1. General physicians and the ADF
CMDR W HEDDLE
RANR
RFD MD FRACP FCSANZ FAMA MAICD
Chair, General Physician Consultative Group ADF
Consultant Cardiologist to RAN

2. PHYSICIANS IN ADF - OUTLINE
• BACKGROUND INFORMATION ON ROLE AND
TRAINING OF GENERAL PHYSICIAN
• CURRENT AND POTENTIAL ROLES IN ADF
• POTENTIAL TRAINING PATHWAYS

3. ROLE IN ADF
• A BRIEF DISCUSSION OF TRAINING WILL HELP
CLARIFY THE POTENTIAL ROLES IN ADF
• NOTE PAST CROSSOVER WITH INTENSIVE
CARE MEDICINE

4. GENERAL PHYSICIANS AND ADF
• WHAT IS A GENERAL / CONSULTANT
PHYSICIAN / PAEDIATRICIAN (CPP)
– QUALIFIED AS PHYSICIAN BY ROYAL
AUSTRALASIAN COLLEGE OF PHYSICIANS (FRACP)
– REGISTERED WITH MEDICARE FOR ONLY SEEING
REEFERRED PATIENTS FOR CONSULTATION

5. TRAINING OF CPP
• ADULT OR PAEDIATRIC PROGRAMME
• BASIC PHYSICIAN TRAINING OF MINIMUM 3
YEARS VOCATIONAL TRAINING (CAN START
PGY 2)
• ASSESSED FOR BOTH CLINICAL SKILLS AND
PROFESSIONAL BEHAVIOURS
• SUCCESSFULLY PASS “PART 1” EXAMINATION

6. SCHEMA OF RACP TRAINING

7. TRAINING OF CPP (2)
• ADVANCED TRAINING (CAN BE GENERAL
MEDICINE OR SUBSPECIALTY TRAINING e.g.
CARDIOLOGY) OVER MINMUM OF 3 YEARS,
PREDOMINANTLY DONE ON “MASTER-
APPRENTICE” MODEL
• MANY DO FURTHER TRAINING AFTER THIS AS
FELLOWS EITHER IN CLINICAL MEDICINE OR
RESEARCH ( THIS OFTEN LEADS TO SUB-SUB
SPECIALISATION e.g. Myself as “Cardiac
Electrophysiologist”)

8. TRAINING OF CPP
• RIGOROUS CONTINUING MEDICAL
EDUCATION REQUIRED
• DUE TO VARIED TRAINING PATHWAYS, LARGE
VARIATION IN EXPERTISE, BUT COMMON
UNDERLYING BASIC TRAINING AS CPP WITH
CONCENTRATION ON DIAGNOSTIC AND
MANAGEMENT OF COMPLEX MEDICAL
CONDITIONS; SOME ARE HIGHLY TRAINED IN
INTERVENTIONAL TECHNIQUES

9. CPP
• TRAINED IN BOTH ACUTE / EMERGENCY CARE
AND CHRONIC CARE, WITH PROPORTIONS
DIFFERING AS TO SUBSPECIALTY

10. CONFUSION AS TO CAPABILITY AND
ROLES OF CPPs IN ADF

11. INTERNIST VS INTENSIVIST
• UNITED NATIONS IN 1980s DESCRIBED THE
HIGHER LEVEL ADVANCED MILITARY FACILITY
AS HAVING SURGEON, ANAESTHETIST, AND
INTERNIST
• WHEN AUSTRALIA DEPLOYED MEDICAL
FORCES TO RWANDA, THE TEAM COMPRISED
SURGEON, ANESTHETIST, AND INTENSIVIST

12. SUPPORT ROLES
• CONSULTATION
– INDIVIDUAL SERVING MEMBER WITH SERIOUS OR
COMPLEX MEDICAL PROBLEMS
– ON HEALTH POLICY e.g. INFECTIOUS DISEASE

13. OPERATIONAL ROLE
• IN LEVEL 3 HEALTH FACILITY
• IN ‘SUBSTITUTE” ROLE IN LEVEL 2E
– E.g. As “INTENSIVIST” or as “GDMO”
• IN “SUBSTITUTE” ROLE e.g. IN MAJOR FLEET
UNITS OF RAN AS GDMO
• IN HUMANITARIAN AID OPERATIONS WHEN
USEFUL OR NECESSARY FOR FACILITY TO HAVE
MORE THAN GDMO

14. OPERATIONAL ROLES
• VERY USEFUL IN TREATMENT OF NON-BATTLE
INJURY AND IN POST-OPERATIVE CARE OF
BATTLE INJURY (NB MANY HOSPITALS DO NOT
PERMIT SURGERY UNLESS GENERAL
PHYSICIANS AVAILABLE TO HELP WITH POST-
OPERATIVE COMPLICATIONS)
• ENHANCED SKILLS IN FEBRILE ILLNESS
INCLUDING INFECTIOUS DISEASE, AND IN
PAEDIATRICS

15. TRAINING
• PRINCIPLE
– CPPs WELL TRAINED IN DIAGNOSTIC AND
THERAPEUTIC SKILLS
– MAY FACE AREAS WITH WHICH THEY ARE NOT
CURRENTLY PRACTISING
– A SHORT MODULARISED TRAINING SCHEME OF 5-
7 DAYS TO UPDATE IN SUCH AREAS

16. EXAMPLE
• EMST ( 2-3 DAYS)
• “BASIC “ COURSE (2-3 DAYS)
• INFECTIOUS DISEASE, ESPECIALLY TROPICAL ID
(ONE DAY)
• PAEDIATRICS - PRINCIPLES AND COMMON
DISEASES (ONE DAY)
• MEDICAL EMERGENCIES NOT ALREADY
COVERED

17. EXAMPLE

18. SUMMARY
• TRAINING AND POTENTIAL ROLES AND
TRAINING OF PHYSICIANS
• FOR DISCUSSION AND HOPEFULLY ACTION