Neurology postgraduate training: what is to be done?

In 1992, Kenneth Calman chaired a working group to reform British postgraduate specialist training. These reforms included a reduction in the duration of specialist training, the replacement of the old senior registrar and registrar grades by a combined specialist registrar grade (SpR), and the creation of a certificate of completion of specialist training (CCST), which would be recognised in all member states of the European Union. This latter recommendation implied the creation of objective setting, induction at the start of any training programme, training agreements, and rotational placements. The CCST would only be awarded once the trainee had “completed specialist training, based on assessment of competence, to a standard compatible with independent practice.” How these parameters might be measured was not strictly defined, and differing systems were subsequently organised by the various colleges and specialist societies. No additional resources were made available to NHS Trusts for their implementation and no mandatory training programmes were introduced to ensure that the trainers were competent in the delivery of postgraduate medical education.1

It has been assumed that these reforms were designed to improve the quality of existing training programmes. However, it could be argued that the main aim of this restructuring was to develop a system of training more akin to existing models within the European Union. In 1992, before the publication of the Calman recommendations, there was great media interest in the “Goldstein” case, where a Harley Street rheumatologist had been denied inclusion on the specialist register in spite of holding a European community specialist certificate.

The Department of Health document “Hospital Doctors: Training for the Future” was published in April 1993. The working group responsible for producing this report was specifically requested by the Secretary of State for Health to advise her on …