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Intercontinental Critical Care Centre of Excellence Steering Committee Meeting. Jan. 30 to Feb. 1 / 2002 Palm Springs. Down. Under. The view from down under. Dr. Yahya Shehabi FFIC.ANZCA Director Intensive Care Services Prince of Wales Campus UNSW Medical school Randwick - Sydney

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intercontinental critical care centre of excellence steering committee meeting
Intercontinental Critical Care Centre of Excellence Steering Committee Meeting

Jan. 30 to Feb. 1 / 2002Palm Springs

slide2

Down

Under

the view from down under

The view from down under

Dr. Yahya Shehabi FFIC.ANZCA

Director Intensive Care Services

Prince of Wales Campus

UNSW Medical school

Randwick - Sydney

yshehabi@ozemail.com.au

shehabiy@sesahs.nsw.gov.au

undergraduate m edical education and training
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
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.
postgraduate medical education and training1
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
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
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
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 times1
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
‘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
slide15
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
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 training pyramid of unit based program
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 units1
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 australia anzics review 2000
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 australia anzics review 20001
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
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
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 education future needs1
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