Electives are a highlight of clinical training but probably often represent missed opportunities. There are both educational and moral reasons for seeking more considered approaches to reduce the 'medical tourism' that can result from the current largely ad hoc arrangements.

The challenge to both students and their sending institutions is to progress towards giving something proportionate back in return for the learning experiences received. There is clearly room to improve electives from the hosts' perspective, but individually host institutions lack the opportunity or ability to achieve change.

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Bangladesh shares many socio-cultural, financial, and health issues typical of developing countries. Despite some encouraging developments in health measures at grass-roots level, medical education in Bangladesh faces many challenges. This article provides a snapshot of the current situation of undergraduate and post-graduate medical education with particular emphasis on pedagogical issues, highlighting challenges faced and suggesting an immediate five-point action plan.