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Information for Trainers

We offer guidance for trainers who are managing a doctor experiencing difficulty in work or in their personal life which affects their training

Managing trainees in difficulty can appear challenging however the majority of trainee difficulties are fairly straightforward and can be managed at a local level. The following "Guiding Principles" provide a quick reference to the steps you should take when managing these trainees.

Ten Guiding Principles

  1. Ensure patient safety
  2. Address problems when they occur - not at the end of a post
  3. Find out the facts; speak to colleagues/members of the team and consider not only the trainee but also the context in which the trainee is working e.g. is the workload appropriate, is the post compliant with Working Time Regulations, is there appropriate senior support, are there any concerns about bullying or inappropriate behaviour etc.
  4. Speak to the trainee - remember there are two sides to every story - ensure that the trainee is aware of the purpose and boundaries of this meeting.  For example the meeting may/may not be confidential and this needs to be clarified.
  5. Consider whether there is an underlying health problem or any mitigating circumstances e.g. language problems influencing the trainee's performance
  6. Seek help/guidance if unsure how to proceed
  7. Set realistic measurable goals and timescales
  8. Document everything in writing this should be signed, dated and shared with the trainee
  9. Ensure actions taken are proportionate, consistent and fair
  10. Confidentiality will be respected and maintained in line with Good Medical Practice

Further detailed information this is available from the NES Policy and Operational Guide on the Management of Doctors in Difficulty.


If you are unsure how to proceed there are senior personnel in each Region who can provide guidance.  From a service perspective you should contact the Clinical Lead for your area.  If you are concerned about the health of your trainee a management referral should be made to the Occupational Health Service in your area.


Documentation is an essential component of this management process.  It provides an evidence trail on which decisions can be made in the short and longer-term. It is therefore important that you ensure that there is documentary evidence of concerns, meetings and agreed actions/timescales.

The Record of Meeting form provides a template for recording meetings with trainees; however, its use is optional.  Meetings can be recorded in a number of other ways e.g. letters to trainees outlining discussions and agreed actions etc.  When documenting meetings, ensure that the information you record is: factually accurate, justifiable, objective and fair.

Training for Trainers

There is a 2-day SCOTS Doctors in Difficulty Course which is available across Scotland.