Emeritus Professor

Over the years, I have had the good fortune of receiving invitations from educational institutions, university departments, academic organisations, professional associations and structured societies to deliver one lecture or the other in memory or honour of a member or someone who, in the opinion of that body, has impacted society positively.1-6 As much as time and other commitments did allow, my response was always in the affirmative as I considered myself privileged to be so recognised. Choosing an appropriate topic, researching it, learning about the epicentre of the lecture, interacting with the organisers and the actual process of presentation are all exciting intellectual exercises and opportunities for thrilling social exchanges that are too good to be missed, I always opined. As I expect no less a delight from today’s event, I wish to commence by thanking the sponsors of the Frontiers On Medical Education (FME) for inviting me to deliver this lecture – the second in a series of annual lectures that are designed, among others, to acclaim our revered Professor Linus Ajabor and to bring to the fore, his tremendous contributions to medical education in Nigeria and beyond.

Frontiers On Medical Education and Linus Ajabor in perspective.

As I understand it, FME is a project which seeks to improve the quality of medical education in Nigeria by providing a platform for ventilating contemporary issues in medicine and related disciplines through lectures, publications and debates. This laudable project was established and is financed by a group of grateful protégés and mentees, whose lives have been profoundly influenced for good by Professor Ajabor through his teaching, training and mentorship at one time or the other. Members of the group include generations of seasoned academics, physicians and general Practitioners spread all over the world. While a public display of gratitude remains an important motive, more significantly, the group is anxious to drum those salient attributes of the professor that have made him such an outstanding teacher, skillful clinician, astute researcher and generous father to so many within and outside the country, for others to learn from in the quest to improve medical education in Nigeria. By these actions, members not only express their gratitude, they live by them.

And indeed all who know Professor Ajabor will accept that his iconic life sets him out as a model in many firmaments – administration, community service, philanthropy, professional practice, and not least, medical education. A man, who for over one half of a century taught, motivated and guided students from different corners of the world to understand, acquire and imbibe, not just the scientific foundations of Medicine but also their correct applications to the sick, based on the principles of respect for all and sanctity of human life, deserves to be emulated. A man who has devoted the better part of his life to respond, without stint, to the needs of the infirm, with peerless professionalism, merits our collective applause. Little wonder the organisers of FME have thought it fit to commence the series when the icon is still alive.

It was at the universities of Ibadan and Benin along with their respective teaching hospitals where Professor Linus Ajabor spent the bulk of his working life that most members of the FME passed through the carrot and stick of the professor. As I was neither a student nor staff of any of those institutions at anytime, my interactions with this “disciplinarian with a kind heart”7 were of a different hue. In 1990, Professor Ajabor was the external assessor at my interview for professorship at the University of Port Harcourt. Not only was he kind to me at the interview, he was very supportive of my appointment. Then there were our encounters at the floor of the Society of Gynaecology and Obstetrics of Nigeria (SOGON), especially when he served as President (1999-2002), and the fora provided by various university and professional examinations – University of Benin, National Post Graduate Medical College of Nigeria and the West African College of Surgeons. But it was our membership of the Board of the University of Benin Teaching Hospital (March 2009-October 2011) where he served as member representing the Edo State Chapter of the Nigerian Medical Association(NMA) and I as Chairman of the Board, that exposed me to the full breath of his energy, capacity, firmness, compassion, fairness, knowledge, industry and much more. For indeed Professor Ajabor brought to that Board zeal, vibrancy and the propensity to be forthright that was unsurpassed by any other. So, if the profound accolade the Board received at the end of its tenure for having done a good job, was apposite, I, as chairman, put it down largely to the cooperation I received from all members, especially Professor Linus Ajabor. Accordingly, my acceptance to deliver this lecture is partly predicated on the platform it offers me to publicly say so and to thank the professor for his commendable services not just to that Board of Management, but indeed, the entire hospital, which earned him the recognition of a ward, Professor Linus Ajabor Maternity Ward, being named after him.

Review of First in The Series.

Some speakers request for copies of previous editions on invitation to deliver lectures in the mold of that of today. They do so to identify a trend of thought – if one exists – and to review issues that had been examined in previous ones. I find the practice valuable and I do so often.

For the FME series, today’s lecture, happily, is only the second – the first having been delivered about this time last year, at a forum at which I was present. Most befittingly, that delivery was by a colossus in size, content and achievements, Professor Friday Okonofua, FAS, the first vice-chancellor ever, in Nigeria, of a medical university – the University of Medical Sciences, Ondo.

In addressing the topic: Postgraduate Medical Education in Nigeria: Past, Present and Future7, Professor Okonofua drew attention to a number of challenges – funding difficulties, poor research infrastructure, inadequate monitoring and evaluation, the argument regarding the need or otherwise for clinical teachers to obtain other academic qualifications outside the fellowships from accredited bodies for postgraduate training in the clinical disciplines and some others. While acknowledging that post graduate medical education has gained considerable momentum and ascendancy in Nigeria, he however concluded by lamenting that the quality of its development has not matched the enthusiasm with which it was begun several years ago.

Today’s Lecture

As important as postgraduate medical education is, I wish to take one step back in today’s lecture to examine issues that concern the internship or the pre-registration housemanship in Nigeria as it was known in the late 1960s when I had the privilege of serving in that capacity and I do so for some good reasons.

• In reality, internship, a period of one-year, compulsory, supervised medical practice with a Certificate of Provisional Registration, tenable only in designated hospitals, is part of the complete training for the Bachelor of Medicine, Bachelor of Surgery as well as the Bachelor of Dental Surgery degrees which are all professional as well as academic qualifications. The training for these degrees is jointly supervised by a university accredited for the purpose by the National Universities Commission (NUC) on the one hand and the Medical and Dental Council of Nigeria (MDCN), on the other. The university awards the degree to the candidate at the successful completion of the prescribed university course while the MDCN fully registers the candidate to practise medicine anywhere in the country at the successful completion of the internship.
• The Certificate of Full Registration from the MDCN which is only earned at the successful completion of the internship, is an absolute requirement for the practise of medicine or dentistry for the balance of the candidate’s life.
• The internship serves an important purpose as it affords the newly graduated doctor the opportunity to apply the humongous knowledge acquired in medical school and to fine-tune the skills and competencies that were learnt in a controlled environment before taking full responsibility for the care of patients elsewhere.
• The internship is the first period that a candidate interacts with a patient, takes and executes decisions as a doctor with some form of formal registration, albeit, under the supervision of consultants. Prior to the internship, all the candidate’s interactions with patients were done in his or her capacity as a student without any form of formal certification.
• The internship is the first step and the approved entry point of a graduate into the medical profession for practice and further training. Experience during this period has the potential of influencing a candidate’s behaviour and attitude towards the profession for the rest of the candidate’s life either for good or bad.

Thus, internship serves as a wrap up of the several years of lectures, seminars, practicals, surgeries, patient contacts and much more, which a student had gone through in the course of training to become a medical or dental practitioner. Consequently, it is a significant and important component of medical education.

The emphasis is on practical service delivery by way of patient care, under the supervision of senior colleagues with appropriate knowledge, competence and integrity. Done properly, the candidate emerges as a well-rounded professional ready to take on the gamut of challenges in the health sector – wellbeing, disease prevention, patient care, rehabilitation, community health and much more. Done badly, the converse is likely to be the case.

During the internship, candidates should learn professional ethics; how to relate to colleagues; the correct application of the principles of medicine and the development of a desirable doctor-patient relationship as these are core tools they need for a successful career thereafter. On their part, consultants to whom house officers are assigned should be responsible and seek to influence the lives of the young doctors in a worthy manner. The house officer should be treated with respect and not confined to history taking, phlebotomy and running errands. Clinical teaching – in theatre, by bedsides, at outpatient clinics, and elsewhere should continue. Mentorship should be robust and consultants should always strive to set good examples by not coming late to scheduled events – ward rounds, clinics, operating sessions; not dressing shabbily and being transparent and honest in all that they do and say. Such combined actions would ensure that the newly qualified doctor is released to the world at large as a competent and proficient professional worthy of public respect and deference.

Situation at my time.

Let me illustrate what the internship was like in the 1960s and 1970s by giving a brief account of my experience as I transited from being a medical student to a pre-registration house officer as this would help place things in context. I graduated Bachelor of Medicine, Bachelor of Surgery (MB.BS), University of Lagos, in June, 1969 and at that time, proceeding directly to a pre-registration house job appointment was a given. On that fateful day of my graduation, I had my final examination – the viva voce in Surgery at about 9am. By 12 noon, all aspects of the final MB. BS examination for all twenty-four candidates had been concluded and the provisional results (required ratification by the University Senate) posted on the notice board of the college of medicine. By 2pm, officials of the Nigeria Medical Council, as it was then known, led by Dr. Melford Senibo Douglas, the first registrar of council, were in the college where they swore in those that had passed all sections of the examination and handed over provisional registration certificates to us. By 5pm I had received a letter of appointment as a pre-registration house officer from the Lagos University Teaching Hospital, the key to my residence at the house officers’ residence and three long white coats to replace the three short ones I had as a medical student. By 9pm, dressed in my long white coat instead of the short one I had worn in the morning as a medical student, and a good tie, I confidently walked into the casualty department as Dr. N. D. Briggs, the Doctor on Duty, along with a registrar in surgery.

The one year was spent in surgery, medicine and obstetrics and gynaecology departments – four months in each, with occasional postings to cover casualty and a spell with the military. In each of the departments, I spent one month in a consultant’s firm. As much as was possible, I participated in the care of all patients in every firm and served as the first contact person in the care of the patients. There was cohesion in every firm and all members, from the consultant to the senior house officer were supportive. There were neither strikes nor holidays and so I worked for the complete year and was on call at least once weekly, with one in three weekend calls. At the end of the internship, all the consultants in whose firms I had worked attested to my character and competence on a form provided by the medical council which enabled council to fully register me as a Medical practitioner in Nigeria.

On the whole, I found my internship an exhilarating and rewarding part of my training and till this day, I recollect events in the period with zest and nostalgia. All my colleagues who passed the final examination with me had similar experiences.

The experience was also not different with our colleagues who studied abroad and returned to Nigeria for their internships – a practice that was not uncommon at the time. Raphael Oruamabo, retired professor of paediatrics in the University of Port Harcourt and currently Dean of Medicine, Rivers State University of Science and Technology, Port Harcourt, returned from Leningrad (now St. Petersburg) where he had studied medicine, in 1972. He reported at the University College Hospital, Ibadan, saw the House Governor at the time (Mr.FGA Cole) and introduced himself as the one who had applied from Leningrad for an internship position. Dr. Oruamabo was immediately directed to another official who handed over the keys to his room at the house officers’ residence to him. On the same day, he was given the necessary papers of introduction for the medical council in Lagos to obtain his provisional registration certificate. Within forty hours (<2days) of reporting to Mr. Cole, Dr. Oruamabo had commenced work as a house officer in the Department of Surgery.8

Obtaining Information.

The main purpose of today’s presentation is to compare my experience and the nature of the supervision that I had during my internship year in 1969/70 with those of my colleagues in recent times (2000 and beyond) and following this, to make necessary recommendations to redress identified anomalies. To be able to do so, I sought information from the authorities of the universities of Port Harcourt, Benin, Usmanu Dan Fodio, Sokoto and Ahmadu Bello, Zaria and their respective teaching hospitals regarding the total number of medical graduates and the total number of doctors whose internships the respective hospitals had supervised between 2000 and 2015. From some of the hospitals, I also sought to know how long it took each of the candidates doing their internship programmes in 2015, to obtain placement and also for how long their internship programmes were interrupted due to strike actions. Further more, I obtained data from the MDCN on fully accredited medical schools, their approved quota for admissions for the MB. BS as well as BDS programmes where applicable and also the health institutions that are accredited for the training of pre-registration house officers in the country and the number of trainee positions approved for each institution. In order to better manage the national data from the MDCN which were presented on state basis, I aggregated them into the six geo-political zones of the country. Thus, from the information I obtained from all sources, I was able to construct the following:

• Figure 1. A horizontal bar chart indicating the time it took for serving house officers (2015) at the teaching hospitals of the University of Port Harcourt (103 doctors) and the Usmanu Dan Fodio, Sokoto (55) to obtain placements for their pre-registration house jobs after obtaining their provisional registrations from the MDCN. This was expressed as percentages.
• Table 1. showing number of medical graduates produced by universities of Ahmadu Bello, Zaria, Usmanu Dan Fodio, Sokoto and Benin between 2000-2015 and the corresponding number of interns that were trained by their respective teaching hospitals.
• Table 2. showing the distribution of approved medical schools and their admission quota, as well as accredited hospitals for the internship programme and the number of positions approved for each institution in the six geopolitical zones of Nigeria.

Current Situation.

The analyses as contained in Figure 1 as well as Tables 1 and 2 show that the experience of many newly graduated medical doctors with respect to the compulsory one-year internship programme is very different from what obtained in my time. Few, if any, walked into a job the way I did; less than 5% found placement within a month of their induction ceremony (see figure 1). The bulk of the candidates searched for placements for periods of up to six months (about 75-85%) and about 15% did so for more than one year (figure 1). Furthermore, the candidates informed me that since demand appeared to outstrip supply, especially in the big teaching hospitals, some health institutions request applicants to sit for an examination from which only a handful are picked for the internship. For instance, in March 2016, five hundred and seventeen doctors (517) applied for one hundred and twenty (120) internship positions at the University of Port Harcourt Teaching Hospital9, while 320 applied for 24 positions at the National Hospital, Abuja during the same period.10 I was further informed that in order to be seen to be fair, a number of hospitals draw up waiting lists where candidates may be expected to wait for their turns for up to two years. While this waiting game lasts, some applicants solicit assistance from highly placed individuals to secure placements through high level contacts with medical directors of hospitals; others accept supernumerary positions without pay – as at May 2016, eleven doctors were serving in this category at the University of Port Harcourt Teaching Hospital and yet others get employed in a number of private clinics and practise illegally (i.e., without certificates of full registration) for some slave pay. Worse still, some take to new trades – fashion design, sewing, buying and selling and even deadlier, utterly dishonourable and reprehensible pursuits.

Where a placement is secured, the one-year period is not infrequently truncated by strike actions. Table 3 shows that between 2000 and 2015, pre-registration house officers at the University of Port Harcourt Teaching Hospital, on the average, lost up to 15% of work time due to industrial actions. Furthermore, the quality of service depreciated by shortages of essential materials as well as epileptic electricity supply. I also received information to the effect that some interns on completion of the one-year period or thereabout, find their way into another house job programme for possibly another year in order to continue to be on a pay roll as employment thereafter is difficult to come by.

Regarding the firm arrangement that serves as the teaching and learning unit, it was reported that it functioned poorly in many hospital departments: teaching ward rounds by consultants are frequently not held on their designated days, operations often got cancelled on account of shortages of sterile linen and out patient clinics were occasionally skipped due to lock outs. Furthermore, accommodation for pre-registration house officers, in some hospitals where it existed was hardly enough. So, a number of the house officers made do with private accommodation outside hospital premises in contravention of the stipulation by the MDCN for all house officers to be resident in hospital premises.

What came through was that although most doctors got signed up by consultants at the end of their one-year periods and then went on to receive full registration certificates from council, the internships programmes some had, may have been unsatisfactory.

Comment.

The initial impression one gets on looking through the findings of the survey and also interacting with the applicants for house job placements is that the observed anomalies are as a result of a glut of doctors from overproduction by the universities leading to dilution of services and a quick depletion of the approved internship positions: Table 1 shows that all three universities surveyed (ABU, Sokoto and Uniben) produced doctors beyond the capacities of their respective teaching hospitals to absorb house officers. However, a closer look suggests otherwise: Table 2 shows that there is not much difference between total approved students’ admission quota which in a way could be taken to represent annual graduation numbers for medical schools (3080) and the total approved internship positions (3033) in the country. So, the problem may lie elsewhere and I wish to suggest that we look in the direction of:

• lack of adequate planning and management of the internship programme by the MDCN,
• reluctance of interns to work in some parts of the country and
• their preference for the big teaching and general hospitals.

With this background, I will now make some recommendations that could help to address the problem.

Way Forward

• On a general note, problems with the training of pre-registration house officers pale into insignificance and cannot be treated in isolation from the enormous difficulties being currently faced by this country in many areas but especially so in those of substantial level of insecurity; grinding poverty; large scale unemployment, especially of the youths; epileptic electricity supply; rudimentary health care services and poor infrastructure. Some regard all these as interrelated emblematic symptoms emerging from the same underlying malaise – bad and ineffective governance. So, they posit that until the country is able to have governments that are transparent, forthright and focused on the wellbeing of the people, the chaotic external manifestations, including the difficulties with medical education as was described in the last edition of this lecture series as well as the problems highlighted in the current one, will continue.11 The process of bringing such a situation – the country of our dreams – into being is everyone’s collective responsibility.
• The training of a medical doctor is complex, long and expensive; in many universities, it is the most time consuming and expensive. Tables 4 and 5 show that the training of the medical doctor is the most expensive programme offered in Nigerian universities as well as at the Johns Hopkins University – one of the world’s most sought after tertiary educational institution. Accordingly, countries usually ensure some correlation between the production of this cadre of professionals and the demands of national development through a synergy between the various organs that participate in the training of the doctor, especially the universities and the agency responsible for the registration of the doctors. Such a correlation not only avoids waste and glut; it also prevents a bottleneck which could build up a backlog at any point along the training chain. Sadly, such a correlation is absent in Nigeria as the various entities essentially work in silos, without reference made to well-defined short, medium and long term national development objectives. So, part of the current problem with the internship programme in the country arises from this failure as proper planning remains a fundamental prerequisite for favourable outcome. Graduates of higher educational institutions, including physicians serve as arrowheads for local, regional and national development; their production, ideally, should be tied to well-articulated development plans.
• From their interactions with me, I got to know that most prospective pre-registration house officers prefer to have their internships in the big teaching hospitals. They do so because such hospitals are usually situated in big cities – Lagos, Ibadan, Kano, Sokoto, Maiduguri, Enugu, Port Harcourt, Benin City and others, where social amenities – electricity supply, accommodation, housing, schools, recreational facilities – are expected to be better. There is also the belief that supervision of the internship programme would be better in such big hospitals where there is usually a good number of well-qualitied consultants. So, one way of tackling the problem could be to incorporate the one-year Internship into the curriculum of medical schools such that every student on passing the MB. BS; BDS final examinations is absorbed and stays back for another one year for the internship in that same hospital where he or she studied. He or she then leaves at the end of that extra one year, with a Certificate of Full Registration instead of one of Provisional Registration.
• Our study showed that a good portion of the one-year internship period is lost to strike actions – about 15% in the case of one big teaching hospital. This is without prejudice to the depreciation of services brought about by shortages of essential materials in hospitals and erratic electricity supply. The net effect of all this is that even when candidates are certified to have completed the internship programme, the overall quality of training they have had may have been unsatisfactory. To ameliorate this situation, I wish to suggest that the two main professional bodies to which the interns are affiliated: The Nigeria Medical Association and the Association of Resident Doctors should exempt the interns from participating in strike actions. Failing which, the MDCN should prohibit all interns from participating in strike actions. If this is done, it will enable interns to continue their training under their respective consultants who are obligated to render skeletal services during such periods of strike actions.
• The point was made earlier that approved internship positions in the country appear to be adequate for the number of graduates currently being produced by medical schools and that the absence of a proper arrangement for the deployment and supervision of these new graduates may be partly responsible for the difficulties that are currently being encountered. It is inappropriate that the MDCN leaves candidates to be completely on their own after administering the Physician’s Oath in an internship programme which council accepts as its responsibility, until the candidates resurface at council headquarters with certificates signed by consultants as having completed their internships. There is no form of Quality Assurance or Control as is done with the MB. BS or even the postgraduate programmes by way of accreditation, in course assessment and exit examinations. This lack of proper supervision also leaves room for some of the deviant behaviours that some interns engage in, like hopping into another housemanship programme in order avoid unemployment.

This is unsatisfactory and I suggest that council becomes more proactive and gets better involved in the supervision of the internship programme, which truly is council’s responsibility. Council should liaise with universities and approved hospitals for internship and post students on graduation to vacant positions as is done at the National Youth Service Corps. Such an arrangement will make it possible for council to keep a tab on each intern and to hand over information on postings for the internships at the same time as it is handing over Certificates of Provisional Registration after the administration of the Physician’s Oath. Council should establish an office for this purpose and appoint a senior official to take charge of this important aspect of its operations. Furthermore, interns should be made to indicate where they resided during the period, the number of call duties they had and number of days they were out of work as a result of strike actions; they should be held more to account. The House Officers’ (Internship) Performance Report that is currently used by council for evaluating performance and suitability for registration, does not contain these pieces of information which to my mind, are relevant in the context of our present realities.

• The information from the MDCN used in constructing Table 2 was as at 2015. Since then, things have changed. For instance, the University of Port Harcourt which had an approved admission quota of 100 for the MB. BS programme, now has an increase to 130.12 Also, there are a number of medical schools that council has granted partial accreditations – Bowen, Ado Ekiti, Abuja, Babcock, Afe Babalola – that are currently training but are yet to graduate students. Furthermore, a new medical university – the University of Medical Sciences, Ondo, first of its kind in the country has recently come on stream, just as other universities, like the Rivers State University of Science and Technology, Nkpolu and the American University of Medical Sciences, Abuja are planning to commence medical schools. The number of medical graduates who would be requiring internship placements, is therefore likely to rise steeply in the near future. As Council gives approval for the new medical schools, this is the time for it to also ensure that there will be a corresponding increase in the places where internship programmes can be undertaken.

Conclusion.

Medical Education – the overall object of the FME project – is a system comprising a formidable array of scholarly and professional activities in medicine and related disciplines that aim to formally and informally train and educate students, at different strata, to acquire knowledge and proficiency as professionals, academics and scientists, through active engagement, knowledge transfer, research and the provision of specialised services. To achieve these complex objectives satisfactorily, sufficient provision must be made for students to maximise gains at each of the various levels the training is organised – pre-medical, pre-clinical, clinical, internship and postgraduate and therein lies my point of emphasis in today’s lecture. Thus, the internship being a vital component of this educational chain which eventually produces the specialist whose expertise is crucial in the health care delivery system of the nation, needs a better management. The chaos that currently attends its operation in the country beckons relief and it is for this purpose that I have made some recommendations which no doubt have their merits and demerits – a number, probably contentious as well.

As we once again, applaud FME for providing the opportunity to debate contemporary issues in medical education, we must cast our nets wide and be as encompassing as possible – the number, quality and dynamics of students’ admission; the environment in which they are trained, including the laboratories and hospitals; the commitment of their teachers; the quality of the programme in all its sections and much more. It is this type of holistic approach and attention to details, spread over several years and various institutions at the University of Bristol, the Bristol and Weston-Super-Mare group of hospitals, the Royal College of Obstetricians and Gynaecologists, the universities of Ibadan and Benin, among others, that produced our venerated Professor Linus Ajabor – one that was worthy enough to receive the SOGON Jubilee Award 2015. Our collective wish today and always should be to plead no less for our younger colleagues instead of the purgatory in which some of them currently find themselves.

Acknowledgements

I wish to express my gratitude to the large number of persons who provided the information that made it possible for me to write this paper. They include: Dr. Abdul Ibrahim, Registrar, MDCN; Professor Friday Okonofua, vice-chancellor, University of Medical Sciences, Ondo; Professor Folasade Ogunsola, Provost, College of Medicine, University of Lagos; Professor Christopher Bode, Chief Medical Director, Lagos University Teaching Hospital; Professor Vincent Iyawe, Provost, College of Medicine, Univeristy of Benin; Professor Michael Ibadin, Chief Medical Director, University of Benin Teaching Hospital; Dr. Jafaru Momoh, Chief Medical Director, National Hospital, Abuja; Professor Christie Mato, Provost, College of Health Sciences, University of Port Harcourt; Dr. Charles Tobin-West, Chairman, Medical Advisory Committee, University of Port Harcourt Teaching Hospital; Dr. Nestor Inimgba, Former Ag. Head of Obstetrics and Gynaecology Department, Univeristy of Port Harcourt; Professor Bissallah Ekele, formerly of the Usmanu Dan Fodio University Sokoto; Dr. Umar Mohammed and Dr. C. Shehu of the Usmanu Dan Fodio University Teaching Hospital, Sokoto. Preregistration house officers in the various hospitals that gave me information. I also express my appreciation to Professor Raphael Oruamabo and Professor John Ikimalo for reading through the paper and offering valuable suggestions.

References

1.Briggs, Nimi. Human Cloning: What would Felix Dosekun have said about it? First Felix Dosekun Memorial Lecture. College of Medicine, University of Lagos. Wednesday,21 November, 2001.

2. Briggs, Nimi. Life Depends on Birth weight. Keynote, Address in Honour of John Bateman Lawson at the 36th.Annual Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON). November, 2003.

3. Briggs, Nimi. The Contributions of the Obstetrics and Gynaecology Department, College of Medicine, University of Lagos and Lagos University Teaching Hospital to Obstetrics and Gynaecology in Nigeria and Internationally. A Lecture organised by the Obstetrics and Gynaecology Department of the University of Lagos to mark the 80th. birthday anniversary of Oladele Akinla. 28 April, 2004.

4. Briggs, Nimi. Change in Life style as Antidote to Emerging Diseases. The 13th Abimbola Awoliyi Guest Lecture delivered at the 2007 Biennial Conference of Medical Women’s Association of Nigeria. 20. September, 2007.

5. Briggs, Nimi. Why do Many Women Still Die in Child Bearing in Nigeria? The 2008 Annual OK Ogan Memorial Lecture, Department of Obstetrics and Gynaecology, University of Nigeria. 14 October, 2008.

6. Briggs, Nimi. Environmental Health: A Pillar of General Medical Practice. The 24th. Samuel Etim Andem-Ewa Memorial Lecture. 36th. Annual Conference of the Association of General and Private Medical Practioners of Nigeria (AGPMPN). 3 April, 2014.

7. Okonofua, Friday. Postgraduate Medical Education in Nigeria: Past, Present and Future. Lecture Delivered in Honour of Professor LN Ajabor under the series on Frontiers In Medical Education at the International Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON). November 2015.

8.Oruamabo, Raphael, Professor of Paediatrics, Personal Communication.

9. Tobin-West, Charles. Chairman, Medical Advisory Committee. University of Port Harcourt Teaching Hospital. Personal Communication.

10. Momoh, Jafaru. Chief Medical Director, National Hospital, Abuja. Personal Communication.

11. Harrison, Kelsey. We reap what we sow. Lecture delivered at the University of Medical Sciences. Ondo.

12. Mato, Christie. Provost College of Health Sciences, University of Port Harcourt. Personal Communication.

Table 1

NUMBER OF GRADUATES OF MEDICAL SCHOOLS AND INTERNSHIP PLACEMENTS IN THEIR RESPECTIVE TEACHING HOSPITALS

ABU UDSOKOTO UNIBEN

(2000 – 2015) (2000 – 2015) (1999 – 2013+dents)

Grads Intens. Grads. Intens. Grads. Intens.

Nos. 1231 939 698 644 1793 138

Table 2

No. of Approved Medical Schools.

No. Approved Annual Admission. ? Grads.

No. of Approved Health Institutions for Internship.

No. of Internship Positions Approved

For Each Geopolitical Zone of Nigeria as at 2015.

ZONE	Apprd. Medical Schools	Apprd.No. Admission	Apprd. Health Insts. for Internship	Apprd. Internship Positions
N. West.	3	220	11	319
N. East.	1	325(25)	9	200
N.Central.	4	400	11	230
S.West.	6	680(105)	31	1076
S.South.	9	850(150)	18	581
S.East.	7	605(30)	11	459
FCT.	–	–	5	168
TOTAL	30	3080	96	3033

( ) Admissions for the Dentistry programmes.

Source: extracted from data obtained from Medical and Dental Council of Nigeria.

Table 3

UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL

PERIODS OF INDUSTRIAL ACTION

2000-2015

PERIOD	No. of Working Days Available	No. of Days on Industrial Action
2000-2004	1,827	370 (20.3%)
2005-2009	1,826	112(6.1%)
2010-2014	1,825	340(18.6%)
2015	365	56(15.3%)
TOTAL	5,845	878(15.0%)

Source: Annual Reports. Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital.

Table 4. Observed and Expected Unit Cost per Student per Discipline (2012)

Discipline	Observed Unit Cost (N)	Expected Unit Cost (N)
Administration	525,000	719,250
Arts	555,000	760,350
Agriculture	690,000	945,300
Education	555,000	760,350
Engineering	645,000	883,650
Environmental Sciences	735,000	1,006,950
Law	594,000	813,780
Social Sciences	549,000	752,130
Science	615,000	842,550
Medicine	906,000	1,241,220
Pharmacy	735,000	1,006,950
Veterinary Medicine	735,000	1,006,950
Management Tech	510,000	698,700

Table 4. Source: Towards Innovative Models For Funding Higher Education in Africa. Association of African Universities. Editor: Peter Okebukola.

Table 5.

TUITION FEES FOR VARIOUS PROGRAMMES AT THE JOHNS HOPKINS UNIVERSITY

 

Expense Budget 2016–17 Academic Year
Tuition	$50,410
Matriculation Fee (new students only)	$500
*Room & Board (on-campus)	$14,976
Room & Board (off-campus– estimate) Transfer applicants	$10,522
Personal Expenses	$1,044
Books & Supplies	$1,220
Average Travel (costs vary depending on home state)	$702

 

Tuition fees for medicine $76,740

Engineering $48,710

Source:https://www.google.com/search?q=tuition+fees+at+the+johns+hopkins+university&ie=utf-8&oe=utf-8&client

INTERNSHIP IS AN IMPORTANT COMPONENT OF MEDICAL EDUCATION.

A Lecture delivered in honour of PROFESSOR LINUS AJABOR. JP. OON. FRCOG. Hon. DSc.

By Nimi Briggs Emeritus Professor, University of Port Harcourt.

Pro-chancellor and Chairman of Council, Federal University Lokoja. in the series on Frontiers On Medical Education (2nd in Series). At the 50th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON 2016) AKURE, ONDO STATE.

email: nimi@profbriggs.net

website: http://www.nimibriggs.org
7th October, 2016.

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