The Tooke report and the government response

Change in the delivery of surgical education started in the 1990s when the senior registrar grade posed problems because of oversupply and lack of career posts. The Chief Medical Officer reformed the training structure by abolishing the senior registrar grade, and proposing run-through posts of 5-7 years. This change created a bulge at the senior house officer grade; this was resolved by proposing to have a run-through grade after 2 years of foundation training. This failed because the selection process was unacceptable to the profession and, unexpectedly, 10,000 foreign doctors applied. Tooke was asked to solve the problems. The report advised a return to core training with one foundation year and three core years before specialist training, as well as long overdue and very important administrative changes of great benefit in the long term. Unfortunately many questions remain unanswered and the trainee awaits further reports to know the detail of his/her training.