This article reflects the conversations in the breakout group on this topic at the Recently Appointed Consultants symposium on Friday 13 March 2015.


Handling poor performance or dealing with trainee doctors who are struggling can be time consuming and feel uncomfortable. It is important to ensure that adequate SPA time is assigned to this aspect of postgraduate medical education. It can be difficult recognising the early warning signs of someone who may be struggling, but once recognised it needs to be discussed. Starting the conversation about someone’s work performance can be tricky and it can be difficult to know how to approach that individual without causing upset or harm. Patient safety must be prioritised and problems addressed as they occur. Initiating a meeting and conversation is important.

The aim of an initial meeting is to be constructive and maintain the trust and confidence of the trainee. It is important to remain fair and confidential if appropriate. If the meeting is not going to be confidential then state this openly. Prior to any conversation, first consider the context in which the problem is occurring. Assess any underlying factors such as high workload or lack of senior support. What you see may just be a symptom of a different or greater problem. Getting the correct facts and gathering evidence prior to the meeting is the main aim. This will allow you to enter into the conversation with an agenda to discuss and a structured approach to the issue. The meetings should be documented. The first rule is to listen, as there are two sides to every story.

When supporting an individual it can be helpful to identify a support network of colleagues within the unit with extra skills, training or with SPA time allocation available to help. Training programme directors and the deanery can also offer support. Where appropriate, share information between colleagues in order to produce a strategy to address the problem.


Supporting Trainees with Difficulties | Scotland Deanery (

PowerPoint Presentation (

Breakout group leader: Ms Fiona Anderson, Training and Education Development Manager, Medical Directorate, NHS Education for Scotland.

Reviewed & links updated September 2021.