Postgraduate medical training has been going on in Ghana for many years. However, it was in 2003 that the country established Ghana College of Physicians and Surgeons for the purpose of local training of specialists. This training programme has achieved some success by turning out over 1200 graduates at the Membership level. These graduates are deployed as specialists within the Ghanaian health delivery system. However only about 140 of these graduates have pursued further training to graduate at the Fellowship level. The low proportion of trainees who have progressed from the Membership to the Fellowship level is a cause of concern and we need to perform a detailed analysis to identify and address the reasons for this slow progression. The areas of specialization of all graduates since the start of our local training is shown in Figure 1.
This distribution of specialists shows that there are clearly some areas where the rate of production of specialists is much lower than desired. This observation however needs to be situated within the context that there is no specialty area that has the required number of specialists per population in the country. Specialists are needed in all these areas and need to be available in all parts of the country. It is therefore important to find ways of increasing the output of specialists in all areas while emphasizing the more deprived areas and to also put measures in place that would ensure that the specialist services are easily accessible throughout the country.
The most obvious reason for producing specialists is for the provision of necessary health services and this is what we currently focus on as a country. This focus is due to the relatively low number of specialists in the country and can be justified. This focus however tends to strongly influence the thinking of the specialists themselves so that they lose sight of other important reasons for specialist training.
A medical specialist who has been trained to the highest level possible is the person best suited to serve as a leader and advocate in the field. Such specialists must have been exposed to the practice of their discipline in different parts of the world either through direct contact or through reading and other means of communication. This exposure should help the specialists to come up with the best way of delivering training and service within the Ghanaian context. Given the reality that all the needed infrastructure for specialist training and services will not be fully available within a short time, specialists need to know how to make use of existing facilities to produce the best possible results. These leaders in healthcare must be actively involved in policy formulation processes as well as in the engagement of political leaders and other important stakeholders for advocacy. If specialists are only concerned with the practice of their discipline and will work within the context of available facilities, then the development of the specialty will be very slow and will be determined by people who do not have the full understanding of the practice.
The needs of the specialty area as well as the interventions best suited for our context can only be discovered through research. The person best suited to lead this kind of research are the fully trained specialists who practice in the country. Medical specialists generate large amounts of data in their daily activities and it is important for these data to be properly collected and analysed to come out with the best way of improving the health of Ghanaians.
The need for specialists to be involved in service delivery, policy formulation, advocacy, training and research among many other things brings out the need for an acceleration in the rate of specialist production. It also brings out the need to ensure that specialist training is not overly focused on clinical skills but also addresses the other equally important skills.
Ghana College of Physicians and Surgeons must be aware of these contemporary needs in specialist training and practice and so should be actively engaged in reviewing training programmes and policies that are responsive to our national challenges.
Richard MK Adanu MBChB, FWACS, MPH, FGCS, FACOG
Rector, Ghana College of Physicians and Surgeons.
Email: radanu@gcps.edu.gh
