Candidates in Difficulty in the Fellowship Training Program

Approval Date: December 2017
Review Date:    December 2018
Review By: Training Progress Committee and Education and Training Committee

  
Policy statement

The RACMA is committed to ensuring that candidates in the Fellowship Training Program are provided with optimal opportunities for learning about medical leadership and management and it has a framework which:

·      Accredits training posts which meet the training standards;

·      Appoints preceptors to oversee training supervision and mentor candidates;

·      Identifies risks early;

·      Addresses processes which are hindering candidate learning;

·      Suggests appropriate remediation strategies and facilitates their implementation; and

·      Oversees dismissal processes which are justifiable and equitable.

In the processes of monitoring progress there will be:

·      Natural justice, fairness and equitable treatment of Candidates in Difficulty

·      Confidentiality as far as possible at all stages

·      Initial attempts at resolution at a local level to address Candidate performance issues

·      Maintenance of adequate and accurate documentation and records of discussions; and

·      Appropriate and transparent appeals processes.

Purpose

The purpose of this Regulation is:

•          To outline roles and responsibilities of relevant stakeholders in processes for assisting RACMA Candidates experiencing difficulty in progressing with their training.

Scope

This policy applies to all Candidates in the RACMA Fellowship Training Program.

Background and Principles

Candidates experiencing difficulty in the Fellowship Training Program (FTP) may be identified by the candidate her/himself, by the relevant Supervisor, Preceptor, and Jurisdictional Coordinator of Training (JCT) and/or by the Training Progress Committee.   

Unsatisfactory or suboptimal performance or limited progress in the training environment may be demonstrated in the following, but not limited to:

Candidate specific matters:   

·      Demonstration of deficiencies in skill and/or attitude development, identified by a Supervisor or Preceptor during workplace observation and feedback and thence identified in ITA (In Training Assessment) Reports; or

·      one or two failed examinations; or

·      claims of personal or health problems interfering with work or study.

Workplace matters:   

·      Quality of training post and quality of experiential training opportunity

•     Poor communication or poor organizational or professional behaviour (e.g. bullying, harassment, discrimination and victimization) by candidate, or of candidate;

Regulatory matters:

•               Serious professional misconduct that may require reporting to the Medical Board of Australia relative to AHPRA, or to the Medical Council of New Zealand.

Responsibilities

Employers:

·      Committing in the accreditation (and re-accreditation) processes, to maintaining an appropriate and fulfilling training environment,

·      Offering a range of learning opportunities in terms of exposure to relevant topics,

·      Providing candidates with training supervisors who are skilled and trained in training,

·      Meeting relevant occupational health and safety standards for candidates (including those related to workplace mental health and well-being),

·      Appropriately addressing performance breaches by candidates and supervisors with respect to workplace and employment responsibilities,

·      Taking prompt action in the event of a serious issue potentially affecting the Candidate in training, a patient or the safety of any other person,

·      Reporting a Candidate’s behaviours or attitudes to the College if it is believed that it has relevance to the Candidate’s training progress.

Candidates

•          Candidates are expected to behave professionally in terms of their commitments to their employers.

•          In addition, they are expected to plan realistically for the balance that will be required in their lifestyles, to complete their work commitments along with their assessment activities in the training program.

•          Candidates should seek early assistance if they are aware of a problem. In the first instance, Candidates should speak to their supervisors, or seek professional health advice if needed;

•          Candidates may seek assistance and guidance from the Employer HR unit, particularly in relation to Bullying and Harassment;

•          Professional associations, unions or indemnifiers may also be sources of assistance where the Candidate may seek legal advice in relation to a particular matter within their employment;

•          Candidates may at any time communicate with or seek confidential advice about process from the Chair of the \ Candidates’ Advisory Committee (CAC), the Jurisdictional Coordinator of Training (JCT) or the College-appointed Preceptor;

·             Candidates may identify that personal or workplace conditions are hindering their progress to the extent that Special Consideration may be sought for examinations or In-Training Assessments.

Supervisors will:

•          Identify levels of knowledge, skill or behaviour through commitment to honest evaluation of performance and provision of appropriate feedback;

•          Identify and advise Candidates of risks relating to their non-performance;

·             Initiate early exploration of the Candidate’s insight and advise Candidates of options for assistance if it is perceived that they are in difficulty;

•          Liaise with the Preceptor of the Candidate and/or JCT in these processes for advice and any actions requiring decision – making re remediation at the local level;

•          Articulate and record any concerns, feedback from examination reports and relevant preceptor discussions, and action plans in the In-Training Assessment Report (ITA);

•          Maintain well-documented confidential records, either written or audio (with permission), of relevant incidents or conversations with the Candidate if deemed appropriate;

•          Notify the senior management of the employing institution immediately they become aware of serious mental health or other issues potentially affecting the safety of the Candidate, patients or others; and advise the College Training Progress Committee accordingly through the Preceptor, JCT or the CEO of the College.

·               Foster and provide appropriate experiential training activities to support the remediation of Candidates in difficulty or at risk, if identified, by the Training Progress Committee or Faculty Board, as the appropriate supervisor.

The Jurisdictional Coordinator of Training (JCT):

•          Advise the Candidate (if appropriate), the Supervisor, Preceptor, and senior management at the National Office of the training/knowledge or behavioural issues that may impact on training and/or safety of Candidate, patient or other stakeholders;

•          Oversee/Monitor any action plans and their implementation as determined for remediation in consultation with the Candidate, the Supervisor and Preceptor, at the jurisdictional level;

•          If required, act as or appoint a mentor to assist with remediation.

•          Recommend external professional support if needed and provide guidance on avenues for its

             engagement;

•          Maintain confidential records, either written or audio (with permission), of relevant conversations with the Candidate and/or Supervisor/Preceptor;

·               Ensure that the action/remediation plans are followed and advice on progress is made to the Training Progress Committee;

•          Ensure that any serious mental health or other issues potentially affecting the safety of the Candidate, patients or others are brought promptly to the attention of the senior management of the employing institution, if not already actioned by the Supervisor and the RACMA;

•                      Notify the relevant RACMA Committee (Training Progress Committee) through the National Office officer if aware of mandatory notifications;

·               Recommend when there is a mandatory notification required by a RACMA officer to the Medical Registration Authority and/or other legal/statutory reporting required.

Note: that in NZ this is Section 34 of HPCA Act if it refers to a competence issue or to the circumstances/requirements outlined in the Section 45 if it is related to a health issue – either mental or physical.

Preceptor:

•          Provide professional and personal guidance and development to Candidates in difficulty;

•          Consult with the JCT and Supervisor in relation to mentoring processes for the Candidate;

•          Report to the Supervisor and relevant JCT on the Candidate’s progress and meetings with the Preceptor, in particular, in relation to critical performance or behavioural matters, and if deemed necessary advice on any mandatory reporting to the Medical Registration Authority.  

Training Progress Committee:

• To provide governance advice on identified trends in implementation of workplace assessment,
• To monitor relevant in-training information on all Candidates
• To stratify the Candidates according to levels of success in identified in-training assessments,
• To recommend levels of investigation (at site, jurisdictional or Faculty Board level) for Candidates with apparent difficulties,
• To develop recommendations for remedial actions for individuals who appear to be at risk of lack of progress,
• To suggest options for training posts in which there appear to be trends in difficulties,
• To identify areas for strategic policy development related to aspects of Candidate progress.

The RACMA National Office:

•          Provide process advice and support to the JCTs, Supervisors and Preceptors on Candidates’ progress;

·               Provide permitted advice to the relevant stakeholders on any cases in which Candidates are deemed to be in difficulty;

•          Provide to JCTs, Supervisors and Preceptors, relevant data on Candidates in relation to examination results, feedback from stakeholders, and unusual requests on training and employment related issues if these are critical to Candidates’ performance and welfare; 

•          Generate relevant reports, by jurisdiction, on the status of Candidates in the Fellowship Training Program to the Training Progress Committee, ensuring clear identification of Candidates at risk, potentially at risk or in difficulty;

•          Notify the RACMA CEO immediately, or the relevant JCT, or the Dean of Education or the Chair of the Training Progress Committee of serious mental health or other issues potentially affecting the Candidate, safety of patients or others.

•               Advise RACMA Candidates to follow the Policy for Reconsideration, Review or Appeal of

decisions by a College Officer or Committee under the appropriate RACMA Policy. Advice may be sought from the Ombudsman in accordance with National Health and Safety regulations (where applicable, may be different avenues for the NZ Candidates).

Faculty Board

The Faculty Board is made up of the Dean of Education, the Chair of the Training Progress Committee, the Censor in Chief and relevant senior Training Program officers. One of its terms of reference is oversight of remedial or dismissal actions in response to identification of trainees in difficulty. It will:

·      Receive reports and recommendations from the Training Progress Committee, Board of Censors, Accreditation Training Panel and/or National Office staff;

·      Investigate situations surrounding the reports;

·      Determine levels of remediation or response required;

·      Develop action plans for implementation by State Committees;

·      Receive reports of outcomes of action plans.

·      Report to the Education and Training Committee on recommendations re dismissal from candidacy, with subsequent discontinuation of membership.

Remediation

·      Candidates may need to suspend their training for short periods for medical support. If this is so, they will be able to do this without financial hardship.

·      They may also be required to attend special courses, to organize special observatory periods in different settings or to repeat submissions of certain assignments.

·      If a candidate’s terms have been unsatisfactory they may be allowed to continue in accredited training posts to fulfil the need for a minimum of three full time equivalent years, for Fellowship.

Dismissal from training

·      If a candidate’s terms have been unsatisfactory for a third time, s/he will need to show cause why s/he should not be dismissed from the Fellowship Training Program and recommended for revocation of Candidate member-status.

·      Dismissal from the training program will not occur without due consideration of natural justice, and making the policy for appeals available to those Candidates.

Recommendations re training posts

It is acknowledged that some Candidates in difficulty may be in difficulty because of lack of conditions in the training posts that are conducive to wellbeing of Candidates.

Recommendations will be made to the Faculty Board and the Accreditation Review Panel for investigation of sites in which this issue has arisen, for action in relation to accreditation of those sites.

References

Policy for Supervised Practice

Regulation for Accreditation of Training Posts

Terms of Reference – Training Progress Committee

Regulation for the Conduct of Examination  

Regulation for eligibility to sit the RACMA Oral Exam and for election to Fellowship

In Training Assessment Report

Annual Training Plan

Policy for RACMA Officers’ Code of Ethics

Supervisor Manual

RACMA Privacy Policy

Policy for Reconsideration, Review and Appeal of Decisions of the College Committees and Officers

HPCA Act 2003 (NZ)