Challenges in medical education—what the doctor ordered?

It is hard to imagine a greater range of challenges than those currently facing the providers, purchasers, and consumers of medical education—a clear case of multipathology, with several vital systems facing the prospect of becoming overwhelmed. How will our patient, “medical education”, as an undergraduate (“paediatric”), postgraduate (“mediatric”) or in its continuous professional development (“geriatric”) state, respond? Will the two billion pounds the NHS spends annually on medical education and training be sufficient to pay for treatment?1

From its earliest days, our patient has had two guardians, the NHS and the universities, looking after its welfare, and protecting its interests. These guardians have been and are continuing to work on their relationship.2 The General Medical Council and the royal colleges set the standards by which the guardians are judged. Both the guardians and standards organisations are being challenged. This is not simply as a result of the increased political demand for accountability and transparency, but is part of the bigger picture being reflected in policy and evident in documents fromThe New NHS Modern. Dependable,3 through to A Health Service of all the Talents.1 This proposes radical changes, including that postgraduate deaneries coalesce with regional health authority boundaries, and the royal colleges participate more closely with others in workforce planning initiatives to establish wider consultation for the accreditation and location of training places.1 It is also proposed that funding formulas for specialist registrar posts should become more flexible, reflecting the needs of service delivery and learning opportunity. The availability of high quality clinical training posts for the service areas that need them is a priority. Historic precedence will give way to carefully planned allocation of resources to meet workforce demands, to be driven by population needs and care pathways. Thus the relationship between …