NUC and policy somersault for medical lecturers​

When the eggheads at the National Universities Commission (NUC) concluded plans to make PhD a prerequisite for medical doctors teaching in Nigerian universities, they felt they had done the world a favour. Head, Education Desk, IYABO LAWAL writes that the plan is wrought with confusion and controversy.​

In 2008, a former Executive Secretary of the National Universities Commission, Prof. Julius Okojie, had directed that all university lecturers must possess a doctoral degree by 2009 or lose their jobs. In the end, nobody lost his or her job except Okojie. The same threat was repeated in November 2009 by a former Minister of Education, Dr. Sam Egwu. Nothing changed and nothing has changed except the current furore a similar directive has generated.​

The NUC announced on its website in June 2018 that it had developed academic postgraduate programmes (Master’s, PhD -Doctor of Philosophy and MD -Doctor of Medicine) in Medicine in its bid to meet the academic postgraduate requirements of the Nigerian university system. When the NUC eggheads concluded plans to make PhD a prerequisite for medical doctors teaching in Nigerian universities, they believed they had done the world a favour.​

To the mind of the NUC’s executive secretary, Prof. Abubakar Rasheed, there was a “general need to overhaul the medical curricula” for both undergraduate and postgraduate programmes.​

He had wanted to “enhance” and “refresh” the medical profession, thus, it assembled “experts in the field” to develop the curriculum which means graduates of Medicine and Dentistry who were lecturers currently on their fellowship, could now undertake their PhD concurrently with some concession.​

The seemingly fantastic idea was to re-introduce the option of MD by publication to provide an opportunity for professors to keep contributing “new knowledge” for as long as they wanted without the rigour of interfacing with any supervisor.​

Rasheed had noted that the PhD was not a replacement of the fellowship training in the medical field “but an option to the medical profession as a whole”. ​

However, here’s a statement that triggered a whirlwind of cacophony and controversy: “It would henceforth be a pre-requisite for any medical professional that wanted to pursue the teaching career,” the NUC had asserted.​

According to the commission, the three categories of people that would be allowed to get a PhD were those that must have enrolled in the fellowship programme of either the national or west African medical schools and successfully passed the part one of either or both and embark on part two without a Master’s degree can be allowed to start their part two and enrol for a PhD; fellows who want to have a PhD in addition to other qualifications could register for the programme without any requirements or course work but would be required to write a thesis within the specified period under the supervision of a very reliable lecturer, and those not interested in becoming fellows but have very good MBBS degrees but want an MSc and a PhD.​

Last December, the commission then issued a circular to vice-chancellors and registrars, defining the structure of the PhD programme in clinical sciences, duration, admission and graduation requirements, informing them that the introduction of the PhD programme is to reposition “postgraduate training for medical academics in Nigeria, which has no clear-cut guidelines for Masters and PhD programmes in the clinical sciences”. ​

Some have argued that MD or PhD is sufficient to teach. There are basic science faculties that only have PhD teach medical students as well. For clinical instructions, they conclude that MD, but not PhD, is needed.​

In Uganda, medical doctors had once expressed strong views that a PhD or equivalent should not be a minimum requirement nor should it be a prerequisite for promotions though it should be encouraged. Policy documents from the nation’s universities did not require a PhD or equivalent qualifications as a minimum requirement for appointment to the academic ranks of those institutions. ​

“Whereas it is desirable for the academic staff to acquire a PhD, it should not be a mandatory requirement. The policy was not in the best interest of the Faculty of Medicine and may not be for other medical schools to impose that requirement for appointment or promotion. University policymakers should consider schools of medicine as an exception to the policy requiring a PhD or equivalent as a minimum requirement for teaching at a Medical School,” a research study said.​

In the US, in the clinical teaching faculty, the minimum requirement for an assistant/associate professor is an MD or DO degree with speciality board certification and eligibility for a medical licence; not a PhD.​

In the UK, as another example, requirements for the position of a lecturer/senior lecturer in pathology include holding an educational qualification in relevant subject areas such as a medical degree qualification e.g. MD, MBBS. MBChB; a postgraduate qualification and or training in a relevant area. Applicants applying for the senior lecturer role have recent evidence of scientific publications, conference presentation.​

It is similar in Canada.​

In March this year, the chairman of University College Hospital (UCH), Ibadan chapter of the Medical and Dental Consultants’ Association of Nigeria (MDCAN), Dr. Dare Olulana, the NUC’s policy would collapse the nation’s health sector with its circular on a doctoral degree for clinical lecturers in universities.​

According to Olulana, insisting on the compulsory acquisition of PhD by clinical lecturers in medical schools will sound the death knell of the health care system in Nigeria and that the number of clinical lecturers standing at about 50 percent of requirements in the medical schools would be further reduced.​

It would also lead to a brain drain of senior lecturers who are fellows but without PhD. In the United Kingdom, the United States and Canada, a residency training programme culminating in the fellowship of the postgraduate medical colleges, is the minimum requirement to practise as a specialist and to teach clinical medicine.​

“The PhD alone is an insufficient qualification to assume responsibility for patient care or to teach clinical medicine. For this reason, the universities require clinical lecturers to have the fellowship of the postgraduate colleges, as well as to practice as specialists with the teaching hospitals in order to be able to teach as lecturers in clinical medicine in the university.​

“Whereas the PhD is useful to those individuals that have chosen a voluntary career path in research (where research infrastructure exists), it does not significantly translate into improved patient care skills, nor better able to teach clinical medicine.​

“Patient care is the overriding focus of medical education both at undergraduate and postgraduate levels, from the inception of medical education by the founding fathers of medicine to date, a target that the country is nowhere near meeting currently.​

“The structured residency training programme of a minimum duration of six years is a mandatory requirement for the employment of clinical lecturers by the universities, a condition not imposed on other lecturers. To add to this the burden of compulsory acquisition of PhD is simply superfluous,” said Olulana.​

In fact, in February, the President of the MDCAN, Prof. Kenneth Ozoilo, threatened at a Jos press conference, that doctors would go on a nation-wide strike if the NUC decision was not rescinded.  ​

“We agree that PhD is a highly respected degree. We don’t have issues with that. It (PhD) should be by choice for doctors that have completed their residency programme, and should not be made compulsory for them because of the peculiarity of medical training. Acquiring PhD is of no much value in the training. It is cosmetic,” Ozoilo argued.​

The MDCAN had since written to the NUC but it claimed the commission refused to acknowledge its letter and did not address the council’s concerns.​

Said Ozoilo, “We have written to NUC to this effect, expressing all these concerns, but they did not even deem it fit to acknowledge our letter not to talk of responding to it. That was what led to the (strike) ultimatum of 24th of this month (February).​

“No university will employ you to teach clinical disciplines if you have not done residency training, because you have to be hands-on-patients in training the students.”​

The NUC has been accused of “duplicity and deceit”. Those on the council’s side claimed what was agreed with the commission was that pursuing a PhD be a “personal, voluntary and optional endeavour for academics”. ​

The NUC boss claimed otherwise. He stated, “Our circular seven never prescribed PhD as a requirement for them to teach in the colleges of medicine. We said PhD is desirable but not necessary for progression in medical education.” ​

According to Rasheed, what the NUC said was that a consultant in the university system would continue to be promoted but the promotion of those with a PhD would be faster.​

Rasheed was lying, said Ozoilo. He stated, “(It) is an outright lie. If full fellows (including professors of medicine) require PhD, to what rank will they be promoted? While a PhD is a predominantly academic pursuit, fellowship is both academic and professional. ​

Some have argued that the MDCAN has no say in the matter because it is the NUC that has the mandate to regulate higher education in Nigeria including postgraduate medical training to ensure that it is in line with global best practices.​

In the UK, most clinical lecturers will have a PhD and some experience of working in a practical medical environment. They will have a very good bachelor’s degree: a first or upper second class. Clinical lecturers are sometimes expected to do a teaching qualification soon after they start, run by their own university. This is done part-time while working. An example of this is the Diploma in Post-Compulsory Education.​

“Our problem is with the universities, NUC and the Federal Ministry of Education. We have no problem with the teaching hospitals, but they will, however, become affected in due course if the NUC does not accede to our demands. Apart from withdrawing their circular and returning to the status quo, NUC should convene stakeholders’ meeting to address the injustices that clinical lecturers endure in the universities that are making teaching unattractive for medical doctors,” Ozoilo added. ​

Well, by March the flaring tempers were calming down when the NUC and the MDCAN resolved at a meeting in Abuja that the PhD is not a compulsory requirement for the career progression of clinical lecturers.​

At the end of the meeting, the warring parties agreed that the Fellowship is the highest qualification for clinical specialists and remains the qualification for employment for clinical lecturers into the university (Lecturer I); that the PhD is the highest academic qualification in the university.​

It was also agreed that the possession of PhD by clinical lecturers is voluntary and optional; that non-possession of PhD will not hinder the clinical lecturer from being promoted from one rank to the other up to the level of professor in the Nigerian university system.​

In Nigeria, medical students are taught clinical by academics from medical colleges and consultants (the latter undergo fellowship training from the National Postgraduate Medical College of Nigeria, West African College of Physicians, West African College of Surgeons among others) from the teaching hospitals.​

Still, the NUC was determined to have its say and its way.​

“One of the issues on the front burner is the postgraduate training for medical academics, which has no clear-cut guidelines for Masters and Ph.D. programmes in the clinical sciences. To this end, after exhaustive deliberation at series of meetings held between the commission and the management of the National Postgraduate Medical College of Nigeria (NPMCN), stakeholders unanimously agreed to introduce PhD programmes in the clinical sciences in the Nigerian university system, for the postgraduate training of interested medical practitioners, especially for those in the academia,” Rasheed stated after the meeting.​

According to him, medical school graduates with relevant Masters of Science degrees; holders of the Fellowship of the NPMCN, WACP, and WACS; and those who have completed first level (part-one) of the Fellowship can enroll for the PhD in Clinical Sciences. But holders of the Fellowship will only be required to complete a thesis to get the PhD.​

For many observers, the situation is a conundrum of confusion and controversy. In October 2017, the doctoral degree issue was said to have been laid to rest. ​

The then-President NPMCN, Prof. Ademola Olaitan had argued that holders of postgraduate fellowships did not need to possess doctoral qualifications to achieve career progression in the NUS and added that a policy decision would be taken on the issue, which sometimes disqualifies holders of medical postgraduate fellowships from attaining the position of vice-chancellorship for not having PhD. ​

“Any clinician that has only a PhD as his only postgraduate attainment cannot be appointed as a consultant or have patients under his care,” Olaitan had stated.​

“The possession of a Fellowship is thus a sine qua non for the appointment of anyone as a consultant and clinical lecturer.  The National Postgraduate Medical College of Nigeria is, therefore, the only Federal Government agency that has the capacity to certify specialists that will train other medical and dental doctors to professorial level.”​
At the 35th convocation ceremony of the college, Olaitan had said further, “Comments have been made, fears expressed and diverse reactions abound on the relevance or otherwise of clinical teachers’ possession of PhD to teach or to progress in the university system. This was associated with uncertainties about career progression for holders of the fellowship of our college or its equivalent. The fear of inability to make progress academically or administratively as holders of our fellowship or its equivalent has been laid to rest.​

“The executive secretary of the NUC, Prof. Abubakar Rasheed, by his declaration has confirmed that the fellowship training undertaken by our college is robust, all-inclusive and possession of the fellowship or its equivalent was all that a clinical lecturer requires to get to the top of his career.”​

Similarly, in 2017, Prof. Stanley Anyanwu had disclosed, “But we have discussed with the NUC and we agreed to get PhD programme structured into the fellowship training programme so that while the resident doctors are doing the residency training, they will register in a university and the dissertation they will submit to the college can be used as a thesis for PhD programme. This template obtains in many parts of the world. It’s not something new.”​
Case closed? Hopefully.​