ABSTRACT
In all professions it is recognised that on occasion trainees may encounter difficulties. These may be manifested as ill health, misconduct, poor performance or dropping out of the system. The cost of training doctors is high and retention of doctors is therefore important to the service, but it cannot be at the expense of patient safety. A doctor in training is usually employed by a National Health Service trust, and is subject to individual trust policies and procedures. Prevention is better than cure, and ensuring that a sound educational framework is in place wherever doctors are being trained is the first and most important step in any strategy to deal with trainees in difficulty. When a trainee's competence or reliability is below the expected standard, colleagues or patients may recognise a problem before it comes to the attention of the consultant. Poor clinical performance in trainees is usually considered an educational issue and handled locally by intensified training and supervision.
