Medical training in Nigeria is a progressive process toward becoming a fellow/consultant in the medical field, encompassing both academic and professional development. This journey commences after completing undergraduate medical training and a one-year internship. This grants the full license to practice medicine or pursue postgraduate medical education. The training process spans six to seven years, involving leadership training, clinical experience, lectures, and managerial development. It comprises three stages of exams before one attains specialist or consultant status in medicine and dentistry. These fellows also supervise the training of junior doctors.
Achievements of Medical Training in Nigeria
Nigeria undoubtedly produces some of the highest-quality doctors globally. This is all thanks to the postgraduate medical training, which has influenced the development of medical tertiary curricula and the training of graduate doctors.
Recently, Ahmadu Bello University in Zaria achieved a significant milestone with the birth of an In Vitro Fertilization (IVF) baby. This accomplishment can be credited to a specialized team of doctors who are fellows of the postgraduate medical training program. This success follows the groundbreaking research of the renowned specialist Dr. Adebayo, another fellow in the field of cardiology. His work continues to echo in the hall of fame of doctors who have saved lives and contributed to global advancements.
The National Postgraduate Medical College of Nigeria (NPMC), established in 1979, is the primary body responsible for planning, implementing, monitoring, and evaluating postgraduate programs. In its 44th year since inception, it has facilitated the training of competent clinical specialists across 16 areas of medicine in Nigeria. This specialization has elevated the medical profession’s standards through field-specific expertise and further studies. Since the program remains aligned with global medical advancements, it ensures that medical doctors stay up-to-date with recent developments while enhancing their technical skills. A doctor groomed through training by the NPMC stands at a different caliber than a non-postgraduate trainee doctor.
Limitations and Challenges
These commendable achievements by the NPMC in Nigeria are not without their challenges. Problems associated with trainee working environments, harsh economic realities, and system evaluation constitute the three primary challenges.
One facet of these challenges concerns the working conditions in trainee institutes in Nigeria, often described as suffocating and insensitive. The working environment for many medical trainees in Nigeria is marred by a shortage of necessary medical facilities and infrastructure for accurate diagnosis and treatment. A patient attending a federal hospital may need to be referred to another state for a simple MRI procedure, hormonal testing, or any necessary investigation, which not only inflates costs but also frustrates both doctors and patients. Establishing at least one well-equipped hospital in each state could alleviate this situation, reduce doctors’ frustration, and improve patient care.
Another aspect of the harsh conditions is work overload. Reports indicate that Nigeria needs at least 12,000 doctors annually to address medical conditions effectively. However, this number remains unmet due to the phenomenon of medical students emigrating (“Japa”). The common saying, “Doctors are soldiers” has merit, as doctors working up to three calls a week often experience physical, mental, and emotional exhaustion. They have limited time for exam preparation and research, diminishing the quality of their training.
In this understaffed environment, junior doctors are frequently subjected to unappreciative superiors, further exacerbating their workloads. This leaves little room for socialization or spending time with family, particularly for female doctors. In conservative Northern Nigeria, female doctors, along with other medical professionals, confront domestic and cultural criticisms linked to work prioritization and family absence, circumstances beyond their control.
Tragically, some doctors succumb to the pressures of these stressful environments and turn to energy substances as coping mechanisms, fully aware of the negative consequences. This necessitates urgent intervention. Trainee hospitals must ensure that doctors work under optimal conditions, addressing their physical, professional, social, and emotional needs. The training program should define precise requirements, including research, case studies, maximum monthly working hours, minimum case requirements, and publication expectations. This would allow trainees time for research and study.
Another significant challenge of postgraduate medical education in Nigeria is the lack of funding. Medical scholarships are often insufficient to cover trainees’ financial needs. While doctors are highly respected in Nigeria and seen as the pride of families and communities, they face immense pressure to support not only themselves but also their extended families. This financial burden is particularly pronounced for female doctors in conservative societies, who are expected to contribute significantly to their families due to their extended absences. These high expectations have led many doctors, later in their careers, to engage in private practice to supplement their income.
Despite these cultural stereotypes, it is crucial that trainee doctors are adequately compensated for their efforts. However, the current harsh economic realities in Nigeria have strained the nation’s ability to provide adequate facilities and salaries that match doctors’ needs and contributions. Doctors frequently resort to strikes to voice concerns about working conditions and the financial disparity between their needs and the available funds. Even the Federal Medical Center (FMC) of the Federal Territory of Nigeria has recently reported financial struggles. As the cost of living continues to rise amid economic instability, Nigeria is losing doctors annually to the diaspora in search of better working conditions and opportunities.
Lastly, postgraduate medical training in Nigeria grapples with a lack of system evaluation and cohesion. The curriculum lags behind medical advancements, and there is a lack of consensus in training methods across various institutes. This lag occurs because medical advancements are not effectively integrated into the system, resulting in tension between the two forms of training. To address this, the system may need to incorporate doctorate certification into postgraduate medical training, aligning with existing universities to combine both programs. Such integration could be made optional in some institutions.
Innovations and Prospects
Despite a reported decline in fellowship applications at the National Postgraduate Medical College of Nigeria, there is confidence that Nigeria’s medical training system has untapped potential and can achieve many more breakthroughs. As we reflect on the achievements and limitations of this system, it’s essential to consider the innovations and prospects that can shape its future. These include:
Technological Advancements: Embracing cutting-edge medical technologies and telemedicine can enhance diagnostic accuracy and expand access to specialized care, especially in remote areas.
Collaborative Research Initiatives: Fostering collaborative research projects involving trainees, universities, and healthcare institutions can create a culture of evidence-based medicine, further elevating the quality of medical practice.
Mental Health Support:
Recognizing the mental health challenges faced by trainee doctors and implementing dedicated support systems, counseling services, and stress management programs within the training curriculum will ensure the well-being of medical professionals.
Gender Equality
Promoting gender equality by addressing cultural stereotypes and supporting female doctors in balancing their professional and family responsibilities will contribute to a more diverse and inclusive medical workforce.
Financial Reform
Advocating for increased government funding for medical education, offering more scholarships, and improving working conditions will help retain doctors in Nigeria, reducing the brain drain phenomenon.
Continuous Curriculum Update: Establishing a mechanism for regular curriculum updates will ensure that postgraduate training remains aligned with the latest medical advancements, maintaining the highest standards of medical education.
Quality Assurance: Emphasizing the importance of rigorous evaluation and accreditation of training institutes will guarantee high standards in medical education, benefiting both trainees and patients.
Global Collaboration
Exploring opportunities for international collaboration in medical training, knowledge exchange, and skill-sharing will bring global best practices to Nigeria’s medical education system.
Community Outreach
Encouraging trainees to engage in community health initiatives and public health projects as part of their training can help address healthcare disparities and promote holistic healthcare approaches
Professional Associations
Promoting active involvement in professional associations and organizations will facilitate networking, mentorship, and advocacy for trainee doctors, enhancing their career development.
Conclusion
Nigeria’s postgraduate medical training system has produced accomplished fellows who have made significant contributions both within and outside the country’s health institutions. Nigerian doctors like Dr. Salamat Aliu, the first female certified neurosurgeon in West Africa, and Dr. Stella Ameyo Adadevoh, who identified and contained Nigeria’s first Ebola case, exemplify the potential of Nigerian trainees when provided with optimal working conditions and compensation within a well-structured system.
