ABSTRACT
Hospitals in the UK are led by the triumvirate of, and this relationship is an important relationship to drive through transformational change. However, the complexity of emergency medicine raises some questions as to the best fit of this model with the complex and multiple systems of emergency medicine and the challenging short supply of a medical workforce in Emergency Medicine. In a devolved 'medical leadership' culture within Emergency Medicine Departments, there is evidence to show that where clinicians are supported to self-determine solutions to the 'system', consultants will gravitate to these working environments. The Certificate of Eligibility of Specialist Registration (CESR) is an alternative model of enabling the registration of speciality doctors after years of equivalence of training, experience and practice in one of the sixty-six clinical specialties. The General Medical Council argued that postgraduate medical training has to change as the training is "out of date and urgently needs reform".
