A CASE AGAINST THE MEMBERSHIP PROGRAMME PROPOSAL OF THE WEST AFRICAN COLLEGE OF SURGEONS
ABSTRACT
Following the meeting held in Accra, Ghana in September 2012, a draft proposal on Harmonization of Surgical Training was submitted for final consideration by the four Colleges in the West African Sub-region. The Council of the West African College of Surgeons (WACS) was mandated to produce a Membership Curriculum separate from the Part 1 programme of the Fellowship Examination. This, in essence, means that there is a proposal to have a Membership Examination and certification in addition to the well established Fellowship Examination and certification. This means that there will be a lower standard of examination for Membership certification than the Fellowship Examination.
The President of WACS in the presidential address in Liberia at the 52nd annual meeting made an allusion to “the reluctance of Faculty of Surgery to go along with the Membership” plan.
We fully support the reluctance of the Faculty of Surgery in this regard, and the following will explain our position. It was George F. Will writing for Newsweek Magazine some years back that stated that what people learn from History is that people do not learn from History. This statement could not be truer when we consider this proposal. The Canada Experience.
Before 1972, Canada used to have two categories of post-graduate certificates: the Specialist certificate and the Fellowship certificate. This is how it worked. After an approved four-year residency surgical training, a resident is eligible to sit for the Fellowship Examination of the Royal College of Surgeons of Canada (FRCSC). Those who passed very well were awarded the Fellowship certificate while those who did not meet up to the standard but considered to be probably on the borderline were awarded the Specialist certificate of the Royal College of Surgeons of Canada. The third group consisted of those who failed completely; they were awarded nothing. In essence therefore, the award of a “Specialist Certificate” in Canada was tantamount to the award of a “Failed Fellowship Examination”.
The candidates with Specialist certificates and those who failed the Fellowship examination completely were at liberty to repeat the Fellowship examination many times until they were, by their performance, qualified to be awarded the Fellowship certificate.
But in 1972, Canada abrogated this practice, and jettisoned the idea of awarding Specialist certificate. So, one has to pass the Fellowship examination well and be awarded a Fellowship certificate, or he failed the examination and be awarded no certificate at all. Canada must have had very valid reasons for doing away with having two categories of post-graduate certificates. This is also what the Faculty of Surgery practices now. The competence of such residents with the specialist certificate is inappropriate and could do harm to the unsuspecting patients if left to practice unsupervised.
Comment
Now in 2013, it is being proposed that WACS adopts what Canada abrogated in 1972 - 40 years ago! What a gargantuan retrogressive step! If the reason for this is because of a high failure rate in the Fellowship examination, do we have to lower the standard for the sake of mass production of mediocre surgeons? A needs assessment should be carried out to identify and provide lasting solutions to the high failure rate. Fellowship examination is an exit examination and since there is no limit as to the number of times a candidate can sit for the examination (and there should be no limit), the candidate just has to repeat his clinical postings in order to improve in all domains of surgical training, and repeat the examination until he/she meets the required standard when the performance is appropriate and safe to function independently as a surgeon, in the interest of the general public.
If we accept this Membership certification proposal what will be the status of such candidates? Will they be regarded as “Specialists” or “half-specialists”? Will they qualify to be consultants in hospitals or “half-consultants”? Will they qualify to be lecturers in medical schools or “half-lecturers”? These are the insurmountable, unnecessary complications that will surface if this membership shenanigan is introduced.
The Way Forward.
In making decisions in academic line, political brinkmanship should not be allowed to cloud our judgment. What therefore should be the way forward? Any surgical resident who has completed adequately the approved period of training should be given an “internal” testimonial by the hospital where he trained stating that the candidate has completed his residency programme in the specialty, and therefore eligible to sit for the fellowship examination. Such testimonial should be signed by the Chief Medical Director (CMD) of the hospital, the Head of Department (HOD) of the candidate and the Programme Director of the candidate. This will be similar to what obtains in the USA where after completion of residency programme one is considered as Board Eligible.
University College Hospital, Ibadan in Nigeria tried something like this some years ago; this could be re-appraised. The “internal certificate” means that he can function as a surgeon but he has not passed the required examination to make him take up a university teaching appointment or function as a consultant surgeon in any hospital.
Conclusion.
In conclusion, the idea of introducing membership programme is seen as a retrogressive step that will create a cadre of mediocre surgeons who may claim the full right of a Fellowship candidate. But giving a testimonial of exit indicating the rotations and years of their residency training (Fellowship eligible) will suffice until they are able to pass the Fellowship examination. This used to be the practice in America and it has worked very well. The competence of such a resident is inappropriate and could do harm to the unsuspecting patients; he still needs to practice under supervision.
Professor O. G. Ajao FRCSC, FWACS.
c/o Department of Surgery,
University College Hospital,
Ibadan, Nigeria. E-mail: ogajao@gmail.com
&
Professor B. T. Ugwu FWACS.
Department of Surgery,
Jos University Teaching Hospital,
Jos, Nigeria. E-mail: ugwub@yahoo.com
RE: A CASE AGAINST THE MEMBERSHIP PROGRAMME PROPOSAL OF THE WEST AFRICAN COLLEGE OF SURGEONS Dear Editor-in-Chief,
The summary of the Commentary is a rejection of the proposal. The reluctance of the Faculty of Surgery to produce second class surgeons should be understood from the reasons adduced.
In the past, the pass rate of candidates sitting the examination in surgery was a lot better than it is currently. Perhaps candidates took their studies more seriously than the present candidates who seem to have many distractions such as need for exotic cars, lack of adequate accommodation with its security implications and the need to raise a family. These are factors amenable to control by the individual or government. Countries which need surgeons should invest in the proper training of surgeons. Sadly, the orientation of several governments towards the welfare of citizens leaves a lot to be desired.
Government can designate those who have not been able to obtain fellowship certification as government wishes. Resort to blackmailing the Faculty of Surgery to award membership certificates to candidates who fail to obtain the Fellowship status cannot solve the need for well-trained surgeons now or in the future.
The West African College of Surgeons should brainstorm with practicing surgeons to find ways to improve on the education of surgeons in terms of numbers, quality, skills acquisition, best practices and specialization. This is preferred to the issuance of second rate certificates. We should borrow a leaf from the history of Canada on the subject matter.
By
Professor Ndubuisi Eke, FWACS
Department of Surgery,>br>
University of Port Harcourt Teaching Hospital,
Port Harcourt,
Nigeria.
E-mail: ndueke2004@yahoo.com