Postgraduate medical training in Pakistan: observations and recommendations.

An appraisal of postgraduate training under the aegis of the Higher Education Commission in 2006-2007 showed strong input of supervisors and enthusiasm of trainees. Problems were evident however, beginning with the virtual absence of training for family doctors. Early moves in provision of this training are applauded. Greater undergraduate contact with primary care may help to raise its status but a trained workforce is necessary to make student placements practicable. Some uncertainties about specialist qualifications need to be resolved. Trainees' concerns focussed on the absence of stipend for many; inadequate supervision due in part to insufficient faculty; the poor condition and maintenance of some teaching hospitals; difficulties with aspects of College of Physicians and Surgeons processes; and the lack of career paths. All trainees should receive payment for their clinical duties and responsibilities; there should be a national review of faculty numbers; the management and suitability of hospital facilities should be examined. It is pleasing to know that problems at the College are being addressed; and the provision of career paths including post-fellowship experience should be a priority matter. Medical workforce planning is addressed and a call made for better data. Overcoming deficiencies will mean an increased budget for health, presently among the lowest in the region.