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Performance coaching for trainees - case study
SpR in general surgery
This case study is fictitious but based on CDU experience.
Dr MP was in the middle of his fourth job on the SpR rotation. He had felt that, although there were problems in all the departments he had worked in, on the whole he had received adequate training. He was resentful to hear from his consultant trainer that his multisource feedback had included comments from a few nurses who had said he was repeatedly rude to patients and their relatives. He could not understand why his trainer did not accept that these nurses were difficult and basically had it in for him. He said the nurses did not understand his sense of humour. His trainer made it clear that he had had similar feedback in his previous posts and that unless he changed his manner towards his patients and their relatives he might not pass his RITA.
Dr P did not know how to defend himself and sought advice at the BMA. He did not think that they were very helpful.
Dr P's trainer suggested referral to the Career Development Unit but Dr P did not initially agree to the referral, resulting in several months of delay. Then there was a written patient complaint about him being overbearing when dealing with his elderly mother and not respecting her need for dignity and privacy. At this point he was referred again to the CDU and this time he agreed.
At interview Dr P was very defensive and had excellent reasons why the hospital staff were 'ganging up on him'. It was difficult for him to admit that he had behaviours he should change. In conjunction with his trainer a performance improvement plan was developed which included some work shadowing and protected time for discussion. The coach doing the work shadowing would get him to describe the manner of a senior surgeon he respected and contrast this with his own language and behaviour to patients. Gradually he began to understand the problem. Dr P went on a residential consultation skills course and, despite his initial scepticism, learnt different ways of talking to patients.
Although his manner to patients has improved, he himself is concerned that he might relapse under pressure and is aware that he will need to monitor himself for many years. He managed to get through his RITA and he recently commented that he was glad someone identified the problem while he was training as he might have got into real difficulties as a consultant. However he did wish that he had agreed to CDU referral a bit earlier.
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