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Neurocritical Care Medicine in Australia and New Zealand

By Currents Editor posted 06-27-2018 17:40

By Andrew Udy, BHB, MB, ChB, PGCert(AME), FCICM, PhD

A History of Intensive Care Training in Australasia NCS_201806_Neurocritical_Care_M_1.jpg

The body responsible for vocational training in intensive care medicine in Australia and New Zealand is the College of Intensive Care Medicine (CICM). CICM was established in 2008 and formally took over the responsibility for training and certification of intensive care specialists from the Joint Faculty of Intensive Care Medicine on Jan. 1, 2001.

Prior to 2001, two training programs in intensive care medicine were available in Australia and New Zealand. The Faculty of Anaesthetists (Royal Australasian College of Surgeons) commenced a training and examination system in intensive care in 1976. The training program consisted of four years and two examinations. In 1992, the Australian and New Zealand College of Anaesthetists was formed and established a Faculty of Intensive Care in 1993, responsible for the conduct of all intensive care education. The Royal Australasian College of Physicians established a training program in intensive care at approximately the same time as the Faculty of Anaesthetists.

In 1996, a Joint Specialist Advisory Committee (Intensive Care) between the Faculty of Intensive Care and the Royal Australasian College of Physicians was created. The aim was to develop a single training program for the specialty and to supervise all intensive care trainees on behalf of the two bodies. This aim was realized in 2001, with the establishment of the Joint Faculty of Intensive Care Medicine.

NCS_201806_Neurocritical_Care_M_2.jpgCICM Premises, Prahran, Melbourne Victoria, Australia

Current Intensive Care Training

The CICM training pathway consists of a minimum of six years, with prescribed terms in intensive care units, anesthesia and medicine. In addition, trainees must also successfully pass both a first part and second part examination, which are a combination of written, oral and clinical assessments. At the conclusion of training, successful candidates obtain their fellowship, either via the general or pediatric pathway, which entitles them to apply for Specialist Registration in Intensive Care Medicine with either the Australian Health Practitioner Regulation Agency or the Medical Council of New Zealand. Prior to commencing CICM training, trainees must have completed a one-year internship (after medical school) and six months supervised intensive care experience in a CICM accredited training unit.

Neurocritical Care Training and Advocacy

Currently, there are no specific post-graduate qualifications unique to neurocritical care in Australia and New Zealand. However, all intensive care specialists who have completed CICM training will have had substantial exposure to neurocritical care practice, typically in larger tertiary centers. In many instances, brain-injured patients are cared for in “general” ICUs, although some specialized neurocritical care units do exist. Monitoring and therapy is largely based on measuring intracranial pressure (ICP), with brain tissue oxygenation and/or tissue microdialysis being infrequently employed. Advanced diagnostic techniques, such as transcranial doppler, continuous EEG and/or interventional neuroradiology are more commonly available.

Given the number and complexity of neurologically injured patients being cared for in ICUs in Australia and New Zealand, the CICM has recently established the Neurocritical Care Special Interest Group (SIG), the goals of which are:
1. To foster a coordinated and interdisciplinary approach to caring for neurologically injured critically ill patients in Australia and New Zealand.
2. To provide a forum for discussion, debate, case review and clinical support for CICM trainees and fellows caring for neurologically injured patients.
3. To enhance knowledge, education and training around neurocritical care practice in Australia and New Zealand.
4. To promote a collaborative research agenda aimed at improving long-term outcomes for neurologically injured patients.

The CICM Neurocritical Care SIG will be holding an inaugural ENLS course in November 2018 in Sydney. This will be in combination with a one-day symposium, covering a wide range of topics relevant to practice in Australia and New Zealand. The CICM also became a Neurocritical Care Society (NCS) global partner in August 2017. Indeed, there is substantial enthusiasm to collaborate globally on educational issues, quality assurance and research relevant to this patient group. We look forward to engaging with all members of the global NCS community.

#NCSRoundup #International #Australia #NewZealand #AndrewUdy #June2018​​​​​​​
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