When Sir Liam Donaldson wrote Unfinished Business: proposals for reform of the senior house officer gradein 2002 (Donaldson, 2002), only the most cynical of minds could have predicted the quagmire that we lie in today. On the contrary, there was an atypical professional consensus on the need for improvements to be carried out. The Sysiphean task of sending off hundreds of CVs for 6 months of poorly regulated training with no continuity and scant supervision was just one element of a system ripe for improvement. And so Modernising Medical Careers (MMC) was born – a 21st century training system that ould streamline medical training and bring us in line with our European counterparts. This shining new system would also herald the ‘consultant-led health service’ promised in the NHS Plan(Department of Health, 2000).