Conference Dispatch – ASA / Hobart, Australia / Sept. 2012

Dr Jennifer Racine is a 4th year resident at Western University in London, Ontario.  She represented the CAS at the Australian Society of Anaesthetist’s Annual Meeting this past September in Hobart and below is her report from attending the meeting.

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In September, I was fortunate to escape the start of a cold Canadian autumn for a sunny Australian spring by attending the 2012 Australian Society of Anaesthetists’ (ASA) Annual Scientific Congress with the support of the CAS. It being my first time in Australia, I took the opportunity to get acquainted with the famous city of Sydney. There, I visited the Opera House and ate great fish and chips on Bondi beach. 

After Sydney, I flew to Melbourne. Its many coffee shops and tiny laneways full of quaint stores added to the city’s charm. This beautiful cosmopolitan city reminded me of Montreal and is definitely somewhere I would like to return. 

Arriving in Hobart, where the conference took place, I discovered the rich history of Tasmania. It is named after the Dutch explorer, Abel Tasman, the first European to sight the island in 1642. The first British colony established in 1803 consisted mainly of convicts and military guards, who were tasked with developing agriculture and other industries. There was a strong Aboriginal resistance to this colonization and troops were deployed across much of Tasmania to drive the Aborigines into captivity on nearby islands. As is the case in Canada, government reparation to the relationship is ongoing.

Tasmania has one of the largest marsupial populations in Australia and over a dozen species of birds are native to the state. Undoubtedly the most famous animal in Tasmania is the Tasmanian devil. Unfortunately it is under threat of extinction, suffering from Devil Facial Tumour Disease (DFTD), an aggressive non-viral transmissible parasitic cancer likely originating in Schwann cells. It affects a high-proportion of the population with 100% mortality. 

Anesthesiologists might be interested to know that Tasmania is the largest opium poppy processing state producing about 50% of the world’s legally concentrated poppy straw for morphine and related opiates.  Other major players are Turkey with 23%, France 21% and Spain 4%. Most of Tasmania’s exports are opiates including codeine, and thebaine. The poppy industry is a major financial contributor to Tasmania’s economy. 

Now let’s get to the conference. Let me just say WOW! 

The theme for the highly successful 2012 event was “Pushing the Boundaries” and the goal was to challenge anesthesiologists in multiple disciplines. Highlights included workshops, small group discussions, enlightening international plenary session speakers, riveting debate and lively follow-up discussions. The event offered an enriched learning experience in a warm and collegial atmosphere. 

To go along with the theme, the introductory lecture given by Professor Donald Chalmers focused on the ethics of human genome and embryo stem cell research. He addressed the future of personalized medicine and its challenges. It seems that there is a growing focus on this subject. Sooner than we think, we might be scanning someone’s DNA-coded armband pre-surgery and tailoring this individual for a specialized anesthetic. Is this too far-fetched or is this the future? 

I also enjoyed international speaker Professor Kelly McQueen’s talk. She addressed the challenges of global health and its relationship to anesthesia, discussing the global burden of surgical disease and the growing public health concerns. Her captivating lecture and pictures from her various trips made me realize how lucky we are. We provide care using “top of the line” anesthetic drugs and equipment, often taking it for granted. In some third world countries, if anesthesia is available, it is often delivered with inadequate monitoring, without oxygen and a provider with limited education and training. Dr McQueen indicated that the anesthesia-related death rate can be as high as 1/140! I really value her work and hope to be able to provide a contribution at some point in my career. 

Professor Simon Mitchell’s lecture also proved to be very fascinating. He is an anesthesiologist and diving physician. He gave a talk about an Australian cave diver who in 2005 suffered fatal respiratory failure at extreme depths. Video from a camera mounted on the diver’s helmet recorded the circumstances. Professor Mitchell went into detail on the respiratory physiology of cave diving and the possibility of respiratory failure. 

Analysis of the video revealed a progressive dyspnea that ultimately ended with characteristic “coughing exhalations” and respiratory arrest. This captivating talk inspired me to purchase the book Diving Into Darkness by Phillip Finch (2005), an incredible but sad story about human endurance. 

Having a special interest in pursuing a fellowship in obstetrical anesthesia, this conference was the perfect opportunity to attend lectures on the latest trends, such as the informative session by Dr Pierre Diemunsch from the University of Strasbourg, France, on recent updates in obstetric anesthesia. I met Professor Michael Paech, the Chair of Obstetric Anaesthesia in Perth, Australia, who presented the growing challenges of obesity and the parturient. He and I had the opportunity to discuss the various topics as well as available fellowship opportunities, something I am strongly considering.

The GASACT (Group of ASA Clinical Trainees) Committee organized the Sunday with sessions focused specifically for Residents. Dr Neville Gibbs discussed the top 10 papers in anaesthesia and intensive care in 2011. The discussion centered on the Australian and New Zealand College of Anaesthetists’ (ANZCA) curriculum in 2013. 

The Residents in Australia are in the process of changing their curriculum, and a series of change management activities is currently underway in Australia and New Zealand to prepare for the implementation. These include workplace-based assessment workshops and development of online resources. Based on recommendations, the College adopted our famous CanMEDS© roles in their curriculum framework as well as the display of the CanMED logo. This I found interesting since it was actually developed in Canada by the Royal College of Physicians and Surgeons of Canada (Royal College) in 1990. 

This is an innovative concept that describes the core knowledge, skills and abilities of specialist physicians known as the CanMEDS Physician Competency Framework, formally adopted by the Royal College in 1996.

Under the revised Australian program, trainees will complete the training over four periods: introductory training (26 weeks), basic training (78 weeks), advanced training (104 weeks) and provisional fellowship training (52 weeks). Progression through each of the four training periods is dependent upon the trainee successfully completing the requirements for each period. During the first six months of training, trainees must successfully complete an initial assessment of anesthetic competence before being eligible to move to basic training. 

Once progression to basic training has been approved, trainees can complete any of the 12 specialized study units within the curriculum. Is the introduction of an interim examination worth considering in our Canadian curriculum? It is something to think about. It could help alleviate the stress of the one and only final exam. 

Other discussions focused on incorporating a trainee logbook. Canadian trainees started this a couple of years ago. The Australian concept consists of an online database where Residents can input their procedures and accomplishments, and cases seen throughout their whole Residency program. This tool helps the program assess whether or not trainees have enough exposure to different specialties and if they have done enough procedures in order to be considered experienced and skillful at the end of their training. A lot of the discussions centered on the concerns of how to keep the information confidential and accurate. Some Australian residents are worried that it might not help or be useful. After sharing how our logbook works in Canada with the Residents and staff, the feedback was more positive. 

A Resident lunch was organized, which I found very enjoyable. Residents and staff were interspersed at tables for a nice sit-down lunch and discussed a range of topics from the organization of training programs across Australia to more talk on fellowship opportunities, while enjoying Australia’s finest wines. It was also a great opportunity for the Residents to network with staff anesthetists from all over the country and to ask questions. 

A cocktail night at the MONA (Museum of Old and New Art) was another social highlight of the conference. Lonely Planet ranked Hobart as number seven out of the top ten cities to visit in 2013, citing MONA as a major tourist attraction. During the evening, I met Dr Richard Chisholm, CAS Past President, and socialized with Canadian colleagues from Calgary amid tons of great food, wine and “out of the ordinary” exhibits. This superb conference was capped off by the gala, one of the finest evenings I have ever attended. Tuxedos, ball gowns, a wine sommelier and a full jazz band – Australians definitely know how to do it right! I was extremely lucky to be seated with past ASA presidents and we had great conversation and many laughs. 

I would like to thank CAS and ASA for this amazing opportunity. It was certainly a highlight of my Residency. 

I established many professional contacts and am looking forward to strengthening them during the course of my career. This conference foretold of an amazing future!!