The experience of casualty officers at the time of appointment has been compared, by questionnaire survey, with abilities and responsibilities 3 months after starting work in Accident and Emergency Medicine. Initial clinical and practical knowledge frequently did not match the demands of the new post. Some doctors felt unable to assume initial responsibility for important and commonplace clinical conditions. Many expressed dissatisfaction with the teaching they received. Only one-fifth of respondents had received any form of introductory course. Accident and Emergency work provides useful training for Senior House Officers pursuing a variety of careers, but adequate preparation is essential. This is not provided in the preregistration year. It is recommended that medical schools make greater efforts to ensure relevant comprehensive experience amongst their students before graduation. Introductory courses should be arranged for all new casualty officers and greater emphasis placed on the immediate availability of experienced supervisory staff in Accident and Emergency Departments.