POSTGRADUATE MEDICAL EXAMS: OBJECTIVE ASSESSMENT OR FOUL PLAY?

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.

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About Dr. Ken

Medical Doctor, Publisher, Editor, Novelist, Playwright, Visionary Poet, Activist, Blogger
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82 Responses to POSTGRADUATE MEDICAL EXAMS: OBJECTIVE ASSESSMENT OR FOUL PLAY?

  1. Ande Is Lisa says:

    The colleges certainly need to adapt and evolve, and take the issue of peer review and international best practices seriously. The failure rate can be a result of several factors, I know that the UK Faculty of Public Health, reports about 25% pass rate per sitting; the difference however is that a comprehensive syllabus, instructions and scoring system is available online, including past question papers and other guidance. One knows what to expect. Our colleges need to start from the basics, all I see on their sites is the advert for the next set of exams and the price.

    • Dr. Ken says:

      Hi Lisa,

      You’ve said it all!

      We need a complete overhaul of the system. A comprehensive syllabus, instructions and scoring system should be made available online, including past question papers and other guidance, not just advert for the next set of exams and amount to pay!

      Cheers!

  2. Anon says:

    Well done, Dr. Ken.

    It’s hi-time someone spoke up!

    Our so-called medical elders are killing the medical profession.

    Those in the educational sector are better off. There is a tightening of the circle on us and the imposition of the certificate in education for any medic planning to be a VC or registrar.

    We make life difficult for ourselves instead of entrenching the quality via practise.

  3. Anon says:

    Well done, Dr. Ken.

    It’s hi-time someone spoke up.

    Our so-called medical elders are killing the medical profession.

    Those in the educational sector are better off. There is a tightening of the circle on us and the imposition of the certificate in education for any medic planning to be a VC or registrar.

    We make life difficult for ourselves instead of entrenching the quality via practise.

  4. Prechy says:

    Nice article.

    We are fighting against what I’d like to call ‘residency contraception’.

    23 passed out of 70, but these 47 will pass very well abroad . Alternatively we must look for other means of career progression aside fellowship.

    If I pass and you don’t, does that mean I’m better than you? Perhaps some of us still prefer bowing, godfatherism and ‘ophthalmologic displays’ to proper health care and delivery. Besides, these 3 negative indices is what has made many so docile, fearful and pretentiously quiet, living like others but never like themselves.

    WHY SHOULD A RESIDENT BE MADE TO DO AN EXAM 7 TIMES while his mates become fellows? Besides, you always have to re-enter at conmess 5/3!

    It’s very ANNOYING!!!

  5. Kemi says:

    Nice one, bro!

    Medicine don tire person!

    Compared to other professions, medicine is too problematic.

    The legal minds are smarter because they based their assessment on years of practise and cases they win in courts especially all levels. The management sciences are equally as smart. It is based on your attendance of professional development courses and payment of license fees.

    In surgery, you are not scored on doing the surgery but saying what you did. If at all you eventually passed,in ur minds,ur ego is battered and bruised while your solace is to unleash insults and negative criticisms on those you train as residents.

  6. Richie says:

    Na wa!

    But wait ooo.

    Why do our products do so well abroad where the skills and equipment are more recent and sophisticated but failed here?

    Black man, black mentality, black behaviour!

  7. Dr. Ngozi says:

    I like making comparisons. Lecturers pay package are better than ours and oil companies are granting them sabbatical scholarships while our medical elders are busy hiking exam fees.

    Truce may not be gotten via holding out of a white flag alone.

    It’s a pathetic situation!

  8. Dauda Suleiman says:

    I think the incessant and certainly unwarranted hikes in the exams borders on corruption and criminality. A part 2 candidate in the faculty of pathology, NPMCN has to pay 140,000 Naira for the exams!! Who sets these fees. Who regulate their workings??? We need to sit down and look at ourselves; a lot of faculties need restructuring as their current model of operation is outdated at best. We all clamor for international best practices. It is time to back up our words with action!

  9. Pee says:

    When I started reading through provided and available usmle materials, it became glaring, that half our teachers are unfit to train doctors.

    When I started pratice here, it became obvious that half our medical elders want us to lick the ground they walk on to progress in medicine.

    You are blessed if you are the son or daughter of a specialist in Nigeria.

    Few slots are even available for those with primaries, which has an expiry date attached to it.

    The medical sector needs an overhaul, not just the postgraduate college for doctors, but the system as a whole! From the class rooms to the practice.

    I wish we were trained in diverse fields and had more opportunities as an economy, so one can survive without this medicine, cuz its not worth it anymore.

    • Dr. Ken says:

      “The medical sector needs an overhaul, not just the postgraduate college for doctors, but the system as a whole!”

      True talk, Pee! We need a revolution!

  10. Walter O. says:

    No system thrives without a form of unbiased auditing of its practices. This has been one major problem of the Nigerian state, a structural collapse is inevitable and Medicine and allied courses won’t be spared. There has to be an independent re-evaluation of the current system and an overhaul where necessary. God help us.

  11. Dr. Haruna, MPH, FWACP says:

    I’ll speak from personal experience.

    What I think is responsible for high failure rates across board is non-uniformity in training. I could remember vividly that having prepared well in my own opinion from my centre for Part I in Community Medicine, on getting to UCH Ibadan you will be perplexed at the level of exposure and vital information available with their own candidates coupled with skewed examiners within UCH and LUTH.

    It will usually take God’s grace for you to be able to match with supposedly same residents that want to write the same exams. You now need to do other things apart from your stuff such as parleying with them to guarantee success.

    May God help us all.

    • Dr. Ken says:

      Thanks for commenting, Sir.

      Nice hearing from a Specialist in the field.

      Are we saying individual knowledge ain’t enough for these exams? One has to ‘parley’ or ‘lobby’ as the case may be?

  12. Anonymous says:

    It is sad and discouraging. I really don’t know what to say or do whether to do residency or go to academic line!!!

  13. Dr. Chykes says:

    These colleges are nothing but scam!

    They function chiefly to fleece doctors of their hard earned cash and rape their pockets repeatedly until most individuals are left financially moribund.

    I strongly believe that the high failure rate in postgraduate exams is deliberate so that they can have a huge chunk of doctors paying through their noses to satisfy their devilish financial appetite.

    I have been asking this question all these while, and I’m yet to get a satisfactory response. Who regulates the national and West African colleges?

    The rate at which they act with impunity – increasing exam fees at will, and churning out horrible examination results without being checkmated – is legendary.

    Is it a crime to be a doctor, or worse still, a resident doctor? Which kind life of servitude and perpetual poverty be this abeg?

    • Dr. Ken says:

      “Who regulates the national and West African colleges? The rate at which they act with impunity – increasing exam fees at will, and churning out horrible examination results without being checkmated – is legendary.”

      You hit the nail on the head, my brother!

  14. Juliana says:

    What is NMA and NARD doing about this?

    • Audu says:

      You’re waiting for NMA & NARD?

      You’ll wait for an eternity for NMA or NARD to say a word here.

      You should know that!

      NMA gives no thought whether you live or die, so does NARD.

      All we can do here is rant.

      Hopefully, the authorities won’t single us out for challenging them in this platform.

    • Dr. Sandy Green says:

      Which kine yeye NMA or NARD?

      I think we should be grateful to JOHESU for their anti-doctor aggression. Right now, that’s the only thing that brings Nigerian doctors together.

      Our common enemy is about the only reason we can call ourselves one body (NARD, NMA or whatever).

    • Dr. Ken says:

      @Juliana As you can see, some answers are already been provided by colleagues here.

  15. Dr. Irene says:

    Imagine the recent increase in exam fees across board. 90k for primaries. MCQ! Even JAMB never collect like that! The worst is that of Part 1. Even if you don’t cross the staggered you end up paying same amount!

    Even if you are disqualified from the exams, your money is gone. We should start getting reasons why each candidate is failed.

    You can’t pay such amount for nothing!

    Choi!!!

    • Dr. Ken says:

      “Even if you are disqualified from the exams, your money is gone. We should start getting reasons why each candidate is failed. You can’t pay such amount for nothing!”

      Dr. Irene, you’re absolutely right! The amount we pay for such exams is simply ridiculous!

    • Abubakar says:

      I don’t think there is any increment. The amount in dollars remains the same. The college charges in dollars, so blame our currency, not the college.

      • Dr. Efe says:

        Abeg stop talking like this!!!

        Even with the rise in dollar it shouldn’t be this high bcos the last time I checked official exchange rate is #192/1$ unless they are using the parallel market rate which an organization like WACP should not.

      • Dr. Ufuoma says:

        What is the relationship between dollars and a local African exam? What are they importing? A4 papers???

      • Dr. Ken says:

        @Abubakar, can you back this up with facts?

  16. Audu says:

    An MCQ exam of the nature of primaries shouldn’t cost more than 10,000 naira for any reason!

    Next year or the year after it, the fees will still go up again.

    NARD won’t say peem as long as it’s not relativity & skipping.

    NMA won’t bat an eyelid as long as it’s not about consultancy status or CMD/MD position.

  17. George says:

    Doctors will forever be the problem(s) of doctors.

    That pathological “hatred” for younger colleagues seems entrenched in our very innermost self as we go through a supposed “training” which almost turns out to be self-administered.

    We all should sincerely look inwards and tell our very own self consciously and subconsciously that we must not be like the so called elders, if not this state of “harakiri” we find ourselves is just but the tip of the iceberg.

  18. Rotimi says:

    The ‘change’ we so desperately need starts with you and I. Until the HO sees the Medical students as his/her brother or sister, until the Jnr Reg does same to the HO, the Snr Reg does same to the Jnr Reg, and the relatively younger Consultants do same to the Snr Reg, believe you me this ranting will not stop and we may just be heading towards a state of “cum gargantuan gaga”!!!

  19. Suleiman says:

    Some one needs to set up the WACS/WACP/NPMCN with the NASS. At least to a public hearing, then to national TV and things will spin out of control. May be then PMB will get involved. Just an awareness, and things will go out of control.

    • Dr. Zainab says:

      I’m just wondering how NASS, NARD or PMB have any jurisdiction over a body that belongs to several different West African countries.

      Agreed Nigerians form the bulk of candidates, examiners and officials but doctors from other countries are members of WACS and WACP too.

      I’m just wondering how Nigerian authorities can intervene in and regulate a body that does not belong to Nigeria alone.

      • Dr. Chuks says:

        The same way these countries belong to WAEC. There is no enabling law for WACP and WACS in Nigeria. The law recognise NPMCN and it’s equivalent. The FG can suspend further WACS and WACP equivalent until they finished re-evaluating / reassessing them (remember suspending residency training by Onyebuchi Chukwubuike/GEJ so as to restructure it!).

        WACS and WACP are Nigerian packages. In fact the francophones do not write it, they are awarded same after passing their respective countries fellowship in order to maintain the ‘international or regional’ statutes of WACP and WACS.

      • Dr. Ken says:

        Aren’t we the ‘Giant of Africa’? We should show it in our actions, not words.

    • Dr. Ken says:

      Not a bad idea. But is the political will there?

  20. Paul says:

    Some Doctors can be so dumb. Someone is mentioning JOHESU here. Which is our biggest problem – Medical elders or JOHESU? As far as I am concerned, JOHESU is the least of our problems, that’s even if they are. Doctors are the biggest problems of doctors.

  21. Dr. Adaora says:

    JOHESU fight is the only pivot for the Nigerian doctors’ brotherhood.

    It’s our only common interest.

    It’s the only unifying tower.

    We can’t thank JOHESU enough for this.

    Let the fight not finish biko.

  22. Dr Elle says:

    I belive there is a lot of corruption going on and the colleges need to be regulated somehow. Some faculties dont even have a curriculum. And what is this thing about expired certificates and training already recieved? I can never understand the mentality of Nigerians.

    • Dr. Ken says:

      You’re absolutely right! We really should be more forward thinking than the level we are right now. The outside world has left us behind!

  23. Miaza David says:

    If the problems being faced by doctors make rounds on social media and news outlets, something good will be done about them.

  24. Anonymous says:

    God help us o!

  25. Kings says:

    I think the major problem is our mentality. To an average black man, he thinks the best way to gain relevance is for people to fail his exams. White men hardly fail their students. They have forgotten to know that the more your students fail ur exam, it shows how bad you are as a trainer.

    • Dr. Ken says:

      If our trainers think the best way to gain relevance is to ensure massive failure in the exams, then the problem is bigger than we thought.

  26. Kings says:

    The black man mentality is very bad. We pride ourselves in making people suffer. The feel great to hear that only few passed the exam and as such they are wonderful. The White man feels he has not done well as a trainer when his student fails his exams, but that is the opposite of a black man. May God help us with a change in mentality.

  27. Dr.Okereke Nnaemeka Odii says:

    I was a victim of the unregulated exam this April where contrary to the tradition of making sure a candidate was not examined in the logbook and oral exam by his trainers, my HOD came into the room and sat with my examiners throughout my logbook exam and yet I was informed that the logbook section was the only section of the exam I failed and hence I did not pass the exam.

    So the question on my lip today and always will be is, what was my HOD doing exactly in my examination room when my my examiners knew he is my trainer and the rule of the college says he shouldn’t be there?

    • Dr. Ken says:

      In other words, your HOD went the extra mile to ensure you failed that exam!

      Isn’t that victimisation and witch-hunting of the highest degree?

      My God!

  28. Dr G says:

    My candid advice to all younger doctors is to seek professional development elsewhere, outside these so called fellowship bodies which are currently nothing but SCAM!

    The worth of a doctor is the medical procedures he or she is conversant with to prevent mortality and morbidity. This could be achieved by applying yourself.

    Also think private practice! (Be a Medical director of your own!) Embrace capacity building.

    Forget fellowship, it’s strictly for them, their children, godchildren.

    It’s NEVER academics!

  29. James Ben says:

    Hmmmm… wahala dey oo.

    What’s happening in medicine? I bet if Hippocrates was to wake up and see this, he would shed tears.

    Am an undergraduate and I thought that all these problems will end after MBBS. In my school, final year after spending 8 years in an accredited college cannot write final MBBS because JOHESU are on strike. We have finished postings but exam is till further notice. Meanwhile nursing students in the same school and faculty are on postings in other major hospitals in the city. Principal officers of the faculty are “doctors”.

    Wahala dey ooo.

  30. Tijjani Magashi says:

    I my opnion, there is need for a regulatory body that will comprise education specialists, not only doctors. What we have now, the examiners are the board members and are the ones doing accreditation for training institutions and also regulate the activities of the college.

    A separate regulatory body like NUC regulating universities and their activities is needed.

    Then we need to decentralize exam centres. What we have now is a person will travel from Borno to meet examiners he has never seen in Lagos or Ibadan, while another person resides in the exam centre, will only walk from his room to the exam venue to meet his teachers that had trained him for the same exams the Borno man is writing with him. Home advantages will surely play a role.

    May God save the medical profession!

  31. Dr. Ifeanyi says:

    It seems in medical postgraduate colleges the exams fee is inversely proportional to exams pass rate. When would NARD realise that this is an important problem facing it’s members.

  32. Dr. Amaka says:

    The more money we pay, the more malicious the examiners become!😩😩😩

  33. Dr. Stan says:

    The question now should be which is the way forward. How do we put an end to all these injustice?

    • Dr. Ken says:

      There have been several suggestions in this platform. Your opinion will be welcome, Sir. What do you think is the way forward?

  34. Dr. Emeka says:

    In my opinion, I think the WACS exam is the most messed up… After the long case, you are faced with the short case which I personally believe to be the most stupid part of the exam! Almost everyone fails that part!

    The exam is not based on hard work, but on luck and at the same time, it also depends on whether your father/mother is an examiner… bcos such candidates MUST pass! I can give examples!

    Very stupid exam being conducted by old fashioned, senile men who don’t understand the rules guiding modern candidate assessment… an exam you are judged and failed based on procedures that were performed centuries ago and not on things that are currently obtainable… an exam where the examiner is always right, the candidate isn’t allowed to argue his point, if he does, he is labelled UNTRAINABLE…

  35. Anonymous says:

    WACS remains the worst of all! Passing is based on luck and if your parent is an examiner… Their kids always pass!

    They should make the exam more objective. Moreover, all those senile, close-to-the-grave examiners should all retire and stop coming for exams. The MCQ should be de-centralised too.

    The exam is frustrating! Things have remained this way cos they are dealing with doctors… Try that with other specialties!

    The annoying part is that these idiots that call themselves examiners are people that trained abroad and passed through objective exams!!!

  36. Dr. Bimpe says:

    The exam is just too subjective! Our so-called medical elders that make up the examining board are too old-fashioned.

    They are frustrating us!

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