400-level Medicine & Surgery
Lagos State University
Good day, Sir. Thank you for taking out time from your busy schedule to grant this interview. First, we would like to know you. Please tell us a bit about yourself.
My name is Douglas-Iyalla Pepple. I am from Rivers State. I attended medical school at the University of Calabar but had a first degree in Human Anatomy at the University of Port Harcourt. I am currently a General Practitioner in the UK with the NHS, and I am married to a doctor with a two-and-a-half-year-old son.
What was studying medicine in Nigeria like for you?
I went to two universities; for my 1st degree, I went through the university but the university didn’t go through me, probably because I was uninterested in the course of study. I eventually got into medical school which was the best part of my life. Medical school was a smooth ride for me with no experience of failure because I was more mature and had a good understanding of anatomy, physiology and biochemistry from my first degree. I was class president for three years through the clinical classes where I managed to build sustainable friendships with my mates and rapport with my lecturers. I got contributions from my classmates to get airtime for organising lectures as well as to fuel the school buses for postings; this was quite interesting but challenging.
I did my Masters in Reproductive Medicine, Science and Ethics at the University of Kent, Canterbury. Studying in the UK was a huge cultural shock for me, a direct opposite of Nigeria, from the library facilities to how you relate with lecturers and how they delivered their lectures. Everyone gives you the attention you need to pass your exams; if you’re struggling, there’s always an advisory/support officer assigned to help you improve your grades and offer psychological support. As a resident doctor in the UK, the Royal College and your deanery have financial provisions to sponsor your training courses through your study leave budget and all support towards your professional exams. All these are geared towards assisting you to become a consultant or GP in record time. The Nigerian education system needs restructuring and reformation in terms of adequate funding and improvement of students/lecturers relationship.
Wow. So, contrary to what the Minister for Health said, even the exams are paid for aside from your salary? More reasons for me to leave (laughs). When and why did you leave Nigeria?
I left seven (7) years ago in 2014. It had always been my plan from the beginning to study and practice abroad. So, after my house job in Port Harcourt, I proceeded to the UK for my Masters during which I sat and passed the PLAB exams, got my GMC UK license to practice and subsequently secured a job to work as a Senior House Officer.
I am one of those who still believe in the Nigerian project. I believe in acquiring knowledge, developing skills and returning to make an impact in our dear country.
Can you walk us through what it entails to work as a doctor in the UK?
I talked about a similar topic in one of my YouTube episodes. Working as a doctor in the UK is similar to working in Nigeria; the main challenge is communication (not language) and the shift from a strict environment to a liberal one.
Communication entails how you pass information in a British-friendly lingo to get your patients and colleagues on board with you. For instance, when a patient here says he has been sick from yesterday, it means he has been vomiting not that he has been feeling unwell. Learning the work ethics, culture and traditions of the UK will help you to integrate well. The relationship between junior doctors and consultants here is cordial and you find that your opinion truly counts; there is no unhealthy rivalry and unnecessary superiority.
You have to be confident in your knowledge and skills. The same way you treat a patient in Nigeria is how you treat them over here, only that this system has proper checks and balances and everything is done according to guidelines. You are not required to know everything by heart. You’ve got national guidelines, hospital treatment protocols and other allied health practitioners who are always available to guide and assist in patient management. You just need to know the limit of your knowledge and the appropriate time to escalate and call for help.
This is a question I’m quite particular about. How did studying in Nigeria affect the country you chose to emigrate to?
The first and most important factor I considered was language, I wanted an English-speaking country. My reason for not going to the USA was that I already spent ten years getting my medical degree in Nigeria and the USMLE exams would take about 2-3 years, which was more time compared to the duration to sit and pass the UK Plab exams. Postgraduate studies in the UK is way longer than in the US (takes 6-8 years to become a GP in the UK but just 3-4 years to be board certified in the US). However, the remuneration is way higher in America compared to Britain.
I was also influenced in medical school by a British consultant who spent a few weeks with us. That made me tilt towards the British way. I also considered proximity to family. I wanted somewhere I could wake up one day and decide to be in Lagos in six hours, especially since I have some political ambition for maybe 2023. Finally, I also wanted a country with a lot of diversity yet similar to my Nigerian background, and the UK is that country.
Regarding relocation, considering the cost and duration of doing the USMLE, if you’re desperate to practice abroad, you can consider sitting the PLAB exam and securing a job as a senior house officer in the UK. You can then make your American move.
Running for a position in 2023 is an amazing feat, Sir. Unfortunately, I cannot cast my vote for you but you’ll have my support. As an undergraduate medical student in Nigeria, what were the specialities you considered? What changed when you left the country?
I had always wanted to specialise in O&G. I have strong family influence in the speciality, I’m surgically inclined and with my Anatomy background, it was just natural to tilt towards O&G. I also performed effortlessly well in it in med school.
What residency program are you running?
I’m in the last few months of my General practice training (called family medicine in Nigeria) with a subspecialty interest in women’s reproductive health. I had my postgraduate in Fertility Medicine and attended GP & O&G interviews. I got a GP training offer first and was placed on the waiting list for O&G. I was impatient and went for GP which I’ve come to enjoy. While training as a GP, you can subspecialise in anything. For example, as a GP with a special interest in female reproductive health, you can fit in coils, run sexual infections and contraception clinics, and set up a fertility clinic which I intend to do as a private practice in Nigeria soon.
I strongly believe that, in choosing a speciality, your skill set should match your interest. It should be one you have the grit and resilience to go through while taking pleasure in your work.
With your experience so far, what are the systems you believe could be implemented in the Nigerian healthcare system that would greatly improve it?
Mainly, hospital administration and governance. In the UK, the Medical Directors are not necessarily doctors. Hospital administrators are professionals, and this helps everyone understand their role; round pegs fit into round holes, you know. There is also unhealthy friction in the hierarchy of the Nigerian health care system. If everyone understands their role, this tuberosity will be smoothened.
I also believe the system should be strengthened to reduce corruption: the workers in the sector should be properly remunerated, and the required equipment should be available and functional. Continuous education and training for clinical & non-clinical staff should be prioritised. I believe revolution comes from one man. One person can begin a cycle of change, let’s start seeing ourselves as agents of change and not wait for someone else to start it.
How did you start your YouTube channel and teachings? What’s your long term plan for this?
I started Dr Pepple’s Hub on YouTube to assist international students and International Medical Graduates transitioning to study and practice in the UK. My life’s purpose is to teach, inspire and lead people. So, when I tread a very difficult path, I try to light a candle for others to see. I like to project my optimism to people so that they see the possibility in all they want to do despite the rough journey. For now, the channel is still free and I’m trying to devise a means for PLAB tutorials, CV reviews and job interview coaching.
What do you miss about Nigeria?
I’ve not been to Nigeria in two years. I miss everything: the sounds of ‘okada’, cars honking, the freedom to visit friends and families unannounced. I miss the communal living and the lovely Nigerian spirit.
How do you balance work, being a husband and father and other aspects of life?
I have a schedule and I try to follow it. I set priorities, use online diaries and flashcards to write what I need to achieve daily, monthly, yearly and long term. It’s a habit I’ve cultivated since I was in medical school. I also delegate jobs as much as possible; for example, I delegated my YouTube editing when I started preparing for my exams.
What’s the longest shift/call you’ve done as a resident?
13 hours is the longest shift I’ve done. You work for a maximum of 48 hours a week as a doctor in the UK and a minimum of 11 hours between shifts. Hence, if you had a 12 pm to 12 am shift, your next shift doesn’t come until at least 11 hours later, no matter how short-staffed the hospital is. Some people take shifts in different hospitals as a locum to get extra pay, and it’s usually at a higher hourly rate.
Could you give us some insight into how a typical day at work goes?
Different days have different itineraries; we have call days, clinic days, ward round days and theatre sessions depending on what rotation you’re on. My ward round day usually starts at 9 am, but we have a prior handover meeting that has everyone in attendance. Then, work starts with junior doctors reviewing the patients and preparing the day’s ward round notes 10-15 minutes before consultants come in.
After the ward round, I take a break and then carry out tasks that typically include ordering investigations, reviewing management plans and discharge summaries. At the end of the shift, there’s a handover meeting to the incoming team. But as a GP registrar, I run my clinic which is now done remotely via telephone consultations due to the COVID-19 situation. The most important things are to be punctual, go for breaks and know when to escalate a patient’s situation and ask for input from seniors.
Do you have any other thing to tell a medical student exploring career and emigration options?
Medical school is the easiest part of the medical career. A pass in postgraduate studies abroad means an A, and even PLAB requires above 65% to pass, so enjoy your life in medical school now. To practice abroad, you need to be versatile. Take time to develop other interests apart from medicine. Have a life and develop yourself. Medical school is also the time to forge lasting relationships with colleagues and seniors. Tap into their vast wealth of knowledge, develop yourself and hone your skills. Learn more about information technology and entrepreneurship. Monetise your knowledge if you have to but try to maintain your humanity.
Start preparing early before every exam in every class. Practice Active Recall & Spaced Repetition. This will help you study and pass with ease. Try not to do twice what you can do once! Possibilities lie within your reach, and Medicine is a beautiful profession. Thank you.
It’s our pleasure.
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