To qualify as doctors in the Republic, students must spend a pre-registration year working as an intern in a hospital. Overseas students are expected to return home to complete their intern years. The Medical Council is proposing sweeping changes to this year.

"The existing arrangements for the intern year provide, at best, opportunistic training and much inappropriate work experience . . . Change is possible and necessary," says the council.

Up to 375 intern posts are filled annually. They are salaried and cost £6 million annually. "The educational content of the posts is small and the service component often includes much inappropriate clerical work," the council notes.

The council is now proposing that all graduates be offered internships in Ireland and that the number of posts be increased to 500. This will enable three interns to do the work that is currently being done by two and give them time for education, training and personal study. Their pay will be adjusted accordingly.

According to the plan, a central intern training agency is to be set up to link posts to specific medical schools. "All posts and educational schemes will be subject to audit and monitoring by the Intern Training Agency (ITA). Unsatisfactory posts or schemes may not receive funding." Each student, says the council, should spend between seven and 10 hours each week in a structured educational course.

Although most intern posts are taken up by Irish graduates, these graduates are less likely to take up the further training positions in Irish hospitals (see panel). Just under 40 per cent of house officers in Irish hospitals are from overseas. (At registrar level, almost half are from non-EU countries.) Only a relatively small number of training posts are structured, while others are approved for training but not structured.

Irish graduates are eschewing postgraduate training in Ireland because of a perception "that some training posts do not provide a good level of training," says Professor Kevin O'Malley, registrar of the RCSI. In surgery, he says, nearly 50 per cent of posts are taken up by overseas graduates. "They make an important contributions to the healthcare system and take up positions that Irish graduates don't take."

Smaller hospitals are unable to provide the range of training to which Irish graduates aspire. In order to provide high quality training, "we're talking about closing 15 to 20 hospitals around the country," O'Malley says. "It was all set out in the Fitzgerald Report, 25 years ago, everyone knows what should have been done and never was."