It has been assumed that these reforms were designed to improve the quality of existing training programmes. No additional resources were made available to NHS Trusts for their implementation and no mandatory training programmes were introduced to ensure that the trainers were competent in the delivery of postgraduate medical education. The CCST would only be awarded once the trainee had “completed specialist training, based on assessment of competence, to a standard compatible with independent practice.” How these parameters might be measured was not strictly defined, and differing systems were subsequently organised by the various colleges and specialist societies. This latter recommendation implied the creation of objective setting, induction at the start of any training programme, training agreements, and rotational placements. These reforms included a reduction in the duration of specialist training, the replacement of the old senior registrar and registrar grades by a combined specialist registrar grade (SpR), and the creation of a certificate of completion of specialist training (CCST), which would be recognised in all member states of the European Union.
In 1992, Kenneth Calman chaired a working group to reform British postgraduate specialist training.
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