Statement on the Medical Training Review

The Royal College of Physicians of Edinburgh supports the following recommendations for the urgent reform of postgraduate medical education and training. These reforms are essential to ensure that the UK’s medical workforce is sustainable, equitable, and capable of meeting the changing health needs of our population.

1. “We recommend that a reform of postgraduate medical education and training is undertaken as a matter of urgency.”

The College endorses this call for immediate reform. The current system, while robust in many respects, is under unprecedented pressure. According to NHS workforce data (NHS Digital, 2024), over 10% of UK medical posts remain unfilled, and one in four doctors in training report feeling unable to access the experiences they need to progress. Reform must deliver a system that balances training quality with service provision and ensures that every doctor is equipped for modern, multidisciplinary care.

2. “Addressing bottlenecks at all points in training and development should be considered urgently. This will have to include consideration of the right ratio between new international graduate entrants to medicine in the UK and those who are already working and training in the NHS, taking into account the workforce need.”

Workforce bottlenecks - particularly at the transition from Foundation to Specialty Training - remain a major challenge. Around 1 in 5 foundation doctors do not progress directly into specialty training each year (UKFPO, 2023). A balanced approach that recognises the vital contribution of international medical graduates (IMGs) while safeguarding training opportunities for the domestic workforce is vital for workforce sustainability and fairness.

3. “Training should become more flexible.”

Flexibility must become a core principle of postgraduate education. Currently, over 40% of trainees (GMC National Training Survey, 2024) report difficulty balancing training with personal or caring responsibilities. Greater flexibility through portfolio careers, modular training pathways, and recognition of prior learning could enhance retention and inclusivity.

4. “All doctors working in the NHS should be supported to progress and the differentiation between ‘training’ and ‘service’ roles should be made less rigid for doctors early in their careers. We recognise, however, that progression will not be at the same rate for all doctors.”

We support reducing the artificial divide between service provision and training. Many doctors in non-training posts deliver vital patient care but face barriers to progression. Providing structured development opportunities for all will ensure that the NHS benefits from the full potential of its workforce.

5. “The output from the review of rotational structures must be incorporated in the wider reforms.”

Rotational structures should support continuity of care, community-based training, and workforce stability. Incorporating the findings of this review into broader reform may help deliver training models that work for both patients and trainees.

6. “Reform of medical training must consider the need to provide a medical workforce across the country for the whole population equitably...”

Equity of workforce distribution is essential. Current data shows that per-capita doctor availability is up to 40% lower in some rural and coastal areas in England compared to London and the South East (NHS England, 2024). Expansion of medical school and training places should be targeted where patient need is greatest, recognising the tension between regional preference and national workforce equity. In Scotland, care must be taken to ensure that the north of Scotland, which has disproportionally fewer doctors, does not get left further behind.

7. “A strategy to deliver educators who are supported and enabled to train the future medical workforce in a fit for purpose environment and with transparent funding should be a fundamental part of NHS reform...”

The quality of training depends on supported educators. We endorse the call for a clear national educator strategy with ring-fenced funding and reduced bureaucracy. Investing in clinical education leadership will improve morale, retention, and ultimately patient outcomes. Consultants must be afforded the time to teach the next generation of doctors.

8. “Resident doctors training in craft and procedure heavy specialties must have time to develop procedural skills...”

Hands-on training time is essential for patient safety and professional competence. Procedural training must be protected, with obligations on both NHS and independent sector providers where public funding supports procedures. Data from the Royal College of Surgeons shows a 30% reduction in elective training opportunities since 2019, which must be addressed.

9. “We should work with the other UK nations to support the GMC’s review of standards and outcomes...”

We fully support collaborative working across the UK to align postgraduate curricula with the GMC’s updated standards and the 10-Year Health Plan. Emphasis on maintaining generalist competencies, developing digital literacy, and embedding innovation will ensure doctors are fit for future healthcare delivery.

10. “The recruitment to medical training should be reviewed to ensure it supports future models of training delivery and training flexibility and is fair and equitable...”

Recruitment reform is critical to fairness and excellence. Selection processes must reflect both service needs and the diversity of candidates. Ensuring transparency and equity can help reduce the differential attainment gaps that currently exist between demographic groups in recruitment outcomes.

11. “Clinical academic medicine is essential for the delivery of healthcare now and in the future...”

We strongly endorse investment in clinical academia, especially across primary care, community, and public health. The academic workforce underpins innovation and evidence-based practice. Currently, fewer than 5% of NHS doctors hold formal academic posts, yet their contribution drives national health improvement. Doctors must be afforded time to undertake research, by their employers. 

Next Steps

“The development of future models of training will need the engagement and support of the key stakeholders in the delivery of healthcare and training...”

We agree that this must be the next step. The future of medical education in the UK depends on close collaboration between the Royal Colleges, the General Medical Council, deaneries, the Department of Health and Social Care, NHS England – and the relevant authorities in the devolved nations, including Scotland. Joint action will ensure that reforms are coherent, patient-centred, and deliverable within the realities of the NHS.

Commenting, Professor Andrew Elder, President of the Royal College of Physicians of Edinburgh said:

The College supports these recommendations. Reforming postgraduate medical education and training is not only an educational imperative, it is a workforce and patient safety necessity. The UK faces a projected shortfall of over 50,000 doctors by 2036 according to the NHS Long Term Workforce Plan. Bold, collaborative reform now will safeguard the quality, resilience, and equity of the medical profession for decades to come.