Supporting the Trainee in Difficulty (1 Oct 2026)

This transcript has not been edited for accuracy.

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00:00:18 Dr Ailish Nimmo

So hello and welcome to the Consultant Conversations brought to you by the Recently Appointed Consultants Committee at the Royal College of Physicians of Edinburgh.

00:00:26 Dr Ailish Nimmo

My name is Eilish Nimmo and I'm a member of the Recently Appointed Consultants Committee and I'm a kidney consultant working in Bristol.

00:00:32 Dr Ailish Nimmo

This podcast has been developed to support early career consultants and today we will be discussing supporting the trainee in difficulty.

00:00:39 Dr Ailish Nimmo

I'm going to be joined by my colleague Dr.

00:00:41 Dr Ailish Nimmo

Saira Risdale, who's also a kidney consultant in Bristol and training program director for renal medicine in the southwest of England.

00:00:47 Dr Ailish Nimmo

During my training, at the point of becoming a consultant, I felt I had a progressive increase in the amount of clinical responsibility I had, but I actually had fewer opportunities for formal supervisory roles.

00:00:58 Dr Ailish Nimmo

And I therefore found becoming a clinical and educational supervisor was a new learning curve for me.

00:01:02 Dr Ailish Nimmo

In the next 20 to 25 minutes, we hope to cover some of practical advice, how as a consultant we can help support the training in difficulty.

00:01:09 Dr Ailish Nimmo

So thank you so much for joining us today, Zaira.

00:01:12 Dr Ailish Nimmo

I thought we could start just by asking you quite broadly about the training difficulty.

00:01:17 Dr Ailish Nimmo

I think this is a term that is used quite frequently, but maybe you could run over a bit about what you think this actually means in clinical practice.

00:01:24 Dr Saira Risdale

So having a training difficulty means many different things.

00:01:26 Dr Saira Risdale

So there are things that are quite obvious, really.

00:01:28 Dr Saira Risdale

So in terms of things like clinical underperformance, people may be struggling with exams, but there are many other things.

00:01:34 Dr Saira Risdale

So things like problem for the team fit or behaviour problems in terms of

00:01:39 Dr Saira Risdale

of having leadership responsibilities and how people might cope with that and attitudinal problems.

00:01:44 Dr Saira Risdale

And then I think, obviously, people will go through things in their personal lives or face other challenges.

00:01:48 Dr Saira Risdale

So there might be some health concerns or some other things relating to well-being or mental health problems.

00:01:54 Dr Saira Risdale

So I think it covers a really wide spectrum of issues which trainees might face.

00:01:59 Dr Ailish Nimmo

And how common do you think this is?

00:02:01 Dr Ailish Nimmo

Do you think it's something which we under-recognise in our role as a consultant?

00:02:05 Dr Saira Risdale

I think it is actually very common.

00:02:07 Dr Saira Risdale

I think probably the kind of traditional thinking was that you might get one trainee in your sort of supervisory role who might have a particular difficulty, but actually I think it is under-recognised and it is very common.

00:02:18 Dr Saira Risdale

And I think some of the things that we see, they might be really significant at a particular time point in someone's life or when you're supervising them.

00:02:26 Dr Saira Risdale

And then some of those things may improve.

00:02:29 Dr Saira Risdale

But there's definitely under recognition of trainees who are in difficulty.

00:02:33 Dr Saira Risdale

And I think part of what you need to do as a supervisor, as a training programme director, is to be able to work out how to recognise issues which trainees might be facing.

00:02:42 Dr Ailish Nimmo

And I guess leading on from that, then you've talked about trying to recognise the problem.

00:02:46 Dr Ailish Nimmo

What kind of signs do you think it's

00:02:48 Dr Ailish Nimmo

important that we look out for that might identify a trainee that is struggling.

00:02:52 Dr Saira Risdale

So I think probably patterns of behavior, so things like people sort of repeatedly turning up late for work or calling in sick repeatedly, perhaps not using the usual channels to call in sick or maybe by doing it on a WhatsApp group rather than more formally.

00:03:07 Dr Saira Risdale

Things about how much of people's clinical work, like are they kind of performing to the standard expected for their level of training?

00:03:12 Dr Saira Risdale

Are there issues going on with people's health that you might be able to pick up on, you might be able to see that they don't look very happy at

00:03:18 Dr Saira Risdale

struggling, and then thinking about things like exam performance and where people should be in terms of progression.

00:03:22 Dr Saira Risdale

So I think there are lots of things to look for.

00:03:25 Dr Saira Risdale

You might have a trainee who's moving into your region from somewhere else or from another hospital within that region or elsewhere.

00:03:31 Dr Saira Risdale

You might have been given some notice that there have been some issues for this particular person, and that's helpful if you've got some background, but sometimes even when there has been an ongoing issue,

00:03:42 Dr Saira Risdale

and other people have known about it and then there are some too, but information isn't always passed on.

00:03:47 Dr Saira Risdale

you're kind of reliant on either some information from someone else or by trying to notice and recognise what's going on with the trainee himself.

00:03:56 Dr Saira Risdale

I think it's difficult to think about where people are in the time point in their training.

00:04:01 Dr Saira Risdale

We were discussing that people might be on the same rotor, but you might have an ST4 who's brand new to your specialty, and you might have an ST7, and you have to recognise that they're not able to perform to the same level.

00:04:12 Dr Saira Risdale

And are they safe, and are they competent, and are they able to function at the level that's needed?

00:04:18 Dr Saira Risdale

And if not, then what extra support do they require?

00:04:22 Dr Ailish Nimmo

And I guess maybe just following on from that last point that we obviously work with trainees that are kind of a whole range of experience.

00:04:29 Dr Ailish Nimmo

How can you distinguish between what might be like a normal learning curve and somebody who's just at the early part of their training versus something that might raise like genuine concern about an individual's kind of clinical performance?

00:04:43 Dr Saira Risdale

I think that's really difficult, isn't it?

00:04:44 Dr Saira Risdale

But I think that's where it's important to look at the trainees progression over time.

00:04:48 Dr Saira Risdale

And I think actually this is where being a supervisor, whether that's clinical educational

00:04:51 Dr Saira Risdale

is absolutely crucial and why you do need to meet the trainee early and have a conversation with them about where they think they are and why it's important for them to do assessments over the course of their training time.

00:05:02 Dr Saira Risdale

There's this definite pattern to people, which is that they often get all of their assessments done in the months prior to ARCP.

00:05:09 Dr Saira Risdale

But actually to be able to assess someone's progress over time formally and not just by you as an individual, but by the wider group of people who are working with that person is very helpful.

00:05:17 Dr Saira Risdale

And I think people generally are quite good if they feel the trainee is underperforming clinically

00:05:22 Dr Saira Risdale

a team or multidisciplinary team will often feedback to the educational clinical supervisor.

00:05:27 Dr Saira Risdale

But it gets about then how is that reported and what are you going to do with that information?

00:05:31 Dr Ailish Nimmo

And I think that's one of the things that I have found maybe more challenging as a supervisor because we often don't always work directly with our trainee on a regular basis.

00:05:42 Dr Ailish Nimmo

And that means that you might not have your own kind of personal experiences of seeing their clinical performance or identifying things like people turning up late or sickness absence.

00:05:52 Dr Ailish Nimmo

for example.

00:05:53 Dr Ailish Nimmo

Do you have any advice on how you pick up on those difficulties when you aren't working regularly with the trainee?

00:05:59 Dr Ailish Nimmo

And I suppose maybe as you've alluded to, that's where it's important for us to feed back to other people as supervisors on individuals that we have worked with.

00:06:07 Dr Saira Risdale

Yes, absolutely.

00:06:08 Dr Saira Risdale

So I think that is really tricky.

00:06:09 Dr Saira Risdale

I've often supervised trainees who I might have met once and never worked with them clinically, and then you're being asked to provide a report for them.

00:06:15 Dr Saira Risdale

So some centres might discuss trainees regularly and that might be at all grades, so they have a progress report,

00:06:22 Dr Saira Risdale

think they're doing and get that wider view.

00:06:25 Dr Saira Risdale

It's important for trainees, depending again on the level of their training, to ask for placement supervision group feedback.

00:06:32 Dr Saira Risdale

And Geneva Tab and MSF is an excellent way of being able to assess what's happening with the trainee.

00:06:37 Dr Saira Risdale

But you also want to encourage your colleagues to raise concerns if there are concerns about that particular individual and about how they do that.

00:06:44 Dr Saira Risdale

So verbal feedback in the corridor is one thing, but you need to have some formal written feedback, whether that's in an e-mail or an e-portfolio

00:06:53 Dr Saira Risdale

in order to be able to assess what's happening.

00:06:55 Dr Saira Risdale

People like rota coordinators.

00:06:57 Dr Saira Risdale

So how much sickness has this person had?

00:06:59 Dr Saira Risdale

How are they reporting it?

00:07:00 Dr Saira Risdale

Are they doing it through the official mechanism or are they doing it more informally?

00:07:04 Dr Saira Risdale

And also trying to meet with your trainee regularly.

00:07:07 Dr Saira Risdale

As a supervisor, you should be meeting your trainee obviously at the beginning of their placement.

00:07:10 Dr Saira Risdale

Some people might welcome or want to make a placement review.

00:07:13 Dr Saira Risdale

And actually, I think that's quite valuable.

00:07:15 Dr Saira Risdale

It's not mandatory, but to be able to meet your trainee a couple of months within their four month placement if they're not in higher specialist training,

00:07:22 Dr Saira Risdale

can be really helpful.

00:07:23 Dr Saira Risdale

And that's an opportunity then to review how they are in general, their progress, their portfolio and curriculum requirements.

00:07:29 Dr Saira Risdale

So I think there are a number of ways of doing it, but it's about being quite proactive and encouraging reporting from your colleagues.

00:07:35 Dr Ailish Nimmo

Yeah.

00:07:37 Dr Ailish Nimmo

Recognise that sometimes trainees feedback on the portfolio will be good or certainly satisfactory.

00:07:44 Dr Ailish Nimmo

But as you've said, these kind of corridor conversations, sometimes as a supervisor, you receive verbal feedback from other colleagues, which raises a concern about an individual's performance, but that might not be documented on the ePortfolio, for example.

00:07:58 Dr Ailish Nimmo

I find that situation quite difficult because without it being formally written down, you maybe don't have the objective evidence to have a discussion with them about.

00:08:07 Dr Ailish Nimmo

Do you have any suggestions for how you might manage a situation like that?

00:08:11 Dr Saira Risdale

I think if you're giving informal feedback about a trainee, I mean, really what you need is to formalise that.

00:08:16 Dr Saira Risdale

And if the person themselves doesn't have the mechanism to do that, because obviously the trainee needs to raise a ticket in order for that person to complete an assessment about them, and they may not do that in that scenario or they may never ask that person, then you would probably need to do a review with the trainee and then document that on the ePortfolio that way.

00:08:32 Dr Saira Risdale

So certainly from the TPD perspective, if things aren't documented on the ePortfolio, then

00:08:37 Dr Saira Risdale

There is no other kind of mechanism formally of being able to review that and look at that.

00:08:41 Dr Saira Risdale

So it has to be documented in the e-portfolio somewhere.

00:08:44 Dr Saira Risdale

And that's what I would suggest.

00:08:46 Dr Saira Risdale

So you can have a mid-point appraisal or you can have an educational meeting any time during someone's training.

00:08:52 Dr Saira Risdale

And so I think if a particular concern was raised, that would be the way to do it and do that with the trainee so that they are fully aware of what's going on.

00:08:59 Dr Ailish Nimmo

And I guess as TPD, do you have any other techniques that you have done to try and broaden the range of feedback?

00:09:06 Dr Ailish Nimmo

So for example, encouraging trainees to get feedback from different individuals.

00:09:11 Dr Ailish Nimmo

I suppose we all naturally have certain people that we might gel with more easily that we get feedback from, but that might not be representative of the wider team.

00:09:20 Dr Saira Risdale

Yes, so I think that is a natural tendency, isn't it, for people to ask for feedback from someone who they're friends with or who they know is going to give them good feedback.

00:09:30 Dr Saira Risdale

to get feedback from the wider team, so the whole multidisciplinary team and having a number of responses and several have to be from consultants, but it should be not just from doctors, it should be from lots of people that are allied to the medicine.

00:09:43 Dr Saira Risdale

So that is helpful, I think, and to encourage your trainee to do that.

00:09:45 Dr Saira Risdale

So when you have your meeting, just to let them know they need to have the spectrum cross section of all the people they're working with.

00:09:51 Dr Saira Risdale

And I think the placement supervision group for foundation doctors is really helpful because it's the educational supervisor who was asking various

00:09:59 Dr Saira Risdale

of work to that doctor.

00:10:00 Dr Saira Risdale

So then you're getting again, a much broader view of actually feedback for that particular person.

00:10:06 Dr Ailish Nimmo

Yeah, that's a really good point.

00:10:07 Dr Ailish Nimmo

I think maybe you mentioned before as well that you've had times where in an ARCP setting, you've advised individuals to have different feedback for the following year, for example.

00:10:18 Dr Saira Risdale

Yes, absolutely.

00:10:19 Dr Saira Risdale

So yes, to ask people to get to a broader group of people to do it early in the year so it can be assessed earlier in the year.

00:10:25 Dr Saira Risdale

And we've had some individuals who maybe have had MSF that was less

00:10:30 Dr Saira Risdale

and ask them to repeat the MSF, so to do that within that one-year time period rather than just waiting until the next ALCP.

00:10:37 Dr Saira Risdale

So I think if an issue is identified, and I guess this is a very broad point, that once an issue has been identified by the trainee, then there are ways that you can try and improve things.

00:10:46 Dr Saira Risdale

And there are particular issues with feedback, for example, getting another MSF within six months and getting a time scale by which the trainee has to fulfil that is something that can be really helpful.

00:10:54 Dr Ailish Nimmo

And I suppose once you've identified that there might be a problem, one of the next difficult things is how

00:11:00 Dr Ailish Nimmo

actually have that conversation with the individual trainee.

00:11:03 Dr Ailish Nimmo

Do you have any advice about how you might approach a trainee when you have concerns about their performance or any kind of helpful phrases that you use to try and broach this conversation?

00:11:14 Dr Saira Risdale

I think one of the things to do is to obviously get in touch with the trainee to let them know that you need to have a meeting with them.

00:11:19 Dr Saira Risdale

And I think to do all of that over e-mail is obviously not appropriate.

00:11:22 Dr Saira Risdale

So you just need to kind of arrange a face-to-face meeting with them in private at a time when they're ready to hear what might be coming.

00:11:28 Dr Saira Risdale

I think generally that's

00:11:30 Dr Saira Risdale

The person needs to be ready to hear it and to know that what you're giving them is feedback.

00:11:33 Dr Saira Risdale

So I think you need to think about, obviously, patient safety, but you need to think about the well-being of the trainee.

00:11:40 Dr Saira Risdale

You really need just to have a very open and honest conversation.

00:11:43 Dr Saira Risdale

And I think the way of doing that is by asking the trainee how they think things are going and how they're getting on and then letting them talk.

00:11:50 Dr Saira Risdale

And I think if there's maybe some under-recognition from the trainee about what might be happening, then I think you do then need to step in and say, well, there have been some concerns about this or

00:12:00 Dr Saira Risdale

I've had some feedback and I think we need to discuss it.

00:12:02 Dr Saira Risdale

So really you have to balance honesty and integrity and you really need to think about obviously patience but you need to think about the trainee who's in interview as well.

00:12:12 Dr Ailish Nimmo

And I suppose you say that the trainee being ready to receive feedback is really important.

00:12:18 Dr Ailish Nimmo

I suppose sometimes individuals might have a recognition that things maybe haven't been going as smoothly as

00:12:24 Dr Ailish Nimmo

they would have hoped.

00:12:25 Dr Ailish Nimmo

Do you have any advice on individuals who maybe don't have that level of awareness?

00:12:31 Dr Ailish Nimmo

Because I imagine that's a more difficult situation to approach.

00:12:34 Dr Saira Risdale

I think that is very difficult.

00:12:36 Dr Saira Risdale

And I think that that is a situation that probably we will all encounter at some point in our lives as consultants and as supervisors.

00:12:42 Dr Saira Risdale

And I think it is really going gently, but not losing that sense of honesty.

00:12:47 Dr Saira Risdale

So saying, how do you think it's going here, and this is some of the stuff that I've heard, and what do you think about this?

00:12:54 Dr Saira Risdale

you might not be able to do that all in one meeting you might need to have multiple meetings with the trainee, but it isn't.

00:13:00 Dr Saira Risdale

You'd never want to be in a situation where a trainee is struggling in any sense, and they don't know.

00:13:06 Dr Saira Risdale

And I think that's one of the things I was going to mention is that you should never put something in an e-portfolio, I don't think in any way, especially in terms of feedback, that the trainee isn't expecting to see or isn't expecting to hear.

00:13:17 Dr Saira Risdale

If you've identified an issue with the trainee's performance or leadership skills or attitude, then that's a conversation that needs to be had, and not necessarily by you, but saddened by the ES.

00:13:30 Dr Saira Risdale

But if not, then I think that's a gentle and open and perhaps multiple conversations that you need to have.

00:13:35 Dr Ailish Nimmo

And I suppose that kind of maybe leads on to thinking about how you actually then provide them with some advice or support.

00:13:43 Dr Ailish Nimmo

I realize if you are having to give feedback to an individual, you want to provide some suggestions or ideas for next steps for them rather than

00:13:52 Dr Ailish Nimmo

something that is more open-ended.

00:13:54 Dr Ailish Nimmo

I guess I wondered if you could talk us through some of the support mechanisms that are available on a sort of day-to-day basis once you've identified A struggling trainee or trainee in difficulty.

00:14:05 Dr Ailish Nimmo

Do you have any examples of any interventions which you've used or seen that have helped make a real difference to trainees?

00:14:12 Dr Saira Risdale

Yes.

00:14:12 Dr Saira Risdale

So I think it depends what the particular issue is for that trainee.

00:14:15 Dr Saira Risdale

So I think if it's a clinical issue, then you might need some extra mentoring or clinical mentoring.

00:14:21 Dr Saira Risdale

So they might need someone else where they can go to for clinical questions or advice.

00:14:25 Dr Saira Risdale

And that's difficult day-to-day when everyone's obviously busy and stretched, just to know that there's somebody there that you can speak to.

00:14:32 Dr Saira Risdale

And they might need a bit of time off the rota, if that's possible, within the structure of the rota.

00:14:36 Dr Saira Risdale

So I've seen that somebody has been supernumerary for a short period of time while they were

00:14:42 Dr Saira Risdale

their clinical skills.

00:14:44 Dr Saira Risdale

I think if there are particular issues around communication, there are communication skills courses that the trainee can access.

00:14:51 Dr Saira Risdale

There's obviously an all trust well-being teams who can offer additional support and about psychological support or further signpasting.

00:14:59 Dr Saira Risdale

In our trust, we have a staff psychology service, so they can help with all sorts of things.

00:15:02 Dr Saira Risdale

But in terms of work-related issues, they can do things like confidence training and helping with kind of coaching and mentoring.

00:15:09 Dr Saira Risdale

The TPD, obviously, even if you're a supervisor and you

00:15:12 Dr Saira Risdale

need some more advice, you can escalate things to your TPD, and they can signpost more things.

00:15:17 Dr Saira Risdale

But the deanery is actually also a really good source of support.

00:15:20 Dr Saira Risdale

Most deaneries will have a professional support unit, and that covers all sorts of things.

00:15:24 Dr Saira Risdale

So actually, our deanery provides coaching, mentoring, communication skills courses.

00:15:29 Dr Saira Risdale

So there's lots and lots of other things that you can access.

00:15:31 Dr Saira Risdale

And I guess also thinking about things like getting-- if there's a particular problem with mental health or physical health.

00:15:39 Dr Saira Risdale

making sure the trainee is in contact with their GP and better in touch with occupational health as well.

00:15:44 Dr Saira Risdale

So I guess one of the things I would say, one of the key things is that you don't have to take all of this on yourself.

00:15:50 Dr Saira Risdale

And it's really important to have some boundaries.

00:15:53 Dr Saira Risdale

If you've got a trainee who's in difficulty and as a supervisor, you very much feel that you want to make it better.

00:15:58 Dr Saira Risdale

You want to help and support them.

00:16:00 Dr Saira Risdale

And of course, you are doing that, but you cannot do it there yourself.

00:16:03 Dr Saira Risdale

And you have to maintain some personal boundaries for yourself because if you've got a trainee who's in significant difficulty and you're

00:16:09 Dr Saira Risdale

to manage it all alone, then that's a huge burden on you as the individual as well.

00:16:13 Dr Saira Risdale

So yeah, definitely reach out for support to other people and definitely don't feel like it's all your responsibility to make it better.

00:16:20 Dr Ailish Nimmo

Yeah, definitely.

00:16:21 Dr Ailish Nimmo

I think that's really helpful advice.

00:16:23 Dr Ailish Nimmo

I was just reflecting on some of the kind of clinical support that you were talking about there.

00:16:28 Dr Ailish Nimmo

So perhaps considering restructuring of the rota for the trainee period of time that's supernumerary.

00:16:33 Dr Ailish Nimmo

Do you have any advice on how you balance

00:16:37 Dr Ailish Nimmo

that level of support while also maintaining, I guess, a degree of privacy for the trainee.

00:16:44 Dr Ailish Nimmo

Not everybody wants their issues to be known about more widely.

00:16:49 Dr Ailish Nimmo

And if there are changes to rotas, that's obviously going to have an impact on a kind of broader level of the team.

00:16:55 Dr Ailish Nimmo

Do you have any advice on how you might approach that?

00:17:00 Dr Saira Risdale

I think obviously the first thing you need to do is speak to the trainee about it.

00:17:02 Dr Saira Risdale

Because if you're suggesting that they're going to be supernumerary, obviously, as you said, it's going to be obvious to everyone else that they're not on the rota.

00:17:09 Dr Saira Risdale

And people will always question why that might be the case.

00:17:11 Dr Saira Risdale

I don't think it's information that needs to be widely disseminated.

00:17:15 Dr Saira Risdale

And I think that is the responsibility of the trainee.

00:17:17 Dr Saira Risdale

And if they want people to know, then that's up to them.

00:17:20 Dr Saira Risdale

I think as the person who's making these decisions, you need to share it with their ES, you need to share it with the rota coordinator.

00:17:26 Dr Saira Risdale

But not everybody needs to know.

00:17:27 Dr Saira Risdale

And people will perhaps make their own

00:17:30 Dr Saira Risdale

incorrectly about why that person is no longer on the rota.

00:17:33 Dr Saira Risdale

But you do have to balance that trainee's individual privacy.

00:17:38 Dr Saira Risdale

And if they want to tell the wider group of people that they work within, that's obviously entirely up to them.

00:17:42 Dr Saira Risdale

But that shouldn't be the role of the supervisor.

00:17:45 Dr Saira Risdale

So really, it should be on a need-to-know basis.

00:17:48 Dr Saira Risdale

Yeah.

00:17:49 Dr Ailish Nimmo

And I suppose having the conversation with the trainee to find out what they may be happy for you as a supervisor to share.

00:17:55 Dr Saira Risdale

Absolutely, yes.

00:17:58 Dr Ailish Nimmo

Yeah.

00:17:59 Dr Ailish Nimmo

I suppose we kind of reflected there that there are lots of mechanisms of additional support that can be provided to trainees.

00:18:07 Dr Ailish Nimmo

I suppose on the less significant end of the spectrum, you might be managing some of these challenges independently as their supervisor or in liaison with some of your other colleagues in the department.

00:18:19 Dr Ailish Nimmo

What certain things should we be looking out for as supervisors by considering when we might need to escalate to look for these additional levels of support or raise

00:18:28 Dr Ailish Nimmo

the concerns with the kind of higher levels of structure?

00:18:31 Dr Ailish Nimmo

And how would you go about doing that?

00:18:33 Dr Saira Risdale

I think if someone's got significant difficulties, so secondly, if someone's got significant psychological difficulty that's affecting not just their well-being but their performance at work, that's probably something you can't manage as an individual supervisor.

00:18:45 Dr Saira Risdale

So you do need to access extra support for the well-being team, through the trainee's GP.

00:18:50 Dr Saira Risdale

I think if there's no sign of progression over time, so if you're meeting your trainee in difficulty regularly and giving them kind of achievable and actionable

00:18:57 Dr Saira Risdale

and objective targets to read, but there's been no sign of improvement, and that's where the feedback from other people is important, then I think that's probably another situation where you need to seek advice from elsewhere.

00:19:08 Dr Saira Risdale

So I think there are things to look out for, and I guess that's one of the important things about very regular contact, which is pressure, isn't it, on the consultant and on the supervisor, but having regular contact with the trainee to see if there has been evidence, and there has to be evidence, obviously, objective evidence that they are improving, that they're making progress.

00:19:27 Dr Saira Risdale

See that, then that's when you're going to need to get support from elsewhere, and some situations might be completely out of your, realm of experience or your remit.

00:19:38 Dr Saira Risdale

it's important to recognise where those situations might be and to get external support and as I said not to manage at all by yourself.

00:19:46 Dr Ailish Nimmo

And I think that leads on into kind of my next question which was I suppose we've been thinking a lot about what support is available for the trainee but obviously as a supervisor or in your kind of consultant role it can be quite challenging particularly if these are situations that you haven't been in before.

00:20:04 Dr Ailish Nimmo

What kind of support exists for the consultants who might be dealing with some

00:20:08 Dr Ailish Nimmo

some of these complex trainee issues.

00:20:11 Dr Saira Risdale

I think speaking to a senior colleague, somebody who's got more experience than you do, I think speaking to your local TPD, because they won't have a whole wealth of experience themselves, but they will also know what might need to be signposted to the deanery, and that might be through the education program manager, who was a particular specialty, or it might be to the deputy deans or the head of school.

00:20:29 Dr Saira Risdale

So if there's a particular training issue, then that's something that they can definitely help with.

00:20:33 Dr Saira Risdale

And I think sometimes what might happen with a trainee who you're supervising can have a significant psychological

00:20:38 Dr Saira Risdale

on you too.

00:20:39 Dr Saira Risdale

So I think thinking about your own well-being and accessing the staff, well-being and psychology service from your own trust.

00:20:45 Dr Saira Risdale

Sometimes that isn't necessary if you're dealing with a particularly difficult situation.

00:20:49 Dr Saira Risdale

But I think reaching out to your colleagues, your TPD, thinking about when to escalate to the deanery and anything about staff well-being are the things that I would recommend.

00:20:57 Dr Ailish Nimmo

And I suppose as your role as TPD, you're there obviously to try and help signpost trainees and support, and you're probably also thinking a bit about your consultant colleagues and their supervisor roles who might

00:21:08 Dr Ailish Nimmo

might be carrying that additional kind of supervisory burden.

00:21:11 Dr Ailish Nimmo

Do you try and manage anything differently in that situation if you know that a consultant has a kind of increased supervisory role?

00:21:19 Dr Saira Risdale

So I think for consultants in that supervisory role, I guess I would try and then keep in touch with them and support them through that.

00:21:25 Dr Saira Risdale

And I think when thinking about allocation of trainees to supervisors, perhaps if someone's had a training difficulty in the previous year and you know that somebody's come in who might have a particular issue, then you might not want to allocate a trainee who

00:21:38 Dr Saira Risdale

difficulty again to that particular consultant.

00:21:40 Dr Saira Risdale

I think it's natural to allocate trainees who may have had a previous difficulty or maybe in difficulty to somebody who you think might be more compassionate or more kind, but equally it does need to be a balance for that particular consultant.

00:21:54 Dr Saira Risdale

I think that's one of the reasons why having a broad range of people in your department is helpful because more senior consultants will probably have had more experience in supporting a training difficulty and it may be that you would then be able to move a trainee who's

00:22:08 Dr Saira Risdale

difficulty to a consultant who has had more experience at dealing with so many situations rather than a new consultant.

00:22:13 Dr Saira Risdale

But lots of this is unpredictable, so you won't necessarily know.

00:22:17 Dr Saira Risdale

But I think it's about having a really open and approachable way of working with your colleagues so that they know that they can come to you for advice and additional support.

00:22:25 Dr Saira Risdale

And I think if a particular consultant is really struggling with a trainee, then the trainee can have a different supervisor.

00:22:30 Dr Saira Risdale

And that's completely fine to do that, as long as the trainee knows why it's not punitive, it's able to provide additional support.

00:22:38 Dr Ailish Nimmo

Yeah, definitely.

00:22:39 Dr Ailish Nimmo

And I think you can really see the potential benefits of having continuity with a supervisor if there are sort of challenges or nuances that that individual is going through and also potential benefits for having a fresh pair of eyes or somebody who's got maybe a different supervisory style.

00:22:55 Dr Saira Risdale

Yes, absolutely.

00:22:56 Dr Saira Risdale

And we thought we're all different, aren't we, in our approaches to people and our own kind of life experience and work experience.

00:23:03 Dr Saira Risdale

So yes, I think sometimes having someone else to see you, whether they formally take on that training is one thing

00:23:08 Dr Saira Risdale

But even having a meeting with someone else who can give, as you said, an objective view on what's happening and what progress might be needed to be made and what actions can be taken, then that can be really helpful.

00:23:19 Dr Ailish Nimmo

As we come towards the end, I wondered if you could reflect on any situations that you have been in which you think you might have handled differently in hindsight or any areas that you think consultants might struggle with in this situation or areas that you think could be done differently.

00:23:35 Dr Saira Risdale

I think the personal reflection for me is exactly what I was talking about before, that when I had a particular training difficulty, I felt like I needed to kind of make her better.

00:23:44 Dr Saira Risdale

And I felt like I could do it all on my own and I didn't need to seek support from anyone else.

00:23:48 Dr Saira Risdale

And I think the boundaries actually between being a supervisor in that situation.

00:23:52 Dr Saira Risdale

and not being the trainee's friend or GP.

00:23:56 Dr Saira Risdale

I think those boundaries became quite blurred from the end for the trainee because I was so desperate to help and it was such a difficult situation for the trainee in question.

00:24:05 Dr Saira Risdale

And I think actually reflecting on that now, that took quite a toll on me, a personal toll actually, and it was an ongoing situation for many months.

00:24:11 Dr Saira Risdale

So I think reflecting on that have really made me appreciate the importance of setting some boundaries and also seeking support earlier and that's one of my bigger recommendations from this

00:24:22 Dr Saira Risdale

conversation is that no one is an island and you don't have to do it all by yourself.

00:24:27 Dr Saira Risdale

So yeah, reach out.

00:24:28 Dr Saira Risdale

There are loads of people who can help you and use them wisely, but definitely use them.

00:24:33 Dr Ailish Nimmo

Brilliant.

00:24:34 Dr Ailish Nimmo

Thank you so much, Saira.

00:24:35 Dr Ailish Nimmo

I think my reflection actually is that even when you are not the supervisor for a trainee as well, it's important that we maintain our responsibility to give feedback and not leave all of the responsibility to one person because when it is shared, it is definitely much easier.

00:24:51 Dr Saira Risdale

Yes, absolutely.

00:24:52 Dr Saira Risdale

And actually, this is probably another tip at the very end is that if you are completing feedback forms for somebody in the ePortfolio, just ticking boxes with no comments as a TPD, it's really hard to then get an impression of how that trainee is doing.

00:25:03 Dr Saira Risdale

if you can put any comments, whether they're good, whether they're constructive, whatever it is, it's really helpful to have some comments.

00:25:08 Dr Saira Risdale

Obviously, I've seen lots of portfolios recently, having done my first round of ARCPs, and there were so many just tick boxes with no comments on an individual's performance or ability.

00:25:18 Dr Saira Risdale

And I think to have a bit more granular detail is so valuable, especially when you're reviewing training who you don't know.

00:25:25 Dr Saira Risdale

So that's another top tip for me.

00:25:28 Dr Ailish Nimmo

Brilliant.

00:25:28 Dr Ailish Nimmo

Well, thank you ever so much for joining us, Saira.

00:25:31 Dr Saira Risdale

Thank you so much for having me.

00:25:31 Dr Saira Risdale

It's been pleasure.