Where is the present flurry of activity in medical education leading and what sort of future is envisaged? This paper looks at trends in postgraduate medical education. Four themes and two trends for each theme have been identified. The themes are: the postgraduate medical curriculum, the application of learning technologies, assessment of competence, and professionalism in medical education. The trends are: outcome based education and a unitary approach to medical education; the use of simulators and e-learning; competency and performance based assessment, and portfolios and self assessment; and training the trainer and best evidence medical education. Any limitations in implementing change will likely result from a lack of imagination in those planning postgraduate medical education and their ability to bring about the necessary changes. To avoid a growing gap developing between what is possible educationally and what is delivered, it is clear that we need a new paradigm for postgraduate medical education.
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