Framework to manage the exceptions
| Safeguard | Explanation | Applied to physician training |
| Establish oversight authority | Group to develop and oversee guidelines, ensuring input of stakeholders | Professional societies should develop guidelines for training new physicians |
| Compelling justification | The interests of the present patient should be compromised only for a compelling reason | Training new physicians is a vital social interest |
| Protect relationship | Guidelines should minimise impact on relationship by minimising judgement required of individual physician | Require patients to be informed of and consent to care by inexperienced trainees. Limit judgement of supervising physician to determining whether selected patient is appropriate |
| Minimise risks | The risks to the present patient should be as low as possible | Require supervision and limit care by trainees to less complicated cases |
| Equitable distribution | Risks should not be limited to some groups | Institutions assign trainees to patients in a way that distributes risks among groups |
| Added safeguards | When risks to present patient are more than minimal, include additional requirements, such as consent and compensation | Compensate patients who agree to face greater than negligible increased risks from inexperienced trainees |