Good training should not depend on luck

For many resident doctors, the challenges facing postgraduate medical training will feel familiar.

This is precisely the problem.

Across the last two decades, successive reviews of medical training have identified many of the same issues: service pressures crowding out education, inconsistent supervision, inflexible pathways, assessment processes that do not allow development or reflect true capability, and difficulties progressing through training. Across the RCP’s next generation campaign, resident doctors told us remarkably similar stories.

The NHS does not need another description of the problem – after all, the same concerns identified in successive reviews continue to appear in the experiences of resident doctors today. It needs a system that is answerable for solving it.

In the RCP’s 2025 next generation survey of more than 1,000 resident doctors, only 26% felt ready for the next stage of their career. Fewer than half were satisfied with their clinical training. Just 17% believed postgraduate recruitment processes were fair. These are not isolated frustrations. They are indicators of a system struggling to consistently provide the training experience resident doctors expect and patients deserve.

For too long, training quality has depended on goodwill. One of the most striking conclusions of our major new report, Training physicians for the future: a blueprint for reforming postgraduate medical training, is that we already know what good training looks like. Protected learning opportunities, meaningful supervision, high-quality assessments and supportive progression pathways are not new ideas. The problem has been implementation.

When training quality falls short, responsibility is often fragmented across employers, education bodies, regulators and professional organisations. Everyone has a role, but too often it becomes unclear who is responsible for driving improvement when problems arise. As a result, concerns can be repeatedly recognised but insufficiently addressed. That is why our report argues that educational quality must become visible, measurable and accountable.

We are calling for a strengthened quality assurance system that identifies problems earlier and makes it harder for poor training environments to remain hidden. This includes a small number of specialty-specific educational key performance indicators, developed with resident doctors, focussing on practical questions such as access to supervision, attendance at protected teaching and the reliability of educational opportunities.  

This is about transparency. If a trust, health board or hospital is repeatedly cancelling educational activities, failing to release doctors for training or struggling to provide supervision, it should be visible. More importantly, there should be clear expectations about what happens next.

We are also calling for designated education leads in departments, stronger regional oversight and regular scrutiny of training quality by trust and health board leaders. Educational performance should be treated with the same seriousness as patient safety, operational delivery and financial performance. Importantly, accountability should not mean blame. Not every organisation starts in the same position. Many face considerable workforce and operational pressures. The first response to problems should be support and improvement. However, it must become unacceptable to allow the same educational failings to persist year after year without meaningful action.

Resident doctors themselves must remain central to this process. The most reliable measure of a training environment is the experience of those learning within it, so resident doctor feedback should sit at the heart of future quality assurance arrangements.

We wrote Training physicians for the future as the RCP response to phase two of the medical education and training review. We consulted widely with other resident doctors, RCP committees and networks, and the final report was debated and signed off by RCP Council. We are proud to say that the RCP is taking this review as a genuine opportunity to do things differently. After all, the NHS has spent many years diagnosing the problem, and the next phase must be about delivery.

Good training should not depend on luck. It should not depend on geography. It should not depend on the determination of individual resident doctors to overcome barriers that the system should be removing. It should be an explicit expectation of every organisation involved in training. And until educational quality is measured, reported and acted upon with the same seriousness as other core NHS priorities, we will continue to have the same conversations for years to come.

After all, getting medical training right is not only an investment in the next generation of doctors, but in every patient who will rely on their expertise in the future. 

Dr Stephen Joseph is the RCP Resident Doctor Committee (RDC) co-chair and a member of the writing group that developed Training physicians for the future. He works as a registrar in respiratory and general internal medicine in East London.

Dr Alexandra Pain is the RCP RDC representative for Oxford and Thames Valley and a member of the writing group that developed Training physicians for the future. She works as a registrar in geriatric and general internal medicine in Buckinghamshire.