The paper by Raine in this issue of the journal¹ on the results of his analysis of the experiences of young paediatricians in obtaining the degree of MD between 1984–93 is not only thoughtful and provocative, but also a scathing indictment of our specialty in the support given to the brightest and most highly motivated of our young colleagues in pursuing training in clinical research. His article makes depressing reading, with a catalogue of difficulties and a litany of the hurdles experienced by those who managed to achieve the doctorate in due course. Since the paper does not give any information on the experiences of those who fell by the wayside and failed to deliver an MD, it is likely that the total picture is very much worse than that articulated.

Raine highlights a number of important issues, and they can be categorised into (a) the circumstances of the MD student, (b) the quality of the supervision given, and (c) the requirements and inefficiencies of different universities in processing the theses. The following deserve special emphasis.

It is thoroughly unsatisfactory that only 29% of those in research posts were able to submit the MD thesis by the end of the post. The fact that up to 80% of research time was spent on non-research related activities, including regular on call commitments, reveals the abuse of post holders to support service delivery. With this work load it is hardly surprising that so few theses were completed before the expiry of the post. Altogether 46% of submissions required revision. The need to resubmit while holding a full time clinical post probably accounts for the inordinately long length of time taken to obtain the MD—nearly a third of candidates did not obtain their MD until they were consultants, with a median time …