Royal College of Physicians - Resident doctors speak out: ‘Postgraduate training is outdated and unsustainable – it’s a patient safety issue’

The Royal College of Physician's latest resident doctor national survey results reveal:

• one in four resident doctors are actively dissatisfied with medical training,
• almost a third don't receive regular constructive feedback,
• only 17% think recruitment is fair
• three in four want reform or abolition of rotational training.

RCP Resident Doctor Committee co-chairs Dr Anthony Martinelli and Dr Catherine Rowan said:

‘Postgraduate medical training in the UK is increasingly out of step with the needs of doctors, patients, and the wider NHS. For many resident doctors – those delivering care while training to become specialists – the system is no longer sustainable. 

'Resident doctors rotate between posts with little say over where they go, how long they'll be there, or what comes next. This constant upheaval makes it hard to build professional relationships, clinical confidence or personal lives. At a career stage when many are starting families, the system offers little stability or flexibility. 

'Training is often overshadowed by relentless service delivery. High workloads, inflexible rotas, and inconsistent supervision are fuelling frustration. This is more than a workforce issue – it's a patient safety concern. Burned-out doctors deliver worse care. Demoralised teams make more errors. A fragile training system undermines professional development, and that shows up in patient outcomes.' 

The RCP's Resident Doctor Committee's key takeaways from the latest RCP resident doctor 'next generation' survey results: 

1. Current training structures are unsustainable – inflexible rotations, inadequate supervision and poor work-life balance undermine doctor wellbeing and patient safety. 

2. Resident doctors are not getting the support or experiences they need – they want more constructive feedback, protected learning time and access to key clinical opportunities. 

3. Generalist training is too narrowly defined – with an overemphasis on acute care and insufficient preparation for community-based, long-term complex care.  

4. Reform must address both recruitment processes and geographical rotations – to ensure fairness, stability and high-quality training across all nations and regions. 

Earlier this year, the RCP launched a national snapshot survey of resident doctors as part of the next generation campaign. Of 1,684 responses, 1,010 were working clinically as resident doctors in the UK – almost all in the NHS and primarily in hospitals – and included specialty registrars (36%), internal medicine trainees (24%), foundation doctors (18%) and locally employed doctors (17%). 

Our survey findings paint a sobering picture 

Only 44% of respondents to our next generation survey were satisfied with the quality of their training. One in four were actively dissatisfied. Resident doctors reported what they need: hands-on experience, manageable workloads, high-quality supervision, and to feel like valued team members.  

Yet 30% rarely or never receive constructive feedback. Only 29% found the ARCP process useful. Almost half said they lacked protected time for self-development, and one in four said they couldn't access key training opportunities, including outpatient clinics, simulation, or procedural skills.

The latest findings were presented this week at the RCP's annual conference Medicine 25 in a session dedicated to exploring the impact of rotational training and the future of UK postgraduate medical training.

Speaking to the conference, Dr Hatty Douthwaite, deputy chair of the RCP's Resident Doctor Committee, said: 

'Resident doctors today are the clinical leaders of tomorrow. Reform of medical training is no longer option - it's essential.'

Dr Anthony Martinelli and Dr Catherine Rowan added:

'If we want to retain the next generation, we must make time for training, supervision, and rest – and ensure employers are held accountable for delivering it. 

'Resident doctors are asking for more than clinical experience. They want time to grow as leaders, researchers, and educators. They want to develop skills in digital health, financial literacy, and community engagement – training that reflects the reality of modern medicine, where doctors lead multiprofessional teams across sectors and settings.' 

'General internal medicine (GIM) is a case in point. Since the Shape of Training review, there's been a push to develop more physicians accredited in GIM, equipped to manage patients with multiple long-term conditions. But in practice, GIM training is often equated solely with the acute medical take – the ‘front door' of the hospital – with too little focus on chronic disease management, balancing uncertainty, and cross-sector working. That must change if we're serious about shifting care into the community.'

National recruitment and rotation must be reformed  

Only 17% of respondents thought recruitment into training posts was fair. They called for more transparent shortlisting, better consideration of geography and personal circumstances, and a broader view of merit beyond exams. While the multi-specialty recruitment assessment (MSRA) has been suggested as a solution, it remains very unpopular – with 68% of respondents to our survey opposed to its introduction for physicians.  

Dr Anthony Martinelli and Dr Catherine Rowan continued:

'As the RCP made clear in our February position statement, the NHS must urgently address competition ratios for specialty training and ensure that publicly funded medical school places lead to more NHS doctors. One thing is very clear – the current system is not working for applicants or services trying to plan their rotas.  

'The national recruitment system is closely linked to the UK's model of deanery-administered rotational training which is the most direct route to becoming a consultant. In our survey, 41% said geographical rotations had a negative impact on their training, compared to just 26% who were positive. 28% wanted them abolished entirely, and 50% said they should continue only with reform.'

What needs to change? 

In May, the RCP submitted evidence to the NHS England national medical training review. We called for a radical transformation in how training is structured and valued, including:  

• modular, flexible pathways that support continuity of care and build autonomy, belonging and competence 

• reform of rotational training, with moves only required when there's a clear educational need 

• additional support for hospitals in under-served areas to deliver high-quality training (or we risk worsening inequalities in both workforce experience and patient care) 

• greater investment in supervision and mentorship, with protected time for educators and accountability for employers 

• a broader, more inclusive vision for generalist training that supports care closer to home  

• protected time for non-clinical development, including research, teaching and quality improvement.

Dr Anthony Martinelli and Dr Catherine Rowan concluded:

'Resident doctors are not just service providers. They are the future specialists and clinical leaders of the NHS. If we want them to stay, we must build a training system that respects their time, supports their growth, and gives them reason to believe in the future of the profession.'