In the 50 years that I have spent in hospital practice and academic medicine in Malta and abroad, I have marvelled at the explosion of medical knowledge and the changes of medical practice that have taken place throughout the years. One could truly say that there were more advances in the last 70 years than there had been in the previous 500 years. Indeed, the medical breakthroughs of the past 60 years have saved more lives than those of any epoch since medicine began.

These changes have influenced undergraduate medical education with teaching focused on basic principles, approach to problem solving and attitudes in order not to overburden the curriculum. The five years in Medical School are, therefore, intended to prepare the graduate for professional training.

The two years of internship are followed by several years of professional training and a lifetime of continuing medical education. This postgraduate medical education and training may lead to the attainment of academic degrees such as M.Phil. or PhD or to a professional diploma which, at present, can be obtained mostly from the UK through the Royal Colleges, the Specialty Boards in the USA and, in more recent years, from European universities.

In Malta, the medical profession has recognised for many years the importance of postgraduate medical education and training. Since the late 1940s, medical graduates went mostly to the UK but also to the USA for further clinical studies and training, though there were also such cases in the 1930s. Many of those who went overseas returned to Malta with higher qualifications, usually from one of the Royal Colleges.

With the remarkable advances in science and medicine, specialty and subspecialty knowledge has markedly increased and the new developments have contributed in a major way to better patient management. It is obvious that specialisation is necessary to maintain the standard of medical and health care at a high level.

While postgraduate activity is being organised in both the Medical Faculty and in the Health Department, I believe that training is still uncoordinated and under-funded.

So far, the government bases its resource allocation on service requirements. I also feel that advanced training in specialty and subspecialty is still not adequate. The truth is that the postgraduate training in hospitals has been conducted by the medical staff out of professionalism and goodwill with no designated time and no resources. It is obvious that a better-organised and adequately-funded training programme is needed.

The medical profession in Malta has reached a certain maturity in postgraduate training and increasing attention is being paid to develop definitive-structured training of medical specialists. There are now strict criteria for training requirements, which are common to all countries in the European Union.

I strongly feel that it is time for the Medical Faculty, the Department of Health and the specialist associations to join forces to establish a Maltese Academy of Medicine, similar to the one established in Hong Kong in 1993. In Hong Kong, it is a statutory body and undertakes and supervises postgraduate medical education and training.

A multidisciplinary body like the academy is needed to act as a focus for postgraduate medical education and training. Malta is too small to have specialist associations acting on their own. However, the strength of the academy will be in the different specialist associations, together with the academic and service chairmen of departments, which will be responsible for the training programmes, accreditation of posts and continuing medical education in the specialty.

I am sure that the many graduates of our Medical School practising abroad and who have attained an international reputation working in medical centres of excellence overseas would surely give support and contribute to such a venture.

One should also investigate the possibility of holding exit examinations in the specialty with overseas examiners to provide international recognition of the academy's diploma or support the trainees to sit for the examinations of the specialty boards of the European Union. In the early 1990s, the Postgraduate Committee of the Medical Faculty had proposed the establishment of such an institution. Though it was generally thought that it was a good proposal, nothing materialised perhaps simply because it was a few years in advance. It is definitely not so now!

The Department of Health plays a vital role in such a set-up as the cooperation and assistance of the hospital authorities are crucial. I feel that basic specialist training is being carried out locally though possibly in an uncoordinated manner. There has to be "protected time" for educational purposes for the trainees. Provision should be made for advanced trainees to spend one to two years in medical centres abroad to fulfill training requirements and to acquire new perspectives and specialised skills.

It is in this context that the projects of the Irish Royal College of Surgeons and St George's University Medical College of London should be viewed. It is a positive measure that the Irish Royal College of Surgeons is keen to establish a medical school mostly for overseas students while St George's is ready to provide support to the University of Malta to set up its own international graduate entry programme. But to me the most important element in this is whether they or other centres of medical excellence can provide trainee posts for the Maltese graduates during their time in advanced specialist training.

It is only the successful implementation of a well-funded sound postgraduate training programme that will re-assure and raise the morale of our trainee specialists and will go a long way to solve the medical brain drain.