Neurocritical Care Medicine
in Australia and New Zealand
By Andrew Udy, BHB, MB, ChB, PGCert(AME), FCICM, PhD
A History of Intensive Care Training in
Australasia
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.
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.
CICM Premises, Prahran, Melbourne Victoria, Australia.
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