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To sum up

The effective management and support of a trainee in difficulty is complex and approaches adopted will vary depending on the nature of the difficulties faced by the trainee and your role in training. However, some general principles are relevant for all.

1. Seek to create an open, trusting relationship with all trainees, where the interplay between work and life is acknowledged and respected.

2. Know your structures and use them well. A trainee in difficulty is likely to require advice and guidance from a range of people, and, as their supervisor, so will you.

3. Keep contemporaneous records of all encounters with the trainee in accordance with employer, deanery and professional body guidelines.

4. Use workplace-based assessments diagnostically. It is vital that you are explicit about labelling all causes for concern and that these are recorded.

5. Set realistic goals for improvement, monitor these and record outcomes. The importance of ensuring clear feedback, based on observable behaviours and with specific suggestions for improvement cannot be overstated here.

6. Remember that trainees in difficulty are also employees in difficulty, who may put patient care or safety at risk. Involve appropriate colleagues with specialist skills within your organisation and your local deanery at an early stage.

7. Don’t underestimate the power of regular ‘developmental conversations’. These may be with the trainees’ educational supervisor and/or with a named mentor who can provide a longer-term sustaining developmental relationship with your trainee.

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