The trainee in difficulty

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The trainee in difficulty

• Basic issues and key principles

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Alison Cooper

• Consultant Anaesthetist
• Director, PGME 2002 to date

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Incidence

• Approx 5 of trainees will have problems
• 1-2 of trainees will have significant persistent
  problems

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Aims

• What to do if you are the clinical supervisor
• What to do if you are the Educational supervisor
• Where to get help
• Awareness of other considerations

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General Principles

• Prevention is better than cure and early
  intervention is essential
• When a problem is identified, do not ignore it,
  it will not go away.
• Ensure that all the basic structures are in
  place, that is effective educational supervision

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Educational Supervision

• Induction
• Named Educational supervisor
• Regular meetings with appraisal
• Regular assessment
• Feedback
• Be aware of the Gold Guide 2007 (LDA)

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Poor performance

• Clinical capability
• Personal and behavioural
• Health
• Environmental issues

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Outcome

• Remediation

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Documentation

• All relevant discussions and interventions must
  be documented
• Communicated to trainee
• Communicated to other key individuals
• Followed up by named accountable individual
• You must not deal with this alone!

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Diagnostic framework
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Clinical supervisor

• Observing or assessing poor performance
• Describe what you have seen
• Describe why you think it is deficient
• If you are able, give constructive feedback to
  trainee
• Written report to Educational supervisor

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Educational supervisor

• Notified of an incident
• Collate as much evidence as possible
• Include the individual concerned
• Do not rush into a judgement
• Be objective
• Document in detail
• Arrange/obtain further assessments

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Answer the question

• Is there any concern about patient safety
• If there is, how can patients be protected?
• Seek advice
• Be aware of Trust/Deanery guidelines for
  accountability framework

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Interventions based on diagnosis

• Clinical capability
• Personality and behavioural issues
• Health issues
• Environmental

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Clinical Performance and Capability

• Knowledge, technical skills, non-technical and
  professional skills
• Focussed training with close supervision
• Feedback
• Use of other resources

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Personality and behavioural issues

• Close clinical supervision, mentoring, feedback
• Use of confidential counselling
• Occupational psychologists
• Feedback

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Health

• Physical and mental
• Occupational Health
• G.P.
• Counselling and support
• Consider flexible training

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Environmental issues

• Organisational issues
• Lack of resources
• Poor staffing/ shift patterns
• Lack of senior support, both clinical and
  educational
• Team dysfunction

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Outcome

• Plan of action
• Specific responsibilities
• Review progress regularly
• Amend plan if necessary
• Document
• Communicate

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Who can help

• Clinical Tutor/Director PGME
• Programme Director
• College tutor
• Deanery staff
• Associate Postgraduate Dean
• Dean
• Human Resources