Awakening Future Youths to the Choice of Medicine

"I want to become a doctor." Many Nigerian children have uttered—and continue to utter—this sentence. But the one question these children need to be asked is why? Why do you want to study one of the most demanding courses on earth? Why do you want to become a doctor in a failing educational system? Why do you desire a title in a health system that does not appreciate you? What has inspired this mindset?

The answer is simple: they don't know any better.

Many Nigerian children who make this declaration can be broadly classified into two categories:

1. Victims of subtle implantation

2. The "gifted" child

1. Victims of Subtle Implantation

As the name implies, these children are victims. They grew up with adults encouraging them—directly or indirectly—to choose the profession. Even as babies, before they could form reasonable thoughts, parents and pastors had already "blessed" them with the bright future of becoming doctors. Some of them have relatives who are doctors—parents, uncles, aunties, cousins. They grow up seeing these doctor figures as role models.

This is not inherently a bad thing; doctors are indeed wonderful role models. The problem arises when these role models fail to encourage the child to explore and develop other talents they may have. It is beautiful to hear a child say, "I want to be like you when I grow up," but adults must never fail to let that child know that they can be better—regardless of the path they choose. It is the adult's job to help discover and nurture whatever gifts the child may possess.

Adults also have the responsibility to prepare the child for the challenges that lie ahead—especially those who are doctors themselves. They know the trials and tribulations they endured. Yet the memories of sleepless nights, inappropriate caffeine intake, lost relationships, and deep regrets seem strangely forgotten. They simply tell the child that medical school is "extremely difficult," but they never go into detail about what the child will lose.

Many youths in medical school today know it is hard, but they are never prepared for the toll it would take on their mental, physical, spiritual, and financial well-being.

These "victims", therefore, grow up aspiring to become doctors without ever truly understanding why.

2. The "Gifted" Child

This is the child who displays intelligence far above their peers. The adults around them quickly conclude that the best course for such a child is to become a doctor. The child accepts this and makes it their life's goal.

Now, don't get me wrong. Being a doctor is a marvellous thing. It is a testament to one's skill, sacrifice, and perseverance. But that does not mean every intelligent child must automatically become a doctor, lawyer, or engineer—the holy triad of professions in Nigeria. Such a child's intelligence should be explored, nurtured, and guided to ensure they end up doing what they love, not what is merely "convenient" because their abilities can carry it.

Now, for those who still choose to become doctors, this article will try to show you the experience of an average medical student in a Nigerian federal university.

The average student scores above 290 in JAMB and writes numerous post-UTME exams in different universities because he knows the demand for medicine is high and the available slots are limited. He eventually enters a university—whether it is his choice or not.

He spends his first year breezing through his courses. After all, he is brilliant, and he has prepared for this his whole life. He finishes the year with a first class, joins a few university organizations to acquire skills he believes he lacks, and thanks God that ASUU did not strike before the session ended.

He begins the second year with a heavy heart. He is now a preclinical student—and with this new title comes new cost. He gathers money from parents, sponsors, and his personal savings to buy dissecting sets, lab coats, and physical copies of all his textbooks. Digital copies alone are not enough.

Nevertheless, he begins classes. Anatomy, Physiology, and Biochemistry will be his bread and butter for the next year. He is aware that he is expected to learn, in one year, what some courses take four years to cover. He doesn't complain; he is a medical student. He spends his days listening to long lectures, attending practicals where all he sees is a pink blur of H&E while the enthusiastic histology lecturer asks, "Can you see it?" He nods—because he cannot be the only one in a class of 200 who can't.

He attends anatomy practicals, dissecting cadavers. It was sickening at first, but now his biggest concern is the stinging burn of formalin in his eyes.

He spends his nights reading heavy textbooks, rewriting class notes, reviewing lecture materials, and completing physiology and biochemistry reports—all within 24 hours. How? He is a medical student. He has sacrificed all nonessential things—sleep, outings, enjoyment—in the pursuit of success. Soon, the first in-course test arrives. He is ready. He writes it and comes out smiling; his sacrifice has not been in vain. A week later, the results are out: he barely scores above 50.

He spirals—first into depression, then self-doubt, then anger. He blames the lecturers; they must have made a mistake. But he does not want trouble, so he approaches a friendly lecturer who bends the rules to show him his script. There are no mistakes. His marks are his marks.

He finds camaraderie among fellow students who have also been humbled. He becomes re-inspired. He forms a new plan: skip lectures and focus on textbooks—the "secret" to success.

The second in-course is worse.

He restrategizes again. He attends classes, joins tutorial groups, and cuts out anything that takes time away from his precious self-study. He accepts his new reality of barely passing and focuses on gaining as much knowledge as possible.

Somehow, he passes the first Medical Board exam (MB I). He is now a clinical student. Clinical students not only have their workload multiplied tenfold but also are expected to practice self-directed learning. Self-directed learning to the uninitiated is when you confidently tell everyone you're "studying independently," then spend three hours lost in lecture slides, videos, textbooks, and tutorial chats—emerging exhausted, slightly wiser, and convinced that you are now conversant in the topic only to be stony dull on percussion when you interact with your consultants. Medical student percussion, to the uninitiated, is when a doctor asks you questions that your self-directed learning should have helped you answer. But this is not always the case and you end up producing stony dull percussions and purulent stuff. This is a staple on every ward round, clinic, and anywhere a medical student finds himself fortunate enough to be wearing a ward coat next to a doctor.

Our medical student is given a rude introduction to self-directed learning when a senior registrar screams at him on his first day of the posting because he didn't clerk the patient. He stands there utterly confused about how "clerk" became a verb. After this initial pallaver, he stands on the round and grows even more shocked when the same senior registrar says "You people just finished anatomy now? What is the course of the falciform ligament?" So they knew he had just finished anatomy? Which one is clerk? How is he supposed to do a full history, examination, and management? 

He ends the morning round convinced that medical doctors are truly knowledgeable. After being driven from the clinical application of visualizing the falciform ligament on a plain abdominal radiograph to Whipple's triad and Beckwith-Wiedemann's disease all the way to appendicitis, the actual topic of discussion, he is humbled. He leaves, determined to study hard and measure up, the humiliation of a few hours ago forgotten. Then someone whispers the words that will eventually kill his passion, "They said we must ensure we are signing all of these things too". He whips out his booklet, and scrambles, filling boxes left and right and center. Then he chases his new hero, the senior registrar, to sign ward round and tutorial and assisted on venipuncture. He says he will sign tomorrow. 

Every single day of the next few years of his life remains a magnified or minimized repetition of today's events. After chasing procedures for the first day, he lands tired in his room. He drifts off dreaming of being whatever dream chased him here. When he wakes up the next morning, it is hardly any different from a year later. His motivation has waned and waxed over and over again. Our medical student discovers another painful truth, a steady income in many ways is needed to ensure he can truly focus on his studies.  He then gives up for some weeks to learn crypto, then he picks up his passion again for some months, then gives up again. Of course, he might be one of the rare few, the ones who find a side hustle and never look back, or those who find a certain specialty they love and never look back. Some key into the medical grind and just lock in, determined to learn this thing perfectly. 

He tries to find a balance and never does, but he keeps on pushing from one posting to the next, learning as much as he can via a rigid self-directed learning schedule, observations of the doctors, and trying to keep the flames for his passion alive.

Our clinical student has endured months of percussion and has finally regained some of the confidence he lost when he was full of pus. Surprise, an organization full of capital letters whose meaning makes no sense to him, decides to go on strike, and so his time in the clinical posting is extended. His one 6-year course is now approaching its 9th year.

He manages to write 4 grueling MBs and passes. He is now a doctor.

The point of this article is not to discourage the Nigerian masses from wanting to be a doctor; it's to educate them on what to expect. The point remains that whatever is worth having is going to be hard to access. Otherwise, it would be common, and hence not worth having. Even then, becoming a doctor is not a calling, it's a conscious choice that should be made after having all your facts. Before you choose the path, are you willing to sacrifice your youth learning skills to save a life? Are you willing to deal with individuals who do not value your expertise until it is too late? Are you ready to deal with a government that does not value you? Are you ready to walk down the noble and painful path of being a doctor?

Olajide Olamide