Registrar of the Medical and Dental Council of Nigeria (MDCN), Dr Tajudeen Sanusi, in this interview with SADE OGUNTOLA, says foreign-trained doctors need to be certified fit to practice their profession for the safety of the larger population, and there is no discrimination against an individual or country.
WHERE does MDCN come in determining doctors, including dentists, that practise in Nigeria?
It is a global practice that if you train in a particular jurisdiction and want to go and practice in another jurisdiction, you will need to do an assessment examination. Even a professor of medicine in Nigeria who decides to go and practice medicine in the USA, is not exempted from this assessment examination for licensure that qualifies him/her to practise in those countries. It is Professional and Linguistic Assessments Board (PLAB) and the United States Medical Licensing Examination (USMLE) in the UK and USA respectively. It bears different names in different countries.
Each medical licensing authority sets its own rules and regulations and requires passing an examination that demonstrates qualification for licensure. Nigeria is not exempted from this. Licensure to practise is not automatic. In Nigeria, we also have foreign-trained doctors who want to be licensed to practise medicine. The majority of them are trained in the Eastern bloc, especially Ukraine. Their medium of expression in these countries is not English. They float a programme in the English language after 5 to 6 years, the students are back with an MD degree. So, how many years were used to learn and master the language and settle down to learn in school?
Are there issues with their training? Is the five or six years too short a period for their training?
The quality of their training is worrisome. The scenarios we see when they come for the examinations also call for concern if we as a regulatory body will execute our mandate of ensuring Nigeria’s health is not in jeopardy. In the assessment examination we conducted in 2017, for example, a former provost of a College of Medicine in Nigeria and a member of the board of examiners identified six of his former students that were withdrawn from the medical programme here in Nigeria, and who went abroad and then were granted MD degrees when their colleagues that did not fail in Nigeria are still in final year in the medical school.
What is worrisome is that those who do not have a science background are usually admitted and graduated with an MD degree. Also, many of those with science backgrounds had very weak scores. We all know that in Nigeria some with even five distinctions may not be able to get admitted into the medical programme. These are the problems and so each time we conduct the examination for their licensure, there is mass failure. And the next thing is they go to the National Assembly and start complaining, forgetting that their profession is about lives and no nation can afford to put its people’s health in jeopardy. Meanwhile, if candidates write other examinations such as WAEC, JAMB, ICAN and Law School examination and fail, they will not go to the National Assembly to complain and be entertained. Why complain about what has to do with the health of the people?
Is the situation similar in other countries where these graduands with MD degrees go back for licensure to practise?
It is similar in many countries, including Ghana and India where there is also a large number of medical students coming back from Ukraine’s medical schools. Presently, the Medical and Dental Council says doctors who studied outside Ghana who fail the mandatory registration examination after five attempts will be rendered ineligible to practise in Ghana. The policy was agreed upon in 2018 after a consultative engagement concerning stakeholders and is to take effect in 2022.
In 2019, 25.79 per cent of Indians cleared the Foreign Medical Graduate Exam (FMGE), a test conducted by the National Board of Examination (NBE) and mandated by the National Medical Commission (previously the Medical Council of India) to qualify for practice in India. These included foreign-trained doctors from Countries like Russia, Ukraine, China, the Philippines, Bangladesh and Nepal, among others. However, Bachelor of Medicine and Bachelor of Surgery (MBBS) graduates from the US, UK, Australia, Canada and New Zealand do not need to take the examination.
Currently, the ruling by India’s Supreme Court is that foreign MBBS holders can’t be given provisional registration to complete their internship in India without completing the clinical training in physical form.
Is there any physical form of training ongoing for these foreign-based MBBS holders, or those that left the Russian-Ukraine war to ensure they can be certified and practice in Nigeria like India is doing?
We have many schools in Nigeria to which they can apply to continue their studies, some are already doing that. But the majority are not. Even if they want to go to another country to go and complete their studies, there is no problem. But it is shocking to note that these schools in Ukraine now resorted to online teaching of medicine. Before the war, when they were in class they were not passing, let alone now that there is war and they are doing online teaching. The situation will be horrible. Medicine requires both clinical and theoretical teachings; these are some of the things that we saw compromising the standards of their medical training.
In Nigeria, we cannot compromise standards. We have a body of examiners that are drawn nationally, people of high repute to assess whether they are competent to practise in Nigeria. We know that when the background is weak, they cannot get something meaningful out of it. But rather, they said that we are jealous of them and that is why we fail them.
You can see that the Medical and Dental Council of Nigeria is up and doing. Anytime any of our registered members are reported, we investigate and if they have cases to answer, refer them to the Tribunal. Last year, the name of a professor of Medicine was struck off the MDCN register for negligence. There are so many doctors whose names have been struck off the relevant register.
Coming to the foreign-trained doctors whose results in our assessment examination are often poor; it is not about the method of teaching medicine or rating medical students in training. There are so many factors that could have contributed to their poor performance in the assessment examination conducted by MDCN.
First, is the quality of students themselves. These are mostly people who could not secure admissions locally into our medical training Institutions. We cannot say much about the quality of their teaching, the medium of communication which is the Ukrainian language in Ukraine may be a barrier to learning, how much more when the programme is in English Language. How are we sure that those people teaching them are even proficient in English and they are also doctors? Also, they don’t see patients, so they don’t have clinical exposure.
Another disturbing thing is that when you reach the 500 level, they ask them to go to their countries of origin to do one-year clinical training. Meanwhile, for that year, they still collect tuition fees from them. We were shocked in one of the countries we went to when we saw a paper that said the trainee had undergone a year of clinical attachment at a primary health care centre in Nigeria. Also, when they go back after the supposed clinical attachment, there is no form of assessment again. They just awarded the MD degrees certificate. And the most worrisome thing about their training is that they don’t allow them to practise in their country of training. They send them back to their home countries.
I will tell you about the programme in Ukraine. After the award of the MD degree which is equivalent to an MBBS in Nigeria, there are some hospitals which have been approved that you need to go to for the next two years. After those two years, you will sit for what is called the National licensing examination, it is on passing that examination that you can now practise in those countries. But they don’t allow foreigners to go to those hospitals. It is only for the locals and their system.
When we were in Cyprus, for their locals, the quota for medical training was 50. But for the international students, it was limitless. It is in our practice that when we go anywhere we normally address Nigerian students there, and there were lamentations. They said at times some of those lecturers could not express themselves in English, so they just changed to their local language. Also, they don’t do the same examination as the indigenes.
Howbeit, before commencing the foreign-based training in medicine, nobody ever referred to MDCN for guidance. And I will tell you what we discovered: many of these schools use the name of established universities in their country and they say that it is an English-speaking training centre, which I will say is a fraud.
The certificate that will be issued is also different from that of the established university they initially used to attract the students. It is a big problem. Over time, we have a record of such institutions in our office. We update the record of these institutions regularly and most of these institutions are from Ukraine.
Now, we want to segregate it down institution by institution so that some institutions can be blacklisted outrightly. Certainly, international relations will be involved in this matter and we are very aware of its implication in the diplomatic environment, even as we try to tell them that there is a minimum standard that must be fulfilled to practise medicine in Nigeria.
Any plans to tackle the mass failure of foreign-trained doctors?
The council at a point proposed a remediation programme and we tried to choose a centre from each of the geopolitical zones with the hope of brushing them up and in the process ensuring that they undergo clinical training. If those training them believe that this candidate is not good enough, that candidate will not be presented for the examination.
Of course, the teaching hospitals came up with their cost implication. The initial cost they came up with was N1.5 million for the six months of training. Our chairman at MDCN brought it down to N900,000 because we realised that the training will do them a lot of good to meet up with the standard and reduce the so-called financial burden on their parents. We did not make it compulsory for anybody. Everyone is free to train wherever they want and present themselves for the examination.
Surprisingly, when we brought out the publication, there was a big reaction, to the extent that MDCN was summoned by the National Assembly asking why we were charging them N900, 000. But the idea was shot down by the National Assembly. Of course, this may end up bringing people who are not properly trained into caring for Nigerians and killing people.
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