Managing trainees in difficulty in the healthcare sector


The diagnostic framework and suggested management options attempt to provide guidance on the identification, support and management of trainees in difficulty and to provide clinicians with a systematic approach to dealing with these challenging and often complex issues. The pre-eminence of maintaining patient safety should be paramount when managing trainees in difficulty. Formal management guidelines and protocols from your local LETB/Deanery or NHS employing organisation supersede this guidance in all circumstances.


  • The spectrum of performance problems is wide and ranges from minor, momentary aberrations of behaviour, to major misdemeanours, persistent unprofessional behaviours or even acts of gross criminality.
  • Periods of transition (changing jobs, moving regions, countries/cultures, personal life events etc) can be associated with a deterioration of clinical performance, which may require additional vigilance and support
  • Serious performance issues amongst trainees are rare. This infrequency, together with the trainer’s perceived lack of expertise and the increasing requirement for robust evidence, heightens anxiety and concerns amongst those who may have to deal with such matters when they do occur.


In dealing with any serious performance issue remember that there are often many dimensions to the problem.


  1. A significant number of colleagues come from other countries, cultures and religions where healthcare systems and social/cultural norms are sometimes quite different. This complexity may introduce conflicting tensions and make effective management all the more challenging.
  2. Confounding elements include legal aspects such as health and safety, employment, race, sexual and gender discrimination legislation. There may also be moral, ethical or confidentiality considerations.
  3. HR factors such as bullying and harassment, litigation, industrial tribunals, conflict management, the need for mediation and reconciliation.
  4. Challenge of effective difficult conversations. Communication can be challenging in both verbal & written form, and formal & informal contexts.
  5. Issues around professional accountability and professional registration including your own. Take advice and seek support.


Do not try to deal with complex scenarios on your own!


Escalate and engage local and regional resources at your disposal in a proportionate manner. Effective and fair management of trainees in difficulty requires an objective assessment of the circumstances. It is important to involve an experienced colleague early to assist in identifying and exploring underlying factors and to help set clear goals for improvement. Remember: early and proportionate intervention may prevent problems becoming intractable.


Early intervention is essential if adverse consequences are to be avoided for patients, the doctor concerned and his/her colleagues. Early recognition and appropriate intervention, coupled with effective feedback and appropriate support for trainee and trainer are essential if trainees in difficulty are to be managed effectively and successfully.


Source : NACT UK


Maguire Healthcare Training can assist in developing the practical skills required in this sometimes challenging element of the role and help build confidence.


Alternatively call us on 0333 5777 144 to talk through how we can help you with developing non-clinical skills.

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