Why Nigeria needs more average (instead of star) doctors

Or, Thoughts on pre-med degrees as a bad idea

There was a bit of a scare in March when an official of the National Universities Commission here in Nigeria was believed to have announced a proposed increase in medical school duration from the current six years to eleven. After an uproar against this alleged proposal within the medical community, it came out that this was a misrepresentation.

Here’s what the NUC actually said:

NUC’s basic minimum academic standard for Medicine and Surgery had been reviewed such that anyone wishing to study Medicine and Surgery and Dentistry will first have to study any of the four-year basic medical science courses, such as Anatomy, Medical Biochemistry and Physiology, before proceeding to the clinical training that would run for three years.

This idea is not a new one. It’s pretty much what obtains in the United States, and talk of it has been around for awhile in Nigeria.

(Really though, when will we stop doing copy and paste? Especially when what we copy is questionable. Like trying attempt to duplicate, of all health systems, the one that has consistently proven to have the worst indices among developed nations—that of the US.)

Me, I have a problem with this idea of having intending doctors first do a pre-medical degree.

But before I say why, let’s be clear: this practice is not general worldwide. It’s a country by country thing. In the UK, for instance, the option of a pre-med exists for those already with a degree who then decide to do medicine. It’s not the default as in the US — and as on the minds of the folks at our dear NUC.

Back, though, to my problem with the pre-med degree idea.

Problem #1: Naija copy-and-paste

First, I have a problem with how we do things in Nigeria, generally. I mean, is it just me or do you often get the feeling we copy and paste bright ideas without really ever asking: Is [insert bright idea] going to produce the results we need?

Which of course raises the question: What results do we need?

I would argue that what we need in Nigeria (and Africa as a whole) is WAY more doctors. (And while we’re at it, way more healthcare everything.) I mean, before we get all crazy about specialisations, are we taking seriously the sheer fact that we don’t even have enough doctors?

Problem #2: How many of the 25 will come back?

Sorry, but have we actually considered the higher dropout rates we risk by insisting on a pre-med degree?

One 5-year study from right here in Nigeria found an attrition rate among medical students of about 8 percent—that’s 1 in every 25 students dropping out of regular medical school. (The study also cites another one which found a lower attrition rate in the US than in the UK, but the US figures were for those who had already completed pre-med and started medicine itself.)

God only knows how many of our remaining 24 actually go on to become doctors, or how many of us who do will stay in clinical medicine and actually see patients. If the entire 25 had to do pre-med first (and in this same Nigeria where the average graduate is probably glad just to be out of a frequently dysfunctional system, what numbers would we be talking about?

Problem #3: More or better—what if we had to choose?

I think the people of Nigeria deserve more doctors. In fact, I’d argue that Nigeria needs more doctors so much, we’d better take the chance of having more average doctors.

Why? Let me explain with a quote from one of my favourite stories:

“There is nothing like looking, if you want to find something. You certainly usually find something, if you look, but it is not always quite the something you were after.” ― J.R.R. Tolkien (from “The Hobbit”)

See, every system gets the results it is set up to favour. The problem is, sometimes, those results differ from the results those running the system intended. What you get may not be quite what you were after. The question is if you will realise and accept the inevitable result of your system, or if you will blame the system users (more on this in my post on how we misunderstand leadership, at the bottom of this one).

Of course it sounds nice to set up a system that will produce “great” doctors, true stars of the profession. In theory, why choose one when you can go for both? What that leads to in reality, though, is a system that makes it harder for the average person to pass through. Where the average person is, of course, most people. That then leads to more frustration, which would leads to dropouts, and in the end, less doctors. Not all of whom would still be the intended star doctors.

(As a Nigerian, do you find this “everything is harder” system strangely familiar?)

I know it might sound absurd to set up a system to produce “average” doctors, who are “just okay.” Why plan for “just okay”? Because going for that would lead to you graduating more doctors overall. Plus you’ll probably get more of the stars, too, just from the sheer numbers game of it.

There’s something else, though.

A number of really brilliant doctors didn’t do so great in medical school (I’m not mentioning any names). Some are considered stars, now. It makes one wonder, though, how many other potential medical stars withdrew from med school to other professions now. Doctors come in all flavours, and not all of those flavours were able to cope with the rigours of med school. (And as any doctor can tell you, surviving those rigours is itself no guarantee of competence.)

Ultimately, the difference between a system focused on producing “great” doctors and one trying to produce “just okay” ones comes down to the question they are looking to answer. Remember that quote says you may not, however find what you sought. In terms of the questions being asked of each medical student, we can say the choice of systems depends on whether we’re asking: “How much do our students get things right?” or “How much do our students not get things wrong?”

A system asking the first question is one looking to produce star doctors, with low tolerance for anyone who’s average. A system focused on the second question could focus more on producing safe doctors.

(To be clear, I’m not saying star doctors aren’t safe. I’m saying they may not be. And I’m saying that safe doctors don’t have to be stars. And yes, you can have both: safe doctors who are stars, but like I said earlier, systems tend to be biased toward particular outcomes. The point is, the two don’t necessarily go together.)

An example of a star doctor who is not safe. (I can’t use real ones, of course.)

As it turns out, the second question better positions us to produce doctors who really get the famous medical dictum.

Primum non nocere.”

Above all, do no harm.

I know I’ll seem to some (or many?) people to be oversimplifying the case, so I’m totally open to hearing your thoughts.

The post on leadership I referenced earlier:


Published by Doc Ayomide

I’m a medical doctor with specialty training in psychiatry, and I love thinking and writing about what it means to be human.

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