The 1948 Spens report on the remuneration of consultants and specialists anticipated that a medical graduate 23−24 years old would achieve specialist status by the age of 32.1 In practice, most doctors are appointed to their first consultant post between the ages of 35 and 40. Sir George Pickering commented in his 1962 review of postgraduate medical education, “I cannot believe that any responsible body would have so long a period of training (10−15 years) . . . the situation has got out of hand.”2

The introduction of the specialist registrar grade in December 19953 was the first major change in speciality training since the inception of the UK National Health Service (NHS). This change was prompted by the need to meet European models and to provide a means to a certificate of completion of specialist training (CCST); to provide a shorter, more structured training programme; and to control the numbers of people entering this grade relative to expected consultant vacancies. These changes have been met with scepticism and in some cases antagonism. They have caused greater focus on what is required and desired in the making of a competent specialist. There is, however, continuing concern that the training period is too rigid and too short for many.

The implementation of this change has come on top of the “New deal” in 1990, which had already significantly increased the number of junior doctors required to provide for service. New rotas have led to the loss of the “firm” structure, and responsibility for continuity of patient care has meant longer working hours for consultant staff. At the same time the demands of formal provision of postgraduate education and the organised supervision and appraisal of junior doctors has eroded consultant time, which previously was spent on service, personal professional …