The new diploma and masters programmes at the FSM have attempted to address the problem of designing courses where the teaching resources and trainees may be spread over vast distances. The theory component of the courses consists of modules designed to be distant taught. The learning philosophy is case based with problem solving methodologies. Each of these theoretical modules has final and enabling objectives which these underpin the development of the module. Clinical case stems are produced. The cases unfold by progressively revealing information. Self-assessment pretests help the candidates assess their prior knowledge. Readings are either recommended or provided separately. The specific learning objectives are detailed in the "tutor guides". These guides allow the module to be taught by those not involved in the initial development. The clinical teaching is largely achieved by the trainee working with adequate supervision in an approved unit in a Pacific Island country. The range and quantity of trainee experience is recorded and certified in a personal logbook. Each trainee has an allocated day to day supervisor who is responsible for the practical training supervision. It is envisaged that as far as possible part of the practical training will take place in the home countries of the trainees and that some sub-specialty training will occur offshore.