Pain Medicine 2014; 15: 1992–1995 Wiley Periodicals, Inc.

PROFESSIONALISM & COMMENTARY Commentary The Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists – History and Strategic Plan

Edward A. Shipton, FANZCA, FFPMANZCA, MD,* Brendan Moore, FANZCA, FFPMANZCA,† Michael Cousins, FANZCA, FFPMANZCA, AO, MD, DSc,§ and Leigh Atkinson, FRACS, FACS, FRCS (Edin), FFPMANZCA, FAFRM (RACP)‡ *Department of Anaesthesia, University of Otago, Christchurch, Canterbury, New Zealand; †Centre for Integrated Preclinical Drug Development, ‡Department of Surgery, University of Queensland, Brisbane, Queensland; §Department of Anaesthesia and Pain Management, University of Sydney, Sydney, New South Wales, Australia Reprint requests to: Edward A. Shipton, FANZCA, FFPMANZCA, MD, Department of Anaesthesia, University of Otago, Christchurch, 2 Riccarton Avenue, Christchurch 8011, New Zealand. Tel: 164-33641642; Fax: 164-3-3572594; E-mail: [email protected] Disclosure: There are no conflicts of interest or support obtained. Abstract Since its formation, the Faculty of Pain Medicine (FPM) has grown into an organization with 369 fellows. It has 29 accredited pain medicine training units in Australia, New Zealand, Hong Kong, and Singapore. This article reviews the history of its birth and subsequent growth. The FPM fellowship is widely recognized as a high-quality qualification, based on a sound curriculum, excellent clinical exposure, and robust continuing professional development. But how does the Faculty position itself for the future? The Faculty’s 5-year Strategic 1992

Plan (from 2013 to 2017) sets out its vision “to reduce the burden of pain in society through education, advocacy, training and research.” Key Words. History; Strategic Plan

History Establishment of the Faculty The Australian and New Zealand Faculty of Pain Medicine (FPM) has reached its adolescence having been established in 1998. Since its formation, the FPM has grown into an organization with 369 fellows, 346 of whom are still active. It has 29 accredited pain medicine training units in Australia, New Zealand, Hong Kong, and Singapore. It was felt timely to review the history of its birth and subsequent growth. The Australian and New Zealand College of Anaesthetists (ANZCA) convened a working party in 1992 to examine the possibility of developing a formal certification for anesthetists wishing to further their interest in pain management. This working party was known as the “Working Party on Pain Management” [1]. This committee then liaised with the other medical colleges. This led to the formation of a Joint Advisory Committee in Pain Medicine (JACPM). Under the leadership of Professor Michael Cousins, this committee consisted of representatives from the ANZCA, the Royal Australasian College of Surgeons (RACS), the Royal Australian and New Zealand College of Psychiatrists (RANZCP), the Royal Australasian College of Physicians (RACP), and the Australasian Faculty of Rehabilitation Medicine (AFRM). In 1997, JACPM started on the development of training requirements for a “Certificate in Pain Management.” It identified institutions in Australia and New Zealand that

Faculty of Pain Medicine were suitable for training candidates. The ANZCA Pain Medicine Committee met with JACPM on August 3, 1998 and on October 1, 1998. On October 2–3, 1998, ANZCA Council announced that the ANZCA Pain Medicine Committee and the JACPM of the Specialist Medical Colleges had recommended that a “Faculty of Pain Medicine” be developed. A number of draft regulations had been drawn up for the Council to consider. The training program would consist of 1 year of relevant experience during years 1 to 4 in a vocational specialist training program of all the participating colleges. Due consideration would be given by the censor to application by trainees for approval of experience gained (in pain medicine) in the first 4 years of training. This would be followed by a year of full-time training in an approved multidisciplinary pain unit during the fifth year of training in the speciality of anesthesia or the equivalent in the other participating colleges. The initial requirements for summative assessment consisted of the following: a logbook (of cases) over an 18month period; 4 case studies (of which two would be mini-reviews); a written examination of two and a half hours (of 15 short answer questions, 8 of which would be compulsory); and a long clinical case (of 60 minutes for history and examination, 30 minutes for preparation, and a 40-minute oral). Initially, a Certificate in Pain Management of the ANZCA would be awarded to successful candidates. It was recommended that acute pain medicine and pediatric pain medicine be incorporated into the new program. On October 3, 1998, the second day of the ANZCA Council meeting, draft regulations were approved regarding the formation of the inaugural board of the FPM and for the operation of subsequent boards of the Faculty. The ANZCA Council appointed six ANZCA fellows involved in the practice of pain medicine to the inaugural board. The president of the ANZCA Council and the chairperson of JACPM wrote to the presidents of the other participating colleges inviting them to nominate one member for appointment by the ANZCA Council to the inaugural faculty board. A revised version of the document prepared by JACPM on “Requirements for Multidisciplinary Pain Centres Offering Training in Pain Medicine” was approved as well. The first teleconference of the inaugural faculty board was held on November 23, 1998 [1]. The first face-toface inaugural faculty board meeting was held in Melbourne on February 4, 1999 [2]. Professor Michael Cousins of the University of Sydney and the Royal North Shore Hospital was elected foundation dean. There were representatives from each of the participating colleges. Ten members of the appointed board were then elected as foundation diplomates of the FPM [2]. The faculty board met again via teleconference in March and April 1999. In total, 47 foundation diplomates were

elected. Their names were published in the ANZCA Bulletin of June 1999 [3]. Of the 47 foundation fellows, 65% were anesthetists, 10% were physicians, 10% were rehabilitation specialists, 8.5% were psychiatrists, and 4% were surgeons. A panel of examiners was appointed by September 1999. The first fellowship examination was held in November 1999. The inaugural appointees were elected to fellowship of the FPM in February 2000. They were named as foundation fellows of the Faculty. Five representatives of the five participating colleges were represented at the faculty board meeting in May 2000. The first applicant to undergo training came from the Royal North Shore Hospital in Sydney. Applications for additional foundation fellowships were assessed using the ANZCA Council criteria. Ms. Margaret Benjamin became the Faculty’s first executive officer. She was succeeded by Ms. Helen Morris as general manager of the Faculty. At present, the general manager has four full-time support staff, one full-time project support officer, and a part-time director of professional affairs. There have been eight deans since the foundation of the Faculty. In order, the seven deans have been Professor Michael J. Cousins (anesthetist), Professor R. Leigh Atkinson (neurosurgeon), Professor Milton L. Cohen (physician), Associate Professor C. Roger Goucke (anesthetist), Dr. Penny A. Briscoe (anesthetist), Dr. David Jones (anaesthetist), and Associate Professor Brendan Moore (anaesthetist). The eighth (current) dean is Professor Edward Shipton (anaesthetist). The establishment of the Faculty, incorporating multidisciplinary representation from other medical specialties, was an important and innovative advance in the management of acute, chronic noncancer, and cancer pain. Australian and New Zealand specialists with backgrounds in anesthesia, surgery, rehabilitation medicine, psychiatry, and general medicine worked together to establish robust governance processes needed to progress the training, examination, and continuing professional development of pain medicine specialists. Over the years, the Faculty’s reputation with local stakeholders and on the international stage has grown. Becoming an Independent Medical Specialty Epidemiological studies in Australia have shown that one in five Australians reported suffering from chronic pain (overall prevalence of 17.1% for males and 20.0% for females) [4]. Data from the 2006/2007 New Zealand Health Survey showed that one in six New Zealanders (16.9%) suffered from chronic pain [5]. The prevalence of chronic pain has made it a critical public health problem in Australia and New Zealand. In November 2005, the Australian Medical Council recommended to the Australian government that pain medicine be recognized as an independent medical specialty, and pronounced the Australian and New Zealand FPM to be the body responsible for training, education, and standards for pain medicine in Australia [6]. 1993

Shipton et al. This was the first acknowledgment of its type in the world. Following a lengthy application process undertaken by the FPM, the Medical Council of New Zealand accredited pain medicine as a scope of practice in New Zealand in December 2012 [7]. This gave formal recognition to this medical specialty and its associated qualification. Fellowship of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists FFPMANZCA is the registered specialist qualification in pain medicine with the Australian Medical Council and with the Medical Council of New Zealand. The ANZCA Council delegated certain powers and functions to the FPM. This is reflective of the supportive and collegial relationship that existed between the College and the Faculty. The Faculty’s work is directed by a board elected by the Fellowship and is supported by committees including an Education Committee, an Examination Committee, a Hospital Unit Accreditation Committee, a Research Committee, and a Continuing Professional Development Committee. The dean and other office bearers are elected by the board. The administration is based in Melbourne under the leadership of the general manager. The Faculty is supported by regional committees in Queensland, New South Wales, South Australia, Western Australia, and Victoria, which provide continuing medical education in the regions. On May 22, 2013, a National Committee of the Faculty was formed in New Zealand. In summary, the FPM was established within ANZCA in 1998, incorporating true multidisciplinary representation from the RACP, the RACS, the RANZCP, and the AFRM. Training and education of specialist pain medicine physicians are at the heart of FPM’s role and reason for being. Fellows of the FPM have a wide knowledge of the clinical, bio-psycho-social, and humanitarian aspects of pain, and are well placed to follow a developing and challenging career path. The FPM fellowship is widely recognized as a high-quality qualification, based on a sound curriculum, excellent clinical exposure, and robust continuing professional development. But how does the Faculty position itself for the future? The Faculty’s Strategic Plan The Faculty’s Strategic Plan sets out a 5-year framework (from 2013 to 2017) on which to focus its work [8]. Its vision is “to reduce the burden of pain in society through education, advocacy, training and research.” The strategic plan aims to achieve this vision and be implemented according to its values. The Faculty’s Strategic Plan has two main aims, specifically to advance pain medicine and to improve patient care. To do this, the Faculty would need to focus on three priorities, namely to build fellowship and the Faculty, to build the curriculum and knowledge, and to build advocacy and access (via support of a community-based organization [painaustralia.org.au]). 1994

Building the Fellowship and the Faculty [8] Since its inception in 1998, the Faculty has seen a steady increase in the number of fellows. This trend needs to continue for the Faculty to remain sustainable and to enable it to achieve in other priority areas. Fellows’ contributions as teachers, examiners, advisors, mentors, and committee members need to be encouraged and supported. Building the capacity and capability of the Fellowship, including promoting pain medicine as a career and attracting trainees, remains an important focus over the next 5 years. To build the fellowship, the Faculty will need to strengthen relationships developed within the fellowship. The creation and regular review of clear policies and procedures ensure an interaction that can be both efficient and effective. Training and education of specialist pain medicine physicians are at the heart of the Faculty’s role and existence. However, this needs to be pollinated by robust research that will make a contribution to the global scientific knowledge of pain and pain medicine. In Australia, access to research funding in pain medicine competes with some success via the National Health and Medical Research Council (NHMRC). Complementing the NHMRC in Australia (and the Health Research Council in New Zealand) is the ANZCA/FPM Foundation Research grants program that provides close to one million Australian dollars in grants each year. Also, the ANZCA clinical trials group helps in the design of multicenter studies, enhancing the chance of success via ANZCA, NHMRC, Health Research Council, or the equivalent. Building the Curriculum and Knowledge [8] The Faculty has set out to redesign and develop a new innovative curriculum to provide a leading role in pain medicine education. As pain traverses most areas of health practice, the Faculty will continue to improve its relationships with other medical colleges and organizations. This should ensure that an ever-increasing number of health care professionals have access to pain medicine training, information, education, and research. These health care professionals can in turn provide their patients with evidence-based and effective pain management. The Faculty played a key role in the National Pain Summit, leading to the National Pain Strategy (see painaustralia.org.au), as well as providing financial support, board membership, and close collaboration with the community-based advocacy body, Pain Australia. Pivotal to the National Pain Strategy has been the Faculty’s collaboration with the Royal Australian College of General Practitioners to produce a web-based educational module on pain, which is currently being modified for all primary care practitioners. Multidisciplinary-based assessment and management of pain at a primary care level have been advanced by the Faculty/Pain Australia

Faculty of Pain Medicine initiatives sponsored by the Australian Federal Government-funded Medicare Locals that support “team medicine.” The Faculty will continue to pursue these and other primary care initiatives. For example, a training pathway has now been developed to enable general practitioners to become fellows of the Faculty. All of the following will greatly enhance patient access so that chronic pain patients will have equity of access to pain management compared with patients with other chronic conditions. Building Advocacy and Access [8] The problem of persistent pain and its resultant suffering continue to be misunderstood. With our partner organizations, consumer, and industry groups, the Faculty endeavors to promote a unified understanding of pain in the health sector and in the wider community. Access to pain management information and treatment is alarmingly inadequate. There is a need to increase the numbers of pain medicine trainees and specialists and to empower other health care professionals to provide safe, high-quality pain management. The Faculty will continue to lobby government agencies, industry, and the wider community to advance the cause of patients’ suffering in pain and to improve access to pain medicine services. It will seek to keep the management of pain on the national policy agenda in both Australia and New Zealand. Here, the Faculty’s collaboration with Pain Australia has already yielded major benefits with the enhancement of the National Pain Strategy by all but one of Australia’s regional governments and the funding of Regional Pain Care Plans. Of considerable assistance to such initiative has been the Declaration of Montreal: “Access to Pain Management is a fundamental human right” [9]. Implementation and Monitoring [8] Implementing the strategic plan requires sound business planning. A business and operational planning cycle occurs on an annual basis. This is approved by the faculty board. Specific activities under each of the three strategic priorities are identified. In order to achieve its vision, progress toward the Faculty’s objectives as outlined in its strategic priorities is closely monitored. Detailed reporting has become part of the annual business planning cycle. Areas that need more attention or a new approach are sought. The Faculty management reports regularly to the Faculty board. Measures linked to the strategic objectives are used, and the Faculty management informs the board of any emerging issues. Such a strategic plan needs to be balanced with some flexibility in order to guide the organization in meeting new challenges and in making the most of emerging opportunities. A review of the strategic plan may be required at times.

Over the next 18 months, the Faculty will report on new initiatives such as the new redesigned curriculum, the electronic Persistent Pain Outcomes Collaboration, and the Online Pain Management Education Program entitled ‘Better Pain Management—Pain Education for Professionals.’ Although still in its adolescent years, the Faculty seeks “to serve the community by fostering safety and high quality patient care in pain medicine.” Acknowledgments The assistance of the ANZCA librarian, Fraser Faithfull, and the Faculty general manager, Helen Morris, is gratefully acknowledged.

References 1 Archives of the Australian and New Zealand College of Anaesthetists. Minutes of the Meeting of the Executive Committee of the Council of the Australian and New Zealand College of Anaesthetists. Hailes Room at College Headquarters, Melbourne, 13 March 1993. 2 Archives of the Australian and New Zealand College of Anaesthetists. Minutes of the Meeting of the Board of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists. Council Room, at College Headquarters, Melbourne, 4 February 1999. 3 Archives of the Australian and New Zealand College of Anaesthetists. Australian and New Zealand College of Anaesthetists (ANZCA) Bulletin. June 1999. 4 Blyth FM, March LM, Brnabic AJ, et al. Chronic pain in Australia: A prevalence study. Pain 2001;89(2–3): 127–34. 5 Dominick C, Blyth F, Nicholas M. Patterns of chronic pain in the New Zealand population. N Z Med J 2011;124(1337):63–76. 6 Australian Medical Council Limited. Assessment of Pain Medicine as a Medical Specialty. Report Dec 2005. Available at: www.amc.org.au/index.php/ar/ rms/publications/73-pain (accessed May 2010). 7 Medical Council of New Zealand. Notice of new scope of practice and qualification prescribed by the Medical Council of New Zealand. New Zealand Gazette 8 November 2012;(134):3880; 2012. 8 Board of the Faculty of Pain Medicine. Advancing pain medicine and improving patient care. Faculty of Pain Medicine Strategic Plan 2013–2017, September 2012:1–11. 9 Cousins MJ, Lynch ME. The Declaration Montreal: Access to pain management is a fundamental human right. Pain 2011;152(12):2673–4.

1995

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The faculty of pain medicine of the Australian and New Zealand college of anaesthetists - history and strategic plan.

Since its formation, the Faculty of Pain Medicine (FPM) has grown into an organization with 369 fellows. It has 29 accredited pain medicine training u...
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