Each trainee brings with them their own unique suite of clinical knowledge and skills acquired in their training and in previous posts. How they apply these knowledge and skills in practice will affected by three factors:

A.1. Issues with behaviour. Trainees will also bring with them their own suite of personal attitudes and these attitudes will manifest as observable behaviours. Usually these will be within an ‘accepted norm’ but sometimes can lead to more extreme behaviours; examples range from poor teamworking and communication skills to more extreme behaviours including rudeness, bullying, racial and sexual harassment and occasionally even criminal behaviours such as fraud and theft.  Here trainee support systems will have to be complemented by the employer’s own policies and disciplinary procedures

A.2. Health and sickness issues - Doctors become ill sometimes like everyone else. Consider physical and mental health problems as well as substance misuse such as drugs or alcohol if a trainee’s behaviour changes. All trainees should be registered with a GP (not their GP Trainer). Checks should be made that all trainees in need of support have registered with a GP and have consulted with them as appropriate. The Disability Discrimination Act (1995) covers both physical and mental impairments that affect a person's  ability  to  carry  out  day-to-day  tasks  and  requires  employers  to  make  reasonable adjustments to work pattern, content, and environment.

A.3.  Environment.  It  is  important  to  remember  that  there  may  be precipitating factors in the trainee’s home / social life as well as their working environment that could affect their performance.

These factors are summarized in the NCAS performance triangle below.

Early recognition and appropriate intervention, coupled with effective feedback and appropriate support for trainee and trainer are essential if trainees in need of support are to be managed effectively and successfully.

NCAS Performance triangle; from Severn PGME Trainee Support pages, available at;



 Appendix A 1 triangle

Appendix A2