THESIS/DISSERTATION AS A PART OF SURGERY FELLOWSHIP EXAMINATION: IS THIS NECESSARY?
From time immemorial and until the present, surgical post-graduate examinations in many advanced countries have never included the presentation of Thesis or Dissertation (T/D) for full fulfillment of certification for the post-graduate examination. The National Postgraduate Medical College of Nigeria copiedthis method of assessment from the European countries. Although those countries we copied from do not include T/D in their final post-graduate assessment, this does not preclude us from introducing T/D into our own examination if it will improve our certification. However, the introduction of T/D does not improve the quality of our certification, and it may even be a retrogressive step. We suspect this idea originates from the twaddle argument of comparing medical post-graduate qualification with a science PhD degree.
In the medical clinical settings, Theses/Dissertations (T/D) are usually submitted for a post-Fellowship degree after Fellowship qualification and after many years of practicing a specialty. This is not required as a part of a final post-graduate degree. Such a submission makes the specialist to have an additional higher degree Fellowship such as an M.D or an M.S (Master of Surgery) The M.S is not a science MSc degree but a much higher achievement!
the submission of T/D as a part of the Fellowship final examinations often argue that “such candidates are usually good at writing papers”. One should however ask what is the end point of our training programmes? Are we training our surgeons to be good at writing papers or are we training them to be good at diagnosing, operating on and managing surgical cases successfully? The aim of all specialist examinations in surgery is the later. and the fact that our Fellows are certified by the American Board, Canadian Fellowship, Arab Board or British Fellowship attest to it. The issue at times may be the level of dedication, commitment to work and willingness of the fellow to update in order to fit into the technology in the industrialized nations – a height which our training hospitals in the sub-region are yet to attain.
Many world-acclaimed researchers did their meaningful researches and discoveries after postgraduate qualifications and after many years of practicing their specialties. Some examples are: Drs Cole and Graham(1) who devised new method to detect gall bladder in 1924; Evarts A. Graham performed the first successful pneumonectomy in 1933; Allen O. Whipple introduced “Whipple’s procedure in 1935; surgical resident Robert E. Gross performed the first successful ligation of patent ductus arteriosus in 1938, and repaired of coactation of the aorta in 1945; Michael DeBakey invented roller pump for blood transfusion in 1940; Joseph E. Murray performed the first kidney transplant in 1954; Felix Eastcott and Charles Rob performed the first carotid artery surgery in 1954; Thomas J. Forgarty devised Forgarty catheter in 1961; Thomas E. Starlz performed first liver transplant in 1967; Christiaan Barnard pioneered heart transplantation in 1967 (1) and many others who popularised vascular surgery, like Charles Robb, DeBakey, Denton Cooley, Frank Spencer etc.
On the other end of the spectrum, using only Thesis/Dissertation as the part two of a FellowshipFellowship examination instead of the normal format of examination is even more questionable. Does a Thesis/Dissertation on insertion of a chest-tube make one a thoracic surgeon? Does the T/D on prostate cancer make one a urologist? Does the T/D of cases of head injury seen over a certain period of time make one a neurosurgeon? These are situations difficult to reconcile. And it is doubtful whether any meaningful research can be done at this stage of training. The format of our post-graduate examination should not be different from the internationally accepted format unless we can prove ours is better. After all, we do not want a West African surgeon; we want a surgeon from West Africa!
At the inception of the West African postgraduate training and certification, we used to have external examiners from the Royal College of Surgeons of England, and our certification enjoyed some reciprocity with the Fellowship of the Royal College of Surgeons (FRCS). That was how international our postgraduate certification was. We need to re-introduce the participation of external examiners from the UK and USA and maintain the reciprocity.
There seems to be some evidence to suggest that the idea of T/D for post-graduate examination by doctors is the result of an attempt to satisfy If this is so, it is most unfortunate. How can people who have never worked in a hospital or been involved in medical training of doctors dictate how Fellowship examination should be conducted? After all, any doctor who wants to conduct a meaningful research is at liberty to do so after post-graduate training and years of practising his or her specialty to obtain an MD or an MS degree.
One indirect negative effect of this Thesis/Dissertation policy is that it will convert our Fellowship into a “local examination” instead of an international Fellowship that it is now. Because of the logistics of getting a supervisor, approval of the proposal etc, a foreign doctor cannot just fly down during the week of our examination from other countries to write our Fellowship examination as some of us did for other Fellowship examinations. Some, while training in the US, flew to Canada and UK to write their Fellowship examinations. If these countries had T/D for full fulfillment of their certification this would not have been possible. But this did not preclude those candidates from conducting a meaningful research to write for an MD or an MS (Master of Surgery, not science MSc) degree in future.
Conclusion:
Theses or Dissertations in medical clinical setting are not meant to be a part of an exit post-graduate Fellowship examination in surgery. They are meant for award of post-graduate higher degrees like MD and MS (Master of Surgery.)
The main objective of a Fellowship examination is to certify a surgeon who is able to diagnose, operate on, and manage surgical patients successfully. The Fellowship examinations test cognate knowledge, requisite skills and best practices of the candidates which a thesis or dissertation could never do.
Reference
1. 100 Years of Surgical Quality Improvement. A publication of American College of Surgeons Page 7-15. O. G. Ajao
c/o Department of Surgery,
UCH
Ibadan, Nigeria
Phone: 08023138528
E-mail: ogajao@gmail.com