The proposals by Kenneth Calman1 to restructure the training of middle grade staff were introduced to “produce a shorter, more structured and organised training pathway so that independent clinical competence as a consultant can be achieved much earlier than in the past in many disciplines”.2 By the allocation of a National Training Number (NTN) and a more formalised training programme, the goal was to provide the health service with doctors of a consistently high quality in appropriate numbers for the forecast consultant vacancies. From the registrars’ point of view they would receive their NTN, which guaranteed, subject to satisfactory progress, training in their chosen discipline, and a training post within a specific region.

Unfortunately the realisation has differed somewhat from these ideals. The key weaknesses in the current implementation are:

• A wide heterogeneity of assessment and appraisal—the benchmarks for monitoring trainees’ progress

• A lack of flexibility in the system to encompass the training requirements of either paediatric subspecialists or academic paediatricians

• The regional allocation of trainees can cause clashes between regional manpower requirements and an individual’s training needs

• A fixed length of training applied at the same time as the “new deal” on hours is severely limiting experience before consultancy.3

 These points are discussed in more detail and I propose amendments to the current system to address these shortcomings.

I speak from the position of a paediatric specialist registrar, just starting my third year of higher specialist training. Much of my time has been spent trying to understand the Calman training programme and to make the best use of the bureaucracy that has evolved to support it. Unfortunately, the rapid introduction of this system has lead to many omissions. Notably, it does not cater for the diverse needs of trainee generalists, academics, and subspecialists.2 3 It …