Changing postgraduate medical education: a commentary from the United Kingdom

The current changes in postgraduate training in the United Kingdom are largely driven by government rather than the profession, and are aimed at producing a medical workforce more quickly and more fit-for-purpose in a rapidly changing National Health Service. Most aspects of the changes are, as yet, untested. Postgraduate training now consists of a 2-year varied Foundation program, followed by selection to a longer training program within a chosen specialty (often with further selection points to different subspecialties after 2 years). Assessment systems are a combination of workplace-based assessments and national examinations of knowledge and skill. The changing, highly managed and partially privatised health service in the UK presents challenges in terms of providing appropriate clinical experience for training. Postgraduate medical education is now regulated by the Postgraduate Medical Education and Training Board, which sets standards for all aspects of training, and approves curricula, programs and assessment systems. The lessons to be learned from the UK are: When education changes, the actual rationale should be clear. It is important to understand the difference between political and professional agendas. Protection of adequate clinical experience is paramount. Competence models can "instrumentalise" medical education (ie, deconstruct integrated professional performance, attempt to micromanage, streamline, objectify and rationalise for purposes of cost or time containment or for managerial imperatives). Standards for medical education should be clear, but not at too specific a level. If trainees' career structures change, careers advice must also change.