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General physicians and the adf Heddle

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General physicians and the adf Heddle

  1. 1. General physicians and the ADF CMDR W HEDDLE RANR RFD MD FRACP FCSANZ FAMA MAICD Chair, General Physician Consultative Group ADF Consultant Cardiologist to RAN
  2. 2. PHYSICIANS IN ADF - OUTLINE • BACKGROUND INFORMATION ON ROLE AND TRAINING OF GENERAL PHYSICIAN • CURRENT AND POTENTIAL ROLES IN ADF • POTENTIAL TRAINING PATHWAYS
  3. 3. ROLE IN ADF • A BRIEF DISCUSSION OF TRAINING WILL HELP CLARIFY THE POTENTIAL ROLES IN ADF • NOTE PAST CROSSOVER WITH INTENSIVE CARE MEDICINE
  4. 4. 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
  5. 5. 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
  6. 6. SCHEMA OF RACP TRAINING
  7. 7. 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”)
  8. 8. 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
  9. 9. CPP • TRAINED IN BOTH ACUTE / EMERGENCY CARE AND CHRONIC CARE, WITH PROPORTIONS DIFFERING AS TO SUBSPECIALTY
  10. 10. CONFUSION AS TO CAPABILITY AND ROLES OF CPPs IN ADF
  11. 11. 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
  12. 12. SUPPORT ROLES • CONSULTATION – INDIVIDUAL SERVING MEMBER WITH SERIOUS OR COMPLEX MEDICAL PROBLEMS – ON HEALTH POLICY e.g. INFECTIOUS DISEASE
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. EXAMPLE
  18. 18. SUMMARY • TRAINING AND POTENTIAL ROLES AND TRAINING OF PHYSICIANS • FOR DISCUSSION AND HOPEFULLY ACTION

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