Different types of difficulty
In considering ways to best support a trainee who is experiencing difficulties, we have distinguished between three ‘categories of difficulty’. The emphasis of this module is the trainee in difficulty, that is, a trainee who is failing to make satisfactory progress overall or has areas of specific difficulty with their training. However, as a supervisor, you are likely to come across trainees with difficulties of a transient, more personal nature, who for a certain period of time need particular support. Finally, you may also come across trainees who you and others find ‘difficult’ (the so-called ‘difficult trainee’) because of conduct issues. Distinguishing between these different types of difficulty can be seen as a triage process, involving looking for ‘signs and symptoms’ and gathering ‘case’ information, before formulating a diagnosis of difficulty and subsequent management plan. As a supervisor, it is often easier to manage the first two situations than the third, and it is helpful to distinguish problems that arise from current circumstances (see box below) from problems that are related specifically to the personality and behaviour patterns of a trainee.
Common circumstantial problems for trainees
- educational challenges, exams, revision
- anxiety concerning career decisions
- pressure of work, lack of team support
- unfamiliarity, inexperience
- changes in team dynamics
- personal health problems
- sickness within the family
- personal relationship difficulties
- cultural isolation, culture shock (e.g. overseas graduates)
- domestic responsibilities or pressures
It is helpful to apply a triage process to the doctor in difficulty, in a similar way to other clinical problems, by considering the history, the presenting problem, and the relevant social and employment context.
Think of a trainee in difficulty you have supervised in the past.
- How were you alerted to the possible difficulties the trainee had?
- Was it an isolated instance or were you aware of a repeating pattern of concerns?
- What information did you need to help the trainee (e.g. observations, workplace-based assessments, reported concerns from others in the team)?