• If you have reached this page because you have concerns about a trainee, you should refer to our Trainee Support Guide for information on how to support a trainee. 

  • If you need additional help, please speak to your Programme Director, Director of Medical Education and/or Head of School.

  • If you would like to make a referral to Severn Postgraduate Medical Education, please complete our Referral Form. 

Severn Postgraduate Medical Education is committed to providing a comprehensive resource base for trainers in order that you feel equipped with the right information to support trainee doctors experiencing issues which are disrupting their training progression. If you have any queries or would like to make a referral, please email SevTraineeSupport@hee.nhs.uk.


Overview of the research: 

It is not uncommon for doctors to experience personal or professional difficulties at some point in their career which can impact directly or indirectly upon work or training and for which one may require additional support. Such difficulties can include personal health, confidence, exam failure, relationship with colleagues, family cancerns and career uncertainty to name a few.

Such issues often (though not always) present themselves when a trainee is not progressing satisfactorily in their training programme, either in their technical clinical ability or in their professional interaction with others – for example with patients or colleagues. International literature has illustrated that approximately 6% of doctors experience performance concern at some point in their career and it is speculated that this figure is actually much higher in reality. 

The model below is used by the NHS Resolution (formerly National Clinical Assessment Service (NCAS)) to help categorise the types of different issues that can arise:

NCAS Triangle

 Analysis of the data NHS Resolution has collected shows that performance issues are not mutually exclusive in origin, but often are the result of overlapping isues:

NCAS Statistics

Sample = 1472 cases handled by NHS Resolution Dec 2007 – Mar 2009.


Processes - responsibilities and who to contact 

Severn PGME - Professional Support and Well-Being Team (PSW) has adopted a levels-approach when supporting a trainee, starting off at the level of the trainee’s supervisor and finishing at the level of the Severn PGME. The framework recognises that most doctors at some stage in their career will encounter personal and/or professional issues that may affect training progression. Early identification, support and management by the appropriate people can improve the chances of resolving such issues.

The levels are not independent of each other and communication is important.


Level 1

This level represents trainees with minor concerns or dilemmas, presenting a potentially low risk to patients, themselves or others, for which a formative developmental approach is appropriate. For example, trainees who are missing some information from their e-portfolio or who have failed to obtain the required response rate for Multi-source Feedback (MSF)

These trainees will be primarily supported by their Educational or Clinical Supervisor with support from the appropriate School and / or the local Director of Medical Education. Educators and supervisors should use this guide to assess and document what support and actions have been put in place for the trainee at this level (see Appendix 1).

The local Director of Medical Education should always be kept informed of any local issues in line with local trust processes and policies.

Level 2

Level 2 represents trainees with issues that, if left undetected or unresolved could pose a moderate risk to the individual trainee, patients or the organisation, but are not yet sufficiently serious to warrant disciplinary action. For example, trainees who need to develop a particular clinical competence area, or who are showing signs of poor health.

At this stage advice and guidance should be sought from the Programme Director, Associate Postgraduate Dean (GP), Head of School or Director of Medical Education. Advice can also be obtained from Human Resources, Occupational Health and the Trainee Support team at any stage for specialist support and development opportunities for the trainee.

Level 3

This level represents trainees with serious concerns and/or repetitious performance issues for which specialist input and resources are appropriate. Examples can include repeated absence from work without explanation, poor relationships with colleagues or visible signs of stress and anxiety.

Issues at this level may also represent a high level of risk to patients and others and therefore requires a skilled approach. At this stage, you can recommend and advise the trainee to contact the Professional Support and Well-Being team at SPME so that they can access further support and development resources. It will also be appropriate to ensure that Human Resources and your Medical Director are aware of the serious concerns raised. In some extreme cases, suspension from work may need to be considered in order to protect patient safety and indeed the safety of the trainee.

It is important that you remain closely involved through liaison with SPME while this support is being put in place and good communication should be maintained at every stage.

**Patient safety issues MUST be reported to the DME as soon as they become apparent so that they can inform the MD. Trust HR and SPGME should also be immediately informed**


Severn PGME Professional Support and Well-Being Referral

If you feel you are dealing with a complex Level 3 issue, we recommend you contact Severn PGME for advice and support. Referral of a trainee for support can be made by completing in the Referral Form and emailing it to SevTraineeSupport.SW@hee.nhs.uk

Please be aware that joint meetings between the Professional Support and Well-Being Team here at Severn PGME are confidential and sharing of any action is agreed with the trainees.

When to involve Human Resources and/or Occupational Health

  • If the issue impacts upon the trainee’s employment contract, for example, periods of sick leave or absence from work, then HR should be informed of the situation
  • If there is concern regarding the impact of the trainee’s health on the work environment, or of the impact of the work environment on the trainee’s health, then Occupational Health should be consulted. This often leads to a referral.

Important Considerations

  • Managing issues at a local level very much depends on how confident you feel in dealing with certain issues and how much experience you have of this. Always ask if you are not sure.
  • Do not attempt medical diagnosis of your trainee; leave that to the experts – for example Occupational Health, Clinical Psychologists and Educational Psychologists.