FACTORS DETERMINING THE RESULTS OF THE EXAMINATION OF THE WEST AFRICAN COLLEGE OF SURGEONS IN GENERAL SURGERY.

BACKGROUND: The general surgery results of the West African College of Surgeons (WACS) post-graduate fellowship examination could not be regarded as satisfactory when compared with the results of similar post-graduate examinations in some developed countries. For example the pass rate of the West African College of Surgeons examination was usually under 40% whereas the pass rate in oral examination in a similar post-graduate examination, the American Board of Surgery was 84% in 2006, 73% in 2012. The first time pass rate in general surgery of final year general surgery residents at the American Board of Surgery qualifying and certifying examinations were 74% - 78% between 2000 and 2007. AIM & OBJECTIVES: To identify the factors responsible for the high failure rate at the general surgery fellowship examinations of the West African College of Surgeons. STUDY DESIGN: Descriptive study .We studied and analyzed the West African College of Surgeons examination results for April 2012, October 2012, April 2013 and October 2013 with emphasis on the results, the conduct of the examination and the opinion from fellows about the examiners. Well structured questionnaires were sent to fellows who had passed all the various fellowship examinations of the West African College of Surgeons in general surgery to indicate their opinion about the examination, and the examiners. SETTING: University College Hospital, Ibadan, and Jos University Teaching Hospital, Jos, Nigeria. METHODOLOGY: The first part of the study dealt with an analysis of each section of the examination prospectively studied over a 2-year period. This consisted of four sets of examination results. The second part was a questionnaire-based study administered to Fellows who had passed the WACS final fellowship examination in general surgery. The questionnaire had three sections: primary, part 1 and part 2 and included basic demographics, date at attempts in each grade of the examinations and the outcome. It also included the views of the respondents on the conduct of the examination and outcome. The data were analyzed using Microsoft Excel. RESULTS: A total of 720 candidates with age range of 28 - 39 years and a mean of 33.2 years sat for the Part 1 Fellowship examinations in 2012 and 2013 with an average of 180 candidate per examination. At the Part 2 fellowship examination, 84 candidates with the age range of 31 - 42 year and a mean of 36.5 years sat the Part 2 Fellowship examination with an average of 21 candidates for each Part 2 examination in general surgery during the same period. The examinations held in April and October of each year. While an average of 28.8% of the candidates passed, an average of 71.2% of the candidates failed the Part 1 Fellowship examinations in 2012 and 2013. The aggregate clinical score was responsible for failure in 59.5% of the candidates. In the Part 2 Fellowship examination in general surgery during the same period, 31.5% of the candidates passed while an average of 68.5% of the candidates failed per examination. The aggregate clinical score was responsible for 53.3% of the candidates who failed the Part 2 examination. Furthermore, 60 - 69.7% of the candidates had a favourable opinion about the conduct of the examination, 54.5 - 63.6% rated the professionalism of the examiners high, even though the pass rate at the first attempts of the various grades of the examination by the respondents was about 50 percent. CONCLUSION: The clinical part of the examination is a major factor responsible for the high failure rate in the general surgery fellowship examinations of the West African College of Surgeons. In order to mitigate this, residents in training should be exposed to the clinical management of a wide range of cases in the discipline with majority of the operations performed by them under the direct supervision of their consultants.

The evolution of surgical procedures in the management of duodenal and gastric ulcers.

Surgical procedures for the surgical management of duodenal ulcer had evolved through many stages, over the years. It started with gastroenterostomy alone, then followed by subtotal gastrectomy, vagotomy alone, vagotomy and gastro-jejunostomy, vagotomy and pyloroplasty, and highly selective vagotomy - all which started as open surgical procedures. Now unless there are complications the treatment is essentially medical following the work of Marshall and Warren. Currently, even when surgery is indicated, minimal invasive procedures are preferred. Four main types of pyloroplasties are well known. They are Weinberg, Heinecke-Mikulicz, Finney and Jaboulay. Vagotomy can be truncal, selective, and highly selective. Accepted surgical treatment for gastric ulcer is the distal gastric resection to include the ulcerated area, but not resecting more than 50-60% of the stomach. In the uncommon cases of Zollinger-Ellison syndrome, aggressive gastric surgery, the use of drugs, and the resection of the tumour have all been recommended in appropriate cases. With the discovery of Helicobacter pylori and its effective medical treatment, surgery has little role in the initial management of peptic ulcer disease. The place of the history of the surgical procedures employed earlier in the treatment of this disease would remain relevant.

What should constitute the clinical component in fellowship examinations in surgery.

The consensus of opinion is that in all medical examinations, a failure in the clinical aspect of the examination automatically means a failure in the whole examination regardless of what the total score may be. But opinion differs as to what constitutes the "clinical aspect" of the examination. Some think it should be the average score of only long case and short cases. Others think it should be the total score of long case, short cases and viva voce. Yet others think when the orals are of two parts it should be the average score of long case, short cases and a part of the orals. We therefore used the result of 197 surgical residents that sat for the part 1 fellowship examination of the West African College of Surgeons in April 2012 for this study. We collated the scores of various categories of clinical aspect of the examination to see whether there is any difference in the pass rate of the group.

A four-year analysis of manuscripts submitted for publication in West African Journal of Medicine (June 2001 to May 2005) (a brief report).

There are various criteria that could be used to rate a tertiary institution. One of these is the productivity of the members of staff which is shown by the research conducted, publications submitted and manuscripts published in indexed journals. Manuscripts submitted and published in one of the highly rated indexedjournals in our locality were analysed with a view to identifying how the institutions add to knowledge by their contributions. Our findings show that the four top-rated institutions in terms of manuscripts published in West African Journal of Medicine (WAJM) are University College Hospital (UCH), lbadan, University of Ilorin Teaching Hospital (UITH), Obafemi Awolowo University Teaching Hospital (OAUTH), and Jos University Teaching Hospital (JUTH).

An unusual cause of lower gastrointestinal bleeding: a case report and a review of literature.

This is an unusual case report of a 60-year-old man who presented with massive rectal bleeding due to angiomatous formation. He was also found to be cirrhosis and to have an ectopic left kidney in the midline over the roof of the mesenteric vessel. He was treated successfully by performing a right hemicolectomy.

Guidelines for assessment of publications for contribution to scholarship: a view point.

BACKGROUND: There does not seem to be a uniform method of assessment for promotion in the various tertiary institutions in Nigeria. The result of this is that a professor in one institution may just qualify to be a senior lecturer in another in the same country. An attempt is being made in this write-up to devise a method of standardization for promotion in tertiary institutions in Nigeria. METHOD: Literature dealing with peer review process, writing clinical research papers, and assessment were reviewed. Also various methods of assessment for promotion in some tertiary institutions were studied. RESULTS: There are six areas of assessment of the publications of a candidate for academic promotion. They are (a) the quality of the journal where the article were published; (b) the type of research; (c) the scientific quality of the paper; (d) the relevance of the paper to the author's discipline; (e) the numerical position of the authorship of the candidate being assessed; (f) and the number of publications. CONCLUSION: Having a clear-cut and more objective way of grading a prospective candidate will ensure uniformity, allow the candidate to work realistically towards a goal and to aim high, reduce subjective assessment, reduce the chances of injustice, and encourage non-indexed local journals to aspire to get indexed or die a natural death.

The Ibadan conjoined twins: a report of omphalopagus twins and a review of cases reported in Nigeria over 60 years.

An omphalopagus set of female conjoined twins, undiagnosed prenatally, who presented as obstructed labour needing operative delivery is reported. Their anatomic characteristics and clinical features, including overwhelming sepsis in twin II which forced early separation, and those which led to their demise are described. Twelve other cases reported in Nigeria over the past 60 years are reviewed with reference to the aetiology and epidemiology of conjoined twinning and the determinants of successful surgical separation.

Enterocutaneous fistula.

Based on the modality of treatment, historically the management of enterocutaneous fistula has been grouped into three periods. The era of antibiotics (1945-1960), the era of intensive nurse care (1960-1970) and the era of intravenous hyperalimentation (1970-1975). Schein's modification of Sitges-Serra classification of enterocutaneous fistula is now preferred to the old classification of high-output type and low output type. A major cause of enterocutaneous fistula is technical failure. Serum level of short-turn over proteins such as albumin retinal-binding protein, thyroxin binding pre-albumin as serum transferring are predictors of mortality and spontaneous fistula closure. Immediate surgical correction of the fistula is not a priority of treatment. The control of sepsis and adequate nutrition are the two most important aspects of management. The use of somatostatin and octreotide has been shown to shorten the period of spontaneous closure of the fistula.

The changing pattern of malignant neoplasms among females in Asir region of Saudi Arabia.

OBJECTIVE: The study was undertaken to compare the frequencies of the various types of malignant neoplasms affecting females in the Asir Region of Saudi Arabia during the years 1996-1998, to the experience of a previous report (1987 to 1989) in the same population with rapid advancing health care services. METHODS: A retrospective descriptive approach was adopted. Histopathological records of Asir Central Hospital were reviewed to extract data on female malignant neoplasms seen in the years January 1996-December 1998. The cancer from various sites were ranked based on their percentage (crude relative) frequencies, and compared with the previous report (1987-1989). RESULTS: Of the 274 cases of histologically confirmed female malignant diseases, the breast (22%), skin (9%) and thyroid (7%) were the leading sites. This ranking contrasts with the previous finding (1987-1989) which involved the skin, breast and non-Hodgkin's lymphoma, in descending order of frequencies. The frequency of gynecological malignancies was relatively higher than in the previous report. CONCLUSION: There may be a need to review the pattern of malignancies in the female population in this region from time to time in order to concurrently update planning on preventive and treatment measures.

Swallowed foreign body: Is interventional management always required?

A retrospective study of 20 cases diagnosed as "swallowed foreign body" seen over a five-year period (July 1993-June 1998) at Asir Central Hospital was performed. Six (30%) were children and 14 (70%) adults. In the children, five were boys and one was a girl. Objects swallowed included metal nails. coins, hair pins and a chain pendant. In the adult group, eight (57%) were males and six (43%) females. Objects swallowed included sewing needles, sharp blades, pieces of glass, paper clips and gravel. The swallowed foreign body in all the patients passed innocuously through the gastrointestinal tract in two to ten (average 4.7) days. Our method of treatment consisted of giving high fiber diet, Metamucil or lactulose and liquid paraffin. There was no mortality.

Writing a clinical research paper.

A well-known unwritten law in institutions of higher learning is that of "Publish or perish". The duties of a University teacher, in order of priority are teaching, research and service. Reasons for writing clinical research papers are to get promoted, to get research grants and to make known, one's findings in order to improve patients' care. Writing papers is also a means of delivering continuous education, therefore publication is essential for any one pursuing an academic career. Research papers can be in the form of case reports, retrospective studies, prospective studies and laboratory or animal research. Two popular formats of writing papers are: The Vancouver Style and the Harvard System.

Post operative nausea and vomiting in Nigerians.

A retrospective survey of postoperative nausea and vomiting (PONV) in the recovery room over a five year period was conducted, followed by a prospective study of 200 adult patients to estimate the incidence and predisposing factors to nausea and vomiting during the first 24 hours after anaesthesia and surgery in Nigerians. In the retrospective study only records of 61 patients (0.79%) out of the 7714 post anaesthetic recovery room charts reviewed revealed documentation of vomiting. These were 20 males (32.8%) and 41 females (67.2%). In the prospective study, the incidence of post operative nausea and vomiting within twenty four hours of surgery was 41.6% and 19.6%, respectively. But only two out of 39 patients (one per cent) vomited within the first three hours in postoperative period. The frequency of vomiting varied from one to 15 times and women had significantly more emetic symptoms than men (p < 0.05). Preoperative administration of pethidine and morphine was associated with postoperative nausea and vomiting. It is suggested that Nigerian women should be considered for prophylactic anti-emetic therapy, especially when narcotic analgesic are to be employed in their anaesthetic management.