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Structure, roles and responsibilities

It is important that clear structures, carefully defined roles and responsibilities, and effective, contemporaneous documentation is in place to support all trainees.

The importance of these mechanisms in supporting a trainee in difficulty has been highlighted by the National Association for Clinical Tutors (NACT UK), whose 2008 guide to managing the trainee in difficulty emphasises the need for supervisors to be aware of local and regional resources and able to access and utilise these appropriately when required.

A summary of roles and responsibilities for those involved in training (adapted from NACT, 2008)

Trainee Holds a contractual relationship with their employer and is therefore subject to local and national terms and conditions of employment

Employing local education provider


Is responsible for management of performance and disciplinary matters yet, should keep the deanery advised of any issues arising. Colleagues in human resources and occupational health may also be involved

Educational and clinical supervisors are likely to be involved in the identification, management and support of the trainee in difficulty. Those with more senior educational roles and responsibilities (e.g. clinical/college tutors, training programme directors, directors of medical education and, ultimately, the medical director) may become involved, depending on the nature and severity of the difficulties faced

Deanery Is responsible for all doctors in training and problems that arise which prevent normal progressions. They can offer a range of support to trainees in difficulty and their supervisors. They also quality manage training programmes and should address any concerns that arise


(General Medical Council)

May be involved where there are concerns around fitness to practise. This extends from undergraduate education through to postgraduate training

Supporting a trainee in difficulty can be challenging: the old adage of a ‘problem shared is a problem halved’ holds true. As a supervisor it is important to access the support and guidance of colleagues with more senior educational roles and responsibilities within your workplace, and also within the deaneries, who hold a wealth of knowledge on how to best support trainees.


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