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How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
How To Recognise And Support Trainees With Performance Issues
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How To Recognise And Support Trainees With Performance Issues

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  • Do not refer to performance management as "poor" to describe a level of trainees performance.
    Words like "poor“, "fair" and "good" that imply a value judgment on the person, rather than an objective assessment of their work, present enormous obstacles to helpful conversations about performance.
    Better are words or phrases that focus on work accomplishment such as "Consistently meets (or does not meet) stated performance expectations" for example. 
    Biggest obstacle to effective performance management is trainers' ability and willingness to have difficult conversations with trainees about their performance.  Using different language will help you to make these difficult conversations more effective by implying a judgment on the worth or quality of the person.
  • Increase awareness of all training issues.
    Review ARCP and RITA outcomes and review trainees
    Performance Lead in each specialty school
    educational supervisors training on assessment, feedback
    Encourage early identification of concerns and readily available appropriate support in accordance with the standards of PMETB.
    Establish single contact point by establishing an email address: performance@cf.ac.uk
  • Poor time keeping
    Failure to answer bleeps
    Disappearing trainee
    Frequent sick leave (Mondays & Fridays especially)
    Poor organisation
    Unable to prioritise
    Poor record-keeping
    Change of physical appearance
    Anger
    Erratic or volatile behaviour
    Lack of insight
    Unaware of limitations
    Clinical mistakes
    Critical incidents
    Lack of knowledge
    Lack of skills
    Defensive reactions to feedback
    Over or under motivation
    Exam failure
    Communication problems (with patients or other team members)
    Team working issues
    Attitude Problems
  • Generic development
    Unable to pass exams
    Questioning career or specialty choice
    Clinical performance
    Issues with technical or non technical skills
    Lack of leadership skills
    Issues with decision making
    Behavioural and personality issues
    Family and personal issues
    Communication skills and team working
    Recently changed rotations
    Environmental
    Dysfunctional Team
    Bullying
    Personality clash
    Workload
    Lack of resources
    Stress due to exams
    Sickness and ill health
    Drug or alcohol abuse
    Health problems (physical or mental)
    Undiagnosed disability
  • Speak to nurses ask for documentation
    Speak to trainee
    MSF?
    Ask about health – Occ Health? – GP?
    Document meeting
    Refer? PGO?
    Deanery?
  • Speak to nurses ask for documentation
    Speak to trainee
    MSF?
    Ask about health – Occ Health? – GP?
    Document meeting
    Refer? PGO?
    Deanery?
  • Transcript

    • 1. Performance Unit forthe Postgraduate Medical Training in Wales School of Postgraduate Medical andDental Education Cardiff University NeuaddMeirionnydd HeathPark Cardiff CF144YS Contact: 02920687417/7411/7412 Email: General: performance@cf.ac.uk LeonaWalsh: walshla@cf.ac.uk DrSallyDavies: daviessj8@Cardiff.ac.uk DrHeatherPayne: payneeh@cf.ac.uk HOWTO RECOGNISE AND SUPPORT TRAINEES WITH PERFORMANCE ISSUES
    • 2. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit forthe Postgraduate Medical Training in Wales FACTS
    • 3. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom PERFORMANCE UNIT TRAINERS All to recognise Raise concerns Documentation Local support for failing trainees Specialty Performance Leads Training for trainers Occupational Health involvement Human Resources TRAINEES Full time Less than full time training (LTFT) Registrars DEANERY Careers Disability / Reasonable Adjustments Specialty Training Schools Less than full time Training (LTFT) Foundation School Training Database General Practice Dentistry Quality Assurance OTHERAGENCIES Undergraduate Medical School Educational Providers (NHS Trusts in Wales) GMC/NCAS BMA Human Resources OtherDeaneries DEANERY COMMISSIONED SERVICE PROVIDERS Individual Support Programme Occupational Health OtherAssessments as required NETWORKIN G
    • 4. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School 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. • performance@cf.ac.uk AIMS
    • 5. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom SIGNS&TRIGGERS • Attitude and Behaviour • Clinical Performance • Communication • Health • Unsatisfactory Progress
    • 6. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit forthe Postgraduate Medical Training in Wales • Why this trainee? • Why here? • Why now? CAUSES
    • 7. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit forthe Postgraduate Medical Training in Wales SCENARIO • 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 thereanyimmediatechallengeordilemmapresentedbythis situation? • What do youthinkmaybetheunderlyingcauseof theproblem, and why? • What areyougoingto do next?
    • 8. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit forthe Postgraduate Medical Training in Wales SCENARIO • 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 animmediateactionplanandongoingeducational planforthis trainee.
    • 9. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit forthe 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 important KEYPRINCIPLES • 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
    • 10. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School 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 3 48 0 10 20 30 40 50 Foundation Programme Core Training Specialty Training Performance Unit forthe Postgraduate Medical Training in Wales AUDIT MARCH08 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% DATAAUDIT CURRENT STATUS 9 6 5 3 32 1 0 5 10 15 20 25 30 35 F1/F2 ST1 ST2 ST3 ST4 SpR
    • 11. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit forthe Postgraduate Medical Training in Wales REFERRED SPECIALTIES 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
    • 12. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit forthe Postgraduate Medical Training in Wales REFERALREASONS 0 2 4 6 8 10 12 14 16 18 A ttitude & B ehaviour C linincalC om petence C om m unication H ealth U nsatisfactory Progress Mar-08 Sep-08
    • 13. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit forthe 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 DrHeatherPayne disabilityequality@cardiff.ac.uk DISABILITY
    • 14. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit forthe 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 FUTURE DIRECTIONS
    • 15. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit forthe Postgraduate Medical Training in Wales LESSONSLEARNT  DOCUMENT EVERYTHING  ACT PROMPTLY & COURTEOUSLY  DO NOT PASS THE PROBLEMON  KEEPALL PARTIES INFORMED
    • 16. Developing the Performance Unit forthe Postgraduate Medical Training in Wales WalshLA, Davies SJ, PayneEH, GallenDD School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit forthe Postgraduate Medical Training in Wales QUESTIONS

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