Intercontinental Critical Care Centre of Excellence Steering Committee Meeting Jan. 30 to Feb. 1 / 2002Palm Springs
The view from down under Dr. Yahya Shehabi FFIC.ANZCA Director Intensive Care Services Prince of Wales Campus UNSW Medical school Randwick - Sydney email@example.com firstname.lastname@example.org
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
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 • Registrarin training, register with College / Faculty • Final exam. / Advanced training ( physicians ) • Fellow, Final year / formal project • Total of 8 years minimum.
PostgraduateMedical 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
Intensive care training:The Early Years • 28th 1974Meeting to discuss setting up a joint diploma in intensive care held November • November 13th 1977Inaugural meeting of the SAC-IC of RACP held at RMH • October 1979First Final Examination for FFA.RACS endorsed in Intensive Care held
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
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
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.
‘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
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
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
Medical education and trainingPyramid ofUnit 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
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
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
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
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. 1:1 patient ratio & no RTs. • Arrange and conduct family conferences • Has the final say... • Shared rather than Closed units
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 ?
Critical care educationFuture needs • Joint Faculty Intensive Care Medicine Future challenges • New training program • Resource management • Effective Lobbygroup • Evolution into College of CCM • Government • Health insurance commission • Private health providers • Rural intensive care needs