| Summary: | The under-performing medical student or trainee in difficulty, is the subject of extensive discussion in the medical education literature. In contrast, literature on the high-performing medical student or trainee is limited, possibly because high-performers are considered the 'quiet achievers' requiring little assistance. High-performers however are diverse and they may also have difficulties with their learning and face particular impediments. Whether quiet achievers or otherwise, high-performers provide challenges to the educator and educational institution alike. This is a discussion paper based largely on the author's broad experiences in General Practice (GP) training. It references educational theories of giftedness and knowledge management theory in order to provide an understanding of high-performing GP Registrars (GPRs) and the gifted, their attributes, particular challenges and needs. It argues that high-performing GPRs, those having talent or showing potential, should be supported and encouraged to excel. This requires striking the right balance between challenge and support as well as the optimization of: learning, experience, self-reflection and self-actualization. In addition, impediments to learning should be addressed, psychosocial needs met and assistance provided to surmount any disabilities. This is important, not only that high-performing GPRs will aim higher and attain their ultimate potential but also to give impetus to the gifted amongst them, who have special abilities and the potential to make new discoveries, challenge extant ideas and create new paradigms.
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