The Southern District Health Board (DHB) has been put on notice by the Medical Council of New Zealand (MCNZ) because it is failing to properly train new doctors when they start working at its hospitals.
The DHB, which covers Otago and Southland, has lost its full accreditation to train doctors and has only been given interim approval.
From 30 November, the annual intake of new doctors, fresh from medical school, will begin in hospitals nationwide.
But the Medical Council's report on the Southern DHB's training uncovered 19 failings including no formal orientation for new doctors, no manager being responsible for supervision and no requirement for doctors to do handovers about patients.
Resident Doctors' Association national president Dr Deborah Powell said the Southern DHB had only just scraped through its assessment by the Medical Council's team.
"SDHB passed its last MCNZ accreditation three years ago, so these failures have come about in a reasonably short timeframe and under the incumbent management," Dr Powell said.
"It also comes on top of Southern DHB's ICU [intensive care unit] department losing training accreditation for 2015/2016, and the New Zealand Orthopaedic Association withdrawing advanced orthopaedic trainees from Dunedin Hospital effective December 2015."
Dr Powell had been told horror stories about new doctors not being taught the hospital's systems, she said.
"I was talking to someone yesterday, who has recently started work in Dunedin and their cell phone went off and they were needed urgently in the department and they didn't know where it was.
"It's not just the physical environment - each of our hospitals has different computers, different ways of recording patient notes, different ways of accessing results," she said.
Training doctors properly in hospitals from the start was essential, because it was where they learned the safe clinical practices they took with them to every hospital they worked in and used with every patient they saw, she said.
Lack of evidence around training - Medical Council
Accreditations are handed out to DHBs by the Medical Council after its team visits hospitals and assesses whether training is adequate.
Medical Council chairman Andrew Connolly said it had found management took very little interest in DHBs' training responsibilities.
"What we found, and what worried us considerably, was the lack [of] definitive evidence that the education and training of our interns was seen as a strategic priority in the DHB," he said.
If the DHB did not improve it could be stripped of its training status and lose those junior staff as a result but, in this case, it seemed unlikely, Mr Connolly said.
Southern DHB Acting Chief Medical Officer Mr Richard Bunton refused to be interviewed but provided this statement:
"At the time of the accreditation, the responsibility for the prevocational education and training had not been formally delegated due to the departure of [the] Chief Medical Officer.
"This has now been addressed and executive accountability for meeting the prevocational education and training standards lies with myself as Acting Chief Medical Officer."
The Southern DHB has until 16 May 2016 to make the improvements.