All Medical Practitioners
All doctors have a duty as outlined in 'Good Medical Practice' and 'Good Medical Practice of General Practitioners' that 'if you have concerns that a colleague may not be fit to practise, you must take appropriate steps with delay, so that the concerns are investigated and patients protected where necessary. This means that you must give an honest explanation of your concerns to an appropriate person from your employing or contracting body, and follow their procedures.' (Good Medical Practice, paragraph 43)
Employers: It is the employer’s responsibility to manage issues of conduct and capability. It is imperative that the employer liaises with the Deanery when dealing with capability issues for trainees. The Deanery must have a full record of progress of each and every trainee in Wales so that accurate educational supervisor reports are available to the next employer / placement on the rotation. (Letter 28/11/08 to STC Chairs, Programme Directors, Medical Directors, Chief Executives & Heads of Specialty Schools from Prof D Gallen, Postgraduate Dean)
Employers should advise the Deanery of any trainee who is experiencing difficulties and of the action being taken to support and remedy any deficiencies. The Postgraduate Dean and employer must work closely together to identify the most effective means of helping/supporting the doctor, whilst ensuring that patient safety is maintained at all times. Educational and informal but clearly identified and documented action should be taken wherever possible, prior to invoking formal measures. Trainees involved in a disciplinary investigation or suspended should not rotate to the next placement until disciplinary procedure has concluded. Should a conduct issue become the subject of police investigation or is likely to attract media attention the Deanery must be informed promptly.
Trainees may be implicated in repeated episodes which taken individually would be insufficient to cause concern but considered as a whole may indicate a significant issue.
Trainees involved in critical incidents which are being investigated by the employer must remain in the placement of the investigating employer until the investigation has concluded. The Deanery must be informed.
Clinical Supervisors (CS)
A Clinical Supervisor is responsible for assessing if a trainee is safe and competent to carry out the clinical work appropriate to his/her level.
- Is the person working with that trainee – includes on call, clinics, and theatres
- Undertakes assessments as appropriate
- Teaches and trains
- Gives constructive feedback at the time
- Guides reflection on practice
- Informs the Educational Supervisor if concerns arise
Clinical supervisors are in an excellent position to identify any potential issues affecting training. These may vary from clinical, behavioural, health related and communication issues.
- Any questionable behaviour observed should be documented, discussed with the trainee and the educational supervisor.
- Employer policies and procedures must be followed as appropriate.
Educational Supervisors (ES):
Educational Supervisors are responsible for overseeing training to ensure that trainees are making the necessary clinical and educational progress.
For trainees on six month placements, Educational Supervisors should meet with the trainee at least three times during the placement period. The meetings should take place in comfortable bleep free environment; be encouraged by the Educational Supervisor, but be led by the trainee. For placements of four months or less it would be sufficient to hold two meetings during the period of the placement.
Please notes that each Specialty School has a different approach to educational supervision and the model varies accordingly.
Educational Supervisors' need to encourage some trainees to undertake assessments, collect portfolio documentation and reflect on practice.
It is imperative that educational supervisors provide honest and objective feedback to their trainees to ensure that the trainees have a clear perspective on their progress and any concerns regarding their performance. It is not helpful if, with the best of intentions, a registrar is given a false impression of their level of performance.
(Good Medical Practice, paragraph 18)
- First Meeting
- Initial appraisal
- Discuss educational training plan
- Objective setting
- Discuss study leave/exams
- Document meeting
- Second Meeting
- Ensure trainee is gathering assessments
- Address any concerns
- Collate assessments
- Review progress with objectives
- Document meeting
- Final Meeting
- Review assessments
- Compose Educational supervisor report for ARCP/ RITA
- Document meeting
Significant concerns identified by the educational supervisor should be shared with the training programme director, the PSU Specialty Lead, the Postgraduate Centre Manager and the Deanery Professional Support Unit. If appropriate, the Educational Supervisor may also need to inform clinical governance officers and the employing/ contracting Health Board of significant clinical events.
Points to Remember
- Have you met with the trainee to gain their perspective?
- Have you talked to staff/colleagues confidentially to verify your findings?
- Have you asked your staff/colleagues to document their concerns?
- Is there any documentary evidence?
- Have you got the trainees permission to share the information and refer the trainee for further support?
College tutors are responsible for advising and supporting trainees within a particular specialty in a LHB and ensuring that trainees and supervisors adhere to College standards.
Specific advice areas:
- Career advice about their specialty
- Exam procedure and requirements
- Specialty-specific issues
Postgraduate Centre Managers
Centre Managers are appointed by the LHB to manage Postgraduate Centres. Their role encompasses of monitoring educational provision, liaison with LHB management, organising regular meetings of the local Postgraduate Board, managing the Study Leave process and managing induction programmes for trainees.
Centre Managers can provide documented evidence (records of study leave, Foundation portfolio) as well as advice when trainee is experiencing performance issues.
Centre Managers are invaluable source of information to both trainees and their trainers and are often aware of performance issues before they are highlighted to the Educational Supervisors.
Associate Dean - GP (AD-GP)
The Associate Postgraduate Deans – GP have geographical responsibilities for general practice training programmes and form the key link between training programmes and the Deanery.
In managing performance concerns, AD-GPs can assist in identifying targeted training placements either locally or on neighbouring programmes. They also act for the Deanery in overseeing the progress of a GP specialty registrar during targeted training and are a source of advice for GP educational supervisors and training programme directors.
Foundation Programme Directors
Foundation Programme Directors work in collaboration with Postgraduate Organiser(s) and the Centre Manager(s) to ensure the Foundation Programme is delivered within the LHB, to deliver career guidance, provide and review internal quality control information and acting on results as necessary and to ensure that the interests of Flexible Trainees, Trainees with Special Educational Needs and Trainees with Performance issues participating in the Foundation programme are respected and protected.
FPD may also arrange placements for trainees with special educational needs when necessary.
In managing performance problems Foundation Programme Directors are often best placed to liaise with LHBs and the Deanery when a performance concern regarding a Foundation Trainee are raised.
Specialty Professional Support Leads
Professional Support Leads serve as the key interface between Wales Deanery Professional Support Unit and the Specialty School in order to support trainees in Wales with issues around performance, professional competence, health (including disability) and updates the School Board on any issues relating to Performance. This role is often fulfilled by the Training Programme Director or another member of the STC.
- First point of contact for the Deanery Performance Unit within the School for matters relating to any concerns raised.
- Is familiar with support provision, resources and procedures from the Deanery.
- Disseminate and/or reinforce above information to STC chairs, educational supervisors, clinical supervisors, college tutors, PG Managers and others involved in supporting doctors in specialty training who have performance issues.
- Assist the Performance Unit in organisation and delivery of specialty specific performance related training to educational and clinical supervisors.
- Act as a point of contact for educational supervisors and tutors who seek specialty-related information and advice to help inform their ongoing educational planning, assessment implementation and discussions with training doctors.
- Ensure that doctors identified with issues with progression of training have a specific educational plan in place with reasonable identified objectives and outcomes needed for satisfactory progression.
- Provide, where appropriate, expert advice to training doctors who are referred with more detailed or complex performance issues within the specialty. Alternatively, signposting them to the Deanery Performance Unit for further intervention.
- Distribute emerging information related to performance issues within the specialties/Royal Colleges etc to the Performance Unit to ensure up to date developments are shared.
- Liaise as necessary regarding reasonable adjustments required for trainees with a recognised disability.