From Reform to Regional Hub: Fiji’s Medical School and Pacific Health Education

Foundations and expansion (1966–1973)
From 1966 to 1973, the Fiji School of Medicine (FSMed) embarked on a period of reform and growth that would anchor it as a regional hub for medical education in the Pacific. The department of Nutrition and Dietetics was established with support from the Freedom from Hunger Campaign, introducing dietetics as a formal professional discipline within FSMed. Hoodless House was built on the grounds of the Colonial War Memorial Hospital to provide teaching and residential facilities for clinical students. The opening of the University of the South Pacific (USP) in 1968 shifted responsibility for the first year of medical and dental training to USP, a development that both challenged and framed FSMed’s evolving role. By 1970, USP was actively considering a full takeover of FSMed, and entry standards were raised in 1972, requiring a pass in Preliminary Science I at USP or the New Zealand University Entrance examination. Despite these reforms, FSMed continued to graduate a substantial number of students, producing 195 graduates in the five-year program between 1956 and 1973.

Infrastructural growth and new programs (1974–1979)
The mid-1970s brought significant infrastructure and programmatic expansion. Hoodless House was expanded in 1975, and a three-year Medical Assistants’ course was introduced to broaden service delivery in rural areas. By 1977, an amphitheatre was constructed with support from the New Zealand Lepers Trust Board and the Government of New Zealand, aligning with the graduation of the first Medical Assistants. Two years later, new pathology laboratory facilities and upgraded library resources complemented the campus. The Second Cole Report (1979) examined FSMed’s relationship with USP and set the stage for a more formal integration pathway, signaling a push toward closer collaboration within the regional training network.

Restructuring and the MBBS transition (1980–1984)
The 1980s marked a decisive shift toward an autonomous FSMed within a redefined regional framework. A Conjoint Committee comprising USP, the Ministry of Health, and FSMed was established to design a new MBBS program. That year also saw FSMed celebrate a milestone with its first graduate admitted to the Membership of the College of Radiologists of Australia. By 1981, a Memorandum of Understanding between USP and the Ministry of Health formalised the awarding of an external MBBS degree through USP. In 1982, the first intake of 36 MBBS students began training at FSMed after completing their Foundation Year at USP, supported by renovations to the physiology laboratory and anatomy museum to accommodate this transition. The Hardy/Frank Report (1983) prompted a reorganization of FSMed, and 1984 brought governance reforms that dissolved the Advisory Board and established an autonomous FSMed Council. That year also marked the closure of the Diploma of Surgery and Medicine (DSM) program, which had produced 250 graduates since 1968, and the discontinuation of the Diploma of Dental Surgery (DDS). From then on, two dental students per year were sent to train at the University of Adelaide.

Centenary, new curricula, and regional leadership (1985–1986)
FSMed’s centenary in 1985—later commemorated in 1988—was a milestone in reflecting on a century of medical education. By this point, FSMed had produced 789 medical graduates and 146 dental graduates across 35 years. A new MBBS curriculum was introduced, accompanied by recommendations from Biddulph and Boelen advocating closer amalgamation with USP. The school expanded its regional leadership with a Medical Officers Training Programme for Micronesia, reinforcing its role as a Pacific training hub. In 1986, a Master Plan for FSMed was prepared with support from the World Health Organization (WHO). The 11th Regional Conference of Permanent Heads of Pacific Health Services endorsed FSMed’s incorporation as a USP Faculty and recommended transferring dental training to the University of Papua New Guinea (UPNG), further integrating FSMed into a broader regional framework.

Legacy and impact
The 1966–1986 era established FSMed as a cornerstone of health professional education across Fiji and the wider Pacific. The period saw modernization of curricula, stronger cross-institutional partnerships, and a shift toward locally produced health professionals tailored to tropical medicine and community-based care. By building local capacities and aligning with regional institutions, FSMed reduced reliance on expatriate staff and laid the groundwork for national and regional self-sufficiency in healthcare leadership. Graduates from this era would go on to help shape health systems across Pacific Island nations, reinforcing the idea that regional collaboration and locally grounded education are key to sustainable health outcomes.

Additional context and connections
Beyond the FSMed timeline, later developments in Fiji’s health education landscape reflect a continuing thread of regional cooperation and practical training improvements. In the mid-1970s, Fiji’s barefoot doctors program trained medical assistants to serve rural communities, an initiative aimed at expanding access to basic health services while doctors focused on more complex cases. This emphasis on rural capacity-building aligns with FSMed’s early expansion of the Medical Assistants’ course and its broader regional mission. In recent years, partnerships involving the University of Fiji’s Umanand Prasad School of Medicine and Health Sciences with private and public healthcare providers have emphasized clinical placements, telemedicine, and collaborative research. These contemporary efforts echo FSMed’s legacy of training locally, fostering regional collaboration, and strengthening health systems through education and practical experience.

Looking ahead
The historical arc from FSMed’s reforms in 1966–1986 to today’s regional partnerships demonstrates a sustained commitment to building resilient health systems in Fiji and the Pacific. By continuing to invest in locally trained clinicians, expanding access through innovative training models, and leveraging international collaborations, the region can push toward broader universal access to quality care, greater self-reliance in medical leadership, and improved health outcomes for communities across the Pacific. The enduring lesson is clear: sustained investment in medical education and regional cooperation remains essential to addressing tropical health challenges and ensuring a healthier future for the Pacific.