FAQs for Educators

What is the Professional Support Unit?

The Professional Support Unit (PSU) exists to help get doctors in training back on track with their training. Support may include the dedicated time of Case Managers for 1:1 assessment and support, and, when needed, access to problem specific expertise or supernumerary placement funding.

What is the role of a Case Manager?

Their role is to assess and manage doctors in training referred to the PSU, by carrying out an objective assessment, based on available information and their own findings. They identify what further action is required and access the relevant support. They then continue to support the doctor in training and monitor their progress, reviewing the situation until problems are resolved. A Case Manager will communicate with relevant parties and document their assessments and actions taken.

What are the possible signs of a doctor in training who needs referral?

The ‘Disappearing Act’: - not answering bleeps; disappearing between clinic and ward; lateness; frequent sick leave.

Low work rate: - slowness in doing procedures, clerking patients, dictating letters, making decisions; arriving early, leaving late and still not achieving a reasonable workload.

‘Ward Rage': - bursts of temper; shouting matches; real or imagined slights.

Rigidity: - poor tolerance of ambiguity; inability to compromise; difficulty prioritising; inappropriate ‘whistle blowing’.

‘Bypass Syndrome’: - junior colleagues or nurses find ways to avoid seeking the doctor’s opinion or help.

Career problems: - difficulty with exams; uncertainty about career choice; disillusionment with medicine.

Insight failure: - rejection of constructive criticism; defensiveness; counter-challenge.

Paice, E (2006)

What are the different levels of concern and how are they dealt with?

Level 1: Low Level Concerns - Trust/Specialty

Level 2: Intermediate level Concerns - Trust or Specialty/HEEoE

Level 3: High Level Concerns - HEEoE with access to Remedial training.

What form do PSU ‘level 3’ concerns generally take?
  • Serious untoward incidents
  • Serious and/or repetitious performance problems (health, conduct or capability)
  • Complaints from patients, relatives or healthcare professionals
  • Poor performance in the workplace clinically, managerially or inter-personally
  • No or limited insight into difficulties
  • High level risk to patients and others
  • Failure to engage in the educational process
  • Erratic behaviour or issues around bullying or harassment
How do I make a referral to the PSU?

Level 1 Concerns

Where concerns are of a low level nature, the Educational and Clinical Supervisor, or for GPST in conjunction with the TPD, should discuss these with the trainee and document the discussion by completing the  Professional Support Framework (FORM 2). Information regarding the concern and resolution must be recorded in the Educational Supervisor’s report.

With early intervention, low level concerns will be resolved without further escalation.  Where appropriate, careers support and/or input from Occupational Health may be of benefit.  However any concerns, even if resolved, should be documented and communicated through the Educational Supervisor’s report and e-portfolio for consideration by the trainee’s next ARCP panel.

Level 2/Level 3 Concerns

Where concerns are of an intermediate or serious nature, there should be an escalation of approach within both the Trust and the appropriate Postgraduate School (Foundation or Specialty). The  Professional Support Framework (FORM 2) can be used to guide review and discussion with the trainee.

In addition, the  Professional Support Unit should be notified using a PSU Referral Form (FORM 1). This will normally be undertaken by a TPD or HOS, but may also be an Educational Supervisor. The trainee must be notified that the referral is being undertaken.

What happens after I submit the referral forms?

Referrals are screened and triaged by the PSU Team, then allocated to a clinical case manager and will be invited to a meeting to discuss the concerns raised.  

When should a referral be made to Occupational Health?

The Occupational Health service can advise on the impact of work on health and of health on work. It is important to take advice when a doctor’s health is considered may have the potential to impact their safe care of patients and in order to help decide on the appropriateness and manner of a return to work after sickness absence.

Would I ever have to consider informing the next LETB if a doctor in training who has had issues is moving on?

Yes. There is a professional obligation to inform the next LETB if a doctor in training has unresolved issues or ones that could re-emerge and might have an influence on their practice and/or training. This should be done with the doctor’s involvement and ideally also their consent. The most appropriate people to inform would be the DME and Dean.

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