Professional Conduct Challenges in Medical Training
A trainee faces suspension over unprofessional social media behavior, while another trainee's poor attendance leads to probity concerns. The discovery of locum work raises questions. In a separate case, a patient disputes a recorded examination by a trainee. The challenges of handling such issues in medical training are explored.
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SOCIAL MEDIA The local trust suspends an ST2 whilst investigating an The local trust suspends an ST2 whilst investigating an unprofessional entry on her Facebook page. It was a unprofessional entry on her Facebook page. It was a comment about the comment about the behaviour behaviour of colleagues (who work at a work at a neighbouring neighbouring) trust at a party. You cannot ) trust at a party. You cannot access the comments. access the comments. How would you handle this? As her TPD, or her trainer? How would you handle this? As her TPD, or her trainer? of colleagues (who
PROBITY An ST1 obtained leave from his hospital consultant to attend HDR. An ST1 obtained leave from his hospital consultant to attend HDR. She did not attend HDR and did not send apologies. Her attendance at HDR was poor. She did not attend HDR and did not send apologies. Her attendance at HDR was poor. On being challenged by the TPD, the trainee stated that there had been a family On being challenged by the TPD, the trainee stated that there had been a family emergency as she was setting out for HDR. This was a domestic issue in London emergency as she was setting out for HDR. This was a domestic issue in London relating to a lost key. When asked by the consultant about it her story was relating to a lost key. When asked by the consultant about it her story was changed. She subsequently complained because the failure to attend HDR was changed. She subsequently complained because the failure to attend HDR was written as unauthorised absence in her Educators Notes. written as unauthorised absence in her Educators Notes. How would you deal with this? What issues does it raise? How would you deal with this? What issues does it raise? Please turn over Please turn over
Subsequent to this, you discover that the trainee had actually been doing a locum Subsequent to this, you discover that the trainee had actually been doing a locum shift on that afternoon at a nearby trust. shift on that afternoon at a nearby trust. Does this make a difference to your actions? Does this make a difference to your actions?
PROBITY 2 A trainee in general practice records a detailed examination of a patient, and A trainee in general practice records a detailed examination of a patient, and confirms their findings during debrief. confirms their findings during debrief. The patient subsequently consults you and tells you they were disappointed with the The patient subsequently consults you and tells you they were disappointed with the previous consultation as they had not been examined at all. previous consultation as they had not been examined at all. What would you do? What would you do? What if the trainee is adamant that they did the examination and that the patient What if the trainee is adamant that they did the examination and that the patient must have forgotten? must have forgotten? Would it be different if this was not the first occasion that a patient had disputed a Would it be different if this was not the first occasion that a patient had disputed a recorded examination by this trainee? recorded examination by this trainee?
VAGUE CONCERNS You are preparing an ESR for an ST1 after 6 months in hospital posts. He has failed to You are preparing an ESR for an ST1 after 6 months in hospital posts. He has failed to arrange a meeting at the correct time, so this is 2 months late. arrange a meeting at the correct time, so this is 2 months late. You read his CSR for O&G and Gen Med and see some concerns about his interaction You read his CSR for O&G and Gen Med and see some concerns about his interaction with nursing staff, and his punctuality which is poor. He has completed the with nursing staff, and his punctuality which is poor. He has completed the minimum required assessments, but all at the last minute, and you do not minimum required assessments, but all at the last minute, and you do not recognise recognise the names of all the assessors, one of whom is identified as ST . His the names of all the assessors, one of whom is identified as ST . His MSF score is rather low, but there are very few comments to suggest why. MSF score is rather low, but there are very few comments to suggest why. There are not many log entries (18) and none have been read or validated. His There are not many log entries (18) and none have been read or validated. His curriculum coverage is low as a result. He has recorded no significant events, nor curriculum coverage is low as a result. He has recorded no significant events, nor professional conversations. professional conversations. At the ESR he is pleasant and listens to your concerns, saying he has talked to his CS At the ESR he is pleasant and listens to your concerns, saying he has talked to his CS about them, and that he will try to improve. about them, and that he will try to improve. What ESR outcome would you give him? Would you record your concerns? If so, What ESR outcome would you give him? Would you record your concerns? If so, where and how? Would you talk to the TPDs to find out more? What tools can you where and how? Would you talk to the TPDs to find out more? What tools can you use to identify concerns more precisely, and quantify them? use to identify concerns more precisely, and quantify them?
EDUCATIONAL PRESCRIPTIONS A trainee has failed the CSA and been awarded an extension for 4 months. The ARCP A trainee has failed the CSA and been awarded an extension for 4 months. The ARCP panel has advised shared surgeries, video review amongst their list of panel has advised shared surgeries, video review amongst their list of educational interventions. educational interventions. The only place you can find for him is a partner down (long term illness) and has only The only place you can find for him is a partner down (long term illness) and has only one trainer. The trainee seems to expect at least one whole shared surgery per one trainer. The trainee seems to expect at least one whole shared surgery per week. The trainer feels unable to do this, as it limits his patient s access in a week. The trainer feels unable to do this, as it limits his patient s access in a difficult time. difficult time. What would you advise? What would you advise?
TRAINEES ON EXTENSIONS You are a TPD trying to place a trainee who has failed the CSA three times, and has a You are a TPD trying to place a trainee who has failed the CSA three times, and has a 3 month full time extension for his final attempt. His scores so far suggest he is 3 month full time extension for his final attempt. His scores so far suggest he is unlikely to pass the next time without a lot of input. You do not have a place in any unlikely to pass the next time without a lot of input. You do not have a place in any of your experienced training practices. The only place available is in a practice of your experienced training practices. The only place available is in a practice with a trainer who started only 6 months ago, and has had one ST1. with a trainer who started only 6 months ago, and has had one ST1. What might you do to support this trainer? What might you do to support this trainer? Is there an alternative to placing the trainee here? Is there an alternative to placing the trainee here?
SICKNESS ABSENCE A trainee (ST1) has frequent short sickness absences A trainee (ST1) has frequent short sickness absences often weekends. weekends. often centred centred around around Over the first year, they have had 49 days in total. Reasons given have included viral Over the first year, they have had 49 days in total. Reasons given have included viral diarrhoea diarrhoea, headaches, migraine, flu, gastritis, back pain . , headaches, migraine, flu, gastritis, back pain . What issues do you need to consider? What issues do you need to consider? What would you do about it? What would you do about it?
TRAINEE NOT ENGAGING An ST1 is allocated to you for Educational Supervision. You fail to make contact with An ST1 is allocated to you for Educational Supervision. You fail to make contact with him for his first ESR despite many attempts, by email, phone and educators note. him for his first ESR despite many attempts, by email, phone and educators note. At the time for the second ESR he fails to respond again. AT this point he has At the time for the second ESR he fails to respond again. AT this point he has made 9 log entries, done no assessments at all, and is obviously not engaging made 9 log entries, done no assessments at all, and is obviously not engaging with his portfolio in any meaningful way, nor with you. with his portfolio in any meaningful way, nor with you. What should you do? What should you do? Can you do an ESR with a trainee who won t engage and do their bit? Can you do an ESR with a trainee who won t engage and do their bit?
REFER TO PANEL You have just completed a mid year ESR on your trainee. You have just completed a mid year ESR on your trainee. You have concluded that they are not making satisfactory progress and you press the You have concluded that they are not making satisfactory progress and you press the refer to panel button on the ESR. refer to panel button on the ESR. What else should you do? What else should you do?
SHARED TUTORIALS You are in a practice with more than one trainer and trainee. You are in a practice with more than one trainer and trainee. You learners are often at different stages of their training and vary in their You learners are often at different stages of their training and vary in their background. background. What steps could you take to ensure shared tutorials are appropriate and useful? What steps could you take to ensure shared tutorials are appropriate and useful?
A TRAINEE APPROACHES YOU! A trainee who thrived with you for their 4 months in ST1 is now at another practice A trainee who thrived with you for their 4 months in ST1 is now at another practice and struggling after 6 months of their ST3 year. and struggling after 6 months of their ST3 year. The trainee approaches you and knowing you have spare capacity asks if they can The trainee approaches you and knowing you have spare capacity asks if they can change to your practice. change to your practice. How would you handle this situation? How would you handle this situation?
SHARING THE LOAD Your learner needs to know more about the management of Your learner needs to know more about the management of childhood asthma. You have a nurse who is particularly strong in childhood asthma. You have a nurse who is particularly strong in this area. this area. You plan to put the learner in to one of her clinics. You plan to put the learner in to one of her clinics. What are the key considerations? What are the key considerations?
LEGAL TRAINEE ERROR You have received a formal complaint from the mother of a 12 yr old You have received a formal complaint from the mother of a 12 yr old child your trainee saw last week. child your trainee saw last week. The mother states that the trainee was very rough when examining The mother states that the trainee was very rough when examining the child s ears and throat, and made the child cry. the child s ears and throat, and made the child cry. By coincidence this was videoed, and having watched the By coincidence this was videoed, and having watched the consultation you would agree with the mother. consultation you would agree with the mother. What are the implications for you and the practice? What are the implications for you and the practice?
LEGAL EMPLOYMENT Your learner s behaviour is not satisfactory. They are continually late Your learner s behaviour is not satisfactory. They are continually late for work, and disappear in the middle of the day, often leaving for work, and disappear in the middle of the day, often leaving paperwork, results and prescriptions outstanding. They have not paperwork, results and prescriptions outstanding. They have not responded to feedback from you as their trainee, and the practice responded to feedback from you as their trainee, and the practice manager. manager. Whose job is it to sort this out? Whose job is it to sort this out?
EQUAL OPPS You are due to take your first GPST1 in 3 weeks. At an informal You are due to take your first GPST1 in 3 weeks. At an informal meeting they tell you that they have had problems with anxiety and meeting they tell you that they have had problems with anxiety and miss their family (Inverness). They have applied for 80% less than miss their family (Inverness). They have applied for 80% less than full time training, and are requesting Fridays off. full time training, and are requesting Fridays off. How do you handle this? How do you handle this?
EQUAL OPPS RELIGIOUS MATTERS You have a trainee who has asked for a quiet place to pray during You have a trainee who has asked for a quiet place to pray during lunch time and in the early evening. There is a room he can use lunch time and in the early evening. There is a room he can use (broom cupboard) but this affects his ability to attend practice (broom cupboard) but this affects his ability to attend practice education meetings twice a week. education meetings twice a week. Options? Options? What would you What would you really really do? do?
LEGAL You discover that your trainee has not got indemnity cover, despite You discover that your trainee has not got indemnity cover, despite having been reimbursed for this. He has been seeing patients in the having been reimbursed for this. He has been seeing patients in the practice for almost 3 months. practice for almost 3 months. What do you do? What do you do?
