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Rapid response to:

Personal Views Personal views

What is the future for training overseas graduates?

BMJ 2000; 321 doi: (Published 29 July 2000) Cite this as: BMJ 2000;321:307

Rapid Response:

Training of overseas graduates still necessary

Editor - The personal view by Dr Mangalam Sridhar (1) and the
accompanying editorial by Christopher Welsh (2)
requires a response from some of us in the countries
that are benefiting from the Overseas Doctors Training

I found the statement, "No medical system can
afford to have as its main or even secondary aim the
training of doctors who eventually will not serve the
system" by Dr Sridhar sad.The reasons are as below.

It should be appreciated that doctors are a rare
commodity in most of the developing countries.(3)For
many years, some countries have relied on medical
assistants and clinical officers who are trained to
managed first level village health centres. The
situation is so difficult that even medical assistants
and clinical officers may be in-charge of departments
in a referral hospital. The need for general doctors
and specialists can not therefore be overemphasised.
My country, Malawi falls in a special category. When
we decided to start our own medical school in 1986, it
was agreed that 100 eligible students would be sent to
in the next 4 years to London University, St Andrews
(Scotland) for their pre-clinical training.(4) In the
interim, preparations would be under way to receive
the students in their clinical years. Our students
went to the UK, sadly and obviously, these places
would have been utilised by British students. Without
the British contribution, we would not today be
boasting of 116 doctors having graduated in Malawi but
having done most of their pre-clinical studies in the
UK, Australia and South Africa.

Now we need to grow. We need specialists who would
take over the running of our medical school when the
expatriates are gone. the Overseas Training Scheme is
just one of the avenues to realise that goal.

The overseas scheme that Britain runs is not
convertible. If it were possible, we could have
appreciated if when the places are limited in the UK
but the money is avaialable, the assistance could
still be given to enable that developing country
graduates train in their own regions, and possibly at
less than half the expense.

Lastly, I wish to report that the College of Medicine
in Malawi has already embarked on a postgraduate
training programme. Some modalities are still being
worked out, but to cut off the overseas training
scheme just now would be close to homicide!


1. Sridhar M. What is the future for training overseas
graduates. BMJ,2000;321:307

2. Welsh C. Training overseas doctors in the United
Kngdom. BMJ,2000;301:253-254

3. Pereira C et al. A comparative study of Caesarian
deliveries by assistant medical officers and
obstetricians in Mozambique. Br J Obste

4. Dahlenburg GW. Letter from Malawi...the first year
of the College of Medicine of the University of
Malawi. Tropical Doctor, 1993;23:4-6

Competing interests: No competing interests

22 November 2000
Muula Adamson