The West Africa College of Physicians concluded the second diet of exams recently. The faculty of psychiatry declared a pass rate of 13.8% at its part one membership exams (8 of 58 candidates). The faculty of public and community health recorded a 32% pass rate (23 of 70 candidates).
Twice every year, candidates from all over the country converge in Ibadan and Lagos for the West Africa College of Physicians and National Post Graduate Medical College exams respectively, each diet of examinations consisting of written, objective structured clinical exams, picture tests and oral/long case exams as the case may be. It is usually a very grueling and trying time for any candidate with psychological, emotional, financial and sometimes physical consequences.
A minimum of N60,000 is paid for each exam attended without consideration of transportation, feeding, and other ancillary expenses incurred. That minimal fee is usually increased by several percentages annually! The exams are funded by the candidate after an initial one time sponsorship by the willing training hospital.
A candidate may repeat the exams as many as seven (7) times. There are records of up to 10 times and over at one stage. Usually, candidates do not scale the first stage, and there are several hurdles in subsequent stages of the exams. Each stage must be passed independently, usually under stifling time constraints.
It is pertinent to shed some light on the Long Case examination, already phased out by certain faculties of the college owing to its largely subjective nature. A candidate is assigned a patient for the purpose of the exam, and he is to conduct an interview, physical examination and prescribe a course of management under harrowing time constraints. The candidate is to make an oral submission of his findings to two or more examiners who are usually less than dispassionate in their assessments. You can bet that less than 10% of these examiners have a degree in education or any pedagogic training for that matter.
The very malignant nature of the exams is revealed in its fullest during the Long Case. A lot of examiners find fault in every little thing their candidates do!
Thus, a candidate who manages to scale through the first, second and third stages, is truncated at the last stage by an examiner who chooses to sleep during proceedings!
A lot of candidates have been maimed as a result of the activities of these colleges with the active connivance of some training hospitals. Failing to pass these exams, a doctor is unable to make any professional advancement; he is stuck, and sooner or later he is shown the way out of the residency program with no lifeline. He is unemployable as a specialist, and cannot proceed as a general practitioner.
Medicine is touted to be an apprenticeship; so, if a candidate has to repeat a particular exam so many times, has he been properly mentored? Candidates who are frustrated out of the system for their inability to scales these exams, where do they go? Where do they start from with families and other dependants? What about the psychological toll on him? What now happens to a candidate who commits a lifetime of effort and suffers untold deprivation?
Does this ‘high’ standard that candidates are held up to translate to favorable health indices for the country – reduced morbidity, mortality and medical tourism to India and other nations? Is the nation any better off from the efforts of the Postgraduate medical college?
What does a failure rate of 87% connote? The trainers are not doing their jobs? The trainers do not understand what is required of them? The candidates are so dull? The candidates are ill-prepared? The candidates have too many distractions like involvement in unionism (NARD)? Or is it simply a case of unregulated and misguided leadership?
What role does national interest play in the determination of proceedings, procedures, modus operandi and outcomes of the colleges?
The national postgraduate medical college of Nigeria prides itself in having produced 4,000-plus specialists in over 30 years of existence and in a country of about 160 million people. Whose interest do they really serve?
What is the role of international best practices in the regulation of the colleges? Any peer review mechanism? Any validity and reliability studies on the mechanisms of these colleges?
Should each region or state not regulate its own postgraduate education, its requirements and needs? Who oversees the activities of these colleges?
It is high time the House Committee on Health, the Federal Ministry of Health, policy makers and other interest groups gave some scrutiny into the workings of these colleges in the interest of all stake holders, and the nation as a whole bearing in mind the various ramifications, dimensions and implications of the activities of these colleges on all and sundry.
It is no longer acceptable that things remain the way they’ve always been. Indeed, the mark of humanity is the ability to adapt, to evolve, to meet challenges and peculiarities of the day, a peculiarity that once again challenges our resourcefulness.
Credit: Timi Babatunde, The Nation.