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Table of Contents
Year : 2019  |  Volume : 24  |  Issue : 2  |  Page : 95-99

Entry points into a Nigerian medical school at the graduate and undergraduate levels: A three-year prospective and retrospective comparison of performances at the first MBBS professional examinations

1 Department of Human Physiology, Faculty of Basic Medical Sciences, Nnewi Campus of Nnamdi Azikiwe University, Awka, Nigeria
2 Department of Physiology, Faculty of Basic Medical Sciences, University of Nigeria Enugu Campus (UNEC), Nsukka, Nigeria

Date of Web Publication18-Nov-2019

Correspondence Address:
Prof. Ugochukwu B Anyaehie
Department of Physiology, Faculty of Basic Medical Sciences, University of Nigeria Enugu Campus (UNEC), Nsukka.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmh.IJMH_21_19

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Background: It is alleged that there is a mismatch between candidates’ performance in University Matriculation Examination (UME) and their subsequent academic achievement in medical schools in Nigeria. Aim: The present study compares the performance of medical students admitted via Direct Entry (DE) module and that of UME using their 1st professional examination. Methodology: A total of 343 undergraduate medical students of College of Medicine, Nnamdi Azikiwe University, Nnewi, Anambra state, Nigeria were used for this study. 270 of the students were admitted through UME, while 73 were admitted through DE modes of admission. The results of the 1st MBBS examinations taken in the years 2014 to 2017 were collated, analyzed and compared between the two groups of students. Results: The rate of success in 1st MBBS examination was greater in the DE students (74%) compared with the UME students (44.1%). The failure rate was higher in the UME entrants (55.9%) compared with the direct entrants (26%). The frequency of withdrawals in the group with UME (n = 28) was greater than that of the group with DE (n = 0). Chi square test of association indicated significant (p < 0.001) association between performance of students in 1st MBBS examination and the mode of admission. Logistic regression test shows that the odds of failure were against students with UME module than those with DE. Conclusion: The present study indicates that the admission module of DE with previous degree increases the chances of academic success in medical education in Nigeria. This suggests the need for a review of the mode of admission into medical schools to favour students that have a previous degree.

Keywords: Examination, medical education, Nigeria, surgery

How to cite this article:
Nwobodo E, Dimkpa U, Ugwu C, Anyaehie UB. Entry points into a Nigerian medical school at the graduate and undergraduate levels: A three-year prospective and retrospective comparison of performances at the first MBBS professional examinations. Int J Med Health Dev 2019;24:95-9

How to cite this URL:
Nwobodo E, Dimkpa U, Ugwu C, Anyaehie UB. Entry points into a Nigerian medical school at the graduate and undergraduate levels: A three-year prospective and retrospective comparison of performances at the first MBBS professional examinations. Int J Med Health Dev [serial online] 2019 [cited 2023 Jun 5];24:95-9. Available from: https://www.ijmhdev.com/text.asp?2019/24/2/95/271086

  Introduction Top

University admissions in Nigeria in general are centrally moderated by Joint Admission and Matriculation Board (JAMB) via two modules: the university matriculation examination (UME) into first year and the direct entry (DE) into the second year of program.[1] Successful performance in the core subjects in the secondary-school exit examination called Senior Secondary Certificate Examination (SSCE) or General Certificate Examination (GCE) are prerequisite for all admissions. Candidates with good grades in either advanced level General certificate examination (A/LEVEL GCE) or an acceptable prior university degree are also eligible for admission through the DE module.[2] Regulation of undergraduate medical education has continued to be under the dual oversight of the National Universities Commission (NUC) and the Nigerian Medical and Dental Council (NMDC).[1],[2]

The standard six-year Bachelor of Medicine and Bachelor of Surgery (MBBS) program in Nigeria consists of 12 months in preliminary basic sciences, 18 months in the preclinical program in Basic Medical Sciences (which includes courses in human anatomy, medical biochemistry, and human physiology), and the remaining 42 months as clinical training in the teaching hospitals.[3] Students admitted via DE for a five-year program are excluded from 12-month basic sciences and thus commence activities with the 18 months preclinical in Basic Medical Sciences. Progress in the MBBS program is moderated via different professional examinations called first (for preclinical) and second, third, and fourth during clinical years.[2],[3] The first MBBS professional examination serves as the gateway into clinical programs for all medical students irrespective of admission mode. It is thus a high-stake examination that serves as a strong further selection force for successful medical education in Nigerian medical schools.

Further to a dwindling of the skills and knowledge levels in addition to quality of practice of millennial graduates of Nigerian medical schools,[4] it has always been argued if medical school admission should be at the UME level or restricted to DE for holders of prior full degrees of universities as in the practice in some countries (e.g., USA).[5] At the moment, postbaccalaureate students are few and the policy has been to admit students through the regular UME examination conducted by JAMB and admit a handful at the DE level. For many recent years, curriculum stagnation has been severally identified as a major problem with Nigerian medical education.[6] This study compares the performance of students admitted via DE and that of UME using the first professional examination at the Nnamdi Azikiwe University Medical School.

Forced withdrawal from progression in medical education in Nigeria is largely because of failure of first MBBS and selection by admission testing has been reported to have an independent, protective effect on medical school dropouts.[7] In consideration of the socioeconomic effects of medical school's dropout and recent synergetic attempts by the Nigerian University Commission (NUC) and NMDC to review medical education curriculum in Nigeria, this paper reviews the progression capacity of students admitted via the two modules of admission in Nigerian medical schools. The aim is to provide evidence that may be useful for the impending curriculum review of medical education in Nigeria.

  Materials and Methods Top


The undergraduate medical students from the Nnamdi Azikiwe University College of Medicine, Nnewi, Anambra State, Nigeria were selected for this study. The students admitted in the years 2011 to 2014 were segregated via admission modes into the UME and DE admissions. The subsequent results in the first MBBS examinations for these groups of students taken in the years 2014 to 2017 were collated, analyzed, and compared.

Ethical clearance

The study was approved by Departmental Ethics Committee and Faculty Board. Confidentiality was maintained as there was no disclosure of the names of the students from the origin of the data.

Inclusion and exclusion criteria

The students admitted in the years 2011 to 2014 who participated in the relevant first MBBS examinations were included in the study. Students who were admitted through interuniversity transfers were excluded from the study. All other students with uncertain entry points were also excluded from the study.

Data analysis

Data were collected and analyzed by descriptive and inferential statistics using the Statistical Package for the Social Sciences software version 20.0 International Business Machines Corporation (IBM, New York, USA). The chi-squared test of association was used to determine the association between mode of admission and academic performance. The logistic regression test was used to determine the risk of failure in UME mode of admission as compared with the DE mode. The level of significance was set at P < 0.05.

  Results Top

[Table 1] shows that a total of 343 students over the three years met our inclusion criteria and were thus included in the study. Percentage of student's passing has declined over the years even with a nonsignificant increase in the number of students.
Table 1: The incidence of failures and passes according to academic years of examination

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[Table 2] shows that a higher percentage (29.1%) of students who repeated the class was admitted through UME, whereas a lower percentage (26.1%) of them came from the DE students. The UME entrants constituted a smaller percentage (31.1%) of those who re-sat for only one preclinical course as compared with the DE students (52.6%). Both DE and UME entrants had equal percentages of students that re-sat for two preclinical courses. Interestingly, 28 (18.5%) UME entrants were withdrawn from the medical program, whereas the DE student had zero withdrawal.
Table 2: Distribution of the types of failure recorded by students according to their mode of admission

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The chi-squared test of association indicated that mode of admission is significantly (χ2 = 3.60; P < 0.001) associated with academic performance [Table 3]. Furthermore, logistic regression shows that students with the UME mode of admission are more likely (OR, 3.60; CI, 1.96–6.68; P < 0.001) to fail in the MBBS examination as compared with the DE students.
Table 3: Association of mode of admission with academic performance and the risk of failure in UME mode of admission compared with the direct entry mode

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[Figure 1] shows that the rate of passes among students with DE mode of admission (74%) was significantly (P = 0.006) higher as compared with those with UME entry module (44.1%). In addition, the rate of failures was significantly (P = 0.001) higher among students with UME mode of admission (55.6%) as compared with DE students (26%).
Figure 1: The incidence of failures and passes according to students' mode of admission. UME = university matriculation examination

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  Discussion Top

The first MBBS professional examination is a huge volume curriculum and high state examination at which many of the otherwise bright teenagers drop off unfortunately from the medical school because of many compounding problems. The findings of this study show that the rate of success in the first MBBS examination was found to be higher in the DE students than that in the UME students, suggesting that students admitted via this mode have a greater probability of progressing beyond the first MBBS professional examinations. This finding is further supported with the higher rate of the passes among students admitted via DE mode. These findings are in agreement with the report that graduate students come into the medical training program at different level of maturity and experience and may possibly be better positioned to task learn.[8] In general, our finding shows that the odds of failure were against students with UME module than those with DE module. Given that students have different learning styles, the approach should be to present a variety of learning strategies to make teaching and learning more inclusive[9] but implementation may be more difficult for the Schools due to staffing and resource challenges.

We report that academic performance of students in the first MBBS examination was significantly associated with the students' mode of admission (P < 0.001). Also, in the years under review, there was no withdrawal in the group admitted via DE. It is noteworthy that one of the criteria for DE admission into the medical program is the achievement of a cumulative grade point average (CGPA) of ≥3.50 in a prior undergraduate program; it is therefore not surprising that they could perform better than their counterparts admitted via the UME pathway. Previous studies in which a previous college degree was a prerequisite for admission to medical school have also reported predictability of successful completion of the medical courses using undergraduate GPA.[10],[11] Many studies have reported the dominance of intellectual variables such as scholastic assessment test scores, percentile rank in high-school graduating class, grades in previous courses, and college grade point averages as predictors for academic success in universities.[10] Numerous nonintellectual variables, for example, personality traits, behavioral tendencies, and demographic characteristics, have been predicted as contributors to academic success[12],[13],[14],[15],[16] among college students; however, our study was limited to the first professional examination at the completion of the preclinical courses.

Dropping out of medical school is an unfortunate event, which adversely affects the student, the family, and the society. In our study, the frequency of withdrawal (dropouts) in the group with UME was far greater than that of the group with DE (28, 18.5% vs. 0%). Previous studies have shown the impact of previous academic achievement on the risk of dropping out of medical school.[17],[18] The overall zero dropout rate in this study could be explained by the fact that our data included DE students who had successfully completed their first degree and also achieved the required minimum CGPA. The higher dropout rate in the group with UME suggests that the overall rate is likely to be higher if students with Joint Matriculation Examination results were admitted into medical school without effective screening mechanisms.[19] Most Nigerian universities that depend solely on UME scores for admission of students have come to realize that candidates with very high UME scores do not do well in the university and are often asked to withdraw.[20],[21] A good preselection method for admission into medical colleges will help optimize the use of resources and reduce student wastage.[22] The results of this study indicate that students with UME module are more likely to fail their first MBBS examination as compared with those with DE. This finding supports the use of DE with minimum CGPA requirement as an admission criterion to proceeding into the medical course. Such call is borne out of alleged mismatch between candidates' performance in UME and their subsequent achievement in MBBS examinations in Nigerian medical schools.

  Conclusion Top

This study suggests that the admission module of DE with previous degree increases the chances of academic success in medical education in Nigeria. We support the calls for reexamination of the modes of selecting candidates for admission into the medical program in Nigerian universities. The findings of this study while not advocating for the scrapping of the UME suggest the provision of early interventions for UME admitted students as well as review of admission procedure to favor students who have a previous degree. We also recommend the reevaluation and improvement of other predictors of academic performance such as educational environment and quality of teaching.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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