• Calman
• human patient simulation
• intensive care
• quality assurance

This paper describes the potential consequences of the reduced duration of the training grades in combination with the reduction in working hours and centralisation of paediatric intensive care, on the level of expertise at appointment to consultant as paediatricians in dealing with critically ill children.

The lack of change in educational method has failed to compensate for these changes with no lowering of public expectation. This is an unfair position in which to place doctors in and represents an unacceptable risk to patients. A potential solution is proposed involving a restructuring of trainee rotations, the inclusion of Paediatric Intensive Care Medicine into the General Paediatric Requirement for Higher Specialist Training as is Neonatal Intensive Care, the establishment of hi fidelity simulation centres in all lead centres, and lo fidelity simulation centres at all hospitals to form an educational matrix increasing the efficiency of training and allowing for an integrated approach to critical illness previously unobtainable.

Medicine continues to increase in complexity, depth, breadth, and level of interventions possible. The speed of this change in medicine and society has overtaken our current system of development in education and training. This has lead to an increasing gap between expectation and the ability to deliver.