Covid-19 Displaced trainees
The COVID-19 pandemic has meant that many trainees have not been able to continue their normal clinical activity and as a result have been COVID-19 displaced. The umbrella term COVID-19 displaced should be used to cover all trainees who are unable to continue their normal clinical work due to the pandemic, including those who have previously been referred to as shielding. If you think your trainee may fall into the definition of being COVID-19 displaced, you should contact them to discuss the issue as soon as possible and not wait for them to contact you.
The prolonged nature of the pandemic has had a significant impact on the training of COVID-19 displaced trainees. While many trainees have experienced excellent support and accommodations to their training in order to progress, this is not universal, and some have faced large challenges without the required support.
This page aims to help educational supervisors (ES) understand the importance of their role in supporting trainees and to help reduce the variability of support provided.
This is taken from a national e-learning for healthcare module and should be used in consultations with local guidance.
The prolonged nature of the pandemic has had a significant impact on the training of COVID-19 displaced trainees. While many trainees have experienced excellent support and accommodations to their training in order to progress, this is not universal, and some have faced large challenges without the required support.
This page aims to help educational supervisors (ES) understand the importance of their role in supporting trainees and to help reduce the variability of support provided.
This is taken from a national e-learning for healthcare module and should be used in consultations with local guidance.
Who are displaced trainees?
There are many reasons why a trainee may find themselves COVID-19 displaced, here are just a few examples.
Clinically extremely vulnerable or clinically vulnerable (shielding)
Clinically extremely vulnerable trainees are 'red risk' and have serious health conditions which put them at high risk of serious complications from COVID-19. They are currently on, or will be added to, the government’s Shielded Patient List. They are advised to work from home during COVID-19 surges and will have received letters or emails to this effect. A workplace cannot override this advice.
Clinically vulnerable trainees are ‘orange risk’ and have serious conditions putting them at moderate risk of complications from COVID-19. It may be appropriate for this group to also work from home like CEV trainees given the high-risk context in which they work.
Pregnancy
Currently, most employers are advising that all staff past 28 weeks gestation should work from home but each trainee should check with their employer or occupational health (OH). Special consideration should be given to those pregnant trainees with underlying health conditions and a risk assessment should always be carried out.
Some trainees who are displaced because of pregnancy may return to work if recommendations change, whereas others may progress straight through to parental leave.
Trainees who have been displaced due to pregnancy should not be made to feel under any pressure (perceived or otherwise) to shorten the period of their parental leave to compensate for the time they were out of the clinical environment whilst pregnant.
Ethnic minorities with risk factors
Ethnic minority communities are considered at higher risk of complications from COVID-19, particularly if they are older, male or have underlying health conditions.
A person’s ethnicity should be considered as part of a trainee’s overall risk calculation and most risk assessments will take this into account. It is an employer's role to ensure a risk assessment is carried out but you should still check that your trainee has completed one.
Living with or caring for someone who is vulnerable
Many trainees care for someone who is vulnerable, this is sometimes known as ‘shielding by proxy’. Some employers and OH departments have deemed these trainees as a moderate or 'orange risk', the same risk as a CV trainee.
These trainees may experience many challenges including:
Hard of hearing or Deaf
Trainees who are hard of hearing have been significantly affected by the pandemic due to the mandatory introduction of face masks and coverings, rendering them unable to lipread and muffling sounds, which effectively removed their ability to communicate as they once did.
The discussion around hearing loss and mask use in the pandemic is a complex one involving issues such as listening fatigue, a lack of enough clinically approved clear masks and the need for adjusted roles during COVID-19.
Clinically extremely vulnerable or clinically vulnerable (shielding)
Clinically extremely vulnerable trainees are 'red risk' and have serious health conditions which put them at high risk of serious complications from COVID-19. They are currently on, or will be added to, the government’s Shielded Patient List. They are advised to work from home during COVID-19 surges and will have received letters or emails to this effect. A workplace cannot override this advice.
Clinically vulnerable trainees are ‘orange risk’ and have serious conditions putting them at moderate risk of complications from COVID-19. It may be appropriate for this group to also work from home like CEV trainees given the high-risk context in which they work.
Pregnancy
Currently, most employers are advising that all staff past 28 weeks gestation should work from home but each trainee should check with their employer or occupational health (OH). Special consideration should be given to those pregnant trainees with underlying health conditions and a risk assessment should always be carried out.
Some trainees who are displaced because of pregnancy may return to work if recommendations change, whereas others may progress straight through to parental leave.
Trainees who have been displaced due to pregnancy should not be made to feel under any pressure (perceived or otherwise) to shorten the period of their parental leave to compensate for the time they were out of the clinical environment whilst pregnant.
Ethnic minorities with risk factors
Ethnic minority communities are considered at higher risk of complications from COVID-19, particularly if they are older, male or have underlying health conditions.
A person’s ethnicity should be considered as part of a trainee’s overall risk calculation and most risk assessments will take this into account. It is an employer's role to ensure a risk assessment is carried out but you should still check that your trainee has completed one.
Living with or caring for someone who is vulnerable
Many trainees care for someone who is vulnerable, this is sometimes known as ‘shielding by proxy’. Some employers and OH departments have deemed these trainees as a moderate or 'orange risk', the same risk as a CV trainee.
These trainees may experience many challenges including:
- a feeling of guilt that their work may cause harm to a loved one
- increased carer responsibilities
- inability to take up temporary accommodation or alternative childcare options due to risk or personal circumstances
Hard of hearing or Deaf
Trainees who are hard of hearing have been significantly affected by the pandemic due to the mandatory introduction of face masks and coverings, rendering them unable to lipread and muffling sounds, which effectively removed their ability to communicate as they once did.
The discussion around hearing loss and mask use in the pandemic is a complex one involving issues such as listening fatigue, a lack of enough clinically approved clear masks and the need for adjusted roles during COVID-19.
Risk Assessments
Risk assessments often take varying approaches and it can be difficult to accurately portray the risk to loved ones. The feelings of guilt and responsibility can be overwhelming as a trainee tries to balance the health of loved ones with training expectations and requirement.
Risk assessments are the duty of the employer (this is the deanery for most, trust for foundation and trust grade doctors) - it is not your role to organise an assessment but it is important you check with your trainee that they have had one.
Risk assessments are the duty of the employer (this is the deanery for most, trust for foundation and trust grade doctors) - it is not your role to organise an assessment but it is important you check with your trainee that they have had one.
- A workplace risk assessment should be undertaken for all trainees and an ES should ensure that this has been completed. Risk assessments are the responsibility of the employer - ES’s should familiarise themselves with their employer's process and be able to signpost appropriately.
- The risk for healthcare workers is significantly different than the general public. Government advice may not always be suitable for healthcare workers and trainee circumstances may change. This risk should be reassessed on a regular basis to ensure safety.
- Trainees may have more than one reason to be displaced and their full circumstances should be considered.
- Not all circumstances are covered by generic risk assessments or GOV advice. A trainee can self refer to occupational health (OH) if they feel this is appropriate or they would like to discuss their risk assessment outcome. OH can also help with obtaining various adjustments if needed. Educational supervisors should not make a referral to OH on behalf of the trainee without the involvement of the Director of Medical Education (DME) and other educators relevant to the trainee's situation, however, a trainee can do this themselves. Ensure you signpost them to this if they express any concerns about the outcome of their risk assessment outcome.
- All referrals should also be notified to the deanery (with the consent of the trainee) to ensure they remain abreast of the trainee current situation as they approach ARCP. Due to increased workload and working from home there has been a disconnect between OH & deanery.
SuppoRTT programme
Displaced trainees are eligible for the SuppoRTT programme; this is a programme for the10% of trainees who are taking time out of training at any one time. SuppoRTT is a centrally funded Health Education England (HEE) initiative. It has been developed with the aim of enabling postgraduate doctors who have taken a prolonged period of time away from training to return safely and confidently.
SuppoRTT can offer a targeted individualised return plan and a structure of supervisor support, for example:
Further information on SuppoRTT is available on the HEE website
SuppoRTT can offer a targeted individualised return plan and a structure of supervisor support, for example:
- a period of enhanced supervision
- refresher courses and simulation training
- mentoring or professional coaching
- funding for other courses, conferences, workshops or development, as individually required
Further information on SuppoRTT is available on the HEE website
The SuppoRTT Framework is divided into four separate stages; Initial meeting, displaced, pre-return, post return. The trainee could be in any of these stages. As an ES you need to ensure you are aware what is expected from you and your trainee at each stage. Also be aware these stages could be repeated more than once with a trainee having to go back to being displaced during their training.
Educational and clinical supervisors should ensure that the trainee is able to fully take up the opportunities for virtual work and other non-patient facing or working from home activities as soon as possible after displacement begins. Consider what is useful not only for their portfolio now but also for the next stage of their training. Work with the trainee to find innovative and creative ways of doing this. If needed seek advice and guidance from College Tutor, TPD, HoS as appropriate.
Regular contact with the trainee should be scheduled to discuss progress of ongoing projects and review activities and sign offs.
Trainees should always be aware who is available for clinical supervision and how to contact them. As their ES
Further information on supporting displaced trainees can be found on the GMC website.
Your initial meeting with your trainee should include the following:
Regular contact with the trainee should be scheduled to discuss progress of ongoing projects and review activities and sign offs.
Trainees should always be aware who is available for clinical supervision and how to contact them. As their ES
- Listen, support, be flexible and be kind.
- Acknowledge the isolation, emotional strain and worry that the displaced trainee is experiencing. Help them to feel valued by supporting them to undertake appropriate activities which allow them to feel they are contributing to the work of the department and making progress in their training.
- Be an advocate for your trainee. They will appreciate you being proactive and making every effort to support them.
- Acknowledge that for many it is extremely distressing to balance the health risks to themselves or their loved ones with training and rota requirements. Be non-judgemental – this is an OH issue not the trainee’s choice.
Further information on supporting displaced trainees can be found on the GMC website.
Your initial meeting with your trainee should include the following:
- A discussion of current difficulties and concerns
- A discussion about confidentiality
- A curriculum review and design of a tailored PDP with clear outcomes measures. A trainee should keep a log of activity.
- Ensuring progression It is the responsibility of the educational supervisor to ensure that their trainee has access to adequate training and that reasonable adjustments are being made. Reasonable adjustments must be made under the Equality Act. Examples of reasonable adjustments include:
- QIPs
- audits
- virtual clinics
- Teaching
- working from home in public health or OH
- working in green areas only
- changes to the rota or reduced hours, research or revision
- alternative ways of demonstrating a competency
- removal of redundant aspects of the curriculum that may be difficult for a displaced trainee
- Signposting to resources such as:
- S-STAG 'Activities while Working from Home'
- Professional Support and Wellbeing (PSW) and other wellbeing resources
- BMA
- Early consideration of supportive measures
- Risk assessments and occupational health
Initial meeting checklist
|
Have you:
|
Catch-up meetings should take place every 1 to 2 weeks whilst your trainee is displaced. The frequency of your meetings should have been agreed in your initial meeting.
These meetings are a good opportunity to review the trainee's work plan and progress and consider the following:
These meetings are a good opportunity to review the trainee's work plan and progress and consider the following:
- Do any adjustments need to be made? e.g. trust laptop & remote access
- Is the trainee finding the workload manageable?
- Wellbeing check in, does the trainee feel supported?
- Start discussions about returning to the clinical workplace early.
- If returning to work is not viable, would considering other training options such as Out Of Programme (OOP) or moving Less Than Full Time (LTFT) be worth exploring?
- Should the trainee move or is it feasible/preferable for them to remain in the same organisation/rotation? This may be beneficial for the trainee’s continued training, consistency of advice/work plan and individual circumstances and reduce recurrence of difficult challenges.
- Continue to signpost to key resources.
- Document meeting and arrange time for the next meeting.
Returning to work should be done in conjunction with the trainee and guidance. Many trainees may be anxious to return to the workplace and this should be considered.
Here are some important points to consider:
Note practical issues such as the provision of PPE are the responsibility of the employer - trainees can express any concerns to you but your role is to support, signpost and advocate not supply the PPE itself.
Here are some important points to consider:
- Has a return-to-work plan been put in place?
- Do they need a phased return? Would a mix of onsite and home working be more appropriate?
- Any changes to duties needed, for example no ward rounds or on-calls? Would a supernumerary placement be helpful?
- Has the trainee had an up-to-date risk assessment? Have they booked an OH appointment if needed?
- Have you left enough time for all necessary adjustments to be implemented before the trainee returns so this is not unnecessarily delayed?
- Does the trainee feel well supported? Is there any way this could be improved?
- Continue to sign post to wellbeing resources.
- Would booking any courses such as SuppoRTT courses or other skills refresher courses be useful?
- Document meeting as previously.
- Sign off as many competencies as possible prior to returning to work.
Note practical issues such as the provision of PPE are the responsibility of the employer - trainees can express any concerns to you but your role is to support, signpost and advocate not supply the PPE itself.
- Be aware that coming back to the clinical environment from shielding is an extremely stressful and frightening time. Ensure that detailed planning of the return takes place in good time with appropriate enhanced supervision, supernumerary or phased return periods where possible, always taking into account OH guidance. Ensure the whole department is 'distance aware' and complying with PPE guidelines.
- Recognise that some trainees may experience negative opinions regarding their displacement. Acknowledge the distress this causes and approach it in the same way you would other bullying or undermining behaviour. Do what you can to actively encourage a positive and inclusive culture.
|
|
Have you:
|
References
NHS. Who is at high risk from coronavirus (clinically extremely vulnerable) View website
GOV.UK. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19 View website
Royal College of Midwives. Advice for pregnant healthcare workers View website
GOV.UK. Coronavirus (COVID-19): advice for pregnant employees View website
British Medical Association. COVID-19: the risk to BAME doctors View website
British Medical Association. Doctors can be vulnerable too – shielding under strain View website