The Medical Training Application Service (MTAS) has been the source of much distress to trainee surgeons and a huge lobbying issue for this college throughout 2007. The publication, on October 8th, of Sir John Tooke’s interim report reviewing Modernising Medical Careers (MMC) (this file is 3.1 MB) hopefully heralds a sea change at the Department of Health with the recognition of the need for broad-based early training, with greater flexibility and more rigorous selection for craft specialties.

His report takes account of the concerns of this College and in particular recommends that a further point of selection is required between core and speciality training. He acknowledged that MMC required trainees to make speciality choices too early in their careers.

Tooke’s initiative to split the Foundation years (F1 and F2) into two, returning the first year back to pre-registration, is common sense. This will ensure that the first year of pre-registration training remains under the supervision of the medical schools and the GMC, thus guaranteeing UK medical students their first job.

I am confident that the foundation principles enshrined in F2 can be amalgamated into the core speciality stems, while allowing trainees to acquire some of the basic speciality skills and experience that they require to progress.

His recommendation to follow F1 with a new period of core speciality training, time limited to three years, will allow trainees to progress according to their ability, knowing they will face a further period of selection in their chosen speciality. This will provide ample opportunity for trainees to undergo the ‘taster’ placements that were originally envisaged in MMC but which proved impossible to retain after the rules were changed to dictate run-through training within, and not across, specialties. The return of flexibility was a plea of nearly every respondent to the Tooke questionnaire and something that I firmly recommended.

The creation of core specialty training will ensure that if a trainee fails to be selected into specialty run-through training they will be better equipped to work in the staff and associate specialist grades. Tooke also proposes a fundamental overhaul of the role and title of the NCCG grades, and also a review of the end-point of training to CCT, to make sure that we continue to produce consultants able to function as independent specialists.

For those who are concerned that uncoupling core training from specialty training will be a return to the old days I would urge them to read ‘Unfinished Business’ very carefully, where the Chief Medical Officer’s original intention was not to do away with the SHO grade but to limit it to two years after the foundation programme.

The position of PMETB is also questioned, as it came into existence along with the now discredited MMC process. The recommendation is that it comes under the auspices of the GMC, reporting to Parliament and not to the Department of Health.

At a stroke Sir John’s recommendations, if implemented by the government, will conclude the nightmare of the last three years and allow a proper career structure in accordance with the wishes of the College and the Profession as whole, not least in the interests of our patients.