MMC: Specialty profiles

Medical Oncology

2010-02-20T20:32:32Z

Medical oncology is a subspecialty of internal medicine encompassing the investigation, diagnosis and management of people with cancer. Medical oncology is holistic in nature, rewarding and varied but can be emotionally demanding given the life threatening nature of many cancers. Medical oncologists are key members of a multidisciplinary team who care for cancer patients. It is therefore important that they have good communication skills and work well in a team. The three main forms of cancer treatments are surgery, radiation therapy and medications (such as chemotherapy or hormonal therapy). Medical oncologists are responsible for the medications used to treat cancer. They are often the patient’s primary physician and co-ordinate the involvement of other specialists. They work closely with radiation oncologists, surgeons, palliative care physicians, specialist oncology nurses, pharmacists, dieticians, physiotherapists and social workers. Treatments available for many cancers have improved dramatically over the past 30 years and new treatments are always being researched. For those patients in whom curative treatment has been unsuccessful, palliation of symptoms and good end of life care are regarded as integral parts of medical oncology.

Flexibility in Training

2010-02-18T09:07:24Z

Training should normally be continuous – one year of core training must be continuous; the second core year may be spent discontinuously in two periods of 6 months each. Part-time training will be considered on an individual basis and an application in writing must be submitted. Advanced training must include at least two years of training interrupted only by normal holiday or short-term special (e.g. study or conference) leave. Trainees must notify the Joint Faculty in the event of extended parental or sick leave and seek advice as to the effect on training.

Cost of Training

2010-02-18T09:06:43Z

Current costs of training Trainee once only registration fee: $750 Basic annual training fee: $1,000 Advanced annual training fee: $500 Training assessment fee: $300 Primary examination fee: $2,300 (per exam) Fellowship examination fee and OTS clinical performance assessment fee: $2,300 (per exam) Annual administration fee: $300

Length of Training

2010-02-18T09:05:05Z

Training takes six years in total to complete comprising three years of basic training and three years of advanced training.

Application process

2010-02-18T09:04:41Z

Trainees may enter the basic training program any time after completion of the first postgraduate year. Employment is to be secured independently at a hospital accredited for basic training and the trainee must then register with the faculty. If registering for advanced training, trainees must be registered within 3 months of commencing in an approved post in order to have advanced training accredited.

Training Program

2010-02-18T09:03:58Z

Training, education and standards for intensive care medicine are handled by the Joint Faculty of Intensive Care Medicine, which is a joint faculty of the Australian and New Zealand College of Anaesthetists and the Royal Australasian College of Physicians. Education and training materials, including a careers guide and trainee support kit, are available to trainees. Conjoint training programs are available with anaesthesia, emergency medicine, and physician training, and additional training can be undertaken in paediatric intensive care. A comprehensive overview of the training program is available on the college website. A diploma of six years full time or equivalent is offered, comprising three years basic and three years advanced training. Successful completion of the training program requires passing both primary and fellowship examinations; satisfactory in-training assessment; maintaining a skills procedure logbook; completing a formal project; and completing a medical ADAPT workshop (recommend completion during basic training).

Lifestyle and Practice Options

2010-02-18T09:02:34Z

Intensive care medicine is predominantly practiced in ICUs located in public and private hospitals in capital cities, with the majority of intensivists in acute care public hospitals; there are limited intensive care facilities available in regional and country towns. Intensivists generally work long hours and stress levels are reported as high to very high. In a recent AMWAC survey, about 40% of ICU specialists felt they were overworked, however a large majority of them were satisfied with their work overall. The majority undertake full time employment with work arranged into shifts; there are some on call requirements. Remuneration is according State Staff awards, however there is possibility for greater flexibility and income with career progression and in the private sector. Increasing demand for ICU beds (aging population, increased community expectation), intensive care standards requiring ICUs to be managed by intensivists and safe work practices limiting working hours have all lead to an increased demand for intensivists in both city and regional hospitals.

Medical indemnity

2010-02-18T09:02:31Z

Medico-legal issues, as with all aspects with medical practice, are becoming increasingly significant. Use our risk category tool to assess this specialty.

Intellectual content

2010-02-17T18:07:05Z

Intensive care medicine is an intellectually demanding specialty requiring in-depth knowledge of physiology and pharmacology, particularly cardiac and pulmonary physiology as well as familiarity with the wide variety of life support devices. There are no separate medical and surgical ICUs in Australia and as more complex patients are presenting, intensivists are increasingly required to have a broad, sound knowledge of internal medicine and anaesthetic procedural skills in addition to surgery and emergency medicine. The ICU is generally the most expensive, high technology and resource intensive area in the hospital therefore intensivists need to keep up-to-date with new technologies and medical treatments.

The doctor-patient relationship

2010-02-17T18:07:02Z

Relationships between intensive care specialists and their patients can be short or long-term, depending on the condition of the patient at admission to the ICU but does not usually extend beyond a few days following the treatment period in the ICU. Many patients are too ill to be able to communicate in any meaningful way and as a result the intensivists’ relationship with the patient’s family if often as important as, if not more important than, their relationship with the patient. Multiple trauma in a motor vehicle accident, for example, can mean weeks in a sedated, unresponsive state, and intensivists will often have frequent meetings with family members. Highly developed interpersonal skills and patience are therefore required.

The workplace

2010-02-17T18:05:27Z

Most intensive care units (ICUs) in Australia are closed units, where intensivists are the primary care physicians who take responsibility for orders and treatment decisions as long as a patient is in the ICU. However, there is usually good collaboration between intensivists and other medical specialists. Instensivists have a particularly close working relationship with intensive care nurses who are highly skilled and play a significant role in patient management. Patients in the ICU are usually referred to intensivists by a primary team elsewhere in the hospital. Outside the ICU, intensivists provide assistance in the care of rapidly deteriorating patients. This care is intended to avoid further deterioration and subsequent transfer to the ICU or to optimise the patient’s management while awaiting transfer to the ICU. An intensivists’ expertise in caring for critically ill patients is highly valued and they may be found attending medical emergencies in theatre recovery rooms, emergency departments or general wards. Before admitting a patient to the ICU, the intensivist has to assess on a case-by-case basis whether intensive treatment will better the patients’ condition, giving them a reasonable possibility of surviving with such care. Since at the time of admission to the ICU the patient may be critically ill and the outcome of this intervention difficult to predict, good end-of-life care for both the patient and family is an integral part of intensive care medicine.

Intensive Care

2010-02-17T18:03:37Z

The practice of intensive care medicine involves skills many disciplines, including anaesthetics, surgery, internal medicine and emergency medicine, and focuses on the support of critically ill patients who require or are at high risk if requiring one or life support systems.. Formal Intensive care medicine training was first established in 2 separate schemes in the College of Physicians (RACP) and in the College of Anaesthetists (ANZCA) in the 1970s. Although Australia and New Zealand were the first countries in the world to establish such training schemes, this is a relatively young discipline compared with many long established specialities. In 2002, these 2 schemes were merged into a single training program, supervised by the Joint Faculty of Intensive Care Medicine, which reported to its 2 parent colleges. Initially this is program could be entered by first part examination of either College (RACP, ANZCA) but now the College of Emergency Medicine (ACEM) first part examination will also enable access to this training scheme. More recently (2008), the Joint Faculty members have voted in favor of forming an independent College of Intensive Care but this has yet to occur. An intensive care specialist, or intensivist, needs to have excellent communication, interpersonal, clinical and patient management skills, an aptitude to cope with stress, and an understanding of medical ethics. This is not a specialty for the faint hearted but is a great career choice for those who seek professional challenges, are team players and good communicators. Intensive care medicine is a highly procedural specialty and requires expertise in cardiopulmonary resuscitation, organ and airway management, mechanical ventilation and renal replacement therapy, to list just a few.

Australian Faculty of Occupational & Environmental Medicine

2010-01-04T17:19:04Z

Andrew Messner Executive Officer, Australian Faculty of Occupational & Environmental Medicine

Flexibility in Training

2009-09-29T02:57:17Z

Training is normally undertaken full time, however part time and interrupted training is possible. Part time training must be at a minimum of 50% full time training.

Cost of Training

2009-09-29T02:51:15Z

Current costs of training (AUD$ incl GST) Enrolment or re-enrolment (valid for 6 years) $253 Annual trainee registration fee $2,200 Annual trainee registration fee – trainees currently completing dental and medical degrees or completing intern year $121 Application for recognition of prior learning $1,100 Approval of recognition of prior learning Training fee less application fee Primary Examination $1,640 RACS Early Management of Severe Trauma (EMST) $2,090 RACS Care of the Critically Ill Surgical Patient (CCrISP) $1,914 RACS Australian and New Zealand Surgical Skills Education and Training (ASSET) $2,629 Assessment (AUD$ incl GST) Basic surgical training examination $1,640 Application for assessment of eligibility for the final examination $420 Final examination $2,987 See the Guide to Education and Training on the college website for training costs for overseas applicants.