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Guidance for trainers

It is vital all possible steps are taken to identify and act on early signs of issues which may affect training progress. In most cases, issues are detectable which prevents an issue from escalating.

You as a trainer play a key role in spotting potential issues with a trainee’s progression early. You can then help them put steps in place to prevent things getting worse.


What can affect training?
  • Predisposing factors such as previous ill health, personal issues.
  • Precipitating factors such as acute events, social isolation.   
  • Perpetuating factors such as chronic ill health, organisational issues.

Early identification will reduce the potential risks to the trainee, patients, colleagues and also the organisation. The evidence on prevention of issues suggests that good induction, properly constituted teams, together with effective educational supervision reduces stress and potential challenges.

Signs to look out for

You might spot these stress behaviours:

  • avoidance and difficulty making decisions
  • restlessness
  • paralysed by perfection
  • lower concentration or absenteeism
  • heightened reactions
  • lifestyle impact, such as poor eating, not sleeping and “missing out” on life
  • instant gratifications
  • change of physical appearance.
  • failure to answer bleeps
  • issues with time keeping or personal organisation
  • issues with record-keeping
  • lack of insight or judgement
  • unaware of limitations
  • clinical errors
  • failing exams
  • discussing a career change
  • communication issues with patients, relatives, colleagues or staff.
  • being bullied
  • team working issues
  • bullying, arrogance or rudeness
  • undermining colleagues (e.g. criticising or arguing in public/ in front of patients)
  • frequent sick leave

Act quickly and sensitively, balancing confidentiality and safety. If needed, ask colleagues for documented evidence. Ensure a positive, safe, learning environment - All colleagues should be supportive and non-judgmental.

Ask yourself:

    • ‘Why this trainee?’
    • ‘Why here?’
    • ‘Why now?’


What to do if you spot these signs

  • Encourage commitment to change and a positive outlook.
  • Try to understand the trainee's perspective of their challenges.
  • Listen to the trainee's story and ask for insights from others involved.
  • Speak to the trainee in a confidential setting and document the meeting.
  • Consider assessments to get more information, for example Multi-Source Feedback (MSF).
  • Make the trainee aware that issues have been raised.
  • Ask a colleague to go to the meeting with you so you don’t deal with difficult scenarios on your own.
  • Complete the educational supervisor report to update the trainee’s progression.
  • Don’t wait for the next Annual Review of Competence Progression (ARCP) to raise issues. There should be 'no surprises' at the ARCP.

You can contact the Professional Support Unit (PSU) for support at any point.


Understanding the trainee

Providing the right support to a trainee relies on an understanding of why they’re struggling. Some reasons may include:

  • Capacity: unable to do their job as physical or mental challenges may be causing limitations. Consider changing their role or job.
  • Learning: gaps in skills or not enough training and education. Offer skills-based education tailored to the trainee’s learning style and available resources.
  • Motivation: lack of motivation could be from stress, boredom, bullying, burnout, or an over eagerness to please. Mentoring, counselling, or addressing issues like workload can help.
  • Distraction: external and workplace factors can impact performance. Encourage the trainee to get professional help for external issues.
  • Health: Both chronic and acute health problems can impact a trainee's progress. Occupational health or a visit to a GP may be needed.
  • Alienation: If a trainee has lost interest and commitment, potentially leading to hostility or sabotage, it’s often not repairable and could harm patients and colleagues. The trainee should be moved out of the organisation with support, and disciplinary measures if needed.

If you decide to make a referral to the PSU on behalf of the trainee, you can complete the online referral form. Please ensure you gain their consent so we can engage with them effectively. Learn more about what to expect from the PSU process after you submit a referral.

Alternatively, you can email us on