ACCESS AND QUALITY IN THE MEDICAL PROFESSION IN NIGERIA VIA PSYCHOLOGICAL TESTING

BY

PROFESSOR ALPHONSO I. IKEOTUONYE, fnae

FACULTY OF EDUCATION

UNIVERSITY OF ABUJA, ABUJA

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Abstract

From experience and research it is clear that the medical profession in Nigeria is littered with dangerous doctors. This is because the present admission process into the profession lacks the capability to select only the best candidates. Hence a new selection process has been described in detail, and recommended. This new process has the capacity to identify the best candidates for the profession; candidates with the appropriate levels of intelligence, aptitudes, and school achievement, as well as appropriate personality characteristics. The training programme should also have inbuilt continuous selection procedures. A school testing programme will make the proposed selection process rather easy. The overall aim of the new process is to produce the best crop of medical doctors for Nigeria.

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Introduction

Some years ago, in interactions with his Masters and doctoral students concerning the job performance and behaviours of Nigerian medical doctors, the writer found out that the picture was gloomy. He decided to extend his curiosity to members of the public. The picture that emerged was similar to the one painted by the students. It was then that the writer recalled what happened in a part of Nigeria much earlier; which he commented on (Ikeotuonye 1986). A doctor forgot a pair of scissors in a woman’s belly. Strange! Isn’t it?

The writer’s curiosity about the job performance and behaviours of Nigerian medical doctors got heightened when he became Dean of postgraduate school. A good number of medical doctors applied for admission into Postgraduate Diploma in Business Administration and Masters in Public Administration. He could not believe his eyes and ears. He engaged some of them in conversation in order to find out why they were interested in postgraduate studies in business and public administration instead of medicine. The answers he got actually pointed to interest in making money rather than professional growth and development.

There is still another incident worth narrating here. The writer went to a Nigerian university to clarify the issue of admission for his daughter. While he was with the Head of Department, a man walked in. He was anxious to know if his Joint Admissions and Matriculation Board (JAMB) score came within the cut-off point. The HOD checked through the list and congratulated him. In the process of jubilating, he revealed that it was his fifth attempt at the JAMB examinations. The writer quickly estimated his age, and put it at 25 years. The man said that he got it right. You can imagine that man becoming a medical doctor. The question is: Did he get through, that time around, because his capabilities suddenly increased; or because he became sophisticated in test- taking skills? Another question that could be raised is: Was he the one who wrote the examination in that fifth attempt?

The cumulative effect of the experience narrated above was a very strong doubt about the competence and the behaviours of Nigerian medical doctors. The writer decided to do something about it. He, therefore, got one of his doctoral

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students to research into the personality characteristics, vocational interests and job satisfaction among medical doctors in hospitals in a location in Nigeria. The study (Ojiah 1998) came out with very important findings:

1. Only 44 percent of the medical doctors involved in the study (that is 51 out of 116) had personality characteristics appropriate for the medical profession. This is not only unbelievable but depressing.

2. Only 50 percent of the medical doctors (that is 58 out of 116) had vocational interests appropriate for the profession. Again, this is unfortunate.

3. On the average, the medical doctors liked their job and felt satisfied with it.

One of the recommendations by Ojiah was that there was need for a rigorous selection process into the medical profession.

The Present Selection Process

It is known that there is no special selection process into the medical profession in Nigeria. Secondary school students or graduates who wish to read medicine sit for the Joint Admissions and Matriculation Board examinations. Those of them who come within the cut-off point of various universities are given admission to read medicine. It is only recently that some universities introduced post JAMB examination. Even then, the one that the writer has seen comprises objective questions in English, Mathematics and General Knowledge. This, of course, is similar to JAMB examination in some respects.

In addition to secondary school graduates who are admitted into medicine, there are university graduates in the sciences who are also admitted. This also is not the kind of selection process that will bring out candidates who are talented and properly disposed to read medicine.

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The Uniqueness of the Medical Profession

The medical profession is one of the few areas of human endeavour that require special talents. It is not an all comers’ profession. Even engineering cannot compare with medicine in its requirement of a very high level of talent. If we may compare medicine with teaching, for example, it is easy to see that the teaching profession, particularly at the primary and secondary levels, has tolerance for a very broad spectrum of talents. The medical profession has spaces only for the best of human abilities. The writer is a teacher; thus, he has no intention of discrediting his profession. Some professions or areas of human endeavour have tolerance for a wide range of talents; others do not have that kind of tolerance.

A teacher can afford some types of mistakes which he can correct later. A teacher, for example, can give wrong information and correct it immediately or later. An engineer can come out with a faulty design and correct it later. A lawyer can err in law. If a court judge errs in law at a lower court, the mistake can be taken care of at a higher or appeal court. What has been written can go for some other professions. The question is: Can the medical doctor afford mistakes with human life? Another question is: Can the medical doctor afford to be unethical with human life? The answer to the two questions is: Even the slightest mistake or unethical behavior by the medical doctor can cost human life.

Need for a Very Rigorous Selection Process

The need for a very rigorous selection process into the medical profession cannot be overemphasized. In one of his publications (Ikeotuonye 1990) the writer presented a very common situation that students go to counselors with, namely, “I would like to be a medical doctor.” It was stated in that publication that “this is a complex counseling situation that should bring future happiness to the student; but conversely can spell disaster if mishandled” (Ikeotuonye 1990:204). It is very important to add that if the counseling is properly done, it brings happiness not only to the student but also to society. On the other hand, if the situation is

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mishandled, it spells disaster, for sure, not only for the individual but also for society.

The suggestion was also made (Ikeotuonye 1990) that the following questions are pertinent.

1. At what occupational level can the student perform?2. What are his or her specific abilities?3. What is his or her level of school attainment?4. What are his or her personality dispositions?

A good selection process into the medical profession must provide concrete, precise, valid and reliable answers to the questions stated above. Any process short of that will continue to present the situation of littering the Nigerian nation with dangerous doctors. In fact, Nigeria has no shortage of dangerous doctors. The reason why the situation has not come to the fore is that Nigerians hardly know or bother about their rights. Again medical doctors are still in short supply.

Thus, if the Nigerian nation wants a good crop of medical doctors, the selection process must be rigorous. It is absolutely important to determine a person’s general scholastic and occupational ability (Ikeotuonye 1990, 2003). Here comes the need for intelligence tests. Medicine requires a very high level of intelligence. Split second decisions have to be made. Human life can be saved or lost in seconds. As far as the writer is concerned, the medical profession is not for persons with average intelligence. Average intelligence, which is probably where most Nigerian doctors belong, is not for the medical profession.

Just imagine that Nigerian medical doctors, unfortunately like their counterparts in other professions, view developments in the medical profession with awe and bewilderment. For the average Nigerian medical doctor, practice comprises listening impatiently to patients and prescribing drugs, sometimes the wrong drugs. It is unfortunate. You can imagine what the situation will be in future with ill-prepared Federal, State, and Private Universities pretending to train medical doctors.

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As stated above, the beginning point of selection into the medical profession is the determination of the person’s general scholastic and occupational ability by means of a valid and reliable intelligence test. The next step is to assess the person’s specific aptitudes, that is, if he has the appropriate level of intelligence. If he does not, the selection process, for him, comes to a close. This is because as stated elsewhere (Ikeotuonye 1990, 2003) an intelligence test can tell you the occupational level at which an individual can perform, but it cannot tell you anything about the individual’s specific abilities and limitations.

An individual’s specific aptitudes are easily identified by means of aptitude tests. The aptitude profile of a person very clearly shows his or her strengths and weaknesses. The aptitude profile shows the occupational cluster in which the individual will rely mainly on his strengths with little or no demand on his weaknesses. The write notes with pleasure the recent development in the banking industry whereby selection into the industry is now based on aptitude testing.

The selection process into the medical profession is only about half-way through if the individual scales through the intelligence and aptitude tests. It is now time to look at his school attainment. School achievement helps to determine an individual’s readiness to benefit from a course of training leading to a desired occupation. The training programme that leads to a first degree in medicine requires excellent achievement in the prevocational subjects, namely, mathematics, biology, chemistry, physics and English Language. The person aspiring to be a medical doctor needs to show excellent attainment in the named prevocational subjects.

This is now the juncture at which it is appropriate to recall that Nigerian universities base selection into the medical profession mainly on JAMB scores and school achievement. Even then, very low levels of school achievement are acceptable to most universities in Nigeria, particularly when they are backed up with personal intervention variables, including the notorious quota system of selection. Those interested in the writer’s views on the quota system of selection

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can see a couple of his previous publications (Ikeotuonye 1986, 2003). A summary of his view suggests that for very sensitive situations like selection into the medical profession, the quota system should not apply, not at Local, State or Federal levels. Only the best is good for the medical profession.

If a person who desires to go into the medical profession scales through the intelligence, aptitude, and achievement tests levels, he is close to the end of the initial selection process. What is left is the assessment of his personality. This is as important as the levels before it. Ikeotuonye (1986, 1990, 2003), Ikeotuonye, Maisamari and Badu (2003) and Ojiah (1998) made it very clear that personality characteristics are as important as intelligence, aptitudes and school attainment in talent hunt and development.

In a similar vein some vocational psychologists, for example, Holland (1966, 1973) and Crites (1969) insist on the importance of personality in occupational choice and development. Crites wrote:

People whose personality are congruent with their vocations or environments are likely to experience a more stable vocational choice, higher vocational achievement, better maintenance of personality stability and greater satisfaction…..(p.116)

Holland’s (1973) occupational theory also stated that people are most satisfied, productive and stable in work environments that are congruent with their personality types. The medical profession is social service oriented. Thus, the importance of appropriate personality characteristics for success in it cannot be overemphasized.

Some readers may see the selection process recommended as laborious. Yes, it should be. One reason why the process may seem laborious is that Nigeria has no school testing programme. If it has, all that the counselor needs to do is to call for the counselee’s cumulative record folder and get all the tests results from there. In the writer’s inaugural lecture (Ikeotuonye 2003:22) it was made clear that “ability differentiation and personality clarification are easily achievable by means of an effective school testing programme.” In fact, in that lecture, ‘A Schedule of

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School Testing Programme’ is given. It is up to the Federal and State governments of Nigeria to decide to establish school testing programmes.

The Training Process for Medical Students

It is not enough to have a good admission selection process into the medical school, it is absolutely important that the training process has inbuilt continuous selection procedures. This is because human personality is fluid. If, for example, a student develops very unethical behaviors, he has to be shown the way out. This inbuilt selection process will help to ensure that at the end of the day, Nigeria has the best crop of medical doctors; quite unlike the present situation whereby the profession is littered with dangerous doctors.

Summary

The medical profession in Nigeria does not have a shortage of dangerous doctors. This is because the present admission selection process into the profession does not have the capacity to bring in only the best into the profession. A new selection process has been described in detail, and recommended. This new selection process will help Nigeria to produce a good crop of medical doctors. To continue with the present situation is to place the lives of Nigerians in the hands of many dangerous doctors.

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References

Crites, J.O. (1969). Vocational Psychology. New York: McGraw-Hill.

Holland, J.L. (1966). The Psychology of Vocational Choice: A Theory of Personality Types and Environmental Models. New York: Gin.

Holland, J.L. (1973). Making Vocational Choices: A Theory of Careers. Englewood Cliffs: N.J. Prentice Hall Inc.

Ikeotuonye, A.I. (1986). Assessment of Affective Behaviour for Effective Nurse Midwife Education: Guidance for Nurse and Midwife Trainers. Nigerian Journal of Counseling and Development, 1, 133-139.

Ikeotuonye, A.I. (1990). Appraisal in Vocational Guidance. In A.I. Ikeotuonye et al. (Eds.). Careers Guidance: A Vocational Approach for Schools. Zaria: Hudahuda Publishing Company, 201-214.

Ikeotuonye, A.I. (2003). Talent Hunt: A Basis for Optimum Human and National Development. Inaugural Lectures Series 2. University of Abuja Publication.

Ikeotuonye, A.I., Maisamari, J.Y. and Badu, J.B. (2003). The Vocational Interests of Medical Doctors in Hospitals and Clinics in the Federal Capital Territory, Abuja. Abuja Journal of Education 5, I, 1-18.

Ojiah, P.O. (1998). A Study of Personality Characteristics, Vocational Interests of and Job Satisfaction among Medical Doctors in Hospitals in the Federal Capital Territory, Abuja. Unpublished PhD Thesis, University of Abuja.

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