HouseJob Chronicles: What School Did You Finish From?

Hey folks,

First of all, this post is long over due. I’ve being working on the draft since like forever and even abandoned it at some point, cos no time.

So I have had a crazy few days post-leave. I’m so stressed out that I could use another break! Lol.

My face during Intern’s Pre-round…lol

I’m just glad I got to publish this, at last!

The post is especially for, but not limited to the Foreign Trained Doctors (FTDs).

My “brothers and sisters” from the diaspora, welcome back to REAL LIFE- Naija Version!

I’m sending you thousands of cyber hugs that will last you through the first few months of your House Job at least.


If you’ve passed through the MDCN hurdles already, you’d have observed that the system is NOT ready to welcome you with open arms. I’m not even kidding…

If you’re one of those patriotic FTDs (I’m not one btw🙄), who returned with high hopes of contributing your skills and expertise to the expansion of Naija’s health sector; I’m sorry to burst your bubble:

Whatever fancy reasons you had for returning to Naija, no one cares.

It is a sad reality.

But for what it’s worth, there are some great moments too. Like having patients discharged after spending days/weeks in the hospital or hearing an uncooperative patient Left Against Medical Advice (LAMA)…lol. I should do a separate post on that.

Anyhow.

So once you start your house job, expect to feel intimidated by your seniors. Naija doctors love to move STUFF. Eeesh!!

The million-dollar question that got my fellow interns tongue-tied, like we weren’t expecting it…lol! 

It wasn’t a funny scenario but I can laugh it off now.

The “Ogas” at the top love to deliberate on which is the best medical school in Naija, so they keep setting baits for house officers in form of questions, sane or otherwise.

Whether you are foreign trained or locally, you’ll experience this at some point or the other, although the former seem to be more at the receiving end.

Having passed through the initiation process of getting asked the same question multiple times, I have a few tips for upcoming House Officers:


1. OWN your identity.

You’re a MEDICAL DOCTOR, with a CERTIFICATE and a LICENSE.

So wear it like a cape. Be PROUD of it, because it’s who you are.

Embrace it. Love it. Live it.


If you schooled abroad, it was your decision, your money (whether sponsored or not) and your experience. Ditto if you were locally trained.

Even if studying Medicine was a mistake, it was the best mistake of your life.
Don’t let anyone guilt-trip you on it.
2. You have NOTHING to prove.

You heard that right.

There’s NOTHING to prove to anybody.

Not your skills. Not your knowledge. Not your personality.

What you know was enough to get you to this level. And if you build on your knowledge and skills, you can (and will) get better.

Remember, your senior colleagues (Regs, SRs, Consultants) did not get all their medical expertise during their housemanship year.

They earned it with time. Life takes time. 

So while there’s always room for improvement, you have NOTHING to prove.



Remember this.

3. Do it with JOY!

When all is said and done, what really matters is the impact you made wherever you find yourself.

So whatever you do, do it with EXCELLENCE. And COURAGE. And JOY.

Give the kind of care you would like to receive.


Put in your very best at all times, even when it’s hard. It’s okay to feel out of place sometimes but don’t let anyone (not even yourself) hold you back.

***

Image: http://www.eunicesmiles.wordpress.com

I’ve asked myself this question a couple of times, and tried to answer it as sincerely as possible:

My answer is YES.

And to add to that, given similar circumstances in the current Naija, I’d still study abroad and maybe the very school I attended. Tenkiu!



Cheers!

:::requ1ne:::

   ❤️❤️❤️
Disclaimer: All images unless otherwise tagged, were obtained from the WEB.

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MY MDCN EXPERIENCE (Part 3): TALES FROM LUTH

Hey guys,

Here is the final part of my MDCN Experience. I’ll be sharing some of the highlights and challenges I had in my Centre.  
First, I’d like to thank Dr. Tosin of lifewithtwotees.com, who was kind enough to blog about her MDCN experience (July-October 2015). I was privileged to come across her blog a few months before I returned to Nigeria. Fortunately, I got to do my MDCN remedial course at LUTH as well, and her tips were helpful. 

About MDCN



The Medical and Dental Council of Nigeria (MDCN) is the umbrella body for medical doctors and dentists practicing in Nigeria. A primary function of the council is the issuing of provisional licenses for foreign trained medical and dental graduates, and inducting them into the Nigerian Healthcare System.
The license is issued to Foreign Trained Doctors (FTDs) after a satisfactory performance in the stipulated exam, following a 3-month remedial course at specified Tertiary hospitals.

The MDCN remedial program which takes place twice (January-April/July-October) every year, cuts across different Teaching Hospitals in the country. The usual centers are:

– Lagos University Teaching Hospital (LUTH), Lagos.
– Ahmadu Bello University Teaching Hospital (ABUTH), Zaria.
– Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife.
– University of Benin Teaching Hospital (UBTH), Benin.
– University of Nigeria Teaching Hospital (UNTH), Enugu.

(For more information about MDCN, visit mdcn.gov.ng)

Tales from LUTH



The last MDCN Remedial Course (January-April 2017) was held at Lagos University Teaching Hospital, Idi-araba, Lagos. I resumed a week after the program had commenced and I discovered there was a lot of catching up to do already. To add to the stress, I had to be going about looking for a suitable accommodation. Thankfully, I found one in Mushin, and moved in with a friend about 3 weeks into the program. 
Like I mentioned in my previous post, the earlier you get settled into the program, the easier it will be.
Tbh, the 3 months duration was pretty intense, much like a boot camp experience. In comparison, my medical school days were such a luxury.

The Structure
There were Foreign Trained Doctors from all over the globe: Egypt, Hungary, Ukraine, Russia, St. Kitts, Dominica, St. Vincent, Ghana, South Africa, Sudan, London, Uganda, Ireland, India, Canada etc

Image credit: WEB

Over 300 candidates registered for the remedial course at LUTH. First, we were divided into four groups (A-D) for our clinical postings, then further divided into subgroups for the different units.

Lagos University Teaching Hospital (LUTH) Premises

The Schedule

On week days, we had ward/clinic activities in the 4 major departments (Medicine, Surgery, Pediatrics and Obstetrics/Gynecology). We resumed anytime from 8 a.m. to 1 p.m., depending on the department/unit. We also had logbooks for attendance where the Consultant/Senior Registrar available in the unit would sign.
My postings were in the following order:

1. Pediatrics (Infectious disease/Cardiology unit)
Since I resumed the remedial program a week late, I spent the shortest time in that department.

Highlight(s)
: The usual ward rounds which included bedside patient examinations and drilling, an outpatient clinic with the consultant (who took her time to teach us after we had clerked some patients); and a departmental seminar where a project was proposed by a SR, followed by an interesting debate with the topic- The Doctor: The King Or A Pawn? Several arguments where made for and against both labels, but the moderator’s conclusion was that the doctor is neither the king nor the pawn, but a visionary leader who is to adequately head the healthcare team.

Challenge(s)
: I was a little flustered while in the unit, because of a particular SR who made me nervous on several occasions. I’d missed a rather cheap question (something on an antibiotic) and she seemed to pick on me afterwards. Thankfully, that was the only posting where I experienced such a challenge.

2. Obstetrics and Gynecology (Reproductive Endocrinology and Fertility Regulation unit)

Highlight(s): Outpatient clinics and ward rounds. The Regs in O&G really moved stuff, so I learnt a number of important things, like how to use the Partograph.

ImageCredit: WEB

In one of the clinics, I clerked a patient with another colleague, and our top differential diagnosis was Amenorrhea, only to be told afterwards by the supervising Reg, that it was simply a case of Secondary Infertility!
Shame no fit catch us that day, but we live to learn, and thankfully we did learn.

Challenges(s): Well, the experience was quite pleasant although I didn’t get to observe any labour & delivery or c-section because of the unit I was posted to.

3. Internal Medicine (Renal unit)

Image Credit: WEB


I had an interesting time here as well. There was a lot to learn on a daily basis. The team members were quite accommodating too.

Highlight(s)
: Ward rounds and Outpatient clinics.

Challenge(s)
: It was quite sad to see a number of patients suffering from chronic renal insufficiency, not able to afford payment for their dialysis.

4. Surgery (General Surgery unit)

This was eventually the least stressful of my postings.

Originally, I was posted to the Neurosurgery unit, which I accepted in good faith, despite the rumors of unpleasant treatment from the unit.
To cut the story short, the few days my colleagues and I spent there was “not it”. We were a bit restless trying to be punctual at all costs and to adhere to the rather strict guidelines of the team.
Eventually, we were kicked out by the Chief Reg himself, because we failed to turn up for the unit call that weekend! All our pleas fell on deaf ears.
And how relieved I was, because I had gotten so worked up anyway.

The General Surgery team members were a lot more accommodating and less intimidating and I did learn a couple of things from them.

Highlights
: Ward rounds, Seminars, Clinics and Minor Surgeries. It was overall an interesting experience for me, not just academically but also socially.

Challenges
: I was unable to observe any of the major surgeries, during my posting, due to a limited supply of surgical scrubs. One thing common to the Operating rooms both in my med school and LUTH was this, the “Nursing Sisters” were in charge! Whoever they refused to help remained helpless.

The Lectures

With My Roomie, Dr. Ify Aralu😉

The lectures took place from 2pm to 5pm, from Mondays to Fridays. On some days, we were lucky enough to finish on time and on not-so-lucky days, the lectures ended much later. All lectures were either in PowerPoint or PDF format, and our class representatives did a great job of getting them across to us.
We were exposed to a variety of lecturers, some were really nice and enthusiastic about teaching us, they were not just concerned about the remedial course, but also inquired about our general welfare and how we were coping in the Nigerian environment; a few were indifferent, they simply taught us and left, and we had a number of sarcastic ones, who spoke as if training outside Nigeria was a crime itself.

The courses we covered were quite extensive:

– Surgery
– Pediatrics
– Obstetrics and Gynecology
– Internal Medicine
– Microbiology
– Chemical Pathology
– Anaesthesia
– Morbid Anatomy
– Community Health
– Hematology
– Psychiatry
– Radiology

My favorites were Anaesthesia, Community Health and Psychiatry.

Tuberculosis, Malaria and Sickle Cell Disease were high yield topics that came up in almost every course.

We learnt some interesting mnemonics too e.g.

SHADE
for Family History
S-Sickle cell
H-Hypertension
A-Asthma
D-Diabetes
E-Epilepsy

NASORATI
for Patients Biodata
N-Name
A-Age
S-Sex
O-Occupation
R-Religion
A-Address
T-Tribe
I-Informant

and

5 Cs for h/o Presenting Complaints
Course
Character
Cause
Complication
Care

Overall, it was a worthwhile experience and I enjoyed the MDCN remedial course. For those hoping to participate in subsequent ones, I hope you find the experience equally enjoyable.

I wish you success! 


:::requ1ne:::
❤️❤️❤️

MY MDCN EXPERIENCE (Part 2): How to approach the Exam.

The MDCN exam is relatively easy to attempt, if you have the right kind of information.
I’ll share a few tips that worked for me, which you can apply as well in preparing for the exam.


1. To thine own self be true.
Know why you’re in Nigeria. Not all that came to write the licensing exam, plan to use it. For some, practicing in Nigeria is a second, third or fourth option. Roughly a quarter of the candidates in my centre were planning to port (i.e. Return Abroad). If you’re not ready for Naija wahala, just sit at home and chill. And if you’re in it for real, then make sure you double up.

2. What you don’t know, you don’t know.
You may have to unlearn and relearn some things, especially with history taking and physical exam, because Naija stuff get levels and as far as “they” are concerned, it’s either their way or no way.
For instance, when I saw the way they palpated for enlarged lymph nodes in a patient, I just humbled myself and went to learn it.
Another example was learning to use the Mercury sphygmomanometer, which I wasn’t very familiar with. When you’re not sure, just ask. It may be embarrassing at first, but it’ll be to your advantage later on.

3. Listen with sense.
Not everything you hear is true…learn to sift through the noise and hold on to the fact. There will be rumors to your left and to your right, and some of them will overwhelm you but you must not allow your heart to fear. Remember, it is just MDCN, not an exam to enter heaven 😂

4. Be present when it matters.
Not every tutorial, not every call, not every seminar counts…but MOST of the rounds and classes are important. MDCN requires 70% attendance (of ward activities/classes) for you to participate in the exam; and over 80% of the exam material will be covered during lectures. Be wise.

5. There is no time to waste time.
Start studying the moment you resume…unless you’re a specific kind of genius with a type A brain, your plans to start studying just a few days to the exam won’t work. Trust me, the work load piles up on you like toppings on a slice of Pizza. Just like med school, you can use some of these STRATEGIES to scale through the MDCN exam. Past Questions are the main resources you should revise with for the exam. Don’t be lured into buying giant textbooks and whatnots. The truth is, you don’t need them. 

6. Beware of 419.
There are evil people ready to scam you of your money, abuse your body (Dear Ladies, take heed) and rob you of your integrity. You don’t need the backdoor to succeed in the exam, nor any “special help” from those in-the-know. Exam Malpractice is a grievous offense and the examiners take a lot of measures to curb it. If you’re caught, you’ll be asked to face the music.

7. Don’t lose your Confidence.

This is by far the most important tip. Your Confidence is your greatest ally. Prepare as much as you want, if you lack confidence, you’ll mess up. It took me weeks of motivational articles, positive self-talk and prayers, to get myself mentally ready for the exam. Thankfully, I was able to scale through it.

*** ***

The Exam Format
(LUTH Centre)
From the information I gathered, the exam varies from Centre to Centre. In Lagos University Teaching Hospital (LUTH), where I sat for mine, the exam was 3-fold.

Day 1
PAPER 1- 150 MCQs
PAPER 2- PICTURE OSCE and Clinical Scenarios

Day 2 (Main OSCE)

Station 1 (Pediatrics)
: History taking from the mother of a jaundiced baby.


Station 2 (Surgery):
Abdominal examination for a patient with suspected Acute Cholecystitis.

Station 3 (Obstetrics):
History taking in a woman who presented for Antenatal care.

Station 4 (Medicine):
Cardiovascular Examination in an otherwise healthy young man.


PS:
– For the MCQs, it’s advisable to do as many questions as you’re certain about and leave the rest. We were made to understand that “negative marking” was implemented for our exam, and a lot of candidates in my centre were affected.
– Each OSCE station was timed for 5 minutes, so it’s important to work within the given time. The more you practice with your colleagues, the easier it is to achieve that.
– Arrive early at the venue of your examination, you don’t want to be stressed out before you start. And have a light breakfast if you can, you’ll be glad you did. 

 “You can get horses ready for battle, but it is the LORD who gives victory.”

Proverbs 21:31 GNB

With God, MDCN is possible.
I wish you success.

:::requ1ne:::
❤️❤️❤️
*OSCE: Objective Structured Clinical Examination.