Effects of the Calman reforms: a two year review.

The recommendations of a working party set up to ensure that the procedure for UK specialist certification complied with European law (the Calman report) have had implications that extend beyond the immediate concerns over abbreviated training into every area of paediatric practice—hospital and community, district general hospital, and tertiary centre. Proponents of the reforms promised that more structured training would oVset the inevitable reduction in clinical experience, and that careful assessment and targeted retraining would allow only competent paediatricians loose on the public. Sceptics warned that future generations of consultants would have neither the knowledge to deliver training nor the experience to treat children safely. Trainees in paediatrics and child health entered the transition phase of “Calman” in 1996. At the time the British Paediatric Association (BPA) was an appendage of the Royal College of Physicians without direct responsibility for training or examinations, or even the right to a voice on the new decision making bodies; working hours were becoming progressively shorter for junior doctors (but not for consultants); and the specialty was unattractive to potential recruits. In the two years since then much has changed: the BPA has become a Royal College and acquired statutory responsibilities for training and examinations; the recruitment crisis has shifted to primary care; and there has been a change of Government, which has been accompanied by an explicit demand for more public accountability. Postgraduate medical training in Britain has undergone a sea change, but how many of us would recognise the brave new world of living networks, eVective educational structure, and measurable standards portrayed in a recent review?