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Trainees with difficulties

All of us are likely to face difficulties at some points in our careers and trainees are no exception. Typical difficulties trainees may face include difficulties with their own health, with (personal) relationships or with career-related concerns. The supervisor’s role with the trainee with difficulties may be limited to the recognition of early warning signs and ‘referral’ to colleagues able to provide specific and/or specialist advice or support. It is really important to maintain supervisory boundaries, and while your medical knowledge and counselling skills may be of value, you must remember you are not your trainees’ doctor or their counsellor.

This section of the module synthesises the types of difficulty trainees may face, their implications and the management and support mechanisms available.

Health issues

Physical and/or mental health issues, e.g. diabetes, depression or epilepsy, may arise during training or be of a long-standing nature, disclosed to an employer but not necessarily to individual supervisors. There may be a need for some staff to be aware of certain health issues in order to handle episodes such as potential loss of awareness in an appropriate manner. More subtle health issues may be difficult to discern, and it is helpful to seek input from a range of sources – such as senior nursing staff, clerical and secretarial staff, in addition to other medical staff in contact with the individual – all of whom may have differing perspectives and insights that will help to build a rounded and balanced picture. Some additional short-term support, changes to duties or time out may be sufficient for the trainee to regain health.

Mental health issues and alcohol and drug misuse are more often not disclosed, but where there is cause for concern and patient care or safety may be compromised, advice should be sought from occupational health and human resources (HR) immediately, as trainees are also employees with service commitments. Significant health difficulties may raise issues around fitness to practise: the GMC provides guidance in these cases. Whatever the health issues faced, it is important to ensure that trainees are treated fairly. The module on  Diversity, equal opportunities and human rights provides  more information and advice.

Personal issues

Trainees may experience difficulties with personal relationships or may have carer responsibilities that impact on their ability to fully engage with their training at times. Where these difficulties are sustained and having an impact on their training or their service commitments, you may wish to involve other members of the team in identifying strategies to support the trainee.

Colleagues in HR will be able to advise the trainee of rights in relation to carer or parental leave, for example. Where the disruption is significant, you may need to involve deanery colleagues in identifying options for time out, flexible training or an extension to the training period.

Career development issues

Recent reform of postgraduate medical education and training, along with changes in selection procedures, have undoubtedly been a cause of anxiety and stress for many trainees. See the module on Careers support for structured guidance on how to help trainees facing difficult decisions with regard to their future careers. This module also provides helpful suggestions on how to guide a trainee who appears to have unrealistic career plans.

In summary, the trainee with difficulties will benefit from a trusting supervisory relationship. As a supervisor, you should feel able to be open about labelling any concerns you may have and be proactive in terms of guiding the trainee to possible sources of advice, support and guidance.

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Further information

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