The continued increase in the number of foreign-trained medical and dental graduates who fail the Medical and Dental Council of Nigeria’s assessment examination is a major concern, LARA ADEJORO reports
Every year, thousands of Nigerians aspiring to become medical and dental doctors enroll in foreign universities, spend a fortune on tuition and accommodation fees, and dedicate between four and seven years to pursuing the Bachelor of Medicine, Bachelor of Surgery course.
Most of these students travel to Ukraine, Sudan, Cyprus, Egypt, The Caribbean, Russia, Belarus, India, Hungary, Guyana, Niger Republic, Benin Republic in pursuit of their dreams. But to get a licence to practise in Nigeria, they are required to pass the assessment examination conducted by the Medical and Dental Council of Nigeria.
The MDCN is the body that regulates the practice of Medicine, Dentistry, and Alternative Medicine in the country to safeguard the nation’s healthcare system.
The MDCN conducts the assessment examination twice a year.
The assessment examination tests the candidates’ ability to apply their basic medical sciences and clinical skills in a healthcare setting.
In a recent interview with The Picshitz, the MDCN Registrar, Dr Tajudeen Sanusi, said the assessment examination is a global practice.
“If you train in a particular jurisdiction and you want to go to another jurisdiction, you must subject yourself to an assessment exam. Even if you are a professor of Medicine here and you’ve never practised in the United Kingdom or the United States when you go in there, you must subject yourself to their assessment exam,” he said.
However, the latest data show the investments by the students and their parents are proving to be unproductive for a majority, with over 70 per cent failing to pass the mandatory test required to practise in Nigeria.
According to Sanusi, many medical colleges where Nigerian students attend provide substandard education, and that is one of the reasons they fail the assessment exam.
Hence, the soundness of medical and dental graduates’ courses has been called into question, especially following the progressive decline in pass rates in the assessment examination.
The weak points
The assessment examination at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, in November 2021, showed that only 357 of the 826 foreign-trained medical and dental graduates passed the test.
In June 2022, the council disclosed that no fewer than 469 out of 647 foreign-trained medical and dental graduates failed its assessment test.
In November 2022, a total of 439 out of 916 foreign-trained medical and dental graduates failed the assessment examination.
Also, in July 2023, a total of 529 out of 734 foreign-trained medical and dental graduates failed the examination. The pass rate was barely over 27.4 per cent.
The examination comprises a computer-based test, a picture-based test, and an objective structural clinical examination. Findings show that most of the medical and dental graduates perform poorly in the CBT.
A former National Chairman of the Association of Public Health Physicians of Nigeria, Tanimola Akande, said the type of training exposure of the graduates contributes to the failure rate.
Akande, who is also a professor of Public Health at the University of Ilorin said some of the graduates lack clinical exposure, which is crucial to medical training.
“The curriculum could be such that it makes it difficult for them to pass the examination. In some countries, exposure to clinical skills is not optimal. As far as I know, the standard of the MDCN assessment examination is not higher than what obtains in medical schools in Nigeria.
“Some time ago, opportunities were provided for foreign-trained doctors to have exposure to clinical skills and lecture for a few months in some Nigerian universities, but this is no longer the case. This may contribute to the increasing failure rate,” he said.
The President of the National Postgraduate Medical College of Nigeria, Prof Akin Osibogun said the examination is to ascertain the level of training obtained by the foreign-trained doctors.
Osibogun said, “The only thing we can do is to assess them to determine that they have enough knowledge and skills to treat Nigerians without causing more harm. One way we can have an idea of the curriculum and standard of education where these students go is to ask whether people who train in those medical schools are licensed to practice even in those countries.
“If a country has trained people and is sure of the standard of its training, then it should have evidence that the people trained are allowed to practise in such country. If their training has been thorough, they should be able to pass the examination. The alternative is that those trained abroad should sit the same exams that the final-year medical students in Nigeria take and I bet you, the failure rate will even be more because, in Nigeria, we maintain a very high standard.”
He noted since the foreign schools are not under the control of the Nigerian government, there is a need to ensure the standard of training in those schools.
“If you are trained abroad and you want to practise in Nigeria, we have to ensure that you have the appropriate training, and you will not cause more harm to the citizens,” he added.
The President of the Nigerian Medical Association, Dr Uche Ojinmah, reiterated that some of the foreign-trained graduates lack the required skills to practise medicine.
“Whatever they do there is not up to what the final year students in different Nigerian universities do. If you use the standard benchmark in medicine, which is 50 per cent, I’m sure, you cannot get up to 50 students to pass the exam. Still, there was still an attempt to drop the pass mark for them to pass because we really need doctors, but we must not take doctors that are not well-trained.
“Why don’t they go and practise where they trained? It is because they cannot practice where they trained. When you do a Google search of some of the schools some of them trained, you will feel it is complementary and alternative medicine schools. Some of them don’t even have appropriate O’ level certificates,” Ojinmah said.
On his part, one of the participants in the just-concluded assessment examination identified as Afeez told our correspondent that curriculum differences and examination anxiety are some of the reasons for fail rates.
Afeez who studied in The Caribbean said, “It could be that we didn’t read deep, and coming from different learning environments, the way we are taught is different. So, we need more knowledge on topical issues. I think a lack of enough information is part of what contributes to the failure rate and with exam anxiety, you may pick the wrong option.
“I know people studied hard, but maybe they didn’t study deeply. The questions were not hard but when you do not have enough knowledge of the subjects, you may not pass.”
He, however, urged the MDCN to provide a guideline on areas of focus that would facilitate the assessments needed to help the graduates develop critical skills and knowledge.
Candidates petition NASS
Meanwhile, some candidates who participated in the just-concluded examination have petitioned the National Assembly, alleging that since 2016, the foreign-trained doctors have been experiencing some forms of mental torture, frustrations, rejection, and public humiliation from the MDCN.
The letter dated July 21, 2023, and addressed to the Senate Committee on Health stated that the failure rate has gotten worse with the present Picshitz of the council.
“With the collaboration of some stakeholders and well-meaning Nigerians, an independent investigation into the process of the examination and what was responsible for the reoccurring mass failure no matter how hard the candidates try to attain high scores since this present administration of MDCN resumed office was carried out. It was concluded that the exam process has not been transparent, shrouded with secrecy and so the need for total reforms of the MDCN assessment examination procedures,” the letter read in part.
The petitioners also said there was a need to reconsider 300 CBT questions for three hours as no other medical professional body around the world was doing this.
“This clearly shows that the MDCN wants participants to fail, even before they write the exams. The MDCN CBT exam is done for three hours at 36 seconds per question,” it added.
But Akande said several specialties contribute questions to the 300 questions, and this explains the perceived high number of questions.
“I am very sure the examiners don’t have the mindset to intentionally make the students fail the examination. The questions must have been set to meet the minimum standard. The issue of secrecy is not a valid excuse. Examination questions are not meant to be open before the date of the examination,” he said.
Also, Osibogun said, “What is anybody going to gain for intentionally failing them? I hope it doesn’t get beyond this so that stakeholders can go through the examination and compare it to what students in Nigerian medical schools write.”
Ojinmah added that the MDN examiners are professors from different institutions across Nigeria, “and they standardise the questions. To make sure the exam is transparent, we have the representatives from the National Universities Commission, the NMA, the Minister of Health or the Permanent Secretary, and many other bodies.”
Osibogun said the graduates need a remedial programme to assist them to achieve expected competencies.
“When they get back to Nigeria, they should find a way of getting more training in any Nigerian institution. I know that the MDCN organised a remedial programme for them in the past, but they said the council was extorting them so they backed out. So, maybe the government can persuade some hospitals in the country to organise some remedial training programme for them for six months before writing the MDCN exam.”
Corroborating Osibogun, Ojinmah said it was essential for the graduates to enroll in a remedial course for at least six months in well-established Nigerian universities.
“In some places, they go for a one-year remedial programme, and within that period, they will know those who are untrainable.”
Nigeria’s medical system is one of the largest in the world, but it has a severe shortage of medical professionals, but the MDCN Registrar said, “We will not jeopardise the health of Nigerians and others living in this country, and we are not ready to trade quality for quantity.”