Enhancing Performance of Medical Trainees -July 2014
Severn Postgraduate Medical Education:
Dr Michael O’Connor – Associate Postgraduate Dean
Mr Alan Cook – Head of Medical Education
Ms Tailte Breffni – Support and Development Manager
Prof Selena Gray – Deputy Postgraduate Dean
Peninsula Postgraduate Medical Education:
Dr Hiu Lam – Associate Postgraduate Dean
TBA – Performance & Support Administrator
Appendix 1 - PSU Expert Panel - Terms of Reference
Appendix 2 - PSU Strategy Group - Terms of Reference
Appendix 3 - PSU Performance Coding Maxtrix
- The following policy has been developed by the Severn & Peninsula Postgraduate Medical Education Professional Support Units (PSU) and should be referred to in combination with the Trainee Support Guide.
- Severn and Peninsula Postgraduate Medical Education PSU believe that every trainee in the HESW medical training programmes should have access to support should they encounter difficulties in their training for whatever reason. The development of a three-level model (low, moderate and high level of concern) is designed to ensure that support is available for trainees at the local education provider (LEP) and HESW level. Where a lower and moderate level of concerns cannot be resolved by trainers at LEP and the relevant specialty schools, escalated referral to the Professional Support Units for additional support is required. For initial guidance on how to support trainees, please refer to the PSU Trainee Support Guide.
- This policy applies to all HESW medical trainees enrolled in a GMC approved programme, in any grade or specialty.
- This policy is designed to provide guidance and information for those who are involved in supporting trainees at various levels, including:
- Educational & Clinical Supervisors
- Training Programme Directors
- Directors of Medical Education
- Heads of School
- Specialty (College) Tutors
- GP Educators
- Much of the research and evidence base relating to this area is covered in Cox, J., King, J., Hutchinson, A., and McAvoy, P (2006). Understanding Doctors Performance. Oxford: Radcliffe Publishing (published in association with the National Clinical Assessment Service of the National Patient Safety Agency). Conclusions from the evidence include:
- A trainee’s performance is affected by a complex array of issues
- The influence of work context and environment should not be underestimated and needs to be fully explored alongside factors in the individual
- Early signs of performance issues are possible to detect and, in most cases, potentially amenable to early intervention
- HESW has responsibility for all doctors in training and is responsible for managing concerns that arise which prevent normal progression through the training process, for whatever reason.
- The PSUs aim to support and encourage the development of medical trainees within a HESW training programme who have been referred or self-referred to the service.
- Patient safety and the safety of the trainee are considered at all times.
- The remit of the PSUs is advisory. This approach does not supersede the assessment role of the Annual Review of Competence Progression (ARCP) or Human Resource (HR) policies at the employer level.
- The PSUs rely on the engagement of the trainee in the process in order to be successful. If the trainee does not wish to engage with remedial or supportive plans, future support or training provision may not be provided.
- The support process will be as transparent as possible to reduce ambiguity.
- The PSUs strive to operate with a clear evidence base.
- The PSUs take a responsible approach to the use of funding and resources.
- The PSUs will refer to appropriate national guidelines when appropriate.
- The PSUs will apply the operational guidelines laid out in the PSU Trainee Support Guide.
- To offer and provide support, advice and appropriate resources to trainee doctors who have been referred or who have self-referred to the PSU.
- To address concerns based on the principle of NCAS management of underperformance in doctors (Performance, Behaviour, Health, and Environment).
- To enable trainers and educators to effectively identify, communicate and ‘triage’ different categories and level of concerns that the trainees may have; in order to formulate the best support plan available; by using the Performance Coding Matrix (see Appendix 3).
- To identify and, if appropriate, fund or partially fund resources offered by external agencies in support of the trainee.
- To offer and provide support and advice to trainers and educators involved in supporting trainees by directing to appropriate resources and documentation. This includes the Trainee Support Guide and training courses.
- To come up with a clear and jointly agreed action plan for the trainee moving forward (please see Appendix 1 in the Trainee Support Guide).
- To review progress through updates from both trainers and trainees and to log outcomes for the purpose of on-going evaluation.
- To take regulator (GMC) advice should a concern call into question the doctor’s fitness to practice
- The PSUs have developed a 3-level model of support for trainees. This is described in detail, along with the roles and responsibilities of those within each level.
- The PSU teams document issues and areas of support in line with the NCAS Performance principle. (Behaviour, Health, Clinical Competence and Environment (Home and Work)).
- Data regarding referrals and self-referrals to the PSUs will be stored confidentially in line with the Data Protection Act and local Information Governance Policies.
- PSUs information will be stored separate to the trainee’s main Deanery training file and will only be accessed by members of the PSUs via a secure access server.
- Information will be shared with parties agreed with the trainee, including external specialist resources and agencies for support.
- Data may be anonymised and used for research purposes to identify learning and development opportunities for the PSUs.
- In undertaking our work the PSUs are committed to working within the framework described in the Equality Act 2010 and fully recognise the protected characteristics described within the legislation.
- Where a situation arises where there is a conflict of interest – e.g. a member of the PSU knowing a trainee or trainer on a personal level – appropriate steps will be taken to address this so that this conflict of interest does not impact on the support provided.
- Each new referral to the PSU for ‘High’ Level support will be allocated a sequential case number and details of the referral logged in a confidential and secure database.
- Each new or self-referral will be allocated a case manager by the relevant PSU.
- Cases are reviewed on a regular basis to ensure action and follow up
- For on-going evaluation, cases will be reviewed by an expert panel on a quarterly basis to provide feedback, advice and guidance, referred to as PSU Expert Panel (See Appendix 1 for Expert Panel Terms of Reference).
- Any trainee within HESW who has been issued with an ARCP outcome 3 (and some outcome 2 if required) will be contacted by the PSU to advise on resources available which they may find helpful for their particular circumstances.
- An annual Strategy Group will be held to ensure on-going informative service development for the PSU (see Appendix 2 for Strategy Group Terms of Reference).
- Staff within the PSU will undergo appropriate training and development.
- A rolling programme is in place to inform and develop knowledge and skills of Educational Supervisors who may be required to support an underperforming trainee This takes the form of a half day workshop.
- It may be necessary for a Transfer of Information (TOI) to take place if a trainee receiving support is moving to a new location/department. This will be discussed with the trainee and is for the purpose of ensuring patient safety as well as the on-going support of the trainee. The principle underpinning this process will be fair, transparent and honest.
- For full details on procedures, please see the PSU Trainee Support Guide and the PSU Trainee Support website: http://www.severndeanery.nhs.uk/about/support-and-development/trainee-support/ (amalgamated with Pen – under development)
- National frameworks and guidelines that may be referred to by the PSU include, but is not limited to:
- NACT Guidelines
- NCAS Guidance documents
- GMC Good Medical Practice
- GMC The Trainee Doctor
- GMC Gold Guide 2014
- UKFPO Guidance documents
- DoH Maintaining High Professional Standards
PSU Expert Panel – Terms of Reference
For on-going evaluation, cases will be reviewed by the panel on a quarterly basis to provide feedback, advice and guidance, referred to as the Expert Panel
Objectives and scope
- This is a forum of panel members whose purpose is to review current complex cases being handled by the PSU.
- The aim of such a review is to:
- Provide advice and guidance to the PSU with regards to whether it is felt adequate support is being provided to individuals accessing the service.
- Adequate support is defined as support which aims to, within the limits of available resources, promote the individuals own well-being and safety, whilst also ensuring patient safety or the safety of others is not compromised.
- The scope of the Expert Panel is therefore to:
- Review current complex cases in terms of their history, resources put in place and future actions
- Provide feedback, advice and guidance as to whether it is felt these plans are appropriate
- Provide feedback, advice and guidance on other options the PSU could consider for each complex case.
- Provide expert HR advice where appropriate
- The Expert Panel will not:
- Formally evaluate the effectiveness of the PSU service. This will be conducted through regular and Annual Reports to the Postgraduate Dean, as well as through qualitative evaluation of Trainee experiences in accessing the service.
- Take over the management of any of the complex cases discussed.
Roles and responsibilities
- Members will consist of individuals representing Members of the SPME/PPME executive teams in order to advise on wider processes and guidance.
- Members of the support teams across Severn and Peninsula
- Members will be bound by confidentiality and must not discuss any of the details of the cases disclosed during the Expert Panel meeting with any other party outside the Panel.
- If a member of the Expert Panel recognises a case and feels there is a potential conflict of interest, they must immediately declare this. The other panel members may deem it appropriate for this individual to remove themselves from the Panel whilst the case is discussed and to rejoin when discussions have concluded.
Process and timeframes
- ‘Complex Cases’ for discussion at the Expert Panel will be identified prior to the meeting.
- Notes will be taken at each meeting and these will be stored securely and electronically by the PSU. They will not be distributed to members of the Panel in order to ensure data protection and confidentiality.
- The Expert Panel will meet on a quarterly basis each year where possible.
Professional Support Unit Strategy Group – Terms of Reference
An annual Strategy Group will be held to ensure on-going informative service development for the Trainee Support team.
Objectives and scope
- The Strategy Group is a forum of key stakeholders of the PSU whose purpose is to inform and guide the strategic direction of the PSUs in the HESW footprint
- The Strategy Group will review the principles and objectives of the PSU services as outlined in the Policy.
- The Strategy Group will consider what systems work well, what could be improved and what other processes or resources could be drawn upon.
- The Strategy Group will provide valuable feedback, advice and guidance to help inform the strategic direction of the PSUs.
Roles and responsibilities
- The Strategy Group will consist of key stakeholders involved in the PSUs, including:
- Those detailed in the Three-Level Trainee Support Framework (e.g. Educational Supervisors, Programme Directors, Directors of Medical Education, HoS).
- Individuals representing employers across the Severn & Peninsula footprints, including Human Resource/Medical Staffing personnel.
- Occupational Health representatives.
- Representation from Careers Guidance services.
- Trainee representation – ideally a representative from Foundation and a representative from Higher Specialty training.
- Representation from Severn and Peninsula PME executive team.
- Representation from HESW PSUs.
- Attendees will be bound by confidentiality and must not disclose any data discussed during this meeting with any other party without gaining written consent and confirmation from the PSUs.
Process and timeframes
- Up to date data on referral figures and patterns across the year will be discussed at this meeting but will be anonymised to prevent identification of individuals who have accessed the service.
- No confidential case details will be discussed at this meeting without gaining the individuals prior consent.
- Notes will be taken at this meeting to inform future strategy development for the PSU.
- Strategy Group meetings will take place annually where possible.
PSU Performance Coding Matrix
- Trainees requiring high level support are referred with a Triggered Code(s) using the PSU coding matrix. This will ensure consistency, clarity and communication amongst trainers and PSU staff.
- There are 3 levels of concern: Low (L), Moderate (M) and High (H).
- Low level of concern denotes progression of training is unthreatened (no anticipated change of CCT date).
- Moderate level of concern denotes progression of training may be threatened (CCT date may be changed).
- High level of concern denotes progression of training is threatened (anticipated change of CCT date).
- There are 4 indicators: Performance (P), Behaviour (B), Health (H) and Environment (E).
- Each indicator is subdivided into more specific domains by a numerical value.
- Each domain has a specific descriptor for referrer to use.
- More than one referral code may be used for a single trainee.
- A typical code is represented by a letter (indicator) eg P, B, H or E; followed by a numerical value (domain) and a letter (level of concern). For example a trainee who fails a professional college examination requiring extension of training may be coded as P3H.
- Trainees referred or self-referred are divided into 3 categories:
- New trainees referred to PSU
- Support to trainees initiated by PSU and requirement for regular review at PSU expert panel
- Trainees in whom regular review by Expert Panel is no longer required.
- Blackened boxes in the matrix denote automatic escalation of level of concern due to significance of concern.
- Coding Matrix as below: