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Guidance for trainers

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.


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.
  • emotional: angry or upset
  • failure to answer bleeps
  • poor time keeping or personal organisation
  • poor record-keeping
  • lack of insight or judgement
  • unaware of limitations
  • clinical mistakes
  • failing exams
  • discussing a career change
  • communication problems with patients, relatives, colleagues or staff.
  • bullying, arrogance or rudeness
  • lack of team working
  • undermining colleagues (e.g. criticising or arguing in public/ in front of patients)
  • defensive reactions to feedback
  • erratic or volatile behaviour
  • frequent sick leave (Mondays and Fridays especially).

More information is available on how to recognise and support a trainee with performance issues. Information is also available on how to support a trainee with a disability.


What to do if you spot these signs
  • Act quickly and sensitively, balancing confidentiality and safety.
  • Ask colleagues for documented evidence.
  • Speak to the trainee 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 to raise issues. There should be 'no surprises' at RITA or ARCP.

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


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.