Progressing the perioperative medicine diploma

Anaesthetists all over the world are driving the development of perioperative medicine as both a healthcare model and a clinical specialty.

Although doctors from many specialities are starting to identify as "perioperative physicians", anaesthetists are by far the best placed practitioners to lead the development of this exciting new clinical field, due to their "ideal combination of training, skills, and experience." (Grocott and Pearse 2012)

As one of the largest specialist medical colleges in Australia and New Zealand, and the foremost authority on anaesthesia and pain medicine in each country, we're the logical leaders of perioperative medicine.

In 2018 we established a Perioperative Medicine Steering Committee comprising representatives from ANZCA, FPM, and other specialist medical colleges to reflect the diverse nature of the perioperative space.

In February 2018, ANZCA Council approved a vision for the perioperative medicine program which, with our strategic plan, will guide and inform our approach. 

Here are some of the other things we’ve been working on:

Perioperative Care Framework

Underpinning our perioperative care model is the Perioperative Care Framework  that maps the patient’s journey from the time surgery is contemplated through to an optimal outcome. The perioperative care framework has been constructed to unpack each component of this journey in timeline format. 

Developing the diploma

One of the key ways we're helping to provide patients in Australia and New Zealand with perioperative care is by creating a new qualification that will enable specialist doctors such as anaesthetists, physicians, intensivists and surgeons to enhance their skills and knowledge in perioperative medicine.

The Perioperative Medicine Steering Committee with members from multiple colleges has recommended the development of one-year flexible competency-based diploma made up of six areas of learning that will be delivered in a hybrid model of e-learning, workshops and clinical experience.

We are developing a curriculum and supporting resources based on a graduate outcome statement, our literature review, and the Perioperative Care Framework and definitions. The curriculum has six core topics:

  • Pre-operative assessment.
  • Pre-operative planning.
  • Optimisation.
  • Intraoperative impacts on patient outcomes.
  • Postoperative assessment and management.
  • Discharge planning and rehabilitation.


We are defining the eligibility and prerequisites to participate in the diploma and how it will be assessed, as well as identifying opportunities for participants to build on their experience in the clinical learning environment.
 
We are also developing “grandparenting” for individuals who have demonstrated adequate proficiency in perioperative medicine. Individuals that choose this pathway will be able to be involved in the program as facilitators and supervisors.
 
The cross-specialty nature of the qualification will mean that candidates will need a number of supervisors, so it is likely that some will be off site. This model is well established in university courses. Grandparenting is scheduled to commence in April 2022. Email periop@anzca.edu.au to register your interest.

Advocating and lobbying

Engagement with key stakeholders in perioperative medicine is essential for the successful development of the diploma. Stakeholders include all groups involved in the perioperative care framework.
 
ANZCA has distributed a number of communiques to key stakeholders which tell the story so far. You can see the most recent ones from September 2020, July 2021October 2021February 2022 and April 2022. Updates also regularly appear in the ANZCA Bulletin

Engagement with government and other key influencers is also important for the success of perioperative medicine. Central to our advocacy work will be the development of a value proposition or economic case which will establish the financial benefits of perioperative medicine as outlined by a health economist to be engaged in 2022.

Professional standards

We are reviewing our professional documents and will potentially create new ones to incorporate our perioperative care model. We're identifying specific requirements to ensure perioperative medicine candidates get appropriate clinical exposure and teaching in training hospitals, particularly outside the operating theatre. We are also developing continuing professional development (CPD) pathways.

Perioperative medicine literature review

In 2018, we commissioned a review of recent peer-reviewed and grey literature to better identify the co-ordinated perioperative care models that are effective in improving patient outcomes and cost efficiency.

The review also explored models of postgraduate education and training for health practitioners for co-ordinated perioperative care that have been identified in the literature; and the implications for postgraduate education and training of health practitioners that could be identified in the literature.

While no specific model was superior to another, there was clear evidence that a co-ordinated and collaborative multidisciplinary and multifaceted model of care is effective in providing clinical benefits and reduces costs.

The core elements for success are: close working relationship (leadership, team work and communication), clear protocols, documentation and compliance with those protocols, audit and importantly, patient-centred care.

In 2019, a second literature review explored the economic benefit of perioperative medicine, models of prehabilitation, choosing the right patient for ICU and audit, monitoring and benchmarking. The literature review will again be updated in 2022.

Perioperative medicine surveys

In October 2018, we invited all of our fellows, trainees and specialist international medical graduates (SIMGs) to take part in a survey exploring:

  • Current perioperative medicine practice.
  • The skills required for perioperative care.
  • The level of support for the development of perioperative training.

The survey achieved a 27 per cent response rate (n=2077/7751). Member of the Perioperative Medicine Special Interest Group represented about 15 per cent of these responses. Through the survey, the college confirmed general support for the development of perioperative medicine education offerings

Almost two-thirds of respondents indicated an extra year of training to become a perioperative medicine doctor was reasonable. Support was highest amongst trainees (74 per cent) and lowest in specialists with 20 to 30 years of experience. 

Similarly trainees and provisional fellows (56 per cent and 53 per cent respectively) are more likely to consider doing an additional year of training. Specialists with more than 30 years of experience were least likely to consider any additional training (19 per cent).

More than 70 per cent of respondents want a perioperative medicine doctor to have:

  • Pre-operative management skills to identify and mitigate risk factors.
  • Post-operative management skills including consideration of surgical stress response, fluid management, acute and persistent pain, and delirium management.
  • Discharge planning and an understanding of intra-operative anaesthesia management.
 

Most respondents saw a perioperative medicine service and/or doctor adding particular value in optimising care for higher risk patients (77 per cent), co-ordinating care between medical and surgical specialties (68 per cent) and delivering high quality post-operative care (60 per cent).

In late 2019, in conjunction with the RACP, we surveyed geriatricians to better understand their interest and involvement in perioperative medicine. Findings indicated that:

  • Perioperative medicine adds value to clinical practice through improved coordination with primary and community care, improving patient satisfaction through patient-centred goals of care and sharing best practice with all clinicians.
  • The additional skills and knowledge that a perioperative medicine doctor brings is an understanding of intraoperative anaesthesia management, critical care and resuscitation, and general medicine.
  • Sixty-six percent of respondents agreed that it was reasonable to complete up to one year of additional training in perioperative medicine and 47 per cent would consider undertaking an additional year of training.  This is similar to the responses from the ANZCA survey.


The College of Intensive Care Medicine’s Perioperative Medicine Special Interest Group has also recently surveyed its members. While a small sample, there is substantial participation in – and a desire to increase participation in – perioperative medicine led by intensivists as part of multidisciplinary teams.

Recognising other qualifications

We're exploring the possibility of working with universities and internationally recognised perioperative leaders and other providers that support aspects of perioperative medicine, such as: Echocardiography, regional anaesthesia, anaemia.

Governance and guidance

Meet the agencies, groups, and individuals involved in steering the development of a perioperative medicine qualification.



 
Last updated 12:34 14.04.2022