Supporting Advanced Practice Trainees Experiencing Difficulty – Midlands Faculty for Advancing Practice

– Assign a coordinating educational supervisor who understands the trainee’s qualifying professional registration, prior experience, and regulatory context.
– Where appropriate ensure workplace-based supervisors or a mentor/buddy are in place to provide guidance and support in clinical practice.
– Foster open communication to encourage trainees to express concerns without hesitation or fear of judgement.

– Set and agree on the trainee’s scope of practice, learning objectives, and progress measures from the outset.
– Use job planning to structure clinical and non-clinical time effectively, ensuring the trainee and supervisor are aligned.
– Encourage trainees to ask questions to clarify expectations and reduce uncertainty.

– Assess risk factors. Some trainees may struggle to balance their training programme with family commitments, whilst those with recognised neurodiversity issues may require a more flexible approach to their academic studies.
– Acknowledge individual learning paces that may require flexibility and adjustment of training methods to suit different styles and needs.
– Recognise trainees’ diverse backgrounds, prior learning and employee rights that must be respected.

– Schedule regular check-ins to discuss development, address challenges, and offer constructive, confidence-building feedback.
– Use workplace-based assessments to support reflection and measure progress in real-world practice, with patient safety as a core theme.

– Break down challenging tasks into manageable steps.
– Tackle one task at a time to reduce overwhelm and build confidence incrementally.

– Create a psychologically safe environment that encourages questions, curiosity, and learning from mistakes. NHS Employers offers guidance and advice on how we can achieve this which can be accessed here.
– Acknowledge growth and development over perfection.

– Engage and collaborate with other trainees to promote shared learning and a sense of belonging.
– Enable knowledge exchange through informal peer mentoring and teamwork.

Supervisor Readiness Checklist,
Readiness to Become An Advanced Practitioner,
Employers advanced practice supervision action plan.
Governance Maturity Matrix
An employer’s guide to ADHD in the workplace
Guide to Practice-Based Learning (PBL) for Neurodivergent Students

Kerri Douglas, MSc Advanced Clinical Practice Programme Lead at Keele University, recognises the vital role Higher Education Institutions (HEIs) play in supporting learners with additional needs. She identifies mature students returning to study, those for whom English is a second language, and students with diagnosed or undiagnosed learning needs as particularly at risk or encountering difficulties.

Challenge:
Many learners struggle with mastering varied assessment formats, a difficulty often worsened by inconsistent assessor expectations. These challenges can lead to disengagement, underperformance, and increased stress.

Innovative Response:
Keele University has introduced flexible assessment options within certain modules, allowing students to choose formats that align with their strengths. Early identification of at-risk learners enables tailored support, such as pre-planned assignment extensions. Additionally, pastoral care is strengthened through buddy systems and close monitoring by programme leads.

Impact:
These strategies foster a more inclusive learning environment, reduce barriers to success, and empower learners to thrive academically and professionally.

– Lack of Progress: Frequently misses milestones, struggles to complete tasks, or needs significantly more time than expected.
– Repeated Mistakes: Makes the same errors despite feedback and has difficulty applying learning to practice.
– Poor Quality of Work: Work consistently falls below the required standard with little improvement.

– Low Engagement: Appears distracted, withdrawn, or uninterested; avoids participating in discussions or activities.
– Negative Attitude or Frustration: Displays stress, low mood, or expresses defeatist statements (e.g., “I can’t do this”).
– Decline in Confidence: Shows anxiety or hesitation when performing tasks or discussing material which is new or unfamiliar.
– Avoidance of Feedback: Resists critique, may become defensive, or disregards suggested improvements.

– Reluctance to Ask for Help: Avoids seeking clarification, appears apprehensive or isolated in sessions.
– Isolation from the Group: Works alone and withdraws from peer interaction or group learning opportunities.
– Lack of Initiative: Waits for direction, avoids responsibility, and shows minimal curiosity or motivation.

– Missed Deadlines and Absenteeism: Frequently late, cancelling meetings, absent or fails to submit work without explanation.
– Physical Signs of Stress: Displays restlessness, fatigue, or tense body language (e.g. fidgeting, sighing).

– Ensuring a safe psychological space: Foster open communication, respect diverse perspectives, and ensure everyone feels safe to speak without fear of judgment or retaliation.
– Direct Communication: Initiate a private, open-ended conversation to highlight recognised triggers or change in behaviour.
– Observation: Monitor behaviour during training sessions and team interactions for consistent patterns.
– Feedback Gathering: Seek insights from academic and workplace supervisors, mentors, and colleagues who closely work with the trainee.

Dealing with Trainees in Difficulty (Mahmood, 2012)
Giving and Receiving Feedback
Professional nurse advocate A-EQUIP model: a model of clinical supervision for nurses

The A-EQUIP (Advocating and Educating for Quality Improvement) model, based on Bridget Procter’s work, was developed by NHS England as a clinical supervision framework. Introduced in 2017 within midwifery to replace statutory supervision, it was later adapted for the wider nursing workforce.
Helen Allen, Lead ACP for Quality Improvement at University Hospitals of Derby & Burton, has adopted the model to support Advanced Practitioners across disciplines through restorative supervision. Professional Advocates promote continuous improvement, leadership, and high-quality care, aligning with the four pillars of Advanced Practice.

Education & Development (Formative) – Linked to the Education pillar, this function enhances knowledge and leadership through guided reflection, encouraging ACPs to challenge and improve practice while advocating for patients.

Personal Action for Quality Improvement – Tied to Leadership and Research pillars, it empowers ACPs to engage in improvement initiatives and actively enhance care.

Clinical Supervision (Restorative) – Rooted in the Clinical pillar, this function offers emotional support, reduces burnout, and improves wellbeing, retention, and team dynamics.

Monitoring & Evaluation (Normative) – Spanning all pillars, it reinforces accountability, validates clinical actions, and supports learning from errors to ensure safe, effective practice.

– Open a respectful, honest dialogue with the trainee to outline the specific concerns.
– Review what actions have already been taken to support them and clearly explain the importance of improvement.
– Focus on observable behaviours, explore potential contributing factors, and invite the trainee to share any personal or contextual challenges.
– Ensure the trainee understands possible consequences if issues are not resolved, while maintaining a compassionate, supportive tone.

– Maintain a clear, factual record of performance concerns, including missed deadlines, specific incidents, and actions taken.
– Document all feedback, the trainee’s responses, and any progress made (or lack thereof).
– Consistent, objective documentation will support fairness, clarity, and accountability throughout the process.

– Escalate concerns to the coordinating educational supervisor or academic supervisor, sharing documented evidence and outlining previous interventions.
– Collaboratively identify further strategies or support options.
– Agree on clear, time-bound improvement goals with the trainee and document the action plan, including responsibilities and resources.

– If concerns persist despite informal interventions and supervision, escalate to the Advanced Practice Lead or senior management.
– Provide a concise summary of all steps taken, the trainee’s engagement with the process, and any impact on service delivery, staff morale or patient care.
– This ensures transparency and enables leadership to explore further action where appropriate.

– Refer trainees to Occupational Health where performance concerns may be linked to health issues.
– Seek recommendations for reasonable adjustments to support training and document in a Tailored Adjustments Plan.
– Emphasise the importance of regular breaks and physical rest to support cognitive performance and well-being.

– Promote access to well-being services, including stress assessments.
– Explore options for temporary adjustments:
– Time out of academic study (while remaining within MSc completion limits)
– Leave from work or team reassignment.
– Notify the Regional Faculty of any breaks via the appropriate “Change in Circumstances” form.

– Collaboratively create a learning plan that outlines:
– Specific performance concerns
– Measurable improvement goals
– Resources available
– Timelines and regular review checkpoints
Align the plan with local HR policy and ensure the trainee fully understands expectations.

– Assess the need for additional supervision or focused training to address specific development needs.
– Consider assigning an alternative supervisor if current arrangements are not effective.
– Gather workplace-based assessments from a broad variety of assessors to ensure objectivity.

Signpost or refer to:
– University/Higher Education support services
– Access to Work
– Regional Faculty for Advancing Practice
– Alternative assessment or supervision by an experienced advanced practitioner from another organisation

If all support options are exhausted and no improvement is observed:
– Explore redeployment to a more suitable role.
– Removal from the programme, if not able to meet the capability requirements to continue in training. This must be in accordance with relevant organisational policy and should be as a last resort.

– Manage concerns with sensitivity and discretion, involving only those with a need to know.
– Maintain the trainee’s dignity and privacy throughout the process.

– Conduct a retrospective review of processes such as recruitment, supervision, induction, and placement allocation.
– Use insights to enhance training design and governance, preventing recurrence of similar issues.

AdvanceHE (2022) Education for Mental Health Toolkit
Access to Work
Android Apps for Learners with Dyslexia
Dyslexia Friendly Workplaces – A guide for employers
Useful Resources | mSurgery
Organisational Managing and Supporting Performance Policy
University Policies and Procedures for Authorised Break in Studies

The Derbyshire Faculty of Advancing Practice has produced a guide to managing concerns raised about the progress of a trainee or their performance. The information below provides guidance for all partners organisations within the Integrated Care System.

1: Low Level Concerns
– Gather feedback from colleagues
– Meet the trainee and document the discussion
– Review personal objectives and review regularly
– Signpost to well-being services
– Increase the level of day-to-day support

2: Moderate Concerns
In addition to the above interventions:
– Monitor progress closely
– Identify any reasonable adjustments required
– Inform line manager and ACP lead
– Consider an Occupational Health referral
– Involve senior educators if performance does not improve

3: Significant Concerns
In addition to the above interventions:
– Arrange regular meetings with the supervisory team
– Consider a pause in academic studies
– Refer to the organisational policy for managing and supporting performance
– Gather further assessments of performance

Derbyshire Faculty of Advancing Practice (2024) Training Guide