Postgraduate medical training in the UK is changing, not through evolution but by revolution. There are three inter-related elements to these changes (box), with changes in the body supervising training (PMETB), the structure of training itself (MMC) and the method of application for training posts (MTAS). The recent marked failings in the last of these, both inherent in the selection tools and in the technology delivering it, have been widely discussed in the press.1 MTAS is now being reviewed and revised in an attempt to salvage credible and fair selection for training posts. However, the most dramatic long-term changes are in the introduction of run-through training and it is this that I will focus on here.

RUN-THROUGH TRAINING

Run-through training refers to a single training grade that takes the trainee from the end of their foundation programme, equivalent to intern elsewhere, through to specialist accreditation. Many readers from outside the UK will immediately be thinking “so what?”, because their system may already have run-through training. However, for UK trainees this is a dramatic change—more so for neurology than other specialties. The changes are meant to alter the structure but not the content of training.

The changes are illustrated in the figure. Previously, the first year after qualification was as a “houseman”, followed by 2–4 years in Senior House …