The quality of medical training should be measured and scrutinised as seriously as NHS finances, operational performance and patient safety, according to a major new report published today by the Royal College of Physicians (RCP).
In its new report, Training physicians for the future: a blueprint for reforming postgraduate medical training, the RCP warns that years of underinvestment in medical education, eroded learning opportunities and inadequate accountability for training quality risk undermining patient care, worsening workforce pressures and leaving the NHS without the senior clinicians it will need in future.
RCP research illustrates the urgency of the need for reform. In a 2025 RCP next generation survey of more than 1,000 resident doctors working in UK clinical settings, just 26% felt prepared for the next step in their career and only 65% expected to remain working in the NHS in 5 years’ time.
Developed by a writing group of resident doctors, the report calls for medical education to become a visible, protected and accountable part of delivering NHS services.
The call for greater accountability reflects a longstanding pattern in medical training: concerns have been identified repeatedly but meaningful action has failed to follow. Reviews stretching back over two decades have highlighted service pressures crowding out education, inadequate educational supervision, inflexible career pathways and assessment processes that do not always support professional development. Many of the same problems were identified once again in the phase one report of the national medical education and training review which was published in October 2025.
The RCP is now calling for:
- postgraduate medical education to become a standing part of trust and health board governance, with named executive and non-executive responsibility
- transparent measures of training quality, reviewed at least every 6 months by named organisational and regional leaders
- clear improvement plans and escalating intervention where organisations repeatedly fail to provide an acceptable training environment
- greater transparency about how funding intended for medical education is used
- sufficient staffing levels to protect training from service pressures and protected time for educational supervisors and trainers to provide high-quality education
- an expansion in doctor training capacity to address career bottlenecks and meet future workforce needs.
Professor Mumtaz Patel, RCP president, said:
‘High-quality medical training is fundamental to safe, effective patient care. Resident doctors today will become the consultants, clinical leaders, educators and researchers on whom patients will depend for decades.
‘Yet education is still too often treated as something that can be postponed or cancelled when services are under pressure. That is a false choice. If we properly support resident doctors, they will be more effective in developing their skills and expertise, provide better care and are more likely to remain in the NHS.
‘We know what good medical training looks like. What has been missing is clear ownership and accountability for delivering it. Training quality must become as visible and consequential as the financial, operational and patient-safety measures against which NHS organisations are already held to account.’
The new RCP report says that resident doctors and their educational supervisors should have protected time for learning, observation, feedback and reflection, supported by staffing levels that enable education to take place without compromising patient care. Skills developed through research, leadership, education and locally employed roles should be recognised consistently, while national standards, examinations and minimum clinical experience must continue to protect patient safety.
Dr Ricia Gwenter and Dr Stephen Joseph, co-chairs of the RCP Resident Doctor Committee, said:
‘Resident doctors do not need another review to tell us that medical training is under pressure. We experience the consequences every day when clinics are missed because of rota gaps, opportunities to learn are displaced by service demands, and frequent rotations make it difficult to build the educational relationships with supervisors that support professional growth.
‘Resident doctors want to provide the highest standard of patient care while also developing the clinical skills and professional judgement that we need as senior decision makers. Those aims should not be in competition. High-quality training embedded within everyday service creates a skilled, supported and sustainable workforce that benefits patients, doctors and the NHS alike
‘The test of the medical education and training review will not be whether it identifies the right problems. It will be whether the system is finally made answerable for putting the solutions into practice.’
Postgraduate training must prepare physicians for changing patient needs and new models of care. The RCP is calling for doctors to develop broad generalist capability alongside deep specialist expertise, with experience of neighbourhood healthcare, prevention, population health and clinical leadership. Digital and AI should be embedded throughout training, including virtual care, evidence appraisal, safety, ethics, governance and the appropriate use of technology in clinical practice.
The report also calls for workforce planning to align the expansion of medical school places with postgraduate training posts and future consultant roles and recommends nationally agreed safeguards against the inappropriate substitution of medical roles. Multidisciplinary teams make a valuable contribution to patient care, but non-medically trained roles must not replace medical expertise or reduce the clinical opportunities through which resident doctors become future senior decision-makers.
Dr Dan Furmedge, RCP senior censor and vice president for education and training, added:
‘Investment in medical training should not be viewed simply as a cost. It is an investment in patient safety, clinical effectiveness, productivity and the future workforce.
‘The immediate cost of providing time and support for training is far outweighed by the long-term cost of failing to train our future senior clinical leaders well: burnout, doctors leaving the NHS, dependence on temporary staffing and the loss of the expertise that patients need.
‘This report provides a practical programme for reform. The RCP will use it to press for change through the medical education and training review and in our continuing work with government, NHS organisations, educators and resident doctors across the UK.’
The report was developed by a resident doctor writing group and informed by two years of engagement with RCP fellows and members. This included evidence gathered through the RCP’s next generation campaign, its 2025 national survey of resident doctors, an internal survey of RCP Council and committee members, and insights from several RCP focus groups with fellows and members that were held between March and June 2026. The report was approved by RCP Council.
