ANZCA Bulletin - June 2009 - Australian and New Zealand College ...

DC: As someone who’s slightly furtheralong his career path, I would hope that itwould give me the opportunity to move intodiving and hyperbaric medicine on a morepermanent sort of basis. The difficulty is,of course, that there’s only a small numberof chambers around the country, so fulltime positions in diving and hyperbaricmedicine are a rare commodity indeed.Most of the time you are left with thedifficulty of having a part-time commitmentto hyperbaric medicine and also workingpart-time in another department. Workingacross a couple of departments can lead topotential conflict in terms of rostering andrequirements between the departments.I would very much like to do morehyperbaric medicine.MW: From my point of view, I’ve beendoing hyperbaric medicine since 1989when I started as a very junior registrar. Inow work primarily in private anaestheticpractice and I come to the public hospitalone day a week and do hyperbaricmedicine. It’s quite nice to have contactwith the public sector – a change in paceand a chance to do some research, which isnot really possible in private practice. Fromthat point of view it’s fitted quite well intomy career path.Most of the consultants who work parttimein our unit are working here one daya week or one day a fortnight. We havea number of people on our roster so wehave a pool of people with expertise whocome in on a rostered basis. That meansthat everyone keeps their skills up andkeeps their interest level going, has anopportunity to be involved in researchprojects, and can cover for after hoursemergencies so it works quite well.How have you found the overalltraining, and do you have anysuggestions for improvement in trainingin diving and hyperbaric medicine?IM: So far I’ve enjoyed the training andI’ve got a great deal out of it. The researchopportunity as mentioned has been veryuseful for me. I’ve also had the opportunityto go on courses and the recent SouthPacific Underwater Medicine Societyconference. So far, two-thirds of my waythrough, I’ve found it very interesting andvery useful. I think it may be a little bit earlyfor me to suggest improvements.DC: As somebody that’s still jumpingthrough the hoops of the training program,I think the training itself is good fun – it’sinteresting, intellectually stimulatingand offers a large range of opportunitiesfor people to sort of grow and develop aseither clinicians or researchers. The majordownside that I have found, however,has been doing it part-time. I’m now nineyears post-fellowship and I’m coming upto doing another college examination as amoderately experienced consultant and it’shard to get back into the mindset and grindof examination preparation. I think thatthe part-time training has the potential tobe a disincentive to future trainees doingthe College certificate. I would recommendthat if people are intent upon doing theCollege certificate that they try and get itdone in a much shorter period of time thanI have taken over it. But that will, of course,depend on the availability of FTEs on thepayroll of the various units.MW: Although I received my certificateas a “grandfather”, I did have to show thatI had satisfied the requirements and ithad also taken me about five years to getthe required number of FTEs up doing itpart-time. I think the major thing with anytraining program is the patient case loadand depending on which unit you work inyou may be exposed to a large number ofpatients with a certain condition but not somuch of another. In our unit there’s a lotof exposure to wound care and radiationinjury and not so much exposure to divinginjury because at the moment we seem tohave our divers behaving themselves andnot getting injured. On the other hand, inTownsville they treat a large number ofscuba divers in their unit, due to the largenumber of divers on the reef. If you were togo to the Alfred you’d get to look after a lotof patients that are intubated and ventilatedso it really depends on where you’re doingyour training as to what kind of exposureyou get.IM: A formal rotation around thedifferent units may be of benefit.MW: I would suggest an attachment toanother unit which has a different kindof case load so you can get to see somedifferent sorts of patients. At the momentthat’s all still evolving, and we’re stillaccrediting units for the entire periodof training, because it doesn’t seem tobe a practical problem at the moment.Above: Dr Ian Maddox in the chamber.The ANZCA Bulletin June 2009 39