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Guidance for Trainers

  1. If you have reached this page because you have concerns about a trainee, you should start using the NACT Guidelines now.

  2. If you need additional help, please speak to your Programme Director, Director of Medical Education and/or Head of School.

  3. If you would like to make a referral to the Deanery, please complete our Referral Form. 

The Severn Deanery 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:

The guidance laid out here has been developed with reference to the National Clinical Assessment Service (NCAS), the National Association of Clinical Tutors (NACT) and the General Medical Council (GMC).

 

 

Overview of the research: 

Many doctors require additional support at some stage during their training for a variety of different reasons, for example biological (health), psychological (behaviour) and social (work or home environment). Often the reasons aren’t independent of each other, but rather linked in a complex interplay.

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 have a performance concern. As a result, you may find that you do not often have to support a trainee and therefore using this site as your information and resource base is crucial for when you do encounter this potentially rare situation.

The below model is used by the National Clinical Assessment Service (NCAS) to help categorise the types of different issues that can arise:

NCAS Triangle

 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:

NCAS Statistics

Sample = 1472 cases handled by NCAS Dec 2007 – Mar 2009.

 

 

Processes - responsibilities and who to contact 

The Deanery 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 Deanery. 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.

Deanery Support Levels

Level 1:

Represents minor issues/concerns with the trainee’s training progression which can initially be managed at a local level using the NACT guidelines to document information during one-to-one meetings with the trainee. Examples of Level 1 cases include:

  • Trainee having to take time off due to ill health
  • Trainee is unhappy with recent feedback they have received
  • Trainee has difficult circumstances at home and needs to take irregular leave
  • Trainee’s portfolio is low on the required WPBAs
  • Trainee is unsure if this is the right career for them
 
Level 2:

Represents moderate issues/concerns with the trainee’s training progression and requires further input from the appropriate Programme Directors, Directors of Medical Education and/or Heads of School. The NACT guidelines should still be used here. Examples of Level 2 cases include:

  • Trainee has been off for a considerable period of time due to ill health which will impact on the competencies they can achieve in certain time frames – it is likely their training will need to be extended.
  • Trainee remains unhappy with feedback and feels their supervisor is being unfair.
  • Trainee takes unplanned leave despite being advised to give suitable notice. This is causing a problem for service provision.
  • Trainee’s portfolio continues to be low on the required WPBAs despite a clear plan for achieving these being put forward at your last meeting with them.
 
Level 3:

Represents major issues/concerns with the trainee’s training progression and requires formal referral and management by the Deanery as well as continuing to involve persons previously informed. Examples of Level 3 cases include:

  • Trainee remains off ill and refuses to see Occupational Health – their training is at serious risk of not being completed and their training has had to be extended at the recent ARCP panel
  • Despite several meetings, trainee and supervisor are having conflicts, with the supervisor claiming the trainee lacks insight and the trainee claiming the supervisor is bullying
  • Trainee does not agree with a plan for early leave notification as their personal circumstances cannot work with this and continue to go off without early notification.
  • Trainee continues to fail to meet the required standard of WPBAs and mentions that they feel overwhelmed by the amount of work they are expected to do. The Educational Supervisor has set out a plan with the TPD which has not worked.

Cases of gross misconduct are also included in Level 3.

Deanery referral:

If you feel you are dealing with a complex Level 3 issue, we recommend you contact the Deanery for advice and support. Referral of a trainee for Deanery support can be made by completing in the Referral Form and emailing it to Tailte Breffni. Alternatively, you can contact Tailte Breffni on 01454 252 653 for a general discussion. Please be aware that joint meetings between the Trainee Support Team here at the Deanery, 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.
Always remember:
  • 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.
  • If you feel there is any risk to patients, the trainee or others immediate action and review is required with input from HR, the Deanery and possibly the GMC.
  • Do not attempt medical diagnosis of your trainee; leave that to the experts – for example Occupational Health, Clinical Psychologists and Educational Psychologists.

 

 

Guide to holding a performance meeting and giving difficult feedback: 

Performance meeting
  1. Introduce meeting and purpose
  2. Clarify confidentiality and time
  3. Identify and agree the problem with the individual (including feedback and discussion)
  4. Establish reasons for shortfall or difficulties
  5. Discuss and agree required action (the action plan)
  6. Discuss resourcing of the action plan
  7. Agree how to monitor and feedback progress
  8. Document the session (open, agreed)

 

Difficult feedback:

Before seeing the trainee:

  1. Consider the reasons why some trainees may be unreceptive to feedback
  2. Gather as much information as you can
  3. Consider techniques and processes you have used in the past to help learners gain insight
  4. Structure the feedback session carefully ensuring that you build in time for listening

 Procedural suggestions and tips for giving difficult feedback:

  1. Begin constructively – show empathy and positive regard for the trainee and state the purpose of the meeting
  2. Review details of the specific incident/s
  3. Have facts and evidence available
    • Use concrete examples that illustrate the behaviour that needs changing: e.g. “do you remember when you were in consultation with Ms S last Tuesday and you said that….
    • Use multi source/360° feedback to heighten awareness: e.g. “Nurse/Doctor XYZ has also commented that you…..”
  4. Challenge existing beliefs: e.g. “Your actions indicate that you think X’s opinion is not of any value – is this what you think?”
  5. Invite the learner to look at the situation from different perspectives: e.g. “If you were Ms M how do you think you would have felt? What do you think Nurse Z was thinking as she watched you?”
  6. Ask the learner to accept some responsibility for their actions: e.g. “Would you accept that when you were shouting at Mr B that he was affected by this - shown by the way he burst into tears and begged you to help him”
  7. Name the resistance if there is any – get agreement to what is getting in the way and Deal actively with any negative behaviour demonstrated during your session with the trainee:
  8. Ask the learner to suggest their own solutions: e.g. “How do you think you might handle things differently next time? OR “Can you think of another way of handling that situation?”
  9. Keep going – until there are signs that the trainee has understood and wants to change
  10. Negotiate a solution and identify a way forward
  11. Set focused goals (SMART – specific, measurable, achievable, relevant and with a time limit)

Arrange to meet again and make a record of everything – in agreement with the trainee if possible

 

 

Guide to documenting information: 

1. Record good and poor performance

  • Enough information to guide an outsider

2. Make prompt file notes

  • Stick to the facts
  • Quote verbatim
  • Include only work information – unless mitigating and agreed
  • Record meeting details: length, venue, date and participants
  • Be balanced
  • Include trainee’s comments

3. Be open

  • Records accessible and relevant, in-date and concise

4. Fair references

5. Consider locums too

For more information, visit the toolkit section of the NCAS website.