The training and education of doctors is a complex process. The traditional apprenticeship model of clinical medical education following a pre-clinical sciences curriculum had many strengths and produced a doctor who met the needs of several generations of patients. More recently, medical training has been criticised for not adapting to the more holistic needs of contemporary society, whilst the scientific literature has highlighted deficiencies in both the procedural and humanistic clinical skills of newly qualified doctors. External bodies have called for radical curriculum reforms and failure to deliver risks increasing political interference. Apprenticeship style training has largely been abandoned as insufficiently systematic in its methods and educational responses have focused on the process of learning. Modified curricula emphasise a humanistic and student-centred approach. Although implementation is widespread, there is little evidence that the finished product is better equipped to meet the demands of postgraduate medical practice. The General Medical Council has defined the desired outcomes of the undergraduate programme. Supporting the best of apprenticeship with contemporary process models offers optimum opportunity for practicebased learning within a systematic curriculum framework. If rapid change is to be achieved, however, then assessment offers an accepted and powerful driver for medical behavioural change. Combining practice-based learning and appropriate formative assessment of generic and vocational endpoints offers the means of effecting changes in both learning behaviour and medical practice that meet the needs of today's patient. © 2004 Taylor & Francis Group, LLC.
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