The training of Papua New Guinean doctors began in the 1950s, when students were sent to the Fiji School of Medicine, graduating with a Diploma in Medicine and Surgery. The Papuan Medical College (PMC) was established in Port Moresby in 1962, training all health professionals, including doctors, nurses, x-ray and laboratory technicians. Medical graduates received a Diploma in Medicine and Surgery. In 1965, when the University of Papua New Guinea (UPNG) was established, the PMC became the Faculty of Medicine. The first medical students graduated in February 1973 with a Bachelor of Medicine and Bachelor of Surgery (MB BS); the first graduating class comprised four expatriates and only one Papuan. In September 1975, PNG became an independent nation. In 2000, with the restructuring of the UPNG, the School of Medicine and Health Sciences became responsible for training in nursing (postgraduate), dentistry, pharmacy, diagnostic imaging and medical laboratory sciences. PNG students are selected for medicine and health sciences on the basis of their results in a common foundation year at UPNG or Pacific Adventist University. Other Pacific islander students who meet the academic criteria enter the MB BS course directly. Approximately 40 students are admitted to the MB BS course each year. Health extension officers (allied health workers with administrative and basic clinical training), who, together with nurses, are responsible for much of primary healthcare, are trained at Divine Word University in Madang.

In 1998, as part of a general restructuring at UPNG, a curriculum committee of the Faculty of Medicine articulated concerns that the traditional curriculum was focused on didactic teaching, that students were not actively engaged in learning and that clinical experience was compressed. The committee examined international trends in medical education and concluded that the most appropriate model was that of an integrated, problem-based curriculum. At a workshop in mid-1998, academic staff, together with senior clinicians from Port Moresby General Hospital and the Department of Health, defined the desired personal qualities, skills and knowledge for a UPNG medical graduate. These now form the basis of the undergraduate program objectives of the new curriculum. These objectives are clustered into five domains of learning: community health; individual medicine (prevention, diagnosis and management of illness); professional and personal qualities and skills; critical analysis and information management; and life-long learning and teaching skills. These domains provide the educational and administrative framework for the new MB BS curriculum, which was introduced progressively between 2000 and 2003. The curriculum is fully integrated and entirely problem-based, with 112 “patient and community problems” studied over the four years. The problems reflect the burden of illness and the health issues confronting PNG (Box). They open up important areas and impart relevance to teaching, rather than replacing didactic teaching. The group work implicit in a problem-based curriculum, the early clinical experience and the emphasis on independent learning skills have all contributed to improvements in student motivation and application, and students are more articulate and confident.

Medical graduates in PNG practise in a resource-poor environment, lacking many of the basic diagnostic tests that are taken for granted in developed countries. There is no computed tomography scanner at Port Moresby General Hospital, and basic tests are often unavailable (eg, serum potassium measurement has been unavailable for several months). Graduates may also be posted, in their first year, to regional hospitals and rural areas where there is limited supervision (see Poka).1 They require good clinical diagnostic skills and must be competent to perform common clinical procedures. In years 4 and 5 of the MB BS program, students are required to admit a minimum of 97 patients, to present 45 of these patients to a senior clinician, to assess a minimum of 20 patients presenting to the emergency department, and to assess and treat more than 100 patients in their urban clinic rotations — these activities must be certified. Experience with procedures (a total of 245 in years 4 and 5) is also specified and certified.

The first graduates of the new MB BS program are now working as resident medical officers. While it is too early to make a judgement on their performance, feedback has been very positive.

The UPNG Faculty of Medicine and the achievement of national independence also provided impetus for the training of clinical and public health specialists. The options for clinical training were to send graduates overseas to obtain membership or fellowship of Royal or other learned Colleges, or to establish local training programs specifically designed to meet the needs of specialists working within PNG. The second option was chosen, and the Faculty introduced the Master of Medicine (MMed) in 1975. The MMed is the degree recognised by the Medical Board of PNG for registration as a specialist. The basic structure consists of two parts: 1 year with an emphasis on basic medical sciences, followed by a minimum of 3 years with an emphasis on acquiring knowledge, clinical skills and experience in the specific discipline. This basic structure has been maintained over the 30 years since its inception, although a research component has been added in recent years.

By 1980, the first graduates in surgery, paediatrics, internal medicine and anaesthesiology were employed as fully qualified specialists, followed rapidly by graduates in obstetrics and gynaecology. Within a relatively short time, the MMed program has produced specialists in ophthalmology, otorhinolaryngology, pathology, dermatology and, most recently, medical imaging. A program in emergency medicine has also now been established. All the programs have been developed and maintained with considerable assistance and support from Australian institutions (learned Colleges and hospitals) and individuals. Standards of training have been set and are maintained by the mandatory participation of external examiners, many of whom are examiners for Australian Fellowship examinations.

Almost 30 years after its introduction, the wisdom of the decision to embark on specialty training based within PNG is clear. One hundred and thirty two PNG clinical specialists have been trained, of whom 93 (71%) are working within the public health service (including the UPNG School of Medicine and Health Sciences). The program has trained 16 specialists from other Pacific Islands, including 10 from the Solomon Islands. Although most of our graduates have spent part of their training in Australian hospitals, their feet have, for the most part, remained firmly on PNG ground. All are “generalists” within their specialty, and able to function effectively and efficiently in a poorly resourced environment. However, some have also developed expertise in subspecialty areas, and UPNG has now introduced a Higher Postgraduate Diploma in the clinical and pathology subspecialties.

The best indicator of the success of the MMed program is that PNG is approaching a situation in which all the available hospital specialist positions will be occupied by fully qualified and highly competent PNG doctors. PNG has also made an important contribution to the training of Pacific Islander specialists. However, nine PNG specialists and three (of 16) Pacific Islander specialists are known to be working outside their own country. While this does not represent a huge “brain drain”, the fact that five of the nine PNG specialists have left since 2000 is a cause for concern.

The history of training public health specialists is more complex. Early postgraduates were trained overseas. In the early 1980s, UPNG introduced a Master of Community Health, primarily based on research, but this has recently been replaced by a Master of Public Health, based on coursework and supervised research. This commenced as a combined program between the University of Queensland and UPNG, with coursework being done in Brisbane, but it is now run completely by UPNG. It is probably too early to assess the outcome of this program.

The financial and logistical support provided by AusAid, together with the National Department of Health and UPNG, has been central to the success of our undergraduate and postgraduate training programs in medicine and the allied health professions. The interdependence of the health professions is of particular importance in a country like PNG. Medical undergraduates gain experience of primary care in both urban and rural settings and learn to appreciate the importance of the contributions made by other health professionals. It may well be time to consider adding postgraduate training in primary healthcare to our specialty training options to ensure that all graduates have the opportunity to further develop their skills and contribute to the health of urban and rural communities. In addition, there is a major need to introduce continuing professional development programs for all health professionals to ensure that the achievements in basic and specialty training are maintained, consolidated and extended.