As a trainer and educator, it is increasingly important to have an understanding of the additional needs of neurodivergent individuals who may rotate through the department. This page aims to provide signposting for general cases and also where issues relating to neurodivergence arise.
Regardless of the presence or absence of neurodiversity, an individualised approach to communication with trainees is likely to yield the most positive results. The advice listed here is not a substitute for a personal conversation. For more support, please consider reaching out to the Training Programme Directors, or your local neurodiversity mentors.
You may have a trainee who discloses a diagnosis to you, or you may have been informed by occupational health or a form R. This is a good opportunity to discuss with the trainee whether they feel their diagnosis has an impact on their practice, as well as any support or adjustments they have utilised in the past. The section on Rights and Responsibilities on this hub provides some examples of reasonable and unfeasible adjustments. It is worth bearing in mind that if a doctor is new to the trust they have likely discussed their diagnosis multiple times during the new starter process and repetition can be frustrating.
This is also an opportunity to speak with the trainee about who else in the department they wish to know about their diagnosis. Some individuals are very open about their neurodivergence, whereas others are much more private. Though there will be times where it is necessary to share information about a diagnosis among the team, this should where possible always be done with the individual's consent and knowledge.
If a trainee with a recgonised diagnosis of neurodivergence is struggling, then a conversation should be broached in the same way it would with a neurotypical individual. All germane factors, including neurodiversity, should be explored to try to best support the individual. Where a trainee does not recognise that their diagnosis is having an impact on their practice, the conversation can be challenging and trainers may wish to read the section below on discussing the impact of neurodiversity for additional support.
Your trainee may have come to you to ask about the process for diagnosis. This hub can be a useful starting point for them, particularly the page on learning more about diagnosis. A discussion of the reasons behind seeking diagnosis may be beneficial in case there are other underlying factors affecting the trainee for which support could be offered. An awareness that the process can be significantly longer and more burdensome than anticipated is important.
Alternatively, you may want to suggest a diagnostic or screening process to a trainee where you feel neurodiversity plays a role in challenges that they face (eg. communication difficulties or exam failure). This can be a challenging conversation to have, and some pointers can be found below.
This can be one of the more challenging scenarios that you may find yourself in as a trainer or supervisor. It is possible that the trainee has a diagnosis of neurodivergence, or is aware of their likely neurodiversity but lacks a formal diagnosis. However it may also be the case that they have not considered this possibility. A possible first step is to consider the necessity of a conversation: if the trainee has no attainment gaps and there are no concerns about their wellbeing, it may not be necessary to raise the possibility of neurodivergence. However, it may be that a conversation is required, either because the trainee is perceived as struggling in terms of their own wellbeing; because of an objective measure of progression such as exam failure; or because of concerns raised by yourself or others regarding the trainee's attainment.
When considering how to have these challenging conversations, it is important to consider the impact of a suggestion of neurodivergence and to allow time for individuals to process and think about any suggestions being made.
If a conversation about possible neurodivergence and its impact on training is necessary, it may be worth involving another member of the consultant team - either a local neurodiversity mentor or another member of the educational team (eg. educational supervisor, college tutor). This ensures that those with a responsibility to support the trainee are all aware. In the event of trainee distress this is of particular relevance.
Establishing the facts early on is likely to be important, for two reasons. Firstly, if an issue has been identified then it is important to raise this with the trainee so that they can be aware and hopefully work to rectify it. In addition, establishing the facts that have led to the conversation allows a potential discussion of neurodivergence to be seen as an explanation rather than an accusation. Where possible, the goal is to ensure that you and the trainee are working together to address any concerns. Where feedback is mixed, it is also important to discuss the positives that have been raised.
e.g. I wanted to talk to you today about your multisource feedback. On the whole it has been really positive, with many people saying you are a pleasure to work with. However, two of the people who provided feedback did say they had some concerns and I wanted to speak with you about that.
At this point in the conversation, it may be worth taking a moment to ask the trainee if they were expecting that feedback. This can help to establish whether there is any insight into potential problems. It may also be advisable, if it is appropriate and no immediate patient safety concerns have been raised, to offer the trainee the opportunity to take the feedback away and come back at a mutually agreed upon date to discuss it further. This can allow time to process and avoid feelings of being overwhelmed, which can lead to defensiveness and an inability to move forwards constructively. It may not always be feasible to do this, but where possible it can be of benefit.
If the trainee was expecting the negative feedback, this is an opportunity to ask them whether they have had any thoughts about why they are struggling in this area. They may at this point disclose a diagnosis, or the suspicion of one. This then allows signposting to the resources on this hub and to other services if required.
If the trainee was not expecting the negative feedback, a further discussion of the details of the attainment gap may be of benefit. Providing specific examples where improvement is required is often of benefit, and may allow the trainee to recognise patterns which develop in their practice (eg. communication issues only in high stress situations, reduction in legibility of records on high turnover lists). While a direct comparison to others is unlikely to be helpful, a comparison to expected standards at the trainee's level of practice may help to highlight specific areas for development.
Where you feel that possible neurodivergence plays a role in the issues the trainee is facing, this may be a time to raise it. This is of particular relevance if this is not the first conversation with the individual about an attainment gap. One way of approaching this is to collate the facts that led you as their trainer to consider the possibility of neurodivergence and describe them to the individual as features that can sometimes be hallmarks of neurodivergence. A specific diagnosis may not be appreciated as it may not fit the trainee's personal view of themselves, but a reiteration of the difficulties that have been noted can frame things in a more personalised rather than diagnosis-driven way.
eg. some of the issues that we have talked about today such as feeling overwhelmed in noisy situations, struggling to focus on a task and struggling with deadlines can be associated with a diagnosis of neurodiversity. Is this something you have ever considered might fit your experiences?
If the trainee responds positively, it may be useful to signpost them to this hub to digest the information over a period of time. Arranging a conversation at a mutually convenient time to follow up is likely to be of benefit.
If the trainee responds negatively, this is an opportunity to reframe the conversation around the issues that were initially flagged. It is not necessary for an individual to accept a diagnosis of neurodiversity if they do not want one, but moving the conversation on in a solutions-based manner can allow time for the information to be digested and returned to at a later time. It also allows a trainer to highlight that while accepting a diagnosis is not necessary, accepting that there is an attainment gap is more essential.
It is important to allow a trainee time to improve on their own following an initial discussion. Where patient safety concerns exist these must be addressed immediately (eg. through a period of supervised practice), but many trainees will be able to take feedback away and build their skills given an opportunity. Where this does not happen and a repeat conversation is required, having a second person involved is likely to be of benefit to both the trainee and the trainer. These discussions can be complex and advise can always be sought from the educational team at a local and regional level. Other useful resources may include occupational health, staff wellbeing services, and if necessary the trust leadership structures.