Canberra Hospital bosses were warned trainee specialists were forced to work unsupervised due to short staffing more than a year before a disastrous radiology training accreditation report was handed down.
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The Royal Australian and New Zealand College of Radiologists interim accreditation report from March said Canberra Hospital's radiology department was at risk of losing its teaching accreditation with its rating dropping from an A rating to a D.
The report found a number of training and safety issues with immediate action across "multiple significant issues" needed to retain accreditation.
The negative environment of the department and lack of clinical control over rostering, recruitment and significant decisions were among the biggest issues facing radiology.
It found there were not always enough consultants rostered on to supervise and train registrars, which did not ensure safe practice for patients and trainee supervision.
Internal documents seen by The Canberra Times show hospital bosses knew registrars had serious concerns about their training at least a year before the report was created, but failed to address them.
A group of registrars met with chief medical officer Dr Jeffrey Fletcher in February last year and said they were being left unsupervised and denied training opportunities.
"Registrars raised concern that frequently consultants are not rostered on," minutes from the meeting said.
"At these times, registrars do not have a consultant to escalate clinical issues to and they are required to work independently, especially in CT and MRI outpatients.
"This may be the case weekly."
In the same meeting, Dr Fletcher was told registrars were concerned they were not meeting their training requirements.
Concerns included that they did not undergo any breast screening training, despite being required to do an eight week breast screening rotation.
The preliminary accreditation report found management's leave practices - reportedly aimed at reducing the accrued leave of consultants - were of great risk to the department and patients and "should be immediately addressed".
"The department should review its leave practices, particularly in relation to taking of extended back leave, and should ensure that the department is staffed such that it is able to accommodate unplanned leave and maintain safe staffing levels appropriate to a teaching department," the auditors said.
At ACT estimates hearings in June, Dr Fletcher was questioned about the report but did not comment on the staff shortages or culture issues that were highlighted by assessors.
He instead spoke of the hospital's lack of a "network" as a reason for the department's poor performance in the audit.
"For certain specialties we need to create certain networks," Dr Fletcher said.
"For radiology, we have a lot of private practice partnerships out in country settings. We are looking at creating a network position with Orange, which is still on the cards."
The auditors will re-evaluate Canberra Hospital within three months to determine its future accreditation status.
ACT Health was asked why registrars' concerns about a lack of consultants to supervise were not addressed in the year between the meeting and the report.
This questioned was not answered.
When asked why registrars continued to miss out on training more than a year after raising their concerns, a spokeswoman said there was a "breakdown in communication" between the two previous directors of training.
The spokeswoman said ACT Health had replaced the two directors of training and was advertising for two new consultants.
She said the chief medical officer would be issuing a charter for all doctors, senior managers and staff regarding behavioural expectations within the department.
"The issues that have emerged from the radiology department are complex and senior managers have been working through appropriate channels over a long period of time with staff to address any concerns that are raised, and that includes holding staff meetings," the spokeswoman said.
"The [accreditation report] has been welcomed by ACT Health as it has articulated a number of issues and provided recommendations for which the majority have already been actioned.
"ACT Health is confident that next year we will return to Level A training accreditation in the radiology department and the department has already met a number of those RANZCR recommendations.
"It’s important to note that no patients have been put at risk as the issues related directly to teaching and training."
