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This policy brief focuses on the challenges that small countries in the WHO European Region face and the opportunities they avail themselves of to develop and maintain postgraduate specialist training in the health sector. The brief reviews recent evidence on specialist and postgraduate training of the health workforce in small countries and illustrates examples of good practice to emulate and build on, as well as tools available to measure and ensure high standards of specialist training. It also highlights the need for small countries to participate in international collaboration and networking to be able to overcome challenges related to postgraduate specialist training over the longer term.