A revival of Continuous Professional Development for Nigerian Doctors and Dentists

Until recently in Nigeria, on completion of your 6 years of medical training, one year housemanship and one year youth service, you could begin to work as a medical doctor anywhere in the country and continue to work for the rest of your life without having to do a single hour of further training. The decision to develope one’s expertise further was left completely at the discretion of the doctor. While some colleagues pursue further training, many go into the world of private practice, sometimes very early in their careers. In most cases there is no incentive or compulsion for further training. Medical knowledge and practice is continuously changing. If the medical profession is to meet its responsibility to provide effective patient care, then all doctors must continuously update their knowledge and skills throughout their working years.

The Medical and Dental Council of Nigeria (MDCN) regulates medical practice in Nigeria (the present website is horrendous, but we have it in good stead that a new one is on the way). For years, the need to update knowledge and skills on a continuous basis has received inadequate attention. MDCN has on various occasions in the past tried to address this deficit in our medical education. It is trying again to do this through the Council’s recent directive for mandatory Continuous Professional Development (CPD) for all doctors in practice in Nigeria. As from January 2011, Continuous Professional Development/ Continuous Medical Education (CPD/CME) has become mandatory in Nigeria. From January 2012, every doctor in practice in Nigeria will be required to show evidence of at least 20 CPD credit units collected in the preceding year before renewal of their annual practicing licenses.
MDCN itself has had a chequered history recently. It was dissolved in 1994 and not reconstituted for another 6 years. It was reconstituted in the year 2000 and again in 2004, but could not appoint a new Registrar because its erstwhile Registrar invoked court injunctions that immobilised it in a legal duel to resist his removal. A new Registrar was appointed in 2006, but within a year the Council removed him. The regulations of the MDCN were revised in 2007 to make renewal of the annual practising licences conditional on showing evidence of having participated in a minimum quantity of measurable training in the form of continuing professional development. Under the leadership of Professor Shima Gyoh, the Council organised a workshop in July 2007 in attempt to inspire the establishment of a network of providers of continuing training for doctors nationwide, facilitating the participation of every doctor especially those in rural areas. Before this could be implemented, our Federal Government in its infinite wisdom again dissolved the Council and it remained dissolved until late 2010. Now we have a new Council ably led by Professor Roger Makanjuola resurrecting the issue of continuous professional development. We hope that the good professor and his team have the determination to see this through and our government gives them the space to implement.
However, mandating this is one thing, facilitating the availability of appropriate CPD courses is another. If one opens the later pages of any edition of the British Medical Journal, the primary journal on the health system we have tried to adapt in our country, one finds a plethora of courses in areas ranging from clinical expertise to ethics, from management and leadership to safety. We challenge the Nigerian medical scene to rise to the challenge and develop the courses to meet this need in Nigeria.
The MDCN will then need a simple system to accredit courses for CPD courses and points, which will then need to be assessed every year before approving a doctor’s licence to enable him to continue to practise. We understand that MDCN is indeed developing an e-platform through which all business with doctors and dentists will be conducted and that their website is being upgraded alongside this (a new website is desperately needed!). MDCN says that it has agreed with an initial number of CPD providers, including the two Postgraduate colleges (NPMCN and WACP), Colleges of Medicine and other bodies engaged in medical education to develope CPD content and is also currently developing a system of certification. 
This will not improve the competence of our doctors over-night. But it will hopefully consolidate a culture of continuous learning among our doctors and empower our patients to demand to know from doctors when last they went on a training course to improve their skills. The MDCN will then have to embark on a massive public education campaign to enlighten patients to request and insist on it. It will also have to brace its enforcement and legal teams to make the consequences for defaulting doctors serious and detrimental.
Maybe, just maybe we might be able to bring some
We will point to a few resources already available:
The 11th annual edition of the popular BMJ West Africa Writing Workshop  will feature its first Open Access seminar. Professor Richard Smith, Director of Chronic Disease Initiative of UnitedHealth, former Editor BMJ until 2004, has  agreed to moderate the event in the4-cities in Nigeria in 11-22nd July.
Africa Health was relaunched as a CPD stand alone journal, and provides an open access opportunity for readers to access the content, as well as to develop a forum for other resources. It als manages peer-reviewed Diabetes (AJDM) and Respiratory (AJRM) journals which are also made available on an open access basis.

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (www.epiafric.com), which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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