Trainees in Difficulty

Being in a Specialty Post: Trainees in Difficulty

KSS web pages on trainees in difficulty (TiD) can be found here.There is also a link to a downloadable guide on this page. The guide advises on the management of doctors in KSS Deanery-funded training posts, brings together resources and details of relevant national and local initiatives, covers both trainees requiring support or in difficulty and those with additional needs  and contains sources of support and guidance.

It is essential to refer to the TiD guide but a summary of its principal elements is provided below:

TiD cases can be prompted by:

a)     Mismatches between trainee and trainer,

excessive workload, harassment, bullying, wrong level of expertise expected of the junior doctor, supervision not congruent with level of expertise expected;

b)    Personal issues

health, emotional difficulties (partner/spouse relationship, critical family illness), wrong career path;

c)     Craft development

speciality specific skills and knowledge, problems with procedures, manual dexterity, depth of understanding and clinical decision making;

d)    Generic professional development

rapport with patients, staff and families, respect for people holding different views, cultural acclimatisation, and acting effectively within the team, motivation, maturity, a lack of insight, time management and basic organisation skills;

e)    Professional behaviours

integrity and probity, reliability, substance abuse.

Minor concerns can be dealt with on a day-to-day informal basis by a trainee doctor’s Educational Supervisor. The Supervisor should:

·        identify the problem

·        take into account all available data

·        if not sure, consult with the college tutor or clinical tutor for a ‘second opinion’ on the seriousness of the problem since major concerns will have a different route

·        be prepared to act on recurrent small concerns, clinical incidents and rumours.

·        Triangulate information with others

Minor concerns may be dealt with verbally, but investigations into more serious concerns should always be documented in writing.  The Educational Supervisor should keep a record of all formal discussions, including those that occur outside of planned meetings. A copy of all documentation must be given to the trainee and at all stages s/he must be kept fully informed about any concerns and the actions to be followed, ideally recorded in the portfolio, together with a record of the conversation kept by the trainer. All documentation must comply with the requirements of the Data Protection and Freedom of Information Acts.

The DME must be fully involved as should KSS Deanery where the problems seem serious or complex. The National Patient Safety Agency (www.npsa.nhs.uk) has published an incident decision tree. This is an interactive web based tool which can be used by doctors and managers to decide how to analyse and manage a single clinical incident. Other serious concerns about trainees (for example, issues of probity) will always need to be investigated by the employing organisation.

For StRsif the problem is not easily resolved, the case must be discussed further. All such cases should be referred to the KSS Trainee in Difficulty Committee for information. For Core trainees or trainees managed by KSS Deanery, the referral must also go to the HoS. For higher speciality trainees managed by London Deanery, the referral must also go to the STC Chair. The HoS will discuss and plan further management based discussion at the Trainee in Difficulty Committee meeting. For London managed trainees the STC Chair will take advice from the London Deanery, and inform the KSS Deanery Trainee in Difficulty Committee. The identification and effective management of repeated bullying can be complex and challenging. Both KSS and London Deaneries have current guidelines. All KSS Deanery LEPs have current bullying or harassment policies, as does NHS Employers. Ill health may be unrecognised by trainer and trainee alike. Trainees may be reluctant to acknowledge illness as they may have to take time off work and their training may be interrupted as a consequence. Trainees who are ill should be managed by their employer’s sickness absence policies

The transfer of information when a trainee moves to a new NHS LEP environment is important. The trainee should be informed of the information transferred but patient safety must override personal confidentiality. Very sensitive information is best transferred by a Dean or HoS to the new LEP DME.