Intercontinental Critical Care Centre of Excellence Steering Committee Meeting Jan. 30 to Feb. 1 / 2002 Palm Springs

The view from down under Dr. Yahya Shehabi FFIC.ANZCA Director Intensive Care Services Prince of Wales Campus UNSW Medical school Randwick - Sydney

Undergraduate m edical 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 –Registrar in training, register with College / Faculty Final exam. / Advanced training ( physicians ) –Fellow, Final year / formal project –Total of 8 years minimum.

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

Intensive care training: The Early Years 28 th 1974 Meeting to discuss setting up a joint diploma in intensive care held November November 13 th 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

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 4 th ) 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 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 training Pyramid of Unit based program Basic foundations of critical care and basic sciences Applied Patho-Physiology and mechanisms of disease Current & EB critical care practice Cutting edge & Research oriented MOPS

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 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 Total admissions patients

Critical care units in Australia ANZICS 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 – 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 education Future 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