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1. INTRODUCTION

There are areas of Australia where geographical circumstances preclude referral of certain types of surgery, and where there are no specialist anaesthesia services. Such areas require general practitioners (GPs) to be administering anaesthesia. Where possible, general practitioner anaesthetists should work in co-operation with resident and visiting specialist anaesthetists.

The College acknowledges the role of rural GPs by its membership of the tripartite Joint Consultative Committee of Anaesthesia (JCCA), in partnership with the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM).

The JCCA oversees the training, examination, and ongoing accreditation of rural GP anaesthetists. These practitioners must have appropriate training and must be administering anaesthesia safely. This training is fully outlined in the Rural Training Curriculum endorsed by the JCCA.

It should be clearly understood that this College Professional Document is not intended in any way to endorse, reflect on, or prejudge the issue of surgery being undertaken in rural and remote areas. Furthermore, the question of hospital facilities and infra-structure is crucial to this matter, and anaesthesia is only one of a number of considerations which must influence any management decisions to be made in the best interests of the patient.

2.   OBJECTIVES OF TRAINING

The objectives of the training of rural general practitioners proposing to administer anaesthesia are as follows:

2.1   To provide general knowledge, experience, skills and competence in the management of common anaesthesia procedures, (especially anaesthesia for obstetrics), in resuscitation, in pain management, and in the early management of severe trauma.

2.2   To provide specific knowledge and practical skills as they relate to a rural general practitioner anaesthetist, including relevant aspects of general medicine, surgery, paediatrics, obstetrics, intensive care and pain management.

2.3   To provide understanding and insight for decision-making about local management, further consultation and referral for anaesthesia and related procedures.

2.4   To develop skills to act appropriately as a member or leader of a therapeutic team, to contribute to the education of nursing, paramedical and medical staff, and to conduct clinical audits, research and quality assurance activities in their anaesthesia practices.

2.5   To ensure a commitment to self-directed learning and other forms of continuing education in anaesthesia, to adaptability to changes in anaesthesia practice relevant to safer management of patients, and to act according to ANZCA recommendations on rural general practitioner anaesthesia practice.

2.6   To foster a commitment to rural general practice anaesthesia where sufficient specialist anaesthesia services are unavailable.

3.   TRAINEE SELECTION CRITERIA

The following criteria are recommended for selection of trainees:

3.1   Completion of two years of the Rural Training Program, which may have included a three month term in Anaesthesia, Emergency Medicine or Intensive Care.

3.2   Successful completion of the Early Management of Severe Trauma Course (EMST), the Effective Management of Anaesthesia Crises (EMAC) course, or a secure position within a future course.

3.3   Demonstration of relevant anaesthetic knowledge, skills and experience including, or similar to, a resident medical officer at the end of a term in anaesthesia.

3.4   Demonstration of a commitment to rural general practice, including experience of at least one term in rural general practice.

4.   MINIMUM TRAINING EXPERIENCE

A minimum period of experience under instruction is required. This should preferably be part of the four year Rural Training Programme of the Rural Faculty, Royal Australian College of General Practitioners. This experience should be:

4.1   At an accredited training post of the JCCA or a hospital accredited by ANZCA. [Some posts in the UK have been utilised for this training, subject to certain conditions being met by the trainee on returning to Australia.]

4.2   Of twelve or more months duration.

4.3   As per the curriculum requirements (Advanced Rural Skills Curriculum in Anaesthesia, Rural Faculty, Royal Australian College of General Practitioners).

The curriculum is designed for two periods of attachment:

4.3.1   attachment to an anaesthetic department in a Rural Training Unit (nine months minimum), three months of which may have been in the first two years of the Rural Training Programme;

4.3.2   three months of the twelve months may be an attachment to Accident and Emergency, Intensive Care, or a rural anaesthesia practice.

5.   ACCREDITATION AND MAINTENANCE OF KNOWLEDGE AND SKILLS

General practitioners should maintain their anaesthesia skills and knowledge, by undertaking an on-going case-load, and by participating in Continuing Medical Education (CME) in the field of anaesthesia. This should be in accordance with the the Maintenance of Professional Standards (MOPS) program(s) endorsed by the Joint Consultative Committee on Anaesthesia.

Relevant documents:

• Advanced Rural Skills Curriculum – Anaesthetics. Royal Australian College of General Practitioners; Rural Faculty Training program. April 1998
• Joint Consultative Committee on Anaesthesia: Quality Assurance and Continuing Professional Development Requirements; 2002-2004 Triennium

College Professional Documents

College Professional Documents are progressively being coded as follows:

TE Training and Educational

EX Examinations

PS Professional Standards

T Technical

POLICY – defined as ‘a course of action adopted and pursued by the College’. These are matters coming within the authority and control of the College.

RECOMMENDATIONS – defined as ‘advisable courses of action’.

GUIDELINES – defined as ‘a document offering advice’. These may be clinical (in which case they will eventually be evidence-based), or non-clinical.

STATEMENTS – defined as ‘a communication setting out information’.

This document has been prepared having regard to general circumstances, and it is the responsibility of the practitioner to have express regard to the particular circumstances of each case, and the application of this document in each case.

Professional documents are reviewed from time to time, and it is the responsibility of the practitioner to ensure that the practitioner has obtained the current version. Professional documents have been prepared having regard to the information available at the time of their preparation, and the practitioner should therefore have regard to any information, research or material which may have been published or become available subsequently.

Whilst the College endeavours to ensure that professional documents are as current as possible at the time of their preparation, it takes no responsibility for matters arising from changed circumstances or information or material which may have become available subsequently.

Promulgated: 1981

Reviewed: 1986, 1991, 1997

Date of current document: October 2002

© This document is copyright and cannot be reproduced in whole or in part without prior permission.

College Website: http://www.anzca.edu.au/