A Long Walk Through Medical School in Nigeria – a Blessing or a Burden?

In this noble profession, what I have come to learn from predecessors is that learning never ends; therefore when it comes to the structure involved in studying medicine, it will encompass where learning begins but not where it ends. I can, however, say the educational aspect of learning has an endpoint for doctors, where they are no longer under the supervision of teachers but can now sufficiently practice in whatever aspect of the profession they choose on their own. Still, as I earlier said, learning never ends. I should add that the structure of medical school as written here in studying medicine is mostly in accordance with that of the University of Ibadan. A few variations may exist in other universities.

In pursuing the profession, one will certainly go through the basic educational requirements and, as stipulated in Nigeria, that is from nursery through primary and junior secondary school. In senior secondary school, science subjects would be studied, majority of which are compulsory and must be passed especially in the major external exams – WASSCE (West African Senior School Certificate Examination) and UTME (Unified Tertiary Matriculation Examination). Such subjects include English, biology, physics, chemistry, mathematics and a few others now made compulsory according to the councils responsible for the exams.

The next stage, now in the university, spans for about six and a half years or more. It begins with the first year commonly called the preliminary stage which is essentially a revision of things learnt in senior secondary school. Next is the preclinical phase which in the University of Ibadan last for about a year and a half where the basic medical sciences which include anatomy, physiology, biochemistry and a bit of medical genetics and community medicine are taught; and toward the end of preclinicals, introduction to clinicals begins which takes us to the next stage spent in the teaching hospital – University College Hospital (UCH). This is done in three and a half years. Courses studied here include pathology, pharmacology, paediatrics, obstetrics and gynaecology, community medicine, surgery and medicine. This stage is basically an application of that learnt in the previous years.

Having gone through these and passed, the student is now given the license to practice medicine in the country, after which is the induction ceremony where the individual takes the Hippocratic Oath. The newly inducted physician must go through housemanship which is a twelve-month internship training in a hospital certified by the MDCN (Medical and Dental Council of Nigeria). Most serve the country after this. When all these are completed, the doctor is now free to pursue further education in varied aspects. It could be in practice, education or administration.

Residency is one of these further pursuits which permit a physician to practice in many jurisdictions. In Nigeria, there is a lengthy process required before one can become a consultant. It includes many specialities and these last up to three, five or most times, seven years. Most people that go for this further training stop here. However, residency training may be followed by fellowship training also called sub-speciality training.

There are a few things I should point out for interested readers who plan to attain further training or practice outside Nigeria, for instance in the USA. To do this, it is compulsory to complete the residency program in the country regardless of the training received here. These physicians are required to take and pass the USMLE (the United States Medical Licensing Examination) which is a three-part exam. They are also required to participate in a program by the ECFMG (Educational Commission for Foreign Medical Graduates) and get certified by this body. Registrations will also have to be made with the appropriate bodies like the NRMP (National Resident Matching Program) after which one can take part in the residency program and therefore practice in the country.
Requirements for other countries are quite different so adequate research should be done, if interested. However, regardless of the country, these physicians are called IMGs (International Medical Graduates). It might seem like a long and cumbersome process; in fact, it is, but with determination, drive and of course passion, there is no stopping you.

A BEGINNER’S GUIDE TO SURVIVING MEDICAL SCHOOL IN NIGERIA

A lot of people have dreams; dreams of what they want to be, where they want to be and who they want to be. Relatively speaking, having dreams is easy. This is why, as we grow up, we often cycle through several of them, most of which are related to what we want to spend the rest of our lives doing. What presents some difficulty is actually transporting oneself from point A – the viewpoint of the dreamer, to point B – that of the doer. For those who dream of, one day, saving lives through their medical knowledge – and who have already passed through the rigours of the pure sciences to make this happen- a new question arises: “What mindset do I need to have to get through medical school?”- a question which some are yet to answer even after spending months in medical school.

Many of the educational systems of the world we live in today tacitly encourage students to pass exams rather than gain any practical knowledge. This often means that our best and brightest are more suited to writing tests than helping people. Thus, the first thing that has to change is your approach to learning. You have to realize that the things you learn today could potentially save the life of someone’s mother, child or brother in the near future (or the lack thereof condemning that person to death). Your goal isn’t to be the best student in class; it’s to be the best doctor you can be. Getting to where you are today (medical school) was hard, getting through it will be even harder. Hard work and, more importantly, consistency are the oars which will keep your boat going till the end. If you can’t put your absolute best into what you do, then you don’t deserve the privilege of having someone trust you with their life years down the line and medical school will ensure that those who don’t deserve the privilege never get it.

However, there is a distinction between a drive to work and a drive to kill one’s own body. Statistically, the best way to be productive, and learn as much as you can, involves taking regular breaks. If you treat your body like a machine and abuse it, it will fail you when you need it the most – such as a day before an examination. Time not spent on school work isn’t a waste and shouldn’t be regarded as such. Ideally, you should try to acquire a new skill or learn something outside the medical profession or else you’ll find yourself having graduated with nothing to show for it but a degree.

In addition, adopting an isolationist mentality the moment you get into medical school will do you no good. Interaction with one’s colleagues and immediate seniors can go a long way in making your journey towards achieving your dream that much easier. Lecturers are unable to touch on every little detail and delineate concepts in a way that will be understood by every single person in a class; this is why you have people all around you. You should have a network of friends with whom you can efficiently exchange ideas and discuss topics which you find challenging. Once you begin your clinical years, you’ll be surrounded by registrars from different institutions with a far more diverse background and a wealth of experience than you. Learning from them certainly can’t hurt you.

Furthermore, a physician isn’t merely a healer of the body but a healer of human beings. Any doctor has at least a basic understanding of clinical pathology; it takes a truly exceptional one to combine that with an ability to engage the patient – bedside manner is vital in the clinic. You can’t leave a lasting impression in a patient simply by being able to analyze his symptoms and prescribe a drug, if you’re unable to do so why are you even in the hospital to begin with? A patient will only be impressed if he feels that you truly care about him and the pain or discomfort he is experiencing. Show that you’re not just another person in a ward coat and he/she another patient. If you have this mindset during each encounter with a patient right from the first time you treat one, you’ll find it far easier to do your job.

Similarly, you can’t afford to be a backbencher if you wish to thrive in medical school. You have to be proactive and take control of the situation. Set things into motion, don’t let them just happen to you. This is especially true when you’re in a class where the number of students greatly outstrips the lecturers teaching. Be punctual to class and volunteer to take up positions or do things which will bring you into close proximity with your lecturers and senior colleagues. Don’t be that guy that just stares with his arms folded from the back while people are up in front actually being productive. If you’re in a venue meant for learning and you aren’t, then you’re clearly just wasting your time.

In conclusion, the path to becoming a physician isn’t an easy one and rightfully so. But, it is achievable and if you start off your journey with the proper mindset, it’ll be that much easier.

GOALS

In the pursuit of a career in medicine, the importance of goals and goal setting can never be overemphasized, both in the long term and in the short term. The short term basically has to do with your journey through medical school – passing the exams and doing very well in a class of geniuses. On getting to medical school, you would have heard tales of how the mighty have fallen and so, many persons sometimes get scared. Beyond all, you must understand that “fear limits a person”. Set your goals right, there’s nothing wrong with aiming for all-round distinctions and in the end, even if you don’t make a distinction, at least you’ll be a distinction. Understand your strengths and make up for your weaknesses.

The long term basically deals with the whole essence of why you’re in medical school, you must realize that one day you might be the factor deciding just how much longer a patient has before his/her final breath, hence aim at garnering as much knowledge as you can, because, in the end, what makes the patient run to you is that they believe you know something that they don’t and consequently, they put their trust in you to bring smiles to their faces and hope to their hearts in one way or the other. Work and study hard then, that you may not betray their trust.

So, in all, in your goals, understand what works for you, understand why you’re in medical school and constantly remind yourself that every human life is SACRED.

EXTRACURRICULAR ACTIVITIES AND BALANCING

Despite our very busy schedule as medical students, we can find time for extracurricular activities (being outside the regular or besides school or the college). “Yes medical school is intense, it is demanding and we have to do well academically” but this does not mean we can not juggle school requirements with any external interests we might have. It does not mean we can not have fun. It is often difficult to strike a balance between medical school and extracurricular activities in any system. If we want to spend more time on academics, we can hardly have time to participate in extracurricular activities. Conversely, if we spend more time in the extracurriculars, we have less time to study and our performance suffers.

Unlike most undergraduate programmes, medical school has a curriculum which may be alien to most direct entry students thus making it difficult to balance extracurricular activities as you did in your high school days. Whether it is the preclinical or clinical years, students will often find that opportunities that were available to them in their pre-undergraduate days may not be present in medical school. With a change in course flexibility (from flexible to inflexible), your time becomes precious.

Do not apply to medical school without a purpose.

Focus on the things that matter to you, things you enjoy (that you just got into medical school does not mean you should stop playing the guitar or basketball; it does not mean you can not learn a foreign language or take an online course on quantum physics), avoid placing sleep on the altar of sacrifice(for sleep deprivation is an increasingly recognised problem among health professionals, particularly residents and medical students), prioritize your activities but every now and then take some time off and do that which brings peace to your heart and rest to your nerves. Once you find that balance there are many opportunities to be involved in something other than anatomy or pathology et al during medical school.

TIME MANAGEMENT

Have you ever been in that position where you wish you had 46 hours in a day? Well, I have, but in the end, I realized it was not how long but how well I managed those little seconds, minutes and hours that mattered. “Time waits for no one” – a simple cliché we’ve always heard and since we have no Flash or Zoom amongst us to defy that, I’d say it still holds true till now and will for eternity.

As a medico (yeah, medical student or whatever), you’ll spend approximately ((365×24) ×6 =)52560 hours of your life in medical school excluding the ever recurrent strike periods. It is indeed noteworthy that the society we live in expects a full-fledged being of immense cerebral capacity and skill, people-oriented and otherwise. Most say our time is divided between our academic, spiritual and extracurricular activities and I quite agree with this. True, our academic activities might seem to or rather WILL take a higher percentage of our time, it is pertinent we create time to feed our soul, maintain a connection with God and create a web of friends to hold you up when the going gets tough.

If you fail to plan then you plan to fail and that is a simple truth. Extravagance with time is the greatest mistake anyone can make. Procrastination, laxity and the sort are things to be avoided and one of the ways to go about this is making a timetable (well that’s how I go about it). Set your time for specific things to do and follow it strictly – set out time to play and do other things, so you’ll need to move with a crowd that follows your routine at least to an extent.

Surely difficulties will be encountered in certain cases, for example when you have an exam approaching, it’s obvious precedence has to be given to greater priorities which in this case are your academics, your main reason for being there. Procrastination, as mentioned earlier, is a killer (oh yes, I’ve tasted its blade of tears). A concise will and dedication to your timetable can be of great benefit to you in escaping the clutches of this seductress called ‘procrastination’.

“Time na money”, the hit track of the legendary Mike Okri is a message to us all. You enter the market with 52560 hours to spend and how you do so will determine a lot.
Well, I wish thou all the best but before I drop this iPhone 9 let me quote a verse from the great evergreen book (KJV Bible) == Ecclesiastes 3, and it says, “For everything under medical school there’s a time for them all. A time to read, and a time to play. A time to socialize and a time to pray but never a time to idle away…”
PS. Go and buy an original Bible.

CAREER OPPORTUNITIES

It’s safe, I think, to surmise that a greater percentage of medical students seek to make a career out of their MB; BS or BDS degrees. Yes, we seek to save lives and bring hope and light into the bleak world of a patient or two (and that, by the way, is what it primarily should be about), but hey, one’s got to eat and clothe and provide for one’s dependents. Thus we’ll try to discuss just how wide the horizon is for us on the medical track; try, because for a mind that dares to dream, the limits are very much like the earth’s horizon- the horizon seems to lie on that highland but you get there and it simply moves to higher ground – always moving, extending as far as the mind’s eye can see. So we begin with the very obvious – clinical work. Many, after studies in medical school, proceed to become residents in different disciplines in medicine or surgery. After that, there are a plethora of places one can proceed to practice medicine – the armed forces, the prisons, companies, overseas aid work (some might have heard of ‘Doctors Without Borders’). Then there’s research work. Through discoveries, we know that there are so many diseases, pathogens, cures out there pretty much still unknown, and waiting to be flushed out of their hiding spots.

Research is how much what we know and study today were discovered. It’s not just about picking up a computer, however, and surfing the web; to do this, you need to acquire research skills. Clinical trial organizations, often working with pharmaceutical companies, and research institutes are few places medical researchers are most indispensable and, might I add, well paid. I believe some of us have done some research work at one time. If you got that thrill, exhilarating as it were, of coming across something new, then perhaps you should think of towing the research line.

A medical student may equally decide to go down the ‘teaching’ lane, university teaching to be precise. This would, of course, require him to specialize in one of the numerous fields, sometimes up to ‘Consultant’ stage. There are also administrative and political jobs available to doctors, within and without hospitals. There are health ministries and parastatals to be headed, universities and hospitals to be directed and doctors are perfectly qualified to do so. Psychiatrists, it is said, write some of the most beautiful poems. It’s possibly false but there abound doctors who’ve made careers out of writing or just used it as an escape from a monotonous lifestyle and my, what good it’s done them. So there’s that too – putting thoughts to paper, like a job or just because you can and love to. This list could go on and on because truly, being a doctor limits you only as much as you limit yourself.
PENDICAL

P. S. Click here to watch our YouTube video on why you shouldn’t study Medicine at the University.