• trainees
• unwarranted variation
• student
• development
• doctor

Just as health services worldwide are under ever-greater pressure, so there is ever-greater potential demand on what professionals need to know. The rate of change in health systems is accelerating, driven by diverse factors, including rapidly advancing technology, changing societal attitudes and demographics of disease. While a great part of learning is experiential, ’space' is at a premium in all formal curricula.

In BMJ Leader’s first year, we have published a wide range of pieces which suggest space will need to be found for elements not traditionally considered core to medical professional knowledge. In this edition, Donaghy et al 1 present findings from a leadership fellowship in Northern Ireland and Pearson et al 2 similarly for a programme in Scotland. Both these suggest that participants (and by extension the systems involved) gained substantially from these selective, out of programme, leadership schemes. But to what extent should the knowledge gained in these programmes be core for all medical graduates, an essential part of the core skill set for ‘doctor’ in future?

More broadly, how well do our current undergraduate and postgraduate training programmes reflect and emphasise what doctors will need to know over the next 30 years? Everyone will have their own story about topics learnt often in great depth which have not proven core to what people find they need when practising. The …