant then of languages and dialects. Despite the carried the patient down five flights of obvious hardship he had to overcome, his stairs, woke him up in the foyer and put enthusiasm for life never diminished. him in a passing car with instructions to In the course of his busy life, Harold take him to a hospital. befriended a large number of overseas Two people were dead and the foyer anaesthetists and other doctors and their was a sea of broken glass and bleeding families. He was a generous host and with bodies. Harold spent the remainder of his extraordinarily capable wife Eleanor, the afternoon resuscitating people and was able to assist these friends in putting them into more passing cars. He many ways. remembered another explosion that he He is remembered by his Australian witnessed during the same conflict that friends as a loyal friend and a most was on the roof of a night club; on that generous person. He is survived by his occasion he decided it was prudent to run wife, Eleanor, their six children, Gerald, in the opposite direction. Jackie, Bernie, Noreen, Alvin and Wendy, In 1986 his career almost came to a and their families. sudden end when he was diagnosed with The words of the Bahasa Melayu an expanding thoracic aneurysm. He proverb best represent how Harold treated travelled to America to have a repair but his friends and how he is remembered awoke from the operation with a dense by them. paraplegia. Months of physiotherapy “Hutang emas dapat dibayar, hutang budi followed with him crawling around the dibawa mati”I (“A debt of gold can be room, determined to regain the use of repaid but a debt of friendship is carried his legs. Eventually he developed some to the grave”) feeling in his legs and was able to walk with the aid of sticks. No airline would Dr Christine Ball, honorary assistant carry him on the interstate leg required museum curator, with Bernie Dunn and to get him home via San Francisco and Noel Cass. in the end he had to personally hire a Lear Jet.
ANZCA Bulletin December 2009 97 ANZCA Council meeting report
• In Australia, the application for Education and Training Committee November 2009 recognition as a QAA was sought and Educational Programs at the ASM Report following the ANZCA Council approved under the Health Insurance As part of the re-design of teacher meeting on November 21, 2009 Act 1973. Obtaining Ethics approval development and support activities, College Award and Election is proving problematic and time Council approved the introduction of ANZCA Medal consuming as there is no national an educationally focused stream each Dr Diana Khursandi (Qld) has been ethics committee approval system in year at the ASM, commencing from awarded an ANZCA Medal in recognition Australia, and individual applications to 2011. The activities will be planned and of her long-term contribution to the each hospital must be made. Individual delivered by Education Development specialty of anaesthesia. Dr Khursandi applications will be sought throughout Unit staff and will be budgeted as part has made a significant and sustained the pilot phase, with the investigation of the ASM budget. They will be aligned contribution in a diverse number of areas of alternative methods for the future with the College training program, and including rural and regional practice, roll-out of the program across all will include core training for all clinical anaesthesia workforce challenges, gender jurisdictions in Australia. teachers, with options for a more tailored approach to meet the needs of those issues in medicine, clinical indicators, Association of Anaesthetists Great who progress to increased educational CPD, education and training, and the Britain and Ireland (AAGBI) – responsibilities, e.g. educational health and welfare of doctors. International Guidelines Group leadership, scholarship, teaching Council has agreed to endorse the AAGBI Election to Fellowship and/or management. Professor Michael Irwin (HK) has been Guideline on the Management of Severe elected to Fellowship under Regulation Local Anaesthetic Toxicity. The group ANZCA Guidelines on Assessment 6.2. Professor Irwin is currently that developed the guideline included As stated in the Regulations, the duties President of the Hong Kong College anaesthesia and emergency physician of the Assessments Subcommittee include of Anaesthesiologists. representatives from Chicago University, the provision of advice regarding non- Dr Khursandi will be invited to receive James Cook University Hospital, Waikato examination, non-workplace-based her medal, and Professor Irwin will be and Hutt Hospitals. assessments, and the blueprinting, co- ordination and evaluation of assessments invited to have his Fellowship conferred Regional/National Committees (examinations, workplace-based and at the College Ceremony in Christchurch It has been agreed to include a Quality other) as part of the curriculum for next year. and Safety Officer in the membership of education and training of trainees the Regional/National Committees. Death of Fellow in anaesthesia. To this end, a set of Council noted with regret the death of The main aims of the role are to: guidelines has been developed, and Queensland Fellow, Dr Agnes Mary Daly, • act as a point of contact and as a endorsed by Council, to guide the review AM – FFARACS 1970, FANZCA 1992. conduit for relevant quality and safety and redesign of ANZCA assessments. Quality and Safety Committee information This work will include blueprinting the Australian and New Zealand Tripartite • seek opinions for submissions relating assessments to the curriculum outcomes Anaesthetic Data Committee (ANZTADC) to quality and safety reviews framework. A copy of the guidelines The software for the initial phase of the • attend pertinent local quality and safety is available in a public section of the development of the on-line anaesthetic workshops/meetings where possible College website. incident reporting system is now in place Additionally, all accredited hospitals have Educational Innovation Funding and being utilised successfully as part a Quality Assurance (QA) Officer, and it is for 2010 of a pilot program. In addition to the envisaged that the Q&S Officer could act This funding was established to support originally targeted pilot sites, several as a conduit with a network of hospital- small workplace-based projects with others sites have expressed interest in based QA Officers, to participate in the modest budgets that are directly relevant participation and have commenced the above three activities. to the ANZCA training program. The total approval process. Regulation 3.15 has been amended to quantum of funding available is $40,000 Two forms of legislative protection are reflect this decision. and the following projects were supported each required to run the program in both by Council for next year: New Zealand and Australia: • In New Zealand, national ethics approval was sought and obtained via the Multi-region Ethics Committee, and the application for recognition as a Quality Assurance Activity (QAA) was sought and approved through the Health Practitioners Competence Assurance Act 2003.
98 ANZCA Bulletin December 2009 Funding Name Project Approved Graham, J et al PCAT: Provisional Check of Anaesthesia Trainees $20,000 Misur, M et al The Mini-Clinical Evaluation Exercise (Mini-CEX) $10,000 Castanelli, D Multi-source feedback for trainees in anaesthesia $10,000
Finance Anaesthesia Continuing Education 2010 Budget Co-ordinating Committee (Acecc) Following an exhaustive consultation Establishment of a Perioperative and review process, and in line with the Medicine Special Interest Group recommendation of the Finance, Audit Council has supported the establishment and Risk Management Committee, the of a Perioperative Medicine SIG to budget for 2010 was approved by Council. progress the work commenced through An overall increase in fees of 4.8% was the Perioperative Medicine Taskforce in accepted, and the fee schedule for next 2004. The proposal is still to be formally year is available on the ANZCA website in approved by the ASA and NZSA Councils. the News section under Council Reports. Dr Leona Wilson Fellowship Affairs Committee President 2010 Annual Scientific Meeting Prof Paul Myles is the Australasian Associate Professor Kate Leslie Visitor to this meeting, and as part of his Vice-President commitments, it has been agreed that he will visit Western Australia following the ASM in Christchurch. 2013 Annual Scientific Meeting The dates for the Melbourne ASM have been confirmed for 4 – 8 May 2013. New Fellows’ Conferences It has been agreed that the NFC will be incorporated into the area of responsibility of the ASM Officer who will act as an advisor to NFC convenors. Dr Michelle Mulligan has been appointed Councillor in Residence to the 2010 NFC which will be held in Hanmer Springs, NZ. The theme of this meeting is Adventure and Anaesthesia.
ANZCA Bulletin December 2009 99 ANZCA Council meeting report 2
ANZCA Medal Education and Training Committee October 2009 Dr Robert Wong (WA) has been awarded Review of in-training assessment Report following the ANZCA Council an ANZCA Medal in recognition of his process meeting on October 10, 2009 contribution to diving and hyperbaric It has been agreed to introduce a medicine, his initiation of the formal Resignations from Council “portfolio of evidence” approach to qualification in this area in 2003 and his Drs Richard Waldron and Peter Cook have in-training assessment (ITA). To this ongoing work to maintain the program at tendered their resignation from Council. end, the ITA form will no longer be the the highest possible standard. Dr Waldron was elected to Council assessment tool, but rather will be a Professor Kam and Dr Wong will summary of performance assessed by in 2006, following a year as a co-opted be invited to receive their medals at member and resigned in August. His direct observations made in the workplace the College Ceremony in Christchurch with sources of evidence documented on portfolios were Honorary Treasurer next year. and ASM Officer. In addition to these the form. The revised form was supported portfolios, during his time on Council, Death of fellows by Council and it was noted that there will Richard served as a member of the Council noted with regret the deaths no longer be ITA1 and ITA2 forms. The Continuing Education and Quality of the following Fellows: new form and revisions to the process will Assurance (CE&QA) Committee, the • Dr Wah Kim (Harold) Chan (Singapore) be implemented from the start of the 2010 Hospital Accreditation Committee FFARACS 1961, FANZCA 1992 training year, and TE14 will be amended and was chair of the Workforce and • Dr Walter Wyndham Biggs (Qld) accordingly. Anaesthesia and Industry Liaison FFARACS 1968, FANZCA 1992 These changes represent the first part of a staged process that will parallel the committees. Honours, Appointments curriculum review and redevelopment. Dr Cook was elected in 2007 and and Higher Degrees A phased ITA revision will also be resigned on October 2. During his time Two Fellows received prizes in the supported by the outcomes of the Clinical on Council, Peter was a member of the 2009 British Medical Association Book Teacher Development Working Group CE&QA Committee, was co-opted to Competition: the Overseas Trained Specialist (OTS) • Professor Teik Oh was awarded first which is reviewing the support and Committee and was ANZCA representative prize in the anaesthesia category for training provided for ANZCA clinical on the Joint Consultative Committee on the sixth edition of the Intensive teachers and supervisors of training. Anaesthesia and JFICM Board. Care Manual. Imgs Committee In accordance with clause 11.2.1 of the • Dr Richard Riley’s Manual of Simulation International medical graduate Constitution, the casual vacancy resulting in Healthcare won first prize in the basis specialists - workplace based from Dr Waldron’s resignation has been of medicine category. assessment process filled by Dr Mark Reeves. Dr Reeves will Quality and Safety Committee At the beginning of 2009, the College join Council as a co-opted member for an WHO Safe Surgery Saves Lives – introduced a new international medical initial period to May 2010. safe surgery checklist launch graduate specialists (IMGS) process that In accordance with clause 8.5 of the The Australian launch was held on allowed any IMGS determined to have Constitution, the casual vacancy resulting August 19 at Parliament House, Canberra, advanced standing towards substantial from Dr Cook’s resignation will be filled and was attended by the Federal Minister comparability to undertake a workplace by Dr Patrick Farrell. for Health, Ms Nicola Roxon, as well based assessment (WBA) during the Associate Professor Kate Leslie was as representatives of anaesthesia, final three months of their supervised appointed Honorary Treasurer, and surgery, obstetrics and gynaecology and practice, in lieu of the Final Examination/ Dr Nicole Phillips as ASM Officer. perioperative nursing. In New Zealand, IMGS Performance Assessment. Two the checklist was launched by the College Awards assessors conduct the WBA, and at its Minister of Health, Mr Tony Ryall, on Orton Medal conclusion, a narrative report, including August 27 and was supported by medical Professor Peter Kam (NSW) has been recommendations is forwarded to the groups including anaesthetists, surgeons, awarded an Orton Medal. This is the IMGS Committee for approval. In order obstetricians, ophthalmologists, College’s highest form of recognition to streamline the process, it has been gastroenterologists and representatives agreed that all WBA narrative reports for its Fellows and has been awarded from organisations such as the Ministry to Professor Kam for his immense will be considered for approval by of Health and the Health and the DPA Assessor and the DPA IMGS. contribution to training and education Disability Commission. across Australia, New Zealand and Unsatisfactory WBAs will continue to South-East Asia over many years. Evidence based medicine portfolio be forwarded to the IMGS Committee – set of ‘outcome definitions’ for consideration. It has been agreed that a workshop will be held to define a minimum set of pre-operative and post-operative data collection for the purpose of auditing anaesthesia outcomes.
100 ANZCA Bulletin December 2009 Anzca Training Scholarships for 2010 Regulation 23 – Advice Regarding PS46 – Recommendations for Training Training scholarships were introduced in Recognition as a Specialist in and Practice of Diagnostic Perioperative 1999, and provide a 50% concession on Anaesthesia Transoesophageal Echocardiography the annual training fee for trainees with In keeping with regulations 14 and 15 in Adults limited income. Scholarships for 2010 relating to examinations and training that It has been agreed that PS46 will be were awarded to the following trainees: include reference to interpretation and reviewed under the new process outlined • Dr Manoharan, Jaya Raj V K (Malalysia) non-binding decisions, Regulation 23 has in ADP1, and to this end, a Quality and • Dr Mohammad Ilyas, Sajidah Ilyas been amended with the addition of the Safety-hosted workshop will be convened Bt (Malaysia) following clauses: in 2010 to assemble the appropriate • Dr Abu Baker, Anisa Aisha (Malaysia) individuals to undertake the review. 23.14 Interpretation and non-binding Fellowship Affairs Committee decisions PS40 – Guidelines for the Relationship Annual Scientific Meeting 23.14.1 Any decision, approval, consent Between Fellows and the Healthcare 2010 – Christchurch or the exercise of any discretion, by the Industry Mr Robbie Deans has accepted the Council or other committee or authority Council established a working group invitation to deliver the Oration at the under Regulation 23 will be considered on to examine the issues surrounding College Ceremony. a case-by-case basis, having regard to the relationships between Fellows and particular circumstances of each case. trainees and the healthcare industry. 2016 – Sydney As a result of their deliberations, it has The dates for this meeting have been 23.14.2 Notwithstanding Regulation 23, Council may exercise or dispense other been agreed that a revision of PS40 confirmed for April 29 to May 4 at the will be undertaken. Sydney Convention Centre. decisions after consideration of relevant circumstances. Joint Faculty of Intensive Care Internal Affairs 23.14.3 Any such decision, approval, Medicine/college Of Intensive Care Strategy plan 2010 - 2012 consent or exercise of discretion will Medicine Arrangements Council has accepted the 2010-2012 not be binding on any other or future Transitional arrangements relating to strategic plan with implementation a work decisions or set any precedent for other or the New Zealand National Committee and in progress over the next three years. future decisions regarding Regulation 23. Queensland Regional Committee have Joint Consultative Committee been agreed. Administrative support 23.15 Communications on Anaesthesia (JCCA) to the other regions will be provided All enquiries, applications, and The final draft of the Advanced centrally by the College of Intensive communications regarding Regulation Rural Skills Curriculum Statement on Care Medicine (CICM). 23 must be made in writing and Anaesthesia was endorsed by Council. In response to a specific request addressed to the Chief Executive Officer, This curriculum was last reviewed in 2003 from the joint faculty, Kate Briggs, Australian and New Zealand College and is used as the basis of training for ASM Co-ordinator, will continue to of Anaesthetists, 630 St Kilda Road, the supervision and examination of GP co-ordinate the CICM ASM for a period Melbourne, Victoria 3004, Australia. registrars and GPs wishing to complete up to 24 months under the transitional a 12-month advanced rural skills post Professional arrangements agreed to with JFICM. in anaesthesia. The JCCA accredits the Professional Documents Advanced Rural Skills (ARS) training PS10 – Handover of Responsibility posts and oversees the anaesthesia During an Anaesthetic examination process. Council accepted a recommendation from the Quality and Safety Committee National Health Workforce Planning that PS10 be reviewed to include recent and Research Collaboration Anaesthetic progress regarding “time-out” features Medical Workforce Study. and the WHO Safe Surgery Checklist. Dr Richard Willis has been nominated as ANZCA representative to the above study.
ANZCA Bulletin December 2009 101 ANZCA Council meeting report 2 continued
Research Research awards for 2010 The following projects were supported by Council: Funding Funding Researchers Project Sought Recommended Greenland, Keith B. “A re-appraisal of the sniffing position and the ‘three axes alignment theory’ for direct laryngoscopy” $25,202.95 $15,000 Sleigh, James W. “The genetics of the analgesic response to opioids in the post-anaesthesia care unit” $60,000 $50,000 Warrillow, Stephen J “Evaluation of exercise rehabilitation for survivors of intensive care” $50,630.40 $20,000 McDonnell, Nolan J. “Determination of equivalent dose rates of metaraminol and phenylephrine, when administered by continuous intravenous infusion, to prevent hypotension during elective Caesarean section under spinal anaesthesia” $21,562 $10,000 Wrigley, Paul J. “Regional changes in cerebral perfusion associated with persistent spinal cord injury neuropathic pain” $56,422 $45,645 Myles, Paul S. “ENIGMA-II trial long-term follow-up study” $60,000 $60,000 Merry, Alan F. “Validation of the ‘WHO Surgical Safety Checklist’ to reduce postoperative morbidity and mortality - the check WHO study” $51,751 $51,751 Finch, Philip M. “Adrenergic receptor involvement in an animal model of complex regional pain syndrome type I” $56,630 $47,000 Barrington, Michael J. “The Australian and New Zealand Registry of Regional Anaesthesia (AURORA study)” (Fellowship ) $76,954 $70,000 (Year 1 of 3) Chan, Matthew “Re-defining the warning criteria for intraoperative neurophysiologic monitoring” $59,438 $59,438 Hogg, Malcolm N. “Perfusion levels and correlation of pain processing regions in the brains of chronic pain patients and healthy people” $59,948 $40,000 Lin, Enjarn “Does remote ischemic post-conditioning reduce ischaemia reperfusion injury in patients undergoing lung transplantation?” $33,500 $20,000
The following application was supported for funding of the second and third year of the project, pending committee review of a satisfactory progress report. Funding Requested Recommended Applicant Project Title for 2010 for 2011 & 2012 Barrington, Michael J. The Australian and New Zealand Registry of Regional Anaesthesia (AURORA Study) $76,954 $70,000
102 ANZCA Bulletin December 2009 Second year funding from 2009 The following application was supported for funding of the second year of this project, pending a satisfactory progress report. Funding Requested Recommended Applicant Project Title for 2010 for 2010 Law, Corinne “Intraoperative tiratability of opioids – can electroencephalographic (EEG) monitoring help us predict how much to give?” $75,000 $45,000
Third year funding from 2008 The following application was supported for funding of the third and final year of the project. Funding Requested Recommended Applicant Project Title for 2010 for 2010 Sumpter, Anita “Age related changes in effects of sedatives and analgesics on quantitative EEG monitoring in paediatric intensive care” $80,000 $40,000
In addition to the above, the Harry Daly Research Award was awarded to Dr Matthew Chan for his project “Re-defining the warning criteria for intraoperative neurophysiologic monitoring”. The Mundipharma ANZCA Research Fellowship was awarded to Dr Paul Wrigley for his project “Regional changes in cerebral perfusion associated with persistent spinal cord injury neuropathic pain”. The Pfizer ANZCA Research Fellowship was awarded to Professor Alan Merry for his project “Validation of the ‘WHO Surgical Safety Checklist’ to reduce postoperative morbidity and mortality - the check WHO study”. The ANS ANZCA Research Fellowship was awarded to Dr James Sleigh for his project “The genetics of the analgesic response to opioids in the post anaesthesia care unit”. Simulation-education grant for 2010 Dr Sandy Garden was awarded a grant of $32,226 for his project “Training for debriefing after simulation of anaesthetic crises: current practices”. Novice investigator awards for 2010 – the following projects were supported by Council: Funding Funding Name Project Sought Recommended Hockey, Brad M. “The use of mechanically skinned muscle fibers for the diagnosis of MH: a pilot study” $18,570 $18,570 Phan, Tuong D. “Comparison of oesophageal doppler with arterial pressure waveform derived cardiac output and stroke volume variation” $19,200 $15,000
The Academic Enhancement Grant was not awarded for 2010. Training Accreditation Committee Accreditation of retrieval of services Council supported the promulgation of a professional document for retrieval services seeking College approval for vocational training in anaesthesia. The consultation process will include a request for feedback from the regional/national committees and the ANZCA Trainee Committee. New Programs Committee Certificate in Diving and Hyperbaric Medicine It has been agreed that completion of the Diving and Hyperbaric Medicine (DHM) formal project will no longer be a prerequisite to for candidates to sit the DHM examination. It is now acceptable for the formal project to be completed after the examination but before the award of the certificate. Regulation 36.4.9 has been amended accordingly.
Dr Leona Wilson Associate Professor Kate Leslie President Vice-President
ANZCA Bulletin December 2009 103 Fellowship Affairs Professional documents
PS9 (2008) Guidelines on Sedation and/or Analgesia for Australian and New Zealand Diagnostic and Interventional Medical College of Anaesthetists or Surgical Procedures Professional documents PS10 (2004) Handover of Responsibility During an Anaesthetic P = Professional T = Technical PS12 (2007) Statement on Smoking as Related to the EX = Examinations PS = Professional standards Perioperative Period TE = Training and Educational PS15 (2006) Recommendations for the Perioperative Care of Patients Selected for Day Care Surgery TE1 (2005) Recommendations for Hospitals Seeking College Approval for Vocational Training in Anaesthesia PS16 (2008) Statement on the Standards of Practice of a Specialist Anaesthetist TE2 (2006) Policy on Vocational Training Modules and Module Supervision PS18 (2008) Recommendations on Monitoring During (interim review) Anaesthesia TE3 (2006) Policy on Supervision of Clinical Experience for PS19 (2006) Recommendations on Monitored Care by Vocational Trainees in Anaesthesia an Anaesthetist TE4 (2003) Policy on Duties of Regional Education Officers PS20 (2006) Recommendations on Responsibilities of the in Anaesthesia Anaesthetist in the Post-Anaesthesia Period TE5 (2003) Policy for Supervisors of Training in Anaesthesia PS21 (2003) Guidelines on Conscious Sedation for Dental Procedures TE6 (2006) Guidelines on the Duties of an Anaesthetist PS26 (2005) Guidelines on Consent for Anaesthesia or Sedation TE7 (2005) Guidelines for Secretarial and Support Services to Departments of Anaesthesia PS27 (2004) Guidelines for Fellows who Practice Major Extracorporeal Perfusion TE8 (2003) Guidelines for the Learning Portfolio for Trainees in Anaesthesia PS28 (2005) Guidelines on Infection Control in Anaesthesia PS29 (2008) Statement on Anaesthesia Care of Children in TE9 (2005) Guidelines on Quality Assurance in Anaesthesia Healthcare Facilities without Dedicated Paediatric TE10 (2003) Recommendations for Vocational Training Facilities (reissue) Programs PS31 (2003) Recommendations on Checking Anaesthesia TE11 (2008) Policy on the Formal Project (interim review) Delivery Systems TE13 (2003) Guidelines for the Provisional Fellowship Program PS37 (2004) Regional Anaesthesia and Allied Health TE14 (2007) Policy for the In-Training Assessment of Trainees Practitioners in Anaesthesia PS38 (2004) Statement Relating to the Relief of Pain and TE17 (2003) Policy on Advisors of Candidates for Anaesthesia Suffering and End of Life Decisions Training PS39 (2003) Minimum Standards for Intrahospital Transport TE18 (2005) Guidelines for Assisting Trainees with Difficulties of Critically Ill Patients EX1 (2006) Policy on Examination Candidates Suffering from PS40 (2005) Guidelines for the Relationship Between Fellows Illness, Accident or Disability and the Healthcare Industry T1 (2008) Recommendations on Minimum Facilities for Safe PS41 (2007) Guidelines on Acute Pain Management Administration of Anaesthesia in Operating Suites PS42 (2006) Recommendations for Staffing of Departments and Other Anaesthetising Locations (interim review) of Anaesthesia T3 (2008) Minimum Safety Requirements for Anaesthetic PS43 (2007) Statement on Fatigue and the Anaesthetist Machines for Clinical Practice PS44 (2006) Guidelines to Fellows Acting on Appointments PS1 (2002) Rec ommendations on Essential Training for Rural Committees for Senior Staff in Anaesthesia General Practitioners in Australia Proposing to PS45 (2008) Statement on Patients’ Rights to Pain Management Administer Anaesthesia PS46 (2004) Recommendations for Training and Practice PS2 (2006) Statement on Credentialling and Defining the of Diagnostic Perioperative Transoesophageal Scope of Clinical Practice in Anaesthesia Echocardiography in Adults PS3 (2003) Guidelines for the Management of Major Regional PS47 (2008) Guidelines for Hospitals Seeking College Approval Analgesia of Posts for Vocational Training in Diving and PS4 (2006) Recommendations for the Post-Anaesthesia Hyperbaric Medicine Recovery Room PS49 (2008) Guidelines on the Health of Specialists and PS6 (2006) The Anaesthesia Record. Recommendations on the Trainees Recording of an Episode of Anaesthesia Care PS50 (2004) Recommendations on Practice Re-entry for PS7 (2008) Recommendations on the Pre-Anaesthesia a Specialist Anaesthetist Consultation PS51 (2009) Guidelines for the Safe Administration of PS8 (2008) Guidelines on the Assistant for the Anaesthetist Injectable Drugs in Anaesthesia
104 ANZCA Bulletin December 2009 Australian and New Zealand PM5 (2006) Policy for Supervisors of Training in Pain Medicine College of Anaesthetists PM6 (2007) Guidelines for Longterm Intrathecal Infusions (Analgesics/Adjuvants/Antispasmodics) and PS3 (2003) Guidelines for the Management of Major Joint Faculty of Intensive Care Regional Analgesia Medicine PS38 (2004) Statement Relating to the Relief of Pain and Professional documents Suffering and End of Life Decisions
IC-1 (2003) Minimum Standards for Intensive Care Units PS39 (2003) Minimum Standards for Intrahospital Transport of Critically Ill Patients IC-2 (2005) Intensive Care Specialist Practice in Hospitals Accredited for Training in Intensive Care Medicine PS40 (2005) Guidelines for the Relationship Between Fellows IC-3 (2008) Guidelines for Intensive Care Units seeking and the Healthcare Industry Accreditation for Training in Intensive Care PS41 (2007) Guidelines on Acute Pain Management Medicine PS45 (2008) Statement on Patients’ Rights to Pain Management IC-4 (2006) The Supervision of Vocational Trainees in Intensive Care and Associated Responsibilities IC-6 (2002) The Role of Supervisors of Training in Intensive PS49 (2008) Guidelines on the Health of Specialists and Trainees Care Medicine Medicine IC-7 (2006) Administrative Services to Intensive Care Units College Professional Documents adopted by the Faculty: IC-8 (2008) Quality Assurance PS4 (2006) Recommendations for the Post-Anaesthesia IC-9 (2002) Statement on the Ethical Practice of Intensive Recovery Room (Adopted February 2001) Care Medicine PS7 (2008) Recommendations for the Pre-Anaesthesia IC-10 (2003) Minimum Standards for Transport of Critically Consultation (Adopted November 2003) Ill Patients IC-11 (2003) Guidelines for the In-Training Assessment of PS8 (2008) Guidelines on the Assistant for the Anaesthetist Trainees in Intensive Care Medicine (Adopted November 2003) IC-12 (2001) Examination Candidates Suffering from Illness, PS9 (2008) Guidelines on Sedation and/or Analgesia for Accident or Disability Diagnostic and Interventional Medical or Surgical IC-13 (2008) Recommendations on Standards for High Procedures (Adopted 2008) Dependency Units Seeking Accreditation for PS10 (2004) The Handover of Responsibility During an Training in Intensive Care Medicine Anaesthetic (Adopted February 2001) IC-14 (2004) Statement on Withholding and Withdrawing PS15 (2006) Recommendations for the Perioperative Care of Treatment Patients Selected for Day Care Surgery (Adopted IC-15 (2004) Recommendations of Practice Re-entry for an February 2001) Intensive Care Specialist PS18 (2008) Recommendations on Monitoring During Australian and New Zealand College Anaesthesia (Adopted February 2001) PS20 (2006) Recommendations on Responsibilities of the of Anaesthetists Anaesthetist in the Post-Anaesthesia Period and (Adopted February 2001) Faculty of Pain Medicine PS31 (2003) Recommendations on Checking Anaesthesia Professional documents Delivery Systems (Adopted July 2003) T1 (2008) Recommendations on Minimum Facilities for Safe PM2 (2005) Guidelines for Units Offering Training in Administration of Anaesthesia in Operating Suites Multidisciplinary Pain Medicine and other Anaesthetising Locations (Adopted PM3 (2002) Lumbar Epidural Administration of Corticosteroids May 2006) PM4 (2005) Guidelines for Patient Assessment and Implantation of Intrathecal Catheters, Ports and Pumps for Intrathecal Therapy
ANZCA Bulletin December 2009 105