Last week, I shared the views of many doctors in our attempt to answer the question of why some foreign trained doctors (FTDs) fail licencing exams in Nigeria. Most of those views were not favourable to FTDs. So today, I am sharing some perspectives – again by doctors – that show that the examiners and the system itself are not themselves blameless. Enjoy.
I’m Nigerian trained but like my friend said we need to put ourselves in their shoes and look at things from their perspective. Truth of the matter is that MDCN exam for FTDs is not a standard exam! For an exam to be standard there are certain criteria that must be fulfilled. Taking GRE or TOEFL as an example, there’s what they call standardization, during this process they follow a pre designed algorithm to ensure that the questions, and the scores/pass rate reflect the standards. Other international medical licensing bodies i.e USMLE, MCE, PLAB etc. follow the same process.
There should be an organisation within the council that oversea the conduct and outcome of the exam with statistical analysis of the results which should be publicly available so that candidates will have an idea of where things go wrong. Each individual candidate report should also contain information as to where a candidate has weakness so that he/she can work to improve on it. For example IELTS TRF comes with detailed scores of different parts of the exam and then the overall band score; they also add a recommendation on how to improve if there’s need to do that.
Another important aspect we must accept is the fact that the examiners themselves do contribute to the failures. My friend @Dr. Bello B.A highlighted some of the horrors we went through in Nigeria to become doctors. I could remember sometime ago, an examiner popularly known for his passion in failing students, examined 20 students (long and short cases) out of which only four passed and 16 failed. In saner climes a result like that will take a toll on the examiner. But like they say, “this is Nigeria”.
Finally they say FTDs write OSCE supposedly objectively, however there’s still subjectivity in it. Anybody that studied in Nigeria will tell you, every consultant has his own peculiarities with regards to history and clinical examination. That is why we always ensured that we had a bedside teaching with all the consultants so that we’ll know what to tell them or techniques to use on the exam day.
To sum up, there are variety of reasons why FTDs fail exam but personally I reckon it has to do with the system. Therefore, reorganisation and attitudinal change will improve the results significantly.
Dr Safana, Maiduguri.
It’s the system that fails them. We are yet to set any standard.
Ahmad A. A. ATBU Teaching Hospital
You have said it all for us Doc, what the FTDs are asking from MDCN is very simple: give a curriculum/syllabus and the result known to at least the candidates just like every other international exams!
I followed the discussion with keen interest. So I will attempt to answer some questions raised by our erudite prof.
One, why are foreign trained Doctors (FTD) failing MDCN qualifying exams?
The exams by MDCN is to test whether you have acquired the basic knowledge and skills to practice as a doctor in Nigeria. Because of some of peculiarities in Nigerian health systems and our disease distribution, it might pose a great challenge to an FTD. The exams usually focus on common diseases in Nigeria which might be different from the country of study. During training as a doctor you will be good in the diseases that are common in that particular area, you will agree with me for some of us that do travel out of the country, Malaria is difficult to diagnose and managed in some parts of this world.
My friend told me a senior consultant in an Arab country missed the diagnosis of malaria because he only read about it.
It took them four days before they finally diagnosed malaria. If FTDs fail to realize this perculiarity and fail to make themselves acquainted with tropical diseases in Nigeria, they will not pass.
To be candid some of the instruments we are using in Nigeria are in the medical museum of the countries they are trained! An FTD told me that he has never seen the type of mercury sphygmomanometer ( BP machine ) we are using because they are using digital versions in school which is easier to use because it requires less skill, in one of the exams station a mercury sphygmomanometer was brought and you are required to display the skills to using it.
More so their is no much guidance on ways to approach such exams, you will hardly find a single book written by a Nigerian – a guide to MDCN exams. Those preparing for US Medical license exams and PLAB have many reference materials (soft and hard copy) that will guide you.
A friend of mine organized a tutorial class for MDCN exams and he told me that 80% of his students passed ( the just concluded exams).
However the issue of hard work can not be overemphasized irrespective of the country you studied, you must work hard to become a good doctor. In medicine, 60% of it is personal efforts. For those that did not study well during the medical training, they will find the exams difficult.
Lastly doctors trained in some countries are not allowed to touch patients because in their curriculum they consider housemanship/internships as part of the medical school training so it is during that period that you can practice/ perform a procedure on a patient under supervision but some students do leave and come to Nigeria for internship. In Nigeria as a medical student you will be supervised to do some minor procedures on a patient. The issue of substandard schools as raised in one of the posts is also a facDue to some of the factors raised above and from previous statistics, FTDs of Ghana, Uganda, Sudan, Egypt and the US do better in the exams.
Dr Sodangi Yahya, TUYMCH Katsina
Frankly, I thought the exams had some degree of standardization. I’m only learning about the other side today. In that case, there’s trouble on both sides of the road.