Background: Many doctors who trained in developing countries always travelled to developed countries for specialization. After specialization, many of them do not return to their countries of origin but stay put in the host countries, and get absorbed into the health delivery system of the host countries. To stop this exodus of much needed man–power in the developing countries, many of these developing countries devised their own postgraduate programs so that there will be no need for doctors that aspire to specialize to leave the country any more. This review article is to assess the quality of the various postgraduate programs in the Third World countries. Study design: The postgraduate programs in some developing countries like Nigeria, Ghana and some countries in the South Pacific were studied and compared with some programs in the developed countries like the United States of America and Canada. There are differences in these programs. We therefore attempt to identify the weaknesses of the programs in the developing countries and make suggestions in some aspects of the programs so as to produce Residency training programs that will satisfy the needs and the peculiarities of the developing countries, and yet measure up to international standards. Results and findings: Many of the postgraduate programs in the developing countries, as they are now, fall far short of international acceptable standard. There are essentially two main reasons for this: some of the programs are directly under the control of the Governments in those countries, where the priorities are more economic than quality. Also, there is this notion among the doctors in the developing countries that surgical postgraduate training must be treated like preparation for a university PhD degree, even though university Senate has no in–put in awarding fellowship certificate. In the Third World countries, it is felt that “special breed” of surgeons must work in the university environment because it is considered “prestigious” to work in the universities. Conclusion: Even though the aim to retain doctors in their countries can be said to have been achieved, it came at a great price because the programs are very different from the well established residency training program as introduced by William Halsted and Churchill. This gives rise to a program comparative to residency training in the specialty of General Medical Practice, which is very different and of lower standard than internationally accepted surgical residency training program. It also equates the training, in some aspects, to that of a university Master’s and PhD degrees. Abbreviations: RTP, Residency Training Program; LSP, Local Specialist Program; GCPS, Ghana College of Physician and Surgeons; NPGMC, National Post Graduate Medical College; WACS, West African College of Surgeons; LST, Local Surgical Training; MCQ, Multiple Choice Questions; OSCE, Objective Structured Clinical Examination; SRTP, Surgical Residency Training Program; MMed, Master’s degree in Medicine.