All newly graduated Doctors both foreign and home trained must undergo one year of Internship (Housemanship) before they can gain full registration with the Medical and Dental Council of Nigeria (MDCN). Housemanship is a one year post-graduation supervised clinical training. It generally involves clinical training in all Medical & Surgical specialties such as Surgery, Internal Medicine, Obstetrics & Gynecology and Pediatrics.
Interns usually refers to as House officers are required to learn basis of diagnosis and management of common cases. Everything learnt in Medical school is expected to be put into practice at this stage. House Officers would work under the guidance and supervision of senior doctors such as a Consultant or Senior registrar. The House officer work routine includes; attending ward rounds, making patient treatment progress note, clerking new patient, carrying out some treatment instruction, attending Consultant clinic and working emergency call-duty.
In order to qualify to apply for housemanship, a newly graduated doctor must possess provisional registration and annual practice licence certificate from MDCN. This is usually issued to Nigerian trained doctors after graduation, where as foreign trained medical doctors obtain these certificates after passing MDCN assessment examination. Other documents that can be requested by the prospective hospital includes; Medical degree certificate, state of origin, birth certificate et al.
Housemanship placement in Nigeria does not have a formal matching process, individual doctors need to find placement by themselves. Usually due to large number of doctors seeking placement, prospective hospitals can request doctors to undertake pre-employment interview/examination.
Finding the housejob
The MCDN usually provide newly inducted doctors among other things a booklet that contains information about the hospitals that has approval to take house doctors across Nigeria. Because housemanship positions are limited and very competitive, it is important to apply to as many places as possible within one’s catchment area. It is helpful to list out the hospital of interest, find out their application date, fill their forms if application is ongoing and follow up to know the time for pre-employment interview/examination (if applicable).
Pre-employment interview for housejob involves oral examination on medical and non-medical subjects. Medical aspect of the exam is usually but not limited to questions on emergency scenarios. For example, you can be asked to explain the steps you would take if an unconscious patient is suddenly rushed into the Emergency. It is important for you to be calm and show confidence while answering the question. Examiners see fidgeting as a sign of incompetence and inability to work under pressure. Non-medical questions mostly include current affairs, some knowledge about the city/state where the hospital is situated and even the hospital itself. Get yourself updated before the interview date. Remember a simple click on “google” can make a difference.
Again due to the limited number of paid position available, some doctors opt to take on a supra-numerary position. This means they would work as intern in an approved centre without being paid. This sort of arrangement helps to save valuable time spent on longterm search for a paid position. This allows SUPRAs (doctors who take on supra-numerary position) to fulfill their internship obligation in time. This is required to gain permanent registration with MDCN. Not everybody can take this option, especially without having a strong family support.
The work environment
There are different types of hospital approved to take doctors for housemanship. There are tertiary level hospitals, secondary level hospitals and private hospitals. Tertiary level hospitals includes all teaching hospital, secondary level includes hospital such as Federal Medical Centre (FMC), General Hospital/State specialist hospital, Military hospital, some Mission Hospitals et al. Private hospitals can either fall into the category of tertiary or secondary level hospital.
Teaching hospitals are attached to a university. They are usually big with many specialist, professors and all kinds of medical practitioner. Teaching hospital is the last hope for most patient. They are quite busy centres sometimes having long admission waiting list. If you gain a house doctor position in this kind of hospital, you will be expose to a lot of teaching, see different kinds of uncommon ailments and have the privilege of observing rare procedures. The only disadvantage observed by most people is that interns might have limited opportunity to try out basic procedures due to availability of more competent hands such as resident doctors.
Secondary level hospitals were noted to give house officers more opportunity to try out basic procedures. This helps interns to perfect their skills and develop confidence in handling patients. They usually carry out most of the treatment instructions and reach out to a senior doctor for help when there are challenges. However an house officer serving in a secondary level hospital may not have the same level of exposure to cases, clinical teaching and procedure observation as one who intern in a teaching hospital.
Personally, it is my belief that it really does not matter where you gain a position. The most important thing is to prepare to learn and work hard. Medicine as a profession involves lifelong learning and commitment to self improvement. This is the only way a doctor can be well equipped to serve his/her patient better.