general physicians and the adf heddle
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TRANSCRIPT
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General physicians and the ADF
CMDR W HEDDLERANR
RFD MD FRACP FCSANZ FAMA MAICD
Chair, General Physician Consultative Group ADF
Consultant Cardiologist to RAN
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PHYSICIANS IN ADF - OUTLINE
• BACKGROUND INFORMATION ON ROLE AND
TRAINING OF GENERAL PHYSICIAN
• CURRENT AND POTENTIAL ROLES IN ADF
• POTENTIAL TRAINING PATHWAYS
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ROLE IN ADF
• A BRIEF DISCUSSION OF TRAINING WILL HELP
CLARIFY THE POTENTIAL ROLES IN ADF
• NOTE PAST CROSSOVER WITH INTENSIVE
CARE MEDICINE
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GENERAL PHYSICIANS AND ADF
• WHAT IS A GENERAL / CONSULTANT
PHYSICIAN / PAEDIATRICIAN (CPP)
– QUALIFIED AS PHYSICIAN BY ROYAL
AUSTRALASIAN COLLEGE OF PHYSICIANS (FRACP)
– REGISTERED WITH MEDICARE FOR ONLY SEEING
REEFERRED PATIENTS FOR CONSULTATION
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TRAINING OF CPP
• ADULT OR PAEDIATRIC PROGRAMME
• BASIC PHYSICIAN TRAINING OF MINIMUM 3
YEARS VOCATIONAL TRAINING (CAN START
PGY 2)
• ASSESSED FOR BOTH CLINICAL SKILLS AND
PROFESSIONAL BEHAVIOURS
• SUCCESSFULLY PASS “PART 1” EXAMINATION
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SCHEMA OF RACP TRAINING
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TRAINING OF CPP (2)
• ADVANCED TRAINING (CAN BE GENERAL MEDICINE OR SUBSPECIALTY TRAINING e.g. CARDIOLOGY) OVER MINMUM OF 3 YEARS, PREDOMINANTLY DONE ON “MASTER-APPRENTICE” MODEL
• MANY DO FURTHER TRAINING AFTER THIS AS FELLOWS EITHER IN CLINICAL MEDICINE OR RESEARCH ( THIS OFTEN LEADS TO SUB-SUB SPECIALISATION e.g. Myself as “Cardiac Electrophysiologist”)
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TRAINING OF CPP
• RIGOROUS CONTINUING MEDICAL EDUCATION REQUIRED
• DUE TO VARIED TRAINING PATHWAYS, LARGE VARIATION IN EXPERTISE, BUT COMMON UNDERLYING BASIC TRAINING AS CPP WITH CONCENTRATION ON DIAGNOSTIC AND MANAGEMENT OF COMPLEX MEDICAL CONDITIONS; SOME ARE HIGHLY TRAINED IN INTERVENTIONAL TECHNIQUES
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CPP
• TRAINED IN BOTH ACUTE / EMERGENCY CARE
AND CHRONIC CARE, WITH PROPORTIONS
DIFFERING AS TO SUBSPECIALTY
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CONFUSION AS TO CAPABILITY AND
ROLES OF CPPs IN ADF
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INTERNIST VS INTENSIVIST
• UNITED NATIONS IN 1980s DESCRIBED THE
HIGHER LEVEL ADVANCED MILITARY FACILITY
AS HAVING SURGEON, ANAESTHETIST, AND
INTERNIST
• WHEN AUSTRALIA DEPLOYED MEDICAL
FORCES TO RWANDA, THE TEAM COMPRISED
SURGEON, ANESTHETIST, AND INTENSIVIST
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SUPPORT ROLES
• CONSULTATION
– INDIVIDUAL SERVING MEMBER WITH SERIOUS OR
COMPLEX MEDICAL PROBLEMS
– ON HEALTH POLICY e.g. INFECTIOUS DISEASE
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OPERATIONAL ROLE
• IN LEVEL 3 HEALTH FACILITY
• IN ‘SUBSTITUTE” ROLE IN LEVEL 2E
– E.g. As “INTENSIVIST” or as “GDMO”
• IN “SUBSTITUTE” ROLE e.g. IN MAJOR FLEET
UNITS OF RAN AS GDMO
• IN HUMANITARIAN AID OPERATIONS WHEN
USEFUL OR NECESSARY FOR FACILITY TO HAVE
MORE THAN GDMO
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OPERATIONAL ROLES
• VERY USEFUL IN TREATMENT OF NON-BATTLE INJURY AND IN POST-OPERATIVE CARE OF BATTLE INJURY (NB MANY HOSPITALS DO NOT PERMIT SURGERY UNLESS GENERAL PHYSICIANS AVAILABLE TO HELP WITH POST-OPERATIVE COMPLICATIONS)
• ENHANCED SKILLS IN FEBRILE ILLNESS INCLUDING INFECTIOUS DISEASE, AND IN PAEDIATRICS
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TRAINING
• PRINCIPLE
– CPPs WELL TRAINED IN DIAGNOSTIC AND
THERAPEUTIC SKILLS
– MAY FACE AREAS WITH WHICH THEY ARE NOT
CURRENTLY PRACTISING
– A SHORT MODULARISED TRAINING SCHEME OF 5-
7 DAYS TO UPDATE IN SUCH AREAS
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EXAMPLE
• EMST ( 2-3 DAYS)
• “BASIC “ COURSE (2-3 DAYS)
• INFECTIOUS DISEASE, ESPECIALLY TROPICAL ID
(ONE DAY)
• PAEDIATRICS - PRINCIPLES AND COMMON
DISEASES (ONE DAY)
• MEDICAL EMERGENCIES NOT ALREADY
COVERED
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EXAMPLE
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SUMMARY
• TRAINING AND POTENTIAL ROLES AND
TRAINING OF PHYSICIANS
• FOR DISCUSSION AND HOPEFULLY ACTION