Identification and management of the underperforming surgical trainee.

Most surgical trainee make steady progress, delivering a safe and reliable service at an appropriate level at the same time as they as learn new skills under supervision. Trainees learn at different rates, and progress that is safe and steady although slower than the norm should not be classed as underperformance. Clinical performance issues may arise at any stage of a doctor's cancer, and should be addressed promptly and constructively. Factors that may impact on performance, such as the personality of the trainee, their personal pressures, and the training and working environment, should be considered and where possible mitigated. Enhanced supervision; regular constructive feedback; psychological support; coaching and mentoring may all be required. A change of trainer or working environment may sometimes be necessary, and the duration of training may need to be extended. A supportive working and learning environment with a sound educational framework will help to ensure that trainees in difficulty are identified early and managed supportively and constructively.