To fresh medical graduates in developing countries, securing a postgraduate training spot in a British or American academic medical centre represents the realization of a dream that has been passionately stoked for years. There are many of us. We come mostly from the Indian subcontinent, from the Far East (especially the Philippines and China), from Middle Eastern countries such as Egypt, Iran and Syria and, more recently, from sub-Saharan Africa. Our countries are able to provide decent undergraduate medical education, but often little beyond. Motivated by professional and material lures, we come to the US, UK and Canada and, increasingly, Australia, New Zealand, South Africa and the Republic of Ireland. Often we fill a need, making up the numbers or stepping in where others are reluctant. Sometimes we come across opportunities to fulfil professional ambitions and we seize them.