A Reaction To The Medical And Dental Council Of Nigeria’s Proposal On Teaching Medical Students, By Mahmoud Bukar Maina

By Mahmoud Bukar Maina

In a letter dated 15 December 2014, the Medical and Dental Council of Nigeria (MDCN) passed a resolution that university medical schools should by 2019 start using “medically qualified” academic staff for teaching medical/dental students. They threatened that failure to abide by this would ensue to the affected medical schools not passing accreditation. I must admit that proposals like this remind me of the friction in our system, which strongly depress our development in science and education as a nation. Recently, we have seen politicians promote ethno-religious bigotry, equally, proposals like this promote discord and intolerance between scientists and the medics, which would depress our science/health research and academic growth.

To start with, teaching is a vital component of university education, but it should not be the principal concern of academics and/or academic institutions, rather, there should be a strong support and practice of standard scientific research, which normally shapes the teaching approach. Research not only find solutions to problems but create job opportunities and better reputation to a country. We have many medical problems/diseases and equally strong potential for the discovery of treatments/cures for these problems, but our poor attitudes towards the importance of research continue to impede us from helping our community in the best way. Thus, I am ashamed by both the different Basic Science bodies and the Medical and Dental Councils, for they have spent too many years fighting, rather than showing respect to one another and collaborating towards better education and research development.

Firstly, for those unaware, knowledge of basic science principles is an integral part of Medicine, for which many institutions in the developed nations, like the United States and Canada, have for a long time incorporated a back-to-basic-science courses in the curriculum of the clinical phase of medical education when students have already become exposed to clinical medicine. The continuous progress in the sciences (e.g. DNA technology, Stem cell technology and Nanomedicine) that have introduced contemporary methods of diagnosis and management of diseases necessitates that students learn how to best integrate and translate basic science into clinical care. Similar to the medics who spend years learning to develop a firm knowledge of medicine, basic scientists spend ages (through their BSc, MSc, PhD, Post Doc) learning about basic science principles and research. Abraham Flexner, who was instrumental in the reform that saw the introduction of basic science in medical education arrived at that conclusion following an extensive research towards the best approach that would produce medically competent graduates. Thus to prevent medical students from benefitting from the extensive knowledge/experience of basic scientists who have competence in basic science principles and research would be counterproductive to the general aim of the preclinical phase of medical degree, and would hence affect them as they make their career decisions. In the West, we attend conference side by side with medical practitioners, exchange ideas and our discoveries; and medical students visit the basic science laboratory to understand and learn about basic science research methods. Indeed, Ferid Murad and Eric Kandel – two renowned scientists, both graduated through medical school and a touch of biological research oriented thinking during their time, motivated them into basic research, for which they both won Nobel Prize in Physiology or Medicine. Hence, a medic may not necessarily pursue a career in the clinic, could go into basic research, or he/she may continue into clinical practice, in each case, one would require a proper training by scientists about basic science principles and scientific methods that would enable the integration of basic science concept in translational research towards better management of diseases.

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Secondly, proposals like that of the MDCN promote the very naive and primitive notion of one profession being superior than another, which has for ages severed the relationship and thus prevented the collaboration between the medics and their counterparts in the non-medical line. I am a firm believer of the importance of every discipline. I have a great respect for medical practitioners for their sacrifice to work long hours to save lives; their striking emotional strength to attend to patients with varying degree of illness and trauma; and for their rigour (especially Surgeons) to successfully deal with the intricate human body in diseases. But I refuse to agree that these qualities meet the requirement that makes them more important than others. Basic scientists work with model systems that are difficult to understand (as they do not speak like humans) – this way they dissect molecular pathways, perturb genes, develop techniques for proper diagnosis, develop drugs for diseases and importantly, their discoveries enable us to understand more about our biology and how we may evolve to become biologically more fit. I have met world renowned scientists who are not medical doctors, but have headed and guided a research group comprised of doctors and surgeons. I have also interacted with basic research scientists whose works are changing our understanding of the genetic basis of inheritance, reproduction, immune response, nervous system physiology and pathology, etc. Engineers, Mathematicians, Physicists, are integral to the current state of our civilisation. We would find it very challenging to survive without their inventions, like electricity and the internet. Most of what we use in the Lab for basic research or are used in the hospitals for diagnosis and treatments are mostly design based on mathematical and physical principles. I can also go on to mention the invaluable contribution of the non-science disciplines towards a better human race and health system, but the important message is that – it is primitive and naive to promote the assumption that there is such thing as a superior discipline. The MDCN has promoted this flawed assumption for too long, as supported by its current proposal. This has to change if we really seek a true progress in basic and clinical science research and education.

Thirdly, it is dishonourable that the MDCN seek to impose monopoly using threats on teaching in the medical college by denouncing the competency of the well-groomed basic scientists who have provided unmatched dedication to support the training of fine doctors. For the record, it is widely known that BSc programmes in Anatomy and Physiology were introduced to train scientists in these subjects that would provide preclinical training in the college. Supplementing their BScs with MSc and PhD through rigorous learning and research, Nigerian medical schools should be in the list of those with the most qualified teachers that train medical students. It is surprising thus that despite Nigeria’s staggering poor doctor-patient ratio of about 1:3500 as against WHO’s standard of 1:600, and the fact that basic scientists are doing a great job in training medical students, the MDCN is seeking to replace them with the medics. Replacing them would be counterproductive to the success of producing finest doctors and would further sever the relationship between the basic and medical sciences, which won’t be good for the success of our health sector. One doesn’t require an expert to understand that the medics alone cannot provide an efficient health sector and so do basic scientists, both need one another. Instead of trying to dislodge the basic scientists, one would expect the MDCN to work towards increasing the number of doctors that our people direly need. As it is now, the number of basic scientists teaching in medical schools is high, with many more lagging due to the unavailability of suitable jobs. But of huge concern is why the system continues to synthesize basic scientists (especially, anatomists and physiologists) if they are not needed. What should be more realistic is for the different bodies in the health sector to work together to stabilise the system to fit our society’s current need by demanding a superior infrastructure that would increase the training of medical doctors, reduce the number of related basic science programmes and provide the remaining/few basic science programmes with excellent research support that would groom them to become world leading scientists. Thus, the MDCN’s proposal to me, lacks sincerity and patriotism, and thus should be retracted and replaced by realistic proposals that would offer solutions for the betterment of our health system.

On a final note, being frank, it is true that our government’s poor policies towards science and research has contributed immensely to the fissure in our health sector, but I want to believe that the basic scientists too have been too weak in declaring the significance of their role. We have not been active in conducting significant researches, are poor in disseminating the significance of our findings to our immediate community, especially the government, and have not actively worked towards attracting our government and/or international support for building a better system of scientific research, despite the high number of experienced and influential scientists amidst us. With Nigeria’s strong potential in drug discovery, I am of the opinion that our basic scientists should have been in the forefront in the search for a cure for the Ebola virus. Instead too much focus has been placed on teaching, neglecting scientific research. This obviously contributes to why the significance of basic scientists is undermined.

Nations with the developed health systems and that are in the forefront of scientific discoveries learned to respect the values of their populace irrespective of their discipline. There exists a great deal of respect, understanding and collaboration between scientists and non-scientists, as wells as the medics and basic scientists. The US National Institute of Health (NIH) which is the largest funding body in the world that actively participate in the promotion of health research is comprised of experts from different backgrounds. Its support for research led to many discoveries, 145 of which led to Nobel Prize awards. One of the important factors that partly contributed to the weakness in our health system is the long-aged rift between the medics and basic scientists, which continue to promote sabotage, greed, power-mongering and corruption, that ultimately affect the whole populace by repressing efforts towards science/medical related breakthroughs. This must change for us to progress!

Mahmoud Bukar Maina is a research scholar in the Serpell Laboratory, Sussex Neuroscience, UK.