The Royal Children's Hospital in Melbourne has been stripped of its accreditation to train doctors in providing urgent medical care to children, following a dispute over its training program.
Accreditation for paediatric emergency medicine is granted by the Australasian College for Emergency Medicine (ACEM), which dictates hospitals must meet strict requirements in order to be recognised as a training site.
In a statement to the ABC, the ACEM cited concerns over the "inappropriate structure of the RCH education programs to cater for all registrars" and "shortcomings in relation to learning opportunities" as being behind the decision to withdraw the hospital's accreditation.
But the Royal Children's Hospital said it had "differing views" to the ACEM over accommodating the different skill levels of trainees.
"Our assessment of trainees when they come to the RCH is that many require additional paediatric emergency medicine knowledge and skills," a hospital spokesperson said.
"ACEM does not share this view.
"We have agreed to work with ACEM on implementing a model where both organisations' expectations and standards can be met, with patient safety and the quality of care the absolute priority."
Just four hospitals remain as training sites
The Royal Children's Hospital is one of the country's largest and busiest paediatric hospitals.
Its loss of training accreditation comes as Victoria's healthcare system is put under increasing pressure with a growing elective surgery waitlist and fatal triple-zero call delays.
On April 6, the ACEM notified the Royal Children's Hospital that its accreditation as a training site for doctors enrolled in the fellowship training program (FACEM) would be withdrawn, effective immediately, after a two-year review process.
The hospital has since submitted a new application to receive provisional accreditation, which is currently being reviewed by the ACEM.
There are now just four hospitals in Victoria that are accredited to train doctors in paediatric emergency medicine: the Northern Hospital, Sunshine Hospital, Monash Medical Centre and the Austin Hospital.
In order to complete emergency medicine training and be recognised as a specialist emergency physician as part of the ACEM's program, trainees must undertake training at both non-major referral and major referral training sites.
With the Royal Children's Hospital's loss of accreditation, Monash Medical Centre is now the state's only major referral training site.
But both the ACEM and Royal Children's Hospital insist the current cohort of trainee doctors will not be disadvantaged.
"Trainees who have signed a contract to work at RCH in 2022, prior to this withdrawal of accreditation, will have their time honoured and counted towards their FACEM training, should they wish to complete their training at RCH," an ACEM representative said.
"ACEM emphasises the decision to withdraw accreditation did not relate to concerns over the quality of patient care that has been delivered to patients and families."
The Royal Children's Hospital said the withdrawal of its training accreditation would have no impact on patient care.
AMA concerned about knock-on effect on health system
The Australian Medical Association (AMA) said it was "disappointing" for both the ACEM and the Royal Children's Hospital that the decision was made to withdraw the hospital's accreditation.
Hashim Abdeen, chair of the federal AMA Council of Doctors in Training, said it was important the ACEM retain high standards to ensure quality of care, but also said the Royal Children's Hospital's loss of training accreditation could exacerbate existing pressures on Victoria's healthcare system.
"Producing the next generation of specialists is really key. We know we have a doctor shortage across the country, particularly in regional and remote areas," Dr Abdeen said.
"If we don't have the workforce to be able to serve the Australian population, then we're going to have more and more problems."
"We're going to have ambulance ramping, people dying in waiting rooms waiting to see a doctor, and that shouldn't be happening in a country like Australia."
Dr Abdeen said it was vital additional support and protected teaching time be given to trainers and supervisors to ensure they do not "burn out".
"This is a big issue. And hospitals, health services and state health departments need to realise that you need to resource these areas properly to ensure that the quality of training and education continues across Australia," he said.
Health Minister Martin Foley said he would leave the debate on clinical standards to clinicians.
"The Royal Children's Hospital is not just Australia's leading paediatric hospital, it is the world's leading paediatric hospital," he said.
"I'm confident the Australasian College for Emergency Medicine and the Royal Children's will work out this professional issue between professions."
