A key aspect of the diagnostic phase of the Medical Training Review was the breadth and diversity of stakeholders engaged, from resident doctors and international medical graduates to educators, employers and patient representatives.
This appendix synthesises what we heard from each stakeholder group, drawing out their specific concerns and priorities in responses to the call for evidence, focus groups and engagement sessions, including the voices of minority groups who are not always well heard or represented in medical education delivery or design.
Different stakeholder groups bring unique and important perspectives to the future of postgraduate medical education (PGME). While there is shared concern about rigidity, fairness and preparedness, each group emphasises different facets of the system in need of reform. Synthesising this evidence reveals a collective desire to build a more equitable, flexible and future-ready training system that respects the diversity of doctors and the complexity of modern healthcare.
We have not carried out a formal statistical analysis given the size of some of the groups; however, the data is provided to demonstrate the level of consistency in responses.
Stakeholder priority emergent themes
Resident doctors (trainees in formal programmes and locally employed doctors, LEDs)
Resident doctors repeatedly raised concerns around recruitment bottlenecks and rigidity of rotations and their impact on wellbeing, training progression and continuity. Rotational instability emerged as a particularly strong theme for foundation and core doctors in training, many of whom described a sense of disconnect and stress during transitions. This is consistent with evidence from the literature, which highlights that poorly co-ordinated transitions can affect learning outcomes and patient safety (Foster et al, 2019). Flexibility and agency over career planning also scored highly in both the call for evidence (CfE Q7: 54.3% disagreed that training is flexible) and across focus groups.
Fairness in assessment and feedback was another dominant concern, particularly for LEDs and trainees with additional learning needs. The CfE responses to Q11 – only 35% agreed PGME is inclusive – reinforce the perception that current systems disadvantage some groups. National data from the General Medical Council (GMC) also confirms persistent differential attainment.
Specialty, specialist and associate specialist (SAS) doctors
SAS doctors articulated frustration about lack of formal recognition for their contribution and the absence of clear, supported development pathways; over 50% of respondents disagreed that training processes fairly support doctors outside formal programmes (CfE Q5). Themes of credentialing, fair access to training and equity in assessment featured heavily across SAS focus groups and were echoed in stakeholder events. The literature confirms these challenges, with SAS doctors often excluded from formal career development frameworks (GMC, 2022).
SAS doctors also emphasised a need for clarity on roles, particularly where they shoulder service pressures comparable to consultants without equivalent autonomy or pay.
International medical graduates (IMGs)
IMGs described a challenging onboarding experience, often lacking induction, mentorship or clarity around their professional rights. Induction and equitable access to training were standout themes in both qualitative and quantitative evidence. The CfE responses to Q5 – 52.1% disagreed selection accounts for diverse backgrounds – strongly supports these concerns, along with literature documenting the need for structured IMG integration (GMC, 2022).
IMGs also flagged systemic bias in assessments and progression, aligning with the findings on differential attainment and reiterated in both the literature and focus group feedback.
Faculty and educators
Supervisors and faculty highlighted workload constraints, lack of protected time for supervision and insufficient recognition of educational roles. Mentorship fatigue and challenges in feedback culture were noted frequently. These issues were supported by the literature, which consistently calls for faculty development and incentivisation.
The need for digital capability, leadership development and support for generalist curricula was echoed in many regional and national events, with many faculty members expressing concern that training curricula are not keeping pace with service transformation.
Employers
Employer representatives, particularly from trusts and integrated care systems (ICSs), underscored the importance of aligning training with local workforce needs. The mismatch between national curricula and regional service demands was a cross-cutting concern, especially in community, prevention and digital transformation agendas. Providers also noted frustration with workforce planning assumptions that fail to consider the breadth of roles filled by SAS doctors, LEDs and IMG doctors.
Patients and public voice
Patients and the public prioritised generalist capability, continuity of care and compassion. They were particularly critical of training models that reinforce hyper-specialisation at the expense of holistic, person-centred care. Evidence from the Richmond Group and Picker Institute supports these findings, highlighting that patients want to see communication, empathy and co-ordination as core competencies in clinical training.
Regulators, Royal Colleges and national stakeholders
Regulatory and national bodies such as Royal Colleges, the GMC and NHS England repeatedly reinforced the importance of embedding prevention, community care, equity and digital transformation in PGME. These themes aligned closely with current policy drivers, including the 10-Year Health Plan for England and Future Doctor programme, which advocate for integrated, community-centred and digitally-enabled healthcare systems.
Feedback emphasised the importance of aligning curricula with broader system needs, including a shift towards generalist capability and cross-setting practice. There was widespread support for credentialing and modular training routes to facilitate upskilling, flexibility and improved workforce deployment, particularly in response to emerging service models and new consultant roles. For example, one national stakeholder commented, “Training must reflect how care is delivered in ICSs, across boundaries, settings and teams”.
Royal Colleges and national leaders also stressed the importance of equity, noting that training pathways and selection processes must be more inclusive. The GMC reinforced the need to address persistent differentials in outcomes between demographic groups and called for greater support structures for underrepresented cohorts. Additionally, there was broad consensus on the need to support educators, embed leadership and digital capability in training and ensure educational governance is consistent and responsive across geographies.
These contributions echoed themes in both the literature and desktop review findings, which emphasise that high-performing healthcare systems require educational alignment with population health goals, multidisciplinary collaboration and agile workforce capability.
Think tanks and charitable organisations
Think tanks and health charities underscored the need for a system-level shift towards more compassionate, inclusive and prevention-oriented medical education. Organisations such as the Richmond Group highlighted how gaps in training often mirror structural inequalities in care, particularly in relation to multimorbidity, complex patient needs and underserved communities.
Charity voices also amplified the call for embedding trauma-informed practice, communication skills and equity in curricula – as core professional capabilities, not adjuncts. These stakeholders emphasised that trainees must be supported to develop emotional intelligence, cultural competence and the ability to advocate for systemic change.
Their contributions aligned strongly with those of public and patient representatives, reinforcing the urgency of training doctors who can lead across settings and connect with individuals beyond biomedical concerns.
Publication reference: PRN01835