Medical Education is a relatively emerging field in Nigeria. The few medical educators continue to clamor for medical training strategy which will nurture an all-round professional physician through the utilization of proven educational theories and best international practices. At the forefront of the battle to overhaul medical education in Nigeria is a Consultant Obstetrician and Gynecologist & Medical Education Specialist, Prof. Uche Onwudiegwu. The renowned Professor is the current President of the Nigerian Association of Medical Educators (NASME). Driven by a passion to advance the course of medical education in Nigeria, Prof. Uche delivered yet another lecture titled ‘Medical Education in Nigeria: Situation Analysis’ in memory of Late Professor Olusola Adewole Ojo at the 10th International Scientific Conference and 53rd Annual General Meeting of the Society of Gynecology and Obstetrics of Nigeria (SOGON) in Abuja. In his presentation, Prof. Uche took the congregation of Obstetricians & Gynecologists through the evolution of medical education in Nigeria.
Accounts of Medical Education in Nigeria started with the Christian Missionary in their early colonial forays, then came the establishment of Yaba Higher College in 1930 for the training of Assistant Medical Officers, followed by the establishment of Ibadan Medical School in 1948, where students had their basic medical education in Nigeria and were trained in clinical medicine in various London hospitals.
Apart from the bold review of the Ibadan curriculum in 1963, no effort was geared towards formal education of teachers on curriculum development, review or update thus medical teachers carried on with teaching methodologies based on natural intuitive abilities or from observation of how they were taught by their teachers which is grossly deficient. In a country where local and international brain drain thrives and the Doctor/Population ratio is 28/100,000 (approximately 1/4000), it would take 100 years for Nigeria to get 1/600 citizens as recommended by WHO. Currently, there are 31 fully accredited medical and dental schools in Nigeria, including 7 partially accredited and 9 fully and partially accredited dental schools. According to 2016 report, 2550 fresh doctors in the country could not secure housemanship placement 18 months after graduation. The gaps have however being partially closed with 80 health institutions accredited to provide 2961 internship positions for the graduating population of 2925 new doctors.
Prof. Uche stressed the need for Medical Education Program to maximize the teachers’ input and make learning more satisfying and more pleasurable for the student. He listed the myriad of challenges militating against the advancement of medical education in Nigeria to include lackof implementation of contemporary curriculum by medical schools, dearth of pedagogy skills amongst teachers and application of ineffective assessment strategies.
Prof. Uche averred that most medical school curricula in Nigeria lacked adequate instructions in professionalism, communication and interpersonal skills, clinical decision making and evidence- based medicine, social responsibility and social accountability, poor remediation of students and lack of exit points for chronologically repeating students. In the same vein, he noted that medical teachers lacked exposure in medical education trends and advances, clinical skills laboratory, structured and integrated teaching and assessments, and increasing insensitivity of the teaching hospitals to the requirements of medical training.
He advised medical schools to lean towards the Seven Years MBBS/BDS programme and shelve the traditional 6-year programme which he described as inadequate. According to him, the 7 year curriculum will produce doctors who will find it easier to progress to Masters or PhD programmes in basic medical sciences and be medically qualified anatomists, physiologists and biochemists which will help solve the acute shortage of preclinical teachers in the medical schools and improve the students’ applicability of these sciences to clinical medicine. It would also serve as a natural exit point for students who may not wish to continue the medical programme due to weak academic stamina or other challenges.
On the other hand, the 4 year curriculum will integrate the strength of all major health professionals and significantly enrich the medical profession in a kaleidoscopic fashion hereby reducing inter-professional tension and rivalry.
He further admonished medical schools to implement the ‘NEW’ Nigeria Undergraduate Medical and Dental Curriculum Template, a product of a 2 year effort (2010-2012) prepared by the FMOH, USAID/Health Systems 20/20 project, MDCN, NUC, ANPA, MANSAG, NMA, NIMR, AGPMPN, Guild of Medical directors, and PATHS2. He described it as an integrated, system- based, community oriented, student-centred, competency0based curriculum template which individual medical schools could adapt for their peculiarities. Major highlights of the new curriculum templates include reduction of overall factual information, especially in basic sciences of teaching, promotion of self-directed learning, development of appropriate attitudes and behaviors, acquisition of essential skills for pre-registration house officer, a system-based approach to core curriculum and an integration of pre-clinical and clinical medicine, emphasis on communication skills, learning systems informed by modern educational theory, continuing review of the curriculum, development of appropriate assessment methods, and establishment of sound supervisory structures.
Most unfortunately, the use of Bloom’s Taxonomy by medical teachers either in teaching or assessment is almost non-existent in medical schools in the country. The Bloom’s Taxonomy is a reference model tool which follows a stepwise fashion of creating, evaluating, analyzing, applying, understanding, and remembering. The application of Bloom’s taxonomy will aid the development of educational objectives and administration of high quality assessment that provide basis for valid conclusions in high stakes examination such as in medical education.
In today’s medical education, pedagogy has become increasingly important for medical school teachers. Worldwide, high quality training and education of physicians in increasingly recognized as critical to global health and much emphasis is therefore being made that the training of physicians should be done by professionally competent medical teachers. Almost all teachers in the Nigerian medical faculties do not have any professional or formal training in imparting and facilitating knowledge acquisition though they are experts in their various fields.
Prof. Uche proposed Kolb’s 4-Stage Learning Cycle which necessitates an effective teacher to consider his teaching audience and different thinking style in planning his educational programs. Kolb’s Learning Cycle features Concrete Experience, Reflective Observation, Abstract Conceptualization, and Active Experimentation.
Based on the educational dictum ‘Assessment drives learning’, assessment fills instructional gaps by encouraging students to read broadly on their own. Prof. Uche suggested that medical schools should adopt a variety of testing methods (Essays, MCQs, Practical Clinical examinations, etc.) which would elicit students’ cognitive, psychomotor and affective skills. An appropriate weighing of written examinations in Nigerian medical schools should be 50% MCQ, 30% SAQ, and 20% long essay. Unfortunately, many medical schools will weigh long essay
higher than MCQs not realizing that the content validity of the MCQs is higher than that of the long essays. He suggested other assessment methods such as Objective Structured Practical Examination (OSPE), Objective Structured Long Case Examination Record (OSLER), Practical Assessment of Clinical Examination Skills (PACES) used in some PG examinations, Case Reports/Commentaries, Research Projects/Dissertations, Research publications/Patents, Log Books, Portfolios (use of Portfolio is alien to our evaluation systems), and Referees’ Reports.
He also suggested task oriented question-construction based on Bloom’s Taxonomy.
Task Oriented Question-Construction Based on Bloom’s Taxonomy
Conclusively, Prof. Uche admonished his colleagues to use the platform of Medical Education to do a better job as teachers, trainers, coaches, and facilitators of knowledge.