The process of admission into medical schools and the medical education curriculum vary from one country to another. Medical students are admitted into Nigerian universities through either the university matriculation examination (UME) or direct entry; having passed physics, chemistry and biology in advanced level GCE or having completed a first degree in any field of science. The University Matriculation Board is responsible for the admission processes. While the students admitted through UME spend a minimum of six years to study medicine, those who were admitted through direct entry spend a minimum of five years. After a year (two semesters) of preliminary study of advanced physics, chemistry, biology and mathematics by the students admitted through the UME, they proceed, along with the direct entry students, to the medical school.
The actual medical training begins in the preclinical years when the students are taught basic medical science subjects which include gross anatomy, embryology, histology, biochemistry and physiology (in the first year); medical microbiology, chemical pathology, haematology and blood transfusion, morbid anatomy, and pharmacology (in the second year and the first half of third year). Medical statistics and ethics, community medicine and anaesthesia are taught in the later part of the third and fifth year. The clinical training spans through the fourth and fifth years. This is the period when the students are taught theoretical and clerkship medicine, obstetrics and gynaecology, surgery, paediatrics and psychiatry.
The Medical and Dental Council of Nigeria (MDCN) is responsible for the design and regulation of undergraduate medical education in Nigeria [1
]. The council has recommended that undergraduate pharmacology course should include topics in basic and clinical pharmacology, as well as therapeutics.
In spite of the pitfalls in traditional teaching of pharmacology [2
], it remains the only method of teaching pharmacology in Nigeria [4
]. The traditional teaching is in the form of didactic lectures and bench work practicals. The teaching method often leaves the students to memorize drug information [2
] and poorly prepare them to prescribe rationally [3
]. Clinical pharmacology and therapeutics (CPT), the speciality responsible for training doctors in the safe, rational and efficacious use of drugs, has been progressively integrated into the undergraduate curriculum in the USA [6
], United Kingdom [7
], Netherlands [8
], India [9
] and Nepal [10
] as a way of improving the prescribing knowledge and skills of junior doctors. The integration involved teaching pharmacology in the preclinical year and all through the clinical years in organ system-based manner. This teaching method has focused less on didactic lecture and more on knowledge and skill acquisition on rational drug use. The benefits of the integration system have been widely reported [11
] and the method has been recommended by the World Health Organization (WHO) as a core intervention to promote rational drug use [13
]. Such integration has been advocated in some medical schools in Nigeria [4
Internship is a period of medical apprenticeship under the supervision of a consultant. The intern is expected to learn clinical skills, perform some clinical procedures and demonstrate a good clinical judgement to arrive at patient management decision. Interns are therefore the most junior doctors in a tertiary hospital. They have been found responsible for a significant number of prescribing errors [14
]. Globally, prescribing-related errors are common [17
] and have resulted in a significant patient morbidity and mortality [20
]. Many concerns have been raised in the United Kingdom [16
] about the adequacy of undergraduate CPT education in preparing new doctors for the complex task of rational and safe prescribing. Looking into the fact that the majority of prescription-related errors in hospital environment are made by junior doctors [15
], there is a need to educate the interns and develop an intervention that will improve their prescription qualities. Many studies have evaluated the teaching of undergraduate CPT and its impact on the prescribing ability of junior doctors [25
]. However, such evaluation has not been done in Nigeria and other African countries.
Traditionally, all newly graduated doctors in Nigeria are required to undergo internship in accredited hospitals for a year before fully registered to practice. The accredited hospitals are listed in the handbook of guidelines on registration as a medical or dental practitioner in Nigeria [28
]. The MDCN has recommended that interns should rotate a period of two and a half month through each of medicine, surgery, obstetrics and gynaecology, and paediatrics departments during internship. A month special posting is required in any of radio-diagnosis, radiotherapy, medical microbiology, chemical pathology, haematology, dermatology, psychiatry, morbid anatomy, ophthalmology, orthopaedic or Ear Nose and Throat surgery. The first experience of unsupervised prescribing by the interns begins during the internship. In spite of the wide gap between the periods CPT was taught in medical schools and the commencement of internship, pre-internship CPT was neither taught during employment orientation nor was opportunity provided for continuous medical education (CME) to enable the interns update their knowledge of rational drug use.
This study was therefore aimed to determine how adequately the undergraduate CPT teaching has prepared interns in Nigeria for safe and rational prescribing, and how in retrospect the interns would modify their undergraduate training to improve patient safety when prescribing. The influence of internship training on the prescribing ability of the interns was also sought.