1. Trainees in Difficulty Jim Boddington Hackney Trainers’ Workshop Sept 2012

2. 1.45Intro to session 2.00Trainees in difficulty: strengths as weaknesses; case studies; diagnosis and resolution. 3.00Tea 3.15Issues affecting international medical graduates 4.15Practicalities: when and how to act

3. Deanery definition The nationally accepted term ‘trainee in difficulty’ describes a doctor in training, who needs extra help and support - beyond that which is normally required - to deal with problem(s) that threaten to delay their completion of a postgraduate training programme. The purpose of identifying a trainee as being ‘in difficulty’ is not to label them; it is to aid the addressing of relevant issues so that they may complete their training successfully.

4. In pairs Think of a time when you have had difficulty with your own learning or training.

5. 5 How strengths become weaknesses (Hogan and Hogan, 1997) StrengthDysfunctional behaviour EnthusiasticVolatile ShrewdMistrustful IndependentDetached FocussedPassive-Aggressive ConfidentArrogant CharmingManipulative VivaciousDramatic ImaginativeEccentric DiligentPerfectionist DutifulDependent

6. Case studies Individually, think of a trainee you have supervised and considered to be in difficulty In groups of 3, share your stories (preserving confidentiality) Choose one case to consider in detail, with a view to an educational diagnosis You may need to speculate about underlying causes Don’t engage in problem solving at this stage Invest time in problem definition

7. ASSESSMENT DOMAINS Health and home Personality and behaviour Organisational issues Clinical capability

8. 8 A model for “diagnosis” Capacity Learning Arousal (Motivation) Distraction Alienation

9. 9 What kind of problem is it? Type of problemWhat is it? Capacity A fundamental limitation that is unlikely to change Learning A deficit of knowledge, skills or experience Arousal/ Motivation Boredom ; stress; burn-out; low morale Distraction A problem elsewhere causing a problem here (or illness/health problems) Alienation Deep rooted anger/mistrust, leading to sabotage

10. 10 Matching resolution to diagnosis FactorWhat is it?Resolution Capacity A fundamental limitation that is unlikely to change Change job or role Learning A deficit of knowledge, skills or experience Training (adapted to learning style); feedback (e.g 360°) Arousal/ Motivation Boredom ; stress; burn- out; low morale Coaching, counselling,mentoring; new project or role Distraction A problem elsewhere causing a problem here Set limits; discuss referral to appropriate source of help Alienation Deep rooted anger/mistrust leading to sabotage Move OUT! Or ring-fence OR “negotiated settlement”

11. Case studies (part 2) Back in the same groups of 3, try applying this scheme to your case Clarify the educational diagnosis What strategies might help resolve the difficulties? Role play: trainee, supervisor, observer

12. 12 What predicts the likelihood of change? Do they have the “key” personality traits to help them change? Are they stable enough? Can they persevere? Do they have insight? Are they psychologically minded? Can they reflect on their behaviour and learn from their experience? Do they want/intend to change? Have they a history of successful change attempts? What will motivate them to change? What kind of environment will they be working in? What support is available? What are the contextual factors that may influence their behaviour?

13. RECOMMENDED APPROACH Act early No surprises – involve learner If it isn’t written down it hasn’t happened Objective – fact not opinion

14. IMPORTANCE OF EFFECTIVE FEEDBACK Ask trainee’s point of view and encourage reflection Phrase feedback in descriptive, non-evaluative language Be specific not general Address decisions and actions rather than assumed intentions and interpretations Be constructive – acknowledge appropriate behaviour as well as areas for improvement