competencies across specialties for working in niche super-specialised areas. Any such provision needs to be structured to protect the value of the CCT and should have the quality assurance processes of pre-CCT training posts. Post-CCT training should not dilute the increasing importance of continuing professional development within the consultant grade. ConclusionIt is clear that there are specialty combinations that remain crucial to service provision and appropriate training must therefore exist to ensure that there are specialists in these areas. However, traditional dual training appears to be under threat and adaptations need to be made to the new structure of postgraduate training to allow trainees to develop the necessary competencies across specialties. The rhetoric surrounding MMC promised greater flexibility of training and it is of paramount importance that this is developed in order for trainees to achieve the broad and diverse range of competencies that are required by these developing services. This will allow us to meet the needs of our patients and deliver the best possible care.

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SummaryWe have assessed the feasibility of Preferential Looking (PL), using Teller Acuity Cards, for the estimation of binocular and monocular visual acuities in a group of mentally handicapped adults. Our results show the comparison between grating and recognition acuities, inter-observer variation, success rate, time taken and the sensi tivity of this method in identifying monocular visual deficit in this group of subjects. The reasons for success or failure with PL methods in relation to criteria for mental handicap are discussed.