In this month’s Bulletin

Physicians in many countries are trained almost exclusively in a hospital setting, where the severer or less common illnesses predominate. The result, as Guiscafré et al. (pp. 434–441) point out with respect to Mexico, is that most physicians receive very little training in treating extremely common childhood diseases like acute respiratory infection (ARI) and acute diarrhoea (AD). The authors describe the activities of a clinical training centre set up in a hospital outpatient ward in Tlaxcala — the state with the highest infant mortality rate in Mexico — to remedy this lack. In the centre’s first four years, consultations for ARI and AD in the area increased by nearly 477% and 134%, respectively; 85% of the 350 government physicians and 45% of the 90 private physicians in the area were trained in the recognition and management of ARI and AD; under-one-year-old mortality from these diseases fell by 36–46%; and 11 clinical research projects were undertaken by physicians trained at the centre. Enough to confound the initial reluctance of health authorities to support the centre’s creation.