Resident doctors speak out: ‘Postgraduate training is outdated and unsustainable – it’s a patient safety issue’

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. 

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. 

Earlier this year, the RCP launched a national snapshot survey of resident doctors as part of our 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 told us what they need: hands-on experience, manageable workloads, high-quality supervision, and to feel like valued team members.  

Yet nearly 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. 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. 

Finding the balance between generalist and specialist training  

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.  

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.