NUC PROPOSED SEVEN YEARS OF MEDICAL SCHOOL: A MEDICAL STUDENTS PERPECTIVE

It is no longer news that the National University Commission (NUC) has developed new Benchmark Minimum Academic Standards (BMAS) for the training of doctors in Nigerian Universities, with extension of the medical program to a 7 -year duration. It was further reported that the aim of the BMAS will address most of the challenges faced by the medical colleges in training doctors in Nigeria in a bid to make Nigerian doctors globally competitive and capable of contributing to Nigeria’s socio-economic development. While no one is attempting to dispute the genuine concern of policy makers towards improving medical education in Nigeria, there is an imperative need to resonate some very realistic issues that hold true in this regard.


To begin with, medical training in Nigeria is not currently 6 years. It is more than that, strikes exclusive. Undergraduate training in any discipline is incomplete without the award of the ensuing degree. For a student to be awarded a degree, he/she must meet the minimum requirements laid down for that degree. Medical training at the undergraduate level is only complete when one receives the MBBS degree. The first year to the sixth year comprises a 6 - year duration, after which the doctor proceeds for an internship. The MBBS degree is only received after a successful completion of internship. Can we now see that undergraduate medical training in Nigeria already takes at least seven years to complete?

Now that it has been correctly established that undergraduate medical training takes at least seven years to meet the minimum requirements leading to the award of the MBBS degree, it is also imperative to note some practical bitter experiences unrelated to the curriculum, and like most of other Nigerian problems, tied to a dysfunctional system and insensitivity of the government.


On successful completion of the sixth year, medical doctors are issued a provisional license to enable them practice under a very vigilant supervision during the internship. Unlike the medical school where one transits from one class to another in a short period of time, transiting from the final year to the internship year can take as little as three months (being the very least likely to occur) to as long as a year (being the most frequent occurrence), due to factors still not unrelated to a vibrant curriculum. Hence the logical questions to ask would be: Is the problem of quality healthcare delivery in Nigeria a curriculum problem or are there more determining factors? Most importantly, what would be the effect of this long duration of training on the Nigerian medical student? Does a long duration of training equate to better quality of training?

If we are to be sincere, we would realize that the state of medical education in Nigeria presents a scenario marked by wishful thinking rather than steps in the necessary direction. In 2004, Dr Liselotte N. Dyrbye and her colleagues at the Mayo Clinic College of Medicine did a survey on 545 medical students in the state of Minnesota. They discovered that 239(45%) of the students suffered from emotional exhaustion, depersonalization, a low sense of personal accomplishment and a progressive decline in mental health attributable to academic pressure, workload, sleep deprivation, exposure to patient death and suffering, student abuse with these factors increasing with more years of training. In a second study, it was discovered that 11% of students surveyed had suicidal thoughts and in a third study it was realized that those students that experienced burnout due to increased years of training had less empathy for patients.


It goes without argument that the problem of healthcare delivery in Nigeria is not a curriculum problem. It is often criticized that the graduates of Nigerian medical schools are not globally competitive, but statistics have proved otherwise. According to the Foundation for Advancement of International Medical Education (FAIMER) Short Report on “Nigerian Medical School graduates and the U.S Physician Workforce”, it was noted that “Nigeria has historically been considered as one of the leading countries in the export of physicians”. Five years ago, the Nigerian Health Journal reported that 2,392 and 1,529 Nigerian-trained doctors practice in the U.S and UK respectively. This means that 5 years ago, about 10% of doctors trained in Nigeria were absorbed in the U.S and UK alone. It would be insincere to note this statistic reflecting the contributions of Nigerian doctors to global healthcare and still put the cause of an uninspiring healthcare system on a ‘faulty’ curriculum.

Prolonging medical school training is not the answer. Currently, medical students inculcate the skills of history taking, physical examination, formulation of differential diagnosis and management plan for various problems. The skill of human resource management, leadership qualities and providing cost-effective care in rural areas is developed during the community medicine and family medicine postings. Students participate actively in the management of patients and these are re-enforced during the internship. It is mandatory to be at the emergency room to gain mastery of practical skills and problem solving ability which are recorded in the logbooks and assessed by the tutors.


The solution to the seemingly unending healthcare problems in Nigeria and the bid to ensuring that the Nigerian doctor is “globally prepared” is not totally in a prolonged duration of training. Those issues are beyond the scope of this article. Prolonging undergraduate medical training to try to fulfill this is unfair and unjust to the Nigerian medical student who is already on the brink of severe emotional stress, physical exhaustion and mental breakdown from the already rigorous nature of training in a system he/she is left at the mercy of those at the helm of affairs. Our policy makers should please try to achieve the same goals with the current timeframe.

Emaediong Akpan-Ekpo is a final-year medical student in the University of Uyo, Akwa Ibom State.

cc: lalasticlala, Ishilove

Great write up.
I sincerely believe that prolonging the present number of years is not really the answer to the problem. The Medical school curriculum in Nigeria at present is still one of the best worldwide. Because the Nigerian medical student has better hands on experience than many other places. Clinical students interact with patients more than most other places. Even leading medical schools worldwide have restrictions on what medical students can do. And the Clinical oriented medicine thought in the schools, though overly influenced by the Western Biomedical model of curative medicine is still patient oriented and not disease oriented like other parts of the world.
We may not have state of the art facilities in our teaching hospitals, we may not be able to do expensive and miracle tests in our laboratories, but on any day, put a Nigerian medical student with another one from anywhere, and give them patients to diagnose and you will see the difference. The art of differential diagnosis is well taught that any Nigerian medical student worth his salt will function well outside the shores of the country. And we see it everyday.
The problem with Nigeria is not the medical school curriculum. It is rather the way medical schools are rum and the criteria for admissions that has been watered down.
Incessant strikes in the health and education sectors bring a multiplier effect on the training of medical students, since they are doubly under the two systems. Then, medical schools are overpopulated. You cannot run a medical school the way you will run an Accountancy class. Hands on experience and tutoring and mentoring by seniors require smaller classes.
Then, medical education anywhere in the world is not cheap. If our government is still bent on subsidizing education, they should do it well and better.
In the aspect of training, what the Postgraduate Medical Colleges and the Medical and Dental Council should do, is to formulate a program to extend training of doctors, not medical students.
Nigeria does not have enough doctors for very many reasons. Not the reason for tthis discussion. But at the same time, the quality if doctors should improve every time. Medicine is a profession where learning is lifelong. I will prefer a system where the minimum requirement for independent practise is Specialist in Family Medicine. This is not impossible. It just means that we need to improve the present structure of hospitals and health centres. The present dearth of doctors in Nigeria will however make this difficult. But it's not a one day or one year job. It will require a lot of restructuring.
For this to be achieved, there should be more delighting of responsibilities to other healthcare staff. Nurses should be made to take decisions more often and contribute more to the care of patients. They should be allowed to take on tthe more routine tasks of junior doctors as much as possible. This doesn't mean they are a threat to doctors. I know this may not sit well with a lot of people because of the present state of interprofessional rivalry in the health sector in Nigeria. But it's the inevitable way forward.
Of course, strict regulations will continue to guide the actions of everyone in the health sector. And accountability will be the order of the day.
For now, I think we should just first concentrate on improving the present deplorable state of healthcare delivery in Nigeria, by pressing ffor the implementation of Participatory UNIVERSAL HEALTH CARE

Too long

My biggest problem is not even the extension. We spend 7 years already with internship making it 8 years. I think the "extension" may not necessarily make it too much longer.
My problem is the proposal to abolish the end-of-posting examination system in favour of the course credit system. This is just so naive and ill-conceived. I wonder who they consulted before coming out with this. I wonder how many course credits Pathology alone will take? 40? Paediatrics? 30? The EOP exam system is just fine and they should let it be. It's so evident these people know very little about the peculiarities of medical education.

Lalasticlala frontpage pls.

I have observed the recent controversies and euphoria generated by the announcement of the new policy by NUC as regard medical education in Nigeria.
One thing that I came to realize about education in Nigeria is that the rot in the education system is as a result of corruption, myopic thinking, insincerity, ineffective policy making of our leaders especially those in the Helm of education affairs.
I don't see how 7 years in medical school will benefit a developing country like Nigeria where strike, lackadaisical attitudes of lecturers, poor facilities, outdated curriculum and other issues.
They should first address the issue of facilities, strike,, overcrowding, nepotism in the admission process before giving us seven years.
Who is deceiving who.
Is it the school authorities, NUC, or the Nigerian government.
Even though u are to teach a medical student for ten years, it is still nothing.
Why offering a nurse, pharmacist, physiotherapist and other paramedics a chance to come back to mbbs where by such persons can contribute more to their respective fields of study.
To me it is like they are trying to kill those other fields after 70 percent Nobel laureate winners in medicine are not medical doctors.
If they are to admit other paramedics into the field of Medicine then we are looking at the collapse of Nigeria health sector.
If everybody were to be doctors then who will be the physiotherapist, nurse and medlab scientist.
Who will observe reaction of hormones in our body, the different metabolic pathways taking place in our body which is the work of the pharmacist and medical biochemist.
U can also see what the unnecessary struggle between doctors and johesu has done to the health sector and still some people are thinking of admitting johesu into mbbs.
You can see how ridiculous the whole thing is.
They should take heed or what they will see next is the collapse of our health sector

Seun, Lalasticlala front page abeg.

...

Chartey:
My biggest problem is not even the extension. We spend 7 years already with internship making it 8 years. I think the "extension" may not necessarily make it too much longer.
My problem is the proposal to abolish the end-of-posting examination system in favour of the course credit system. This is just so naive and ill-conceived. I wonder who they consulted before coming out with this. I wonder how many course credits Pathology alone will take? 40? Paediatrics? 30? The EOP exam system is just fine and they should let it be. It's so evident these people know very little about the peculiarities of medical education.

But you see, the course credit system isn't actually a bad thing. I've been thinking about that for a while now. I think if properly implemented, it will do a lot of good.
First, it will bring an end to the evil system of closed marking. This closed marking system has destroyed a lot of destinies. Do you know that you cannot qualify for most postgraduate programs in many countries of the world because of it? Many programs will require you to have at least a 3.3 out of 4 point GPA. When they see your transcript and calculate all your 50s and 60s, it just gets you nowhere. If you had distinction all through medical school, your calculated GPA will be just 2.8. They don't even understand the concept of closed marking.
But if we have a course credit based system, closed marking will end. Then, the possibility of scoring higher increases......

omoarole:


But you see, the course credit system isn't actually a bad thing. I've been thinking about that for a while now. I think if properly implemented, it will do a lot of good.
First, it will bring an end to the evil system of closed marking. This closed marking system has destroyed a lot of destinies. Do you know that you cannot qualify for most postgraduate programs in many countries of the world because of it? Many programs will require you to have at least a 3.3 out of 4 point GPA. When they see your transcript and calculate all your 50s and 60s, it just gets you nowhere. If you had distinction all through medical school, your calculated GPA will be just 2.8. They don't even understand the concept of closed marking.
But if we have a course credit based system, closed marking will end. Then, the possibility of scoring higher increases......

Interesting angle. Please what programs are those?

Chartey:
Seun, Lalasticlala front page abeg.

The mods are more interested in a photo of a medical student that was reading in church.

omoarole:


But you see, the course credit system isn't actually a bad thing. I've been thinking about that for a while now. I think if properly implemented, it will do a lot of good.
First, it will bring an end to the evil system of closed marking. This closed marking system has destroyed a lot of destinies. Do you know that you cannot qualify for most postgraduate programs in many countries of the world because of it? Many programs will require you to have at least a 3.3 out of 4 point GPA. When they see your transcript and calculate all your 50s and 60s, it just gets you nowhere. If you had distinction all through medical school, your calculated GPA will be just 2.8. They don't even understand the concept of closed marking.
But if we have a course credit based system, closed marking will end. Then, the possibility of scoring higher increases......

The credit system is a plus. Let me rephrase that. The credit system would be a plus. The problem is the implementation. We find it easier to implement retrogressive policies than the good ones.


An additional advantage is that medical students would graduate on time. It usually is painful when you're in 400 level struggling with Path and Pharm when someone you got admitted with in another department is halfway thru or almost done with service. My flatmate that just passed out from nysc was admitted the same year I was. plus he had an extra year in school.

You guys are making serious points. Just wish one of them could see this

Chartey:

Interesting angle. Please what programs are those?

My experience has been with Masters programs in Canadian Universities. Take any Masters program in any university there and visit their school of postgraduate studies. They squarely spell out the 3.3 in 4 point GPA. you can only make that if you got 70% in majority of your courses in school. And the unclassified part to the degree doesn't make it easier.
Another angle to it is that the medical school program does not inspire excellence......it just places emphasis on averageness, since all you have to do is just pass.
Not that the program is not hectic enough, but it leaves you with the mentality that you don't really have to be exceptional. At least, all you need to do is just pass.
I agree that they may need to overhaul the whole process, but I hope the older doctors in the profession won't be against the changes. Most people still feel the old landmarks shouldn't be removed.
Most schools are still doing the longform exams still, which worldwide has been judged to be it only subjective, but not in tandem with the new concept of evidence based medicine....

omoarole:


My experience has been with Masters programs in Canadian Universities. Take any Masters program in any university there and visit their school of postgraduate studies. They squarely spell out the 3.3 in 4 point GPA. you can only make that if you got 70% in majority of your courses in school. And the unclassified part to the degree doesn't make it easier.
Another angle to it is that the medical school program does not inspire excellence......it just places emphasis on averageness, since all you have to do is just pass.
Not that the program is not hectic enough, but it leaves you with the mentality that you don't really have to be exceptional. At least, all you need to do is just pass.
I agree that they may need to overhaul the whole process, but I hope the older doctors in the profession won't be against the changes. Most people still feel the old landmarks shouldn't be removed.
Most schools are still doing the longform exams still, which worldwide has been judged to be it only subjective, but not in tandem with the new concept of evidence based medicine....

OSCE has largely solved the problem of subjectivity.

These programmes you are talking about, are they medical?

Chartey:

OSCE has largely solved the problem of subjectivity.

These programmes you are talking about, are they medical?

They are ALL medical. Check out the Master programs in Universities of Alberta, Calgary and Saskatchewan.
OSCE cannot solve the issue of subjectivity if you still write theory exams that can be marked. That is what introduces human error.
The oral exams can be made more objective by issuing standard questions and marking rules with electronic recoding of the interviews. But that's a long shot.
The tests of objectivity are MCQs in all their various formats scored and marked by a machine Eg. Scantron that is routinely measured for precision and accuracy, and OSCE. Those are the only two forms of exams that are very objective. Most medical schools round the world now have that along with tightly controlled vivas

I don't really understand new policy o....does it mean that candidates won't be admitted to medical school via UTME any longer?...am about obtaining a Jamb form..

Quite busy now, coming back to fully read later. But Dr Lomaxx, I spotted a mistake in ur title. It should be "A MEDICAL STUDENT'S PERSPECTIVE" and not " A MEDICAL STUDENTS PERSPECTIVE ".

Vcojuro:
I have observed the recent controversies and euphoria generated by the announcement of the new policy by NUC as regard medical education in Nigeria.
One thing that I came to realize about education in Nigeria is that the rot in the education system is as a result of corruption, myopic thinking, insincerity, ineffective policy making of our leaders especially those in the Helm of education affairs.
I don't see how 7 years in medical school will benefit a developing country like Nigeria where strike, lackadaisical attitudes of lecturers, poor facilities, outdated curriculum and other issues.
They should first address the issue of facilities, strike,, overcrowding, nepotism in the admission process before giving us seven years.
Who is deceiving who.
Is it the school authorities, NUC, or the Nigerian government.
Even though u are to teach a medical student for ten years, it is still nothing.
Why offering a nurse, pharmacist, physiotherapist and other paramedics a chance to come back to mbbs where by such persons can contribute more to their respective fields of study.
To me it is like they are trying to kill those other fields after 70 percent Nobel laureate winners in medicine are not medical doctors.
If they are to admit other paramedics into the field of Medicine then we are looking at the collapse of Nigeria health sector.
If everybody were to be doctors then who will be the physiotherapist, nurse and medlab scientist.
Who will observe reaction of hormones in our body, the different metabolic pathways taking place in our body which is the work of the pharmacist and medical biochemist.
U can also see what the unnecessary struggle between doctors and johesu has done to the health sector and still some people are thinking of admitting johesu into mbbs.
You can see how ridiculous the whole thing is.
They should take heed or what they will see next is the collapse of our health sector

. I have to laugh when I read your comment. We all are gonna be doctors soon, thank God for lobbying. The pathway will eliminate the JOHESU nightmare, we can do all be the nurse, pharmacist, biomedical scientists ....come on. If the health system will collapse then by all means, let it, not my damn business.

I like the policy though, gives you the opportunity to practice with a dual degree other than only the MBBS and the added advantage of graduating as mature students.
Me thinks, they should've modelled it like US medical school as a graduate program.

LadyFiona:
. I have to laugh when I read your comment. We all are gonna be doctors soon, thank God for lobbying. The pathway will eliminate the JOHESU nightmare, we can do all be the nurse, pharmacist, biomedical scientists ....come on. If the health system will collapse then by all means, let it, not my damn business.

I like the policy though, gives you the opportunity to practice with a dual degree other than only the MBBS and the added advantage of graduating as mature students.
Me thinks, they should've modelled it like US medical school as a graduate program.

Your reply is not a good statement for the benefit of the health system. You said if the health system collapses, by all means let it......iit's not your darn business.
I can conveniently say that we do not need that type of attitude in the Healthcare place in Nigeria here.
Do not be clouded by the present labour union disputes and the resulting disharmony in the health sector. The health care delivery system is not ok the way it stands, but I don't think the way out is to be selfish about ourselves caring less what happens to the system.
Remember that a working healthcare delivery system is a benefit to all and sundry. Remember that we are all patients.....wwe will all be one day, no matter what happens. You will not want to be attended to by a collapsed health system.
Not everyone will be a doctor. That doesn't even happen in other countries. Granted, there is more autonomy for other healthcare professionals, but everyone works together for the good of the patient.
We should not have the attitudes of "the other guy is my enemy". It helps nobody.
Pls, I will like you to be more constructive in your statements. It's that kind of arguments that lifts the spirit and let's us reason together how we can move forward in this country healthwise.
The reasons for this kind of forum is because nobody is an encyclopedia of knowledge, nobody knows it all. It's the Commonwealth of the stakeholders, healthcare providers, patients and government that can help us get through the mess we are in right now.

Thewhizzkid1:
Quite busy now, coming back to fully read later. But Dr Lomaxx, I spotted a mistake in ur title. It should be "A MEDICAL STUDENT'S PERSPECTIVE" and not " A MEDICAL STUDENTS PERSPECTIVE ".

Thanks. Was a typo.

omoarole:


Your reply is not a good statement for the benefit of the health system. You said if the health system collapses, by all means let it......iit's not your darn business.
I can conveniently say that we do not need that type of attitude in the Healthcare place in Nigeria here.
Do not be clouded by the present labour union disputes and the resulting disharmony in the health sector. The health care delivery system is not ok the way it stands, but I don't think the way out is to be selfish about ourselves caring less what happens to the system.
Remember that a working healthcare delivery system is a benefit to all and sundry. Remember that we are all patients.....wwe will all be one day, no matter what happens. You will not want to be attended to by a collapsed health system.
Not everyone will be a doctor. That doesn't even happen in other countries. Granted, there is more autonomy for other healthcare professionals, but everyone works together for the good of the patient.
We should not have the attitudes of "the other guy is my enemy". It helps nobody.
Pls, I will like you to be more constructive in your statements. It's that kind of arguments that lifts the spirit and let's us reason together how we can move forward in this country healthwise.
The reasons for this kind of forum is because nobody is an encyclopedia of knowledge, nobody knows it all. It's the Commonwealth of the stakeholders, healthcare providers, patients and government that can help us get through the mess we are in right now.

Thanks for this. I was having a low time when I wrote that.,
But I sincerely believe that having dual degrees will be an advantage as they used to have in the 70's.
I know many members of allied health who will like to jump ship to medicine since NMA have made it more attractive. It is their decision and nobody should be forced to continue with what they are no longer comfortable in because of " we are all patients and wouldn't like to be treated in a collapsed system" sentimentality.
Let government also decorate others to be more appealing and nobody will dream of studying for the rest of their adult life.

LadyFiona:
Thanks for this. I was having a low time when I wrote that.,
But I sincerely believe that having dual degrees will be an advantage as they used to have in the 70's.
I know many members of allied health who will like to jump ship to medicine since NMA have made it more attractive. It is their decision and nobody should be forced to continue with what they are no longer comfortable in because of " we are all patients and wouldn't like to be treated in a collapsed system" sentimentality.
Let government also decorate others to be more appealing and nobody will dream of studying for the rest of their adult life.

Sorry, didn't mean to disparage you in any way...
But you see, it is anybody's choice to study and become what they want to be.
It is the reason why a very close friend of mine, decided to leave medicine and do clinical research.
Inasmuch as it will not cause chaos or disorder in the system, any solution to the present quandry we are in now, will be welcome.

Rumour is MDCN has rejected the NUC minimum requirements. The MDCN is the only council mandated by law to regulate medical education and it wasn't even consulted. The NUC obviously doesn't know its limits.

Here in Lautech u spend upto 10 or 11yrs studying MBBS.....well even if i have to spend 15yrs...i dnt carr!

Medicine is a calling, not just a course!!

Chartey:
Rumour is MDCN has rejected the NUC minimum requirements. The MDCN is the only council mandated by law to regulate medical education and it wasn't even consulted. The NUC obviously doesn't know its limits.

That's good news to hear, if MDCN has said something. But a point of correction there....MDCN doesn't regulate medical education oooooo....it only regulates medical PRACTICE. It is NUC that has the sole prerogative on medical education. But MDCN can decide they will not induct someone into the medical profession. They can also decide to remove accreditation from schools that they deem doesn't meet their requirements for training doctors that they can register to practise.
In other words, NUC controls university admissions, while MDCN controls medical induction. Thus, if the two bodies decide not to work together, a dangerous situation occurs where medical schools keep producing medical graduates that will not become doctors.
This kind of pproblem is easily solved if both bodies can work together, not just going their own ways.
Internal validity says NUC should consult with MDCN before starting any change to the training of professionals that they don't regulate.

Chartey:
Rumour is MDCN has rejected the NUC minimum requirements. The MDCN is the only council mandated by law to regulate medical education and it wasn't even consulted. The NUC obviously doesn't know its limits.

This is a welcome development. I sent a copy of this article to vanguard and daily sun. I'm yet to see it published. These issues need to be raised in public glare because it would ultimately affect everyone.

Most of the recommendations made by the nuc were devoid of palpable experience of medical undergraduate training. It's more theoretically valuable than practically reasonable.

MedicalSamwise:
Here in Lautech u spend upto 10 or 11yrs studying MBBS.....well even if i have to spend 15yrs...i dnt carr!

Medicine is a calling, not just a course!!

It's first a course. Later it becomes a calling. How you spend the "course time" would determine if it would end up being a calling or a call-in.