Abstract
Approximately 6-9% of trainees will have performance issues of variable degrees with 3-5% of trainees struggling to complete their training and requiring additional targeted time or an extension of training. Some even leave the profession. The environment is complex, often chaotic and overstretched, and, now, made more difficult due to the impact of COVID-19 on medical training. Addressing learning and implementing new behaviours is a challenge and important, as there are still 'never events', and medical errors sadly can include wilful neglect and assault. Such traumatic experiences can be a huge drain of resources for faculty, who often feel underprepared to deal with such occurrences. Failure to address them can lead to bitterness and loss of the medical workforce, rarely suicide, huge remedial costs, and legal challenges to educational institutions and employers. The purpose of this paper is to gain an understanding of why trainees struggle and/or fail and to be able to analyse the causes of poor performance; to know how to pick up these issues early and raise them; and to ultimately deal effectively with performance problems to get a good outcome for the trainees, patients, and institutions.