Training the future trainer – The “double‑barrel” postgraduate training model: A pathway to the development of sustainable obstetrics and gynecological specialists in the West African subregion

Abstract

An obstetrician and gynecologist is a physician specialist who provides medical and surgical care to women and has particular expertise in pregnancy, childbirth, and disorders of the reproductive system. Obstetrics and gynecological practice is usually generalist, although four distinct primary subspecialties have been recognized globally – reproductive medicine (reproductive endocrinology and infertility), uro‑gynecology (female pelvic medicine and reconstructive surgery), maternal and fetal medicine, and gynecological oncology. The past two decades have witnessed an evolution in the pattern of training of resident doctors in obstetrics and gynecology, the world over. The West African subregion harbors countries ravaged by poverty and poor health system, with resultant poor reproductive health indices to the extent that calls to question the relevance of the present pattern of Obs/Gyn specialist training toward addressing the reproductive healthcare needs of the subregion. The objective of the study is to evaluate the evolution of postgraduate medical training in some developed countries and Nigeria; highlight the pattern of Obs/Gyn postgraduate training in the United Kingdome, the United States, West African, and Nigeria; and recommend a dual training model that is expected to produce sustainable obstetrics and gynecological specialist in West African subregion. Material and Methods used was a Review involving Internet and literature search. Postgraduate medical training in Nigeria and other Anglophone West Africa countries commenced as a hybrid of UK, USA, and Canadian postgraduate training models. The postgraduate Ob/Gyn educational training program in the United Kingdom has three components – basic, intermediate, and advanced – related to 7 years duration – ST (Specialist Training) 1 to 2 (basic), ST3–ST5 (Intermediate), and ST6–ST7 (advance). They are determined in context and structure by the Royal College of Obstetricians and Gynaecologists and approved by the Postgraduate Medical Education and Training Board. There are three‑part assessment to the exam: Part 1 MRCOG, Part 2 MRCOG, and Part 3 MRCOG – which on completion leads to the award of a Certificate of Completion of Training or a Certificate of Eligibility for Specialist Registration. The obstetrics and gynecological postgraduate residency training program of West Africa College of Surgeons has a minimum duration of 3 years (after passing the primary exams for the award of membership certificate (Part I), and additional minimum of 2 years for the award of fellowship certificate of West Africa College of Surgeons. The training program in Obs/Gyn of the National Postgraduate Medical College adopts a similar pattern to that of West African College. After passing the primary exams, the resident trainee is expected to carry out a 2.5 years training as a junior resident, and an additional 2 years senior residency training to become eligible for the award of the fellowship certificate (FMCOG). American MD/PhD programs are specifically designed for those who want to become research physicians (physician‑investigators or physician‑scientists). The program runs a “2‑3‑2” or “2‑4‑2” track, consisting of 2 years of basic medical science courses; 3–4 years of PhD research and completion of  thesis; and a further 2 years of clinical residencies. The proposed “double‑barrel” (dual) postgraduate training model requires that the doctor commencing residency training in Obs/Gyn simultaneously enrolls to commence the master’s degree program in any of the subspecialties of Obs/Gyn. By the completion of Part I section of residency training program, the trainee will have also completed the master’s degree in the subspecialty of choice, and by the completion of the full training program for award of fellowship, he/she will also be completing the doctorate degree program in the subspecialty. The dual postgraduate training model will produce robust research‑strengthened Obs/Gyn subspecialist clinicians; add value to the present fellowship certificate and thereby conform to the qualification demand of National University Commission for academic lecturership; encourage the establishment of Obs/Gyn subspecialty centers with appropriately skilled personnel and stem the exit of wealthy nationals abroad to seek such expert healthcare; and encourage the wide spread deployment of Obs/Gyn clinicians with subspecialty skills to various parts of the West African subregion, thereby providing expert reproductive health services to both the rich and the poor alike in the subregion.

Keywords: Double‑barrel postgraduate training model; sustainable obstetrics and gynecological specialist; training the future trainer; West African subregion