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Annual Presidents' Reports

Dr Ian Scott

2005 - Dr Ian Scott

It is again a great pleasure to present my report on the activities and achievements of our society over the last 12 months. Once again I would like to thank all members of council for their hard work and effort during this time and to you our members for your thoughts and comments on some very important initiatives.

Contents:

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Action Plan

The presentation of the long-awaited IMSANZ position statement “Restoring the Balance: An Action Plan for Ensuring the Equitable Delivery of Specialist Services in General Internal Medicine in Australia and New Zealand 2005-2008” is listed as a separate item on the agenda. Council had hoped to officially launch the Plan at this meeting but has decided, in the spirit of collegiality, to postpone the launch to mid-July after the executives of each of the Specialty Societies has had an opportunity to review and endorse the document.

Such a move was recommended at the last Specialties Board meeting on April 29 at which the document was tabled for discussion after being circulated to all Board members 1 week prior to the meeting. While virtually all individuals present expressed no difficulty in personally endorsing the document, they did not feel they could be seen to be officially endorsing it on behalf of their Societies without their respective executives having reviewed it.

IMSANZ is keen to have this important document supported by Specialties Board, the AMDC, College Council and the RACP president, and to carry the full imprimatur of the college, and accordingly, to allow time for this process of review to occur, we have agreed to delay public release of the document for another 3 months. However, I want to reassure all members of IMSANZ that this further review of the Plan by Specialty Societies does not mean that we seek their support at any price and that we will bow to pressure to significantly compromise the reforms we want to see enacted.

The plan in its current form represents a blueprint for achieving a number of key reforms in advancing general medicine as a specialist discipline throughout Australasia. Importantly, it is a document that has been reviewed and endorsed by the vast majority of IMSANZ members. It has also received input from a number of senior office-holders within the college and other organisations and I would like to acknowledge in particular the support and advocacy of the college president, Jill Sewell, the president of the AMDC, Rick McLean, and the chair of the Specialties Board, John Kolbe. Council has confidence that with goodwill and mutual support the college and IMSANZ can move forward and both benefit from enactment of the Plan’s key recommendations.

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Educational Strategy

Advanced training curriculum

At this meeting last year I announced the completion of a training curriculum for trainees wishing to specialise in general internal medicine by members of the Curriculum Writing Group (CWG) chaired by Phillippa Poole. It took some time before we were able to post this curriculum on our website two months ago as we waited for feedback on the final draft by members of the college Education Unit, and advice on what were to be the next steps in integrating the curriculum with those of other societies and with assessment strategies.

I would urge all members to read the document and inform the CWG if they feel important knowledge and skill domains have been omitted or been given undue or insufficient emphasis. The curriculum covers three domains of medical expertise in being a general physician: hospital and inpatient care; ambulatory and community care; and consultation and liaison.

Basic training curriculum

Given the generalist perspective of our discipline, and the fact that the written and clinical examinations in their current format are designed to assess the attributes of a competent medical registrar in general medicine, it was not surprising that members of the IMSANZ CWG were also invited to play a major role in developing the basic training curriculum. Leonie Callaway, Phillippa, Andrew Bowers, myself, David Hewitt, and Dominic Wilkinson are now actively engaged in writing the basic training curriculum which, on completion of the first draft, will be circulated to specialty societies and IMSANZ members for comment.

We are finding this task to be, in many ways, more challenging than writing the advanced training curriculum in that we have had to create a document which is not simply a watered down, aggregated version of advanced training curricula from various specialties, but one which properly provides the trainee with broad knowledge and skills in internal medicine in a way that facilitates an easy transition into whatever form of advanced training the trainee chooses to undertake. This task is yet to be completed but our target date is August and we are well advanced.

Assessment procedures

At the same time that curricula are being written, several of us including Phillippa, Leonie, myself and Andrew have also been working with Tim Wilkinson and folk from other societies and faculties in evaluating new assessment procedures which aim to ensure that the key knowledge and skills we agree are important to being a physician are explicitly examined. For too long the means by which we determine whether trainees should be allowed to become practising fellows has rested almost exclusively on whether they pass the Part 1 written papers and vivas conducted over a period of 2 days.

While there is still much that is useful in the current examination process which we wish to retain, it is now acknowledged that the college assessment process falls well short of sound educational principles. However, I wish to reassure members that the examination process that many of us here underwent and still regard as being a valid assessment procedure is not being jettisoned for some soft and woolly options dreamed up by non-clinical educational theorists. We are taking a hard-nosed, evidence-based approach and considering only those methods which properly reflect real-world physician practice, are educationally rigorous and are practically feasible.

We have discovered new and interesting ways by which we can assess, and thereby promote, the consummate physicianly skills. We are also cognisant of the need to ensure there is matching of assessment procedures that we may wish to apply to trainees with those we may want to apply to ourselves as fellows under a revamped MOPS/CPD program. As the deadline for completion of the basic training curriculum and assessment papers is October there will be much happening over coming months and we welcome your input.

Modular courses

Consideration is also being given to IMSANZ developing a number of certifiable short curricula in particular aspects of practice relevant to general physician trainees. Some potential topics include peri-operative care, obstetric medicine, clinical decision-making, indigenous health, and acute stroke medicine. We would welcome suggestions from members as to other topics worthy of consideration.

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Regional and Rural Services in General Medicine

Council has continued its efforts towards improving regional and rural services in general medicine. Every issue of the newsletter in the last 12 months has contained an article centred on some important aspect of regional and rural practice. The Action Plan has an entire section devoted to strategies for supporting physicians working in regional and rural centres, and the sections on training also refer to the need to encourage dual training and flexible training programs so that more trainees can take subspecialty procedural skills with them into non-metropolitan practice, an approach that has proven very effective in NZ. S

everal IMSANZ councillors are members of the RACP Rural Taskforce which has been proactive in representing the interests of rural physicians within college policy-making. A National Rural Health Policy document co-authored by several folk on IMSANZ council and the Rural Taskforce was submitted last year to the Australian Health Ministers Advisory Council and was summarised in a feature article in the December newsletter. We eagerly await AHMAC responses to the key recommendations contained in the document.

I would like to acknowledge the efforts of Graeme Maguire from Broome, Steve Brady from Alice Springs, Diane Howard from Darwin, and Rick McLean from Dubbo (also chair of the RACP Rural Taskforce) in organising a meeting in September this year involving physicians, college representatives, senior government health executives and public health officials to discuss the many issues around saving medical specialist practice in rural and remote communities. This meeting will be held at Alice Springs Hospital as a satellite forum just prior to the IMSANZ annual scientific meeting. This is a vitally important topic as explained in an article in the April newsletter and IMSANZ is very pleased to be a co-sponsor of this meeting, and I urge all those with an interest in this area to spend an extra day in Alice Springs and participate in what will be lively debate.

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Continuing Professional Development

IMSANZ has continued to expand its inventory of activities and resources in continuing professional development for our members.

RACP ASM:

Most of the adult medicine scientific program for this 2005 meeting was organised by a New Zealand team led by Phillippa Poole, Pip Shirtcliffe and Sisera Jayathissa with assistance, as always, from Les Bolitho. On behalf of the society I thank them for their efforts and congratulate them on serving up another first rate, interesting and diverse program. The 2006 ASM in Cairns however will be a little different. For some time Council has been concerned that less than a fifth of our own members are regular attendees at the RACP ASM, IMSANZ had lost its own identity within the program (the IMSANZ days that used to be held just prior to the RACP ASM were highly popular), the opportunity to generate income for the Society had been foregone, and the work required of IMSANZ folk to procure presentations from Specialty Societies for the RACP ASM was becoming more onerous.

As a result, and in line with the thinking of the Specialties Board which has questioned the aims, format, and intended audience of the RACP ASM, it was recently decided that IMSANZ would not formally involve itself in the organisation of future ASMs beyond Wellington unless there was major restructuring of the meeting and IMSANZ was afforded the ability to have its own scientific program with separate badging under the IMSANZ logo, and with separate registration form and profits from the day returning to IMSANZ. At a college workshop entitled ‘The Future of the RACP ASM’ held in February this year, it was agreed that, subject to ratification by the Board of CPD, a new format would be trialled in Cairns in 2006 with the ASM renamed to the RACP Congress and in which an IMSANZ day would be organised in conjunction with a program of mixed specialties following an initial 1½ day college-sponsored session on Professional Skills.

IMSANZ ASM Alice Springs Sept 1-4, 2005:

In September, IMSANZ is holding a three day scientific meeting in Alice Springs with an educational program specifically designed to meet the needs of the general physician, particularly those practising in regional and rural areas. Registration brochures containing more information on this meeting have been included in your conference satchels. I would like to thank Steve Brady and Diane Howard for their generous assistance in organising this meeting.

ICIM 2010:

IMSANZ welcomed the announcement late last year from the International Society of Internal Medicine that the Melbourne bid to host the 2010 International Congress of Internal Medicine had been successful. We congratulate Les Bolitho and Geoff Metz on their efforts in formulating and marketing the winning bid, and bringing such a high profile educational event to our shores.

RACP NZ/TSANZ/IMSANZ/ASID 2004.

I was very pleased to have had the opportunity to attend this meeting in Christchurch in August which was a collaborative effort between IMSANZ and the NZ branch of the college, the Thoracic Society and the Infectious Diseases Society. The meeting was educationally very good and I enjoyed the camaraderie that evidently existed between general medicine and other societies here in NZ.

CPD resources on the website:

Turning to CPD for individual physicians, IMSANZ is aware of its responsibility to provide useful learning resources to our members independently of RACP. The Critically Appraised Topics (CATs) Library which now features on our website was explained in an article in the April newsletter and we hope that it will come to be seen by the society as the best means for staying up to date with new knowledge generated from clinical research. We have also included resources in teaching evidence-based medicine and quality improvement on the website as well as links to several other sites that provide additional high-quality CPD materials. We welcome any suggestions from members as to what additional CPD resources they would like to see developed by IMSANZ.

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