16.1. The Lead Educator should consider whether to refer to the Career Development Unit, especially in all situations where level two support is needed.
16.2. The Indications for referral include:
• Circumstances are complex, longstanding or require expert diagnosis and/or personal coaching;
• Issues which are serious enough to threaten progression of training (All RITA E, or ARCP panel outcomes 3 and 4, as well as some RITA D/ARCP panel outcomes 2 or 5);
• There are doubts about educational continuity as the trainee is rotating to another geographical placement;
• The issues require specialist help e.g. with cultural differences, language, or exam failure;
• The DME and their advisers are considering involvement of an external agency such as NCAS or the GMC.
16.3. Educators who are considering CDU referral are encouraged to contact a senior member of the CDU for a confidential discussion and advice about a specific case. Initial contact should be made by the CDU email address –
appropriate person.
16.4. Self Referral to CDU
There may be times when a doctor in training wishes to have a confidential discussion with an informed neutral party, for example if he/she is considering a change of career but is not ready to declare this to current supervisors. The CDU is happy to accept self-referrals under these circumstances. Where a trainee wishes to improve their performance in order to progress satisfactorily in their training, they will be strongly encouraged to agree to dialogue between CDU and their educational and clinical supervisors, so that their progress may be effectively monitored.
If the referral is instigated by the supervisor, then this should come as a normal, full referral, rather than asking the doctor to self-refer.
Document Author
CV, educational portfolio Trainee
Written accounts/evidence/feedback Clinical Supervisor Educational Appraisal Summary Report Educational Supervisor Educational Needs Review Report Lead Educator
Educational Governance Report with collated evidence from other relevant stakeholders.
DME/GP associate dean
16.6. Career Development Needs Review
The Career Development Needs Review (CDNR) is the first step in the CDU case management process and involves interviews with the trainee and the
appropriate supervisor. Information from these interviews, together with the above reports, forms the basis of the review. This is not an assessment of clinical competence, which is not the role of the CDU – this responsibility remains with the relevant educational and clinical supervisor(s). An accurate career
development needs review depends on clear reports of the issues of concern from the supervisors and TPD, or other senior Deanery educators.
The purpose of the review is to find out what help the trainee needs to help them get back on track. It sets out to provide external help and support for the trainee who may be struggling to understand the issues and the feedback they have been given. The trainee’s current circumstances are explored with them in the light of their previous experience and put in the context of their personal and professional qualities. The information that is reviewed in the CDNR includes:
• An exploration of personal and professional qualities relating to the trainee’s current and previous experience;
• Trainee’s portfolio and perspective on events; • Education reports (see above).
The CDNR report contains an analysis of the situation and possible reasons why the trainee finds themselves needing help and support. It clarifies the issues of concern and identifies contributory factors.
The trainee has an opportunity to comment on the report as part of a feedback session. If the trainee does not agree with any aspect of the report, their comments are noted and recorded at the end of the report.
The report provides a basis for a negotiated performance improvement plan and the trainee will therefore need to agree that it is shared with his responsible educators prior to a planning meeting.
16.7. Performance Improvement Plan
The Performance Improvement Plan builds on any previous plans and is
negotiated with the trainee and the appropriate supervisor. It deals specifically with the areas of concern and identifies additional educational resources such as personal coaching, courses, workshops and e-learning that could help. Personal learning styles and preferences are used to explore the best way for the trainee to learn. The PIP will include:
• Specific learning objectives, methods and completion dates;
• Recommendations to reduce any contributory factors – for trainee, the supervisors, the department or the Trust;
• Recommendations for additional supervision, observation and feedback; • Specific arrangements for monitoring progress – WPBAs, multi source
feedback etc.;
• Clarity about criteria for success/failure and clarity about the implications.
16.8. Progress review
The CDU coach/mentor, the supervisor and the trainee will formally review
progress at an agreed interval using the results of the agreed monitoring protocol. The CDU coach/mentor will provide a progress report which can support the evidence provided by the supervisor for the next RITA/ARCP panel. If the trainee moves into another job or Trust within the Deanery then the CDU coach/mentor will provide continuity by meeting the next supervisor and creating a further PIP etc.
16.9. Supervised supportive training
The CDU coach/mentor is available to both the trainee and their supervisor/Lead Educator for advice and support during any period of remedial training within the Deanery. The CDU coach/mentor will make arrangements for regular reviews to ensure the PIP and monitoring arrangements are on track and arrange a time for a formal progress review.