Key mechanisms identified for assisting struggling trainees all involve increasing trainees' awareness of gaps in their knowledge and ways of communicating. These included timely and accurate feedback delivered sensitively, potentially from multiple sources. Once GP specialty trainees are aware of their learning needs they can then engage with further support from the local education and training board (LETB) and external specialists. Therefore, LETBs should consider the support they are able to give trainers to facilitate their work with trainees in difficulty.