Surgical Residency Training in Nigeria: An Audit Through the Lenses of the Trainee and Trainer

Abstract

IntroductionResident doctors constitute an important workforce of the Nigerian healthcare system wherein they undergo structured training to become competent specialists in different fields of medicine. The aim of this survey was to audit the surgical residency training process, incorporating both the trainer's and the trainee's perspectives, with a view to improving both residency training and overall patient care. MethodsThis was a multicenter descriptive cross-sectional study involving consultant surgeons and surgical trainees in selected tertiary healthcare institutions in Nigeria. A link to an online semi-structured and pretested questionnaire was sent to study participants whose agreement to fill out the questionnaire was taken as implied consent for the study. The perception of respondents on key areas of surgical residency training like the quality of training, skill acquisition, mentorship, supervision, operative exposures, research, funding, didactic sessions, and work schedule was assessed using a Likert scale. Their perceived challenges to training and measures to improve the quality of training were recorded. Data were analysed using version 23 of the SPSS. ResultsA total of 127 participants (25 trainers and 102 trainees) were recruited with a mean age of 34.8 ± 3.5 y for the trainees and 47.5 ± 6.9 y for the trainers. The majority of both the trainers and trainees (72%, n = 18 and 93%, n = 96, respectively) were dissatisfied with the quality of surgical residency training in Nigeria with the trainers (88%, n = 22) and trainees (97.1%, n = 99) mostly agreeing that surgical training should be standardized across training centres in Nigeria. The trainees and trainers rated mentorship, research, funding, and overall quality of surgical residency training as inadequate, while most of the trainees and trainers rated supervision of trainees as adequate. The trainees predominantly identified poor training facilities as the most important challenge to surgical residency, followed by high clinical workload, while the majority of the trainers identified workplace bullying and high clinical workload as being the predominant factors. The nine-pronged recommendations by both the trainers and trainees to improve surgical training in Nigeria include mentorship program for trainees, funding of surgical residency training, provision of facilities and equipment for training, adequate supervision of trainees by trainers, job description and defined work schedule for trainees, health insurance of patients, overseas training of trainees during the residency program, improved remuneration of trainees, and adequate motivation of trainers. ConclusionsThe quality of surgical residency training in Nigeria is perceived as suboptimal by trainees and trainers. Perceived common challenges to surgical residency training include poor training facilities, workplace bullying, and high clinical workload. Adequate funding of surgical residency program, standardized mentorship, and training of trainees with improved remuneration of trainees and motivation of their trainers would enhance the overall quality of surgical residency training in Nigeria.