Medical education has undergone significant reforms since the 1990s when there were multiple regulators with patronage, inequalities and unreliability for postgraduate training. Modernising Medical Careers was implemented from 2005 to ensure all training posts and equivalents were assimilated into programmes with a defined curriculum and national selection. However, this brought its own problems, with a more rigid route, much control and training not linked to workforce planning. In addition, Workplace-based assessments (WBAs), which had been intended as formative tools to support personal development, morphed into summative assessments together with the Annual Review of Competence Progression (ARCP) becoming high stakes rather than a light-touch review of progression as had been intended. Alternative models of competence progression were explored, and initial poll results suggested that from the perspective of trainee/students, 46% would prefer judgements of competence to be decided on team observations/comments.

Initial discussion was based on the challenge of “compassionate, collaborative, competent, confident doctors” and the role of WBAs where the current assessment tools were not considered to be the key to improving them. The role of the educator and their relationship with trainees was explored in depth including how to enable practitioners to prioritise education and feedback within busy work environments which requires a change in organisational culture. However, some specialties (psychiatry and general practice) have an expectation that dedicated time will be allocated for trainee and trainer to meet together as a recognition of the importance of high-quality training and celebrating excellent educators. If this could be extended to all specialties, it would provide an opportunity for trainers to review and discuss progress with their trainee, thus ensuring that advancement is maintained and any fall off in improvement is identified early and corrected. However, this requires protected time and the service is often under strain. The flip side of this approach is if there is a breakdown in trainer/trainee relationships, degrees of mistrust, this may cause problems. There could also be a possible power imbalance since feedback should be in both directions. Other key themes included ARCP reform to promote a progressive approach with no surprises rather than summative decisions and a clearer recognition of educational growth within appraisal and revalidation.

The way forward should include developmental conversations with a greater coaching and mentoring style rather than tick boxing, more near peer conversations and more focus on programmatic assessment aggregated across a variety of sources. Additional tools may be required to support his approach. It is important to celebrate good training and improve the skills of trainers in developing doctors we want for the future which means going beyond what we do now.

Whilst delegates agreed change is required, it is less clear how this can or should be progressed. It certainly requires collaboration between all key stakeholders to ensure that change happens. Finally, the unconscious competence model reinforces that there is a risk of falling back into unconscious incompetence, both in the trainer as an educator and the trainee as a learner if we do not give due time and attention to educational activity.