VICE PRESIDENT 1
Dr. Musa Dankyau
(MB, BCh, FWACP)
Department of Family Medicine, Bingham, University Teaching Hospital, Jos, Plateau State.
VICE PRESIDENT 2
Dr. S.B. Udoh
Dr. Achiaka. E. Irabor
(MBBS, FWACP, MSc. Dev. Psych)
Consultant Family Physician, Department of Family Medicine, University College Hospital, Ibadan.
Dr. Ayoade Adedokun
Dr. Yakubu Benjamin Ibrahim
Chief Consultant Family Physician/ Head, Department of Family Medicine, ABUTH, ZARIA.
Dr. Elihu I. Medunoye
Writ Schl Dip., FMCFM, FWACP-FM, Dip. HSM,
Cert. Dermatology, Cert. Geriatrics Medicine.
EDITOR OF SOFPON JOURNAL
DR. Olabode N. Shabi
Dr. Udofia Oscar
Health Services, Federal Capital Territory, Abuja.
Col. (Dr.) Akin L. Moses (rtd)
(MBBS, FMCGP, FWACP, DSS)
Chief Consultant Family Physician and Director of Training ,
Department of Family Medicine, National Hospital, Abuja.
Visiting Consultant, Nigerian Army Hospital, Kaduna.
Family Care Multi-clinic, 9 Lord Lugard St. Asokoro, Abuja.
Dr. Blessing C. Chukwukelu
Head, Department of Family Medicine and Director of Training, The EKO Hospitals, Lagos.
The History of Family Medicine training in Nigeria
The early history of the faculty of Family Medicine is closely linked with that of the Association of General Medical Practitioners of Nigeria as well as the Nigerian Medical and Dental Council.
In the early 1970s, a number of young doctors in Lagos opted to go into Private General Medical Practice on full time basis while being resolved to build the right image for the General Practitioners (GPs) in Nigeria. Their first step, taken in 1976, was to establish the Association of General Medical Practitioners (AGMPN). They found out that the association was already in existence since 1921 though inactive. The association was revived with the cooperation of the members of the original association. Thereafter, an inaugural General Meeting of all known General Medical Practitioners in Lagos was convened. At the meeting, the Association’s aims and objectives were clearly articulated and an Executive Committee was elected. Late Dr. Andem Ewa was elected president; late Dr. Yinka Olumide the Vice-President while Dr. A. O. Ajayi was elected the General Secretary. The National Secretariat was located at No. 9 Sam Shonibare Street Surulere in Lagos. The association reached out to General Practitioners all over Nigeria and encouraged the formation of state branches. The first branch members included esteemed members such as the late Dr. S. E. Mbanefo and Dr. Azike from Onitsha, Dr. Mama from Kaduna, Dr. Elukpo and Dr. Oloruntoba from Ilorin. These doctors eventually became our founding fathers. Very prominent among the objectives of the newly revived Association was a Continuing Medical Education Programme for its’ members under the direction of an academic sub-committee. This sub-committee organized regular monthly Sunday lunch-time lectures at the Apapa Club, given by consultants in various specialties.
The Medical and Dental Council of Nigeria (MDCN) administered the Postgraduate Medical Education Programme in Nigeria (established by military decree in 1970 but not yet training doctors in Nigeria) that had and from time to time, conferred Fellowship of the Medical Council in General Medical Practice on any doctor considered fit for such an award. Following a protest from the AGMP on the mode of Fellowship award, a GMP Faculty board was formed based on the advice of the MDCN. The Association was informed that the Council at that time was in the process of establishing training in the National Postgraduate Medical College of Nigeria, which was to have 14 faculties, one of which would be a Faculty of General Medical Practice. The board was charged to prepare a syllabus, vocational training scheme and examination format for the fellowship programme in GMP. There was liaison with the Royal College of General Medical Practitioners (RCGMP) in England, which gave very useful guidance and materials. The Council further indicated that if the Association was willing to take over the responsibility for the proposed Faculty of General Medical Practice it should do three things:
- Set up a sixteen-member General Medical Practice Faculty Board
- Elect a Chairman, Secretary and a Third Member of the Faculty to represent the GMP Faculty on the Governing Board and the Senate of the Postgraduate Medical College of Nigeria.
- Prepare a syllabus, Vocational and Training Scheme and Examination format for the Fellowship Programme in General Medical Practice.
These were to be presented to the Senate of the college for consideration and approval.
Faced with such a great challenge the Association set up a GMP FacultyBoard mainly from the members of its Continuing Medical Education Sub-committee, but included several members from the state branches. Late Dr. Andem Ewa, the president of the Association of General Medical Practitioners of Nigeria was elected the first faculty chairman, Dr. A. O. Ajayi, the then AGMPN General Secretary was elected the Faculty Board Secretary while late Dr. S. E. Mbanefo was elected the third member of the Faculty on the College Senate.
Other members of the first GMP Faculty Board were
Dr. Yinka Olumide,
Dr. C. A. Pearson,
Dr. Col. Bassey-Inyang,
Dr. M. O. Quadri,
Dr. M. A. Okunyade,
Dr. T. A. Oworu,
Dr. C. Okojie,
Dr. Chief Ogunlesi,
Dr. A. Azike and
Dr. T. E. Elukpo.
Having set up the essential infrastructure, the society proceeded to elect its foundation fellows.
These fellows would be responsible to train the new intakes into the GMP specialty.
The criteria for eligibility were:
—Twelve years post qualification as a doctor
—Five years experience as a General Medical Practitioner.
Altogether 152 foundation fellows were elected including all those who had earlier been awarded fellowships by the Nigerian Medical Council. After the election of the foundation fellows the faculty was besieged with requests from many doctors, both GPs and specialist in private medical practice, for the award of its fellowship. However, in order to establish and sustain the desired respectability and value of the new GMP fellowship, it was decided that it could only be awarded based on the presentation and successful defense of a dissertation, which must be on an approved clinical subject of the applicant’s choice and prepared under the supervision of a GMP Faculty Board member. Several members of the AGMPN were opposed to this conditionality. They advocated the automatic award of the Faculty’s fellowship to any GP who had been qualified for a period of twelve years. The Faculty rightly disagreed with them and maintained its stand. A number of senior doctors had already been awarded the fellowships of the NPMCN through the submission of dissertations.
In close collaboration with Dr. Andrew C. Pearson, the Faculty board members drew up the syllabus for the primary, Part 1 and Part II of the proposed Fellowship programme.
Postgraduate training in GMP commenced in 1979. Simultaneously an International Conference of relevant local and international stakeholders was held in Ibadan in 1980. The final draft curriculum, fine tuned at the conference, was thereafter presented to the NPGMCN College Senate for approval, which was unanimously adopted. The curriculum was designed to produce a doctor that needed to have an adequate level of knowledge and competence in surgery, medicine, obstetrics, gynecology and paediatrics to be able to deal with routine uncomplicated cases that need not be referred to the tertiary centers. Such a doctor must however recognise the limit of his ability and know when to refer cases for expert care in the different specialties. Immediately after the fellowship curriculum was drawn up, Faculty members were requested to contribute suitable MCQ and Essay-type questions with answers to the Faculty’s Questions Bank and candidates were invited for the first primary examination in 1980. The response from young doctors who wanted to specialise in General Medical Practice was very encouraging and pass rate compared favourably with the rest of the College. There were five doctors to take the primary exams in Ibadan with resident doctors from the other faculties. Three were successful namely Drs. Abioye –Kuteyi, Ayankogbe and Giwa.
The successful candidates easily secured training posts at the accredited training centers and the Part 1 Fellowship Programme started in earnest. The first sets of GMP graduates were examined in 1985. Dr C. Andrew Pearson was appointed the first Director of Training by the NPMCN in 1983 to direct the training program, accredit secondary care hospital for training and organize workshops and course work. In the mid 1980’s, this model of training was exported to some S/E Asian and Latin American countries that requested for the curriculum and modelled their training along this line.
The 152 foundation fellows elected from 1976-1985 steered the training and the faculty up to and beyond 1985 when the first two fellows by Examination emerged. These first two Fellows by examination were Dr O. O. Imediegwu trainer at Abakaliki and Prof. E. A. Kuteyi trainer at OAU Ile-Ife. Once graduate general medical practitioners were produced in 1985, the criteria for fellowship by election was changed to 20 years post qualification and 12 years experience in the sub region and a modified part 2 examination instituted by satisfying the examiners at a defense of a dissertation appointed by the faculty and a case book of 25 patients report managed by the candidate. Dr A. O. Sangowawa, a UK trained general practitioner, who had obtained a Fellowship by Election by successfully defending a modified Part 2 dissertation, became the second Director of Training in 1985.
The development of the undergraduate curriculum of family medicine in Africa started in 1977 in the University of Pretoria, South Africa 1, then 1980 in Calabar, Nigeria with the first set of medical students sitting the general practice examinations of the MBBCh in 1983 2. This is commendable as South Africa and Nigeria were able to commence undergraduate training in Family Medicine ahead of Canada and the USA both in 1986 3, 1991 in the UK 4 and 1992 in China 5. The medical curriculum developed in 1978 and ratified in 1980, at the formation of the University of Calabar Medical School by Prof. Olufemi Williams had 2 principal objectives namely:
- To produce medical graduates who demonstrate confidence and ability to practice medicine, in any rural or urban setting in Nigeria or similar environment.
- To produce medical graduates who appreciate early their role as a front line doctor or doctor of first contact 6.
Despite this early and commendable start of undergraduate family medicine, there was a stall in progression of teaching of family medicine in our Nigerian universities until 2010 onwards.
In 1992, the West African Postgraduate Medical College (WAPMC) produced the first set of GMP Fellows. The objectives of the family medicine training for the WACP are:
- To develop and extend the knowledge, skills and attitudes to manage any clinical problems within the sphere of expected competency, using the principles of systems theory (bio-psychosocial model) and in the context of family, work and community.
- To prepare for positions of leadership in research, good clinical practice, teaching and management of resources.
- To develop the habit of keeping good records for promoting continuity of care and good clinical practice audit.
- To appreciate the doctor’s role in health promotion and disease prevention.
- To recognise the need to engage in professional development through continuing medical education.
- To demonstrate effective communication skills and maintain appropriate doctor-patient relationship.
- To acquire knowledge in medico-legal and ethical issues.
- To show competence in the use of relevant modern diagnostic and therapeutic aids7.
Many West African countries have adopted the programme including French-speaking Niger. As a regulation the curriculum was to be reviewed every 5 years this was done in 1988. An international curriculum review was organized in 1998 (after 10 years) jointly by the Faculty of GMP of the NPMCN and the WACP on “Training the Front Line Doctor for the 21st Century”, principally addressing the paradigm shift of the curriculum to embrace Family Medicine as it pertained globally. The specialty of Family Medicine was defined as that which provides continuous, comprehensive and coordinated care to individual family and population undifferentiated by age, gender, disease or organization. In 2002 the faculty in the WACP changed its name from GMP to the faculty of Family Medicine and in 2006 the faculty in NPMCN followed suite. All departments of GMP in Nigeria are now re-designated departments of Family Medicine.
Another fall out of the 1998 joint conference of the NPMCN and the WACP on “Training the Front Line Doctor for the 21st Century”, was the birth of the Academy of Family Physicians of Nigeria (AFPON) now known as Society of Family Physicians of Nigeria (SOFPON). This is an umbrella association for all Family Physicians practicing in Nigeria irrespective of their training background. The body holds Annual General and Scientific meetings yearly having had 16 as at 2014.
Family Physicians from all over the world belong to WONCA – World Organization of National Colleges, Academies and Academic associations of General Practitioners/Family Physicians. The AGPMPN had been the country member since 1980. The faculty of GMP became Associate member of WONCA in 1985.
In keeping with the five yearly mandates to review the family medicine postgraduate curriculum, another international conference was held in 2005 in Ibadan (2 years late) to commemorate “25 years of Family Medicine” in Nigeria. The curricula of the faculties at both colleges were reviewed and the “Tenets of Family Medicine and Family Dynamics” were highlighted at this conference and incorporated into the curriculum.
In 2011 the curriculum was once more reviewed, not to effect a change in the postgraduate training but to modify some of its content to improve the quality of care given by Private Practitioners. The birth of the diploma program to achieve a critical mass in other to have enough frontline doctors to man and give leadership in primary care in the era of the National Health Insurance Scheme was born, offering
country wide training in 3 locations namely Lagos, Awka and Abuja. The programme has had three sets of graduates from this yearly diploma awarded by the NPGMCN.
The undergraduate family medicine curriculum of the new integrated undergraduate medical education that was formed in 2010 and adopted by the Nigerian University Commission in 2012 has five objectives that emphasise the need to provide quality primary care by MBBS graduates while avoiding overlap with the objectives of primary health care as is found in the community medicine undergraduate curriculum. The aims of the new curriculum are:
- To produce medical graduates who demonstrate ability to effectively manage undifferentiated disease by using clinical problem solving method, the bio-psycho-social model and the family medicine tools to assess and treat patients holistically and differentiate between illness and disease.
- They should acquire the competence to manage patients in the context of their family and manage the family as a unit of care for cost effective patient management, bearing in mind the family and social dynamics in the context of the Nigerian culture and imbibing an attitude of responsibility to the health team and the patient.
The learning objectives for undergraduate Family Medicine are:
- To produce medical graduates who demonstrate ability to effectively manage undifferentiated disease.
- Must demonstrate the ability to use clinical problem solving method, the bio-psycho-social model and the Family Medicine tools to assess and treat patients holistically and differentiate between illness and disease.
- Must demonstrate a deferential attitude to patients and their family no matter how ‘trivial the complaint may be’
- To produce medical graduates who are competent to manage patients in the context of their family and manage the family as a unit of care.
- Must know the Impact of Family Cycle on Health Seeking Behaviour
- Must know the Impact of the Family on Clinical presentation
- To produce graduates who can use the different levels of medical care for cost effective patient management.
- Must have the knowledge of which medical problems should be managed in which level of health care.
- Must know how to optimize resource utilization for patients in the Nigerian context
- Must know how to manage patients in the primary and secondary levels of care at international standards.
- To produce graduates who can effectively manage patients in the primary and secondary levels of medical care.
- Must demonstrate the skills to integrate knowledge and skills acquired in the other specialties for management of patients in primary and secondary health care.
- Must demonstrate the skills of managing these patients bearing in mind the family and social dynamics prevalent in the Nigerian community
- Must demonstrate an attitude of responsibility to the health team and the patient by being punctual, courteous and following through on patient management to its conclusion.
- To produce graduates who will meet world standards in preventive services and health care delivery in Family Medicine
- Must demonstrate the skills to screen for medical conditions in the context of the patients family and antecedent history.
- Must demonstrate knowledge on how to foresee possible scenarios that would hamper the health of a member of the family
IN 2013, the faculty of Family Medicine in the WACP initiated the process of getting family medicine to our francophone speaking colleagues in the West African coast. This was a response to the call of the President of the WACP then Prof. Roger Makanjuala in 2008 to make the WACP a truly West African College.
There are now over 400 fellows by examination working in;
—Outpatient departments of teaching hospitals,
—Local government areas,
—International development agencies
Dr. Andrew Charles Pearson was born in Shaoyang, Hunan, China on the 10th December 1921 and obtained an OBE in 1974. In 1952 Dr. Pearson was appointed medical superintendent of the Wesley Guild Hospital, a Methodist foundation at Ilesha in Western Nigeria where he stayed for 23 years. He was plunged immediately into the administration of a major building programme as well as heading a medical team that was consistently short-staffed. He had to be an architect, builder and plumber as well as a doctor. Dr. Pearson built a greatly respected team of Nigerians and expatriates health workers. One of his early colleagues was David Morley, who pioneered a revolution in child healthcare through the renowned weight monitoring programmes he developed in and around Ilesha. It was here that the first ever measles vaccine was given a trial and, in order that there should be no question of using the Nigerian population as guinea-pigs, Pearson typically insisted that his own four children should be included. Ilesha became the centre of world attention for its innovative and effective approach to both preventive and curative medicine, and it was described, by the Overseas Development Agency’s health adviser at the time, as “the model hospital”. In 1975 the hospital became part of the Ife University Teaching Hospital Complex. Dr. Pearson became Chief Medical Officer for the University of Ibadan’s community health programme. He trained medical students in community healthcare and general practice. Then, in 1983, he became the Director of Training in General Practice at the National Postgraduate Medical College in Lagos. Before leaving Nigeria in 1985, the Pearsons’ were made honorary chiefs. They retired to Bury St Edmunds but Andrew Pearson undertook consultancies in GP training and attended conferences in many countries. He died in Bury St Edmunds, Suffolk on the 7th November 1997– excerpts from The Independent newspaper; Obituary: Dr C. A. Pearson written by John Pritchard, Thursday 13 November 1997.
Compiled by Dr. Achiaka E. Irabor from contributions by:
Dr. Matee Obazee, Dr. Akin Moses, Prof. Ndifreke Udonwa, Dr. Stephen Yohanna and Dr. A. Ariba.
- Haight KR. Family medicine in the undergraduate curriculum: differing views of where from here? Can Fam Physician 1987; 33: 2792-2794.
- Robinson LA, Spencer JA, Jones RH. Contribution of academic departments of general practice to undergraduate teaching and their plans for curriculum development. Br J Gen Pract 1994 Nov; 44 (388): 489-91.
- Leaman T. (1980) Undergraduate Education in Family Medicine – A Ten-Year Perspective. Archives of Family Practice. Reprinted with permission from the Journal of Family Practice, 9:5:845-854, 1979.
- Joint Committee on Postgraduate Training for General Practice (2002). The Future of GP Vocational Training. JCPTGP, London.
- Huang Y, Guo A. Development of undergraduate family medicine teaching in China. Br J Gen Pract. Apr 1, 2011; 61 (585): 304-305.
- Okokon IB. Undergraduate/Residency Training in General Medical Practice in Calabar. From Proceedings of the International Conference on Curriculum Review in Family Medicine in West Africa- Training the Frontline Doctor for the 21st Century by the Faculties of General Medical Practice of the National Postgraduate Medical College of Nigeria and the West Africa College of Physicians. 22-25 April 1998. Page 51-4.
- West African College of Physicians- Faculty of Family Medicine: Curriculum 2014. ISBN: 978-978-49311-1-3.
- The 2010 MB,BS Curriculum of the College of Medicine, University of Ibadan. Ed E. Oluwabunmi Olapade-Olaopa.
- Okokon IB, Ogbonna UK, Asibong UE, Aluka TM & Dienye PO. Teaching Family Medicine in Medical Schools- The perspective from a Nigerian Medical School. Nig J of Fam Prac., Nov. 2012. 3 (1): 1-6.
- Udonwa NE, Ariba A, Yohanna S, Akin-Moses L. Family Medicine in West Africa: progress, milestones, and challenges so far in Nigeria (1980 – 2010). Nigerian Journal of Family Practice. 01/2011; 1(2): 1 -9.