Dealing with trainee performance: what trainers can expect from the PSU

Consider PSU referral if there are concerns about satisfactory completion of a post, for example a possible RITA D or E, or where there are complex problems unlikely to be resolved using standard training. The earlier the referral is made the better.

If your trainee has a career dilemma or needs to adjust their career for health or personal reasons you can suggest to the trainee that they refer themselves for confidential career guidance.

If you are not sure whether PSU is indicated or would be helpful, contact the PSU for confidential advice on

Trainer report and headings

The Professional Support Unit is not there to take over responsibility from a trainer for a trainee who is in difficulty. The PSU coach works with the trainer who is involved at every stage of the process to help get their trainee back on track.

A clear and detailed report from the trainer is an essential element of an effective coaching process and report headings are suggested below.

Many trainers feel unsure about what to put in a report and many are concerned about putting thoughts and concerns on paper so the PSU coach will make an appointment and come and see you to discuss the issues before seeing the trainee.

Suggested report headings
1. An overview of the situation
2. Summary of the key issues
  • description
  • evidence
  • implications for satisfactory completion
3. The trainee's response to feedback and previous attempts to get back on track
4.  Copy of training record
Previous appraisal reports
Any multisource feedback
Copies of any written complaints

The report should be e-mailed to or given to the PSU coach
All information is kept strictly confidential.

Guidance on writing a formal report is also available, which may be required if a trainee is involved in referral to the GMC or GDC, or there is an issue that involves the courts.

Career Development Needs Report

The Career Development Needs Report (CDNR) normally consists of a confidential one-to-one 2-3 hr interview.
This is a development needs assessment and not a comprehensive assessment of clinical competence. The responsibility for assessing competence remains with the responsible trainer but an accurate development needs assessment depends on a clear report of the issues of concern from the trainer.
The purpose of the needs assessment is to explore how well the trainee understands the feedback they have been given and clarify the issues for the trainee that relate to their performance at work or their failure to pass exams.  Their current difficulties are explored in the light of their previous experience and put in the context of their personal and professional qualities. The information that is reviewed in the CDNA includes:
  • In-depth exploration of  personal and professional qualities in the light of their previous experience.
  • Psychometric tests such as the Myers-Briggs Type Inventory or the FIRO-B.
  • CV, training and appraisal record containing information about assessments and feedback, including multisource feedback.
  • Report from their trainer, including previous RITA assessments or Foundation programme competency assessments.

The CDNA explores the trainee's experience and professional development and can be helpful in identifying the reasons for any difficulty. Crucially it identifies the key personal perspectives and behaviours that have contributed to any area of poor competence or difficulty and the reasons why these may have developed. This usually helps promote insight and self-awareness and there will be an opportunity for the trainee to reflect on the report before the next meeting with their trainer to plan how to get back on track.

Performance Improvement Plan

The performance improvement plan (PIP) is based on the findings of the original career development needs assessment. The CDNA report should provide a summary and identify specific areas or behaviours that individuals may need to change or focus on to improve their performance or demonstrate their competence.

The performance improvement plan is negotiated with the trainee together with their trainer and attempts to realistically tackle the issues involved. Personal learning styles and preferences will be used to explore the best way for the trainee to address these and the trainer will provide information about local educational resources.
A range of options can be considered, including specific courses, other educational opportunities and more formal remedial training.

If there is a need to provide a supernumerary remedial training placement, then the Postgraduate Dean will need to be approached. Robust arrangements for monitoring progress will be an integral part of the plan.

Learning and/or supervised remedial training

The Performance Improvement Plan will have been negotiated with the responsible trainer and is likely to involve increased observation and feedback and further assessments such as multisource feedback. It is worth considering delegating some mentorship of a trainee in difficulty to a senior SpR.

Traditional learning will include personal reading and study but may be augmented by courses in consultation skills, work shadowing and personal coaching.

The PSU coach supervises the programme and is available to both the trainee and the trainer for advice and support. The PSU coach will make a formal arrangement for mid-term review to ensure the PIP and monitoring arrangements are on track and arrange a time for a formal progress review.

Progress review

After a previously agreed interval the PSU coach, the trainer and the trainee will formally review progress using the results of the agreed monitoring procedure.

The CPS coach will provide a report which can support the evidence provided by the trainer for the next RITA.

If the trainee moves into another job then the PSU coach will provide educational continuity by meeting the next trainer and creating a further PIP etc.