Table 2 Potential solutions and impact

Adjusting the length of training

• Implemented locally in some specialties only in view of the funding and resources required

• Positive feedback where implemented

Redesigning rotas

• Increased anti-social working hours

• Non-resident on-call has been implemented in some specialties

• Trainees have opted out of the EWTD because of rota gaps in some acute care specialties

Using operating lists dedicated to training

• Popular with trainees and trainers alike

• Limited by employer productivity targets

Setting targets for number of each procedure performed

• Patchy implementation in some specialties

• Targets are limited by individual learning paces and availability of the correct patient population

Using simulation technology for training

• Advocated by the Department of Health

• Limited availability locally because of cost

Reconfiguing services

• Hospital at Night has successfully encouraged multidisciplinary work and cross-specialty cover

• Training in recognized centres only: not popular

Including periods of supernumerary training

• In place in General Practice training programs but not generally available

• Limited by resources

Increasing consultant numbers

• Gradually under way in some acute specialties such as Obstetrics

• Limited by financial constraints in NHS

Providing adequate educational governance

• Standards set by the GMC with regular trainee questionnaires and visits to specialty training schemes

• Educator roles to be encouraged and recognized