Critics suggest that holding UK postgraduate examinations in low and middle income countries undermines the development of domestic postgraduate education, promotes syllabuses that may not be appropriate to the healthcare needs of these countries, and encourages migration, thereby damaging local healthcare systems.1

As a responsible international organisation, we are aware of these important concerns and guard against them when working with our colleagues overseas. The development of effective postgraduate education requires quality assured assessment of trained doctors at an appropriate standard. Rather than undermine local programmes, the provision of a UK postgraduate qualification can provide a springboard for further development of local postgraduate training. We believe our exam and subsequent award of an internationally recognised qualification can contribute to improving standards of clinical care.