bumfem:

NIC has made it clear in its landslide judgements last year that health professionals reserved the right to be appointed consultants in their respective field and that individual professional consultant should have their allowances restored .

...That skipping of CONHESS 10 is a product of collective bargaining btw the govt and its worker and therefore illegal to be abrogated by fiat. So all officers that skip should continue to do so.

.....that Medical lab science is a distinct profession and therefore reserve the right to head their department without any influence from pathologist whose primary duty should be in morbid unit .

You may recall that all high profile profession have their scheme of service that guide their promotion and nomenclature at different level or cadre . All heath profession scheme of service pick at directorate. Mind you this scheme of service documents are approved and gazetted by govt. Another profession (physician) is now telling the govt ttoday that govt should not promote professionals to directors though their scheme of service permit them by law to be such promoted. Mind u,doctors have their own scheme of service that culminate in senior consultant . They chose not to go through directorate cadre ..It is like somebody telling u that u should not get to the peak of your career even though u merit it.

The issue of who should head the hospital was being handle by Yayale Ahmed committee on harmonization in health sector. Any matured mind would have waited for the outcome of such a committee headed by a highly revered restored civil servant before embarking on strike .The strike is like preempting the outcome of the committee assignment .

You need to know that there is only one head all the nurses in Nigeria hospital.The position is headed by chief nursing officer or director of nursing services as the case may be, ditto for pharmacy , physiotherapy. In medical practice it is not so. Depending on the number of specialties a teaching hospital or FMC may have. Their could be as many as many24 specialties in given hospital and they all must have heads of department all headed by doctors. In other words,u may have 20 department in hospital out of wish only three are headed by by non doctors.Yet they are not contented.

Mind u the position of the head of clinical services is still occupied by doctor .No body dispute their them heading this position till today even though nurses can do quite fine in this position. All of this positions are headed by professionall who expertise have a bearing on such dept.

Now comes the position of the CMD .These are the CEO of the hospital .It is a purely administrative position. Individual with administrative prowess in health matter suppose to be hire for this job. But what do we have in Nigeria. Bunch of anomalies where physician that finished residency yesterday are appointed to head the hospital not for any track record but for myopic fact that he is a doctor . So a man that has not manage a hurt in his life wants to manage an institution as complex as hospital.
pls see my third to the last for JOHESU position on this.

bumfem .

bumfem:

NIC has made it clear in its landslide judgements last year that health professionals reserved the right to be appointed consultants in their respective field and that individual professional consultant should have their allowances restored .


...That skipping of CONHESS 10 is a product of collective bargaining btw the govt and its worker and therefore illegal to be abrogated by fiat. So all officers that skip should continue to do so.

.....that Medical lab science is a distinct profession and therefore reserve the right to head their department without any influence from pathologist whose primary duty should be in morbid unit .

You may recall that all high profile profession have their scheme of service that guide their promotion and nomenclature at different level or cadre . All heath profession scheme of service pick at directorate. Mind you this scheme of service documents are approved and gazetted by govt. Another profession (physician) is now telling the govt ttoday that govt should not promote professionals to directors though their scheme of service permit them by law to be such promoted. Mind u,doctors have their own scheme of service that culminate in senior consultant . They chose not to go through directorate cadre ..It is like somebody telling u that u should not get to the peak of your career even though u merit it.

The issue of who should head the hospital was being handle by Yayale Ahmed committee on harmonization in health sector. Any matured mind would have waited for the outcome of such a committee headed by a highly revered restored civil servant before embarking on strike .The strike is like preempting the outcome of the committee assignment .

You need to know that there is only one header all the nurses in Nigeria hospital.The position is headed by chief nursing officer or director of nursing services as the case may be, ditto for pharmacy , physiotherapy. In medical practice it is not so. Depending on the number of specialties a teaching hospital or director.MC may have. Their could be as many as many24 specialties all headed by doctors.chief

to continue latter...

bumfem:

Mind u the position the head of clinical services is still occupied by doctor .No body dispute their them heading this position till today even though nurses can do quite fine in this position. All of this positions are headed by professionall who expertise have a bearing on such dept. of

Now comes the position of the CMD .These are the CEO of the hospital .It is a purely administrative position. Individual with administrative prowess in health matter suppose to be hire for this job. But what do we have in Nigeria. Bunch of anomalies where physician that finished residency yesterday are appointed to head the hospital not for any track record but for myopic fact that he is a doctor . So a man that has not manage a hurt in his life wants to manage an institution as complex as hospital.
pls see my third to the last for JOHESU position on this.

bumfem .

armadeo:



guy you actually make me happy with your half truth and outright lies. lets take this from the top all bolded

1.) that judgement has been put on hold by a court because as usual half truths and outright lies were told to obtain it.

http://www.thisdaylive.com/articles/court-halts-implementation-of-fg-johesu-agreements/182258/

1b) on the issue of skipping i personally don't give a rats arse as long as relativity is maintained.

2.) you say the pathologist is strictly morbid anatomy. i hope you aren't one of the lab people if you are no further comment. yourhealthlabs can educate you further on this.

3.) i think this issue of directors i have also explained. Not all Drs are consultants, in the civil service scheme there are Drs whom have been in service for over 20yrs not consultants they achieved titles such as PMO AND CMO. now under this scheme all these Drs will also become directors where does that leave us with a large array of staff trolling hospitals with the director tag ANARCHY. ( can the govt really afford to pay all these new directors) NMA is against this even though it will still benefit some of her members though anarchy will ensue.

the scheme that results in consultants you are aware of I am very sure. A CONSULTANT IS NOT A DIRECTOR.


4.) The head of hospitals aka CMDS. wait for what? JOHESU members have shown their ability to manipulate because we are all buried in books and research so we have to preempt that action.
I have also explained why it has to be a dr. Don't worry that war can never be won.

5.) This is the most hilarious issue.

You need to know that there is only one header all the nurses in Nigeria hospital.The position is headed by chief nursing officer or director of nursing services as the case may be, ditto for pharmacy , physiotherapy. In medical practice it is not so. Depending on the number of specialties a teaching hospital or director.MC may have. Their could be as many as many24 specialties all headed by doctors.chief
[/b]
to continue latter...

this is also true but with half lies. every medical department (specialty) has the chief nurse in charge of all the nurses, there's only one pharmacy so one chief pharmacist ditto physiotherapy, there's ALSO ONLY ONE CMD.


bring it on!!!!

bumfem:

HA ha ha...it is a pity that I do not have the lustry of time.

For your information the court never stop the implementation of the co tent of its formal ruling. Somebody approach the court on the burning issue resently purputedly to prevent NMA from going on strike.the So the court give an order that everybody should shealt it's swords pending the hearing of the new case b4 it and that nobody should embark on strike.the U can see your NMA flouted the court order and went on strike. If the court order is in favour of the courtNMA do you thing the NMA would have told the govt and the pubic that court order was not refering to it. Till date NMAhas not gone to court or challenge the NIC ruling . Have u ever ask ur seniors why? Aanswer is simple .They have got nothing to proof .

I really need not react to your point3 because PMO or CMO designate are equivalent of deputy director and directors in othru health profession . u chose not to go by directorate .So why should u prevent others from getting to the peak of their career.

I laugh at your submission on CMD issue . So you are afraid . The committee report may not be favourable . so it is better u scatter it......what a gentlemanly way of reasoning. If you will not be the head nobody will . No matter how reasonable other opinion may sound. DOKITA ......not, never about the patient .....it is all about your ego.

Matrons in various dept are not head of department. They are just in charge of the wards and they wip no influence outside their profession and wards.


Say all the time the truth .
Thanks.

Omonoba1: seriously, i have been following your post and they all depict arrogancy...from the previous thread till now, you tend to stress the superiority of doctors.. people like you end up spending abnormal years in medical school because you are freaky too proud...if every one should write jamb again for MBBS/BDS, who will you work with?? dont forget that a Doctor simply have little knowledge of everything in the body but does not have full comprehensive knowledge about anything in the body..

the general84:
Your statement is a complete show of ignorance. Doctors learn about the human body in-depth and extensively. In addition, they learn bits of the other health professionals' courses. Why do u think Doctors' claim that they are indispensable in the health sector? That "pride" must have been backed with a firm standing and not just empty noise. FYI, it's the other health professionals that learn only bits about the human body (bits just necessary for them to understand their course). In years 2 and 3 in university, medical students attend ALL the courses offered by anatomy, biochemistry and physiology before their 1st professional exams. Other health professionals usually offer only selected topics in the above courses in 1st semester year 2 and at most an additional few topics in 2nd semester year 2.

Omonoba1: umm! calm down before you develop myocardial infarction..can you pls write out the course outline for a medical student from yr 2 to 6 for me??

the general84:
Yes I can do that.
Year 1- A-level science courses +general studies courses (these courses are offered by everyone)
Year 2 and 3 - (a)anatomy (gross anatomy, histology, embryology of all body systems); (b)physiology (all body systems); (c)biochemistry (topics are many so won't bother listing them here)
Year 4- (a)pharmacology and (b)laboratory medicine/histopathology/morbid anatomy (comprised of pathology, haematology, microbiology, chemical pathology)
Year 5 - a) obstetrics and gynaecology
(b) paediatrics.
Year 6- (a) internal Medicine (b) surgery. (c) community medicine (d) family medicine.
Note- the year 5 and 6 courses are done ONLY by medical Doctors. Also note that from year 4 (beginning of clinical classes) they start bits of medicine and surgery (final year courses) in addition to the normal courses offered in those years. The reason is that medicine and surgery are so broad that it cannot be handled in final year alone so it's started earlier even though it's actually a final year course.

Omonoba1: well done,, now among the outline, can you point at one part that the doctors have indepth knowledge of?? anatomy, physiology and Medical bch are borrowed courses..path and pharm is also borrowed..or wud you say d doctor has as much knowledge as those who spent yrs studying these courses?? obstr and gyn et others that you listed are also not indepth cos if they were, then the concept of residency becomes fallacy..it readily brings to mind the saying; jack of all trade...what do you think?
.
P.s--just wanna learn from you, so lets do it in a mature way..

Omonoba1: well done,, now among the outline, can you point at one part that the doctors have indepth knowledge of?? anatomy, physiology and Medical bch are borrowed courses..path and pharm is also borrowed..or wud you say d doctor has as much knowledge as those who spent yrs studying these courses?? obstr and gyn et others that you listed are also not indepth cos if they were, then the concept of residency becomes fallacy..it readily brings to mind the saying; jack of all trade...what do you think?
.
P.s--just wanna learn from you, so lets do it in a mature way..

theexpected: Také this scenario, they bring in an emergency accident victim that has lost a lot of blood. Nd requires urgent blood transfusion, resident doctor admits the patient také blood samples and calls for the porter/messenger to také to the lab...... The messenger is no where to be found, will he say he's not interested, no he wont he then sends the already tired House Officer who has been busy all day to také d samples himself to the lab to group and crossmatch blood when d house officer gets there they refuse to release blood, claiming blood has almost finished the house officer then fights tooth and nail with them to collect a pint of blood which he runs to give d other doctor note that all these thing r not he's job bt that of the messenger bt if he doesnt do it, d patient will die then the relatives would say " a doctor refused to treat their son"

Joenz: Another pathological lie typical of the lying egomaniac Nigerian physicians.whrever u practice in Nigeria,hw can u say med students n physicians pay for patients' tests MOST times,dnt u guys av conscience at all?And then to ur example,so cos d second test confirms ur suspesion of anaemia,u then load d patient with all sorts of heamatinics and supplement without caring to know wat d root cause is.let's assume d issue abt renal disorder leading to inadequate production of heamopoietin,then u continue loading ur patient with blood,patient suffers citrate toxicity n dies after massive blood tranfusion.This is exactly why u will b in jail in a sane society cos d will b thoroughly investigated n actsof incompetence or negligence severely punished!

Omonoba1: well done,, now among the outline, can you point at one part that the doctors have indepth knowledge of?? anatomy, physiology and Medical bch are borrowed courses..path and pharm is also borrowed..or wud you say d doctor has as much knowledge as those who spent yrs studying these courses?? obstr and gyn et others that you listed are also not indepth cos if they were, then the concept of residency becomes fallacy..it readily brings to mind the saying; jack of all trade...what do you think?
.
P.s--just wanna learn from you, so lets do it in a mature way..

the general84:
P.s- I'm just quoting the original post for continuity.

From the above links I put in my previous posts, the following deductions can be made:
1) USA, the country we seek to copy from' is a capitalist nation that tries to get the highest profit/productivity at the lowest cost.
2) the Nurse practitioners/ consultants were created in the USA because of non-availabilty of medical doctors in some areas and also the apparently "cheaper" cost of using the Nurse practitioners/consultants compared with medical doctors.
3) these consulting nurses ONLY work in primary care settings/ areas where there is no medical doctor. It can be inferred from here that a medical consultant and a consulting nurse CANNOT be found in the same hospital.
4) come back to Nigeria, these health professional agitating for consultant positions are found in teaching hospitals, federal medical centres, government hospitals. These hospital already have enough medical doctors and consultants.
5) if we are to transfer what is being practised in USA to Nigeria, it should be done properly and not just the parts that are favourable to other health professionals.
As such, other health professional should be consultants only in health institutions where no doctors is available. We have a lot of these in Nigeria ranging from primary health centres, motherless babies homes, secondary schools, old people's homes..etc. On priciple, they should not be made consultants and remain in teaching hospitals with medical doctors and consulatnts but NO. They want to be made consultants in teaching hospitals.
What would be the effect of these? The patients would be exposed to conflicting management. The pharm consultant or nurse consultant may just oppose the management protocol of a medical doctor simply as a show of power just to impress on the medical doctor that he has authority over the patient also. Is this what you want to happen to our already staggering health system?

Omonoba1: you seem to misunderstand me..i have never and will never support consultancy position for nurses et others cos i too wud be a consultant in the nearest future and wouldn't want competition from JOHESU..infact if you go through my post, i tagged it overambitiousness..my post was directed towards that guy who was using this thread as an avenue to show off his arrogancy and rubbish other's profession...in any case, i have gone through the link and it was a good read..thanks!

the general84:
P.s- I'm just quoting the original post for continuity.

From the above links I put in my previous posts, the following deductions can be made:
1) USA, the country we seek to copy from' is a capitalist nation that tries to get the highest profit/productivity at the lowest cost.
2) the Nurse practitioners/ consultants were created in the USA because of non-availabilty of medical doctors in some areas and also the apparently "cheaper" cost of using the Nurse practitioners/consultants compared with medical doctors.
3) these consulting nurses ONLY work in primary care settings/ areas where there is no medical doctor. Should they work with doctors in the same hospital, they are usually under supervision by the doctor. It can be inferred from here that a medical consultant and an INDEPENDENT consulting nurse CANNOT be found in the same hospital.
4) come back to Nigeria, the health professionals agitating for consultant positions are found in teaching hospitals, federal medical centres, government hospitals,etc. These hospital already have enough medical doctors and consultants.
5) if we are to transfer what is being practised in USA to Nigeria, it should be done properly and not just the parts that are favourable to other health professionals.
As such, other health professionals should be consultants only in health institutions where no doctors are available. We have a lot of these in Nigeria ranging from primary health centres, motherless babies homes, secondary schools, old people's homes..etc. On priciple, they should not be made consultants and remain in teaching hospitals with medical doctors and consulatnts but no, They want to be made consultants in teaching hospitals.
What would be the effect of these? The patients would be exposed to conflicting management. The pharm consultant or nurse consultant may just oppose the management protocol of a medical doctor simply as a show of power just to impress on the medical doctor that he has authority over the patient also. Is this what you want to happen to our already staggering health system?

the general84:
The patients would be exposed to conflicting management. The pharm consultant or nurse consultant may just oppose the management protocol of a medical doctor simply as a show of power just to impress on the medical doctor that he has authority over the patient also. Is this what you want to happen to our already staggering health system?

Oduduwaboy:

@ Enigma: thank you for that link.
Everyone who has made a contribution on this thread should read that article and then come back to comment.

dakillmaster: In this issue I pity the common Nigerian folk who don't seem to know the difference between a trained medical doctor and a lab technician/Radiographer/physiotherapist/nurse/hospital clerk or porter or admin staff/pharmacist ....afterall we are in a society where everyone is referred to as Dr or nurse irrespective of their qualification..that is the only reason why these issues arise. there is no clear job description or professionalism in performance of duties..the federal government is too weak and corrupt to handle this issue firmly.in a private setting this will not even be an issue for discussion because in a private setting it is clearly stated what your job/role in healthcare delivery is..smh

rofemiguwa: I can't seem to wrap my head around the fact that medical doctors think that once other professionals become consultants they will be show of power.. How is that exactly

A director or consultant is such in a particular field.my shuld a consultant physiotherapist fight with a consultant surgeon.
It is a very flawed argument. The same way a consultant gyneAcologist seeks the opinion of a consultant surgeon shuld surgery be need in treating her patient. Is the way it is suppose to be

I tink the man issue here is that doctors don't want opinion of any other profession. They jus want to say jump and you ask how high?
They don't respect other profession and think it wiL belittle them to ask for opinions of other other team membersm
This is a very flawed way of reasoning. Very flawed.

Concerning the director cadre. The. Civil service rule allows for every profession to get to director cadre.that is the peak of ur career. However there is a process, you must pass through the promotional excerise which is 3yrs God willing if witches from your village aint after you and there is vacancy.
They are directors even in education.even in engineering. In ministries.and all those people paSs tru a process.if youy are lucky to have finished 35yrs of service and ur promotion didn't get to director that is your luck. But u you get their you shud enjoy it.
Why then in medical sector. Only the doctors wanna be directors. Why don't they want the nurses to be directors or the pharmacist or the radiographers.
Mind you to get to this level is not beans ˚°◦ooo☺º°˚˚°ºo. Why still influence the already difficult process by sitting at the end of peoples career. Shud every other profeessional stop at chiefs? Will that maintain the sanity?. Do u mean to tell me that if others become directors dy will become insane?
Note that they can only be one or two directors at a time sef?
This to me is the height of wickedness. Why stagnate others for your selfish reasons.

Is there power tussle among the doctors that are board of dircetors already? Why den do u guys feel like they will be power tussle and less communication when directorship is given to others.
What is the definition of consultanT? It simply means in a lame mans term u have reached the stage where ur opinion can be seeked.

The end goal is the patient. No man is an island? Seeking other professional opinion is not a crime ? It won't kill u. If u want to open a website for your hospital am sure u consult an ICT consultant. Why can't u consult a consultant pharmacist if u tink this drug is not reliving your patient afterall this pharmacist knws more about the composition of the drugs. U discuss it and pick wats best for the patient. Will it kill u guys to not become demigods?
Remeber it is a team work team work and no team moves forward without respect for each other.

All this power tussle and wickedness in high places will only lead to bitterness and revenge and disgust among professionals who shud be more interested in achieving a common goal- making the patient better.

The sky is big for everyone.let other birds fly. Don't cage them so u alone could own the sky. You neva know when. The bird in the cage could have bin ur only saviour if it was also in the sky with you.


P.S consultAnts in every field are not given based on cadre but based on research and educational track. Even in the US consultant nurse have further studies apart from their basic.u must have proven urself worthy to be consulted.

I rest my case

sexylogan:

That's where you are in the dark, my dear. Let me try to enlighten you.

Some nurses decided that since medical doctors become consultants, they too must become consultants (not considering that

the doctor's residency programmes have a strict curriculum with fixed clinical and practical rotations, and standard exams upon

the completion of the specified rotations)... but I digress.

As I was explaining, the nurses awarded themselves with "consultant" titles and in some teaching hospitals, would refuse to join

Doctors (consultant) ward rounds but rather do their own "ward rounds" with student nurses afterwards. When I heard this I was

like "WTF?"

Doctors' Ward rounds, in an Ideal situation, are meant to have a representation of all the health personnel involved in the medical

management of a patient ie. Doctors, Nurses, Pharmacists, Medical Lab scientists, etc. but the Doctor leads the rounds because

the patients are His. The doctor sees the patient in the OPD, the doctor admits, the doctor sends the patient for investigations

and the doctor writes out the management plan, the doctor prescribes, and when the patient's condition has improved to satisfactory

levels, the doctor discharges the patient.

Now, I'm a firm believer of division of labour. Every health personnel should do what he/she was trained to do. I will not do a nurses'

work, and she shouldnt do mine. The management of a patient is Multi-disciplinary and any attempt to cross over and do another

professionals work is the reason why there is chaos in the health sector today. I respect every health professional and I have no

grudges towards nurses, pharmacists and others. Each groups work is tasking in it's own way.

Concerning JOHESU, well, with the understanding I have, the greatest bone of contention isn't skipping of grade levels. It's

leadership positions such as Chief Medical Director that they want to be eligible for...a position that has been exclusive to doctors.

My take on the issue is this...scrap the title of "Chief Medical Director" and "Medical Director" as hospital heads and give it to

administrators. Being a doctor doesn't guarantee that you will run a hospital efficiently and in most cases, we doctors have been

discovered to be the worst administrators.

Let's allow Public/ Business Administrators to be in charge of running hospitals while doctors, nurses, pharmacists, medical lab scientists, etc

tend to patients.

I rest my case.

sexylogan:

That's where you are in the dark, my dear. Let me try to enlighten you.

Some nurses decided that since medical doctors become consultants, they too must become consultants (not considering that

the doctor's residency programmes have a strict curriculum with fixed clinical and practical rotations, and standard exams upon

the completion of the specified rotations)... but I digress.

As I was explaining, the nurses awarded themselves with "consultant" titles and in some teaching hospitals, would refuse to join

Doctors (consultant) ward rounds but rather do their own "ward rounds" with student nurses afterwards. When I heard this I was

like "WTF?"

Doctors' Ward rounds, in an Ideal situation, are meant to have a representation of all the health personnel involved in the medical

management of a patient ie. Doctors, Nurses, Pharmacists, Medical Lab scientists, etc. but the Doctor leads the rounds because

the patients are His. The doctor sees the patient in the OPD, the doctor admits, the doctor sends the patient for investigations

and the doctor writes out the management plan, the doctor prescribes, and when the patient's condition has improved to satisfactory

levels, the doctor discharges the patient.

Now, I'm a firm believer of division of labour. Every health personnel should do what he/she was trained to do. I will not do a nurses'

work, and she shouldnt do mine. The management of a patient is Multi-disciplinary and any attempt to cross over and do another

professionals work is the reason why there is chaos in the health sector today. I respect every health professional and I have no

grudges towards nurses, pharmacists and others. Each groups work is tasking in it's own way.

Concerning JOHESU, well, with the understanding I have, the greatest bone of contention isn't skipping of grade levels. It's

leadership positions such as Chief Medical Director that they want to be eligible for...a position that has been exclusive to doctors.

My take on the issue is this...scrap the title of "Chief Medical Director" and "Medical Director" as hospital heads and give it to

administrators. Being a doctor doesn't guarantee that you will run a hospital efficiently and in most cases, we doctors have been

discovered to be the worst administrators.

Let's allow Public/ Business Administrators to be in charge of running hospitals while doctors, nurses, pharmacists, medical lab scientists, etc

tend to patients.

I rest my case.

rofemiguwa: It is hard to believe you are a doctor. I wish half of the doctors had such great sense of reasoning. The world would have been a better place. I totally agree with U.

U my friend have great potentials of a great leader.God bless you.
Pls help us educate your collegues on TEAM workthank you

the general84:
Your statement is a complete show of ignorance. Doctors learn about the human body in-depth and extensively. In addition, they learn bits of the other health professionals' courses. Why do u think Doctors' claim that they are indispensable in the health sector? That "pride" must have been backed with a firm standing and not just empty noise. FYI, it's the other health professionals that learn only bits about the human body (bits just necessary for them to understand their course). In years 2 and 3 in university, medical students attend ALL the courses offered by anatomy, biochemistry and physiology before their 1st professional exams. Other health professionals usually offer only selected topics in the above courses in 1st semester year 2 and at most an additional few topics in 2nd semester year 2.
A medical doctor, after learning that extensively about the human body, will after graduation go into a post graduate residency program. Here, the medical Doctor now chooses a particular specialty(body system) and learns even more in-depth on that particular system in the body, so that by the time the med Doctor is through with residency, he/she knows EVERYTHING in every knowledge bank about the system he specialised in.

the general84:
Your statement is a complete show of ignorance. Doctors learn about the human body in-depth and extensively. In addition, they learn bits of the other health professionals' courses. Why do u think Doctors' claim that they are indispensable in the health sector? That "pride" must have been backed with a firm standing and not just empty noise. FYI, it's the other health professionals that learn only bits about the human body (bits just necessary for them to understand their course). In years 2 and 3 in university, medical students attend ALL the courses offered by anatomy, biochemistry and physiology before their 1st professional exams. Other health professionals usually offer only selected topics in the above courses in 1st semester year 2 and at most an additional few topics in 2nd semester year 2.
A medical doctor, after learning that extensively about the human body, will after graduation go into a post graduate residency program. Here, the medical Doctor now chooses a particular specialty(body system) and learns even more in-depth on that particular system in the body, so that by the time the med Doctor is through with residency, he/she knows EVERYTHING in every knowledge bank about the system he specialised in.