Challenging Trainee Scenarios - Extended Training and Exam Failures
An exploration of scenarios involving trainees facing challenges with extended training, exam failures, lack of support, and feedback issues. Dive into the complexities of trainee experiences and panel evaluations in these scenarios.
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Presentation Transcript
SCENARIO 1 An ST3 trainee has had 4 months whole time equivalent An ST3 trainee has had 4 months whole time equivalent extension to training, and has failed the CSA for the extension to training, and has failed the CSA for the fourth time. WPBA is marked 'competent for licensing' fourth time. WPBA is marked 'competent for licensing' by the ES. AKT was passed a year ago. The trainee by the ES. AKT was passed a year ago. The trainee tells the panel that for his last attempt he was tells the panel that for his last attempt he was distressed by a telephone call just before he arrived at distressed by a telephone call just before he arrived at Euston Square telling him his father had been Euston Square telling him his father had been admitted to hospital after an MI. He has not been in admitted to hospital after an MI. He has not been in contact with the college to report the mitigating contact with the college to report the mitigating circumstances within the required 48 hours. circumstances within the required 48 hours.
SCENARIO 2 An ST3 trainee has had 6 months An ST3 trainee has had 6 months whole time equivalent extension to training and has failed the CSA for the extension to training and has failed the CSA for the third time. During the panel the trainee states that third time. During the panel the trainee states that they have had good support and training in their they have had good support and training in their practices. practices. whole time equivalent
SCENARIO 3 An ST3 trainee has had 6 months An ST3 trainee has had 6 months whole time equivalent extension to training and has failed the CSA for the extension to training and has failed the CSA for the third time. During the panel the trainee states that third time. During the panel the trainee states that they have had difficulties in their recent training they have had difficulties in their recent training practice with no regular debriefing after surgeries, and practice with no regular debriefing after surgeries, and dismissive feedback, often given via dismissive feedback, often given via email, than in person. than in person. whole time equivalent email, rather rather
SCENARIO 4 An ST1 trainee has recorded no significant events at all. An ST1 trainee has recorded no significant events at all. The panel cannot find any log entries which could be The panel cannot find any log entries which could be interpreted as such either. interpreted as such either.
SCENARIO 5 An ST2 trainee working the whole year in hospital has An ST2 trainee working the whole year in hospital has made only 36 log entries in the year. Some are made only 36 log entries in the year. Some are rudimentary, but others show some reflection. At rudimentary, but others show some reflection. At ARCP for ST1 the trainee was awarded outcome 1 ARCP for ST1 the trainee was awarded outcome 1 despite having only recorded 40 log entries for that despite having only recorded 40 log entries for that year. year.
SCENARIO 6 An ST2 trainee's ESR is marked 'satisfactory' but the ES An ST2 trainee's ESR is marked 'satisfactory' but the ES has marked them 'below expectations' for 6 of the 12 has marked them 'below expectations' for 6 of the 12 competences. The attached evidence for this is competences. The attached evidence for this is limited, but tends to support the limited, but tends to support the judgment looks in depth at the log entries and assessments, looks in depth at the log entries and assessments, and decides that the ES has made realistic and decides that the ES has made realistic assessments of the competences. In ST1 there were assessments of the competences. In ST1 there were three competences marked 'below expectations', and three competences marked 'below expectations', and these were the same in the ST2 ESR. these were the same in the ST2 ESR. judgment. The panel . The panel
SCENARIO 7 An ST3 trainee has had two extensions of 3 months each An ST3 trainee has had two extensions of 3 months each following two outcomes 3. She has continually failed following two outcomes 3. She has continually failed to meet the deficiencies in her WPBA throughout this to meet the deficiencies in her WPBA throughout this period. period. Her ST1 and ST2 outcomes were 1. You look Her ST1 and ST2 outcomes were 1. You look for evidence in her e for evidence in her e- -portfolio (including the last two portfolio (including the last two ARCP forms) for a statement warning her of a potential ARCP forms) for a statement warning her of a potential adverse outcome and you find none. adverse outcome and you find none.
SCENARIO 8 An ST3 has failed the CSA twice. Their expected CCT date An ST3 has failed the CSA twice. Their expected CCT date is 3 months after this panel and they have a booked is 3 months after this panel and they have a booked place to attempt the CSA again one month before place to attempt the CSA again one month before their end date. Their ESR is marked satisfactory . All their end date. Their ESR is marked satisfactory . All WPBA is satisfactory. WPBA is satisfactory. You are doing a normal panel without the trainee in You are doing a normal panel without the trainee in attendance. attendance.
SCENARIO 9 You are doing a regular panel reviewing an ST3 with a You are doing a regular panel reviewing an ST3 with a satisfactory ESR. The trainee has passed CSA and AKT satisfactory ESR. The trainee has passed CSA and AKT and all Competences are marked as Competent for and all Competences are marked as Competent for Licensing. Licensing. The trainee s expected CCT date is 66 days from today. The trainee s expected CCT date is 66 days from today.
SCENARIO 10 An ST3 was awarded a 6 month whole time equivalent An ST3 was awarded a 6 month whole time equivalent extension in July. She has failed the CSA and AKT 3 extension in July. She has failed the CSA and AKT 3 times, including recent attempts within the extension. times, including recent attempts within the extension. She has asked you, as patch AD, if she can go to 50% She has asked you, as patch AD, if she can go to 50% LTFT for the remainder of her extension (6 weeks left) LTFT for the remainder of her extension (6 weeks left) in order to allow 4 in order to allow 4th thattempts at both exams. attempts at both exams.
SCENARIO 11 You are reviewing an ST2 portfolio (trainee not present). You are reviewing an ST2 portfolio (trainee not present). You notice that during ST1 the trainee took sick leave You notice that during ST1 the trainee took sick leave so that a hospital post was shortened to 2.5 months. so that a hospital post was shortened to 2.5 months. There is no comment about this in the ST1 ARCP form, There is no comment about this in the ST1 ARCP form, nor in the Educators Notes. nor in the Educators Notes. During this post, the trainee did 2 During this post, the trainee did 2 miniCEX and made 15 log entries, but there is no CSR. and made 15 log entries, but there is no CSR. miniCEX and 2 CBD and 2 CBD
SCENARIO 12 You are on the ARCP panel for an ST3 trainee who, because of some earlier sickness You are on the ARCP panel for an ST3 trainee who, because of some earlier sickness absence and working LTFT at 80%, does not finish his training for another 3 absence and working LTFT at 80%, does not finish his training for another 3 months. This is his annual/ calendar ARCP. months. This is his annual/ calendar ARCP. He has not yet taken the CSA, and has failed the AKT once. His WPBA is rated overall He has not yet taken the CSA, and has failed the AKT once. His WPBA is rated overall as Meets expectations. as Meets expectations. You agree with your colleagues that it is likely he will need longer than 3 months to You agree with your colleagues that it is likely he will need longer than 3 months to achieve the MRCGP, not least because the first available CSA sitting is just achieve the MRCGP, not least because the first available CSA sitting is just beyond his current end date. beyond his current end date. Can you recommend to the trainee that he applies to work at 60% for the rest of his Can you recommend to the trainee that he applies to work at 60% for the rest of his training in order to give himself longer to achieve his MRCGP? training in order to give himself longer to achieve his MRCGP? If he says no, can you insist? Or can you award an extension now? If he says no, can you insist? Or can you award an extension now?
SCENARIO 13 An ST1 trainee is on a panel in August. She has already started the first ST2 post in An ST1 trainee is on a panel in August. She has already started the first ST2 post in hospital. The reason the June ARCP was not done was that this trainee has had hospital. The reason the June ARCP was not done was that this trainee has had no ESR to date. no ESR to date. There are 10 log entries for the year, no WPBA assessments other than one CSR There are 10 log entries for the year, no WPBA assessments other than one CSR which is satisfactory. which is satisfactory. There are many educator s notes giving evidence of repeated attempts to contact the There are many educator s notes giving evidence of repeated attempts to contact the trainee, who appears to have been abroad for some of the time. However, dates trainee, who appears to have been abroad for some of the time. However, dates of absence are not evidenced. of absence are not evidenced. You have no ESR, no Form R, but the trainee is in attendance. You have no ESR, no Form R, but the trainee is in attendance.
SCENARIO 14 An ST3 trainee s final ARCP. You note that he has only done one MSF od 10 An ST3 trainee s final ARCP. You note that he has only done one MSF od 10 responses in the final ST3 year. The scores are high and the comments very responses in the final ST3 year. The scores are high and the comments very positive. He is obviously a good trainee. positive. He is obviously a good trainee. Do you need to insist on another MSF of at least 10 responses? Do you need to insist on another MSF of at least 10 responses? What if the trainee had done one MSF of 9 responses, and one of 8? What if the trainee had done one MSF of 9 responses, and one of 8?
SCENARIO 15 A trainee has done an audit which shows 100% standard met at first data collection. A trainee has done an audit which shows 100% standard met at first data collection. The trainee writes that they plan to re The trainee writes that they plan to re- -audit in 4 months. audit in 4 months.
SCENARIO 16 You are chairing a panel for an ST3 trainee out of sync. She has 10 days left of her You are chairing a panel for an ST3 trainee out of sync. She has 10 days left of her training but is about to start maternity leave after which she will come back for 5 training but is about to start maternity leave after which she will come back for 5 days. days. Everything in her Everything in her eportfolio evidence and all her competences rated Competent for Licensing, and all tests evidence and all her competences rated Competent for Licensing, and all tests passed. passed. eportfolio is satisfactory, with full complement of assessments and is satisfactory, with full complement of assessments and Can you give her an outcome 6? Can you give her an outcome 6?
SCENARIO 17 You are looking at the portfolio of a trainee who has been in post for 6 months at 50% You are looking at the portfolio of a trainee who has been in post for 6 months at 50% LTFT. He deferred his start date, and has been LTFT from the start. The ESR is full LTFT. He deferred his start date, and has been LTFT from the start. The ESR is full of statements from the ES saying that the evidence is lacking to make a full of statements from the ES saying that the evidence is lacking to make a full assessment of progress. assessment of progress. What do you do? The evidence is appropriate for the duration of his training to date. What do you do? The evidence is appropriate for the duration of his training to date.
SCENARIO 18 A trainee about whom there seems to be no concern regarding clinical work, had an A trainee about whom there seems to be no concern regarding clinical work, had an outcome 2 at ST1 because of poor engagement with the portfolio. He was seen outcome 2 at ST1 because of poor engagement with the portfolio. He was seen and admonished and promised to get more organised. He was given a review at 6 and admonished and promised to get more organised. He was given a review at 6 months. months. Although there was evidence of a flurry of activity just after the last panel, it was not Although there was evidence of a flurry of activity just after the last panel, it was not sustained and his portfolio is once again lacking evidence. sustained and his portfolio is once again lacking evidence. What are your options? What are your options?
SCENARIO 19 ST2 trainee ARCP, face to face after Panel Opinion Requested by ES. Only two ST2 trainee ARCP, face to face after Panel Opinion Requested by ES. Only two competences marked Below expectations, not much evidence in log, but competences marked Below expectations, not much evidence in log, but assessments done. assessments done. Comments by ES include problems with behaviour and attitude, abrupt manner, Comments by ES include problems with behaviour and attitude, abrupt manner, patient complaints, impulsive behaviour and rude emails. Also arranging leave patient complaints, impulsive behaviour and rude emails. Also arranging leave with no notice and complaining when admonished about it. with no notice and complaining when admonished about it. There is no Report into Progress, and no evidence that the TPDs/ AD have been There is no Report into Progress, and no evidence that the TPDs/ AD have been involved. When you ask the trainee there has been no meeting with TPDs/ AD involved. When you ask the trainee there has been no meeting with TPDs/ AD either. either. What would you do, and what outcome would you give? What would you do, and what outcome would you give?
SCENARIO 20 ES ratings are very different from those of the trainee: e.g. where they have rated ES ratings are very different from those of the trainee: e.g. where they have rated themselves Above expectations/ Competent for licensing the ES has rated them themselves Above expectations/ Competent for licensing the ES has rated them Meets or Below. However, in the comments boxes the ES has written : Meets or Below. However, in the comments boxes the ES has written : Agree with trainee s evidence Agree with trainee s evidence How do you interpret this? What would you do, if anything? How do you interpret this? What would you do, if anything?
SCENARIO 21 Form R at panel states 13 days Form R at panel states 13 days TooT maternity leave since the last ARCP (which was outcome 8 OOPC). maternity leave since the last ARCP (which was outcome 8 OOPC). TooT, but you can see that the trainee has had , but you can see that the trainee has had Should you put 13 into the ARCP Should you put 13 into the ARCP TooT TooT box? box? Or calculate the number of days maternity leave since the last panel, and add on the Or calculate the number of days maternity leave since the last panel, and add on the 13? 13?
SCENARIO 22 A face to face ARCP for an ST1. They have been engaging well with their portfolio, but A face to face ARCP for an ST1. They have been engaging well with their portfolio, but the ES believes they are struggling clinically. The ES also highlights difficulties the ES believes they are struggling clinically. The ES also highlights difficulties with punctuality and timekeeping. with punctuality and timekeeping. When you look at the portfolio you find many Educators Notes which suggest that the When you look at the portfolio you find many Educators Notes which suggest that the trainee is being assessed at a higher level than they are at trainee is being assessed at a higher level than they are at more like an ST3 trainee. trainee. more like an ST3 The trainee admits they have a lot of medicine to learn, especially in relation to GP, as The trainee admits they have a lot of medicine to learn, especially in relation to GP, as she has not done any GP before, and is also new to the NHS. She admits also that she has not done any GP before, and is also new to the NHS. She admits also that her timekeeping has been less than expected, but hints that the time given for her timekeeping has been less than expected, but hints that the time given for her start (8.30 am surgery) is not really the time she is expected to turn up her start (8.30 am surgery) is not really the time she is expected to turn up (8.00am at the latest). She understands this better now and is trying to attend (8.00am at the latest). She understands this better now and is trying to attend earlier as expected. earlier as expected.
SCENARIO 23 Can you ever hold an ARCP panel and give an outcome when the last ESR was signed Can you ever hold an ARCP panel and give an outcome when the last ESR was signed more than 2 months ago? more than 2 months ago?
