Surgical postgraduate examiners and examinees in Nigeria complain of the low pass rate at all levels of the postgraduate surgical training examinations to which several factors are contributing. For several years there has been being a persistently low surgeon workforce in the country despite having two surgeon producing institutions been for at least 37 years. A review of the probable causes was carried out to shed more light on the matter. At the time of writing there are 52 National Postgraduate Medical College of Nigeria (NPMCN) and 46 West African College of Surgeons (WACS) accredited post graduate surgery training programs in Nigeria compared with 99 in the United Kingdom (UK) and 1056 in the United States (US). Based on available data Nigeria has approximately 572 surgery residency training slots yearly compared with approximately 646 in the UK and 4225 in the US. Examination pass rate was less than 40% for primary WACS compared with 98% pass rate in USMLE (United States Medical Licensing Examination) 3, pass rate at part I was 28.8% for WACS compared with 37% at MRCS (Membership Royal College of Surgeons) part A and 57% for MRCS part B. For the exit examination or part II WACS pass rate was 31.5% (general surgery) while it was 64% for Fellowship Royal College of Surgeons (FRCS) cumulative and 70% in the American board of surgery (ABS). Surgeon per 100 000 population was 0.69 for Nigeria compared with 11.7 and 25.6 for the UK and US respectively. In the last 35 years WACS has produced 1638 surgeons (2.8 times more than NPMCN) in surgery and NPMCN has produced 572. The frequency of examination were twice per year for both WACS and NPMCN examinations, 3 times per year for the USMLE step 3, MRCS (A & B) and Fellowship Royal College of Surgeons (FRCS) general surgery. The American Board of Surgery (ABS) is once per year for Qualifying Examination (QE) and 5 times per year for Certifying Examination (CE).
It has been suggested that in environments where there is greater fear of litigation, resident autonomy and education is compromised. Our aim was to examine failure rates on American Board of Surgery (ABS) examinations in comparison with medical malpractice payments in 47 US states/ territories that have general surgery residency programs. We hypothesized higher ABS examination failure rates for general surgery residents who graduate from residencies in states with higher malpractice risk. We conducted a retrospective review of five-year (2010–2014) pass rates of first-time examinees of the ABS examinations. States’ malpractice data were adjusted based on population. ABS examinations failure rates for programs in states with above and below median malpractice payments per capita were 31 and 24 per cent ( P < 0.01) respectively. This difference was seen in university and independent programs regardless of size. Pearson correlation confirmed a significant positive correlation between board failure rates and malpractice payments per capita for Qualifying Examination ( P < 0.02), Certifying Examination ( P < 0.02), and Qualifying and Certifying combined index ( P < 0.01). Malpractice risk correlates positively with graduates’ failure rates on ABS examinations regardless of program size or type. We encourage further examination of training environments and their relationship to surgical residency graduate performance.
Low Pass-rate in postgraduate surgical examination in Nigeria and its contribution to the low surgeon workforce in the country; a review article