This report draws on the work of two meetings. Firstly, a conference of the UK Conference of Postgraduate Deans and the National Association of Clinical Tutors on the present state of postgraduate medical education and training, at which they expressed the urgent need for a more critical examination of current assumptions about educational processes. Secondly, a conference with a wider audience representing all relevant interests. The report explains the present system, considers its problems, and offers solutions and recommendations, in the hope that it will stimulate constructive debate and produce effective action.