1. Trainees in Difficulty Dr Ken McHardy Consultant Diabetologist Associate Postgraduate Dean Member NES Faculty Development Alliance Aberdeen ken.mchardy@nes.scot.nhs.uk RAC Conference Workshop, RCPE 5 th June 2014

2. Aim 1: TO INCREASE CONFIDENCE AND COMPETENCE IN RECOGNITION OF PROBLEMS AND CONSIDERING UNDERLYING CAUSES

3. Definitions Personal conduct – performance or behaviour not associated with the exercise of medical duties Professional conduct – performance or behaviour arising from the exercise of medical duties Professional competence – adequacy of performance related to the exercise of technical skills and professional judgement

4. Problems and Causes There are several types of underlying problem The manifestation may not reveal the problem There are usually several contributory factors Attempts at resolution are facilitated by understanding Modelling can be perhaps useful….

5. Knowledge & Skills Attitudes & Behaviour Health Working Environment External Environment

6. Knowledge & Skills Attitudes & Behaviour Health Working Environment External Environment Trainee Trainer Post Workplace External Expectations : Experiences : Culture : Support Induction : Resilience : Other Responsibilities

7. Aim 2: TO RAISE AWARENESS OF STRUCTURES AND RESOURCES TO HELP MANAGE SITUATIONS WHERE TRAINEES ARE HAVING DIFFICULTIES

8. GMC Health Boards DME NES Educational Supervisor Clinical Supervisor TPD Royal Colleges College Tutor Trainee

9. NES Support Structure NES Policy Operational Framework Trainee Performance Advisory Group www.nes.scot.nhs.ukwww.nes.scot.nhs.uk > Education and Training > Medicine > Help and Support (bottom left) > Doctors in Difficulty…

10. NES OPERATIONAL FRAMEWORK – Ten guiding principles - Classification of problems - Roles and responsibilities - Levels of seriousness - Resources for remediation and assessment - Ill health - Contact details

11. Guiding Principles 1.Ensure patient safety 2.Address problems as they occur 3.Find out the facts 4.Speak to the trainee – two sides to every story 5.Consider underlying health problems 6.Seek help / guidance if uncertain 7.Set realistic measurable goals 8.Document everything 9.Be proportionate, consistent and fair 10.Confidentiality

12. Aim 3: To EMPHASISE THE PARAMOUNT IMPORTANCE AND RELATIVE SIMPLICITY OF TIMELY INTERVENTION

13. Educational Practice or Clinical Practice  Early Detection  Early intervention  Knowing the processes… …. and who is there to help?  Prevention better than cure!

14. REMEMBER! While all trainees have problems of some sort or another during training, most trainees progress satisfactorily most of the time without coming anywhere near to a definition of ‘doctor with difficulty’