Mass failure pitches foreign-trained doctors against council

Lateef Lawal relocated to his home country of Nigeria after bagging a degree in medicine from Kharkiv National University, Ukraine. Before he was eligible to practise in Nigeria, he sat a qualifying examination conducted by the Medical and Dental Council of Nigeria (MDCN), which regulates medical practice in Nigeria.

The exam is exclusively for foreign-trained doctors (FTDs) who, once they have passed, are issued with a one-year provisional licence by the council. They then proceed on a year-long housemanship, a process whereby a house officer is attached to an accredited hospital under the supervision of a physician. Afterwards, the council will issue them a fully operational licence.

FTDs are also required to participate in the National Youth Service Corps (NYSC) – a scheme whereby graduates are posted to different parts of the country to serve the public for one year.

At first, Lawal was unbothered about the qualifying exam, thinking it would revolve around what he learnt at university for six years. He would later realise he was wrong after failing the biannual exams twice in a row.

“I sat for the qualifying exams twice in 2017, but failed,” he told University World News, adding that he attended extra classes for six months before he retook the test the following year.

“I passed on the third attempt in 2018,” said Lawal, who now practises in Nigeria. Lawal’s experience is similar to the plight of many FTDs seeking to operate in Nigeria because the exam is beset by mass failure.

In November 2022, 439 (48%) out of 916 FTDs passed the test. Of the 826 candidates that sat it in 2021, 357 (43.2%) passed, while 469 (56.8%) failed.

Out of 686 candidates who took the exam in 2018, 447 (65%) failed, while only 132 (26%) out of 501 candidates passed in 2017. That year, most candidates complained that the MDCN deliberately failed them, but the council denied the claim. This necessitated a re-sit examination for 309 students; yet only 51 scaled through. This is according to various statements by the council.

“Actually, the MDCN test is designed to fail us. No syllabus. It is crazy; you just have to read randomly to sit for the exams hoping for luck,” Lawal said.

Candidates, council trade blame

There are disagreements over who should be held responsible for the mass failure. The MDCN and many Nigerian-trained doctors believe that a number of FTDs study in substandard schools. However, the doctors accuse the council of deliberately frustrating them.

Speaking on the 2021 results of the test during the induction of some FTDs in Abuja in February 2022, MDCN board chairman Dr Abba Waziri Hassan, said the high failure is a reflection of the training the doctors received abroad.

“It is very important for those sponsoring students for overseas training to seek guidance from the MDCN and the NUC (National University Commission) as to which medical or dental schools abroad are considered of good standard,” he said.

In 2018, Nigeria’s Minister of Health Dr Osagie Emmanuel Ehanire, said the council investigated some foreign schools to determine their fitness to offer acceptable medical degrees.

“The MDCN reports that beyond education in well-known foreign medical institutions, a small number of institutions are known to have sprung up in certain foreign countries over the last few decades that offer medical studies of unusually short duration, of poorly defined content and outside of established traditional clinical settings.

“It is this category of schools that has given the MDCN reason for concern and caused the other highly respectable foreign schools the embarrassment of being lumped together and viewed in a bad light,” Ehanire said.

A Nigerian-trained physician, who works at the University of Abuja Teaching Hospital, Dr Mohammed Ibrahim, said that he had interacted with a lot of FTDs and even assisted some to prepare for the MDCN exam.

He said he observed that most of them lacked clinical exposure, which is crucial to medical training. Ibrahim said, “I can tell you for a fact that the problem most of them have in common is the lack of clinical exposure and the absence of a well-structured medical curriculum like we have here in Nigeria.

“The vast majority of those that I have interacted with from medical schools in Eastern Europe, and most notably China, have little to no clinical exposure. It is important to note that basic clinical exposure and the ability to deductively make basic clinical differential diagnoses from clinical history and examination is the whole essence of medical education at the undergraduate level.”

The MDCN registrar, Dr Tijani Sanusi, echoed Ibrahim’s stance, but declined to name the substandard foreign universities offering medical courses “in the spirit of international relations”.

He told University World News that the council also found that some FTDs either have a weak science background or none at all.

“Also, in countries where they are trained, it seems they have commercialised medical training. Some of these universities are in Ukraine, China, Belarus and Istanbul. The students are trained with mannequins and dolls, not patients. As a council, we have the responsibility not to jeopardise the health of the public in Nigeria and we will insist on standards,” the registrar said.

However, Dr Bayo Bakare, who studied medicine in Ukraine, faulted the health minister and MDCN’s claims. He insisted the qualifying exam is designed to fail FTDs, though he passed it in one sitting, “by a dint of luck”.

He said, “The council does not provide a question bank for us to prepare ourselves for the exam and there is no syllabus. Everybody just reads broadly. Before I sat for the exam, I attended a three-month course organised by the MDCN, but on the examination day the questions were totally different from what I was taught. The absence of a syllabus is the major reason why many FTDs fail. It is not as if they are not brilliant.

“Another issue is the council does not like us [FTDs]. During the exam, some examiners were asking us why we went abroad to study. They said foreign-trained doctors are not good.”

Bakare also disagreed with the council on substandard medical schools abroad, claiming that students’ commitment to learning is all that matters. “Before any school is accredited to teach medicine, it must have a good system and meet some criteria. So, they can’t say some medical schools are substandard,” he said.

Asked why a syllabus is not provided on the exam to guide the FTDs, the MDCN registrar retorted: “If we do not have a syllabus, how do we train our doctors locally?

“Nigeria-trained doctors are well trained. That is why they are sought after all over the world. We cannot lower the standard,” he added.

Training of Nigerian doctors

According to the MDCN, Nigeria currently has 44 government-approved medical schools and colleges of which 37 have full accreditation to offer various medical courses for the duration of six years. After graduation, the doctors complete the housemanship, receive a licence from the council, and are then expected to participate in one-year mandatory national service.

According to the Nigerian Medical Association (NMA) 3,000 to 3,500 doctors graduate across colleges of medicine in the country annually.
Notably, admission to study medicine in Nigeria is particularly stringent because there are limited slots occasioned by a shortage of facilities and human resources.

Professor Ekuh Abdullahi, former chairman of the admissions committee at the University of Ilorin in Kwara State, earlier told University World News how as many as 4,500 candidates would apply for only 150 slots. Abdullahi maintained that many qualified candidates are denied admission in the process.

The NMA President, Dr Uche Rowland Ojinmah, said the high competition for the few admission slots pushed many students to study medicine abroad.

“We know that it is stringent to gain admission to study medicine in Nigeria because the slots are few. That is why some people go abroad to study. We have appealed for the establishment of more universities of medical or health sciences where the focus will be on admitting medical students to increase the enrolment capacity,” he said.

“The conventional universities’ medical schools could also be upgraded. Medicine involves a lot of apprenticeship so there is a need for enough teachers and equipment.”

Resolving mass failure

To address the mass failure among FTDs taking the qualifying exam, Sanusi said the MDCN proposed a remedial programme, but it was rejected because of a high tuition fee.

“It was supposed to be a six-month programme and the candidates would pay NGN1,5 million (about US$3,200). The tuition fee was reduced to NGN 900,000 (about US$2,000) after protests. We had thought of designing a streamlined curriculum for them [FTDs].

“Some people went to the National Assembly (Nigeria’s law-making institution) which shut down the initiative. That was why we left them to prepare for the exam on their own,” Sanusi said.

However, Lawal said if the council could provide a syllabus for FTDs, “the failure rate will reduce drastically”.

At a press conference in April 2022, the chairman of the coalition of parents of foreign-trained medical doctors, Professor Lukman Diso, decried the mass failure and urged the MDCN to compile a list of accredited medical schools across the world so Nigerians can know which schools they may attend.