28 October 2008

Division of Rural Hospital Medicine - Email Newsletter

This is the first of what we intend to be regular monthly newsletters to members of the Division of Rural Hospital Medicine. If you do not want to receive regular email updates or know of a colleague who would like to do so then please let Linda know Linda.Hartstonge@rnzcgp.org.nz.

Staff

Linda Hartstonge has recently started work as administrator for the Division. She will work Monday, Tuesday and Thursday.  Linda can be contacted by email Linda.Hartstonge@rnzgp.org.nz or phone 04 496 5999 ext 712. Welcome Linda. It will be a busy but hopefully rewarding job.  Any questions you may have are to be addressed to Linda not Cathy Webber (as previously).  Funding for Linda’s job for the first year has come as a grant from the Waikato DHB. This support is essential and we are very grateful to the DHB for it.  

Cathy Webber will continue to oversee the operational side of the Division’s activities.

Divisional Council, Board of Studies (BOS) and Executive

The Council and BOS both had their first face to face meetings in August. The Australasian College of Emergency Medicine, Royal Australasian College of Physicians, Royal New Zealand College of General Practitioners and Royal Australasian College of Surgeons have all appointed members to the BOS and three of these members attended the first meeting.

The Executive continues to meet frequently by teleconference.

MCNZ

The Medical Council of New Zealand requires six monthly progress reports, the first being due in October.

Membership

As of September 2008 there were 153 members of the Division, comprising 102 RNZCGP Fellows, 14 RNZCGP Members and 37 RNZCGP Associates.

Grandparenting

There has been a lot of activity around grandparenting.  The Board of Studies met in August and worked its way through a large number of applications. 32 doctors who clearly met the criteria have already been offered an assessment visit. The first of these will take place in November and it is expected the first doctors will receive fellowship early next year.

There are a number of doctors who do not fully meet the criteria. These are usually the MOSSs who lack one of the qualifying fellowships or postgraduate diplomas (most of the GPs have FRNZCGP). Many of these doctors have extensive experience.   Each of these doctors needs an individual plan developed to allow them to meet the grandparenting criteria in the time available.  This means the Division has contacted each individual doctor, which is a process that is proving time consuming. We expect to have this completed and to have contacted everyone who applied for grandparenting by mail or phone by the end of October.

It involves multisource feedback and an assessment visit. The Board of Studies will be meeting in January to discuss who has been successful in achieving Fellowship; contingent on them providing a certificate of good standing from the MCNZ.

Experiential pathway to fellowship

Recent discussions with ACRRM about mutual recognition of qualifications suggested we use the term “experiential pathway to fellowship” rather than “grandparenting” in that it requires not only experience but a postgraduate qualification and assessment.

The “grandparenting” criteria were revised after the BOS meeting in August 2008, copies are available on request.

Compulsory courses (Early Management of Severe Trauma (EMST), Advanced Paediatric Life Support (APLS), ACLS level 7 (Advanced Cardiac Life Support).

It may not have been clear from the initial correspondence but it is a requirement of fellowship that everyone has up to date EMST (GPs can substitute PRIME for EMST) and APLS and ACLS (a course approved by the NZ resuscitation council to level 7). EMST and APLS courses are valid for 5 years and ACLS for 3 years. Please note that PALS is not acceptable as a replacement for APLS.  You have until March 2013 to complete this for the grandparenting window.

Meeting this requirement for fellowship is more of an issue for the GPs but long waiting lists and costs may make it hard for everyone.

However these courses are invaluable CME for the rural hospital doctor. They are well structured and collectively cover the early management of most major medical problems. They also provide the opportunity for the Division to apply recognised standards of care, an important but difficult to achieve task given the breadth and diversity of our scope.

Because of this we have made some changes to the grandparenting scheme. Firstly doctors who meet all the criteria but do not have all their certificates up to date will still be able to apply for grandparenting and have an assessment visit. If the visit is successful then candidates will have 2 years in which to gain up to date certificates and fellowship will be awarded as soon as these have been gained.

GPs are most likely to need APLS. If a doctor has never done a full APLS course they will need to complete one. If they did one more than 5 years ago we would recommend they repeat the full course but we would accept one of the shorter courses available nationally (usually 1 day courses) as an update. Please check with the Division should you wish to use one of these courses to ensure it meets requirements.

EMST runs a specific update course for those who have previously completed the full course.

If you need certificates please get yourself on a waiting list as soon as possible. The contacts for APLS and EMST are below.

If we get enough interest we will try and cluster most of the rural doctors on an APLS course next year. This would give everyone a chance to do it with some of their colleagues. If you need an APLS and are interested in this please contact Linda ASAP.

The College can also provide a list of ACLS providers in NZ: email Linda.Hartstonge@rnzcgp.org.nz for this list.

Contacts for APLS and EMST:

EMST (Early Management of Severe Trauma)             Applicants must register online:  www.surgeons.org                  

1.      Go to 'education & trainees

2.      'skills training'

3.      EMST       

4.      Register online       

APLS (Advanced Paediatric Life Support)                   contact: Margaret Findlay (ph) 04 496 5973 or email margaret.findlay@rnzgp.org.nz

Multisource feedback

We are using a British tool called 360° that was developed by the RCP. It is well suited to our needs and is a validated and commonly used tool to assess the competence of a doctor who has been in practice for some time.  It is managed over the internet.

Those who have had their applications approved by the Board of Studies will need to have a MSF done prior to their assessment visit. Candidates will need to provide the names and emails of 15 colleagues (this will be a mixture of doctors who you work with, refer to and receive referrals from as well as nurses, allied health professionals and managers/ administrators with whom you work) who will be asked to anonymously provide feedback on your performance.

The rest is done for you. It is important to start the process as soon as you as you are requested to do so. It often takes several weeks to get replies back from everyone.

Assessment visits

The assessments visits will be done by one of a team of NZ assessors with GP and rural hospital experience. Their first workshop will include doing the first of the assessments and will concentrate on developing uniform standards. Assessors will then undertake assessments over the following weeks.  The BOS has the option of deciding on a more thorough assessment of any candidates it has concerns about.

Training Programme

RNZCGP staff is working hard to set up the training programme.

We are piloting the training programme for the first year. We have 11 applicants for training, interviews were held on the 16^th and 17^th of October. The CTA funding is delayed but the funding contractor has assured us that five registrars will be funded starting this December. 

Most of the new registrars will undertake training in base hospital runs this coming year but we expect to see the first registrars in rural hospitals by 2010.

Drs Nixon and Blattner will be meeting with the Australian and New Zealand College of Anaesthetists (ANZCA) in November to discuss anaesthetist training for the 2009 intake.

 Rural GP Network Conference

Keep in mind the Rural Network Conference to be held 27^th – 29^th March, 2009. 

Once again this will include a number of CME sessions aimed at rural hospital doctors and the Division of Rural Hospital Medicine AGM.  It is also our intention to hold two pre-conference workshops: one for those using ultrasound in their practice and the second for those involved in teaching in their rural hospitals (this one to be held on Thursday 26^th March 2009).