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Why are foreign-trained doctors failing qualifying exams in Nigeria?

When the issue of our foreign-trained doctors failing their lincencing exams started trending, I simply dismissed it as one of the manifestations of our wickedness. If there is a universally acknowledged dip in the quality of our education, how then, I asked,   would those who went to societies with better infrastructure and technology perform below the expectations of those who trained in Nigeria?

But then, Dr Fatima Damagun wrote an article about it; in which she argued convincingly – with clear examples to boot – that there are indeed subpar foreign-trained medical graduates. I also read somewhere that India was having similar problems with her own foreign-trained doctors. So I thought the question merited a deeper dive.

If only there were a place where I could ask doctors of all types – both locally trained and foreign-trained – about their perspectives on the matter.

Actually, there is. In our Prof. Brainy Whatsapp group, we have more medical doctors than any professionals – that is instructive seeing that we have more than 200 members.

Accordingly, I turned to the group and asked the question: ”why are foreign-trained doctors failing licensing exams in Nigeria?”

First, I was surprised that members were not eager to discuss the topic – only two doctors responded!

But when a few more joined, everyone joined – and shared torrents of insights from their experiences.

Following are some of those contributions:

Very real issues. A lot of them do well back home. I have realized though Drs who studied in places like Sudan and Egypt do better than some from other countries abroad, at least initially and from my experience with fresh graduates. I know some medical students don’t really touch (aren’t allowed? ) their patients  in some countries, at least that is what we have heard. This really detracts from learning some things. But the issues run deeper I guess.

Dr Mukhtar Aliyu, WDH, Abuja

The plight of the FTDs is really quite unfortunate. I’ve worked with some of the FTDs during my house job and abysmal is an understatement. There are so many mushroom universities in the world churning out suboptimal medical doctors for the third world. Like the previous submissions, we’ve our own perennial problems in Nigerian medical schools, but our graduates know what they’re doing. They know the basics, and they have the clinical exposure. That lack of clinical exposure is the biggest undoing of some of the FTDs.

Dr Ibrahim, UATH Gwagwalada

I have also had the privilege of interacting with a lot of FTDs and even guided some of them in preparation for the MDCN exams and 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 curricula like we have here in Nigeria though with the notable exception of countries like Sudan, Saudi Arabia, India and some Caribbean schools . 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 skill of being able to deductively make a basic clinical differential diagnoses from clinical history and examination is the whole essence of medical education at the undergraduate level nothing more nothing less.

From the foregoing, you can see that even where a candidate got his/her medical education matters. Countries like Sudan, Saudi Arabia, Ghana and India have a very good medical curriculum and hardly will you find students from such countries struggling with MDCN exams. While on the other hand, countries like Eastern Europe, China and some of the Caribbean countries have very questionable medical curricula, at least for foreign students and as expected, FTDs from such countries find it difficult to pass the exams and later find it difficult to practice medicine effectively in Nigeria. Curiously, such countries have the cheapest tuition fees.

Like someone posited in a post above, a question that needs answering is that; why are some of these FTDs from such countries not being given the license to practice medicine in their countries of medical training as it applies in most genuinely well-regulated countries?

So, I think Nigerian parents that plan to sponsor their children to study medicine abroad need to be made aware of the importance of doing proper research on the quality of medical education in those countries as well as going for quality rather than economic convenience while selecting foreign medical schools for their children.

Dr. Abdulkareem Kabir, ABUTH, Zaria

Let me lend my voice on this matter. I happen to be privileged to train FTDs on remedial studies and also work with them during the internship program. We were tasked with making lecture notes to cover the basics of history taking, common symptoms and signs of the disease in body systems and how to demonstrate them. Lectures also included basic immunization program. This year, we were told that the FTDs requested lectures only with no clinical demonstrations that it was too tedious for them. So we ended up describing to them how to do that( an inefficient method).

The remedial studies are to prepare them for the MDCN licensing exams.

During the course of work I met an FTD house officer that happened to be lagging behind. After series of discussions she confided that she had no paediatric clinical exposure. I also met another that was doing very well and both finished from Ukraine. I asked the second person how she got it right and she said they went to different universities. She went to one in Kiev, while the other attended a peripheral one. The ones in Kiev are more expensive and allow hands on exposure. She went ahead to tell me that her sister finished from one of the peripheral ones and their parents noticed the problem and so made sure she got better training. This is one out of many. I know there are issues with our educational system but to be fair on medicine, we are trying. You cannot compare me that had 6 months paediatric clinical  posting with someone that had four weeks or none. I happen to also be part of the organisers of the mock exam in my faculty ( paediatrics), the questions asked are below final year Nigerian medical students level but wallahi the responses will surprise you. I had to tell one of the ones that was working with me, you have to up your game and apply yourself so you can learn. Thank God she took that advice and even when she was in another unit she would join my teaching sessions when she was free.

Those from Sudan and UAE  go through similar rigours with us, their clinical postings in medical school are also long.

In one of my sessions I went with a book we used for clinical methods, the famous Hutchinson’s clinical methods( published by Elsevier) but more than half of the FTDs have never seen anything like that.

I also used to think it was the system until I started remedial training two years ago.

Dr. Najaatu Hamza, Katsina

Let the Nigerian train doctors please step into our shoes for once. Let’s say a fresh graduate Nigerian doctor write USMLE (United States Medical Licensing Examination), PLAP ( Professional and Linguistics Assessment Board (A medical license exam for the UK)) or Indian license exams without knowing their curriculum, without knowing the target mark. How many out of 10 candidates do you think can pass please?

Anonymous FTD

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