Australian and New Zealand College of Anaesthetists Name-committees-and... · 1 Australian and New Zealand College of Anaesthetists New Zealand National Committee Annual Report for

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Australian and New Zealand College of Anaesthetists

New Zealand National Committee

Annual Report for January 1, 2018 to December 31, 2018

Total number of national committee meetings for year: Three meetings were held in 2018 – on

March 2, June 29 and November 7.

Elected, appointed, ex officio and co-opted members

Committee role Name

Chair (from June)

Deputy Chair (until June)

Formal Projects Officer

Dr Jennifer Woods

Deputy Chair

Deputy Education Officer

Dr Sally Ure

Quality and Safety Officer Dr Geoff Laney (until June)

Welfare Officer

Quality and Safety Officer (from June)

Dr Rob Fry

Accreditation Officer Dr Gary Hopgood (until June)

Dr Lisa Horrell (from June)

Education Officer

Chair of the Education Subcommittee

Dr Brent Waldron (until June)

Dr Jennifer Taylor (from June)

Fellowship Affairs Officer Dr Kerry Gunn

Other elected members

Dr Rachel Dempsey

Dr Leinani Aiono-Le Tagaloa (from June)

Dr Chris Harrison

Dr Michal Kluger (until June)

Dr Tom Fernandez

Dr Hamish Gray

Councillor members(ex officio) Dr Vanessa Beavis

Dr Nigel Robertson

New Fellow member(co-opted) Dr Richard More (until June)

Dr Courtney Thomas (from June)

Trainee Committee Chair member Dr Jonathan Panckhurst (until November)

Faculty of Pain Medicine representative

(co-opted)

Professor Ted Shipton

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Observers

NZSA President Dr David Kibblewhite

CICM NZNC Chair Dr Jonathan Casement

Other national roles

Chair, NZ Panel For Vocational

Registration

Dr Michal Kluger (until June)

Dr Chris Harrison (from June)

NZNC representatives to New Zealand

committees and organisations:

NZ Anaesthetic Technicians’ Society Dr Rachel Dempsey

NZ Society of Anaesthetists Dr Jennifer Woods

Council of Medical Colleges Dr Jennifer Woods

College of Intensive Care Medicine NZNC Dr Sally Ure

NZ Resuscitation Council Dr Malcolm Stuart

Ministry of Health Disaster Response

Preparedness

Dr Maurice Lee

Royal New Zealand College of General

Practitioners’ Division of Rural Hospital

Medicine Board of Studies

Dr Vaughan Laurenson

National Maternal Monitoring Group Dr Mathew Drake

NZ Anaesthesia Education Committee Dr Jennifer Woods

Dr Kerry Gunn

Dr Tom Fernandez

Staff

General Manager, NZ National Office Heather Ann Moodie

Communications Manager, NZ Adele Broadbent

Senior Policy Adviser, NZ Virginia Mills (until August)

Mary Harvey (from August)

Training and Education Coordinator Alison McKessar

ANZCA and FPM NZ National Committees

Coordinator

Katherine Harris

Finance and Operations Coordinator Alka Rajpal

Assessments Coordinator

CICM NZNC Administrator

Rose Chadwick

Annual General Meeting

The AGM for New Zealand fellows was held on Friday, November 9, 2018 at the Cordis Hotel in

Auckland, with 16 fellows attending.

CHAIR’S REPORT – Dr Jennifer Woods

Leading professional identity and perioperative medicine

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The first goal of the ANZCA Strategic Plan 2018 – 2022 focuses on ANZCA’s role in leading the

promotion of professional identity of anaesthesia and pain medicine and the development of an

effective, integrated and collaborative perioperative care model. Many of the NZNC activities in

2018 advanced this goal.

NZNC Submissions 2018 (highlights in brief)

The Justice Select Committee on the End of Life Choice Bill: In line with ANZCA’s previous positions

on voluntary assisted dying, the submission commented on the proposed legislative framework but

did not comment on whether assisted dying laws are needed in New Zealand.

The Health Select Committee on the Misuse of Drugs (Medicinal Cannabis and other matters)

Amendment Bill: ANZCA and FPM will not endorse use of cannabis-based products in chronic non-

cancer pain until a clear, evidence-based therapeutic role for such agents is identified in the

scientific literature.

The Health Select Committee on the Health Practitioners Competence Assurance Amendment Bill:

Submitted that any amendments to the Act must be consistent with its purpose of protecting health

and safety. Collecting and reporting on demographic data for the purposes of workforce planning

strays from the core purpose of the HPCCA, and this was not seen by ANZCA as relevant to the

principles of the Act.

Pharmac on proposals for national contracts for anaesthesia small equipment and consumables:

Recommended Pharmac set up an anaesthesia clinical advisory group as it moves into purchasing

anaesthesia equipment and consumables.

The Health Quality and Safety Commission on a Maternity Indicators Vital Signs Chart: Suggested

amendments to the chart from an anaesthesia perspective.

The Mental Health and Addiction Inquiry: Submitted on the bidirectional relationship between

chronic pain and mental health and addiction, pointing out the barriers to accessing multidisciplinary

care.

The Civil Aviation Authority on its proposed new definition of supplementary crew member:

Recommended that any training requirements for supplementary crew members are scalable and

proportional to their level of involvement in an operation, and their likely involvement in future

operations.

Medical Council of New Zealand (MCNZ) – Safe practice in an environment of resource limitation:

Supported a number of changes proposed to this Medical Council Statement but also recommended

the Medical Council discuss equity of health outcomes more explicitly throughout the document.

Ministry of Health (MOH) - Draft terms of reference for Review of the New Zealand Health and

Disability System Recommended the TOR explicitly acknowledge the significant health inequities

between Māori and non-Māori in New Zealand. This will allow for Māori health to be specifically

considered when determining membership of the review group.

Medsafe – Codeine use - changes to age restriction – draft alert communication

Recommended the alert should be accompanied by a very clear guidance regarding alternatives to

codeine. Safety issues relating to the prescription of any opioid-like drug should be addressed with

the alert. The alert should highlight that changes are being made for codeine due to the issues of

CYP2D6 polymorphism and consequent issues of over-metabolism.

MOH – Professional Behaviours Taskforce’s stocktake of the current situation NZNC submitted to

the Council of Medical Colleges a summary of ANZCA’s ‘professional behaviours’ activities. All of

ANZCA’s feedback was included in the CMC submission to the MOH. Examples of the type of work

ANZCA is doing, include: the development of a “notification and management of complaints and

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concerns” policy to allow the college to address complaints about anaesthetists; establishment of an

MoU with the Royal Australasian College of Surgeons (RACS) to share educational and other

information; publication of a guide for clinicians to enhance understanding of professionalism and

performance (including BDSH) as it applies to the practice of anaesthesia; monitoring the health and

wellbeing of staff and volunteers and providing ongoing professional development and support.

MCNZ - Consultation on fees payable to the Medical Council

Submitted that the increase to the fee for Vocational Practice Assessment could have workforce

implications such as difficulty recruiting international medical graduates. Also questioned whether

the rationale of avoiding cross-subsidisation would mean there would be reductions in other fees.

MOH - Proposed changes to the NHI system

Submitted against expanding the data collection in some areas arguing the collection of fewer

patient identifiers that are high quality is preferable to gathering additional data that is of

questionable accuracy or use.

MCNZ - Strengthening recertification for vocationally-registered doctors

Submitted that the MCNZ has listened to feedback from vocational educational advisory bodies

(VEABs) and that we are generally supportive of the proposals. We noted that the ANZCA and FPM

CPD program includes most of the key components of the proposed approach. This includes regular

practice review (RPR), which is offered with both mandatory and non-mandatory activities.

ANZCA’s full submissions are available here.

Indigenous health strategy

New Zealand staff consulted widely on the New Zealand aspects of ANZCA’s draft indigenous health

strategy through the early part of the year. Internally, feedback was sought from the ANZCA NZNC,

the FPM NZNC and the NZ trainee committee. Externally, the draft was discussed with RACS. It was

also presented to a number of policy staff from several colleges at the Council of Medical Colleges

(CMC) Policy Group meeting, Te ORA and the policy equity hub. ANZCA has now launched the

strategy and work is proceeding on consulting on a proposal for a Māori name for ANZCA to be used

in New Zealand. Dr Courtney Thomas has been appointed as the ANZCA representative to participate

on a Te ORA advisory group to advance initiatives such as developing cultural competence

standards. ANZCA was a sponsor for the Te ORA Hui in January 2019 to promote anaesthesia as a

career to Māori doctors. Dr Amanda Gimblett and Dr Courtney Thomas represented the college and

staffed the booth for the careers day.

Meeting with government and opposition

We had a very productive meeting with the Minister of Health, Dr David Clark in March 2018. I was

joined by Professor Ted Shipton, Dr Paul Vroegop and Virginia Mills representing both FPM NZNC

and ANZCA. Big ticket topics included medicinal cannabis, the burden of chronic pain in New

Zealand, the mental health and addiction inquiry, and workforce issues. In advance of the meeting,

Dr Vroegop, with support from the New Zealand office, published an opinion-editorial on the link

between chronic pain and mental health and addiction.

I met with the National spokesperson on health, Michael Woodhouse along with Dr Sally Ure and

Heather Ann Moodie in early September. The wide ranging discussion included how perioperative

care can lead to improved patient outcomes, the need for investment in the training of pain

medicine specialists and services, and workforce issues around changing health needs and new

technology.

NZNC Elections and office bearers 2018 - 2022

Twelve nominations were received for the twelve committee positions, so a ballot was not required.

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New members of the committee are: Dr Jennifer Taylor, Dr Leinani Aiono-Le Tagaloa, Dr Ralph Fuchs

and Dr Courtney Thomas. Dr Lisa Horrell is a co-opted member. The following office bearers were

appointed: Dr Jennifer Woods (chair), Dr Sally Ure (deputy chair), Dr Jennifer Taylor (Education

officer), Dr Rob Fry (Safety and Quality officer), Dr Chris Harrison (chair of the NZ Vocational

Registration Panel), Dr Courtney Thomas (new fellow representative), Dr Kerry Gunn (Fellowship

Affairs officer) and Dr Lisa Horrell (Accreditation officer).

2018 ANZCA NZNC meetings

NZNC met three times in 2018:

Friday March 2 at the ANZCA office. This included WBA (SIMG) training. Dr John Wyeth, the Medical

Director of Pharmac and Dr Andrew Simpson, Chief Medical Officer from the Ministry of Health, also

presented at the meeting. The NZNC agenda included an update of the ANZCA’s draft indigenous

strategy, the End of Life Choice Bill submission, Protected Quality Assurance activities related to

reflective practice, ANZCA’s Strategic Plan 2018 - 2022 and associated New Zealand activities,

AMC/MCNZ accreditation, safe sedation roundtable, name change proposal, and an update on NZNC

research and networking events.

Friday June 29 was joint meeting with New Zealand Society of Anaesthetists (NZSA) in the morning

and NZNC in the afternoon. The Health and Disability Commissioner, Anthony Hill, and Jane King, the

Associate Commissioner Legal, gave a presentation to the joint meeting on the work done by the

commission along with three case studies relevant to anaesthesia. This meeting also covered the

issues of sedation and training for the assistant to the anaesthetist. At the NZNC meeting in the

afternoon, topics discussed included NZNC involvement in Pharmac’s funding of medical devices,

specifically the formation of an advisory group on anaesthesia small equipment and consumables.

The committee also discussed a collaboration agreement between the Council of Medical Colleges

and Te ORA, proposing a Māori name for ANZCA, a recently announced review of the Health and

Disability Sector and an update from Dr Vanessa Beavis about the Gender Equity Working Group. Dr

Jonathan Panckhurst gave a presentation on the new NZTC Trainee Handbook and asked committee

members to promote this within their departments.

Wednesday November 7 the meeting was held in Auckland prior to the New Zealand Anaesthesia

ASM. The big issues included a move to get a co-badged advisory from ANZCA, the Ministry of Health

and the Health Quality and Safety Commission to all district health boards on the safe storage of

propofol; the setting up of an advisory group to help provide meaningful clinical feedback on

Pharmac consultations about anaesthesia small equipment and consumable devices; and the setting

up of a Welfare Advocates meeting the first of which will be held in February 2019.

New Zealand fellows’ AGM Friday was held on November 9 at the Cordis Hotel in Auckland during

the New Zealand Anaesthesia ASM.

Anaesthesia small equipment and consumables

Earlier in 2018, Dr Kerry Gunn, Virginia Mills and I met with representatives from Pharmac to discuss

its move into national contracting for anaesthesia small equipment and consumable devices. Dr

Gunn brought Clinical Directors up-to-date at their meeting in Wellington in September and talked

about the need for one strong voice of anaesthesia on this issue. NZNC called for nominees for the

advisory group to help provide meaningful clinical feedback on Pharmac consultations.

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There is a call for this group to consider sustainability issues when equipment is reviewed. NZNC will

raise this with Pharmac and also promote PS64 which is currently in its pilot phase.

CMC

Three New Zealand office staff attended the policy meeting of the Council of Medical Colleges in

Wellington in January where the colleges shared their positions so they can work together on best

practice in cultural competency and indigenous health policies. Virginia Mills presented on ANZCA’s

Indigenous Health Strategy draft. Other issues discussed were aid in the Pacific and Pacific

communities in New Zealand, and the End of Life Choice Bill. The new Minister of Health addressed

the first CMC meeting of the year on March 1. Some of the Government’s plans for health were

discussed, including the parameters of the Mental Health and Addiction Review and an update on

the Therapeutic Products Regulatory Regime – an exposure draft bill. Key issues for the second

meeting held on May 24 covered the changed governance structure for Choosing Wisely NZ; CMC’s

collaborative agreement with Te ORA; ACC’s strategy for working with the sector; an update from

Health Workforce regarding its structure within the Ministry and the funding for medical education;

and an update on the Mental Health and Addiction inquiry. Dr Sally Ure attended CMC on August 30

on behalf of NZNC. There were a number of presentations including the Ministry of Health (MoH)

which is seeking closer working relationships with medical colleges. The spokesperson outlined the

new structure of the MoH and spoke about how the relationship managers can work with colleges.

The chair of the Health and Disability System Review, Heather Simpson, explained the review is more

about looking at future-focused design rather than fixing the present system or service level. There

were also presentations from Health Workforce New Zealand and the launch of the new Choosing

Wisely recommendations.

VEAB – strengthening recertification

At the Vocational Education and Advisory Body (VEAB) meeting in September the Medical Council of

New Zealand outlined plans for updating recertification of vocationally-registered doctors. The

ANZCA CPD program already meets most of the proposed changes although anaesthetists planning

their annual CPD activities may need to tailor them to their specific practices. The Medical Council

also updated the colleges on current consultations: Safe practice in an environment of resource

limitation, and Sexual and professional boundaries.

Faculty of Pain Medicine NZNC Teleconference meeting 6.30pm Monday February 12. AGM on Sunday May 6 in Sydney as part of the Refresher Day. Face-to-face meeting in Wellington Friday June 22. Teleconference meeting 6.30pm Monday October 16. National Anaesthesia Day in NZ

Anaesthesia departments around the country embraced National Anaesthesia Day on October 16

with ten hospitals holding staffed interactive displays and nearly all public, plus a few more private

hospitals than last year, putting up posters and patient information. Dr Nigel Robertson was the

overall spokesperson on the theme – Anaesthesia isn’t sleep. It’s so much deeper. He spoke on

National Radio on October 15. Healthcentral.nz ran a comprehensive online story here on ANZCA

research. And the Otago Daily Times also ran extensive coverage. The Minister of Health, David

Clark, supported the day by accepting an ANZCA invitation to visit Wellington hospital but was held

up at the last minute at Caucus.

Media

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An opinion editorial was published in March on the connections between chronic pain and mental

health issues leading up to the ANZCA/FPM meeting with the Minister at the end of that month.

Media releases were put out around the ANZCA media awards that were shared between a New

Zealand and an Australian journalist. ANZCA facilitated a two-page Listener article on the

anaesthetist/anaesthesiologist debate in April. Media releases were put out about funding for

research into genetics and pain after surgery for breast cancer both earlier in the year and during

the time of the Sydney ASM in May. In August a release went out on research into risks for patients

stopping vital medicines on the day of surgery. Fellows continue to get reported in the media

commenting on pain medicine and other issues including the Thai cave rescue and what the role of

an anaesthetists was in that incident. National Anaesthesia Day was covered over three different

releases plus radio and newspaper coverage. There was also a Stuff story following a release on a

multi-centre trial around optimum blood pressure during life-saving stroke surgery. Six media

releases were sent out during the NZ ASM resulting in two interviews of speakers on Radio New

Zealand’s National Programme, and two on Newstalk ZB plus a several Stuff articles. A Fairfax health

journalist attended all three days of the conference.

Growing lifelong education, training and professional support

Quality Assurance Coordinators’ (QAC) Network

The QAC network completed its second year, meeting in April and again on November 23. The

network is an initiative of ANZCA’s New Zealand National Committee (NZNC). The Health, Safety and

Quality Commission attended the April meeting and outlined their vision for equity and health

improvement. (See Safety and Quality officer’s report.)

The National Obstetric Anaesthetist network

The National Obstetric Anaesthetist network (NOA) members regularly shared advice between the

three meetings held in 2018 in March, August and November 19. NZSA and ANZCA NZNC jointly host

this event. The group has ongoing online discussions and at the meetings issues have included

reviewing the draft of the national maternity early warning score (MEWS) chart as part of the

escalation pathway for deteriorating maternity patients, ongoing developments with the NZ

Maternity Clinical Information System, and tackling obesity in pregnancy.

2018 New Zealand Anaesthesia ASM

The New Zealand office worked closely with the Middlemore Hospital organising committee for the

promotion of the NZ A ASM. The office liaised with their counterparts in NZSA to produce timely

reminders and updates across all platforms. ANZCA facilitated the attendance of a Fairfax journalist

and six media releases were produced with good radio and press coverage. It was a highly successful

meeting with record numbers attending.

Australasian Clinical Educator of the Year Award

ANZCA fellow Dr Johnathan Albrett of Taranaki won the Australasian Clinical Educator of the Year

award for his Acute Skills Training Programme.

New Zealand Trainee Committee (NZTC)

The NZTC met by teleconference in March, June and September. The new 2019 committee and the

outgoing members met at the ANZCA New Zealand National Office on November 30. The NZTC

elections were held in October. Nominations did not exceed the number of vacancies so a ballot was

not required. The Handbook: Anaesthesia Training in New Zealand Made Easy was updated and

published online. During 2018, two Anaesthesia Trainee Collective events have taken place

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(Auckland and Wellington). These sessions are designed as feedback/networking sessions for

trainees outside of the hospital walls.

NZNC Education Subcommittee (ESC)

The ESC has met twice during 2018 – in Wellington in April and in Auckland in October. This

committee brings together New Zealand supervisors of training, rotational supervisors and

education officer. From August 2018, Dr Jennifer Taylor took over as education officer from Dr Brent

Waldron. I attended both meetings. ANZCA Operations Manager Training Assessment, Tamara

Rowan, and Operations Manager Learning and Development, Helen Ho, provided an update on

recent college initiatives in training and education for the October meeting.

Clinical Directors’ meeting

The annual Clinical Directors’ (CDs) meeting was held in the Wellington office on September 17 with

most hospitals represented around the table. I chaired the day which is the one time a year CDs get

to share common issues in practice and departmental management in New Zealand. The agenda

included safety and security of medication use and supply including the storage of propofol, an

electronic tool for leave management and an update on NetworkZ.

Driving research and quality improvement

NZCOM withdraws recommendation

The New Zealand College of Midwives (NZCOM) released their Choosing Wisely statement on 30th

August, with some associated media coverage. One of five recommendations was “Do not offer

epidural analgesia to a spontaneously labouring woman whose labour is progressing normally” and

was accompanied by a non-systematic review of the evidence which asserted the harm of labour

epidural analgesia to both mother and baby. The National Obstetric Anaesthesia (NOA) network

quickly responded to this statement, and NZCOM has subsequently agreed to remove the statement

and to collaborate with NOA as it is revised. NOA asserts that not offering a form of analgesia to a

labouring woman based on questionable evidence is a significant threat to women’s autonomy and

potentially adds to their perception of “failure” should they choose an epidural.

Storage of propofol

Dr Sally Ure (deputy chair) and I met with the Ministry of Health/Medsafe to discuss safety concerns

about the storage of propofol that were raised at the CDs’ meeting. We discussed possible options,

including reclassifying propofol. Although it has significant potential for misuse/abuse, we would not

want propofol to be a controlled drug as it needs to be readily available and accessible for

emergency use. Medsafe agreed with our position. It was considered that an appropriate response

would be to develop a joint statement/advisory from the Health Quality and Safety Commission

(HQSC), the Ministry of Health and ANZCA to DHBs to implement stronger safety measures for

propofol storage. We have written to the Chair of the HQSC to progress this approach.

2018 research grants awarded

Three Auckland anaesthetists were awarded ANZCA Research Foundation Grants. Professor Alan

Merry’s project – A bundle for anaesthetists to reduce postoperative infection: the Anaesthetists Be

Clean (ABC) Study. Dr Daniel Chiang’s research award is for the influence of genomic and

neurophysiological factors on persistent pain after breast cancer surgery (PPBCS). Development of

pharmacokinetic models for antibiotics prophylaxis in paediatric cardiac surgery is Dr Brian

Anderson’s award project.

Great insight into research

The ANZCA Research workshop drew a range of national and international speakers to Auckland on

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March 23. Comments from the trainees included “great insight into how to go about starting a

career in research”. Researchers shared experiences, how to get published, and some of the ‘dos

and don’ts’ of different types of research. The session called the young and the restless about the

reality of juggling post graduate study at PhD, Masters and Diploma level was both entertaining and

revealing. The Research Workshop is held every two years. My thanks to Dr Tom Fernandez for

convening this successful event.

Health Quality & Safety Commission (HQSC) Workshop

Dr Geoff Laney attended a HQSC Workshop ‘Putting Prevention First’ in May on behalf of the NZNC

which was aimed at leadership and action on preventing healthcare associated infections.

Patient deterioration conference outcomes

Dr Kerry Gunn attended a two-day conference jointly hosted by the Health Quality & Safety

Commission and the Australian and New Zealand Intensive Care Society (ANZICS) in late November

looking at patient deterioration in New Zealand. It brought up a number of issues for the NZNC to

discuss around collaborative initiatives in the perioperative space which Dr Gunn will report back on

at the next meeting.

Supporting workforce and wellbeing

Health Workforce New Zealand workshop

In May, Senior Policy Advisor Virginia Mills and I attended a Health Workforce New Zealand

workshop on developing a flexible, sustainable health workforce. The workshop included a number

of international speakers from the United States, and presentations from Health Workforce New

Zealand on its supply and demand modelling. New Zealand staff met with HWNZ representatives

later in May to seek more information on forecasting for the anaesthesia workforce. HWNZ noted

that its projections were currently forecasting a shortage of anaesthetists, whereas last year HWNZ

had predicted the workforce was stable.

Bullying Prevention Training

The New Zealand staff have completed the Bullying Prevention Training module which is offered

within the ANZCA Learning Hub.

Staff training

New Zealand staff attended a Treaty of Waitangi workshop on Thursday and Friday April 26 and 27

as well as a full day team planning session on Monday May 21.

Dr Jennifer Woods Chair, New Zealand National Committee

EDUCATION OFFICER NEW ZEALAND REPORT – Dr Brent Waldron

EDUCATION OFFICER NEW ZEALAND REPORT – Dr Jennifer Taylor

Education Officer

Dr Brent Waldron stepped down from the role of Education Officer mid-way through 2018 and Dr

Jennifer Taylor has taken on the role.

Training Program

The 2018 updates to the training program and training portfolio system (TPS) were demonstrated to

Supervisors of Training (SOTs) at the October 15 Education Sub-Committee meeting. The updates

were welcomed and received favourable feedback. We are now several months post-

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implementation and informal feedback on the improvements from both SOTs and trainees continues

to be positive.

Education Sub-committee meetings

There were two education subcommittee meetings, both held face-to-face in 2018. The first meeting was held in Wellington on April 13, following an SOT education session. Education sessions included DPA question time with Dr Leona Wilson and a session on Entrustable Professional Activities, Competence Committees and other developments in medical education by Dr Jennifer Woods. The second meeting was held in Auckland on October 18. The educational component of this

meeting comprised an update from the ANZCA education unit on training program and TPS updates

as well as a short introduction to the updated Workplace Based Assessment (WBA) forms by Dr

Jennifer Taylor. There was also a very well received presentation on trainee welfare initiatives by Dr

Nicola Moore.

Supervisors of Training

Whangarei Hospital Dr Andrew Childs

North Shore Hospital Dr Clare Fisher Dr Marlin De Silva Dr Nav Sidhu (from November)

Auckland City Hospital, L4 Dr Sara Allen

Auckland City Hospital, L8 Dr Colin King Dr Ivan Bergman (to October) Dr Amber Chisholm (from May) Dr Nola Ng Dr Rosemary Duckett Dr Liam O’Hara (from May) Dr Tom Fernandez (from October) Dr Andrew Pitcher (from October)

Auckland City Hospital, L9 Dr Matthew Drake (to December) Dr Setareh Ghahreman (from August)

Starship Children's Health Dr Graham Knottenbelt

Counties Manukau Health Dr Jennifer Taylor Dr Damian Simpson (to January) Dr Alastair Ineson (to October) Dr Rachelle Lumsden Dr Joanna Sinclair Dr Johanna Karpik (from September)

Waikato Hospital Dr Alan Crowther Dr Nicola Whittle (to November) Dr Tim Starkie Dr Tania Bailey Dr Nina Civil Dr Anthony Aho (from September)

Rotorua Hospital Dr Shane McQuoid

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Tauranga Hospital Dr Sophie Van Oudenaaren

Taranaki Base Hospital Dr Charlie Brown Dr Joseph Taylor

Hawke’s Bay Regional Hospital Dr Tony Diprose (to December) Dr Allanah Scott Dr Joseph McKerras (from October)

Palmerston North Hospital Dr Vikram Singh

Hutt Hospital Dr Philip Eames Dr David Prior

Wellington Regional Hospital Dr Kirsten Cunningham Dr Nicola Moore Dr Rachel Dempsey Dr Matt Levine

Nelson Hospital Dr James Tuckett

Christchurch Hospital Dr Frances Cammack Dr James Dalby-Ball

Timaru Hospital Dr Thomas Gough

Dunedin Hospital Dr Jason Henwood Dr Sheila Barnett Dr Michael Hamilton (from August)

Southland Hospital Dr Roger Wandless Dr Richard More

Rotational supervisors

Northern Rotation Dr Sarah Nicolson Dr Kim Jamieson (to December) Dr Alastair Ineson (from October)

Midland Rotation Dr Rob Carpenter

Central Rotation Professor Sandy Garden

Southern Rotation Dr David Bain

Hospital Accreditation Dunedin Hospital Intensive Care Unit (ICU) remains unaccredited and trainees have been completing ICU placements at Christchurch Hospital. The central rotation hospitals are due for accreditation visits in March 2019. Trainees The New Zealand office facilitated the trainee placement teleconference on July 18 for trainees due to start training in New Zealand in the 2019 hospital employment year. There were anticipated shortages at registrar level (BT and AT level) in all rotations aside from the southern rotation at the start of the hospital year.

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Exams The first sitting of the Part One exams saw 23 candidates sit in various regions: Auckland (10), Hamilton (5), Wellington (2), Christchurch (4), and Dunedin (3). The second sitting had 39 candidates: Auckland (13), Hamilton (12), Wellington (9), Christchurch (4), and Dunedin (1). The final exam first sitting was held at the Manukau Super Clinic in South Auckland with 31 candidates. The second sitting was held at the Greenlane Clinical Centre in Auckland City with 18 candidates. The final exam coordinators were Dr Craig Birch and Dr Simeon Eaton for South Auckland and Dr Catherine Sayer for Auckland City. Seven examination remediation interviews were required during 2018. They have been reported to be useful for the trainees. Organising remediation interviews was in general straightforward this year, with most of the coordination occurring through the ANZCA office in Melbourne. Trying to conduct these via Skype did prove challenging at times and many of these ended up being undertaken by teleconference. TIONAL MEDICAL GRADUATEINTERNATIONAL MEDICAL GRADUATE (IMGs)

NZ TRAINEE COMMITTEE (NZTC) REPORT – Dr Leesa Morton & Dr Jonathan Panckhurst

2018 NZTC office bearers and members

Chair Dr Jonathan Panckhurst, Nelson

Deputy Chairs Dr Lisa Barneto, Wellington.

Dr Leesa Morton, Christchurch.

Members Dr Michael Webb, Auckland.

Dr Caroline Ariaens, Waikato (From June 2018)

Stepping down November 2018

Dr Cara Thomson, Auckland.

Dr Priya Shanmuganathan, Dunedin.

Dr Daniel Frei, Wellington.

Dr Wei-Lyn Chung, Wellington.

Dr Lucy Johnstone, Hamilton.

Dr Seung Joon Chin, Auckland.

Commencing November 2018 Dr Julius Dale-Gandar – Auckland Dr Sam Perrin – Auckland City Dr Elizabeth Robinson – Middlemore Dr Jason Goh – Middlemore/Whangarei Dr Stephen Manning – Christchurch Dr Mehreen Farrow – Christchurch

Ex-officio Dr Jennifer Woods, Chair, ANZCA NZNC.

Dr Brent Waldron, Education Officer NZ (Until June 2018).

Dr Jennifer Taylor, Education Officer NZ (From June 2018).

Dr Sally Ure, Deputy Education Officer NZ

Committee member changes

Mid-year Dr Caroline Araiens was co-opted to the committee to increase representation from the

Midlands rotation. At the end of 2018 Dr Thomson, Dr Shanmuganathan, Dr Frei, Dr Chung, Dr

Johnstone, Dr Chin and Dr Panckhurst (chair) finished their time with the committee. We

acknowledge and thank them for their hard work and commitment to the NZTC during their terms.

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Nominations for the vacant positions were sought. An election was not held as the number of

nominees matched the number of vacancies. We welcomed six new members to the committee in

November; Dr Farrow, Dr Perrin, Dr Manning, Dr Goh, Dr Dale-Gandar and Dr Robinson. Dr Barneto

and Dr Morton continue for second terms. Elections were held for the chair and deputy chair at our

November face-to-face meeting. Dr Leesa Morton was elected as chair and Dr Lisa Barneto as deputy

chair.

NZTC meetings

Three well attended NZTC teleconferences were held in 2018. The annual face-to-face meeting was

held at the end of November with good representation from the regions as well as incoming and

departing committee members. Dr Brent Waldron finished with the committee as the Education

Officer in June. We welcomed Dr Jennifer Taylor in his place. Dr John Burnett and Dr Nicole Vogts

acted as trainee representative from NZSA. They were present for each of our meetings and

reported on NZSA activities.

The workload for the committee continues to increase. In addition to our four meetings we held a

number of smaller teleconferences throughout the year to discuss specific issues such as the Part

Zero course and the Trainee Handbook. Aside from our annual responsibilities, the NZTC has been

involved in discussing and advocating on a number of other trainee issues including;

The delivery of the final examination results. Specifically trainee welfare issues and lack of

support for unsuccessful candidates. These concerns were raised with the chair of the final

examination and SOTs. As a result the process of delivering results has been altered.

Discrepancies between the way rotational and independent trainees are viewed across the

country. This was discussed and clarified at the ESC meeting. Efforts are being made to improve

consistency across the country.

Numerous issues with access to teaching across NZ. These were raised at the ESC meeting.

Opinion on the Anaesthetist vs Anaesthesiologist debate was sought from trainees.

Initial reports suggest the November 2018 TPS enhancements have been well received. Trainees

and SOTs both finding the dashboard system very useful.

Other meetings attended by the chair, deputy chair and other members:

ANZCA NZNC meetings

Australasian Trainee Committee Meetings

NZNC Education Sub-Committee meetings

Doctors-in-Training Council Forum

ANZCA Educators Subcommittee

ANZCA NZNC and NZSA Executive joint meeting

Trainee Survey Subcommittee

New Zealand Anaesthesia Education Committee

Activities

Trainee Survey

The fourth iteration of the trainee survey occurred in 2018. The survey was delivered by KPMG.

Questions were completely revised for this survey with the aim of providing better and more

consistent data. This resulted in a shorter, more functional survey, however, this has meant it will be

difficult to compare data to previous years. We were pleased to see a 49% response rate from NZ

trainees (from 38% in 2017). The full analytics are pending and the results will be disseminated in

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due course. On first review the results for NZ are positive. Trainees generally feel well supported and

are satisfied with the training program. Almost 60% of NZ trainees engage in an active mentoring

relationship. Similar themes came out from previous surveys including the fact that NZ trainees work

longer hours than their Australian counterparts and run closer to leave caps to accommodate study.

In NZ working hours are seen as less flexible and are less able to access part-time training. Only 5%

identify as Maori. There is a large discrepancy in the trainee ethnic make up to match the NZ

population Dissemination of this information to individual hospitals with departmental results is

being discussed at a higher level. In 2019 we will again participate in the trainee survey. We will

follow up on any significant discrepancies noted in the results of the 2018 trainee survey.

Handbook

The Anaesthesia Training in New Zealand Made Easy Handbook is a New Zealand specific guide for

trainees. This underwent significant revision and redevelopment led by Dr Leesa Morton in 2017. It

was released early 2018 after review by the DPA and communications. This iteration is easier to use

and utilises hyperlinks to ANZCA resources as well as providing summaries for each training hospital.

It is seen as a very valuable resource both by trainees and supervisors of training. The handbook has

been updated again to reflect changes that occurred in 2018. The latest edition will be available on

the ANZCA NZ website from December 2018. The committee will continue to revise the handbook

on an annual basis.

Social Media

At the end of 2017 we launched our ‘NZ anaesthesia trainee’ Facebook page. This was used as a

medium to convey trainee relevant information and encourage participation in events that are

important to ANZCA trainees in NZ. There were 156 members at the end of 2018. This represents

approximately 60% of ANZCA trainees in New Zealand. In 2019 we will look to expand our use of

social media and investigate using more platforms to improve communication with our trainees.

Anaesthesia Trainee Collective

The Anaesthesia Trainee Collective (ATC) initiative was piloted in Auckland in 2017. The ATC, funded

jointly by ANZCA and the NZSA, aims to establish forums where trainees can engage and socialise to

break down isolation and share problems in a non-hospital environment. This year these events

were rolled out across the country. Committee members from Auckland, Wellington, Christchurch

and Dunedin all held successful events. These have been viewed very positively across the regions.

In 2019 we will endeavor to run more events across the country with increased support from our

funding bodies.

Part Zero Course

This is the third year that ANZCA trainees have taken responsibility for running the Part Zero Course.

Again this year Dr Lisa Barneto and Alison McKessar reviewed the course based on feedback from

previous years and to reflect changes to the training scheme. The rotational course conveners have

also had input to ensure content is relevant and complete at a local level. Each rotation hosted a

Part Zero Course which was well attended by new trainees. Support for the Part Zero course across

the country is good. In 2019 the course will continue be improved and adjusted to reflect changes to

training and comments from the 2018 years courses.

Other activities

Dr Panckhurst and Dr Morton reviewed and contributed to a draft Welfare Working Group

Document.

Dr Thomson was part of the TPS enhancements and upgrade through her work with the ANZCA

educators subcommittee.

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Dr Frei attended the DiTC Forum. The Forum invites a trainee representative from each college

to discuss things that are going well and challenges being faced.

Dr Morton represented the NZTC at the first trainee luncheon at the NZ Anaesthesia ASM in

Auckland. This event received very positive feedback and is likely to continue for future ASM’s.

Dr Webb representatives the NZTC on the Gender Equity Working Group for Australia and NZ.

This group aims to promote the importance of equal gender representation within anaesthesia

and increase the number of women in leadership and management roles.

Plan for 2019

The committee has seen a large turnover of members for 2019. The running of the committee

will be structured slightly differently with each of our projects being managed by a leader and a

sub-committee. This will improve efficiency and workload distribution, ensure the committee

accumulates institutional knowledge and increase opportunities to develop projects. The NZTC

has good representation from the Northern and Southern rotations but will look to co-opt

members from the Midland and Central rotations to improve the spread of representation. The

committee members will make a dedicated effort to seek feedback and issues from trainees in

each hospital. This will including linking with trainees in hospitals where there are no committee

members to ensure they are heard. Committee members will continue to represent the NZTC

and ANZCA trainees on various committees. This will remain an important part of our external

relations. Internally, the NZTC will also continue to engage in our regular annual activities. We

will continue to seek feedback on the introduction of the new WBA forms and recent TPS

changes to ensure these are working for trainees. Similarly, we will monitor the changes made to

delivery of exam results. Issues related to trainee welfare remain topical and we aim to identify

specific areas of concern and address these appropriately. In particular, we will pick up on issues

identified in the trainee survey. We intend to support ANZCA’s efforts to improve cultural

competency and access to welfare resources.

NEW ZEALAND ANAESTHESIA EDUCATION COMMITTEE (NZAEC)

NZAEC membership

The NZAEC CME committee comprises: Dr Kerry Holmes (chair), Dr David Kibblewhite, Dr Kathryn

Hagen, Dr Jennifer Woods, Dr John Burnett, Dr Kerry Gunn, Dr Leesa Morton, Dr Nicole Perrin, Dr

Tom Fernandez and NZATS observer Kirstin Fraser. Julie Drury is the administration officer from

NZSA.

Completed activities

• Visiting Lectureships 2018

March (Tauranga Hospital), July (Timaru Hospital) and September (Whanganui Hospital).

Dr Ian Williams (A Personal Journey, My Experience with TIVA), Dr David Sidebotham (Opioid

Epidemic in the US, Lessons Learned) and Dr Lara Hopley (A Cure for Health IT Allergy) presented in

2018.

• NZ A ASM 2018, Auckland, November 8-10, 2018

This meeting was the second ASM jointly held by ANZCA and NZSA since 2013. The organising

committee from Middlemore Hospital Department of Anaesthesia were pleased with its success.

Future activities in 2019

The NZ A ASM 2019 will be held in Queenstown on August 21-24, 2019.

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The BWT Ritchie Scholarship has been awarded to Dr Felicity Judith Dominick of Counties Manukau Hospital and Dr Chris Badenhorst of Capital & Coast Hospital. Dr Dominic started a 12 month fellowship at Uppsala University Hospital in Sweden in September 2018. Dr Badenhorst has been appointed one of only two, highly competitive Paediatric Fellowships at the British Columbia Children’s Hospital in Vancouver, Canada commencing in July 2019. Interim reports will be due January 2020.

The Visiting Lectureships for 2019 have been awarded to Dr Matthew Drake, Auckland DHB for his presentation ‘What’s new in Obstetric Anaesthesia’ and Dr Jane Thomas, Waitemata DHB, for her presentation ‘Paediatric pain management’. Expressions of interest to host a visiting lecturer have been received however the venues not been decided upon.

FACULTY OF PAIN MEDICINE – Professor Ted Shipton

The Faculty of Pain Medicine’s NZNC has produced a comprehensive annual report to the Faculty

Board. FPM NZNC met face-to-face in June in Wellington with two teleconference meetings held in

February and October. Here are the highlights of 2018 in brief.

Meeting with the Minister

The burden of chronic pain on New Zealand was high on the agenda when the chair of FPM NZNC,

Professor Ted Shipton and committee member Dr Paul Vroegop along with the chair of the ANZCA

NZNC, Dr Jennifer Woods, met with the new Minister of Health, Dr David Clark in March. The

inequitable access to pain medicine services across the country, the lack of services, and the link

between chronic pain conditions and mental health was discussed.

FPM numbers in New Zealand

The committee continues to encourage specialist pain medicine physicians to register in the pain

medicine vocational scope of practice with the Medical Council of New Zealand. At the end of 2018

there were 35 practicing FPM fellows and eight FPM trainees in New Zealand.

Economic analysis shows ballooning cost of chronic pain

An FPM-commissioned report examining the cost of chronic pain to New Zealand is being shared

with stakeholders before wider release. The Sapere Research Group report estimates the total cost

of chronic pain to New Zealand to be up to $15 billion in 2016 and it says that could rise to more

than $24 billion by 2048.

Submissions

FPM NZNC submitted on a number of issues during the year including:

A detailed response to the Misuse of Drugs (Medicinal Cannabis) Amendment Bill detailing

the ANZCA position on medicinal cannabis for use in chronic non-cancer pain. The bill has

now been passed.

Feedback on proposed changes to age restrictions for codeine by Medsafe.

Pain medicine spotlighted for inquiry A comprehensive document from the FPM NZ National Committee was submitted to the government inquiry into mental health and addiction. This submission is part of an overall advocacy to draw attention to the burden of chronic pain on the country’s health system, and what impact chronic pain has on mental health and wellbeing. Health Workforce New Zealand (HWNZ) Development fund FPM NZNC NZ facilitated a proposal to a new development fund for workforce training. HWNZ called for registrations of interest (ROI) that support innovative and participatory models of care, with a focus on professional and service collaboration to address health equity and unmet need. HWNZ has

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faced delays in releasing the next steps in this process. Pain@Otago Research Theme This Pain Research Group started three years ago and is growing. A successful research seminar was held in Dunedin on Wednesday February 14, 2018. The involvement of AUT and the University of Auckland would be canvassed as well to form collaborations between researchers. A million dollar grant has been received from the Health Research Council to researchers at Pain@Otago for the project ‘Co-creating a digital self-help intervention for people with persistent pain’. FPM Long Case Examinations in New Zealand The Long Case Examinations were held at the outpatients department of the Greenlane Clinical Centre, Auckland District Health Board on April 20 and September 14. Dr Wei Chung Tong was the convenor facilitating these examinations. There were four candidates for both sittings. Better Pain Management (BPM) Since the appointment of the BPM coordinator in Melbourne, Alex Charles Ffrench there has been some movement on promoting the modules in New Zealand. FPM has been working on a number of strategic collaborations with Australian organisations where there is an alignment. Alex is keen to extend this work to the equivalent New Zealand organisations. The Royal College New Zealand College of General Practitioners is currently reviewing the BPM content. Possibility of a CME event in 2020 The possibility of holding a joint CME before the New Zealand Pain Society Annual Scientific Meeting in 2020 has been discussed between the Faculty of Pain Medicine, the New Zealand Pain Society and Pain@Otago

SAFETY AND QUALITY OFFICER’S REPORT – Dr Rob Fry

There have been two Anaesthesia Quality Assurance Network meetings this year. Attendee feedback

from both has been very positive. At the April meeting Dr Marco Meijer presented his Fit for surgery

Fit for life program using basic outcome data which was the result of previously unidentified

anaesthetic risks for patients undergoing joint replacement with a high BMI greater than 40. GPs

were found to have no idea of anaesthetic requirements so were given a surgery checklist with cut

offs for patients. Working with Whanganui Sport, there are now pathways to physiotherapists,

dieticians and fitness, instructors with each patient assigned a ‘navigator’ to ensure the continuity of

care. Dr Meijer has subsequently been awarded Accident Compensation Corporation funding for a

pilot. He is hoping to brand the program so it can be taken up by other hospitals incorporating all co-

design, multi-modal features that can be translated to other settings. Members have been

continuously updated on the progress of the first binational audit – the CADENZAA and Laparotomy

Audit. A letter to the New Zealand National Council was drafted regarding support for Qa/QI

activities with regards to time and financial support.

At the second meeting Dr Starkie presented a four-year “normothermia audit” and was encouraged

to publish his findings. The group decided that Dr Sally Roberts should be approached to ascertain

why hypothermia did not form part of the SSRI bundle. The failure of snap audits to produce long-

term changes or variations as shown in this large audit was discussed and the suggestion made that

perhaps ANZCA should be approached to consider this, as snap audits are presently encouraged. A

presentation from the Ministry of Health (MoH) about the Minimal Dataset was very interesting and

raised many questions for the presenters. The Ministry relies heavily on DHBs to input this, there is

no method for checking the data received and auditing is problematic. The small amount of data

submitted by hospitals regarding anaesthesia is again coded by coders and the definitions did not

appear useful to the group. Investigating who is coding this in every hospital and taking some time to

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assist them would mean more accurate data was sent to the MoH. The presenters encouraged

clinicians to get to know the coders and assist them in any fields. A health database, shareable

across the country, is the aim but there is a lack of funding. The Ministry is unable to direct or even

guide District Health Boards on any data collection or database choice under current law which

negatively impacts on patient care outside their region of residence.

Implementation of non-luer, non-interconnect able neuraxial connectors: A “clinical Roundtable” ,

hosted by ANZCA but chaired by the ACSQHC, was held in August 2018 and it was agreed that a

consistent and standardised approach to the introduction of small bore neuraxial connectors in

Australia (and New Zealand) is essential to reducing errors. The timeline is critical to the

implementation. Once the timing of product supply is established it is anticipated that clinical staff

will require approximately 12 months lead time to prepare and introduce devices with new

connectors. There has been an instance in a Perth maternity hospital indicating that representatives

from a device company talking about making the change but this needs to be well coordinated

nationally, with everyone involved. We should be aware of this potential problem in New Zealand.

Currently there is no approval or registration of medical devices in New Zealand. The current

regulation of medical devices is limited to post-market controls.

A draft of the new Therapeutics Products Bill (which will replace the Medicines Act 1981) has been

released for public consultation. This may address some of these anomalies. The regulation of

medical devices under the new regulatory system will align with international best practice and

standards. It is reasonable that any joint policy, especially if adopted or agreed to by the TGA, will

roll out in some form to New Zealand.

SPECIALIST INTERNATIONAL MEDICAL GRADUATE (SIMGs)

The New Zealand Panel for Vocational Registration assesses specialist international medical

graduates through interview, on behalf of the Medical Council of New Zealand (MCNZ) as part of the

council’s registration processes. The panel also assesses SIMGs as part of the ANZCA process for

FANZCA.

Dr Chris Harrison held the position of chair of the panel, with the following fellows serving on the

panel during the year: Dr Vaughan Laurenson, Dr Leona Wilson, Dr Andrew Love and Dr Sally Ure.

In the reporting period, eleven interviews were held at the request of MCNZ and one re-interview

was undertaken. Five SIMGs from the UK were assessed as substantially comparable and three

SIMGS from South Africa were assessed as partially comparable. Three SIMGS (from Egypt, Iran/

Malaysia, and India) were assessed as not comparable.

Ten preliminary assessments of SIMGS were completed by the Directors of Professional Affairs

There were fourteen successful workplace-based assessments for FANZCA purposes which were held

at Invercargill (two), Christchurch, Palmerston North, Rotorua (two), Tauranga, Whanganui, New

Plymouth, Nelson, Whangarei, Auckland, Greymouth and Blenheim. Assessors were Dr Leona

Wilson, Dr Indu Kapoor, Dr Vanessa Beavis, Dr Chris Harrison, Dr Mohua Jain, Dr Michal Kluger, Dr

Nigel Robertson, Dr Geoff Laney and Dr Andrew Love.

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ACKNOWLEDGEMENTS

New Zealand-based fellows who died in 2018 were:

Dr Anna Illingsworth in Nelson on July 5 aged 48

Dr William Thomas Raeburn (Bill) Ward in Invercargill July 23 aged 80

Professor Geoff Cutfield in Dunedin on August 6 aged 69

Dr Darcy Price died in Auckland on September 29 aged 52

Dr Yatin Young died in Auckland late September aged 55