A training college is still concerned about "severe issues" facing trainee supervision in Canberra Hospital's cardiology department, despite improvements in other areas.
Trainees also have to travel to Sydney for a portion of their training as there are not enough specialists to supervise in electrophysiology, documents released to The Canberra Times have shown.
The Royal Australasian College of Physicians said there was an "urgent need" to appoint further consultants especially in electrophysiology, following an assessment of the hospital's department in July.
Canberra Health Services has said electrophysiology staffing had increased over the year and work was under way to increase this further. More cardiologists have already been employed and are expected to start next year.
Cardiac electrophysiologists are cardiologists that specialise in treating abnormal heartbeats or arrhythmia.
The July assessment, released under freedom of information, was a follow-up from a visit last year where training accreditation for the department was under threat. This followed the suspension of four senior cardiologists over allegations of bullying and misconduct following an investigation into the department last year.
The college appeared to endorse the suspensions in its December 2022 review but said their suspension still had a negative effect on the department.
"As representatives of the advance training committee in cardiology, we applauded the Canberra Hospital in their initiative in taking a hard-line on 'bullying' and poor behaviour in the work place. This initiative, in the long term, will have beneficial effects on all aspects of work life, importantly training," the December review said.
"Nonetheless, during this time, we have noticed these events have impacted on advanced training in cardiology at the Canberra Hospital."
The suspensions were criticised by a group of private cardiologists in a letter earlier this year, who warned of an "unacceptable and dangerous deterioration" in cardiac care at Canberra Hospital.
More cardiologists have left Canberra Health Services this year, with the organisation confirming four have resigned. This also includes cardiologists working at North Canberra Hospital. It took the organisation more than two weeks to answer the question, which also included information about more staff being employed.
"This year Canberra Hospital has recruited two senior specialists for its Cardiology Department and has another two due to commence in early 2024, with the recruitment process ongoing," a spokeswoman said.
One of those suspended was working at the former Calvary Public Bruce Hospital and was still involved in training following their suspension. This has since stopped but Canberra Health Services would not confirm whether the cardiologist was still working at the hospital following its compulsory acquisition
During the 2022 review the department did not meet two of the five training standards; this was around supervision and the "profile of work". In the more recent review, the department met the standard around the "profile of work" but the supervision standard needed improvement.
The July review said there was an "urgent need" to employ more staff in the electrophysiology space. Trainees have had to go to Westmead in Sydney to do a portion of their electrophysiology training and while the college said this was suitable for the time being it was not a permanent solution.
"In the absence of a full quota of EP staff, the hospital has put in place some useful, if incomplete, EP training opportunities," the review said.
A Canberra Health Services spokesman said this arrangement was expected to continue for about a year.
"This is a short-term solution until such times as the electrophysiology service is operating at previous levels," he said.
"Specialised electrophysiology staffing within the cardiology department at Canberra Hospital has increased throughout 2023, with recruitment for another senior specialist position underway as a priority for the leadership team within the department."
The 2022 review showed trainees had a lot of exposure to inpatient work but this came at the expense of procedural work.
However, in the follow-up review the college said this had completely shifted to the point where there were now concerns trainees were doing too much procedural work and not enough hands-on experience.
"Feedback overall on this change was positive however there are internal concerns (that we share) that the 'pendulum has swung too far the other way'," the July review said.
Canberra Health Services said the department was hoping to better manage this balance.
"This will be managed carefully though, as excess ward work was the main complaint from a previous review," the spokesman said.
The December review also showed trainees had significant concerns about the culture in the cardiac catheter lab. This lab was also identified as a problem area in the investigation into cardiology.
"Trainees described less than satisfactory cath lab exposure and experience. The lab was described as a 'toxic' and unwelcoming environment, with the nursing staff identified as the chief concern," the review said.
"[Advanced trainees] indicated that the removal of certain cardiologists from the department had no positive impact on the cath lab culture for them and seemed to indicated that from their point of view the former consultants were less of an issue than some remaining non-medical staff."
The situation in the cardiac catheter lab had improved in the July review.
Canberra Health Services said a senior cardiologist had been appointed and the director of training and was the direct supervisor for all trainees.
"The cardiology department has undergone a lot of change in recent years as Canberra Health Services has been working to improve both the culture and operating model for cardiology services," the spokesman said.
"The leadership team within the department are committed to improving the learning environment for our junior doctors as part of these changes and are working closely with the Royal Australian College of Physicians to act on recommendations and ensure the department continues to meet its accreditation requirements."
