Table 2.

Potential solutions and impact

Strategy	Implementation 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