MDCN assessment test: Controversies over failure rate of foreign trained doctors

The recent report that out of 700 Nigerian foreign trained doctors who participated in the assessment test conducted by the Medical and Dental Council of Nigeria, MDCN, failed the test, has been generating reactions from Nigerians.

The MDCN Registrar, Dr Tajudeeen Sanusi broke the disturbing news in Abuja during the induction of 205 foreign-trained medical doctors and dentists, who were successful in the assessment test. The figure, according to Sanusi, represents 72.6 percent of the total number.

This is coming on the heels of another startling revelation that no fewer than 99,985 Nigerian students had left the country to study in the universities in the United Kingdom in the last five years, specifically between 2017 and 2022.

This figure was released by the Minister of Interior, Olubunmi Tunji-Ojo at the opening ceremony of the 2023 University of Lagos International Week on Monday, October 9.

According to the Minister, the figure was from the Higher Education Statistics Agency’s report.

The MDCN assessment test is a hurdle that must be scaled through before any doctor, locally or foreign trained, is allowed to practise medicine in Nigeria.

So, when the report of the number of Nigerians that had gone to study in the UK universities in the last five years is placed side by side with the performance of the Nigerian foreign trained doctors in the recent MDCN exams, it only underscores the reason for the concerns and worry being expressed by some Nigerians.

Sanusi noted that the assessment examination was designed by the MDCN to test the capacity of the doctors on the knowledge and skills they claimed to have acquired from their various institutions abroad.

“This time, we had over 700 applications from the foreign-trained doctors. Unfortunately, 205 passed the examinations, indicating 27.4 percent success rate.

“The Ukraine trained doctors were more than the candidates from other places. Unfortunately, the assessment test exposed that they never had enough clinical training that could have earned them the MDCN certification.

“For the locally trained doctors, we have our own monitoring tools unlike the doctors that were trained abroad. Local institutions are always under our watch, and we don’t hesitate to take actions whenever we suspect any foul play,” he said.

He confirmed that the newly inducted doctors would embark on one year of compulsory housemanship, and would be expected to complete the exercise uninterrupted.

“They are expected to spend 12 uninterrupted weeks in any of the postings. There are 52 weeks in a year; they are expected to spend 48 weeks in active service, and use the remaining four weeks as leave,” he said.

However, Nigerians have continued to react to the development with many saying it only shows that the quality and standard of medical education in Nigeria is very high.

Those who hold this view are also saying that the message being passed is also that Nigerian parents need to watch out for the kind of schools they send their children to in foreign countries.

But, there are others who still believe that despite what has happened, foreign trained doctors still have a lot of advantages over the doctors that are trained in Nigeria.

Those pushing this line of argument are saying that apart from the fact that Nigerian trained doctors are not exposed to the kind of modern medical facilities as their foreign trained counterparts, they still rely on research by foreign institutions to function.

Leading the pack on the side of this divide is a lecturer in the Department of Microbiology, University of Nigeria, Nsukka, Dr. Kenneth Ugwu, who is also a certified nurse and medical laboratory scientist.

Ugwu, while speaking to DAILY POST, argued that the poor performance of the foreign trained doctors in the MDCN assessment test should not surprise anybody in Nigeria because what happened applies to every other field of study, not only to medicine.

This, he attributed to the way doctors are trained in Nigeria.

“You see people who manage to pass their courses here but when they go over there, they excel. The way we train our people in Nigeria is not the way they train people overseas.

“First, our people will expect you to cram very big textbooks, and if possible cram the citation if there is any in those books.

“For instance, during the second MBBS exam, the foreign universities would break the courses into modules. They will test the students based on each module.

“In other words, after each module has been taught, an exam is conducted for the students based on that particular module and after they have passed the module, the next one will be introduced. But, in Nigeria, during the MBBS, they would bring everything together for the students from year one to third year.

“Again, most students that are studying medicine overseas are required to have studied one other basic science program, before delving into medicine, and they don’t spend as many years as we spend in our own College of Medicine here in Nigeria.

“Modern facilities for training are readily available for students overseas unlike here, where you sometimes find medical students carrying bone-bags. But, over there, they have video simulations that are available for the students at any point in time, such that any average student will pass the exams over there,” he said.

He countered those who used the doctors’ performance in the recent MDCN exams to conclude that doctors trained in Nigeria are better than their foreign counterparts.

He insisted that what is being taught in Nigeria were the things that were invented or discovered by the foreign institutions.

He said: “Even at that, do we produce better doctors in Nigeria? The answer is still an obvious no. What do we teach here? Is it not what they discovered over there that we teach here in Nigeria? Do we win any Nobel Prize in Medicine and Physiology? No, we don’t.

“So, they are the ones that carry out research and make discoveries and it is what they discovered that our students are expected to cram here in Nigeria. They are busy making new inventions and discoveries, while we are here in Nigeria cramming their works and claiming that we are intelligent. That is just the truth.”

Using his own field of Microbiology as an illustration, he said: “Just like all of us here in sciences. I am in microbiology. My friends in the UK are carrying out funded research that adds to the existing knowledge, but ours here in Nigeria is to cram their works.

“We are busy forcing students to cram and give us back what those people are doing overseas, and those who cannot cram, are punished with failure. It only means that with or without me here, those students will still graduate because what I am teaching them is what is in textbooks, which some of them can read on their own and understand without anybody teaching them. But, the other people are doing the real research over there.

“So, it is just the system. Those who trained over there are not subjected to the level of stress which we subject our students here in Nigeria.

“For instance, in some hospitals in some rural areas, doctors perform appendectomy, but a foreign trained doctor will not do that in such an environment. He will tell you that you cannot achieve aseptic technique in such an environment, where you are expected to open somebody’s abdomen. There is no air-conditioner, you don’t close the windows, the cottons are still dusty with cobwebs everywhere. How do you sterilise the materials you are going to use in such an environment?

“But, somebody here is telling you that he has finished the appendix surgery. So, it is just the way we designed our system. So, it is possible that some of the doctors trained abroad will fail the exams here because our system of training is quite different from what is obtained abroad.”

He also drew an analogy to drive home his point with a Kenyan distance runner and his Nigerian counterpart.

He said: “Another example is a Kenyan highlander that has very limited oxygen. They have limited oxygen in Kenya, and that is why a long distance runner from Kenya coming down to Nigeria will excel better than Nigerians.

“This is because at the point when the Nigerian begins to complain of lack of oxygen, the Kenyan will just be getting to the normal oxygen level in Kenya. That was why somebody derisively cajoled Bush for challenging Barack Obama who is from Kenya to a long distance race. And that is also why Kenyans amass medals in long distance races in any international competition.

“So, somebody who is surviving in an environment where many things are lacking will naturally excel when such a person finds himself in an environment where everything is available.

“That is why when our students go outside, they excel because here they lack a lot of training facilities, but over there, all those facilities are readily available.”

He also argued that foreign trained doctors may not perform very well in exams conducted here in Nigeria because the emphasis overseas is always on specialty unlike in Nigeria, where a student is expected to know everything.

“Again, they lay emphasis on specialty unlike here where we want to be jack of all trades; a hero.

“A German friend of mine was introducing his wife as a nurse to me because I am also a nurse, and the lady was telling me that she studied nutritional management of certain chronic diseases. That’s her own part of training as a nurse.

“So, why won’t she fail our own nursing exam here in Nigeria? She will fail woefully because as a nurse, I covered all her own field and other aspects of nursing,” he said.

For those saying that Asian schools are not as good as Nigerian schools and may not produce doctors that are as good as those trained in Nigeria, Ugwu did not buy into the argument.

He wondered how anybody would compare Nigerian doctors with Japanese or Chinese doctors.

“Since they are saying we are so good, what have we produced industrially? Which facility have we designed in medicine? Nigerian doctors are not even researchers because if you read their publications, you will find out that they are just competing with the people in social sciences and arts, where they engage in knowledge and attitude.

“Take the time of COVID-19 as an example, when Nigerian doctors were just researching on knowledge, attitude and practice. What then is the difference between them and social scientists?

“Their own work should be experimental based, where they will be thinking of new diagnostic approaches or new approaches to management of diseases and so on.

“Even though the study of medicine is science, the practice is pure art. Appendix is on the right side of the lower abdomen and it is not in a hurry to change that position. So, just like a Catholic reciting the holy rosary, once you know how to go through those layers and bring the appendix out, there is no rocket science or physics there. So, the real science of medicine is the everyday advances but none is coming out from Nigeria,” he submitted.

However, the Lagos State chapter chairman of the Nigeria Medical Association, NMA, Benjamin Olowojebutu believes that since the greater percentage of the foreign trained doctors who failed the exams was from Ukraine, the war between Ukraine and Russia must have contributed a great deal to the low quality of training they got over there.

He told DAILY POST: “I think the crisis ravaging Ukraine and Russia has affected the quality of the training our medical students are getting from those places because the practical experience they are getting is not as consistent as it should be.

“So, they are not getting the real practical knowledge and it is affecting the quality of their education.”

He stressed that they only needed some crash programmes in Nigeria and they are good to go.

He said: “What we need to do is to give them an opportunity to come back to Nigeria and do a one year programme, like an extension so that they can get proper training before the exams.

“The six months they do for the training is not adequate enough because of the crisis. We hope that the war in Ukraine will end soon so that they can go back to school and get proper education in their medical training.”

Olowojebutu also believes that the development is a message to most parents in Nigeria who don’t see anything good in Nigeria’s education system.

He reminded them that Nigeria’s education system still remains topnotch as can be deduced from the MDCN’s recent assessment test of the foreign trained doctors.

He said: “It is also a message to parents that Nigeria’s education still remains the best. We export the best doctors and best people all over the world; it is just that we don’t have enough medical schools in Nigeria.

“We are now telling the government to create more medical schools so that we can have more medical doctors, because we need about 60,000 doctors every year to be able to get an adequate number of doctors that we need to cater for the country’s medical needs.

“We only have about 3,500 medical graduates every year; so if the government can create more medical schools in Nigeria, then we will have more medical doctors that we can use and they can stay back in Nigeria to help us as a nation.

“Education in Nigeria remains the best. We were all taught and trained in Nigeria and we are great doctors in Nigeria,” he said.

For Dr Uche Okenyi of the Hova’s Place Hospital, Festac, the medical training for those of them from Eastern Europe, especially the clinical aspect is substandard and quite unfortunate.

“What is not clear is whether it is a deliberate policy targeted at foreign medical students, especially as most of the graduates are not absorbed into their health system or because of low quality education across board,” he told DAILY POST.