ANZCA Bulletin June 2012 - final.pdf - Australian and New Zealand ...

ANZCA’s revisedtraining programcontinuedNo longer is it a subject to be tickedas Module 10 and forgotten! Theimportance of early, adequate andongoing management of acute pain tominimise the development of chronicpain syndromes must be integral to everyanaesthetic; and the ability to provide thebest clinical care for chronic pain patientswho need concurrent therapy through theperioperative period is essential.Perioperative medicineSimilarly, perioperative medicine isemphasised throughout training toenable the whole patient to be managedas part of the perioperative process, andnot just to be swotted up for the finalexamination! This ability to assess andmedically manage patients throughoutthe perioperative period is what providesthe most compelling argument as to whyanaesthesia is best managed by medicalgraduates.Regional anaesthesiaPatients will benefit from recognitionin the revised curriculum that regionalanaesthesia is a very importantalternative or adjunct to generalanaesthesia in many areas of practice.The advent of good compact ultrasoundimaging has improved the safeapplication of regional anaesthesia,and this technology has helped in theresurgence of this form of anaesthesia,which has considerable benefits for theperioperative care of patients.Crisis managementAnaesthetists have been integral to thedevelopment of the team managementof the critically ill, especially inadvanced life support and trauma teams.Anaesthesia itself can be associatedwith the management of life-threateningcrises such as anaphylaxis and malignanthyperthermia. The knowledge and skillsrequired of anaesthetists to manage thecrises that may occur in their practice,and to contribute to the team managementof the critically ill have been definedin the resuscitation, trauma and crisismanagement fundamental.Safety and quality inanaesthetic practiceThe issues of safety and quality inanaesthetic practice have not previouslybeen gathered together and highlightedfor training, though anaesthetists have forover 60 years led the medical professionin these aspects of practice. Anaesthetistswere the first to systematically investigatedeaths that may have been due totheir own clinical management of thepatients; anaesthetists were also thefirst to introduce knowledge generatedfrom aviation experience to improvecrisis management and implement safetyalgorithms; and similarly anaesthetistswere the first within the medicalprofession to use high fidelity teamsimulation exercises to improve the safetyand high quality of anaesthetic delivery.It is appropriate to acknowledge this rolein anaesthetic practice by introducing thesafety and quality in anaesthetic practicefundamental.Thus the ANZCA ClinicalFundamentals were developed to expandon areas where there were perceiveddeficiencies in the 2004 curriculum. Mostimportantly, they focus the attentionof trainees, supervisors, Fellows andother Colleges on the main areas whereanaesthetists are trained and educatedto be clinical leaders.TutorsTo implement these clinicalfundamentals, the College plans tohave clinical fundamental tutorswithin teaching departments for eachANZCA Clinical Fundamental. In smalldepartments, some Fellows may needto tutor more than one fundamental.We hope that there are enthusiasticanaesthetists with particular interests andexpertise for each of the ANZCA ClinicalFundamentals in each department. Thesetutors will lead the way in making thelearning experience for trainees satisfyingand educational. Above all, they willsupport their trainees so that they obtainthe best possible clinical experience todevelop essential knowledge and skillsin these clinical fundamentals. Thissupport may require greater opportunityfor regional anaesthesia in hospitalswhere this activity is not strong; thedevelopment of simulation situations,for example, for specific rare airwaymanagement scenarios; improvedperioperative assessment proceduresprior to and following anaesthesia; andcarefully supervised acute pain roundswith strengthened links to services forpatients with persisting pain.Enhanced curriculumThere are many challenges in developingthe full potential of these ANZCA ClinicalFundamentals, but the enthusiasm thatFellows have displayed for this conceptmeans we are confident this initiative willconsiderably enhance the curriculum.The ANZCA Council is extremely proudand excited to be part of the deliveryof ANZCA Curriculum Revision 2013with its innovative ANZCA ClinicalFundamentals. We believe it will enhanceconsiderably the training and educationof our trainees.Professor Barry BakerDean of Education, ANZCA22 ANZCA Bulletin June 2012