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© 2020 The Authors. ESC Heart Failure published by John Wiley Sons Ltd on behalf of the European Society of Cardiology.BACKGROUND Urological surgical trainees who underperform are difficult to identify, manage and require significant resources in an already stretched system relying on pro bono supervisors that often have no formal training. While there are commentaries on how to manage underperforming surgical trainees, there is a lack of data detailing the complex reasons for under