Determinants of Choice of Specialty by Resident Doctors: A Multi-Center Based Study in South-West Nigeria

BACKGROUND AND OBJECTIVES

An appropriately balanced specialty distribution in residency training will ensure adequate coverage and delivery of essential health needs to the people. An understanding of the factors which influence doctors' career choices is important for all those involved in the training of Resident doctors. The aim of this study is to examine the factors influencing the Resident Doctors' choice of specialty.

METHODS

This was a cross-sectional study. A well-structured questionnaire was used as the instrument for data collection.

RESULTS

A total of 110 Resident Doctors participated in the study with 74.5% falling within the age group 31-40 years, and 87 (79.1%) were males. A natural love for a specialty (66.4%), personal experience during medical school (47.3%) and the influence of mentors (30%), love for a particular class of patients (26.4%) and presumed higher income (17.3%) were reasons for initial choices of specialties. The most stated reasons for the change of specialty were because of the acquisition of more information (39.0%), the influence of mentors (26.8%), a change in perspective (24.4%), availability of vacancies (24.4%) and the influence of senior colleagues (17.1%). About 80% had no career guidance prior to the initial choice of specialty; likewise, 92% had no guidance prior to current program. However, 89% were happy with their final choices while only 21% would still consider a change of specialty.

CONCLUSION

In our study, we found that personal interest in a specialty, previous experiences and mentorship were key to most individuals' choice or change in choice of specialties.

Molecular and phenotypic profiling of colorectal cancer patients in West Africa reveals biological insights

Understanding the molecular and phenotypic profile of colorectal cancer (CRC) in West Africa is vital to addressing the regions rising burden of disease. Tissue from unselected Nigerian patients was analyzed with a multigene, next-generation sequencing assay. The rate of microsatellite instability is significantly higher among Nigerian CRC patients (28.1%) than patients from The Cancer Genome Atlas (TCGA, 14.2%) and Memorial Sloan Kettering Cancer Center (MSKCC, 8.5%, P < 0.001). In microsatellite-stable cases, tumors from Nigerian patients are less likely to have APC mutations (39.1% vs. 76.0% MSKCC P < 0.001) and WNT pathway alterations (47.8% vs. 81.9% MSKCC, P < 0.001); whereas RAS pathway alteration is more prevalent (76.1% vs. 59.6%, P = 0.03). Nigerian CRC patients are also younger and more likely to present with rectal disease (50.8% vs. 33.7% MSKCC, P < 0.001). The findings suggest a unique biology of CRC in Nigeria, which emphasizes the need for regional data to guide diagnostic and treatment approaches for patients in West Africa.

Understanding the molecular and phenotypic profile of colorectal cancer (CRC) in West Africa is important for early detection and treatment. Here, the authors use a multigene next-generation sequencing panel to identify genomic differences in Nigerian CRCs compared to those from TCGA and MSKCC cohorts.

Establishing a Cancer Research Consortium in Low- and Middle-Income Countries: Challenges Faced and Lessons Learned

PURPOSE

There is an increasing effort in the global public health community to strengthen research capacity in low- and middle-income countries, but there is no consensus on how best to approach such endeavors. Successful consortia that perform research on HIV/AIDS and other infectious diseases exist, but few papers have been published detailing the challenges faced and lessons learned in setting up and running a successful research consortium.

METHODS

Members of the African Research Group for Oncology (ARGO) participated in generating lessons learned regarding the foundation and maintenance of a cancer research consortium in Nigeria.

RESULTS

Drawing on our experience of founding ARGO, we describe steps and key factors needed to establish a successful collaborative consortium between researchers from both high- and low-income countries. In addition, we present challenges we encountered in building our consortium, and how we managed those challenges. Although our research group is focused primarily on cancer, many of our lessons learned can be applied more widely in biomedical or public health research in low-income countries.

CONCLUSIONS

As the need for cancer care in LMICs continues to grow, the ability to create sustainable, innovative, collaborative research groups will become vital. Assessing the successes and failures that occur in creating and sustaining research consortia in LMICs is important for expansion of research and training capacity in LMICs.

ORAL CLINICAL LONG CASE PRESENTATION, THE NEED FOR STANDARDIZATION AND DOCUMENTATION

BACKGROUND

The oral presentation of the clinical long case is commonly an implied knowledge. The challenge of the presentation is compounded by the examiners' preferences and sometimes inadequate understanding of what should be assessed.

OBJECTIVES

To highlight the different opinions and misconceptions of trainers as the basis for improving our understanding and assessment of oral presentation of the clinical long case.

METHODOLOGY

Questionnaire was administered during the West African College of Surgeons fellowship clinical examinations and at their workplaces. Eligibility criteria included being a surgeon, a trainer and responding to all questions.

RESULTS

Of the 72 questionnaires that were returned, 36(50%) were eligible for the analysis. The 36 respondents were from 14 centers in Nigeria and Ghana. Fifty-two percent were examiners at the postgraduate medical colleges and 9(25%) were professors. Eight(22.2%) indicated they were unaware of the separate methods of oral presentation for different occasions while 21( 58.3%) respondents were aware that candidate used the "5Cs" method and the traditional compartmentalized method in long case oral presentation. Eleven(30.6%) wanted postgraduates to present differently on a much higher level than undergraduate despite not encountering same in literature and 21(58.3%) indicated it was an unwritten rule. Seventeen (47.2%) had not previously encountered the "5Cs" of history of presenting complaint in literature also 17(47.2%) teach it to medical students and their junior residents.

CONCLUSION

This study has shown that examiners definitely have varying opinions on what form the oral presentation of the clinical long case at surgery fellowship/professional examination should be and it translates to their expectations of the residents or clinical students. This highlights the need for standardization and consensus of what is expected at a formal oral presentation during the clinical long case examination in order to avoid subjectivity and bias.

A 5-year Review of Darning Technique of Inguinal Hernia Repair

Context:

The Darning technique of inguinal hernia repair is a tissue-based technique with documented low recurrence rate in some parts of the world. Though practiced in our setting, little is documented on its outcome.

Aims:

The aim was to review the outcome of Darning technique of inguinal hernia repair in our setting.

Study Design:

A descriptive retrospective study.

Patients and Methods:

Clinical records of all patients who had inguinal hernia repair using the Darning technique between January 2007 and December 2011 in our institution were obtained. Details of sociodemographic data, intraoperative findings and postoperative complications were reviewed.

Statistical Analysis Used:

simple frequencies, proportions and cross-tabulations.

Results:

A total of 132 patients whose ages ranged from 15 to 84 years (mean = 49.4 years) with a male: female ratio of 12:1 were studied. Majority of the hernias were right sided (68.9%), mostly indirect (81.8%). The procedures were for emergencies in 17 (12.9%) cases whereas the rest (87.1%) were done electively. Most procedures, 110 (83.3%) were performed under local anesthesia. Surgical site infection was the most common complication occurring in six patients (4.5%), while four patients (3%) had chronic groin pain. At a mean follow-up period of 15 months there were two recurrences (1.5%) both occurring in patients with bilateral hernias (P = 0.001).

Conclusions:

The Darning technique of inguinal hernia repair is a safe and effective method for inguinal hernia repair in our setting.

A review of the management of perforated duodenal ulcers at a tertiary hospital in south western Nigeria

BACKGROUND

Gastro-duodenal perforations are common and may complicate peptic ulcer disease. Management is often by surgical closure.

OBJECTIVE

To determine the patterns of presentation and mode of management of duodenal ulcer perforations.

METHODS

Retrospective review of patients with duodenal ulcer perforations seen at the Obafemi Awolowo University Teaching Hospital between June 2001 and July 2011. Patients' records were reviewed for demography, duration of disease, probable risk factors, type of surgery and complications. Data obtained was analyzed using SPSS 15.0.

RESULT

Forty- five patients were reviewed. There were 37 males (82.2%). Mean age was 39.7years (range 15-78years). There were 10 (22.6%) students and 8(17.8%) farmers. NSAIDs abuse (11), previous peptic ulcer disease (2), and no prior dyspeptic symptoms (20) constituted 24.4%, 4.4% and 44.4% respectively of cases. Seven (16%) patients presented less than 24 hours of onset of illness. Forty one perforations (91.1%) involved the first part of duodenum. Twenty two (49%) patients had Graham's omental patch. We had one (2.2%) failed repair and six (13.3%) mortalities.

CONCLUSION

Late presentation of duodenal ulcer perforation is common with high mortality. Pragmatic surgical intervention with Graham's omentopexy with broad spectrum antibiotics is still commonly practiced.

Chronic obstructive pulmonary disease in OAUTHC Ile-Ife: a ten-year review of hospital mortality

Chronic obstructive pulmonary disease (COPD) is a spectrum of chronic lung disease. The prevalence and incidence of COPD is on the increase globally with an attendant increase in morbidity and mortality. There is a lack of data on the prevalence and incidence of chronic obstructive pulmonary disease COPD in developing countries, which is what prompted this study. We reviewed mortality due to COPD in order to identify risk factors for death and possible preventive measures. Out of 161 admissions during the review period-1990 to 1999-there were 41 deaths, accounting for a mortality rate of 25.46%. The highest mortality occurred in the sixth and seventh decades of life with a male to female ratio of 3:1. Chest infections, cor pulmonale, and respiratory failure were the most common complications. Extremes of age, lower socio-economic group, smoking (>10 packs per year), and respiratory tract infection were the most commonly identified risk factors for death. Attention should be paid to preventive measures to halt the development and progression of the disease. This offers the best hope of minimizing mortality.

Chronic obstructive pulmonary disease: a ten-year review of clinical features in O.A.U.T.H.C., Ile-Ife

The case notes of all patients admitted for chronic obstructive pulmonary disease (COPD) between 1990-1999 were reviewed. A total of 160 cases satisfied the American Thoracic Society criteria for COPD and were subsequently analyzed. The age of the patients ranged from 41-90 years: with a mean of 65 years. The male-female ratio was 4:1. Indoor pollution and smoking were found to be the commonest aetiological factors; while farming and trading were the major occupational groups at risk. The clinical features of the patients showed a mixed pattern of chronic bronchitis and emphysema. The study identifies the need to make an early diagnosis and commence appropriate treatment to retard progression to severe disease and death.