Pre-internship exams: A tale of ageism

In John Nicholson’s book, Was Football Better in the Old Days? Or is it Better Now?, he attempts to settle the perennial debate between football’s past and present, pitting the Peles and Maradonas of yesteryear against the Ronaldos and Messis of today. 

The notion that some golden age has passed, leaving everything worse than it was, is as ancient as civilisation itself. 

It’s a sentiment often encountered in the medical profession as well. 

Scarcely a day passes without hearing some senior or even long-retired doctor admonishing the younger colleagues: “We were not like you back then. You don’t measure up.”

It is no surprise that the old crop of doctors have tirelessly pushed for pre-internship exams, similar to the pre-entry exams that were abolished at the LDC. 

Even this month, some of those doctors have once again raised this idea, while they remain conveniently silent on the fact that over a thousand medical graduates have been condemned to languishing for more than a year and a half, waiting for internships.

The assertion that doctors are becoming increasingly incompetent is speculative, built on subjective musings rather than comparative studies. 

These doctors, shaped in more authoritarian settings where the doctor was to be revered, even feared, now find themselves unsettled by the confidence and assertiveness of the younger generation.

They balk at the sight of a young doctor daring to push back against a bullying senior, at male doctors styling their hair or female doctors sporting coloured hair, pinned noses, or heels. Modern touches such as stylish slang, fitted white coats are seen as signs of impudence and an affront to the dignity of the profession. 

But hey, the fact that the Ronaldos blend fashion, style, and talent does not diminish their talent compared to the Peles, who, in their time, were not exposed to such a fashionable lifestyle. 

It’s not uncommon to witness an intern today on the verge of fainting with hunger during rounds, only to be dismissed by the older generation as lacking seriousness. 

But really, should competence be measured by the ability to endure 36-hour shifts on an empty stomach?

One wonders, too, if they ever had to face their shifts without basic PPEs, as today’s young doctors often do. 

Did they worry about their job security, about how they would pay rent? Certainly not. 

And yet, these are the pressing realities of medical practice in Uganda, realities that they seem all too willing to overlook.

Medical schools already have rigorous curricula and assessments—no one passes them by accident, to borrow a phrase from Hon Adolf Mwesige, who opposed the LDC’s pre-entry exam. Were it otherwise, there would be no retakes. 

If they truly believe that passing a pre-internship exam makes one fit to handle patients, then surely, that should earn every candidate who passes a practicing licence outright, skipping internship altogether.

In countries like the US and Canada, where post-medical school exams like the USMLE and MCCQE exist, passing them leads directly into residency. There is no internship. 

In the UK, graduates enter the Foundation Programme without a pre-internship exams. Even South Africa, Africa’s medical giant, has no pre-internship exam. 

Then, on what grounds are the Omaswas making their comparisons?

And more questions remain. What happens to a graduate who fails this pre-internship exam? 

Will they return to their university, already having been conferred a degree, to receive better training? 

Given the ministry of health’s poor absorption rate of interns, might this exam simply become another tool for limiting the number of admissions, similar to the accusations made against the LDC pre-entry exam?

Internship in Uganda has long been overseen by experienced specialists, who retain those who need more training and release those who have proven themselves competent. Why replicate their responsibility in such a manner? 

A year of closely supervised internship is far better suited to assessing a doctor’s competence than an exam that attempts to summarise five years of learning in a few hours.

Ssekyonda Zeddekia, Ugandan Medical Doctor