Trainee performance: FAQs

I am a consultant and have an SHO in difficulty: everyone in my department agrees we can't sign him up for his six months. He moves on to another post in 2 weeks. If I refer him now can I presume that his next trainer will be involved with the CDU and not me?

There are various issues here. Presumably you have used a systematic approach to collecting evidence about his performance and used the SHO RITA framework as a guide.

If you feel you can't sign him up, then you probably mean to give him a RITA E. This indicates that he needs remedial training and the Postgraduate Dean may need to be approached about a remedial training post, probably in your department. It is unusual to issue a RITA E without warning.
If you feel you can give him a RITA D - which means focused training - then it would be a good idea to refer him to the CDU so that an effective Performance Improvement Plan (PIP) can be put in place.

However you will still need to be involved as you are the one who understands the issues that need to be addressed. The CDU coach will want a report from you and will need to meet you to understand the concerns. You will have an opportunity to comment on the Career Development Needs Assessment (CDNA) report but the PIP will probably be negotiated with his trainer in his next job.
In this way the CDU can be used to provide educational continuity from one job to another within the Deanery.

There has never been any problem with my SpR's performance, however I have been told that he was caught by a senior nurse manager taking a controlled drug out of the drugs trolley. Should I refer him to you?

This is an example of a professional conduct problem and should be dealt with by the Trust under their approved disciplinary procedures. His programme director and the Postgraduate Dean should be informed.

It is worth noting that occasionally these sort of conduct problems occur because of some outside stress or illness. If you think this may be the case he may need referral to Occupational Health.

Otherwise he will need a source of support and understanding which you are well placed to provide while the disciplinary process goes forward.

My new SHO is from China and this is her first post in the UK.  I find her behaviour unusual - she agrees with everything I say and if we are walking down the corridor she refuses to talk to me but walks several steps behind me. I have asked her to walk beside me and she says she will but never does. The patients like her and say she is very conscientious and takes endless trouble with them.

This may be an example of cultural difference. In China it can be seen as very rude to your teacher if you disagree with anything or do not show absolute respect, such as walking behind.

If your SHO means to stay in the UK she may need some help adjusting and may benefit from a short course run in the Deanery on Inter-cultural communication and team working skills.  Your postgraduate centre manager should be able to help her access one.

I would like to refer my SpR to the CDU because I think she would benefit from some specialised help dealing with some of our emotionally draining patients. I believe she is protecting herself because she has become withdrawn and distant with her patients and this is now making her a much less effective doctor. However I don't want to destroy her confidence as she is basically a competent doctor - Consultant, Palliative Care.

Why don't you share your concern with her and suggest that she refer herself confidentially to the CDU? In that way you can make it clear that you are not questioning her competence but are concerned not only for her well being but also because you have seen her be a more effective doctor previously.

She may prefer to go to Medic Support, which is a free psychological support service for trainees in the Oxford Deanery. She can contact them on : 01865 223924 or 01865 556648.

I am responsible for seven junior doctors and most of them seem to be in difficulty. I am run off my feet and don't know where to go for help or advice. Everyone says you have to collect evidence and write everything down but when am I supposed to do that in the small amount of time available?

Many people will identify and sympathise with your situation. Approaching your district clinical tutor and also your clinical director would be a useful first step. The clinical tutor may help you prioritise and sort some of your trainees and your clinical director may help you adjust your clinical commitments and workload. It may be that you can delegate some of the supervision to others in the department and an experienced SpR can provide excellent mentorship for a struggling trainee.

If you have a trainee with complex, longstanding difficulties than a referral to the CDU may be appropriate. It should be remembered that one chaotic trainee can have a disabling effect on their colleagues - and even their trainer.