Early identification of issues with progression can prevent escalation to a more serious situation.
Trainees' performance can be impacted for various reasons:
Early intervention will reduce the potential risks to the trainee, to colleagues, patients and also the organisation. There is evidence to suggest that good induction, properly constituted teams, together with effective educational supervision reduces stress and potential challenges.
You might recognise these stress behaviours:
Act quickly but sensitively, balancing confidentiality and safety:
Successful support for trainees requires an accurate understanding of the underlying reasons for the difficulty, in order to tailor subsequent intervention to the individual's circumstances, personality, abilities or learning style (e.g. McManus et al, 2004). Ask yourself:
There may be any number of reasons.
Capacity - a fundamental limitation that will prevent them from being able to do their job (e.g. mental or physical impairment). If so, then change of role or job may need to be considered.
Learning - a skills deficit through lack of training or education. In these cases, skills-based education is likely to be appropriate, provided it is tailored as closely as possible to the individual learning style of the doctor and is realistic within existing resources.
Motivation - a drop in motivation through being stressed, bored, bullied or overloaded - or being over motivated, unable to say no, anxious to please, etc. In these cases some form of mentoring, counselling or other form of support may be appropriate and/or addressing organisational issues like workload, team dysfunction or other environmental difficulties that may be affecting motivation.
Distraction - something happening outside work to distract the doctor; or a distraction within the work environment (noise or disruption; team dysfunction). The doctor may need to be encouraged to seek outside professional help if the problem is outside work.
Health - an acute or chronic health problem which may in turn affect capacity, learning or motivation. Occupational Health may have a role here; or the doctor may need to be encouraged to visit his or her GP.
Alienation - a complete loss of any motivation, interest of commitment to medicine or the organisation, leading to passive or active hostility, "sabotage" etc. This cannot generally be rectified and damage can be caused to others (patients and colleagues) and to the organisation if allowed to continue for too long. The doctor should be moved out of the organisation, with whatever support or disciplinary measures may be deemed appropriate.