By Timi Babatunde
About three or four years ago, the British Royal College of Physicians was involved in a peer review process with one of her Nigerian counterparts, the West Africa College of Physicians. The objective was to assess areas of collaboration in medical education, evaluation and practice.
Unfortunately, as is typical for brilliant, well intentioned and novel ideas which go against well entrenched vested interests, the initiative came dead on arrival!
A cabal that eschews public scrutiny and accountability presided over the death of the initiative.
A few of us continue to aver that too much power is vested in the post graduate Medical Colleges which remains both the judge and prosecutor in her own cases! It determines the standards of graduate medical education, determines the standards for residency programs, determines the standards and formats for the examinations, administers these examinations and determines individuals it deems fit to qualify as specialists. She will also adjudicate in any appeals against it, an exercise in futility.
The colleges are a law unto themselves with no external checks and balances. They are not accountable to the public. They carry on as though not answerable to anyone.
The reason is that the federal government which underwrites the salaries of these resource persons has never demanded results. No one has ever challenged their methods. They resist oversight from the National Universities Commission in a battle of egos and continue to inflict unimaginable pain on multitudes of wannabe specialists through their non evidence based methods. The tragedy is that no one is asking questions!
For each resource person maintained and millions of naira in salaries, what are the correspondent outcomes in terms of specialists produced annually? Are any quotas for training outcomes specified? Are the throughputs done with local and national needs in mind? What is been done to meet the specialist needs of the North East in five years time? Their need for pediatricians, Psychiatrists, Surgeons, etc?
Indeed, the thrust of the recommendations by the Royal College was precisely in the areas of planning, resource allocation, objectivity, standardization, transparency, accountability and international best practices. These recommendations were roundly dismissed by some of the faculties (Psychiatry) and selectively adopted by others. A case of double standards, raising questions of governance and regulation.
The developed countries adopt a process which matches supply of specialists with demand, which ensure outcomes for resource allocation and which lends little opportunity for manipulations, ensuring accountability from top to bottom.
Transparency and accountability is often achieved by a process of quality assurance which articulates what the definitions, standards or measures of quality are what needs to be done to achieve this quality and spells out the steps to achieve this end- in a dispassionate manner.
Quality assurance in graduate medical education should begin with the separation of the bodies responsible for setting and upholding the standards for graduate medical education and the body that implements these standards.
This transparency, accountability and quality assurance continues by ensuring that each medical specialty conforms and implements the recommendations of the ACGME to the letter. Interestingly, each specialty or faculty is made to apply individually to the ABMS, and its conformity to recommended guidelines assessed before acceptance to the general board. A case of the dog wagging its tail, not the other way round.
The Objective Structured Clinical Examination, OSCE also replaces the obsolete and highly subjective clinical “long case” exams. Adoption of OSCE ensures uniformity, and standardization of clinical examinations, and all candidates get to see the same patients and examiners without the allegations of bias or nepotism.
The sector will remain in its current sorry state unless the conceptual underpinnings of healthcare delivery is revisited, new mechanisms and processes engaged, accountability and transparency to the public made its cornerstone, and a more appropriate model for its delivery employed.
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