Cardiovascular Journal of Africa: Vol 28 No 5 (September/October 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017 AFRICA 293
Factors affecting interest in cardiothoracic surgery
among junior surgical residents in Nigeria
Emeka B Kesieme, Umar Abubakar, Olugbenga Olusoji, Ismail Mohammed Inuwa, John Kefas,
Ndubuisi Anumenechi
Abstract
Objective: A survey was undertaken to determine the factors
that affect interest in cardiothoracic surgery (CTS) among
junior surgical residents in Nigeria.
Methods: A cross-sectional study was done using a pilot-
tested, 56-item, semi-structured questionnaire, which was
filled in by 238 junior surgical residents in accredited hospitals
in Nigeria.
Results: Few of the respondents (8.4%) were committed to
specialising in CTS. A minority of them, 28.2 and 2.1%, had
assisted in major thoracic procedures and open-heart surger-
ies, respectively. The relationship between the level of train-
ing, rotation in CTS in junior residency and interest in CTS
were statistically significant (p < 0.05). The main important
factors responsible for the low interest in CTS include the lack
of equipment (92%), limited training positions (64.9%), poor
or lack of exposure in CTS as a junior resident (63%) and in
medical school (58.8%).
Conclusion: There is a dire need to provide facilities and train-
ing opportunities to improve the cardiothoracic workforce in
Nigeria.
Keywords: open-heart surgery, thoracic surgery, developing
countries
Submitted 21/4/16, accepted 12/1/17
Published online 1/3/17
Cardiovasc J Afr 2017; 28: 293–297
DOI: 10.5830/CVJA-2017-004
In Nigeria, postgraduate training in surgery is conducted in
designated hospitals approved and accredited by theWest African
College of Surgeons (WACS) and the National Postgraduate
Medical College of Nigeria (NPMCN). Junior surgical residents
who are interested in cardiothoracic surgery are required to pass
Part 1 of the examination of the Faculty of Surgery, WACS or
NPMCN in general clinical surgery, after completing a minimum
of 24 months’ posting in core surgical specialties.
The training in cardiothoracic surgery lasts for a minimum
period of 48 months and involves rotations in general thoracic
surgery (24 months), cardiac surgery (12 months), vascular surgery
(six months), adult and paediatric cardiology (three months) and
cardiopulmonary imaging (three months). There are eight centres
partially accredited for cardiothoracic surgery speciality training
with approximately 30 positions. These centres do mainly thoracic
surgery. In the absence of a viable cardiac surgery centre in the
country, cardiac surgery rotation is done in recognised centres in
Ghana, South Africa, India and Western Europe.
The number of candidates who sit for the exit/qualifying
examination in cardiothoracic surgery of theWACS andNPMCN
has remained small. In April 2015, out of the 95 candidates
who attempted the exit/qualification examination (Part 2) of
the WACS, only four candidates in the entire Anglophone
West Africa sat for the exit examination in cardiothoracic
surgery. Only two candidates sat for the exit examination in
cardiothoracic surgery of NPMCN in November 2015. This
shows apathy towards a career in cardiothoracic surgery among
junior surgical residents and a clear preference for other surgical
specialities.
Cardiothoracic manpower is relatively unavailable in West
Africa. In a study by Kesieme et al. in 2011, the number of active
cardiothoracic surgeons serving a population of about 160 million
people was about 26.1 Only 22% of cardiothoracic surgeons were
active in cardiac surgery.1 The availability of cardiac surgeons per
million of the population in North America and Europe is more
than 10 times the figure for Africa.2 The cost of the diagnosis and
treatment of heart disease is way beyond the means of the largely
indigent population in Nigeria and West Africa.
Hence we carried out this study to rate the interest of junior
surgical residents working in Nigeria in cardiothoracic surgery,
weigh up their exposure in cardiothoracic surgery, ascertain
factors they consider while making decisions on speciality choice,
and examine factors that may be strong points or drawbacks in
choosing a career in cardiothoracic surgery.
Methods
We targeted all the junior surgical residents in the 40 institutions
accredited either fully or partially by the faculty of surgery,
NPMCN, between April and October 2015. An active trainer
was identified in these institutions to help with data collection.
Department of Surgery, Irrua Specialist Teaching Hospital,
Irrua, Edo State, Nigeria
Emeka B Kesieme, MRCS,
Department of Surgery, Usmanu Dan Fodio University
Teaching Hospital, Sokoto, Sokoto State, Nigeria
Umar Abubakar, FWACS
Department of Surgery, Lagos University Teaching
Hospital, Lagos, Lagos State, Nigeria
Olugbenga Olusoji, FWACS
Department of Surgery, Aminu Kano University Teaching
Hospital, Kano, Kano State, Nigeria
Ismail Mohammed Inuwa, FWACS
Department of Surgery, Tafawa Belawa University Teaching
Hospital, Bauchi, Bauchi State, Nigeria
John Kefas, FWACS
Department of Surgery, Ahmadu Bello University Teaching
Hospital, Zaria, Kaduna State, Nigeria
Ndubuisi Anumenechi, FWACS