Work-based assessments (WBAs) were only recently introduced into medicine. However, since their introduction, they have rapidly grown in popularity. WBAs are now a routine part of medical training. As WBAs are being implemented, the practical difficulties with their use have come to light. A major problem is failure of the trainees, trainers and training programmes to adequately engage with them. In this review, the reasons for this and how these can be overcome are discussed.