Nigerian Medical School Research Articles

<b>Insights From the Frontlines: Students' Perceptions of Teaching Methods in a Nigerian Medical School </b>

Background The teaching skills of the teachers impact the learning outcomes, and it is expected that learning can be enhanced through appropriate instructional strategies that will optimally help the students. An understanding of student’s perception of the available teaching methods will provide insight into what the challenges are, and how this information can be used to further optimize learning outcomes. Methods A qualitative phenomenology study using focus group discussions among 41 clinical medical students in a developing Nigerian medical school. An inductive thematic analysis was performed on the transcribed recorded data from the group discussions. Results Six themes emerged: participation, clarity and applicability, encouragement and feedback, teaching aids, students-teachers relationship, and learning environment. Students preferred problem-based learning and small group teaching, perceiving didactic lectures as lengthy and boring. They emphasized the need for teachers to use real-world examples, provide feedback, and adopt student-centered approaches. The majority of students preferred visual learning aids but noted inadequate infrastructure and resources for their preferences. Conclusions This study highlights the importance of student-centered teaching methods, incorporating visual aids and problem-based learning, to enhance engagement and retention. Teachers should adapt their instructional strategies to cater to diverse learning styles and promote interactive learning. The study suggests retraining clinical teachers to adopt student-centered approaches and utilize available resources effectively. By prioritizing student feedback and adopting inclusive teaching methods, medical educators can optimize learning outcomes and prepare students for the demands of healthcare practice. Keywords: medical, students, perceptions, teaching, methods.

A content analysis of two african medical schools' antibiotic stewardship curricula.

Antibiotics are precious substances that have saved millions of lives since their discovery, resulting in significant advances in modern medicine. However, antibiotic resistance and a slowdown in the discovery of new antibiotics with novel mechanisms of action are affecting the sustainability of antibiotics. The objective of this study was to describe the content of South African and Nigerian medical students' curricula with respect to prudent antimicrobial prescribing. A content analysis framework was used to identify, describe, and count the keywords, key phrases, and sentences relevant to the teaching of prudent antimicrobial prescribing in the complete curricula content of two African countries' medical schools. The courses are taught in the Graduate Entry Medical Programme (GEMP) curriculum (years 3-6) of the South African medical school and years 4-6 of the Nigerian medical school. The frequency of keywords/key phrases relevant to prudent antibiotic prescribing such as antimicrobial stewardship, mechanisms of bacterial resistance, and principles of antibiotic therapy was determined. The two curricula reviewed were found to be different. While the South African medical school uses an integrated curriculum in the GEMP (a stream where candidates with undergraduate degrees are enrolled into the 3rd year of medical school and spend 4 years), the Nigerian medical school operates a traditional (discipline based) curriculum from MBBS 1-6. A greater number of keywords and key phrases were found in the South African curriculum compared to the Nigerian curriculum in relation to prudent antibiotic prescribing and antimicrobial stewardship. The key phrase "antimicrobial stewardship" or "antibiotic stewardship" was absent in the Nigerian curriculum but appeared four times in the South African curriculum. The findings of this curriculum review suggest a need for revision of the medical curricula of the two countries, to one that will better prepare learners for antimicrobial stewardship.

Awareness and knowledge of rheumatology subspecialty among clinical students in a Nigerian medical school

Awareness and knowledge of rheumatology subspecialty among clinical students in a Nigerian medical school

Digital Pathology and ICT in Medical Education in the Pre-COVID Era: Measuring the State of Readiness of Medical Students in a Nigerian Medical School for the Changing Technological Landscape

Background: Information Communication Technologies (ICTs) have caused significant improvement in the practice and teaching of medicine worldwide. The novel coronavirus disease (COVID 19) pandemic has heightened the need for increased development and improvement in ICT skills and infrastructure. ICTs are causing a revolution in the way Pathology is practiced and taught worldwide. This study was carried out to evaluate the utility of ICTs in undergraduate pathology education in a tertiary institution in Nigeria.
 Materials and Methods: This was a cross sectional study in which a structured questionnaire was used to assess students’ access to ICT, ICT skills and perceptions regarding ICT in pathology education. Questions regarding learning challenges and knowledge of pathology related resources and the current state of utilization of computer based/ digital tools in pathology education in the institution were also examined. Data was analysed using SPSS version 20 and reported in charts.
 Results: Questionnaires were administered to 146 students out of which 97 responded. Only 44% of the students had personal computers with 24% using their computers daily and 69% having internet connectivity. Most were proficient in Word processing (84%) and Email (80%), while very few had programming or database skills. Eighty-nine percent (89%) considered ICT as being useful in pathology learning, while 65% considered ICT as being more effective than traditional learning methods. Gross demonstrations were rated as being superior to digital images in gross pathology by 55%. The most commonly used ICT tools by the students were photomicrographs, online lecture notes, images and tutorials with interactive ICT tools (webinars, teleconferencing and simulations) hardly being used.
 Conclusion: The need for formal training in relevant ICT skills in specific content areas is very necessary in our environment, more so now with the appearance of the COVID - 19 pandemic on the scene.

Entry points into a Nigerian medical school at the graduate and undergraduate levels: A three-year prospective and retrospective comparison of performances at the first MBBS professional examinations

Background: It is alleged that there is a mismatch between candidates’ performance in University Matriculation Examination (UME) and their subsequent academic achievement in medical schools in Nigeria. Aim: The present study compares the performance of medical students admitted via Direct Entry (DE) module and that of UME using their 1st professional examination. Methodology: A total of 343 undergraduate medical students of College of Medicine, Nnamdi Azikiwe University, Nnewi, Anambra state, Nigeria were used for this study. 270 of the students were admitted through UME, while 73 were admitted through DE modes of admission. The results of the 1st MBBS examinations taken in the years 2014 to 2017 were collated, analyzed and compared between the two groups of students. Results: The rate of success in 1st MBBS examination was greater in the DE students (74%) compared with the UME students (44.1%). The failure rate was higher in the UME entrants (55.9%) compared with the direct entrants (26%). The frequency of withdrawals in the group with UME (n = 28) was greater than that of the group with DE (n = 0). Chi square test of association indicated significant (p < 0.001) association between performance of students in 1st MBBS examination and the mode of admission. Logistic regression test shows that the odds of failure were against students with UME module than those with DE. Conclusion: The present study indicates that the admission module of DE with previous degree increases the chances of academic success in medical education in Nigeria. This suggests the need for a review of the mode of admission into medical schools to favour students that have a previous degree.

Impact of ophthalmology posting on the attitude and perception of senior medical students in a Nigerian medical school to ophthalmology as a specialty and a career choice

Background: Ophthalmology posting/clerkship is an integral part of the curriculum of medical schools globally. This provides ophthalmic educators an excellent opportunity to positively influence the medical students undergoing the posting. Materials and Methods: A pretest–posttest, noncontrolled, nonrandomized experimental study was conducted among 5th year medical students of the College of Medicine of the University of Lagos who underwent ophthalmology posting between November 2015 and February 2016. All respondents were requested to fill a semistructured questionnaire on the first and the last day of the posting. Information on sociodemographic data, perception and attitude toward ophthalmology, future practice plan, and a possibility of taking up a career in ophthalmology were obtained using a semistructured questionnaire. The data were analyzed using IBM Statistical Package for the Social Sciences version 20. Results: A total of 210 out of the 228 students participated in this study constituting a response rate of 92.1%. The mean age was 23.0 ± 2.3 years, and the male-to-female ratio was 1:1.1. There was a statistically significant improvement in the overall mean attitudinal scores after posting compared to the scores before posting (P < 0.01). Furthermore, there was a statistically significant improvement in the overall mean perception scores after posting compared to the scores before posting (P < 0.01). Although there was an increase in the mean score of disposition of respondents to ophthalmology as a future career from 2.18 before posting to 2.30 after posting, this was not statistically significant (P = 0.06). Conclusion: The 4-week ophthalmology posting impacted positively on the perception and attitude of respondents to ophthalmology as a discipline, but did not translate to a significant improvement in the consideration of ophthalmology as a future career.

Spectrum of Anxiety Disorders Among Medical Students in a Nigerian Medical School: A Cross-Sectional Study With Standardized Screening Tools

BACKGROUND: Anxiety disorders among medical students constitute a global problem, and also reflect the mental state of the general population. There is paucity of data on the spectrum of such disorders among medical students in Nigeria.AIM: The study aims to determine the prevalence of anxiety disorders among medical students, and the effect of socio-demographic characteristics.METHODS: A total of 217 medical students from the second to the final years of study at Enugu State University of Science and Technology in south-east Nigeria were enrolled by simple random sampling. Five pretested, self- administered standardized questionnaires were used as screening tools for anxiety disorders. Data were analyzed using the Statistical Package for Social Sciences program (SPSS version 20). A p-value less than 0.05 was taken as statistically significant.RESULTS: Thirty one (14.3%) of the enrolled medical students fulfilled the screening criteria for anxiety disorders. Specifically, generalized anxiety disorder (GAD) was significantly related to gender (p =0.017) and the year of study (p =0.017). Post-traumatic stress disorder (PTSD) was significantly related to the year of study (p =0.037), and social anxiety disorder (SAD) to the year of study (p =0.003) and gender (p =0.04). Similarly, panic disorder was significantly related to the year of study (p =0.025) while specific phobia was significantly associated with marital status (p =0.003), parental monthly income (p =0.022) and student’s monthly allowance (p =0.002). Finally, obsessive-compulsive disorder was significantly related to marital status (p =0.034) and year of study (p =0.028).CONCLUSION: Medical students in Nigeria are prone to a spectrum of anxiety disorders. This susceptibility is influenced by socio-demographic characteristics.

Survey of Opinions of Medical Students on Pharmacology Education in a Nigerian Medical School

Survey of Opinions of Medical Students on Pharmacology Education in a Nigerian Medical School

Self-directed learning: Status of final-year students and perceptions of selected faculty leadership in a Nigerian medical school – a mixed analysis study

Background. Self-directed learning (SDL) is the essential mechanism of lifelong learning, which, in turn, is required for medical professionals to maintain competency because of advancing technology and constantly evolving disease care and contexts. Yet, most Nigerian medical schools do not actively promote SDL skills for medical students. Objective. To evaluate the status of SDL behaviour among final-year students, and the perceptions of faculty leadership towards SDL in a Nigerian medical school. Methods. A mixed research method was used, with a survey consisting of a validated Likert-based self-rating scale for SDL (SRSSDL) to assess students’ SDL behaviour. Focus group discussions with selected faculty leaders were thematically analysed to assess their perceptions of SDL. Results. The medical students reported moderate SDL behaviour, contrary to faculty, who considered their students’ SDL behaviour to be low. Faculty leadership further defined SDL as the self-motivated student demonstrating initiative in learning under the guidance of teachers, who use interactive forums for teaching. Furthermore, teachers and students should partner towards the goal of ensuring that student learning takes place. Teachers expressed concerns about SDL methods in medical schools owing to the fear that this will require medical students to teach themselves medicine without expert guidance from teachers. Conclusion. This study suggests that final-year students have a low to moderate level of SDL behaviour. The index faculty are willing to develop teacherguided self-motivated learning for their students, rather than strict SDL. Faculty should be concerned about this behaviour and should encourage SDL in such a way that students realise its benefits to become lifelong learners. Further study of the perceptions about self-regulated learning are recommended.

Prevalence of stress, stressors and coping strategies among medical students in a Nigerian medical school

Introduction: Several international studies suggest that medical school training is associated with high levels of stress. Although stress is peculiar to the medical profession, it is rarely given the desired attention, especially in resource-constrained settings. This study was therefore conducted to determine the prevalence of stress stressors, coping strategies of medical students in the University of Calabar, Nigeria. Materials and Methods: A cross-sectional descriptive survey of 451 medical students was conducted on available classes during the study period. A semi-structured self-administered questionnaire was used to elicit information from respondents. Data were summarized using proportions, and Chi-square test was used to explore associations between categorical variables. Level of significance was set at P < 0.05. Results: Majority (94.2%), of undergraduate medical trainees perceived the training as stressful. The major stressors identified were excessive academic work load (82.3%), inadequate holidays (76.4%), and insufficient time for recreation (76.2%). Feeling depressed, sleeping problems and anxiety were the most common effects of stress reported by the respondents. The coping strategies adopted by the students were mainly positive. Perceived stress was significantly associated with being in the clinical level of study, residing on campus and a higher monthly allowance (P < 0.05). Conclusion: Majority of the students interviewed perceived their training as stressful. There is, therefore, an urgent need for medical educators to introduce of stress management courses or programs into the curriculum.

Prevalence and factors associated with susceptibility to stress-related illnesses among medical students in a Nigerian Medical School

Prevalence and factors associated with susceptibility to stress-related illnesses among medical students in a Nigerian Medical School

Refractive Errors and Spectacle Use Behavior among Medical Students in a Nigerian Medical School

Aim: To determine the prevalence of refractive errors and spectacle use behavior among medical students in University of Calabar Teaching Hospital, Nigeria. Study Design: Cross sectional study. Place and Duration of Study: Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria, between April 2010 and July 2010. Methodology: The study population consisted of fifth year medical students. Subjects had cycloplegic auto refraction with Topcon auto refractor during their rotation in ophthalmology at the Ophthalmology department of the University of Calabar Teaching Hospital. A spherical equivalents (SE) ≥ +0.50D were determined as hyperopia; SE of >Original Research Article British Journal of Medicine & Medical Research, 4(13): 2581-2589, 2014 2582 0.50D myopia and >-0.50D cylinder as astigmatism. Statistical analysis, which included chi-square test was carried out with Statistical Package for Social Sciences (SPSS) version 20.0. Results: Sixty-six (79.5%) of subjects had a form of refractive error; 63.6%%, 16.7% and 19.7% were myope, hyperope or simple estigmat, respectively. The prevalence of ametropia was 82% in female and 78% in males. The association between refractive errors and gender was not statistically significant (p = 0.35, 95% Confidence Interval [CI], 0.34-0.36).Minus spherical errors ranged from -0.16 to -5.25 diopters (D) and plus spherical errors ranged from +0.25 to +1.00D, spherical equivalent between -0.25D and 2.75D being the most common type (85.5%). Eight students (12.1%) were wearing glasses at the time of the study corresponding with 10 (15.2%) who had eye pains while reading. Conclusion: The prevalence of refractive errors among fifth year medical students of the University of Calabar was high and eyeglasses were worn by students who were symptomatic.

Objective structured clinical examination vs traditional clinical examination: An evaluation of students′ perception and preference in a Nigerian medical school

Background:Method of testing clinical competence of medical students in this setting has been controversial. This report evaluates the perceptions and preferences of 5th and 6th year medical students about traditional clinical examination (TCE) and objective structured clinical examination (OSCE).Materials and Methods:A cross-sectional study using a structured questionnaire, administered to 156 students, who had been previously exposed to TCE and OSCE.Results:There were 110 (70.5%) males and 46 (29.5%) females, with median age group of 26–30 years. One hundred and thirty-one respondents (84%) felt TCE is more difficult and 20 (12.8%) felt OSCE was more difficult. One hundred and forty-two (91%) felt OSCE was easier to pass, 8 (5.1%) felt TCE was easier to pass and 6 (3.8%) were undecided. Majority of the 5th and 6th year students (95.5% and 100%, respectively) preferred OSCE for assessment. In relation to validity and reliability of OSCE, 124 (79.5%) of all the students felt it provides a true measure of essential clinical skills, 130 (83.3%) felt its scores are standardised, 143 (91.7%) felt it is a practical and useful experience and 135 (86.5%) felt students’ personality, ethnicity and gender will not affect OSCE scores. Overall, there were no significant differences in preference and perceptions between 5th and 6th year students and between males and females.Conclusion:Students preferred OSCE as method of assessing clinical competence and considered it a more valid and reliable method of examination.

Impact of some low-cost interventions on students' performance in a Nigerian medical school.

Students' poor performance in physiology examinations has been worrisome to the university community. Reported preference of peer-tutoring to didactic lectures at the University of Nigeria Medical School has not been investigated. The aim of this work is to design/implement low-cost interventions to improve teaching and learning of physiology. This is a postintervention retrospective review of medical Student's performance in 2 nd Bachelor of Medicine and Bachelor of Surgery examinations physiology. Data were collected and analyzed by descriptive and inferential statistics using the MedCalc Statistical software (Turkey). The odds ratio (OR) was used to determine the chances of passing before and after the intervention. The level of significance was set at P < 0.05. A total of 2152 students sat for the professional examination over the study period, and 1485 students passed the examination at first attempt giving an overall pass rate of 69%. The pass rate from 2008 when our interventions started was significantly higher than the pass rate before this reform (OR: 0.53; 95% confidence interval: 0.43-0.64; P < 0.0001). Results support the engagement of teachers with strong translational interests and clinicians to augment existing faculty in basic sciences, innovative alternatives to passive lecture formats and students involvement in program evaluation.

Mistreatment among undergraduate medical trainees: A case study of a Nigerian medical school.

Several international studies have shown that abuse or mistreatment is a regular phenomenon faced by medical students. However, there is limited information on medical student abuse/mistreatment in Nigeria. The study was therefore conducted to assess the prevalence and patterns of mistreatment experienced by Medical Students in the University of Calabar. A descriptive cross-sectional study was conducted among 451 undergraduate medical trainees in the University of Calabar. Systematic sampling was used in recruiting participants into the study. A self-administered questionnaire was then employed to obtain information on patterns of mistreatment experienced by medical undergraduates. Data were analyzed using Statistical Package for Social Scientists version 19 and level of significance set at <0.05. More than a third (35.5%) of all respondents interviewed had experienced one or more forms of mistreatment during their training, with 38.5% of them experiencing it weekly. The most common form of mistreatment experienced was verbal abuse (52.5%), and the main perpetrators of these incidents were medical consultants, (18.6%) other cadre of doctors (17.3%) and lecturers (14.4%). Being in the clinical level of study and aged above 25 years were significantly associated with experiencing mistreatment in this study (P < 0.05). However, only 8.8% reported these incidents. With more than a third of undergraduate medical trainees experiencing mistreatment, development of appropriate strategies for the prevention and reduction of these incidents are strongly recommended.

Impact of evidence‐based innovative interventions on students’ performance in a Nigerian medical school

Need for periodic evaluation of students’ performance and observed initial findings of poor performance and students preference of peer‐tutoring to didactic lectures at the University of Nigeria Medical School, we implemented innovations at improving learning environments for Physiology in our institution. These innovations included securing the services of Faculty clinicians to augment existing number of lecturers, use of question‐driven format for assessments, evidence‐based change in tutorial format and post‐results interactive review of continuous assessment questions. Present study is a retrospective review of medical student's performance in 2nd MBBS examinations physiology pro and past the innovations. Data were collected and analyzed by descriptive and inferential statistics using the statistical software for social sciences (SPSS) version 15. Chi‐square test (x2) was used to determine the association between the student's performance before and after our interventions. Furthermore binary logistic regression was equally used to determine the association between student's performance before and after. The level of significance was set at p&lt; 0.05. A total of 2152 students sat for the professional examination over the study period, and 1485 students passed the examination at first attempt giving an overall pass rate of 69%. The pass rate from 2008 when our interventions started was significantly higher than the pass rate before this reform (2004 – 2007) [(76.4%), (n =1646) vs 63.4% (n=1364); P&lt;0.0001]. There was significant association also when the model was adjusted for after 2008 (OR, 1.901, 95% CI (1.566–2.307), P=O.001. Results support the call for institutional leadership by clinical investigators and PhD physiologists with strong translational interests, evidence‐based innovative alternatives to passive lecture formats and students involvement in program evaluation.

An audit of basic practical skills acquisition of final year medical students in a Nigerian medical school

Young medical graduates undertaking their housemanship are naturally expected to demonstrate reasonable competence in basic practical skills. Failure to do this may not only be a source of anxiety to the doctor but also potentially dangerous to the patient. The objective was to assess the level of exposure of final year medical students of a Nigerian medical school to basic practical skills. This is a descriptive cross-sectional study. Structured questionnaires were distributed to a set (all) of 86 final year medical students of the University of Port Harcourt immediately after their last lecture in their final posting in medicine and surgery. The questionnaires listed some selected basic practical skills (e.g. phlebotomy, male urethral catheter insertion, etc.) that house officers are expected to be competent in. The students were asked to anonymously fill them and return same before leaving the lecture hall. Of the 86 students, 84 completed and returned the questionnaires, giving a 97.7% response rate. No student had performed an arterial puncture for an arterial blood sample. Seventy-six students (90.5%) had not inserted a naso-gastric tube. Only 14 (16.7%) students had successfully inserted more than 10 intravenous canulae. A significant number, 38 (45.2%), had never inserted a urinary catheter (for male patients) nor had any experience with bag/mask skills. Majority, 59 (70.2%) had had some experience with intravenous antibiotics administration. Forty-one (48.7%) students had had 6 or more successful attempts at venous blood sampling. The exposure level of final year medical students to basic practical skills was low.

Experiences of mistreatment among medical students in a University in south west Nigeria

This study was conducted to assess the experiences of mistreatment and harassment among final-year clinical students in a Nigerian medical school. A self-administered questionnaire was used to obtain information on the various forms of mistreatment experienced by 269 students in the 2007 and 2008 graduating classes of a medical school in Nigeria. Almost all the respondents (98.5%) had experienced one or more forms of mistreatment during their training. The commonest forms experienced by the students were being shouted at (92.6%), public humiliation or belittlement (87.4%), negative or disparaging remarks about their academic performance (71.4%), being assigned tasks as punishment (67.7%), and someone else taking credit for work done by the student (49.4%). Religious or age discrimination was reported by 34.2%, sexual harassment and other forms of gender-based mistreatment by 33.8%, and threats of harm by 26.4%. These incidents were mainly perpetrated by physicians and occurred mostly during surgical rotations. The effects included strained relationships with the perpetrators, reduced self-confidence and depression. Most medical students experienced verbal forms of mistreatment and abuse during their training. Appropriate strategies for the prevention and reduction of medical student mistreatment should be developed.

Attitude of Preclinical Students to Cadaver Dissection in a South West Nigerian Medical School

Attitude of Preclinical Students to Cadaver Dissection in a South West Nigerian Medical School

An in-house usage assessment of print reference materials in a Nigerian medical school library

The study investigated the utilization of print reference materials in a Nigerian hybrid medical school library, factors influencing utilization or under utilization, and if utilization commensurate with the library’s prospect on the use of these materials. During the period of study, it was assumed that all reference materials pulled out of their shelves and probably left opened in the reference section of the library, have been consulted, and recorded as such on a spread sheet to determine usage. And, on the other hand, 245 students who visited the library and consequently used any of the library’s workstation voluntarily completed a questionnaire to determine if they searched online reference materials. Findings indicate minimal utilization of the library’s print reference and the main factor for under-utilization of the print reference materials was users’ preference for the free online reference resources, since the library has no active subscription to commercial electronic/online reference resources. Amongst other things to be done by library managers and collection development librarians are the review of acquisitions policy to be inclusive of considerable subscription to online or electronic reference resources.