The recently released ‘‘transitional interim advice’’ from the College of Emergency Medicine¹ regarding implementation of the Modernising Medical Careers (MMC) post-Foundation programme indicates that we are entering a crucial phase in postgraduate medical education. The time for procrastination is over. Operational implementation is the next step.

MMC has had a controversial gestation. From conception to delivery there has been debate, discussion, angst and even hostility about its merits. It is probably a more complex and radical overhaul than the Calman reforms of the late 20th century. Supporters believe that the medical profession needs to get its act together to cope with healthcare delivery in the 21st century and streamline training in a consistent and coordinated way. Detractors argue that it will reduce the quality of the end product, is confusing and there is no guarantee that it will achieve its desired target. The Foundation Programme (the first phase of MMC and currently in only its second year) is too nascent to be judged objectively.

At first glance, a slightly jaundiced eye might see the seven pillars at the heart of the new programme (training will be trainee centred, competency assessed, service based …