Views of early career doctors on residency training and clinical practice in Nigeria: A qualitative report from charting study

In Nigeria, Early Career Doctors (ECDs) constitute a significant number of the doctor's health workforce and play a crucial role in health service delivery. However, there is a paucity of data concerning attitude, perception, and challenges in training and skill acquisition faced by ECDs undergoing residency training in Nigeria. This study is a component of Challenges of Residency training and early career doctors in Nigeria (CHARTING study) a multicentre and multidisciplinary study that explored the views of ECDs on residency training and clinical practice in Nigeria. Methods: Focus Group Discussions (FGD) were conducted among fourteen respondents, to address specific aspects of the residency training program and encourage respondents to express themselves about issues relevant to their personal experiences as regards the assessment of practice and proffer recommendations. Discussions were digitally recorded with an audio recorder. Audio-recordings was transcribed verbatim. Transcripts were analysed, and coding was done using NVivo 12 program. Results: All the study participants expressed various degrees of dissatisfaction and challenges such as lack of up to date knowledge, poor&contingent rewards, workload distribution, lack of mentorship, and unequipped facility during the residency training program. Majority of the study participants considered the program is currently skewed towards service delivery at the detriment of training and research. Conclusion: The study provided robust information on the knowledge of the trainees' perception of the residency training program in Nigeria as well as the challenges of residency training among ECDs as regards their experience and practice; it also proffered recommendations to mitigate the challenges. Keywords: Career, Internship, Postgraduate, Registrar, Trainee, Residency, Doctors, Dentist, Early Career Doctors, Nigeria, Education, Graduate Medical, Residenc

Challenges of residency training and early career doctors in Nigeria study (charting study): a protocol paper

Introduction: Early career doctors (ECDs) make up a significant proportion of the workforce of medical/dental practitioners in Nigeria. ECDs play pivotal roles in the Nigerian healthcare system. However, several factors affect ECDs in their career endeavours, ranging from poor remuneration to psychosocial problems (such as burn out, job dissatisfaction, etc.). While other countries have tried to investigate these factors and their impact, no national inquiry has been done yet in Nigeria. This demonstrates the critical need to conduct a nationally representativestudy exploring these factors, such as demographic, workplace and psychosocial factors, among ECDs in Nigeria. This article is a protocol paper for the challenges of residency training and early career doctors in Nigeria study; charting study to be conducted under the auspices of the Nigerian Association of Resident Doctors of Nigeria(NARD).Methods: The Charting Study would be a mixed study design, utilizing both qualitative and quantitative study designs and access data from structured questionnaire, focus group interview and secondary data available to the association.Conclusion: The outcome of this study will provide great insight into various issues affecting ECDs in Nigeria and make necessary recommendations.Keywords: Nigeria, early career doctors, junior doctors, physicians, dentists, workplace, psychosocial issue

Clinical Characteristics of COVID‑19 Patients Admitted at the Federal Medical Center, Abeokuta

Background: As the coronavirus disease 2019 (COVID‑19) continues to ravage the world as a pandemic, there is a paucity of data in resource poor countries like ours on the clinical characteristics of these patients. Aim: The aim of our study was to find the sociodemographic, clinical, and laboratory characteristics of COVID‑19 patients admitted in our facility between May and July 2020. Materials and Methods: A cross-sectional observational study was carried out on COVID‑19 patients admitted during the study period. Their baseline demographic, clinical, and laboratory details were obtained from their clinical notes, recorded electronically, and analyzed. Results: Twenty‑six COVID‑19 patients were admitted during this period, with a mean age of 47.19 (standard deviation 16.56) years, and more males 16 (61.5%). Fever was the most common complaint 17 (65.4%), followed by breathlessness 15 (57.7%), weakness 11 (42.3%), and cough 9 (34.6%). Hypoxemia (SPO2 <93%) was present in 10 (38.5%)of patients at admission, with dyspnea being the most common abnormality on general physical examination 20 (76.9%). Eleven (42.3%) patients had associated comorbidities with hypertension being the most common 7 (43.7%), followed by diabetes mellitus 4 (25.0%). Just 3 (11.5%) patients had mild disease, 13 (50.0%) had moderate disease, and 10 (38.5%) had severe disease. Lower respiratory tract infection or suspected COVID‑19 was the initial diagnosis in 10 (38.5%) of patients at admission, while 16 (61.5%) were admitted with other diagnosis. Leukocytosis was found in 8 (30.8%) patients, 14 (53.8%) patients had anemia, elevated urea in 20 (76.9%), and elevated Creatinine in 11 (42.3%). Seventeen (65.4%) patients were discharged home, 2 (7.7%) referred to another center for hemodialysis, while 7 (26.9%) died. Conclusion: Understanding the clinical and laboratory characteristics of COVID‑19 in our local environment will be integral to earlier identification and treatment outcomes for our patients

Exploring Issues and Challenges of Leadership among Early Career Doctors in Nigeria Using a Mixed-Method Approach: CHARTING Study

(1) Background: leadership behaviour is a poorly explored phenomenon among early-career doctors (ECDs). Good leadership is vital in maximising the effective management of patients in a clinical setting. While a good number of studies, though with small sample surveys, have researched the role of leadership in clinical setting quantitatively, qualitative investigations are yet to be done in Nigeria. This study aims to explore the attitudes, skills, and experience of ECDs in Nigeria on issues pertaining to leadership in a medical setting, using a mixed-method approach. (2) Methods: we conducted two sessions of key informant focus group discussion (FGD) that involved 14 ECD leaders in Nigeria, exploring their leadership experience in a clinical setting. Furthermore, we used a self-administered questionnaire to quantitatively survey 474 ECDs from seven Nigerian teaching hospitals to explore their attitudes, skills, and experience on issues pertaining to medical leadership. (3) Results: taking on leadership roles is a common phenomenon (52.7%) among the surveyed ECDs; however, the medical leadership position can be very challenging for ECDs in Nigeria. Despite the fact that many (91.1%) of the surveyed ECDs perceived leadership skills as essential skills needed by a doctr, many (44.1%) of them were yet to be formally trained on medical leadership. About three out of every 10 (23.6%) of surveyed ECDs that have ever held leadership positions in a medical setting experienced major leadership challenges while in such office due to their lack of training on leadership skills. Leadership skill acquisition programmes are highly recommended to become an integral part of medical training programmes in Nigeria. (4) Conclusion: there is a need for a structured leadership skill acquisition programme for ECDs in Nigeria. This programme will help in the robust delivery of highly effective healthcare services in Nigeria, as effective leadership is crucial to patient care services

Exploring issues and challenges of leadership among early career doctors in nigeria using a mixed-method approach: CHARTING study

Background: leadership behaviour is a poorly explored phenomenon among early-career doctors (ECDs). Good leadership is vital in maximising the effective management of patients in a clinical setting. While a good number of studies, though with small sample surveys, have researched the role of leadership in clinical setting quantitatively, qualitative investigations are yet to be done in Nigeria. This study aims to explore the attitudes, skills, and experience of ECDs in Nigeria on issues pertaining to leadership in a medical setting, using a mixed-method approach. (2) Methods: we conducted two sessions of key informant focus group discussion (FGD) that involved 14 ECD leaders in Nigeria, exploring their leadership experience in a clinical setting. Furthermore, we used a self-administered questionnaire to quantitatively survey 474 ECDs from seven Nigerian teaching hospitals to explore their attitudes, skills, and experience on issues pertaining to medical leadership. (3) Results: taking on leadership roles is a common phenomenon (52.7%) among the surveyed ECDs; however, the medical leadership position can be very challenging for ECDs in Nigeria. Despite the fact that many (91.1%) of the surveyed ECDs perceived leadership skills as essential skills needed by a doctr, many (44.1%) of them were yet to be formally trained on medical leadership. About three out of every 10 (23.6%) of surveyed ECDs that have ever held leadership positions in a medical setting experienced major leadership challenges while in such office due to their lack of training on leadership skills. Leadership skill acquisition programmes are highly recommended to become an integral part of medical training programmes in Nigeria. (4) Conclusion: there is a need for a structured leadership skill acquisition programme for ECDs in Nigeria. This programme will help in the robust delivery of highly effective healthcare services in Nigeria, as effective leadership is crucial to patient care services

Dominant modifiable risk factors for stroke in Ghana and Nigeria (SIREN): a case-control study

Summary: Background: Sub-Saharan Africa has the highest incidence, prevalence, and fatality from stroke globally. Yet, only little information about context-specific risk factors for prioritising interventions to reduce the stroke burden in sub-Saharan Africa is available. We aimed to identify and characterise the effect of the top modifiable risk factors for stroke in sub-Saharan Africa. Methods: The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study done at 15 sites in Nigeria and Ghana. Cases were adults (aged ≥18 years) with stroke confirmed by CT or MRI. Controls were age-matched and gender-matched stroke-free adults (aged ≥18 years) recruited from the communities in catchment areas of cases. Comprehensive assessment for vascular, lifestyle, and psychosocial factors was done using standard instruments. We used conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% CIs. Findings: Between Aug 28, 2014, and June 15, 2017, we enrolled 2118 case-control pairs (1192 [56%] men) with mean ages of 59·0 years (SD 13·8) for cases and 57·8 years (13·7) for controls. 1430 (68%) had ischaemic stoke, 682 (32%) had haemorrhagic stroke, and six (<1%) had discrete ischaemic and haemorrhagic lesions. 98·2% (95% CI 97·2–99·0) of adjusted PAR of stroke was associated with 11 potentially modifiable risk factors with ORs and PARs in descending order of PAR of 19·36 (95% CI 12·11–30·93) and 90·8% (95% CI 87·9–93·7) for hypertension, 1·85 (1·44–2·38) and 35·8% (25·3–46·2) for dyslipidaemia, 1·59 (1·19–2·13) and 31·1% (13·3–48·9) for regular meat consumption, 1·48 (1·13–1·94) and 26·5% (12·9–40·2) for elevated waist-to-hip ratio, 2·58 (1·98–3·37) and 22·1% (17·8–26·4) for diabetes, 2·43 (1·81–3·26) and 18·2% (14·1–22·3) for low green leafy vegetable consumption, 1·89 (1·40–2·54) and 11·6% (6·6–16·7) for stress, 2·14 (1·34–3·43) and 5·3% (3·3–7·3) for added salt at the table, 1·65 (1·09–2·49) and 4·3% (0·6–7·9) for cardiac disease, 2·13 (1·12–4·05) and 2·4% (0·7–4·1) for physical inactivity, and 4·42 (1·75–11·16) and 2·3% (1·5–3·1) for current cigarette smoking. Ten of these factors were associated with ischaemic stroke and six with haemorrhagic stroke occurrence. Interpretation: Implementation of interventions targeting these leading risk factors at the population level should substantially curtail the burden of stroke among Africans. Funding: National Institutes of Health