Performance Unit for the Postgraduate Medical Training in Wales

1. Performance Unit for the Postgraduate Medical Training in Wales School of Postgraduate Medical and Dental Education Cardiff University Neuadd Meirionnydd Heath Park Cardiff CF14 4YS Contact: 029 2068 7417 / 7411 / 7412 Email: General: performance@cf.ac.uk Leona Walsh: walshla@cf.ac.uk Dr Sally Davies: daviessj8@Cardiff.ac.uk Dr Heather Payne: payneeh@cf.ac.uk HOW TO RECOGNISE AND SUPPORT TRAINEES WITH PERFORMANCE ISSUES

2. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales DIFFICULTY FACTS POOR

3. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom NETWORKING

4. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Increase awareness of all training issues. Encourage early identification of concerns Monitor progress and the outcomes Establish networks across Wales. Provide faculty development for clinical & educational supervisors Establish a close relationship with the Individual Support Programme of Cardiff University to provide assessment and remediation for individual trainees. Develop clear protocols for appeals. performance@cf.ac.uk AIMS

5. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Attitude and Behaviour Clinical Performance Communication Health Unsatisfactory Progress SIGNS & TRIGGERS

6. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales Why this trainee? Why here? Why now? CAUSES

7. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales • Dr A is a ST1 trainee in medicine. • She has done her first four months in Dermatology and has been signed up. She started in Emergency Medicine. • Within two weeks you receive complaints from her clinical supervisor that this trainee is unable to cope in the Admissions Unit. She is missing when needed, and allows other trainees / medical students to do things for her. • Is there any immediate challenge or dilemma presented by this situation? • What do you think may be the underlying cause of the problem, and why? • What are you going to do next? SCENARIO

8. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales You speak to the trainee and encourage her to perform observed patient assessment. The clinical supervisor reports that this trainee is lacking in confidence and lacks experience of examination and procedures such as venflon insertion. The clinical supervisor has discreetly asked the previous firm and discovered that she did very little under observation and was generally unavailable when things needed to be done. Dr A has come into Core Medical Training from a trust grade post in Public Health, where she was employed for 4 years. Suggest an immediate action plan and ongoing educational plan for this trainee. SCENARIO

9. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales Do not deal with difficult scenarios on your own Different causes require different solutions Do not wait for the next annual review to raise issues ‘No surprises’ at annual review (ARCP) Contact Deanery Performance Team for support, advice or referral Immediate action once aware of concerns Ask for concerns to be documented Consider appropriate assessments to gain information e.g. MSF Investigate and document yourself Speak to the trainee and document the meeting Feedback is very important KEY PRINCIPLES

10. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales Current status: • 57 active cases • 17 referred June 08 – Sep 08 Cases referred to ISP: • Total since Feb 08: 9 • Active cases: 11 Trainees are being referred earlier! AUDIT MARCH 08 CURRENT STATUS 95 cases were identified • 31 trainees resumed satisfactory progress following a period of support (32%) • 8 trainees left the training programme (8%) • 56 active cases Stage of training • Foundation Programme 1.6% • Core Training 0.2% • Specialty Training 5.6% DATA AUDIT

11. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales REFERRED SPECIALTIES

12. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales REFERAL REASONS

13. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales A Doctor with a disability may have problems with specific aspects of training or the workplace. With the right help and support, training can be kept on schedule. Queries regarding disability issues should be addressed to Dr Heather Payne disabilityequality@cardiff.ac.uk DISABILITY

14. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales • Group of advanced educational supervisors within Specialty Training Schools • Performance Leads within each Specialty Training School • Clear structure for identifying and addressing the issues. • Advice and guidance Provide Training to: • Identify issues early • Feedback identified concerns to the trainee • Keep good contemporaneous documentation FUTURE DIRECTIONS

15. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales • DOCUMENT EVERYTHING • ACT PROMPTLY & COURTEOUSLY • DO NOT PASS THE PROBLEM ON • KEEP ALL PARTIES INFORMED LESSONS LEARNT

16. Developing the Performance Unit for the Postgraduate Medical Training in WalesWalsh LA, Davies SJ, Payne EH, Gallen DDSchool of Postgraduate Medical and Dental Education, Cardiff University, Cardiff, United Kingdom Performance Unit for the Postgraduate Medical Training in Wales QUESTIONS