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The Trainee Experiencing Difficulty

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SOURCES OF HELP – FOR TRAINEES

  • Please contact one or more of your Clinical Supervisor, Trainer, Educational Supervisor and TPD.   You will find at least one (if not all) of them understanding and sympathetic.
  • Please make an appointment with your own GP.  If you’re not registered with one, now is the time to do it.  
  • You can ask to see the doctor at the local Occupational Health Department  (usually based at the local hospital you’ve been working in).
  • Take Time Project - confidential counselling based at Leeds University for trainees in psychological issues.   www.leeds.ac.uk/studentcounselling   Tel: 0113 343 4642   Email: taketime@leeds.ac.uk
  • Doctors’ Support Line: 0844 395 3010       www.dsn.org.uk       info@dsn.org.uk     DSN provides ongoing confidential advice and support to doctors with mental health problems. All calls are dealt with by doctors.
  • GP Safe House: www.gpsafehouse-avon.co.uk   GP Safe House (GPSH) is a virtual safe house providing a refuge and support for practitioners experiencing professional challenges.
  • Use the BMA Counselling Service.  Click here for the BMA Counselling Service.  They also have Industrial Relations Officers available to provide free advice about contractual and employment issues.
  • Do not forget about your defence organisation as a source of advice too.
  • Specific Support Organisations: Click here for a full list of support organisations – including addiction, gambling, bereavement, financial, housing, mental health, stress, disabilities and lots of others.

SOURCES OF HELP – FOR EDUCATORS

  • Educators – Do not act in haste.  Stop and gather more information first.  Try and understand the situation.
  • Contact your local TPD and/or Deputy Director for you patch in your Deanery.   (Deputy Directors: Kirsty Baldwin for WYLO, David Rose for NENL, and Ben Jackson for SYLO)
  • Ask the trainee to see their own GP.
  • Refer them to Occupational Health  (usually based at the local hospital)
  • In Yorkshire & the Humber region, your TPD may refer toUse the BMA. They have Industrial Relations Officers available to provide free advice about contractual and employment issues.
    • Nick Whelan who is the Performance Tutor at Y&H Deanery to whom trainees with educational reasons for their poor performance should be referred (via Grace Cogill, his secretary). Grace.Coggill@yorksandhumber.nhs.uk
    • Tim Norfolk who is an Independent Educational Psychologist and can only be referred to through your local TPD (after they have permission from their Associate Advisor for their patch). Tim will carry out an RDMp assessment of the trainee.
  • Do not forget about your defence organisation as a source of advice too.
  • Take Time Project - confidential counselling based at Leeds University for trainees in psychological issues.   www.leeds.ac.uk/studentcounselling

This page provides guidance for BOTH trainers and trainees who are experiencing difficulty either with each other, in their personal lives or with their progression of training.

Trainees

Please be discuss things EARLY with either your GP Trainer, Consultant, Educational Supervisor or Training Programme Director.   If the issue involves one of these people – try someone else in the list.  The important thing is to aire your problems early to stop them from escalating to exponential levels.  We understand that this requires a level of openness, honest and trust.

 Trainers

The same principle applies which we have given trainees – PLEASE talk to someone EARLY to help implement early remediation and stop things from deteriorating drastically.   Remember that there are many sources of support for you too.   Start by talking to one of your local Training Programme Directors or perhaps a fellow Trainer or aire your concerns via your Trainers’ group (try to maintain some sort of confidentiality).   Don’t fret too much over whether you think you are making too much of a fuss or not – it’s better to be safe than sorry!   When concerns are past on late, there is very little space for effective suggestions and alternatives.

 Training Programme Directors

Don’t forget to use the Deanery. Deputy Directors are available to help GP training schemes and its individual members.   They can sometimes remove the load of making difficult decisions from your shoulders if you would find this helpful. At all times they must be provided with documented information to facilitate their decision making. Do not short-circuit the ladder however, the natural place for Trainers to initially voice any concerns is with their Programme Director(s). Don’t forget about the BMA either. They have Industrial Relations Officers available to provide free advice about contractual and employment issues. And of course, there are the Defence organisations too who might be able to help.

WHAT TYPES OF TRAINEE DOCTORS TEND TO EXPERIENCE DIFFICULTY? (click to open me)

WHAT TYPES OF PROBLEMS DO DOCTORS IN TRAINING EXPERIENCE?

HAVE YOU ANY TENETS FOR MANAGING DIFFICULT SITUATIONS?

You must share your concerns with the trainee at the earliest possible time. Document all concerns that you have (in the trainee’s ePortfolio, under Educators’ Notes). You must involve the TPD at an early stage and they may involve the Deanery.


If you believe it will be difficult for you to make the decision relating to signing off the Clinical Supervisor’s Report or the Educational Supervisor’s Report then you should share this concern with your TPDs at an early stage. DO NOT FALL INTO THE TRAP OF SIGNING THE ESR/CSR IN THE HOPE AND BELIEF THAT THE DOCTOR INVOLVED IS CERTAIN TO IMPROVE IN FUTURE POSTS.

SIX SPECIFIC SITUATIONS

Let’s look at the following 6 problems…

  1. A personality clash
  2. Health problems
  3. Criminal activity
  4. Failing academically
  5. Unexplained Absence from Work
  6. Abscence from Half Day Release

HOW TO DEAL WITH THESE SITUATIONS?

1. Personality Clashes

These situations should be faced sooner rather than later. Share your concerns with the involved trainee. Try and seek advice from your TPD and perhaps fellow GP Trainers (if at a Trainers’ Workshop – try and maintain confidentiality). A TPD should involve themselves at this stage with the aim of clarifying issues and arbitrating if this is feasible. Every effort should be made to solve this problem quickly at a Scheme level. If the problem seems complicated Deputy Directors are available to advise and guide you and your TPD. It is vital that trainers document their concerns and also share these concerns with the involved trainee – the place to do this is in their ePortfolio (under Educators’ Notes). Do NOT keep hidden external records. The outcome of external arbitration may be to move the trainee to another practice. It is important that neither of the involved people see this as failure. The scheme will have a responsibility to keep in contact with those involved over the following few months to deal with any developments.

What not to do : Do not keep these situations to yourself. Do not think that the answer is to “sack” the trainee. Do not think the Deanery will sort this out `sometime’.

2. Health Problems

The important principle again is that you share your concern about your trainee’s health both with the trainee and your Scheme’s TPDs. You should encourage your trainee to have a personal GP who is not based within the training practice. You should document any concerns in the trainee’s ePortfolio (Educators’ Notes). Occupational health services are available for trainees and you should refer them via your scheme for an assessment if you are concerned. It may be necessary for the trainee to take sick leave from work to allow this process to happen. Where trainees lose a period of training due to illness there are now easy mechanisms for ensuring extended training is provided.

In a small number of cases the health problem will be such that it raises doubt about the safety of the doctor to practice. If you have these concerns you should share then urgently with your Scheme and also with your patch’s Deputy Director at the Deanery. The Deanery has clear mechanisms for referral to the General Medical Council. It is vitally important that you have documented your concerns in these situations (again, the place to do this is in the ePortfolio, under Educators’ Notes) as you will eventually have to provide a written report for the General Medical Council.

What not to do : Do not take on the role of becoming the trainee’s personal GP and taking over all responsibility for their health. Refer them back to their own GP.

3. The Registrar who may have committed a criminal act

As an employer you must follow employment law. All training practices should ensure that the contract that they provide for GP trainees contains sections relating to discipline and is in line with current employment law. Advice about contracts is available from the BMA. In any situation where you have concerns you should share your concerns at the earliest possible moment with your TPDs and with the Deanery. You may have to suspend the GP trainee on full pay whilst investigation is taking place.

4. The Registrar who is failing academically

The key words again come into play.

  • SHARE
  • INVOLVE
  • DOCUMENT

You must share your concerns with the trainee at the earliest possible time. Document all concerns that you have (in the trainee’s ePortfolio, under Educators’ Notes). You must involve the TPD at an early stage; they may have to involve the Deanery. If you believe it will be difficult for you to make the decision relating to signing off the Clinical Supervisor’s Report or the Educational Supervisor’s Report then you should share this concern with your TPDs at an early stage too. DO NOT FALL INTO THE TRAP OF SIGNING THE ESR/CSR IN THE HOPE AND BELIEF THAT THE DOCTOR INVOLVED IS CERTAIN TO IMPROVE IN FUTURE POSTS.

5. Unexplained absence from work

Any unexplained absence from work should trigger an attempt to contact the involved GP trainee. “Case Law” usually suggests that there is an underlying problem that has overwhelmed the involved doctor. Be supportive. If you are unable to contact the doctor or unable to undercover a significant problem communicate with your local TPDs who may involve the Deanery. Do not “sack” a GP trainee without discussing this with your TPDs first.

6. Absence from Half-Day Release (HDR)

GP Trainees vary in their attendance at half-day release. It may well be that they have identified a more effective personal method for education. They should however have discussed this with you and got your and the TPDs’ agreement. What is not acceptable is absence because they don’t feel like attending. If they are not spending the time, when they are not at half-day release, working in the surgery they are in fact acting fraudulently and action will have to be taken. They are paid to attend HDR.

I'M NOT SURE MY GP TRAINEE IS SUITED TO GENERAL PRACTICE

The Sci59 link in the ‘Resources’ section above is an online assessment tool for doctors or medical students. Once your student or trainee has answered all 130 questions, he/she will be provided with a report which states which out of fifty-nine specialties or sub-specialties he or she will be most suited to. In addition it will provide a list of the specialties the student/trainee is least suited to. The assessment report also provides a list of 12 career-related dimensions.  There is a cost implication for using the tool, however Sci59 is freely available to members of the BMA.  Otherwise some medical schools, NHS Trusts and deaneries may have paid for additional licences so it is worth finding this out.

WHERE DO I RECORD MY CONCERNS ABOUT MY GP TRAINEE?

Rule 1: DO NOT KEEP SEPARATE RECORDS DETAILING THE CONCERNS YOU HAVE ABOUT A TRAINEE.   It’s against the Data Protection Act and you will be fined!   A trainee has a right to see everything that is written about them – including emails!

Rule 2: KEEP THE TRAINEE IN THE LOOP AT ALL TIMES.  This means sharing all your concerns with them, and perhaps even documenting them together so that both of you are on the same wavelength or that subsequent dialogue can ensue.

Rule 3: DO NOT BE HOSTILE.  There’s no need for hostility.  Aim for and adult-to-adult type conversation with your trainee.   If your trainee is being defensive, it’s often because they are scared (wouldn’t you be?).   Be open and honest.  Show them that you want to do what’s right for them and get them back on track.

Rule 4: RECORDING MEETINGS AND EVENTS SHOULD GO IN THE ePORTFOLIO.  Write things in the Educators’ Notes section.   This section is open for all who have access to the trainee’s ePortfolio to see (including the trainee).  If you’re going to put something potentially emotionally upsetting in the ePortfolio – please consider writing it up in the presence of the trainee (of course, after signposting it).  There’s nothing worse than a trainee logging in and finding an unexpected comment which they also find hurtful.