Recently, medical interns from Uganda’s five public universities overwhelmingly protested a decision by the Ministry of Health to set pre-entry exams that will be taken by all medical graduates for them to be enrolled as interns. They also protested failure to be facilitated by the government, as well as poor working conditions. In the process, they elicited support as well as opposition in nearly equal measure.
Dr Simon Peter Kawoya of Naguru Hospital was spot on when he said: “The ministry delayed to introduce this pre-entry internship programme. Many times students cheat in exams so that they are admitted to study medicine yet the results are not theirs. The pre-entry exam will help sieve out those to keep only the cream because this is a course that is aimed at handling people’s lives.”
The Ministry of Health decision is to enable government sponsor only interns who qualify and improve the quality of human resource in health facilities countrywide. The ministry says huge numbers of medical students graduate each year but the majority are under-skilled. Moreover, government only releases money to train 350 interns but currently, they are over 10,000. Obviously part of the problem is a limited budget, inadequate space, insufficient time and overstretched supervisors for the interns.
The Ministry believes there are many institutions training medical personnel, including medical doctors, dental surgeons, pharmacists and nurses, but several do not have the capacity. In fact, one university is said to produce 500 graduates annually but health officials wonder how it manages to ably train this huge number. It should be noted that in the same week that interns held demonstrations, close to 10,000 nurses from six institutions of higher learning were rejected by the Uganda Nurses and Midwives Council due to lack of requisite skills.
The interns might not, therefore, sustain their argument on pre-entry exams. The odds are against them and the tide is unstoppable. Similar exams have already taken root at the Law Development Centre, and the Engineering courses at Makerere University are said to be toying with the same idea.
Suffice to benchmark a few countries. In the United Kingdom, where Uganda’s education system originated, interns undertake a BioMedical Admissions Test. This is a subject-specific test taken by applicants to human and veterinary medicine or related courses. They even pay for it. The two-hour written test does not require extra study, coaching or preparation as it concerns the skills and knowledge that candidates should already have.
A number of medical and dental schools also administer clinical aptitude tests as part of the selection process for entry into their courses. Introduced nine years ago and also paid for by the applicants, the test assesses a wide range of mental abilities and behavioural attributes which are considered important for doctors and dentists to possess. Since it doesn’t test academic ability, it doesn’t draw on any specific areas of knowledge or from a curriculum that needs to be learnt. In New Zealand, one must pass a prescribed three-hour written exam for registration to practice as a medical doctor.
By passing the clinical, one is deemed competent enough to have provisional registration. Communication skills and professionalism are also assessed.
In Australia, Medicine undergraduates take the Medical and Health Sciences Admission Test. Free guides and resources are produced to prepare them for the test whose score is required to apply for undergraduate admission.
In this test, students are assessed on their skills in critical thinking, problem solving, understanding people and abstract non-verbal reasoning. These abilities are considered important to the study and later practice of medicine. The test is designed to complement the academic results, not to replace them.
c Nonetheless, Uganda’s education system requires redemption to meet the current socio-economic and political challenges.
Mr Kyetume is a principal information officer in the Office of the Prime Minister.