Consultants are now required to establish and supervise educational programmes for specialist registrars and senior house officers (SHOs). Fifty per cent of trainees’ salaries is channelled through deans of postgraduate medicine, money which can be withdrawn if the educational component is deemed inadequate. There seems to be a willingness to take on this educational task, although, as Wilson1 has highlighted, consultants have expressed concern about these new demands.

In addition new working practices have changed the process of training. Medical teams have expanded to meet the reduction in junior doctors’ hours of work. Consequently seniors have fewer occasions to work with each junior and may be less able to observe and assess their performance. Concern has also been expressed that the time spent on patient contact has now decreased to a level incompatible with training, although Paice2 disputes this. Nevertheless, the shorter training makes it imperative to maximise the educational value of all aspects of clinical practice.

Despite reduction in trainees’ hours of work, they are still working longer hours than most of their contemporaries in other walks of life. There is evidence that a comfortable balance between service and training has not yet been achieved. Baldwin’s review3 of Scottish medical SHOs in 1996 identified that education was limited by increasing clinical demands.

The content of trainees’ experience also highlights another conflict. Their role is often markedly different from that of the trainer, with greater emphasis on the acute service and less on longer term medical management and the consultant’s institutional roles. This discrepancy was noted in the United States as part of a wider discussion about the survival of general medicine and general paediatrics. Reuben et al were critical of the loss of focus on the primary goal in residency training in the rush to provide …