Postgraduate medical training in England: why reform now – and how collaboration can help
In October 2025, Professor Chris Whitty and Professor Steve Powis published the Phase 1 diagnostic report of the Medical Training Review into postgraduate medical education in England. It draws on the views of more than 8,000 doctors and other stakeholders and sets out a clear message: the current model of training is under real pressure and needs change.
The foreword to the report notes that the last systematic review of medical training was over 15 years ago. In that time, the pattern of disease, the country’s demographics, technology, the way medicine is practised, the shape of the profession, doctors’ career aspirations and public expectations have all shifted markedly. Medical training has evolved too, but often through piecemeal tweaks rather than a planned, system-wide review.
For those of you leading education and training – directors of medical education, TPDs, clinical and medical education managers – it is a moment to pause and take stock. At Miad Healthcare, our aim is to work alongside you to translate this national review into practical support for local training systems.
The state of play
Across England, there is now intense competition for training posts. Recent figures from the BMA show more than 10,000 doctors applying for fewer than 500 psychiatry training places, and around five doctors competing for every GP training post. At the same time, over 30,000 doctors are chasing around 10,000 specialty training places in the first round. The result is a growing group of doctors who are qualified, motivated and working hard in service posts, but unable to progress in formal training.
The Medical Training Review describes this as a bottleneck, and it is increasingly visible on the ground: trust grade roles that feel like holding patterns, SAS and locally employed doctors picking up large amounts of service, and education teams trying to maintain quality with limited capacity.
The report also sets out the changing shape of the medical workforce. There is wide variation in the proportion of international medical graduates (IMGs) in different training programmes – from around 4% in public health to just over half of trainees in GP training. Overall, the proportion of doctors in training who qualified outside the UK has risen from about 18% in 2019 to 27% in 2023, based on GMC workforce data.
Looking ahead, the numbers are equally striking. From 2025/26, 8,126 undergraduates will start medical school each year in England. They may not complete their full training pathway until around 2040. The 8,090 first-year foundation doctors currently in post will not join the substantive consultant and GP workforce until well into the next decade. Some of the doctors starting their careers in 2025 will still be teaching and supervising their successors in 2070.
In that context, it is not enough simply to expand numbers; the way we train and support doctors also has to keep pace. It is timely, therefore, to review how we train and develop the medical workforce.
How doctors say it feels
The Royal College of Physicians’ “Next Generation” survey found that only around 44% of respondents were satisfied with their clinical training. Many reported feeling stuck, over-worked and under-supported, with limited say over where their careers go next.
Alongside this, the Medical Training Review hears repeated concerns about:
- limited flexibility in training pathways
- frequent moves and short-notice rotations
- tension between service delivery and protected learning
- variable access to supervision, clinics and procedures.
Education managers will recognise these themes from trainee feedback, GMC surveys and local conversations. While services must be safe and patients properly cared for, when training is squeezed too far, service itself is put at risk in the medium to long term.
The changing workforce – UK and international graduates
The review points to the rapid rise in IMGs joining the UK workforce and the different roles they occupy. Many are working in SAS and locally employed posts, delivering a large share of day-to-day patient care.
For education teams, this brings both opportunity and responsibility. IMGs bring experience, skill and diversity. They also often need structured induction, mentoring and clear pathways for progression, whether into formal training or portfolio routes.
The report suggests that getting the balance right between UK graduates and international recruits is now a key workforce issue. Any change in policy, however, has to go hand in hand with fair development opportunities for IMGs already in the system. A two-tier approach to training risks losing valued colleagues and weakening teams.
Broader, more generalist training
An ageing population living with multimorbidity, care shifting into community and outpatient settings, and the growth of multidisciplinary teams are all pushing training towards a stronger generalist base.
The Royal College of Physicians and others have called for programmes that give doctors:
- experience across settings, not just in acute inpatient work
- skills in managing complex, multimorbid patients
- confidence to lead and work within diverse, multidisciplinary teams.
Miad’s programmes already support this direction of travel, with courses that build clinical, leadership and communication skills relevant to community, outpatient and integrated care, rather than focusing narrowly on one setting alone.
What this means for education managers
For those planning and delivering education locally, several themes from the review feel immediately relevant:
- Make flexibility real
Doctors are asking for pathways that reflect different life stages, caring responsibilities and career choices. Blended learning – combining in-person sessions, virtual classrooms, self-directed modules and coaching – can help fit training around rota patterns and personal commitments. - Support the “in-between” workforce
Locally employed and SAS doctors are central to service delivery but often have the least structured development. Creating clear frameworks for their progression, with protected time and access to the same quality of teaching as trainees, will be key to reducing bottlenecks and retaining talent. - Build inclusive, welcoming learning environments
Data from the GMC and Medical and Dental Recruitment and Selection show persistent gaps in outcomes at recruitment and assessment, especially for IMGs and doctors from minority ethnic backgrounds. Local induction, mentoring schemes, supervisor development and fair allocation of opportunities all make a real difference to whether doctors feel they belong and can progress. - Protect education within pressured services
Clarity around supervision, clinic access and teaching time, backed by realistic job plans and leadership support, helps ensure education is not the part that always gives way when services are stretched.
Where Miad can help
This is not a change that any single organisation can deliver alone. It will depend on collaboration between national bodies, employers, education teams and training providers.
Miad Healthcare’s role is to work alongside you to:
- co-design flexible training offers that fit your local context and service pressures
- provide development programmes for SAS and locally employed doctors, aligned with GMC and Royal College expectations
- offer practical training for supervisors, education leads and managers who are juggling service and educational responsibilities
- keep learner experience central, so that training feels worthwhile and supports retention rather than becoming another administrative burden.
Given the scale and timescale of the changes described in the Medical Training Review, doing nothing is not an option. It is timely to look again at how we train and develop the medical workforce. At Miad, we want to contribute to that work by partnering with healthcare employers and educators to ensure programmes keep pace with changing needs.
A training offer that simply ticks boxes is not enough. What matters is whether it helps doctors stay, grow and thrive in the NHS, so that patients today – and in the decades to come – have the care they need.
References
- NHS England (2025) Medical training review: phase 1 diagnostic report. London: NHS England.
- Office for Students (2024) Letter to medical schools on the approach to increase maximum fundable limits for the 2025–26 academic year. Bristol: Office for Students.
- General Medical Council (2024) The state of medical education and practice in the UK: workforce report 2024. London: General Medical Council.
- Royal College of Physicians (2025) RCP ‘next gen’ survey: fewer than half of resident doctors surveyed are satisfied with their clinical training. London: Royal College of Physicians.
- Hetherington H (2025) Record competition for GP training posts leaves four in five applicants rejected. Pulse Today, 22 September 2025.
- Sky News (2025) First-year doctors in England vote to strike amid job security fears and row over pay. Sky News, 7 October 2025.
- British Medical Association (2025) Specialty training squeeze. The Doctor, 17 April 2025.
- House of Lords Library (2025) Competition for specialist training programmes in the NHS: sector views and the government’s plans for resident doctor training posts. London: House of Lords Library.