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.

CONTEXTE ET OBJECTIFS: Une répartition équilibrée des spécialités dans le cadre de la formation des médecins résidents garantira une couverture adéquate et la satisfaction des besoins essentiels en matière de santé de la population. La compréhension des facteurs qui influencent les choix de carrière des médecins est importante pour tous ceux qui sont impliqués dans la formation des médecins résidents. L'objectif de cette étude est d'examiner les facteurs qui influencent le choix de la spécialité par les médecins résidents. MÉTHODES: Il s'agit d'une étude transversale. Un questionnaire bien structuré a été utilisé comme instrument de collecte des données. RÉSULTATS: Au total, 110 médecins résidents ont participé à l'étude, 74,5 % d'entre eux se situant dans la tranche d'âge 31­ 40 ans, et 87 (79,1 %) étaient des hommes. L'amour naturel pour une spécialité (66,4 %), l'expérience personnelle pendant les études de médecine (47,3 %) et l'influence des mentors (30 %), l'amour pour une catégorie particulière de patients (26,4 %) et un revenu présumé plus élevé (17,3 %) ont été les raisons des choix initiaux de spécialités. Les raisons les plus citées pour le changement de spécialité étaient l'acquisition de plus d'informations (39 %), l'influence des mentors (26,8 %), un changement de perspective (24,4 %), la disponibilité de postes vacants (24,4 %) et l'influence de collègues plus expérimentés (17,1 %). Environ 80 % n'ont bénéficié d'aucune orientation professionnelle avant le choix initial de la spécialité ; de même, 92 % n'ont bénéficié d'aucune orientation avant le programme actuel. Cependant, 89% sont satisfaits de leur choix final, tandis que seulement 21% envisageraient encore un changement de spécialité. CONCLUSION: Notre étude a révélé que l'intérêt personnel pour une spécialité, les expériences antérieures et le mentorat étaient des éléments clés dans le choix ou le changement de spécialité de la plupart des individus. Mots-clés: Faculté de médecine, Patients, Orientation professionnelle, Spécialité.

Treatment of colorectal cancer in Sub-Saharan Africa: Results from a prospective Nigerian hospital registry.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer worldwide. Mortality for CRC is improving in high income countries, but in low and middle income countries, rates of disease and death from disease are rising. In Sub-Saharan Africa, the ratio of CRC mortality to incidence is the highest in the world. This study investigated the nature of CRC treatment currently being offered and received in Nigeria. METHODS: Between April 2013 and October 2017, a prospective study of consecutively diagnosed cases of CRC was conducted. Patient demographics, clinical features, and treatment recommended and received was recorded for each case. Patients were followed during the study period every 3 months or until death. RESULTS: Three hundred patients were included in our analysis. Seventy-one percent of patients received a recommended surgical operation. Of those that didn't undergo surgery as recommended, 37% cited cost as the main reason, 30% declined due to personal reasons, and less than 5% absconded or were lost to follow up. Approximately half of patients (50.5%) received a chemotherapy regimen when it was recommended, and 4.1% received radiotherapy when this was advised as optimal treatment. With therapy, the median overall survival for patients diagnosed with stage III and stage IV CRC was 24 and 10.5 months respectively. Overall, we found significantly better median survival for patients that received the recommended treatment (25 vs 7 months; P < .01). CONCLUSIONS: A number of patients were unable to receive the recommended treatment, reflecting some of the burden of untreated CRC in the region. Receiving the recommended treatment was associated with a significant difference in outcome. Improved healthcare financing, literacy, training, access, and a better understanding of tumor biology will be necessary to address this discrepancy.

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 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: 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.

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.