The role of AFCs: How national standards benefit Fellows and patients

April 27, 2021 | Author: Royal College Staff

Since 1986, Ken LeDez, MB, ChB, FRCPC, has been working to elevate physicians’ understanding about Hyperbaric Medicine – a discipline that has applications across multiple specialties. Throughout his journey, one principle has kept Dr. LeDez focused: the importance of creating strong national standards in the name of better patient care.

Dr. LeDez is a key player behind the establishment of Hyperbaric Medicine as a Royal College-recognized Area of Focused Competence (AFC) discipline. The Canadian Undersea and Hyperbaric Medical Association, an organization Dr. LeDez helped set up and of which he was the first president and still has a leadership role in, was among the first to apply to have AFC recognized when the Royal College established the diploma program in 2011.

“The motivation for establishing an AFC comes down to a societal benefit,” said Dr. LeDez. “Since the beginning, my colleagues and I have been working to establish national standards for training and education so Hyperbaric Medicine can be pursued across Canada safely, consistently and ethically.”

Among his many other qualifications, Dr. LeDez is associate professor of Anesthesiology at Memorial University of Newfoundland, medical director of the Hyperbaric Medicine Service in St. John’s and of the Centre for Offshore and Remote Medicine (MEDICOR), and chair of the Royal College’s AFC Committee in Hyperbaric Medicine. He also provides medical coverage of offshore saturation diving.

AFCs complement specialty certification

AFCs are disciplines that build on a certified physician’s existing specialty, subspecialty or family medicine training. Every approved AFC addresses a legitimate societal and patient population need that was previously unmet by the system of primary and subspecialty disciplines in Canada.

“For Fellows, the AFC route provides a unique avenue for your career,” explains Jason R. Frank, MD, FRCPC, MA (Ed.) who is the director of Specialty Education, Strategy and Standards at the Royal College. “While this is advantageous for scholarship opportunities for certified specialists, it also ensures a national standard for these distinct areas, which has a direct correlation with patient safety.”

Each application for a new AFC discipline is examined by the Royal College’s Committee on Specialties and undergoes a two-part national consultation process. Physicians who complete all the requirements of an AFC are eligible for an added credential, recognized with a diploma and use of the designation Diplomate of the Royal College of Physicians and Surgeons of Canada, or DRCPSC. A physician can acquire the AFC credential through an accredited training program or by applying via a practice eligibility route.

Hyperbaric Medicine has wide applicability

Hyperbaric Medicine has applicability across many specialties, including Anesthesiology, Internal Medicine, Emergency Medicine and General Practice. Dr. LeDez would like to see as many hyperbaric medicine practitioners as possible access the Hyperbaric Medicine AFC credential for use in their everyday practice. Hyperbaric Medicine comprises two streams (Clinical Hyperbaric Medicine and Diving Medicine) and some physicians may practice in both.

Hyperbaric Medicine originated from diving medicine. Deep sea diving comes with a risk of decompression illnesses, which are treated with hyperbaric chambers.  Diving Medicine physicians are required to assess fitness of occupational divers to dive and provide medical coverage of diving operations.

A second stream of applications for Clinical Hyperbaric Medicine is much broader. Increasing research has demonstrated the effectiveness of hyperbaric oxygen for a number of conditions that are approved by public health insurance plans. By providing oxygen at two to three atmospheres’ pressure, clinical hyperbaric chambers work by boosting blood and tissue oxygen far above normal. Hyperbaric chambers can therefore be used to treat conditions where vascular supply is poor and where improved tissue oxygen delivery is beneficial. Examples include radiation necrosis, non-healing wounds, serious infections such as gas gangrene, failing flaps and grafts. Hyperbaric oxygen also results in complex anti-inflammatory and biochemical changes, including enhanced activity of cells involved in healing and fighting infection, and is toxic to some bacteria.

“Even though the hyperbaric oxygen is only intermittent it is enough to promote new blood vessels, healing and bacterial killing,” said Dr. LeDez. “This means we can use Hyperbaric Medicine to treat many conditions where the blood supply has been damaged, and that covers a lot of territory.”

Guarding against false claims

As sometimes occurs in emerging fields of medicine, hyperbaric treatments have also been widely – and falsely – touted as a panacea for a range of conditions, including HIV/AIDS, cancer, autism and heart disease. Private clinics continue to spring up across the country, giving false hope to people willing to pay large sums for unproven treatments.

“The danger of these false claims is that some patients will opt for hyperbaric treatments and forgo proven therapies,” said Dr. LeDez. “While they’re pursuing unproven treatments, their conditions can worsen.”

Dr. LeDez said the Hyperbaric Medicine credential and the strong national standards that have resulted are helping a wider range of physicians understand the broad and legitimate uses of the discipline. In addition, he said, national standards are helping to elevate training programs, which, in turn, are nurturing a strong faculty for Hyperbaric Medicine. All this leads to better patient safety and care.

“What it comes down to is that we are now seeing better standards of care,” he said. “When we applied to the Royal College for recognition, we made a strong case about the role Hyperbaric Medicine would play in both treating the public for appropriate conditions and protecting the public from false claims and harm.”


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