It aims to set in place a Career Structure & Path for MMO's, whilst promoting real gains in productivity, efficiency, flexibility and co-operation in the workplace. It is also designed to facilitate restructuring and training initiatives.

Each Multi-Skilled Medical Officer is required to have a minimum of 5 years postgraduate, broad ranging, public hospital experience +/- experience in non-public hospital Medicine.

A: MULTI-SKILLING at core of Agreement.

- MMO's strive to attain Multi-Skilling
- Mx to provide training opportunitiesto progress along Career Path.

B: TRAINING:

- Agreement that Training is important part of Multi-Skilling.
- Managment provides opportunities for training to increase "Level".
- paid usual hourly rate during training

1. Base Rates "rolled up" to include 4 wks "paid" + 4 wks unpaid leave (effectively upto 8 wks unpaid leave)

2. Long Service Leave & Superannuation paid separately

Subject to allowances provided as a percentage loading on hourly base rates:

LEVEL 1

Minimum of 5 years postgraduate, broad ranging, public hospital experience +/- experience in non-public hospital Medicine. Willing to undergo training

- Functions unsupervised.
- Consults for the Dx & Mx some presentations.
- Greater than 12 mths A & E experience at SRMO or Reg level.
OR greater than 6 mths A & E experience plus other relevant experience at SRMO or Reg
- Dx comprehensive range of A & E presentations
- May require referral for Dx of some

Resuscitation skills

- basic CPR
- bag / mask ventilation
- peripheral venous access
- ECG interpretation / recognition of arrhythmias
- emergency cardioversion (unconscious patient)
- use of first line anti-arrhythmics
- establish the uncomplicated airway and manually ventilate
- large bore peripheral venous cannula
- intraosseus cannula
- simple use of fluid and blood products
- intercostal catheter

Procedural Skills

- Competence in the following skills, this implies not just technical proficiency but, where applicable a knowledge of indications, contraindications plus complications and their management.  #

- Uncomplicated intubation (unconscious pt/adult and paediatric)
- intercostal catheter
- manual ventilation (BVM/ETT/jet insufflation)
- needle cricothyrotomy  *
- direct laryngoscopy
- venesection (adult & paediatric)
- peripheral venous access (adult & paediatric)
- intraosseus cannula  *
- ABG
- cardioversion (unconscious pt/arrest situation)
- BCLS
- guedels airway
- use of CPAP
- lumbar puncture
- urethral catheterisation
- proctoscopy
- nasogastric tube insertion
- nasal packing
- r/o ENT foreign body
- r/o superficial ocular foreign body
- vaginal speculum skills
- application of splints
- digital nerve blocks
- uncomplicated suturing (lacerations superficial to fascia)

# Indicates core element.

* Indicates procedures that, owing to limited opportunities, individuals may have only limited experience in. They must however demonstrate a thorough understanding of the procedure.

General

Able to initiate management for the majority of A & E presentations though assistance or referral may be required for the management of more complex presentations.

- Functions independently
- Supervise junior staff.
- greater than 24 mths A & E exp at SRMO or Reg level.
OR greater than 12 mths A & E exp plus exp at SRMO or Reg Level

Resuscitation skills

- all items specified at levels 1 & 2
- maintenance of the established uncomplicated airway
- ability to recognise the complicated airway and to possess an appropriate complicated airway drill
- use of mechanical ventilation
- complicated use of fluid and blood products
- cardioversion of the conscious pt
- use of second line anti-arrhythmics
- use of trans-cutaneous pacemaker

Procedural Skills

- Competence in the following skills. This implies not just technical proficiency but where applicable a knowledge of indications, contraindications plus complications and their management

- all skills specified at level 2 plus   #
- recognition of the complicated airway  #
- rapid sequence induction  #
- failed intubation drill (including use of introduces. Laryngeal mask)  #
- use of mechanical ventilation   #
- central venous access   #
- pacemakers (transcutaneous and/or temporary tranvenous)  #
- cardioversion in the conscious patient  #
- pleural aspiration
- biers block
- femoral nerve block
- neurolept anaesthesia
- use of tourniquets/mast suit
- basic fracture and dislocation management
- epistaxis balloon
- cricothyrotomy*
- peripheral venous cutdown*
- pericardiocentesis*
- suprapubic catheterisation*
- urethrogram*
- peritoneal aspiration and lavage*
- ocular tonometry*
- arterial line*
- sengstaken-blackmore tube*
- escharotomy*
- complex suturing (involving structures deep to fascia)*

General

- Able to provide initial management for all and ongoing Emergency Dept management for the majority of A & E presentations.   #

# Indicates core element. An individual must demonstrate competency in 100% of core elements and a significant number of non-core elements to qualify for this grade.

* Indicates procedures that, owing to limited opportunities, individuals may have only limited experience in. They must however demonstrate a thorough understanding of the procedure.

A. "Credentialling Committee"

Meet annually or PRN
Develop Guidelines and Appoint and Credential MMO's Meet Annually or PRN

2 Medical Representatives of the IAHS
2 MMO's
1 Independent Medical Consultant agreed by the parties.

(no MMO to assess own credentials)

B. "Joint Consultative Committee"

Forum for open discussion. Meet Quarterly or PRN

Equal No.s of MMO's and Hosp / Area Hosp Service Officers.

(MMO's paid to attend Committee Meetings at normal hourly rate.)

No representative from the MMOs working in the Illawarra area was able to attend the conference. Apparently they are receiving payments as per MMOs, but have yet to establish guidelines for the "Credentialling Committee".

(Noelene Salmon also spoke at the Industrial Convention. She had been the AMA representative for approx 50 doctors in the "Illawarra Casual Medical Officers Association" and negotiating on their behalf with the Health Department. She subsequently described the setting in which this agreement occurred. )