The UK Medical Training Application Service (MTAS) for specialist training had a bad start. Doctors were angry at its inefficiencies and unfairness.1 2 Many reasons were cited for its problems including using an untried system,3 using the same system for new entrants as for those already committed to a specialty, underestimating the numbers of international medical graduates applying, using a flawed computer system, and, finally, buckling to public outcry by revising the timetable and conditions of application. The secretary of state for health apologised in the House of Commons, the website closed for a security review, and the system was eventually abandoned.

Despite all this, a central application portal with local selection has considerable merit. It has been used successfully in the United States, Canada, and, in a modified form, in Australia and New Zealand for at least 30 years (box). It provides an orderly and transparent way for candidates to decide where to train and for programme directors to decide whom to enroll into postgraduate medical training. So how do these countries make it work?