CLINICAL-TRAINING FOR TROPICAL DOCTORS IN THE NINETIES

Together with economic causes, the declining belief in the relevance o f clinical skills, the omission of the hospital from the health system , and the erroneous generalisation of a complaint centred approach enh anced the decline in clinical medicine in several developing countries over the last decades. Despite a growing interest and important effor ts in continuous education, basic training remains generally knowledge -directed. Clinical training should start from a realistic job descrip tion, and aim at acquiring skills instead of knowledge. Basics of clin ical epidemiology can help refine clinical logic both at the health ce ntre and the hospital level. The district hospital should be awarded a key role ill pre-graduate and continuous clinical training. Awaiting a revival of the economy in most tropical countries, and especially in tropical Africa, an effective way for improving clinical practice is to invest in training, at all levels, with an emphasis on continuous m edical training.