Difficulties on placement fall into three broad categories - concerns expressed by trainees, those expressed by tutors and those expressed by supervisors (these might also include the concerns of other professionals or service users on placement). Although the concerns of all do often overlap, these concerns will be examined separately in the interests of clarity. The below paragraphs identify the processes which will be followed to support trainees and supervisors, as well as to address these concerns directly should they arise.
Concerns of trainees
Trainees may experience personal problems on placement but feel unable to discuss these with their supervisor. They may find that the experience offered to enable them to develop some specific competencies is minimal due to, for example, local circumstances. Trainees may also feel that the quality or quantity of supervision does not meet their expectations (See BPS Guidelines on Clinical Supervision in the appendix below).
In every case the most important action to take is to communicate. The first person the trainee should inform of their concerns should be the supervisor. If this does not happen or if the trainee feels unable to communicate concerns directly to the supervisor then the trainee must contact their clinical tutor. This tutor can discuss the difficulties the trainee is experiencing over the phone or in person with the trainee and may then be able to help address the issue with the supervisor. Whilst a mentor may help by acting as an advocate for the trainee or by supporting the trainee in communicating with their supervisor or clinical tutor, the role of the clinical tutor is central in resolving any such issue.
Should these problems persist and/ or if they constitute a breach of the agreed contract, the programme subscribes to a policy (available in the appendix below) entitled "How the Programmes Manage Serious Concerns with Supervision on Placement" in conjunction with the Liverpool and the Manchester DClinPsy programmes. At placement allocation, supervisors receive a copy of this policy, which states what is expected of them from any of the local progammes and how any problems in achieving these standards of supervision will be addressed. Accordingly, programme staff will follow the procedures detailed in the policy when trainees raise minor or more significant concerns.
Consistent with this policy, trainees who raise minor concerns about quality will be asked to include a full account of these concerns (and how they have been resolved) in their placement audit forms at the end of the placement, so that these concerns can be noted in assuring the quality of subsequent placements.
Concerns of placement breakdown
In some circumstances during the course of a placement, a supervisor or the service in which they operate may cease to be able to provide the practice placement experience required by the trainee. Service provision can often change over a short period, which can deliver a different training experience. These changes are usually discussed and managed within the placement between supervisor and trainee, who can also be supported in this by the clinical tutor assigned to the trainee in question (see Concerns of trainees above). Other changes, such as long term sickness absence of the supervisor, can threaten to compromise the quality of the placement. The following process should be followed to ensure that the least harm is caused to the trainee's learning experience:
- Communication of concerns: Should a supervisor or service manager (where the supervisor is absent) become aware that a change is happening or is expected to happen to placement delivery that would result in the placement no longer being able to meet the minimum required standards for placement quality (see Quality assurance of practice placements in the Programme Specification), they will communicate this directly with a member of the course staff - preferably the clinical tutor for the trainee in question, the Senior Clinical Tutor for Practice Placements or the Clinical Director.
- Assessment of concerns: The clinical tutor concerned or another member of the clinical team, with support from Senior Clinical Tutor for Practice Placements and / or Clinical Director, will discuss the situation with whoever raised the concern, and in the first instance attempted to see what measures might need to be taken to return the placement provision to the required standards. This may be achieved with staff or resource provision from the programme (for example, if this is required over a short period).
- Taking stock: Should an immediate solution not be achievable, then a period of time will be agreed to "take stock" of the situation. During this period, the trainee may continue with placement practice only if there is sufficient and appropriate supervision to make this safe (for the trainee and service users); alternatively, the trainee may be asked to use placement time for study elsewhere. The principle of doing this is not to rush any party involved, whilst recognising that the earlier the trainee returns to full placement practice, the better. During this period, the Senior Clinical Tutor for Practice Placements, supported by the clinical tutors, will be exploring alternative options for placement provision.
- Review of ongoing or new placement provision: Once either the original placement has been renegotiated so that it can meet the required standards (and therefore the trainee's needs on placement) or a new placement has begun, then the clinical tutor will consult with both the supervisor and the trainee, to plan appropriate placement visits, offer placement support as necessary (see Placement support and monitoring) and review the Placement contract.
Concerns of supervisors and tutors
Concerns about trainee performance may be triggered by a perception that, in the light of their stage of training, the trainee is experiencing an unusual level of difficulty in meeting the requirements of the placement. There may also be concerns about the level of appropriate professional behaviour, adherence to the HCPC's Guidance on Performance, Conduct and Ethics or the BPS's Code of Conduct, Ethical Principles and Guidelines (see appendix below) or compliance with local or employing Trust policies. In every case the supervisor and/ or tutor should discuss their concerns with the trainee as soon as problems arise and begin documenting discussions and events. Generally, such concerns can lead to (i) consideration of placement failure, (ii) consideration of whether the trainee is fit to continue practicing, and (iii) consideration of whether to pursue disciplinary action against the trainee as an employee of Lancashire Care NHS Foundation Trust.
Placement Failure Concerns
The procedures outlined are intended to offer a framework of good practice and protection for all concerned in the hope that remedial action will be taken before formal placement failure becomes a consideration. It is important to remember that the supervisor provides information and recommendations to the Exam Board regarding the trainee's performance but does not make the final decision regarding placement failure.
If the supervisor's concerns are not resolved within supervision they should contact the trainee's clinical tutor, with the full knowledge of the trainee, to alert them to their concerns. The following procedure is then followed:
- The clinical tutor speaks to both supervisor and trainee to gain an overview of the situation and arranges a meeting at the placement base as soon as possible. The tutor also informs the Clinical Director that such concerns have been expressed.
- The clinical tutor meets the trainee and supervisor separately at the start of the meeting.
- The Supervisor's Assessment of Trainee form is used as a framework and the other documents (e.g. the Log Book and Placement Contract, the HCPC's Standards of Conduct, Performance and Ethics and, if available, any draft Supervisor's Assessment of Trainee form) act as a resource to ensure that the trainee is aware of the exact concerns of the supervisor. The trainee is invited to respond and their concerns are noted. At the end of the meeting, an action plan is completed containing clearly defined targets, and these are documented and agreed by the tutor, trainee and supervisor. The aim is to facilitate the achievement of the placement goals within the remaining time on placement. A review date is set. Where a trainee is not in agreement, this will be documented, and a clear rationale as to why these targets are being set (i.e. to achieve the required standards) will also be documented. If the trainee still feels these targets are unreasonable, a meeting will be arranged with the clinical tutor and the trainee to address this, if necessary including the clinical director, to allow for any alternative solutions to be explored (e.g. extra support may be identified, or a trainee may request to take a break in their training).
- The clinical tutor concerned informs the Clinical Director that there is a "serious concerns on placement plan" in place for the trainee.
- Contact between the clinical tutor, supervisor and trainee takes place between the initial visit and the review date to monitor the situation. This will vary according to need but will be a minimum of one contact every two weeks.
- Trainee, supervisor and clinical tutor meet on the review date set and consider the trainee's progress towards goals on the remedial action plan. If the review occurs at the end of placement, the relevant forms (SAT, Placement Audit form, Log ) are completed and seen by each party. If the review takes place early in the placement the action taken depends on the progress made by the trainee. A further review meeting may be necessary if the outcome of the first meeting is unsatisfactory. Telephone contact and monitoring may be the only action needed if the trainee is making progress.