Housemanship (Medical Internship) in Nigeria

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Housemanship or House Job or Internship as some people call it is the training program that newly inducted Doctors normally go through, immediately after graduating from medical school before starting their residency or before being given permanent license. I will be discussing on Housemanship training in Nigeria.

Who is a House Officer?

A medical Doctor undergoing House Job or Housemanship is called a House Officer or simply a House Man or an Intern (though doctors in Nigeria dont use this). A House Officer is a fresh doctor that has just been inducted – that is has been given a temporary license to practice and learn medical skills and experience for a specified period before getting the permanent license. The Medical doctors induction is a ceremony that is conducted with the aim of absorbing newly graduating doctors into medical practice after they must have taken the oath to serve humanity well an oath known as the Hippocratic oath.

Immediately the medical induction ceremony is over, the newly inducted doctor has but 2 years to find a placement in any of the approved training hospitals such as Teaching hospitals, Federal Medical Centers (FMCs) or any other approved hospital (such as military hospitals) by the medical and dental council of Nigeria (MDCN). If the newly inducted medical doctor does not find a placement within the stipulated 2 years after induction, then he or she has to take another exam and pass and re-inducted again before getting another placement. Hence the year of induction and the period of starting Housemanship matters.

Once you get a placement in an approved hospital, Congratulations, you are now called a House Officer or House Man. The truth is, this is the beginning of your most stressful and rigorous training in trying to acquire real time medical knowledge and skills where you get to learn as well as practice and take decisions that are critical especially when there is no one around you decisions that could cost the patient his or her life or save them.

In Housemanship, it is not business as usual when you were still a student where you can miss a class and nothing happens or decide to clerk a patient or not. In Housemanship, you must take responsibility for your actions because if you were supposed to transfused a patient and you dont, the patient dies and you will be held responsible. It is a time during which you must learn to pass responsibilities or challenges to senior colleagues especially when you are not sure of what to do. You do not just do things because you think it is the best decision, you do things because you are sure of what to do.

It is a training period where you are expected to be asked questions and you are also expected to ask questions all these help you to learn better because whatever you have been reading in books are now seen practically. You can now follow up a case from the beginning to how it ended how the symptoms of a disease started and how the outcome or prognosis is. Even though you are supposed to be under supervision, some centers may be understaffed because of scarcity of doctors and so you are left alone to make decisions. But in most centers, you will have enough senior colleagues especially in teaching hospitals.

Rotations or Psotings during Housemanship

The Housemanship program runs for a period of 13 completed months. You will rotate from one department to another every 3 months until you complete the 13 months. You can start from Obstetrics and Gynaecology, then Internal Medicine, then Surgery and Paediatrics. In each department, you will also rotate from one specialty such as oncology to cardiology to Nephrology depending on the department. All these rotations help you to gain knowledge of different diseases and are therefore important. Even in departments that the rotations are not enough, you will do well to help yourself by asking some questions from fellow house officers in such specialty to help you so that when you are faced with such cases after completing your program, you can handle any emergency that may arise at least before you you will do 3 months in one department and continue as such till you rotate all the 4 departments. You have one week of casual leave in each department which gives you a total of 4 weeks during the 13 months period of uninterrupted vigorous training.

There are forms that you need to sign after completing every departmental posting by the senior registrars, Consultants and Head of Departments to show that you actually passed through the department. This means these senior colleagues need to monitor you during your training to ensure you get the best as well as assess you during the training because they need to fill the form correctly depending on how you perform. This means you are graded as you practice and you need to have above credit or else, anything below credit will force you into repeating that posting.

Housemanship Salary in Nigeria

I know most people are searching because of this single reason and people will spend more time on this aspect than others, even though I will summarize this aspect. Well, the salary depends on where you are working. Some are paid from 152,000 naira to 200,000 naira depending on where you are working. This includes all the allowances that your mind imagines including the 5,000 naira hazard allowance given even when you catch Ebola or Lassa Fever.

Challenges of Housemanship

There are many challenges you will face while undergoing your Housemanship training ranging from challenges with the stress of work, challenges with difficult patients and their relatives, challenges with fellow colleagues (both seniors and house officers), challenges with other medical professionals and with administration. All these challenges help you to learn how to interact in the corporate world.

The first challenge of stress and rigorous nature of the training is the most important to me. Because the House officer is the first on call, anything that arise during your call duty hours, you are first call upon to see first before passing it to your senior colleague if it is something you cannot handle. There are some call duty periods that you will start and finish without sleeping even for an hour and yet you are expected to resume work the next day before 8 am and still continue without resting till 4 pm (officially) but sometimes the official time depends on when you actually finish.

There was a time we did not sleep during call only to start work the next day and still could not go home by 4 pm until 11pm, when we were about going home, we were call that one of our patients has been rushed to the Intensive Care Unit (ICU) and we have to attend to her, to tell you the truth, we left the ICU after 2 hours and we got home around 1:30 am 3 days in the hospital without bathing or brushing or sleeping. This is just one of the many cases. Did I tell you that when you are on call on Monday, it means you will resume normal daily work of 8 am to 4 pm and continue after 4 pm till 8am of Tuesday. On Tuesday, you are expected to be at the morning meeting by 8am (how is this possible? What time will you have to brush or bath after call? the truth is, you must find a way). After morning meeting on Tuesday, you are expected to continue working till when you finish for the day like I said earlier and not 4pm because if a patient is unstable and it is 4pm, you have to wait and attend to that patient before going home; remember you took an oath to put the life of your patient first.

Another challenge is how to interact with colleagues that are disrespectful and mean especially the senior colleagues who think you need their signatures and so can treat you in whatever manner they want and for those whom you cannot tolerate, some house officers do react and will gladly accept any consequence because of the annoying nature of these type of people. Well, the truth is, everyone seems to be stressed in the practice because you have over 200 patients waiting to be seen in clinics, others need surgery and the theater is frustrating you because even the theater itself is overwhelmed. Virtually anywhere you turned to, there are overwhelming numbers of patients and this frustrates the senior colleagues who then vent their frustrations on you. If this is not considered in medical practice, as the population of the country grows, time shall come that doctors may be involved in suicide due to this work stress because the doctors are few. Patient to doctor ratio in Nigeria is more than 5000 patients to 1 doctor which means either the doctor dies trying to attend to all or some of the patients get substandard care and some may die without getting to see a doctor.

Life after Housemanship

After you 13 months, Congratulations again! You are now called a Medical Officer a doctor who has finished Housemanship. This is when you have to proceed for NYSC (national youth service corps) if you have not passed the age. It is after service that you may want to start residency training to become a specialist in a specific field, or you may just go to a different field or aspect of medicine and surgery as you wished.

All your forms that you have been signing during your postings will be submitted to the CMACs (Chairman, Medical Advisory Committee) office before you can upload to MDCN website and pay the necessary fee before being issued your Permanent License.

Just before I conclude, note that Hosuemanship is a training program and whatever you dont understand, you can always ask your colleagues seniors or fellows, so dont be afraid to ask for help with what you dont know. Remember you are dealing with human lives and you dont have to form boss over something you are not sure of.