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SICOT e-Newsletter

Issue No. 63 - December 2013

Training Around the World

Orthopaedic Residency Training in Nigeria

Amupitan Idumagbodi
SICOT Associate Member - Jos Plateau State, Nigeria

Nigeria is a highly populous country blessed with many natural resources, and the health sector, which is still developing, boasts of a national medical college, the National Postgraduate Medical College of Nigeria (NPMCN), and also a regional college, the West African College of Surgeons (WACS), which is under the West Africa Health Organization (WAHO). Training as a specialist is being undertaken in either of these two Colleges in Nigeria. I am Dr Amupitan Idumagbodi, an orthopaedic surgeon with the Jos University Teaching Hospital, Jos, which is located in the North Central Region of Nigeria.

Residency training in Nigeria is conducted in any of the hospitals accredited by either college to train orthopaedic surgeons. It commences after such an individual has finished his undergraduate training that lasts 6 years, a year of internship divided into four rotations and the mandatory National Youth Service Corps (NYSC) programme which lasts a year.

The training period commences with the acquisition of a pass in the entrance examination referred to as the primaries examinations of either of the two postgraduate colleges and must possess a current practising license to practise medicine in Nigeria from the Nigeria Medical and Dental Council as well as the mandatory discharge or exemption certificate of the NYSC programme. There are dedicated orthopaedic hospitals as well as teaching hospitals that offer residency training in orthopaedics. The intending trainee can then apply to any of the accredited hospitals after a rigorous selection process due to the large number of medical graduates interested in Orthopaedics to commence the training.

The training period is divided into two stages, the junior residency and the senior residency. During the junior residency, the trainee is expected to rotate through various surgical subspecialties for at least 30 months; the trainee is also expected to attend mandatory relevant update courses during the period. The trainee can now proceed for the Part 1 exams of either the WACS or the NPMCN. To qualify for the exams the candidate must have submitted his log book which documents a minimum number of performed procedures. The would be surgeon is expected to acquire skills in principles of surgery, resuscitation of patients and be able to perform basic procedures which cut across all subspecialties. The examinations test summative knowledge of the candidate while the log book documents the formative assessment of the candidate from the training centre.

If a trainee is successful in the Part one examination, he can then proceed to the senior residency training in an accredited hospital. This consists of rotations in various subspecialties of orthopaedics for 6 months each for a period of at least 36 months. During this period the doctor is also expected to carry out an original research and write a thesis which would be presented and defended orally at the final examinations. He is entitled to a one-year clinical attachment which he can do in any hospital outside Nigeria. At all stages, the candidate is expected to be actively involved in the management of all patients and carrying out procedures on patients.

Teaching during the residency periods consists of informal and formal teachings. Informal teaching occurs during the outpatient clinics, ward rounds and theatre sessions and formal teachings take place during the update courses, journal clubs meetings, Grand rounds, clinicopathologic and clinico-radiologic meetings. The resident is also expected to present cases at such meetings.

After satisfactory completion of each of the stages, the resident will have to take exams, which consist of multiple choice and written exams, clinical exams comprising of long case presentations, short case presentations and orals. There is also a presentation of the thesis and defense at the fellowship examinations. The resident then qualifies as a general orthopaedic surgeon, if successful in the fellowship examinations. He is awarded a fellowship of either college. However, the resident is encouraged not to rest on his oars at this stage but rather to proceed to a post-fellowship training in any subspecialty in orthopaedics that is of interest to the individual, which is usually outside the Nigeria.

Orthopaedic training in Nigeria can be very demanding and challenging due to the population of the country and the few numbers of training centres. There are also infrastructural challenges which are not uncommon in sub-Saharan Africa. The orthopaedic surgeon and orthopaedic resident are exposed to a wide variety of cases, the bulk of the work being trauma cases.

The journey to becoming an orthopaedic surgeon can be very tough likened to running a marathon. It gets tougher with each mile but finishing the course with the reception of the fellowship award always overshadows the difficulties.