General physicians and the ADF

CMDR W HEDDLERANR

RFD MD FRACP FCSANZ FAMA MAICD

Chair, General Physician Consultative Group ADF

Consultant Cardiologist to RAN

PHYSICIANS IN ADF - OUTLINE

• BACKGROUND INFORMATION ON ROLE AND

TRAINING OF GENERAL PHYSICIAN

• CURRENT AND POTENTIAL ROLES IN ADF

• POTENTIAL TRAINING PATHWAYS

ROLE IN ADF

• A BRIEF DISCUSSION OF TRAINING WILL HELP

CLARIFY THE POTENTIAL ROLES IN ADF

• NOTE PAST CROSSOVER WITH INTENSIVE

CARE MEDICINE

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

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

SCHEMA OF RACP TRAINING

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”)

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

CPP

• TRAINED IN BOTH ACUTE / EMERGENCY CARE

AND CHRONIC CARE, WITH PROPORTIONS

DIFFERING AS TO SUBSPECIALTY

CONFUSION AS TO CAPABILITY AND

ROLES OF CPPs IN ADF

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

SUPPORT ROLES

• CONSULTATION

– INDIVIDUAL SERVING MEMBER WITH SERIOUS OR

COMPLEX MEDICAL PROBLEMS

– ON HEALTH POLICY e.g. INFECTIOUS DISEASE

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

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

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

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

EXAMPLE

SUMMARY

• TRAINING AND POTENTIAL ROLES AND

TRAINING OF PHYSICIANS

• FOR DISCUSSION AND HOPEFULLY ACTION