Dilemma: My trainee reacts badly to feedback
Three GPs advise on what to do if your trainee has been reacting badly to the feedback you've given
‘My trainee recently implied that the feedback I give verges on bullying. How should I proceed?’
Newly qualified GP view: Check your feedback style
The trainee might be experiencing stress. The ST3 year is incredibly intense, and maybe the trainee feels they’re only just keeping their head above water. Are they keeping to time or running behind during surgery? Do they seem low in mood, distracted or quiet? They could be experiencing stress away from work as well – carefully enquire and offer support.
Establish whether your trainee feels overloaded. If they’re feeling the extra burden, this should be identified before
it can escalate. Take your trainee’s observations seriously, but not to heart, and ask for examples of when they felt criticised or bullied. Were you under stress yourself when you spoke to them? Is a pattern emerging? Be careful to provide constructive feedback, emphasising the trainee’s strengths.
This is an essential part of the training process, which we must all expect, but it must be delivered in the right way.
The GMC’s guidance on leadership and management states that ‘you should provide opportunities for those you manage to keep up to date and develop their skills as teachers and trainers, and make sure there are systems for regular feedback and appraisal of those skills’ and ‘you must develop the skills, attitudes and practices of a competent teacher’.1
It would be worth speaking to colleagues and former registrars to get their opinion on your feedback style,
as they may have useful observations. Failing that, discussing in confidence with your local trainers’ or educators’ group may yield useful advice. Useful tips for trainers can be found on the Bradford VTS2 and Pennine VTS3 websites, which offer a wealth of tips, including how to give feedback (see resources).
Dr Alex Gates is a newly qualified GP in Bath
GP trainer view: Compare notes with other team members
This situation could escalate and become problematic for both you and the registrar, so approach it with caution and care.
First, document specific examples of your trainee reacting in this way, then discuss any concerns with clinical and non-clinical colleagues to assess if this behaviour has been experienced elsewhere within your team. This may be required as evidence if the GP training programme becomes involved.
A key factor will be to ascertain whether the registrar has reacted badly to feedback since starting the post with you, or whether there’s been a change in behaviour. Your approach may also depend on whether you’re the educational supervisor (ES), or clinical supervisor (CS). An ES will oversee training for the duration of the programme, but the CS might only do so for a four- or six-month rotation.
If this has been an issue since the start of the post, review educators’ notes on the registrar’s ePortfolio. If you see a similar pattern of behaviour, think about talking to previous supervisors. A review of the registrar’s previous feedback and supervisors’ reports may prove helpful.
If it becomes apparent that this has been a problem before, voice your concerns with the registrar. Although this is unlikely to be an easy conversation, try to be as open and empathetic as possible. Get to the bottom of why they feel your feedback is inappropriate. It may be straightforward enough to be rectified immediately. But if it’s ongoing, it’s more likely to represent a fitness-to-practise issue, so a discussion with a training programme director will be necessary.
A combination of reasons might explain a change in behaviour, such as how they’re coping with workload, if everything is okay at home, and any health problems. A conversation centred on honesty and openness should conclude with a workable solution. Any concerns and subsequent actions need to be documented, and involve the GP training programme early if an in-house solution isn’t possible.
Dr Pipin Singh is a GP trainer in Tyne and Wear
LMC view: Seek outside support
Such allegations should be taken very seriously. If I was contacted by this GP trainer, I would ensure that the local training programme director is fully aware of the comments and follows an appropriate procedure.
The local training scheme may also provide peer support to the trainer, either one to one, or through small group workshops. This is a safe environment for exploring topics, such as how to provide difficult feedback.
Alongside an assurance that the case is being managed appropriately, my focus would be on the GP’s wellbeing.
At Devon LMC, we have support services for GPs across the county.
Our pastoral support scheme provides a confidential environment for sensitive issues and it would be worth GPs checking what is on offer from their LMC. These allegations can significantly impact an individual’s mental health, and pastoral support could help ensure the doctor engages with their own GP and occupational health services.
Devon LMC also offers a GP coaching programme, for GPs who don’t need the level of support provided by the pastoral scheme. Where available, such support can allow a trainer to work through underlying issues, and help to signpost and develop further skills.
Ultimately, with a correct procedure and appropriate support, there’s no reason why this scenario cannot reach a satisfactory conclusion.
Dr Paul Hynam is a GP educator and trainer and medical secretary for Devon LMC
• GMC, 2012. Leadership and management for all doctors.
• Bradford VTS.The trainer’s toolkit.
• Pennine GP Training. Making training easier.