Educators

Please find below a list of FAQ’s covering guidance for educators in supporting trainees.

What is the Thames Valley Professional Support and Wellbeing Service (PSWS)?

The PSWS is dedicated to helping doctors, dentists and pharmacists in training across the Thames Valley fulfil their career potential. We are a group of case managers and coaches who put trainee support and wellbeing at the heart of what we do. Our services include enhanced exam support, wellbeing services, personal coaching and mentoring to address career and performance improvement needs, and workshops and information designed to support career choices.

Is there a Trainee Information Section which my trainees and I can refer to?

Trainees can access Trainee FAQ’s and further information here.

Additional wellbeing resources are available on the Trainee-curated Wellbeing Resource Hub here.

My trainee is having repeated difficulties passing their exams – what support does the PSWS provide?

It is important for a trainee not to sit an exam if they know they have not been able to put in the necessary revision, whatever the reason(s), to give a reasonable expectation of passing.

Not all trainees will pass their postgraduate exams on their first attempt, even if they have put every effort into preparing for them. The first step to improving the chance of gaining a pass is to recognise the need for further support.

Please see the Exam Support page here for more details about the different services on offer including vocal and performance coaching, and help with exam anxiety.

We automatically screen every referral for exam support for dyslexia. Dyslexia specific guidance is available here.

Trainees can self-refer for support with exams at any stage.

Two consecutive unsuccessful attempts at an exam must prompt Educator discussion with the trainee about referral for Exam Support, with their consent.

What are the possible signs that a trainee is struggling?

The following points may be useful to bear in mind when you are thinking about a trainee that you are concerned about:

Work-based: Absence from duty, persistent lateness, poor time management, backlog of work, failure to learn and change.

Clinical performance markers: Over or under investigating, poor decision-making, poor record-keeping, complaints, failure to follow guidelines, missed diagnosis.

Psychological/Personality: Irritability, unpredictability, forgetfulness, highly self-critical, perfectionism, arrogance, lack of insight, denial, risk-taking, impulsive.

Social: Isolation, withdrawal, poor personal interactions.

Cognitive: Memory problems, poor problem-solving, poor reasoning, poor decision-making, poor concentration, lack of attention, learning problems.

Language/Cultural:  Poor verbal fluency, poor understanding.

What are the guiding principles for accessing trainee support through the PSWS?

When deciding whether to escalate a concern, it is better to react too soon and find on further enquiry that there is no problem, rather than to ignore problems, only to discover that they are serious and complex. In your encounters with trainees, keep in your mind at all times, ‘do I have a concern for this doctor’s progress, their wellbeing and any forthcoming ARCP?’

There are three support levels for addressing concerns:

Level 1: Educational and Clinical Supervision- Support needs that are relatively minor and are likely to be resolved during the current placement. (the lead educator will be the CS or ES)

Level 2: Support network in Trust or Specialty School with a lead educator (ES/TPD) – Support needs that are relatively minor but are unlikely to be resolved during the current placement.

Level 3: Lead Educator (ES/TPD/Patch GP AD/HOS) referral to the PSWS for access to case managers, coaches and other specialist support – Support needs which if left unaddressed might lead to potential risk to patients, or affect the trainee’s progression through training, or their health and wellbeing.

If you have a concern, then gather further information from colleagues who know the trainee in a sensitive and confidential manner to gain a broader understanding of the situation. If concerns remain, and you are not the trainee’s educational supervisor, then you should make the trainee’s educational supervisor aware of your concerns (Level 1 Escalation).

Once informed, the educational supervisor should then formulate an action plan (Level 2 Escalation) being sure at all times to keep the trainee informed of their concerns and involve them in the decision-making process. Concerns of this level should be discussed with the trainee’s local Foundation Programme Training Director/Specialty Training Programme Director/College Tutor. (The DME may also be informed as part of local employer support arrangements.)

Thereafter, unresolved concerns, or those likely to prove more challenging from the outset, should be considered for Thames Valley PSWS referral by the lead educator and the DME must be informed (Level 3 Escalation).

Issues of patient and personal safety take precedence over all other considerations in line with GMC standards.

Patient safety issues MUST be reported to both the DME and Clinical Lead or Clinical Director as soon as they become apparent so that they can inform the MD.  The Postgraduate Medical or Dental Dean will also be informed.

If the trainee refuses consent to be referred to the PSWS, the educator should sensitively explore reasons around this (e.g. lack of knowledge about the PSWS, concerns about stigma, worries about how information will be shared) and direct them to the Trainee FAQs to help answer some of these questions. If the trainee still refuses to consent, this should be noted in the educator reports and discussed with the DME (if involved).

Trainees do not have to engage with the Thames Valley PSWS, but as the purpose is very much about supporting them to make progress with their training, they should be encouraged to do so. Their engagement demonstrates a professional commitment to their practice, which is looked upon favourably. If they do not engage, they may miss out on valuable support.

For all escalation levels, it is very important, on an on-going basis, to document the concerns, actions and related correspondence. This should be stored confidentially in line with Information Governance and Data Protection guidelines.  If you have any doubts about how to proceed then please contact a Thames Valley PSWS case manager for further advice via tel: 01865 932 088 or email: psw.tv@hee.nhs.uk 

Principles of enhanced trainee support

·       Coordination – the lead educator should take an overview of the situation and coordinate the process and people involved in supporting the trainee.

·       Communication – with all members of the educational team working around the trainee as well as with the trainee

·       Patient safety – keeping the CS working with the trainee informed and ensuring adequate handover at post changeover

·       Transparency – information should be shared with the trainee at the earliest opportunity and ideally in a face to face meeting

·       Objectivity – information should be based on specific, factual evidence, avoid anecdotal or second-hand information

·       Record keeping – at all levels, all meetings and statements need to be recorded factually and accurately and the records stored by the lead educator.

When to refer your trainee to the PSWS?

Consider early referral at Level 2:

If there is concern that the support needs may escalate to Level 3, we encourage the lead educator (ES/TPD) to consult with a PSWS case manager to discuss whether earlier educator referral to our services might be a useful supportive and preventative measure and/or refer directly.

Level 3 escalation:

If serious concerns about a trainees practice because of conduct, capability, or health, and those that do not respond to processes at Level 1 and 2

Level 3 support:

DME’s must always be made aware of trainees requiring Level 3 support, by the lead educator.

Can you provide some examples for levels of concern for educators to use when deciding whether to refer to the PSWS?

Concerns about Capability:

Low Level of Concerns

– Insight into capability issues.

– Performance difficulties are not serious or repetitive.

– Does not attempt to perform tasks when not capable.

– Takes responsibility for the task, and ensures that it is completed under supervision or completed by an appropriate colleague.

– Seeks advice and supervision appropriately.

– Demonstrates expected improvement in areas of weakness.

– Demonstrates the ability to learn from experience.

Medium Level of Concerns

– Limited insight into capability difficulties.

– May attempt to perform low risk or simple tasks when not capable, but then seeks advice and supervision.

– Demonstrates some improvement in areas of weakness.

– Demonstrates some ability to reflect and learn from experience, but there are still concerns in this area.

– Repeated sick leave often of short duration and possibly associated with on-call.

– Repeated avoidance of acute situations.

High Level of Concerns

– No insight into lack of capability.

– Performance difficulties are serious or repetitive.

– Attempts to perform high risk task(s) when not capable.

– Inability to communicate effectively.

– Repeated inappropriate delegation of clinical responsibility.

– Repeated inadequate supervision of delegated clinical tasks.

– Ineffective ingrained clinical team working skills.

– Does not seek appropriate advice or supervision, therefore putting patients at risk.

– If unable to complete the task, does not ensure that it is completed by a colleague.

– Seems unable or unwilling to improve in areas of weakness.

– Does not demonstrate the ability to reflect and learn from experience.

– May make formal complaints about colleagues who express concern about capability.

Concerns about Conduct or Professional Behaviours:

Low Level of Concerns

– One episode of minor misconduct only (N.B. need to check that there have not been any episodes in previous posts).

– Individual agrees when challenged that conduct was inappropriate.

– Demonstrates remorse for misconduct.

– Demonstrates the ability to reflect and learn from experience and there is no evidence of further misconduct.

– Seeks advice appropriately on conduct and associated issues.

– External factor present (family/financial/work related/evidence of stress).

– Detailed work history available and no concerns.

Medium Level of Concerns

– Two or three episodes of minor misconduct (check back to other posts).

– Individual agrees when challenged that conduct was inappropriate.

– Demonstrates appropriate remorse for misconduct.

– Demonstrates the ability to reflect and learn from experience, but some very minor concerns about conduct may remain.

– Sometimes seeks advice on conduct and associated issues.

High Level of Concerns

– Repeated episodes of minor misconduct, or one or more episodes of serious misconduct.

– Individual does not agree that conduct was inappropriate, or denies misconduct.

– No expression of remorse.

– Unable to demonstrate the ability to reflect and learn from experience.

– Unable or unwilling to accept advice on conduct-related issues.

– No external contributory factors.

– Work history difficult to verify/previous concerns.

 If there are Health Issues, please consider if Occupational Health Services should be involved:

Low level of concern

– Insight into difficulties.

– Takes appropriate time off sick.

– Insight into limitations caused by health issue.

– Seeks help and advice appropriately (from own GP or occupational health or appropriate colleagues) and follows this advice.

– Responds to concern raised by colleagues and modifies behaviour appropriately.

– Complies fully with all treatment and reasonable adjustments to workplace roles/conditions.

Medium Level of Concern

– Limited insight into difficulties.

– Continues to work whilst moderately unwell.

– Limited awareness into limitations caused by health issue.

– Seeks advice appropriately but appears reluctant to follow this.

– Some appropriate response to concerns raised by colleagues.

– Complies on the whole with all treatment and reasonable adjustments to workplace roles/conditions.

High Level of Concern

– No insight into health problem.

– Continues to attend work even when obviously unwell.

– No insight into clinical limitations caused by health issue; may jeopardise patient care.

– Does not seek help or advice for health issue.

– Unwilling or unable to respond appropriately to concerns raised by colleagues.

– Does not comply with treatment or reasonable adjustments.

What circumstances generally escalate to a level 3 concern?

Serious and/or repetitive performance problems (conduct, capability or health) and/or high level concerns with risks to patients and others (see ‘Can you provide some examples of levels of concern?’ above) which:

– Require a skilled and consistent wider educational system approach to support

– May require targeted or enhanced support approach

– May need help with language and communication issues

– May result in the trainee having to be released from training

ARCP Outcomes and referral to the PSWS

– Educators and their trainees should be discussing whether PSW Services could be helpful long before an ARCP

– No ARCP outcome necessitates a mandatory referral to the PSWS

– BUT! Any outcome that is not a 1 or a 6 should prompt careful consideration of the issues and whether PSWS support could be helpful – call or email to discuss with us if unsure

– Outcome 4 or Resignation from scheme: Trainees can self-refer for 3 sessions of coaching as part of ending the training contract

How do I refer a trainee to the PSWS?

We have moved to online referral forms for all referrals. See educator referral form.

Trainee consent to the referral must be obtained and documented.

We no longer request CV’s, ES reports, ARCP reports to be attached to the referral.

Contact us: Tel: 01865 932 088 or email: psw.tv@hee.nhs.uk 

Can trainees self-refer?

Yes, for a number of different services

However, any educator performance concerns at Level 2 needing PSWS input should be referred by educators, and at a Level 3 must be referred by educators. The DME must be alerted by the lead educator (TPD/HoS) if there are high level (Level 3) concerns.

Services Accessed Directly Through the PSWS:

– Coaching for wellbeing

– Career Dilemma

– Career Development

– Exam support (at any stage)

– Online Yoga via PSWinfo.tv@hee.nhs.uk

Allied Services accessed separately (not via PSWS):

Trainees4Trainees peer support group

Medic Support (confidential psychological service for work stress, anxiety and depression)

What if my trainee refers themselves and I want to be involved?

If a trainee self-refers, they will be encouraged (depending on the nature and level of concern) to include their educator in the planning session with their coach and through ongoing discussion of their progress.

However, the involvement of the educator is not automatic or guaranteed. With self-referrals, educator involvement will depend on the trainee choosing and consenting to include their educator.

If the educator wishes to remain involved, the educator must refer the trainee using the form available here.

If concerns about a trainee are at Level 3, the educator must refer to ensure a coordinated approach to supporting the trainee. If the trainee refuses consent to be referred, the educator should sensitively explore reasons around this (e.g. lack of knowledge about the PSWS, concerns about stigma, worries about how information will be shared) and direct them to the Trainee FAQs to help answer some of these questions. If the trainee still refuses to consent to referral, this should be noted in the educator reports and discussed with the DME (if involved).

Trainees do not have to engage with the Thames Valley PSWS, but as the purpose is very much about supporting them to make progress with their training, they should be encouraged to do so. Their engagement demonstrates a professional commitment to their practice, which is looked upon favourably. If they do not engage, they may miss out on valuable support.

If a trainee needs Level 2 support, we would encourage educators to refer to ensure their ongoing involvement but equally it is appropriate for the trainee to self-refer.

What happens following a referral?

All referrals are responded to within 5 working days. A case manager will contact the trainee, usually by e-mail, and they will be offered an appointment to meet (which may be face to face or virtual, by choice or in response pandemic social distancing measures in place at the time).

The trainee will be given sufficient notice of the meeting and the meeting should usually take place during work time. The trainee should not have to use annual leave to attend PSWS meetings.

Every referral will get a 1 hour consultation with one of our case managers to explore and develop a collaborative understanding of reason for contact.

This will include an agreed written summary of the meeting and proposed support plan shared with the trainee, and stored confidentially on the PSWS database according to IG and GDPR guidelines. It is usually advised that the summary, documented during the 1:1 meeting, is shared with the referrer, and other people who may need to know the plan of support. 

After this first meeting, the case manager will agree next steps with the trainee which can include signposting to coaching services within and/or other services outside of the PSWS.

Trainees do not have to engage with the Thames Valley PSWS, but as the purpose is very much about supporting them to make progress with their training, they should be encouraged to do so. Their engagement demonstrates a professional commitment to their practice, which is looked upon favourably. If they do not engage, they may miss out on valuable support.

If the trainee’s support plan includes PSWS services, the trainee’s progress is then further supported by one of our experienced coaches and mentors, and monitored in conjunction with the lead educator (where present).

The trainee is strongly encouraged to reflect on their engagement and learning during their time with the PSWS in Educational Supervision.

COVID-19 arrangements – due to current social distancing requirements, all meetings are being held virtually.

How will I be kept informed and involved in supporting my trainee after I refer?

If trainees refer themselves, there is usually no educator involvement unless

– Coach and trainee agree this as part of ongoing work, with trainee consent, or

– Educator has trainee consent to request this.

If educator has referred (with trainee consent) then

– The case manager/coach will either correspond by introductory email or arrange an initial 3 way meeting,

– followed by an email at midpoint inviting the educator’s comment to further shape coaching conversations, and

– at closure to inform that the work has ended.

– All this will be with the trainee’s consent.

PSWS feedback from trainers has commented specifically on the usefulness of the joint process in supporting the trainee to make progress.

PSWS trainee feedback highlights need to keep stressing confidential nature of the work from the start – with the usual caveats of personal and patient safety.

When should Occupational Health be involved?

The local Occupational Health service in each trust can advise on the impact of work on health, and of health on work. It is important to take advice when a trainee’s health is considered to have the potential to negatively impact patient safety. Advice should also be sought in order to help decide on the appropriateness, and manner, of a return to work, after sickness absence.

HEE-TV offer a Regional OH service through Cordell Health

– This service does not replace local employer OH service provision, nor the OH service provided by the GP single lead employer arrangement, which must be approached for advice the first instance.

– Access to Cordell Health will be for trainees out of training who require OH advice but are not currently employed by a named trust; and

– trainees who have longstanding physical and/or mental health conditions impacting on their training, not just their current work placement, with no consistent OH physician service follow up across region for the duration of their training programme.

– Prior to referral, the HoS should clarify if local OH service is already actively involved

– Referral to the Cordell Health service will be by a senior educator (HOS) and with trainee consent.

The report will be released to the HoS with trainee consent, and should also be discussed with local OH departments for implementation of recommendations.

– For detailed Occupational Health guidance for Educators click here.

This detailed guidance document is specific resource for trainers, and serves two purposes:

* a general educator faculty development tool about OH, when and how to refer; and

* a guide to HEE-TV educators about different types of OH services, emphasising links and processes between Local Employer /Single Lead Employer OHP’s and our HEE-TV Regional OH Service via Cordell Health

Would I ever have to consider informing the next trust and/or HEE local office if a trainee who has had issues moves on?

Yes. There is a professional obligation to inform the next trust and/or local office if a trainee has unresolved issues, or issues that could re-emerge and might have an influence on their practice and/or training. This should be done with the trainee’s knowledge and involvement, and ideally, with their consent. The most appropriate people to inform will depend on the type and level of concerns. This could be the new CS and/or new ES, the Director of Medical Education and Postgraduate Dean.