how to recognise and support trainees with performance issues
TRANSCRIPT
Performance Unit for the Postgraduate Medical Training in Wales
School of Postgraduate Medical and Dental EducationCardiff UniversityNeuadd MeirionnyddHeath ParkCardiffCF14 4YS
Contact:029 2068 7417 / 7411 / 7412
Email:General: [email protected] Walsh: [email protected] Sally Davies: [email protected] Heather Payne: [email protected]
HOW TO RECOGNISE AND
SUPPORT TRAINEES
WITH PERFORMANCE
ISSUES
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Performance Unit for the Postgraduate Medical Training in Wales
FA
CT
S
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
PERFORMANCE UNITTRAINERS
All to recognise
Raise concernsDocumentationLocal support for failing trainees
Specialty Performance Leads
Training for trainers
Occupational Health involvement
Human Resources
TRAINEES
Full timeLess than full
timetraining
(LTFT)Registrars
DEANERY
CareersDisability /ReasonableAdjustmentsSpecialty
TrainingSchoolsLess than full
timeTraining
(LTFT)Foundation
SchoolTraining
DatabaseGeneral
PracticeDentistryQuality
Assurance
OTHER AGENCIESUndergraduateMedical School
Educational Providers (NHS Trusts in Wales)GMC/NCASBMAHuman ResourcesOther Deaneries
DEANERY COMMISSIONEDSERVICE PROVIDERSIndividual Support ProgrammeOccupational HealthOther Assessments as required
NETW
OR
KI
NG
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
• Increase awareness of all training issues.
• Encourage early identification of concerns
• Monitor progress and the outcomes
• Establish networks across Wales.
• Provide faculty development for clinical & educational
supervisors
• Establish a close relationship with the Individual
Support Programme of Cardiff University to provide
assessment and remediation for individual trainees.
• Develop clear protocols for appeals.
AIM
S
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
KingdomS
IGN
S &
TR
IGG
ER
S• Attitude and Behaviour
• Clinical Performance
• Communication
• Health
• Unsatisfactory Progress
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Performance Unit for the Postgraduate Medical Training in Wales
• Why this trainee?
• Why here?
• Why now?
CA
US
ES
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Performance Unit for the Postgraduate Medical Training in Wales
SC
EN
AR
IO
• Dr A is a ST1 trainee in medicine.• She has done her first four months in Dermatology and has
been signed up. She started in Emergency Medicine.
• Within two weeks you receive complaints from her clinical supervisor that this trainee is unable to cope in the Admissions Unit. She is missing when needed, and allows other trainees / medical students to do things for her.
• Is there any immediate challenge or dilemma presented by this situation?
• What do you think may be the underlying cause of the problem, and why?
• What are you going to do next?
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Performance Unit for the Postgraduate Medical Training in Wales
SC
EN
AR
IO
• You speak to the trainee and encourage her to perform observed patient assessment.
• The clinical supervisor reports that this trainee is lacking in confidence and lacks experience of examination and procedures such as venflon insertion.
• The clinical supervisor has discreetly asked the previous firm and discovered that she did very little under observation and was generally unavailable when things needed to be done.
• Dr A has come into Core Medical Training from a trust grade post in Public Health, where she was employed for 4 years.
• Suggest an immediate action plan and ongoing educational plan for this trainee.
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Performance Unit for the Postgraduate Medical Training in Wales
• Immediate action once aware of concerns
• Ask for concerns to be documented
• Consider appropriate assessments to gain information e.g. MSF
• Investigate and document yourself
• Speak to the trainee and document the meeting
• Feedback is very importantKEY
PR
INC
IPLES • Do not deal with difficult
scenarios on your own
• Different causes require different solutions
• Do not wait for the next annual review to raise issues
• ‘No surprises’ at annual review (ARCP)
• Contact Deanery Performance Team for support, advice or referral
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Current status:
• 57 active cases
• 17 referred June 08 – Sep 08
Cases referred to ISP:
• Total since Feb 08: 9
• Active cases: 11
Trainees are being referred
earlier!
5 348
01020304050
FoundationProgramme
CoreTraining
SpecialtyTraining
Performance Unit for the Postgraduate Medical Training in Wales
AUDIT MARCH 08
95 cases were identified
• 31 trainees resumed
satisfactory progress following a
period of support (32%)
• 8 trainees left the training
programme (8%)
• 56 active cases
Stage of training• Foundation Programme
1.6%• Core Training
0.2%• Specialty Training
5.6%
DA
TA
A
UD
ITCURRENT STATUS
96 5
3
32
10
5
10
15
20
25
30
35
F1/F2 ST1 ST2 ST3 ST4 SpR
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Performance Unit for the Postgraduate Medical Training in Wales
REFER
RED
S
PEC
IALTIE
S
0 1 2 3 4 5 6 7 8
Anaesthetics
Clinical Oncology
CMT
Dermatology
Emergency Medicine
F1
F2
Gen Surgery
GP
Haematology
Histopathology
O&G
Oncology
Opthalmology
Paediatrics
Paliative Medicine
Plastic Surgery
Public Health
Radiotherapy
T&O
Thoracic Medicine
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Performance Unit for the Postgraduate Medical Training in Wales
REFER
AL R
EA
SO
NS
0
2
4
6
8
10
12
14
16
18
Attitu
de & B
ehavi
our
Clinin
cal C
ompete
nce
Comm
unicat
ion
Health
Unsatis
facto
ry P
rogre
ss
Mar-08
Sep-08
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Performance Unit for the Postgraduate Medical Training in Wales
A Doctor with a disability may have problems with specific aspects of training or the workplace.
With the right help and support, training can be kept on schedule.
Queries regarding disability issues should be addressed to
Dr Heather Payne
DIS
AB
ILIT
Y
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Performance Unit for the Postgraduate Medical Training in Wales
• Group of advanced educational supervisors within Specialty Training Schools
• Performance Leads within each Specialty Training School
• Clear structure for identifying and addressing the issues.
• Advice and guidance
Provide Training to:
• Identify issues early
• Feedback identified concerns to the trainee
• Keep good contemporaneous documentation
FU
TU
RE
DIR
EC
TIO
NS
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Performance Unit for the Postgraduate Medical Training in Wales
LES
SO
NS
LEA
RN
T
DOCUMENT EVERYTHING
ACT PROMPTLY & COURTEOUSLY
DO NOT PASS THE PROBLEM ON
KEEP ALL PARTIES INFORMED
Developing the Performance Unit for the Postgraduate Medical Training in Wales
Walsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United
Kingdom
Performance Unit for the Postgraduate Medical Training in Wales
QU
ES
TIO
NS