The formal training and education of trainee clinical photographers started in Cardiff in 1969. Between 1974 and 1995 the trainees' foundation knowledge and skills were taught in purpose built accommodation, but since then has been in the main department, the Media Resources Centre, at the University Hospital of Wales. Prior to 1990 the trainee intake undertook the British Institute of Professional Photographers (BIPP) Qualifying Examination in Medical Photography, and between 1990 and 2001 they undertook this together with the Master of Science (MSc) in Medical Illustration. In preparation for state registration the Postgraduate Certificate (PGC) in Medical Illustration was developed with content that was appropriate to new entrants into the profession, and trainees were registered for this rather than the MSc in Medical Illustration. Since 2003 the on-job training scheme has been developed to follow a more formal structure closely integrated with the PGC. The authors describe the rationale for and implementation of these changes.