Reforming higher specialist training in the United Kingdom - a step along the continuum of medical education

Objectives The requirement to align the arrangements for postgraduate train ing in the United Kingdom with those elsewhere in the European Community pr ovided the opportunity to review and reform our arrangements for higher spe cialist training. This paper describes the case for change - the strengths and deficiencies of the traditional pattern of postgraduate medical trainin g, demographic influences in the medical workforce and the need for a more structural or planned approach to training. Conclusions Over the past 5 years substantial progress has been made: the i ntroduction of new regulatory arrangements and a new higher specialist trai ning grade; the development of a managed and flexible system for delivering training to standards set by the Royal Colleges and which can accommodate the needs of those pursuing academic and research medicine; and the opportu nity for trainees' progress to be measured against published curricula. The significant programme of change has been underpinned by careful workforce planning and the publication of comprehensive guidance. Significant reform of higher specialist training has been achieved. This paper also makes the case for a more strategic approach to planning and developing medical educa tion across the continuum, from entry to medical school until retirement, w hich can guide medical education and improve patient care into the next mil lennium.