Reg 33 Trainee performance review

On occasion the performance of a Registered Trainee may require an independent review to determine the future of the Trainee in the Australian and New Zealand College of Anaesthetists’ (ANZCA) training program. The process will be known as Trainee Performance Review (TPR).

Information on TPR will be published in College documentation provided to Trainees when they join the ANZCA training program, and in documentation supplied to Regional Education Officers (REO)/National Education Officers (NEO), Supervisors of Training (SOT), and Fellows.

33.1 Initiation of TPR:

• 33.1.1 The Trainee Performance Review Process will commence when utilisation of local remedial measures has failed to resolve the problem within the agreed time frame. See TE18 Policy for Assisting Trainees in Difficulty.
• 33.1.2  A report about the concerns will then be made to the Director, Training and Assessments, by the REO/NEO, on the advice of the SOT. Copies of the report must be forwarded to the relevant Head of Department.
• A Trainee may instigate a review when a situation has arisen in which interpersonal relationships are preventing a fair and valid assessment of the progress of the Trainee. In this instance, the review will be initiated by the Trainee raising the issue, in writing, to the Director, Training and Assessments at the College.
• 33.1.3 In the absence of a report of concerns as set out in 33.1, and acting on inherent own motion powers under a common law duty of care, a Trainee Performance Review may be initiated by a majority of the President, the Executive Director of Professional Affairs and the Chair of the Education and Training Committee, to institute a Trainee Performance Review where there are reasonable concerns about the Trainee's performance under Regulation 33.1, or that there are reasonable grounds for believing that the Trainee's performance raises a concern that patient safety might be at risk.

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33.1.4 Examples of concerns may include (but are not limited to) :

• 33.1.4.1 The Trainee performs below a specified standard on any performance- or criterion-based assessment.
• 33.1.4.2 The Trainee lacks an appropriate level of practical skills or competence.
• 33.1.3.3 The Trainee lacks an appropriate level of non-technical skills.
• 33.1.4.4 The Trainee exhibits behavioural or attitudinal problems that significantly impair his or her performance, or adversely affect the performance of the medical team.
• 33.1.4.5 The Trainee has an illness or other problem that precludes a satisfactory standard of performance, for which the Trainee refuses to seek appropriate treatment.
• 33.1.4.6 A situation has arisen in which interpersonal relationships are preventing a fair and valid assessment of the progress of the Trainee.
• 33.1.4.7 Any other situation which arises in the progress of a Trainee that the supervisor believes would best be resolved through an independent review.
• 33.1.4.8 Any other problem that is unable to be resolved at a local level.

• 33.1.5 The TPR process is NOT to be used for a Trainee with difficulties whose practice significantly jeopardises, or has the potential to significantly jeopardise, patient safety (eg substance abuse or other serious illness). In these circumstances, a Trainee must be reported to the relevant Medical Board or Council or Authority.

• 33.1.6 When implementing any form of summative review, it is important to preserve as far as possible the value and effectiveness of the current In-Training Assessment (ITA) process as a formative educational tool for improving Trainee performance. If considered appropriate or necessary by the Review Team, the Review Team may consider one or more In-training Assessment forms (ITAs) concerning the Trainee. The Trainee must do all things reasonably necessary to make the applicable ITAs available to the Review Team, together with any associated documentation required by the Review Team to consider or assess the ITAs. The Trainee will be free to comment on ITAs and raise any material concerns about the ITAs.

33.2 Goals and Objectives of the Review Team:

• 33.2.1 The goals and objectives of the Review Team are to provide an independent assessment of the events that led to the request for review, and make a recommendation regarding the Trainee’s future in the ANZCA training program.
• 33.2.2 A clear and unbiased recommendation, based on the principles of the Brennan Report2, should be reached by the Review Team with regard to the future of the Trainee. This recommendation should be one of the following:
• 33.2.2.1 The Trainee continues training.
• 33.2.2.2 The Trainee continues training subject to him or her meeting certain conditions or requirements, and agreeing to undergo remediation. This may include, for example, the attainment of specific goals on a periodic basis, assessment by working under the supervision of another or senior supervisor of training, completing a communications course, or any other condition or requirement considered appropriate by the Review Team.
• 33.2.2.3 The Trainee is dismissed from the training program.
• 33.2.3 Where specific problems have been identified in the training process, the Review Team may make additional recommendations concerning:
• 33.2.3.1 The training of the Trainee
• 33.2.3.2 The supervision of the Trainee
• 33.2.3.3 The departmental role in training
• 33.2.3.4 The hospital role in training
• 33.2.3.5 The College processes
• 33.2.3.6 Any other aspect of the training program.

33.3 Selection and Composition of the Review Team:

• 33.3.1 The Director, Training and Assessments shall select the members of the Review Team, on the advice of the Chair of the Education and Training Committee (ETC).
• 33.3.2 The Review Team should comprise at least three members, who will be appropriately qualified. No team member must have any identified or perceived conflict of interest with regard to the Trainee under review. The membership shall be as follows:
• 33.3.1.1 Three members shall be senior Fellows of ANZCA familiar with all aspects of the training program, and willing to be appointed for a period of time sufficient to enable continuation of the ‘corporate knowledge’ of the review process.
• 33.3.1.2 Two further members may be co-opted to the team according to the specific needs of each case. For example, additional members may be co-opted to the team to supplement the knowledge of the core team members, with regard to local knowledge about the hospital(s) where the problem was identified and/or expertise pertinent to the problem (e.g. educational, psychological, medical).
• 33.3.1.3 Two or three members of the Review Team may conduct the site visit and interviews, and provide a report. This report will be reviewed by all the members of the Review Team.

33.4 Review Process:

• 33.4.1 Once the membership of the Review Team has been finalised, the ETC, the Trainee, the SOT, and other interviewees will be given notice of:
• 33.4.1.1 The initiation and purpose of the Review
• 33.4.1.2 The reasons for the Review, especially any information relating to the adverse performance or conduct of the Trainee
• 33.4.1.3 The membership of the Review Team
• 33.4.1.4 The date of the interview(s)
• 33.4.1.5 The venue of the interview(s) (at a site remote from the hospital in which the Trainee is working, and which provides privacy and confidentiality)
• 33.4.1.6 The date and location of any site visit(s), and disclosure of materials, if applicable
• 33.4.1.7 The purpose of the interviews
• 33.4.1.8 The process of the Review.
• 33.4.2 When the Trainee is informed of the composition of the Review Team, he or she may raise concerns about potential conflict of interest with any member of the Review Team. If these concerns are substantiated, a substitute appointment will be made.
• 33.4.3 The Trainee should also be informed that his/her failure to comply with the requirements of the review may constitute a breach of the requirements for Fellowship training, and may result in removal from the training program.
• 33.4.4 The Review Team may interview the Trainee, past and present supervisor(s), other relevant past and present instructors, colleagues, other Trainees, hospital staff, and anyone else deemed appropriate by the Review Team. The Trainee may bring a support person to the interview(s), but is not entitled to have an advocate, nor to be legally represented, unless prior consent has been given by the Review Team.
• 33.4.5 The purpose of these interviews is to allow the Review Team to gather information for the review process.  In the case of an interview with the Trainee, he or she must be given a reasonable opportunity to comment on any information that is or may be adverse to himself or herself.
• 33.4.6 If deemed necessary by the Review Team, the team may also undertake one or more site visits, to gather further information relevant to the review process. 
• 33.4.7 Any documentation relating to the situation that gave rise to the review must be available to the Review Team and to the Trainee.  In addition, the Review Team should keep notes of the interview(s) and any site visits to assist them in writing a report for the ETC. 
• 33.4.8 On conclusion of the Review, the full Review Team must prepare a written report.  This report must include recommendation(s) for future action with regard to the Trainee, and must remain entirely confidential.
• 33.4.9 Before concluding the written report, the Review Team will contact the Trainee to discuss any significant adverse information obtained during the course of the Review, and to allow the Trainee to have a final opportunity to respond to any further allegations of adverse information.
• 33.4.10 The report is submitted to the Director, Training and Assessments of ANZCA. 
• 33.4.11 The report from the Review Team is then considered by the ETC.  It is the responsibility of the ETC to make a decision on the actions to be taken as a result of the Review, and to make recommendations to Council.
• 33.4.12 When considering the report from the Review Team, the ETC may decide upon further remediation processes.  It may be deemed appropriate that remediation includes additional training, even though this may prolong the training period.
• 33.4.13 The decisions and recommendations of the ETC, together with the report from the Review Team, are to be considered by Council. 
• 33.4.14 Council’s final decision must be communicated to the Trainee, supervisor and other bodies as appropriate (including, for example, hospitals and medical boards). The Trainee must be notified that failure to comply with requirements may result in removal from the training program.
• 33.4.15 The Trainee must be made aware of the existence of the Review, Reconsideration and Appeal Processes 3,4.

References:

1. TE18 Policy for Assisting Trainees in Difficulty
   
2. Trainee Selection in Australian Medical Colleges (The Brennan Report), November  1997 Medical Training Review Panel
   
3. ANZCA Review and Reconsideration Process
   
4. ANZCA Appeals Process

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