Supporting Trainees in Difficulty Policy

TA545 V2.1

The Australasian College for Emergency Medicine (ACEM; the College) is committed to providing a training support structure for trainees that is fair, consistent, transparent and robust. ACEM acknowledges the importance of the safety and wellbeing of trainees and their right to learn in an environment of professionalism, collegiality and respect.

The purpose of this policy is to provide guidance on the identification and support of trainees who encounter difficulties during their training, and to ensure a process that is fair and transparent, and accessible by all parties involved to assist with the resolution of training difficulties. This policy sets out what ‘in difficulty’ means in the context of the FACEM Training Program. It defines the principles applicable to the trainee, the Director of Emergency Medicine Training (DEMT) and the College when a difficulty is identified, and the roles and responsibilities of the parties involved.

This policy applies to FACEM Training Program trainees and Specialist International Medical Graduates (SIMGs) on a pathway to Fellowship.

Broadly, a trainee in difficulty is a trainee who is not making the expected progress in meeting the training and/or assessment requirements of the training program. 

A trainee in difficulty may not be performing in line with expected standards or may be experiencing other difficulties that are impeding their progress and ability to undertake their training.  Such difficulties may relate to:

• Clinical performance - knowledge, skills and professional behaviours, as described in the ACEM Curriculum Framework
• Examination preparation and/or performance
• Completion and/or performance in Workplace-based Assessments (WBAs)  and other requirements of the training program

The factor(s) contributing to a trainee being ‘in difficulty’ may include, but are not limited to:

• Environmental/organisational issues - workplace culture, lack of support, lack of appropriate clinical management or resources, cultural difference or challenges, trainee/supervisor relationship difficulties
• Physical and mental health considerations, including in relation to immediate family members

This policy does not apply to those situations where a trainee is exhibiting notifiable conduct. In those circumstances, the matter should be referred to the relevant registration authority, either the Medical Board of Australia (MBA) or the Medical Council of New Zealand (MCNZ).

This Policy is based upon the following principles:

• Patient and trainee safety take precedence over all other considerations – employers and clinicians are bound by mandatory notification requirements to the MBA or MCNZ, as appropriate. Reportable behaviours are dealt with directly by the MBA or MCNZ and not by the College. The College has a separate policy relating to Reporting of Safety Concerns arising from Trainee Assessment (TA492) in recognition of its responsibility to act in the public interest where concerns arise during assessment that may compromise the provision of safe, high quality patient care.
• Early intervention – the difficulty is identified as early as possible, with appropriate and timely intervention in order to maximise the opportunity(ies) for resolution.
• Local training setting support wherever possible – trainees and DEMTs are best placed to negotiate and implement individually tailored support strategies. Involvement of consultant colleagues and peers is encouraged, particularly if the difficulty relates to the training setting and/or relationships within the setting.
• Support is centred on educational progress and professional development towards meeting the training program requirements.
• Transfer of important educational information – selected information about the trainee’s progress, performance information and existing support arrangements may be exchanged between DEMTs when a trainee changes employment from one training placement to the next. College staff may provide, on request, relevant information in accordance with ACEM Privacy Policy.
• Support is focused and centred on solutions, utilising available resources. The trainee is an active participant throughout the process, supported by the College, DEMTs, Mentor (if applicable) and colleagues.

The College recognises that trainees may be reluctant to report matters relating to this policy out of fear of reprisal or negative perception.  Under-reporting can limit the capacity of the employer or the College to respond to concerns, including providing appropriate guidance to trainees.

4.1  Trainees

Trainees manage their educational progress within the FACEM Training Program. Trainees have a responsibility to:

• Perform their duties in a professional, respectful and ethical manner.
• Actively review their own performance, assessing areas of strength and improvement.
• Actively seek relevant and timely guidance on their performance and progress in training, particularly if they are concerned about an issue impacting on their ability to progress.
• Actively and constructively participate and contribute to support processes put in place to address identified difficulties.
• Maintain confidential records of any relevant meetings or conversations with their DEMT/supervisor.
• Respond to issues or concerns raised by their DEMT/supervisor in a respectful and civil manner.
• Seek professional health advice, as required.
• Notify their employer regarding any workplace difficulties.  Be aware of and refer to their employer’s workplace policies, cognisant that issues related to employment and the management of these are the primary responsibility of the employer, rather than the College.
• Attempt to resolve difficulties in the training setting, in collaboration with their DEMT and/or Director of Emergency Medicine (DEM).  If training or supervision difficulties remain unresolved, the trainee should contact the ACEM Trainee Support Team who will escalate to the Regional Censor/Regional Deputy Censor. The Trainee Support team can, if requested by the trainee, also contact the regional trainee representative, to offer support whilst the issue is being managed.
• Take advice on vocational options from their DEMT, Regional Censor and/or Regional Deputy Censor if there is consistent and extended evidence that the trainee is not likely to succeed in the training program and achieve FACEM.

4.2 DEMTs

The roles and responsibilities of DEMTs are outlined in the DEMT Position Description.  Of relevance to this policy, DEMTs have responsibilities to their trainees, to ACEM and to their employer to:

• Perform their supervisory roles in a professional, respectful and ethical manner.
• Model the professional behaviours, attitudes and attributes expected of a FACEM.
• Provide timely, honest and relevant feedback to trainees regarding their clinical performance and progress in training.
• Maintain oversight of trainee progress at their site.  For trainees in non-ED placements at their site, this may involve regular discussions with trainees and/or their non-ED supervisor to ensure current and future training needs are identified and communicated to trainees.
• Identify, assess, support and constructively assist trainees encountering difficulty in training, including through the development of learning plans, if required.
• Maintain confidential records of any relevant meetings or conversations with the trainee.
• Notify the relevant DEM, Regional Censor and/or Regional Deputy Censor where any difficulty(ies) in relation to a trainee or training site needs to be reviewed and further monitored.
• Be familiar with and utilise as appropriate, the employer’s workplace policies and any ACEM policies in relation to the issue at hand.
• Notify the employer regarding any workplace difficulties that have been identified, cognisant that issues related to employment and the management of these are the primary responsibility of the employer, rather than the College.
• Respond to issues or concerns raised by trainees in a respectful and civil manner.
• Address behaviours of others that impact upon the trainee’s ability to safely manage patients.
• Recommend and encourage the trainee to take up the Employee Assistance Program (EAP), whether through the employer or the College, for professional counselling and support, if needed.
• Ensure that informed support and guidance is provided to the trainee where they move training sites. This includes the handover of a trainee moving to a different site and the implementation of any assessment and remediation requirements for a trainee commencing at a training site.
• Engage with the DEM, Regional Censor and/or Regional Deputy Censor about any unresolved training setting or supervision difficulties.
• Ensure the appropriate workplace policies are adhered to and involve Human Resources personnel when required.
• Immediately notify the employer if they become aware of the trainee’s physical or mental health or other issues potentially impacting upon the safety of the trainee, patients or others.
• As required, to progress matters under the ACEM Reporting of Patient Safety Concerns arising from Trainee Assessment Policy.
• Mandatorily report, in accordance with Medical Registration Authority and other legal requirements, where there is notifiable conduct.
• Discuss vocational options with the trainee if there is consistent and sustained evidence that the trainee is not likely to succeed in the training program and achieve FACEM.

4.3 Regional Censors and Regional Deputy Censors

The Regional Censor and Regional Deputy Censors play an important role in assisting the trainee and their DEMT to address and resolve, if possible, the training issues. Their role is to:

• Actively monitor trainee progression, supervision and training setting issues within and across the region to improve training quality.
• Provide advice, support and management oversight to DEMTs who are supporting trainees in difficulty.
• Be familiar with relevant workplace and College policies on Bullying, Discrimination and Sexual Harassment and other related policies.
• Provide advice and guidance to the Censor-in-Chief to resolve if necessary, a trainee-DEMT issue.
• Advise the DEMT and/or the trainee on the applicability of workplace and/or ACEM policies relevant to the trainee’s workplace responsibilities.
• Advise and support the DEMT to report a trainee to the relevant Medical Registration Authority where there is notifiable conduct.
• As required, to progress matters under the ACEM Reporting of Patient Safety Concerns arising from Trainee Assessment Policy.
• Upon advice from the DEMT or information provided by ACEM, discuss vocational options with the trainee if there is evidence that the trainee is not likely to succeed in the training program and attain FACEM.
• Where support measures have been applied and issues remain unresolved, notify the Censor-in-Chief, Deputy Censor-in-Chief, Executive Director Training and/or Manager Training. or, in the case of SIMGs on a pathway to Fellowship, General Manager Education Assessment.

4.4 ACEM

The College is responsible for setting the standards for training in emergency departments and monitoring those standards to ensure they are being met.  This includes a responsibility to:

• Set and monitor the standards of expected behaviour of trainees and Fellows, as described in ACEM policy documents.
• Ensure trainees are supervised within a safe and supportive training environment, as detailed in the FACEM training site accreditation guidelines.
• Provide education and professional development to Fellows and trainees on creating an optimal learning environment through teamwork, good communication, collaboration, and constructive feedback.
• Respond to concerns raised by trainees in relation to their supervisors and provide support to trainees.
• Where necessary and/or appropriate, the College will liaise with employers to facilitate resolution of work related matters.

4.5 Employers

Employers have industrial obligations and responsibilities and must also meet the College’s Hospital Accreditation Standards for the relevant training program. This includes:

• Management of all employment issues, including performance management and disciplinary matters in a timely, fair and objective way. Such matters may include, but are not limited to workplace bullying, harassment and discrimination, sexual misconduct, trainee health issues, breaches of workplace policies, standards of work that may affect patient safety.

• Meeting the College’s Hospital Accreditation Standards for the relevant program regarding the provision of a quality environment for ACEM training. The College will endeavour to work collaboratively with employers where a difficulty is both an employment issue and a training difficulty.

5. Associated Documents

• Regulation B – FACEM Training Program (prior to 2022)
• Regulation G – FACEM Specialist Training Program (Trainees Commencing from 2022 Training Year)
• Regulation C – Assessment of Specialist International Medical Graduates
• ACEM Curriculum Framework
• Code of Conduct Policy (COR235)
• Conflict of Interest Policy (COR139)
• Discrimination, Bullying and Sexual Harassment Policy (COR133)
• Exceptional Circumstances and Special Consideration Policy (TA79)
• Policy on Procedural Fairness (COR140)
• Privacy Policy (COR200)
• Reconsideration, Review and Appeals Policy (COR355)
• Reporting of Patient Safety Concerns arising from Trainee Assessment Policy (TA492)
• Whistleblower Policy (COR450)
• Director of Emergency Medicine Training Position Description (PD416)
• Local Workplace-Based Assessment Coordinator Position Description (PD453)
• Regional Censors and Regional Deputy Censors Position Description (PD228)
• Examiner Roles and Responsibilities