At any given time, approximately 10% of doctors in training take time out for reasons such as parental leave, sickness and out-of-programme research or experience. Returning to training after a prolonged period out of practice can be a daunting prospect for any trainee due to the potential impact on their clinical competence, technical skills and confidence. The ACAS Junior Doctors’ contract agreement in 2016 tasked Health Education England to “remove as far as possible the disadvantage of those who take time out due to, for example, caring responsibilities”. In response, HEE created the Support Return to Training (SuppoRTT) initiative, to develop guidance, policy, process and resources for trainee doctors and dentists throughout England.
Any doctor or dentist in training who has had an absence of 3 months or more is eligible. Periods of absence include:
- Parental leave
- Out-of-programme research, career break, training or experience
- Absence due to ill-health
- Period of suspension
- Absence associated with conduct/capability investigation
Please note : A trainee may opt in to SuppoRTT if absent for a period less than 6 months and they and their Training Programme feel it would be beneficial.
If a trainee is planning a period out-of-programme, they should contact and arrange a pre-absence meeting
with their TPD/FPT no less than 3 months prior to their leave date.
The TPD/FPT may delegate this to the ES if suitable but retain responsibility for ensuring the meeting takes place. The relevant employing Trust / LET policies should also be followed, and forms submitted for the differing reasons for time out-of-training (e.g. Out of Programme Policy, Parental Leave Policy etc.) which can be found on the Policies, Procedures and Guidance page of the HEE NE website.
At the pre-absence meeting, the trainee and TPD/FPT should cover:
- The reasons for and length of absence
- Potential CPD activities during absence if appropriate
- Keeping in Touch days (if planning for parental leave)
- Signposting to HEE NE SuppoRTT resources, e-LfH modules and School
- Return to Training courses
- Any concerns surrounding time out-of-training and returning
- Current and anticipated learning and training needs
The Pre-absence form should be completed during this meeting and submitted to the relevant programme co-ordinator, TPD/FPT and uploaded to the ePortfolio.
A meeting should be held when more convenient with a pre- absence form completed and submitted to map out how SuppoRTT will be delivered. This meeting does not need to be face-to-face. Any Occupational Health recommendations for phased return will take precedence and should be incorporated into the SuppoRTT plan.
Trainee and TPD/FPT contact is encouraged during time out-of-training, to ensure that trainees remains supported throughout this period, and is prompted with regards to the resources and opportunities available to the. They should be signposted to HEE NE SuppoRTT resources including upcoming events, training days and coaching programmes.
If on parental leave, Keeping in Touch (KIT) days or Shared Parental Leave in Touch (SPLIT) days should be agreed between the TPD/FPT and trainee in discussion with the LET. In addition to being an opportunity to refresh the knowledge, competencies and practice of normal duties, KIT/SPLIT days can be used to attend relevant study days, courses or meetings. Trainees on parental leave may be eligible for a total of 10 paid KIT/SPLIT days.
*KIT/SPLIT days are fully paid days that a trainee on parental leave can use to help get back up to speed during time out-of-programme. These include days of shadowing in clinic/theatre, attending training courses, accessing mandatory training and other experiences that will assist a trainee return to a training programme smoothly.
Once the trainee is aware of their date of return, they should inform their TPD/FPT at the earliest opportunity (preferably 3 months before the return date). Initial Return Meeting is advisable.
The meeting should cover:
- Any concerns the trainee may have regarding returning (e.g. lack of confidence or loss of clinical skills)
- Learning and training needs (signposting to courses/resources/mandatory training if applicable)
- The manner of returning to training (i.e. supernumerary status or period of enhanced supervision if required)
A supernumerary period is a short, intense period where the trainee is considered as an additional member of staff that enables the trainee to continue with their training in a flexible manner for a set period to help them return to normal duties safely and confidently. During this time, the workplace will be expected to cover the clinical duties of the returner whilst they are completing their supernumerary period, allowing them to complete a programme of focused learning and clinical activities which may include shadowing a senior member of staff. The length of this period and activities within it will be bespoke to the trainee depending on their needs.
An enhanced supervised period is a short, intensive period of focused learning and direct observation of clinical activities with the aim of enabling trainees to return to normal duties safely and confidently.
This should include peer, senior team or consultant supervision covering areas such as routine ward work, outpatient clinics, clinical skills, emergency and out-of-hours work. Simulation could be used to assess some of these skills. Supervised Learning Events (SLEs) should be used as documentation of this supervision, with these assessments acting as sign-off tools where appropriate.
The trainee and ES will arrange a Return Review Meeting
and discuss their progress, review assessments and feedback; addressing any concerns the trainee/ES may have. If both parties are satisfied with the trainee’s progress, then the trainee can be signed off and return to normal duties.
If the trainee/supervisor agree that an extension to the supervision period is appropriate, additional Return Review Meetings should be arranged until both the supervisor and trainee agree the period is complete and the trainee can return to normal practice.
This is a series of structured conversations over a time-limited period where the coach aims to help the coachee achieve a mutually identified set of goals to improve performance and/or develop skills. It is a voluntary, confidential one-to- one relationship which aims to encourage the individual to reach solutions for themselves.
Some Schools have developed specific programmes to provide opportunities to refresh and develop clinical or non-clinical skills, knowledge and confidence through Simulation programmes. Other programmes can be explored via the North East Simulation Network webpage (www.northeastsimulation.co.uk
A range of practical workshops relevant to trainees returning to practice are provided by the Learner Support and Faculty Development team. Further information can be found on the SuppoRTT webpage within the Learner Support area of the website.