Table 1

 Main drivers for change

InitiativeKey featuresImpact
Modernising Medical CareersFoundation programmes Streamlined programmes Assessment of competenciesShorter and more focused training More protected time needed for consultants and other supervisors for supervision and assessment
Postgraduate Medical Education and Training BoardSingle competent authority for maintaining standards in postgraduate specialty and general practice training from September 2005 Definition of standards for entry and recruitment Responsible for quality assurance of postgraduate medical training Article 14 applications to specialist register on the basis of training, qualifications and experienceChanging roles for Royal Colleges with possibility reduced power and influence More lay and public input to postgraduate medical training More doctors will be admitted to the specialist register
Working Time DirectiveAugust 2004: maximum 58 hour week August 2007: maximum 56 hour week August 2009: maximum 48 hour week Innovative approaches to learning and training needed Hospital at Night projectsRadical change to the way in which training is delivered Perhaps longer training needed for the surgical specialties Reconfiguration of services