Medical Training Review Panel: thirteenth report

Australian and New Zealand College of Anaesthetists

Page last updated: April 2010

Training Program

The Australian and New Zealand College of Anaesthetists (ANZCA) approved training sequence encompasses an initial two-year prevocational medical education and training period and the five-year period of ANZCA approved training, which consists of two years basic training and three years advanced training. In the course of ANZCA approved training, trainees are required to successfully complete:
  • five years of supervised clinical training at approved training sites;
  • both the primary and final examinations;
  • a program of 12 modules; and
  • an Effective Management of Anaesthetic Crises (EMAC) or Early Management of Severe Trauma (EMST) course or equivalent.
The training program provides for part-time training. The minimum trainee commitment must be 50% of that of a full-time trainee. There is provision for interrupted training. Some overseas training may be recognised during both basic and advanced training, subject to prior approval by the college assessor.

Trainee Selection

ANZCA's Guidelines for the Selection of Trainees outlines the principles that should be used in selecting trainees for appointment to hospitals approved for training for the diploma of fellowship of ANZCA.

Trainees are trained and educated in approved hospital departments, which must be part of an approved rotation, according to the ANZCA guidelines and policies, and under the supervision of the ANZCA. It should be noted that the hospital is the employing authority, not the ANZCA, and the hospital makes the appointments using a process as outlined by these guidelines. However, the selection committee should include at least one ANZCA representative approved by the relevant regional/national committee. Trainees are not re-selected into advanced training by the ANZCA.

Trainee Assessment

In-Training Assessment (ITA) is carried out at least every 6 months, and requires the trainee and the supervisor of training to carry out a regular process of evaluation, recording goals set and areas identified for improvement. Each trainee must maintain a learning portfolio, which should include formal documents relating to training, including the ITA forms, the trainee's self evaluation
of performance forms, as well as voluntary documentation, such as a logbook.

The primary examination covers physiology, including clinical measurement, and pharmacology, including statistics. Trainees may sit one or both subjects at any sitting. There is no limit on the number of attempts, but progress beyond the second year of training requires a pass in both subjects. Trainees progress to the oral section when they have attained a satisfactory score in the written section. The final examination consists of written and oral sections, and may be taken after three years of approved training.

Admission to fellowship is available to trainees who have successfully completed five years of training, passed both examinations, and completed all other training requirements.

International Medical Graduate Specialists

The international medical graduate specialist (IMGS) assessment process is conducted by ANZCA to assess and make a determination regarding the comparability of the IMGS to a fellow of ANZCA.

The ANZCA IMGS assessment process commences with application via the Australian Medical Council (AMC) and proceeds to a paper-based assessment to establish qualifications, training, clinical experience, recency of practice, health systems worked in, and participation in continuing professional development (CPD). Area of Need applicants are also assessed for comparability, as required.

If eligible to proceed, the assessment then includes:
  • a face-to-face assessment interview;
  • a clinical practice assessment period; and
  • a workplace-based assessment.
Additionally, some applicants are required to undertake the IMGS performance assessment or final examination.

With specialist anaesthesia training, with regard to duration, structure, content, curriculum, sub-specialty experience, supervision and assessment, the onus will be on the applicant to provide evidence of this training. The assessment will take into account the college's training requirements at the time the applicant attained his/her initial post-graduate specialist qualification in anaesthesia.

In relation to the specialist qualification, consideration will be given to the curriculum vitae, references, and details of practice as a specialist anaesthetist. Experience and qualifications must be substantiated by statements and original or certified copies of diplomas from relevant bodies.

Assessment of the specialist’s experience takes into account case mix, use of equipment and drugs, and compliance with standards of anaesthesia practice as promoted in the college professional documents. Evidence of participation in CPD is sought, comparable to the college's continuing CPD program. Continuous involvement in recent years is particularly important.

Accreditation

Accredited hospitals are reviewed according to a seven-year cycle. Where possible, an entire rotation or training scheme is reviewed at the same time. Sometimes it is necessary to visit individual hospitals in between the seven-year rotational reviews. This is usually a result of major staffing or structural changes within the hospital, or a particular concern raised by the hospital, the trainees, the regional/national committee or other parties.

The college approves departments as a whole as being suitable for training; it does not approve a particular number of posts. The number of trainees is decided by the hospital.

Hospitals are normally approved for both basic and advanced training. That is, they may take trainees in any of the 5 years of training. Under very rare circumstances, a hospital may be approved for advanced training only.

Hospitals may also be approved for the potential to offer a provisional fellowship program. This is normally in addition to approval for basic and advanced training, but some hospitals may be deemed suitable for provisional fellowship training only. Trainees wishing to be appointed as
provisional fellows must seek prospective approval from the college assessor.

Further Information

www.anzca.edu.au

Faculty of Pain Medicine

Training Program

The fellowship of the Faculty of Pain Medicine - ANZCA (ANZCA-FPM) is an 'add-on' specialist diploma. Those wishing to enter the field usually will either have, or be training toward, a specialist qualification in one of the participating specialties - anaesthesia, medicine, surgery, psychiatry or rehabilitation medicine.

The ANZCA-FPM training requirements vary from one to three years, depending on the primary specialist qualification, previous exposure to pain medicine and experience. Training may commence during, and may be concurrent with, training programs for the diploma of fellowship
of the participating bodies, including ANZCA, RACS, RACP, RANZCP and AFRM-RACP.

Trainees must undertake a prospectively approved structured training period of one or two years in a faculty accredited pain medicine program. One further year of additional approved experience of direct relevance to pain medicine is required. There is some provision for retrospective approval of prior experience and training by the assessor.

The training program provides for part-time training. The minimum trainee commitment must be 50% of that of a full-time trainee. There is provision for interrupted training.

It is a requirement of the training program that all trainees receive training and experience in the broad areas of acute, chronic and cancer pain. Trainees are provided with a trainee support kit that includes the objectives of training and the reading list. The objectives of training set out in detail the aims of education and training. The objectives divide into four main sections: socio-biology of pain and neurobiology of pain as 'basic' knowledge; principles of pain medicine and practice of pain medicine as ‘clinical’ knowledge.

Trainee Selection

Employers place advertisements for positions in pain medicine training units accredited by the FPM. Interview, selection and appointment processes are determined by the jurisdictions, with representation from the FPM.

Trainee Assessment

Formative assessment includes the logbook that documents workload and experience recorded over a period of six months. It also includes the quarterly In-Training Assessment (ITA), which requires the trainee and the supervisor of training to carry out a regular process of evaluation, with recording of the goals set and areas identified for improvement. Summative assessment includes the final ITA, a case report and an examination.

The faculty examination format comprises a written paper and a clinical long case. Candidates must achieve a mark of at least 50%. Trainees may present for the annual examination during or after the mandatory structured training period in a faculty accredited unit.

Admission to fellowship is available to candidates who are fellows of ANZCA, RACP, RACS, RANZCP, AFRM—RACP, RACGP, RNZCGP, a faculty or chapter of a participating college other than AFRM, or who hold a specialist qualification relevant to pain medicine that is acceptable to one of the five parent bodies and who have successfully completed the training period prescribed by the assessor, passed the examination and completed all other training requirements.

Overseas Trained Specialists

Assessment of overseas trained specialists and Area of Need specialists is undertaken according to ANZCA policy. However there is no entirely equivalent training in multidisciplinary pain medicine, as no other country has a governing body in pain medicine representing the five specialties in the ANZCA-FPM. Overseas trained specialists who come to Australia for training in pain medicine need to fulfil all training and assessment requirements of their parent specialty. Election to fellowship might be available depending on their prior experience. The faculty would accept into its training program overseas trained specialists who met equivalent experience criteria of their primary specialty.

Accreditation

The faculty accredits multidisciplinary pain medicine units that include practitioners from at least three relevant medical specialties and from relevant allied health professions. Comprehensive policies and criteria have been developed by the faculty requiring a specified standard for facilities and adequate supervision by pain medicine specialists. Units seeking accreditation are required to complete a detailed questionnaire and undergo an accreditation visit. During the accreditation process, significant weighting is given to the feedback provided during structured interviews with the trainees who are based at the unit.

Further Information

www.fpm.anzca.edu.au