Objectives Primary care in the United Kingdom is delivered through the National Health Service medical workforce comprising 25% international medical graduates. This study explored the challenges experienced by international participants as they progressed through speciality training in General Practice and sought solutions to those challenges through the lens of applied educational theory, or ‘praxis’. Methods The case-based methodology was founded on a qualitative paradigm and postpositivist theoretical framework. Data were collected from international medical graduates and General Practice Trainers via focus groups, on-line questionnaire and semi-structured interviews. A strategy of convergence of evidence underpinned thematic data analysis, triangulating data to construct theory through cycles of continuous iteration. Findings Challenges relating to difference, relationships, conceptual understanding and expertise, practical barriers, wellbeing and risk were countered by applied metacognition, emotional intelligence, resilience and curiosity. Trainee passivity confounded these solutions. Conclusions The considerable challenges encountered by participants, not all comprehended before commencement of training, were compounded by poor conceptual understanding of the NHS and primary care and impacted on educational progression and wellbeing. Strategies centred on the application of metacognition and applied curiosity. These findings have considerable potential for training programmes and policymakers with respect to trainee orientation and workforce development.