If you have reached this page because you have concerns about a trainee, you should refer to our Trainee Support Guide for information on how to support a trainee.
If you need additional help, please speak to your Programme Director, Director of Medical Education and/or Head of School.
If you would like to make a referral to Severn Postgraduate Medical Education, please complete our Referral Form.
Severn Postgraduate Medical Education is committed to providing a comprehensive resource base for trainers in order that you feel equipped with the right information to support trainee doctors experiencing issues which are disrupting their training progression.
This section of the website provides you with the following:
- Overview of the research in this area
- Processes - responsibilities and who to contact
- Resources offered by Severn Postgraduate Medical Education
It is not uncommon for doctors to experience personal or professional difficulties at some piont in their career which can impact directly or indirectly upon work or training and for which one may require additional support. Such difficulties can include personal health, confidence, exam failure, relationship with colleagues, family cancerns and career uncertainty to name a few.
Such issues often present themselves when a trainee is not progressing satisfactorily in their training programme, either in their technical clinical ability or in their professional interaction with others – for example with patients or colleagues. International literature has illustrated that approximately 6% of doctors experience performance concern at some point in their career and it is speculated that this figure is actually much higher in reality.
The model below is used by the National Clinical Assessment Service (NCAS) to help categorise the types of different issues that can arise:
Analysis of the data NCAS have collected shows that performance issues are not mutually exclusive in origin, but often are the result of overlapping variables:
Sample = 1472 cases handled by NCAS Dec 2007 – Mar 2009.
Deanery Postgraduate Medical Education (PGME) has adopted a levels-approach when supporting a trainee, starting off at the level of the trainee’s supervisor and finishing at the level of the PGME. The framework recognises that most doctors at some stage in their career will encounter personal and/or professional issues that may affect training progression. Early identification, support and management by the appropriate people can improve the chances of resolving such issues.
The levels are not independent of each other and communication is important.
This level represents trainees with minor concerns or dilemmas, presenting a potentially low risk to patients or others, for which a formative developmental approach is appropriate. These trainees will be primarily supported by their Educational or Clinical Supervisor with support from the appropriate School and / or the local Director of Medical Education. You should use this guide to assess and document what support and actions you have put in place for the trainee at this level (see Appendix 1). The local Director of Medical Education should always be kept informed of any local issues.
Next come the trainees with issues that, if left undetected or unresolved could pose a moderate risk to the individual trainee, the patients or the organisation, but are not yet sufficiently serious to warrant disciplinary action. At this stage you should seek advice and guidance from your Programme Director, Associate Postgraduate Dean (GP), Head of School or Director of Medical Education. You can seek advice from the Severn Postgraduate Medical Education Trainee Support Team at any stage.
This level represents trainees with serious concerns and/or repetitious performance issues for which specialist input and resources is appropriate. Issues at this level may also represent a high level of risk to patients and others and therefore requires a skilled approach. Referring your trainee to the Severn Postgraduate Medical Education (PGME) Trainee Support Team at this level is appropriate so that further support and resources can be put in place. It is important that you remain closely involved through liaison with PGME while this support is being put in place and good communication should be maintained at every stage.
**please note, patient safety issues MUST be reported to the DME as soon as they become apparent so that they can inform the MD. Trust HR and PGME should also be immediately informed**
Severn Postgraduate Medical Education Referral
If you feel you are dealing with a complex Level 3 issue, we recommend you contact Severn Postgraduate Medical Education (PGME) for advice and support. Referral of a trainee for PGME support can be made by completing in the Referral Form and emailing it to Tailte Breffni. Alternatively, you can contact Tailte Breffni for a general discussion. Please be aware that joint meetings between the Trainee Support Team here at the PGME, the trainee and the trainee’s Educational Supervisor or Training Programme Director are often required.
When to involve Human Resources and/or Occupational Health
- If the issue impacts upon the trainee’s employment contract, for example, periods of sick leave or absence from work, then HR should be informed of the situation
- If there is concern regarding the impact of the trainee’s health on the work environment, or of the impact of the work environment on the trainee’s health, then Occupational Health should be consulted. This often leads to a referral.
- Managing issues at a local level very much depends on how confident you feel in dealing with certain issues and how much experience you have of this. Always ask if you are not sure.
- Do not attempt medical diagnosis of your trainee; leave that to the experts – for example Occupational Health, Clinical Psychologists and Educational Psychologists.
- Further information can be found in our Trainee Support Policy