In our latest RCP next generation blog, Naabil Khan, RCP student and foundation doctor representative for the South West and a medical student at the University of Exeter, writes about what she learned from attending a recent debate on the future of medical training.
Walking into the Royal Society of Medicine just before Christmas, with decorations lining the reception, people networking over coffee and an unmistakable buzz in the air, one question hung over the room: is postgraduate medical training over-regulated and inflexible?
For a student and early-career professional, it was a privilege to witness this debate unfold. Hearing leading figures argue for and against the motion offered rare insight into the forces shaping the future of medical training and the fault lines within: are doctors being stifled by rigid training or does structure protect quality and patient safety?
‘Postgraduate training has become over-regulated, inflexible and administratively burdensome.’
Naabil Khan
Dr Kristen Davies and Dr Julia Patterson (speakers for the motion) painted a picture of a system that increasingly prioritises documentation over development.
The rise of the tick-box clinician
Modern postgraduate training, they argued, has become dominated by portfolio-driven assessments. Rather than supporting reflective learning, the system incentivises completion of forms and sign-offs.
This situation risks creating ‘tick-box medics’ rather than thoughtful, adaptive clinicians – a critique that is echoed elsewhere. Cleland, Reeve, Rosenthal and Johnston argue that medical education must explicitly reward professional identity formation and lifelong, self-regulated learning, not simply evidence of competency completion.
Loss of mentorship and autonomy
The speakers argued that training has become increasingly impersonal. Supervision, while formally structured, often feels fragmented. Doctors have little control over where they train, how fast they progress or how training fits around life circumstances.
While foundation programme guidance outlines clear supervisory roles, clinical supervisors, educational supervisors, and workplace support; in practice, supervision can feel reduced to data points and assessments rather than meaningful mentorship. The result is a ‘conveyor belt’ model that fails to reflect real careers.
Burnout and opting out
Only 25% of doctors now enter specialty training immediately after foundation training. Of the 2020/21 F2 cohort, 70% delayed specialty training, compared with 38% in 2012/13. Many are taking career breaks or working as locally employed doctors to regain flexibility and autonomy, and GMC national training survey data shows 52% of resident doctors describe their work as emotionally exhausting and 21% are at high risk of burnout.
Geographical rotations also play a major role. The RCP next generation survey found that 41% of resident doctors said geographical rotations had a negative impact on their training, and while most support rotational training in principle, the majority want it reformed, not rigidly preserved.
In a system facing a 7-million-patient waiting list, speakers argued that losing trained doctors because of inflexible training pathways is a workforce failure the NHS cannot afford.
‘The problem is not over-regulation, but fragmented and inconsistent regulation.’
Naabil Khan
Professor Dame Jane Dacre and Mr Harry Cayton (speakers against the motion) argued that regulation is not the enemy – incoherent regulation is.
National standards exist to ensure that doctors trained in different regions, specialties and institutions meet consistent thresholds of competence. Without this, training risks becoming uneven, which was memorably likened to a Jackson Pollock painting: splodges of variable standards across royal colleges and training bodies.
The original intent of regulatory frameworks like ‘Tomorrow’s doctors’ was light-touch oversight. Failure of this regulation, they argued, lies in the implementation, not the principle. More recently, the COVID-19 pandemic exposed the fragility of training systems. Foundation doctors reported disrupted learning, limited progression opportunities, and inconsistent preparedness when rotating between specialties.
Importantly, targeted structure works. Evidence from Wales showed that a simple, standardised induction handbook dramatically improved foundation doctors’ preparedness when rotating, reinforcing the argument that intelligent regulation can improve patient care and resident doctor confidence.
Regulation as a tool for fairness
Regulation enables mobility, mutual recognition of qualifications and public confidence in the profession. Speakers acknowledged that the system is flawed but warned against dismantling structures that protect patients and doctors alike. Reform, not rejection, was their call to action.
The debate convergence
Where I found the debate converging was the agreement that regulation is necessary, but current systems are not working optimally. Medical careers are longer, more varied and less linear than before, and the NHS needs a workforce that is both safe and flexible. The real challenge is moving from blunt-force regulation to intelligent, proportionate systems of oversight that protect patients while trusting doctors as medical professionals, not checklist completers.
Why does this matter?
Debates like this are not abstract policy discussions, they shape where we train, how we work and whether we stay in the profession at all. For students, attending events like this is essential to understand the forces shaping future training, to learn how to advocate for ourselves and our colleagues, and to engage thoughtfully with opposing perspectives in debates about the future medical workforce. The future of postgraduate training should be guided by nuanced, informed conversations like this one… and students need to be in the room learning, listening and growing.
Naabil Khan
SFDN representative for South West
