Sheet 8 Dec 2013

If you are a trainee experiencing any sort of difficulty, then you should first speak to your clinical supervisor, or alternatively, your Educational Supervisor or a member of the Local Programme Educator team. The deanery provides a comprehensive range of confidential support for all sorts of difficulties, for more information go to the Support and Development pages.

If you are a supervisor and have concerns about a trainee then it is important to discuss issues at an early stage with another educator and start to document the nature of the concerns at an early stage. Then consider the following:

  1. How are performance concerns categorised?
    The National Association of Clinical Tutors (NACT) identifies three levels:

    Level 1: Minor concerns or dilemmas, presenting a potentially low risk to patients.

    Level 2: Problems that, if left undetected or untreated, could pose a moderate risk to the individual trainee, the patients or the organisation, but are not yet sufficiently serious to warrant disciplinary action.

    Level 3: Serious and/or repetitious performance problems that present a high level of risk to patients and others and which require a skilled and possibly disciplinary approach.

  2. What might constitute level 1 concerns?
    These might involve issues regarding skills and knowledge, such as repeated poor retention of learning from tutorials, relatively poor acquisition of communication skills following appropriate feedback, minor language issues etc.  Other issues might be attitudinal, such as poor interaction with other team members, failure to complete assessments or minor health issues (eg. repeated single days off sick).

  3. How should a supervisor manage Level 1 concerns?
    There are four important principles. (Supervisors may also wish to consult the NACT guidance for further info)

    Gather further information. Your observations may be isolated or the “tip of the iceberg”.  You should gain as much feedback as possible from other team members and supervisors to elicit if these concerns have arisen in other settings and/or over a period of time.

    Record Observations.  Specific examples of behaviour with dates and settings should be recorded, including those noted by others.  Initially, the supervisor my wish to keep the info personally, although the educator notes page on the eportfolio should be used early on.

    Seek Support. At an early stage, seek support from others to “test” your concerns, and to validate that your early management is appropriate.  For minor concerns, this might involve a discussion with the local GP Programme Director (TPD), or confidentially (and anonymously) with an experienced supervisor or during a supervisor workshop session.

    Feedback to Trainee. Concerns should be primarily addressed through a formative, educational approach.  The trainee needs to be made aware at the earliest opportunity about the nature of the concerns, and a personal development plan, should be formulated to address the issues, with clear agreement about a timescale for improvement.  The discussion and plan should be documented: The Deanery recommends use of the NACT proformas (which would need to be scanned on to the e portfolio). An interim CSR, may also be helpful and all supervisors and educators involved should add comments to the educators’ notes page.  The trainee will be expected to reflect on the issues raised as an entry under “professional conversation” in the learning log.

  4. What might constitute Level 2 concerns and how are they managed?
    Examples might include significant attitudinal issues, such as repeated poor attendance or punctuality at work or learning sessions or deficiencies in clinical performance that fall well short of expected.  A level 1 concern might also evolve into Level 2 if the trainee fails to make progress in the agreed development areas, or shows lack of insight into the issues raised.  In this situation, the 4 principles in 3) still apply, but in addition, the GP Speciality Training Programme Associate Postgraduate Dean should be contacted to give support and advice.  Clearly, the more serious level 3 concerns should be notified to the GPST Programme APD without delay.

  5. What is the role of the ARCP panel and ES Report?
    In the case of level 1 concerns, it would be appropriate to highlight these in the ESR and request “For panel review”.  Level 2 and Level 3 concerns should always be highlighted to the deanery and addressed promptly - these concerns should not be delayed until an ARCP panel before they come to light.  The panel will, however, come to a judgement as to whether training progress is satisfactory, and whether concerns raised are being addressed.  It is therefore important that all concerns are documented adequately on the e portfolio (as noted above).