My Thoughts: Medical and Dental Council of Nigeria (MDCN) verse Foreign Trained Doctors (FTD) By Faith Obianuju

I have read with growing interest the series of events that followed the recently conducted MDCN assessment examination in University of Illorin Teaching Hospital. Of 680 candidates only 243 were said to have passed the assessment test. That is 35% overall. The doctors reacted and called on Nigerians to look into their plight. Well, the last time I checked, I was still a Nigerian. So I looked into their plight and below are my findings.

The exams as I have found out has a lot of inconsistencies and in the most case was poorly organized. First was the rather unnecessary increment in the examination fee from N76,200 to N131,000. Second was the fact that there was a grand design from the onset regarding who those, “who must pass”, those who “may pass” and “others”. The class captain and his assistants made the first list. Other group of candidates who made the “must pass” list, where those whom the registrar himself called to see him during his short session with the class on the 6th of November, 2017. The names of these students were publicly mentioned by him. He had a brief meeting with them and voila! They passed! I listened to the recorded meeting and confirmed it myself! Also in this list are names of those whose parents are renowned in politics and/or elsewhere.

Under the category of “those who may pass” was a list circulating at the onset for a particular group of students meeting particular requirements, some paid anything between N300k to N500k. Well, according to verified reports these group of candidates also passed.

“Others” are further classified into:

Those that made moves and
Those that studied.

Those that made moves mostly didn't go far in their moves as all efforts to get leakages were successful however, the timely change of uploaded questions dashed their hopes. Report also has it that some of them were swindled by University of Illorin Medical Students with one, Toba, a 500L or 600L student tagged as the leader and orchestrator of the fraud group. The GTBank account of his girlfriend Uddi Nora was used as a tool in their nefarious scheme. They made over N3M from their victims.

Those that studied didn't have pleasant stories either. This is because after changing the questions at the last minute, the new questions were found to be outside the coverage of the lectures. Even at that, according to verified sources, 91% of candidates passed the multiple choice questions which was computer based. “It doesn't matter where the questions were taken from as long as it is medicine, we are fine,” one on the foreign trained doctors wrote in their WhatsApp group, “Movement for Justice”, “my only concern is why then was there a need to have a remedial with a compulsory 70% attendance? We could as well have stayed at our respective abodes and study, then show for the exams!”

On the day of their Objective Structured Clinical Examination (OSCE), most candidates confirmed that the coordinator for the remedial courses informed them that the passing score for the CBT was reassuring and that over 90% passed. However, events observed during the OSCE created a tinge of fear in the hearts of the candidates as the examiners appeared to be too distracted, exhausted or just uninterested. One candidate said, “While I was examining the precordium of the simulator, the examiner answered a phone call! I was stupefied!” Another said, “my own examiner appeared to have a lot of things on his mind. He was restless, and for some reason the candy that was given to prevent hypoglycemia held his attention for the better part of the time I took examining the simulator. At a point he stood up to charge his cell phone!”

After the examination, the candidates went home to pray in hopeful anticipation. At about 2pm on Saturday, the results were published on the MDCN website and 437 hearts were broken. Only 243 candidates made it representing 35% of the entire class. Reliable sources revealed that 500 names were submitted to the acting registrar by the UITH coordinator however only 243 were published, making the candidates wonder if there was a possibility of a second pass list. If we are to minus the “must pass” and “may pass” group the list of honorable candidates who passed the exams could have been anything between 100 to 150. And true to that, as at the time of writing my thoughts, information filtered through the rumor mills that only 148 initially scaled through after whatever vetting the MDCN did to the 500 submitted names. Either ways, in advanced countries when less than 40% fails an exam, the fault is with the students, but when more than 40% fails the exam, the teachers and examiners are questioned because either the teachers did not lecture well, or the examination was above the level of the candidates. Hence, countries like US, Australia, UK, etc use standardized questions. Presently, UITH refers worried candidates to MDCN while upon getting to the MDCN office in Abuja, they are referred right back to UITH!

From what many candidates have reported, the new failing trend commenced after the acting registrar Dr. Tajudeen Sanusi took office last November, 2017. It would appear that the MDCN number one has not been debriefed by his predecessor, Dr. Ibrahim regarding the purpose for the assessment. Statements credited to Dr. Sanusi in News dailies has shown he has some form of prejudice with foreign trained doctors and has not hesitated to verbalize same at every given opportunity. According to him, “Nigerian medical schools teach clinical medicine and clinical dentistry, but elsewhere they teach diagnostic medicine. They train Nigerians for export purposes only,” (Tribune). Well, as pleasant as that sounds to the ears, let us not quickly forget that Ghana, Sudan and Egypt are becoming a cynosure of attraction to foreign students. Same cannot be said of Nigeria. Our President also went to U.K. to diagnose and treat an ear infection. We are trying to be self reliant, but we are in a fragile glass house, it is not wise to start throwing stones. As a matter of fact, a good number of medical schools in Nigeria has not made it to the list of World Health Organization accredited schools. A special report by the Daily Trust Newspaper, not so long ago, also presented the number of colleges of medicine in the six geopolitical zones vis-a-vis the number of applicants as summarized thus:

South West: 12 Colleges, 34938 applicants, 910 slots available
South South: 9 Colleges, 35828 applicants, 760 slots available
South East: 9 Colleges, 25103 applicants, 590 slots available
North Central: 5 Colleges, 21992 applicants, 400 slots available
North West: 4 Colleges, 25062 applicants, 330 slots available
North East: 3 Colleges, 9970 applicants, 265 slots available
FCT: 2 Colleges, 3320 applicants, zero slot available.


With the above set up, one wonders if Dr. Sanusi’s claims are grounded on facts or mere assumptions. In a fragile discussion as this one, caution should be considered when selecting words to express oneself. And Dr. Sanusi should know better.

With regards to the statement credited to Dr. Sanusi that Nigerian doctors trained abroad were trained for export purposes, one couldn't help but wonder where he gets these ideas from. Most of these doctors I have verified myself, are trained in the U.K., Canada, US etc. and are duly licensed thereafter. That the love for country brought them back to Nigeria should cause them to be celebrated and not castigated. In fact, Prof. Adedoyin, the coordinator for the remedial course was heard on tape saying his son, currently schooling in a Nigerian Medical college has plans for the USMLE already! A simple search on the internet reveals startling headlines! 80% Nigerian doctors seek jobs abroad (Vanguard Newspaper August, 2017); Crisis looms as 50,000 out of 87,000 registered Nigerian doctors are unaccounted for (Business Day Newspaper, Mar. 12, 2017); Over 40,000 out of 75, 000 Registered Nigerian Doctors are Practising Abroad - NMA Raises Alarm (deereporters.com; Nov. 17, 2017); 700 medical doctors leave Nigeria annually - MDCAN (Daily Post Nigeria; 2017/10/03); ALERT! 2,500 doctors WILL leave Nigeria between August and September (www.icirnigeria.org). The list continues. So one question Dr. Sanusi must answer…who are training doctors for export purposes? Your guess is as good as mine!

Let us proceed. Based on the supra mentioned, it is apparent that the one focus of Dr. Sanusi’s tenure so far has been the foreign trained doctors. In the light of this, two exams he has overseen has had catastrophic outcomes, making one wonder what could be the reason for this change. Under the watch of the past registrar, Dr. Ibrahim, many candidates passed the exams and are doing well, and now under the watch of Dr. Sanusi, the reverse has become the case. So something must be amiss between the approach of Dr. Ibrahim and that of Dr. Sanusi. What could that be? Who among these two is incompetent? Although, not a good argument, one can't be blamed if the mind concentrates on the fact that while Dr. Ibrahim is a medical doctor, his counter part is a dentist. Could this factor in? I leave that question open for further thoughts.

Now let’s shift our focus a bit to look at what Nigerians feel: feed back from Nigerians has never had it that foreign trained doctors are the reason for our failing health system. I haven't read yet of an incidence resulting in gross mortality or deformity due to a foreign trained doctor’s incompetency. For one, medicine is an art and most skills are learned in the field of practice. Wether you are trained in Nigeria or overseas, you still have a lot to learn. In fact, a collaboration between the Nigerian trained and the foreign trained would do our citizens more good than harm. The MDCN requirements for foreign trained doctors are already steep enough. First, School must be on the accredited WHO list, secondly, they must be verified by ECFMG/EPIC, the same body that verifies credentials of those applying to sit for the USMLE. And this cost a minimum of $240! If a foreign trained doctor can meet with these requirements, then there is no need making examination criteria stiff for them. The rules should be straight. A set average should be used, instead of saying, “since many passed OSCE but failed MCQ, let us use MCQ as a basis.” As was seen in LUTH last April, 2017 or “Since most candidates passed MCQ but failed OSCE, let’s use OSCE as a basis.” As was now seen in UITH center this November, 2017. Another candidate express the entire situation as, “under Sanusi’s tenure, consider yourself failed until proven otherwise. The way he is going, it is quite obvious he ain't going to pass more than thirty to forty percent of foreign trained doctors per exam. They are going to frustrate us man, delete the phrase ‘no place like home’ from our medulla and replace it with ‘any place but home’…he is got evil plans up his sleeve man.”

Another candidate, who attempted the exams in both LUTH and UITH said, “honestly, this has caused me serious shifting dullness. What do they really want from us? A passing rate of 50% overall or what? Prof. Adedoyin told us that in the MCQ, which has questions that were not covered in the remedial lectures, we had a 91% pass rate! Highest score was 90% and class average was 58%! The OSCE was not as good because of mostly human factors on the aspect of the examiners, not to mention the obscure marking scheme. But if an average of 50% was followed then the 500 candidates who made the original list would reflect the results more appropriately!”

The November examination has proven to be too big a blow for the young professionals as they have decided to reach out to Nigerians to seek for help. Sadly, majority of responders are Nigerian medical students, House Officers and registrars, most of which are riled with hate speeches as I have seen from screen grabs made available at my disposal. It would appear, honestly, that the wave of targeted hate speeches against these Foreign trained Nigerian doctors has spread far and wide among their supposed professional colleagues. With one doctor who claimed to have played supervisory role with them describing them as, “borderline incompetent”. Another exclaimed, “why are they coming back to Nigeria? Why not practice in the country where you trained?” Reacting to the same thread on Facebook, a foreign trained doctor said, “it is expected. 99.9% of those making those hate speeches wish they had the opportunities we have. Heck! The son of the Executive Secretary of Nigerian Universities Commission (NUC), Prof Rasheed graduated from University of Aberdeen. That in itself speaks volume!” Another FTD I chatted with online, simply said, “I think they misunderstood the word “competent”. All through my medical career abroad (yes, I am a licensed doctor elsewhere!) I have never seen the ‘pinnard’ stethoscope physically. I only saw a picture of it in my textbook, I think second year med school? I mean whoever use that! I have my own Doppler. It is battery operated, so you can't say you got electricity problems. If you say I am incompetent because I cannot use your pinnard thing, then you got to have your head examined. I have seen the diagnostic kit of the medical students, and house officers, I have never seen anything so incomplete. Medicine has evolved. We can learn from them and they can learn from us and the benefit will be on them, really,” She went ahead to add, “That someone keeps mute, humbles herself to learn a thing or two should not be misconstrued as incompetent. No one came here to compete with anyone else. If you really want to know what incompetency truly is, ask the patients. They are at the receiving end of whatever skills we got. Ask them…then you will know who between us and them is incompetent.”

The foreign trained doctors have now formed an association to enable them fight what they perceive as ‘discrimination against foreign trained doctors in Nigeria’. Series of interviews have been granted to news media, and letters have been written to senators. Their parents are also picking interest in their plight. Regardless of what anyone might think, we all know the situation of health care in Nigeria, and we do know the problem is not with foreign trained doctors. The sooner we realize the value of what we have, the better for all of us.

Recently, it was revealed that the Vice President Yemi Osibanjo has received a group of expatriates, mostly from India with a view of establishing partnership projects that would promote medical tourism in Nigeria. Worthy of note here, is that some of the foreign trained doctors also schooled in India. These doctors are already contemplating practicing elsewhere. Let us make a stitch in time to save nine.

Nicely said. Stop the hate,acrimony and discrimination.

Judaamedia, if there's link to this add it so it will be moved to FP
Where's Lalasticala
Seun
Mynd44 when you need them.
It must not be snake, EFE, Tonto dikeh or boob's. This is a national topical issue

Good write up