Intercontinental Critical Care Centre of Excellence Steering Committee Meeting

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Intercontinental Critical Care Centre of
Excellence Steering Committee Meeting
Jan. 30 to Feb. 1 / 2002Palm Springs
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Down
Under
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The view from down under

• Dr. Yahya Shehabi FFIC.ANZCA
• Director Intensive Care Services
• Prince of Wales Campus
• UNSW Medical school
• Randwick - Sydney
• yshehabi_at_ozemail.com.au
• shehabiy_at_sesahs.nsw.gov.au

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The POW hospital complex
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Undergraduate medical education and
training

• Responsibility of the Universities
• Undergraduate teaching and certification.
• Discipline of Critical Care
• Anaesthesia
• Emergency medicine
• Intensive care
• Curriculum prepared by clinicians
• Clinical exposure and rotations

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Postgraduate medical education and training

• Professional colleges and Craft groups
• Rotating Resident medical officer years 1, 2, 3
• Primary exams
• Clinical specialty streams
• Senior RMO
• Research, MD, and lobbying
• Registrar in training, register with College /
  Faculty
• Final exam. / Advanced training ( physicians )
• Fellow, Final year / formal project
• Total of 8 years minimum.

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Postgraduate Medical education and training

• Professional colleges and Craft groups
• Supervised hospital based training and education.
  
• Dedicated Supervisor of training.
• Courses towards primary final exams.
• Clinical refresher and review courses
• Structured exams, written and clinical

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Intensive care trainingThe Early Years

• 28th 1974 Meeting to discuss setting up a joint
  diploma in intensive care held November
• November 13th 1977 Inaugural meeting of the
  SAC-IC of RACP held at RMH
• October 1979 First Final Examination for
  FFA.RACS endorsed in Intensive Care held

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Physician vs. Anaesthetic training
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View the diferences

• Faculty Intensive care
  College of Physicians
• Program Program
• Basic sciences
• Content
• Relevance
• Procedural skills Variable
• In-training assessments 4 x 6 monthly
  3 x annually
• Minimum anaesthesia 12 months
  Nil
• Minimum medicine 6 months 5 years
• Overseas core training No
  Possible
• Fellowship examination Yes
  No

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ANZICS
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A Joint Training Program Recent Times

• 1992
• Formation of Australian College of Anaesthetists
• Working party to establish Faculty of Intensive
  Care within the new College
• 1993
• Inaugural meeting of Board of Faculty of
  Intensive Care FIC.ANZCA (November 4th)
• 1994
• Formation of
• Conjoint Committee on Training and Certification
• Intensive Care Medical Liaison Committee

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A Joint Training Program Recent Times

• 1995
• Decision by Board of Faculty to exempt from
  primary examination trainees who have passed
  FRACP written and clinical examination for the
  purposes of IC training only
• Development of joint training program
• 1996
• Conjoint Committee renamed JSAC-IC
• Joint training program implemented
• FIC.ANZCA commences Paediatric IC certification
• 1997
• RACP representatives on Faculty accreditation
  visits and Faculty Regional Committees
• First Paediatric IC examination by the faculty of
  intensive care.

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New JFICM 2001 / 2002
Joint faculty Intensive Care Medicine

• Foundation Fellowship
• Interim Board meeting Feb. 20 / 2002
• Admission to Fellowship
• Discontinue all training programs
• JFICM takes over trainees
• Dissolve FIC.ANZCA and JSAC-IC
• Elect Inaugural Board
• Develop new training programs

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• Proposed Joint Faculty Training Program
• Basic Sciences electives
• 24 months other than ICU
• Suitable primary or other examination
• Compulsory program
• 24 months core intensive care
• 12 months in level 3 unit
• Overseas training with pre approval
• 6 months Anaesthesia
• 6 months Medicine
• Formal project

• Assessment
• Examination
• Primary
• I T A
• Final Examination
• CPT/Censor

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Categories of Intensive Care Units

• Formal rigorous accreditation and
  inspections
• Level 3 / Core 24 C24
• Ventilated beds and ventilated hours
• Broad case mix and adequate case load
• Active didactic and bedside teaching program
• Academic unit with active research
• Appropriate infrastructure
• At least 3 full time certified intensivists
• 24 hrs. on site RMO / Registrar

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Medical education and trainingPyramid of Unit
based program

MOPS
Cutting edge Research oriented
Current EB critical care practice
Applied Patho-Physiology and mechanisms of
disease
Basic foundations of critical care
and basic sciences
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Categories of Intensive Care Units

• Level 2 / 6 months C6
• Short term Ventilation and organ support
• Appropriate infrastructure
• At least 1 full time certified intensivists
• High dependency units
• Level 1 / 0 time
• CCU and other organ specific units

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Critical care units in AustraliaANZICS review
2000

• 115 public and 55 private ICUs
• 48 , 81 general intensive care units
• 43.5 level 3 units
• Most are closed style management
• 1912 total beds, 1187 ventilated beds
• 6.2 ventilated beds per 100.000
• Total admissions 106.913 patients

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Critical care units in AustraliaANZICS review
2000

• Human resources / Medical
• 245 specialist intensivist FTE
• 3.47 ventilated beds per one specialist FTE
• 112 ICU registrars in training
• In 2001, 166 specialist in training
• Human resources / Nursing
• 5382.9 registered nurse FTE
• 4.53 RN FTE per ventilated bed

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Critical care units in Australia

• Clinical decision making process
• Intensivist on duty
• Ongoing management of all organ support
• Share ideas with referring physician
• Appropriate consultations to other specialists
• Team management / Fellow / Registrar / RMO /
  Nurse. 11 patient ratio no RTs.
• Arrange and conduct family conferences
• Has the final say...
• Shared rather than Closed units

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Critical care education, future needs

• Structured CCM undergraduate teaching
• Full use of IT capabilities
• Distance learning
• Web casting
• Administrative and business principles
• More research Collaboration with universities
• Better maintenance of skills and standards
• Continuing education / Clinical exposure
• Modules / Simulation exercises
• Re certification ?

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Critical care educationFuture needs

• Joint Faculty Intensive Care Medicine Future
  challenges
• New training program
• Resource management
• Effective Lobby group
• Evolution into College of CCM
• Government
• Health insurance commission
• Private health providers
• Rural intensive care needs