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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 / 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

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

  2. Down Under

  3. 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

  4. The POW hospital complex

  5. 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

  6. 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.

  7. 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

  8. 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

  9. Physician vs. Anaesthetic training

  10. 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

  11. ANZICS

  12. 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

  13. 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.

  14. ‘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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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 ?

  23. 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

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