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Coaching for established doctors and dentists - how the CDU can help
The CDU can provide personal coaching to help the doctor or dentist explore the issues and understand why difficulties have arisen. Prior to CDU referral the employing Trust will have undertaken local investigation of concerns and the doctor in difficulty will have a copy of the report. It is essential that the doctor or dentist in difficulty provides a copy of any reports in confidence to the CDU coach so that all issues of concern can be addressed.
Some doctors will have already had a full assessment by the National Clinical Assessment Service (NCAS) or the General Medical Council (GMC) or General Dental Council (GDC) and the recommendations from these reports form the basis of discussions with the CDU coach. Developing an effective plan to deal with any difficulties depends on real understanding of the documented concerns and focuses on the reasons why difficulties have occurred and any possible contributory factors, against the background of the doctor's previous experience and personality.
There are four stages:
See also:
The Career Development Needs Assessment
The Career Development Needs Assessment (CDNA) normally consists of a personal 2-3 hr interview . The personal coaching is not an assessment of clinical competence and in this way it differs from NCAS or GMC /GDC investigations. The purpose of the needs assessment is to clarify the issues for the doctor or dentist that relate to their performance at work. These doctors and dentists may have had a considerable time of uncertainty with some local investigation of their performance and a few will already have had a full assessment from NCAS or the GMC/GDC. The CDU interviewer will go through these reports and, keeping an open mind, will explore the doctor's perspective and what they feel is the full story. It is important to discover to what extent the individual has accepted the findings in the reports and how willing they are to learn and change. Contributory factors will be explored in depth and the identified problems clarified and understood in the light of the doctor's previous experience and the context of their personal and professional qualities. The information that is reviewed in the CDNA includes:
- in-depth exploration of past experience
- report from employer (case manager)
- assessment reports - local investigation, NCAS or GMC/GDC
- CV, professional development and appraisal record containing further information about past achievements, including multisource feedback
- psychometric tests such as the Myers-Briggs Type Inventory or the FIRO-B.
The CDNA can help the individual identify the reasons why they have run into difficulty, explore how any contributory factors can be modified and clarify the specific behaviours that the individual feels they need to change to get back on track. It will also ensure that the issues addressed include those identified in previous assessments and clarify what the individual has to achieve to demonstrate satisfactory competence.
The CDNA report will be sent first to the individual for any correction of fact and is used as the basis for making an individual Performance Improvement Plan, usually done at a subsequent meeting.
Performance Improvement Plan
The performance improvement plan (PIP) is based on the findings of the original career development needs assessment which also takes into account the employer's perspective and any NCAS or GMC/GDC recommendations and should have provided a summary of development need. The performance improvement plan attempts realistically to tackle each identified issue and personal learning styles and preferences will be used to explore the best way for the individual to address these in the light of available educational resources. A range of options can be considered, including personal reading, specific courses, and personal coaching. Personal coaching can take place away from the work place but can include work shadowing or video feedback.
Occasionally an established doctor or dentist requires more formal remedial training with an attachment to another hospital or practice equipped for remedial training. The CDU can try to facilitate this but it requires the agreement of the Postgraduate Dean and the accepting Trust or training practice and there is no guarantee of availability.
Robust arrangements for monitoring progress will be an integral part of the plan and there will be clear criteria that will have to be met in order to demonstrate competence. Some of these may be tests or exams. For example, some of the modules for the Summative Assessment of GP registrars have been used by established GPs to demonstrate competence.
Most aspects of the performance improvement plan will incur costs and these will be specified. Sometimes the employing trust or PCT is prepared to support the individual financially and this is more likely if the individual shows a genuine desire to get back on track.
Occasionally doctors and dentists have a history of non-engagement with previous professional development initiatives and have eventually been referred to the GMC. It is quite common in that situation for the individual doctor to have to finance their remedial training personally.
The agreed plan is sent to the employing trust for approval and the financial arrangements are agreed before performance coaching or remedial training starts.
Supervised remedial training /coaching
The following options may be available:
- Trainer/coach visiting the doctor/dentist in their work place, shadowing them at work, giving observation and feedback - usually 1 session a week or fortnight.
- The doctor or dentist visiting/work shadowing another doctor or dentist in a department or practice that demonstrates high quality of care.
- Full time attachment to a training practice or department, similar to a doctor/dentist in training/GP registrar.
- Assessment opportunities - e.g. GP summative assessment MCQ, video consultation assessment, in-depth focused multisource feedback.
- Clinical attachments to learn specific skills, for example specific surgical or technical techniques.
- Specific courses, Deanery and national to address deficiencies in specific knowledge or skills.
- Personal coaching to develop understanding, self-awareness and reflective practice.
The options available will depend on any restrictions placed on their practice by their employing trust or GMC/GDC.
Each learning objective will have robust arrangements for monitoring progress and criteria that should be met in order to demonstrate competence.
Progress Review
The progress review is a pre-arranged formal event involving a meeting with the supervising CDU coach, the trainer and the doctor involved. Progress against each educational objective will be explored in detail using the information gathered from the monitoring progress. Progress against the criteria for success will be agreed and a report written; this will be sent to the case manager of the employing trust.
The employer may then use the CDU progress report to support any report they may be required to make for their own trust or PCT decision making group (DMG), NCAS or GMC/GDC.
The CDU coach does not make an assessment of overall competence. The progress review report only provides evidence of developmental progress against previously agreed learning objectives.Occasionally the GMC/GDC contacts the Career Development Unit directly, in which case the CDU asks permission of the doctor or dentist to send a copy of the report.
Example of costs
The Career Development Unit is part of the Oxford Deanery and is only funded for remedial training for doctors or dentists in training. However a number of established doctors have approached the CDU either with a career dilemma or concerns about their own performance. The CDU has decided that this should be encouraged and have agreed to provide personal coaching for self-referred established doctors at no cost.
However, the CDU has been approached by employers to help with getting doctors or dentists in difficulty back on track and there is a cost for this service as follows:
- Confidential advice to employer - no charge.
- Attendance of a CDU coach as resource for PCT Performance Advisory Groups - no charge.
- Initial Career Development Needs Assessment with Performance Improvement Plan - £600
- Supervison of remedial training, review of progress and final report - £400
- Remedial training options:
- Trainer/coach visiting the doctor in their work place, shadowing the doctor at work, giving observation and feedback - usually 1 session a week or fortnight - £500 per session
- Full attachment to a training practice or department, similar to a doctor in training / GP registrar - £10,000 for 6 months placement
- Assessment and exams at cost - £150 for Summative Assessment MCQ
- Specific courses, Deanery and national, to address deficiencies in specific knowledge or skills at cost.
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