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One of the few things that Osborne and Craft agree about is that the number of hours of training that doctors undergo has fallen dramatically over the past 10 years.1,2 We will have to make better use of training time as Craft suggests; but with more and more targets for clinicians to reach, surely something will have to give. Will it be training? In the General Medical Council's Good Medical Practice, good clinical care comes in at number one but teaching and training comes in a poor fifth. The good news is that we can learn from other professions and make use of new training methods and technologies to make up for reduced training times. Pilots in training spend hours practising in simulators and a number of realistic medical simulators have grown up around the UK. They do a great job but there are only about three in the UK for the thousands of foundation year doctors to use. But practicing like this should be like taking your brain to the gym—something that juniors should be able to do whenever and wherever they want. How far are we away from this becoming a reality at the moment?
Certainly a number of online learning sites have emerged in the past few years.3 They are scaleable and you can do them in the workplace. Most of them offer interactive case histories which are crude, mainly text-based, first generation simulators. To date there is a small evidence base of their effectiveness.4,5 They do not offer the immediacy that you can get when you attend a course, nor can they offer you as good personal feedback as a one-on-one encounter. But trainees cannot get such training everyday. With the widening availability of broadband and the technology to produce multimedia learning becoming cheaper, there is now a case for increasing the quantity and quality of online learning. Our foundation year doctors have a new curriculum and need traditional and new learning methods to help them.
Competing interests Kieran Walsh works for BMJ Learning, an online learning website. He is paid a fixed salary.