On the quality of foreign-trained medical graduates

THERE have been many comments and reactions to the foreign-trained medical graduates and their performances in the MDCN-organised qualifying examinations in the recent times. Permit me to make a humble contribution to this issue with a peep at both sides of the coin. The first set of medical graduates from the Eastern bloc countries (also called the second orld countries) were probably trained in the former Union of Soviets and Socialist Republic (USSR) in the late 60’s or early 70’s at the Patrice Lumumba Peoples’ Friendship University in Moscow and in some former Soviet republics. Hitherto, most Nigerian foreign trained doctors were from the Western bloc (first world). Later, more medical doctors were trained in other Eastern bloc countries like Poland, Former Yugoslavia, Greece, Former East Germany, Hungary, Bulgaria and so onmostly through Federal Government scholarships and through other platforms. The process of selection to study medicine in those countriesfor these folks was very competitive and was no less rigorous than those that got admission into Nigerian medical universities. Nowadays, the training of Nigerian medical doctors occurs virtually in all parts of the world including the so-called “second and third world countries” through government-sponsored (federal or state) and self-sponsored mediums. Obviously, the quality and integrity of selection process to some of these schools abroad might have been eroded as it is now “an all-comers affair”.

To verify the authenticity of the acclaimed or purported medical training abroad by these people, some forms of verification started in the 70’s which later on morphed into what is now calledqualifying examination for the foreign-trained medical graduates organise twice yearly by the Medical and Dental Council of Nigeria (MDCN), the regulatory body. In the course of preparing and sitting for the MDCN qualifying examination, some of these foreign-trained doctors might have observed subtle intimidation, humiliation (intended or unintended) and some frustration due to the actions or inactions of some individuals. The fact is that such experiences may not be limited to only the foreign-trained medical graduates as most, if not all, medical practitioners in Nigeria might have experienced such anomalies at one time or the other and at any stage of medicaltraining or in the course ofpractice as physicians. Like anything in life, one should not expect complete perfection in everything and the conduct of MDCN qualifying examinations for the foreign-trained medical graduates may not be an exception.

There have been subtle complaints from certain quarters about some inadequacies or irregularities (real or perceived) in the conduct of this examination. These were not brought to public attention until very recently when some aggrieved candidates had to go on protest due to some perceived problems, including the unbearable stress involved, poor organisation of the mandatory orientation course, unbearable financial burdens face by some candidates, low passing rates and so on. Reactions and comments (both negative and positive) on this unfortunate incident have been probably based on information available to the individuals, spiced with varying doses of unnecessary primordial sentiments. In my candid opinion, the decision to go on protest by the aggrieved foreign-trained medical graduates due to some impressions (either right or wrong) and perceived inadequacies in the conduct of the MDCN-organised qualifying examination was both unfortunate and ill-advised. Nowhere in the world can examinees dictate the rules of engagement in the conduct of an important qualifying examination such as ours. This may be likened to a road-side mechanic apprentice dictating to his master how the rituals leading to his graduation from apprenticeship should be performed.

It is instructive to note that many other professional bodies such as Nurses, pharmacists and others also organise some form of qualifying examinations for their foreign-trained graduates withouthaving to wash their dirty linens in public.  While I believe that calling for the repeal of the act establishing MDCN is inappropriate and baseless, it may not be out of place if some restructuring could be accommodated in the ways some aspects of the MDCN qualifying examination is conducted, which may likely bring some relief to both the organising authority, the examiners and the examinees. I will do these in the form of suggestions, advisesand appeal to the both the organising authority, the candidates and their parents. It is common knowledge that when an accident occurs on the highway, the cause may not only be due to the bad condition of the road or the bad condition of the vehiclebut the fault of the driver. It is instructive to note that being well or poorly trained may not be a function of the institution attended or the country in which one was trained. The efforts of the individual or how well a trainee applied himself/herself is also a significant factor. So, blaming the high failure or the low passing rates of MDCN examinations olely on the environment where these guys trained is inappropriate and childish.

Ironically, some of these foreign-trained medical graduates who applied themselves well during their training have managed to pass other foreign examinations such as UK’s PLAB and USA’s USMLE, the usual point of reference in Nigeria. There are also many of these foreign-trained Hippocratic brothers and sisters from these second and third world countries who have distinguished themselves in medical practice both in Nigeria and abroad. It is an incontrovertible fact that over the years, Nigerian universities (both public and private) lacked the capacity to absorb all intending and qualified candidates, including medicine. So, it is natural for the unlucky ones to seek admission outside the shores of the country. Making a categorical statement that all foreign-trained physicians from these countries had poor O-level/JAMB results and hence could not gain admission into the medical schools in Nigeria is illogical and offensive. Such a statement could have been justified if the results of a well conducted audit or the results of a comparative analysis and systematic review of the O/Level and JAMB/Post-JAMB results of those that trained in those Second and Third world countries and those trained at home over the years could be proven to betrue. Otherwise, such unfortunate statement should be viewed as a display of unnecessary arrogance which may be a pathognomic of those who erroneously believe that beingintelligent is the exclusive preserve of medical doctors. (See the rest on www.tribuneonlineng.com)

• Akinwale, an orthodox medical practitioner, is based in Ibadan.

In addition, if the O level/JAMB results of all admissions into medical schools in Nigeriain the past could be gotten for public scrutiny, one may likely find out that some doctorswho trained on our soil might have gained admission into medical schools not based on stiff competition but solely based on the lopsided quota or federal character systemespecially from the so-called less-privileged or disadvantaged enclave.

There is the need to also correct another wrong impression that all the socalled foreign-trained medical graduateswere born with silver spoon in their mouths and so should be able to afford any fee prescribed by the MDCN for the examination. The truth is that some parents, if not most, of these kids are not rich and they passed through a lot of financial hardships to see their children/wards through their medical education. Fingers as we know, are not equal. Of course, those who were born with silver spoons in their mouths or those who have access to easy money may have no problem coughing outbetween five hundred thousand and one million Nairaat each cycle of MDCN examination. For many Nigerians, such amount may just be unaffordable.

Decentralisation of MDCN-organised qualifying examination is not new. Until the very recent past, the MDCN qualifying examinationswere conducted in almost all regions of the country on rotational basis. These include University College Hospital, Ibadan; Lagos University Teaching Hospital, Idi-Araba in Lagos, and Obafemi Awolowo Teaching Hospital, Ile Ife in the South West. Others are: University of Benin Teaching Hospital in the South South region; University of Nigeria Teaching Hospital in the South East and Ahmadu Bello University Teaching Hospital, Zaria in the North. During this period, any candidate who was not financially buoyant to travel to the examination center or those who fear the risk of the journeys, among othersreasons, chose to wait until the examination was scheduled to the region close to them. The reason/s for the change in conducting the examinationon rotational basisin other regions of the countryis probably best known to the organising authority.

Similarly, in the past,all postgraduate medical examinationsorganised by the National Postgraduate Medical College of Nigeria, West Africa College of Surgeons and the West African College of Physicianswere conducted in Ibadan, Lagos in Nigeria and Accra in Ghana only. In a positive response to a barrage of complains by candidates such as undue advantages to some candidates, financial burdens, risks of journey among others, all these postgraduate medical examinations have been decentralised and are now being held simultaneously in other regions of the country and other West African countries without eroding the quality and integrity of these examinations. Likewise, the common qualifying foreign examinations such the Professional and Linguistic Assessment Board (PLAB in UK), the United States Medical Licensing Examination (USMLE) and others are decentralised and can be taking in many countries around the world.

 

My suggestions/advices.

1. To the Foreign-trained medical graduates:
2. Your decision to become medical doctors is highly commendable but you should note and know that medical profession, like other professions involved in life saving, is not for the dull, faint-hearted and lazy individual. Notwithstanding the part of the world destiny pushed you to study medicine, you need to apply yourself right from the beginning to the end of the training. A good grasp of the language in the country of training is a mustas you will definitely need it to interact with patients in the hospitals especially during the clinical years.
3. Before travelling out of the country, you may need to equip yourself with a copy of the “Guidelines on minimum standards for undergraduate Medical & Dental education in Nigeria” which thankfully, is now available on MDCN website. This will compliment the guidelines in your country of training and also serve as a guide in case you wish to practice in Nigeria in the future.

 

1. You need to know that no qualifyingmedical examination in the world is a walk over. Preparation for the qualifying exams in the country you intend to practise should not be left till the dying minutes. Those studying medicine in the country where English language is not a medium of communication or instruction need to start reading appropriate foreignand localEnglish medical textbooks in order to be familiar with medical jargons in English language. In addition, there are loads of information, soft copies of text books and many past question bankson the internet in all branches of medicine.
2. Upon returning to Nigeria, sincere humility and hard-workshould be your watchwords and absolute respect for the constituted authority is highly advised. Your mainfocus and concentration should be to scale the hurdles of the MDCN exams as soon as feasible. In achieving this, one needs to do a candid and honest assessment of oneself.After self-assessment, one may need at least4-6 months or moreof a goal-directed and honest preparation. I advise candidateshould attend the 4-month orientation course organised by the MDCN or undergo clinical attachment in a nearby teaching hospital or a good training centerapproved by the MDCN and rotations through various clinical departmentsshould be highly considered. Frequent interactions, discussions and sharing of knowledge with the 4th, 5th, final year medical students and house officers should also be a priority. These individuals may also serve as sources of getting past questions to practice as such may not be readily available at the MDCN offices or its website. Active participation in ward rounds, seminars and group discussions, clerking and examination of patients and presentations of findings would be highly beneficial.

 

1. Youalso need to bury the insinuation that the low passing rate is deliberate on the part of the organising authority. I belief that no truly God-fearing individual orexaminers will indulge in such ungodly act. Besides, some of these examiners may be your grandparents, parents, uncles, aunties, brothers and sisters.

 

 

1. Suggestions/advices for the parents/guardians of the Foreign-trained medical graduates.
2. Parents/guardians should not force their child/ward to study medicine at all cost. Honest assessment of the child’s ability and possessing a requisite requirement to study such a course is highly advised. Interest of the child should also not be overlooked.
3. Not all that glitters is gold and it is better to look before leaping. Parents should, as much as possible, resist the urge and temptation that a child must go abroad to study by all means without a due diligence. Before sending your child/ward abroad to study medicine (or any other course), one needs a thorough investigation/research through individuals who have studied in the same institution/country or those familiar with the terrain. Information one gets about some foreign institutions onthe internet may not be correct and may be misleading. Parent/guardian should also be aware of educational agents whose sole purpose is to make money off unsuspecting clients. Some agents make grandiose promise and paint pictures of paradise on earth about some tertiary institutions abroad.
4. Proper monitoring especially of the academic pursuits of your child/ward is mandatory. Some of these kids may easily get carried away by other worldly things and attention to academic pursuits may become secondary. Some of these kids may even view their being abroad as a transit camp to move to a better country. It may be better to get a reliable godmother or godfather in that country to help monitor your kid.

 

III. Suggestions to the MDCN

1. I, wholeheartedly, commend the MDCN in her genuine efforts at ridding the medical practice in Nigeria from both the locally breed and foreign breed quacks.
2. I’m appealing to the MDCN management and other interested parties to study the merit and demerit of rotating the conduct of the qualifying exams round the geo-political zones as being done in the past. This may be mutually beneficial to the organising authority and the candidates. It may also give some individuals a sense of belonging. The traditional teaching hospitals who have developed cold feet in hosting the exams should be brought back and more willing centers in all geopolitical zones should be accommodated.
3. I’m also appealing to the MDCN to bring back the orientation course with some modifications and restructuring. The practice of putting about a thousand candidates in a very hot lecture hall for lectures during the orientation course should be looked into. The use of online Zoom may be considered for the theoretical part of the course while candidates should be mandated to go through the practical aspects of the course in a MDCN approved training center of their choice.
4. I believe that it is virtually impossible for one to know everything in the field of medicine. I humbly implore the organising authority to kindly spell out the areas in which these foreign-trainedfolks should focus more including the Tropical medicine which those who trained in the polar or temperate environment might have not been adequately exposed to. This may be in the form of “must know, should know and may know”. This modern approach is commonly used to guide the training of medical students in many climes, Nigeria inclusive.
5. The MDCN management should also please kindly take a look at the fees being paid for the examination. The appeal and the cries of those who are genuinelypoor should not be ignored.

 

1. It may also be good if the MDCN could bring together trainers and examiners from various training centers in the country to produce books and question banks similar to that of PLAB or USMLE series and sell to the candidates. This may serve as another avenue of generating the much-needed funds to the body.

 

1. The MDCN should also empower all accredited training centers in the country to accept any willing foreign-trained medical graduates for clinical attachmentsfor a proper and goal-directed orientation. Fees paid for such orientation courseshould be shared among the trainers in these centres or a favourable sharing formula should be agreed upon. This will undoubtedly serve as an incentive for these trainers to pay necessary attention to the candidates during the clinical attachment.It will also eliminate the complain of “Baboon dey work, monkey dey chop syndrome” from certain quarters.

 

1. May I also suggest that the training centre in which the examinations are conducted should be allowed to keep a copy of the results and should be empowered to announce or release the results of the examination to the candidates.This is a common practice in many climes, Nigeria inclusive. Many faculties in the Postgraduates medical colleges in Nigeria have imbibed this practice. In addition, USMLE results are releasedand individual score reports are made available to examinees via a secure website. If the MDCN can imbibe this culture, it mayallay the fear and also correct the wrong impression in certain quarters that the results might have been manipulated or tampered withbefore being released few days or weeks after the examination. Such a display of more openness or glasnostby the MDCN may further strengthen the general believe that MDCN is the most transparent and absolutely incorruptible professional association in the country.

 

 

1. The authority in the MDCN and interested parties should also take a look at the suggestions and advises from all quarters with an open mind and accommodate the ones that will not compromise the integrity and standard of the MDCN-organised qualifying examination for the Foreign medical graduates.

In conclusion, I hereby seek for a sincere apology and forgiveness from those who my humble submission must have hurt their sensibility or caused to develop unintended psychological pain.