Education leadership has to intimately lead our future champions of students and nurture them as professional, dynamic, reflective scholars to deal with the complex world of healthcare in a post-truth era. In addition the organization structure needs to develop faculty from clinical and educational supervisors through to program directors and Deans. Leadership theories have taken over from the previous decades of teaching on management. The current dogma is intransigent, and produces silos such as leadership and followership or leaders and managers as class differences which reinforces the obdurate and narrow-minded approach. This contradicts the open society of creating change agents, critical thinkers, and scholars of the conceptual age of post modernity who in a knowledge based economy need to take our world forward. Additionally healthcare is rapidly becoming unaffordable as returns on GDP investment do not give the returns that we as patients and tax payers need. There is the obvious waste of people and funding on constant reorganizations and short-term thinking. This reflects the sort of leaders and organizations we are developing and how decisions are made. This paper through ideas confronts the myths and flaws of current leadership teaching in an education framework. It makes the case for innovative, creative, adroit, adept, experiential learners who can see the bigger picture, avoid harm and be able to cope with complexity and uncertainty, thereby creating a paradigm shift so that future leaders can problem solve, through the ongoing seismic changes that healthcare faces.

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International medical graduates (IMGs) are a remarkably successful professional group in the United Kingdom making up to 30% of the NHS work force. Their very success and media publicity about general practice and consultant shortages, has led to a large influx of inexperienced doctors seeking training opportunities in competitive specialties. In 2003 a record 15 549 doctors joined the medical register of which 9336 doctors were non-European Economic Area citizens. The number of candidates sitting PLAB part 1 and part 2 in 2003 rose by 267% and 283% respectively compared with 2001. Changes to Department of Health, Home Office, and deanery regulations with expansion of medical schools, implementation of European Working Time Directive, Modernising Medical Careers, and the future role of the Postgraduate Medical Education and Training Board, will have an important impact on IMGs’ training. Dissemination of realistic information about postgraduate training opportunities is important as the NHS for some time will continue to rely on IMGs.

T Th he e n ne ew w c co on nt tr ra ac ct t a an nd d t tr ra ai in ni in ng gAnn R Coll Surg Engl (Suppl) 2010; 92:000-000 PRESIDENT'S MESSAGE HUGH PHILLIPS PRESIDENT

Our outdated system of medical education needs to change to ensure it meets the country’s future care needs, says Davinder Sandhu