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A significant minority of doctors find themselves in difficulty at some stage in their careers. National data is not currently available for trainees but Deanery data suggests 5-10% of trainees may experience problems which bring them to the notice of the Deanery. Only a tiny number (1-2%) are severe persistent problems. Many problems can be resolved with help and support so early identification and management of problems is essential. This benefits not just the doctor but also patients. Although doctors in difficulty often present with a number of issues, it is helpful to look at the different causes.

Types of Problems:

Knowledge and Skills

This are generally easier for us to identify and describe. They should be picked up using the assessment processes now in place in Postgraduate Medical Education. They may come to light as persistent failure at Postgraduate Exams.

Attitudes and Behaviour

In the past doctors displaying unprofessional behaviour were tolerated but this is now not the case and all curricula include appropriate professional behaviour as a mandatory requirement. Patient safety is dependent on good team working and excellent communication

The organisation

Often overlooked is the influence on the workplace on the doctor’s ability to perform well. Excessive hours, poor work patterns, lack of facilities and lack of senior support can all impact on the ability of any doctors to deliver good performance.

Health and Wellbeing

Most doctors are good at separating home and work and preventing personal issues form affecting their performance at work. But major life events will impact on work and should be recognised. In addition to individual health, both physical and mental, this would include other events relating to close family

The Role of the Educational Supervisor

The Educational Supervisor is key to early identification and appropriate support being offered to any trainee, working in collaboration with the Clinical Supervisor and clinical team. Also required will be support from other resources like DME, TPD, HR, Occupational Health, etc.

General principles are:

  1. Early identification and intervention is essential.

  2. Establish and clarify circumstances and fact as quickly as possible, access as many sources of information as possible.

  3. Do not leap to a conclusion.

  4. Poor performance is a symptom not a diagnosis.

  5. Different problems require different solutions.

  6. Clear documentation, written records and clear communication is vital.


1. Managing Trainees in Difficulty NACTUK

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