C.1 When broaching a concern about a trainee the educator should initially explore and discuss issues with the trainee and collate any relevant information. If there is a specific ‘trigger’ event the interview should explore the any evidence available, its factual accuracy and the trainee’s perspective on the situation, with the intention of reaching a shared understanding of the issues.  If there are performance issues these are often a symptom of an underlying problem and this can be sensitively explored as the meeting progresses. Understanding the nature of the underlying problem will be useful when considering appropriate support measures. It’s important to consider the distinction between a trainee’s conduct and their capability; “could but wouldn’t” or “couldn’t so didn’t”.

C.2 A helpful question is; “Describe a time when everything was going well.” This approach explores both communication and performance and makes the interview less uncomfortable for the trainee. Furthermore this line of questioning casts light on the trainee’s overall perspective and experience. This initial meeting may of itself resolve the problem.  It is important the meeting is documented and that a copy of the meeting is shared with the trainee for factual accuracy.

C.3 Such sensitive discussions require considerable skills, protected time and space. TPDs are in a pivotal position. They have to balance the mandate for patient safety with educational management, and the pastoral care of the trainee concerned.  TPDs will gather information from discussions with the both the trainee and Trainer/Clinical Supervisor/Educational Supervisor.

C.4 After the initial exploratory meeting, follow up meetings will usually be indicated. If a more formal meeting is necessary then the trainee needs to be informed of the purpose, agenda and attendee list for the meeting, following HR best practice guidelines.  During these meetings, reassurance about the confidentiality of health information should be given while informing the trainee that performance issues that might affect patient safety will be discussed with others on a “need to know” basis. Meetings with a trainee may also include the educational and clinical supervisors or may be with the TPD alone. Many problems can be resolved at local level, by employing the principles of finding out the facts rather than opinions, giving honest but constructive feedback and setting targets for improvement.

C.5 All documentation should be complete and shared with all parties. Records should be comprehensive and contemporaneous. If possible these meetings should be documented on the trainees’ e-Portfolio using Educator notes.

C.6 If you are an educator working with a TINS seek support and supervision early. Case management of these trainees is a shared responsibility between the designated TPD and the programme APD.  If simple measures have failed to resolve the problem, APDs should take appropriate action while being careful not to rush into making precipitate judgments or decisions.

C.7 APDs should consult their Head of School as appropriate. APDs need to be aware the limits of their competence in relation to issues that could potentially lead to formal hearings of one kind or another. Remain aware that other resources may need to be employed in order to support the trainee e.g. assessment tools, human resources etc. The Head of School and other senior members of faculty with experience of working with and supporting trainees are available for advice.

C.8 All discussions with trainer and trainee should be reflective and non-judgmental. The objective is always to try and establish (or re-establish) a safe and effective learning environment.

C.9 Consider if the educator also needs support. He/She may value support of various kinds from peers or seniors.

Advice for all educators - Remember:

• Act early but surely.

• Poor performance is a symptom, not a diagnosis.

• If it isn’t written down, it hasn’t happened.

• No surprises.