During the last twenty years there has been a significant growth in the training of overseas students especially within the European Union. This development has been paralleled by the emergence of off-shore medical schools in the American hemisphere. These facilities are to be found in both traditional established universities as well as less robust institutions. This review will deal specifically with students trained within established universities far from their own communities. It will concentrate particularly on the European Union where there are now more than 20 such English Parallel courses. The review considers the experience of students studying in a foreign culture with different teaching and learning norms. It suggests the need to develop support networks and to encourage the emergence of specialist cultural advisors with links across the European Union to ensure that the specific needs of such students should be considered for when they return to their home communities. The long-term benefits of building a trans-European medical workforce are also discussed briefly.