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Trainees in trouble — can you spot the signs?

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Fast forward to the situation you never want to be in as a pre-registration tutor, or educational supervisor. You can’t sign off your pre-registration trainee… and you are not entirely sure why. Reflecting on their period of training, you realise that there were possibly some early warning signs that you missed. There are a number of warning signs that you can look out for early on in your pre-registration trainee, whatever sector of pharmacy you are in.

In the scenario below, there are a number of ‘tip of the iceburg’ signs that may be pointing to issues beneath the surface.

Your pre-registration trainee, A, is ‘on target’ in all practical areas of their training and progressing well. You are surprised when your colleague shares that A did not turn up for a training session that had been arranged with them last week. There was no explanation or apology when A saw them this morning. Your colleague also points out that A’s relationship with her colleagues and their ability to work as part of the dispensing team is causing increasing concern.

Reflecting on this, you realise that A’s ‘high standards’ with their work have led to a couple of arguments with others in the team about dispensary processes… and you realise that over the past week, A has been turning up late to work every day with a range of inadequate excuses.

What would you do? Below are five initial steps you could take to address this scenario.

 1. Trust your professional judgement.

You have valuable experience in both the clinical and the professional elements of pharmacy. Even if you are a new educational supervisor, be sure to recognise and value your professional judgement. The General Pharmaceutical Council Standards1 encourage you to “use your professional judgement in the interests of patients and the public”.

 2. Don’t ignore the ‘small things’

Putting your ‘head in the sand’ won’t make things go away. It is well known that unprofessional behaviour in pre-registration trainees correlates directly to disciplinary action later in their careers2. You have a responsibility to your patients, your trainee and to yourself that you don’t let the ‘small things’ slide. All of the highlighted actions above are potential indicators of a potential ‘trainee in difficulty’3.

3.  Do something!  

Your first step may be talking over your concerns with a colleague or contacting a mentor. Waiting until the next appraisal date with your trainee may be too late. Start collecting and documenting evidence to support any actions that your trainee may or may not have taken.

4. Actively listen to your trainee

 Use your active listening skills that you utilise every day when communicating with patients, to really hear what your trainee has to say. Listen beyond the words and reflect back what you are hearing to ensure you fully understand what they are saying.

5. Be aware of available support

It is important that both you and your trainee have access to the support that you need. This may include documents such as: 

  • Professional appraisal documentation
  • Action plan templates
  • Progress reports
  • Reporting procedures/forms

Other types of support may include:

  • Line manager/colleagues
  • Human resources
  • Occupational health departments
  • LETB (Local Education and Training Board) pharmacy team
  • Specialist services (i.e. PHP (Professional Health Programme))

Trainees in difficulty

Figure 1: The current support structure for educational supervisors and their trainees, overseen by the Kent Surrey and Sussex LETB pharmacy team

So if you have any concerns at all about your trainee, it is your responsibility to take action as early as possible in their training. This is not only part of your role as a pharmacy educator, but also a duty to your trainee, the profession, your patients and the public. 



1. General Pharmaceutical Council. Standards of conduct, ethics and performance July 2012 Available at: (accessed September 2014)

2. Papadakis M et al. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Academic Medicine 2004 79;3:244-9. Available at: (accessed September 2014)

3. Paice E. The role of education and training. In: Cox J, King J, Hutchinson A and McAvoy P (eds). Understanding Doctors’ Performance. Radcliffe Publishing, Oxford 2006:78-90. 

Readers' comments (2)

  • Thanks to Liz Fidler - our lead Pharmacy Technician for her contribution!
    Please let me know what you think about this blog.

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  • Our revised Trainee in Difficulty guide is out now: I would be interested in any comments

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