The Aga Khan University is the first centre in sub-Saharan Africa to offer the reputable Membership of the Royal College of Physicians (MRCP) examinations. These are considered the toughest examinations for doctors who want to specialise in different fields of medicine. For years, doctors in the region had to travel to the United Kingdom to take the MRCP exams – but it’s much closer to home now.
Dr Dilraj Sokhi is a neurologist and assistant professor at the Department of Medicine, Aga Khan University East Africa. He is also the East Africa Lead for the Federation of Royal Colleges of Physicians – meaning he holds an MRCP (UK) diploma.
Dr Sokhi’s journey was not a straight and obvious path – it had challenges, but he overcame them. His story is one of inspiration to young people who intend to pursue a medical career. We caught up with him to find out why this examination is of value to not just doctors, but to the healthcare system in the region.
When did you decide to take the MRCP (UK) Examination?
Passing the MRCP(UK) examination is a pre-requisite for doctors undergoing Internal Medicine Training (IMT) who intend to pursue higher specialist training as a physician e.g. cardiology, endocrinology, or, as in my case, neurology. As per the IMT requirements in the UK, you can sit this exam soon after graduating from medical school, which is what I did from June 2007 onwards.
What was your experience like taking the exam?
Revising for the written exams meant going back to textbooks but this time post-graduate rather than undergraduate, and also studying from specific textbooks and question books designed to pass the MRCP written examinations.
So, this is not the same as other medical exams?
The PACES examination is different: it tests more than knowledge, and reflects one’s competence to deal with patients on more levels such as communication, compassion, physical examination and dealing with complex ethical scenarios. Whilst the theory can be learned from textbooks, the vast majority of the learning is done by how I dealt with patients I was admitting into the hospital or seeing in the clinic and then reading around them. I studied for these examinations together with a friend who had graduated from another university (Manchester), and moved to work and train in Sheffield where I was. We spent most evenings and weekends going to hospitals outside our normal working hours to visit patients with interesting conditions and physical signs to improve our ability to pick up the signs within 5 minutes. We also engaged with more senior doctors who had passed the PACES exam who could be our mock examiners, who themselves had to do it outside their normal work schedule.
How was the experience?
Altogether, it was a very busy and exhausting time but we learned two things after the whole year of revision: despite their illness, most patients are absolutely delightful and always willing to teach doctors whatever time of day or night, and that doctors, especially physicians, will dedicate any time they have to improve the clinical skills of their juniors for the benefits of patient care. This shows that what was practiced over 150 years by the then pioneering physicians still stands now: teaching bedside manners and skills is best delivered through an experienced clinician to a dedicated apprentice.
Did you pass the exam?
Neither my friend nor I passed the PACES exams the first time, which was quite disheartening. However, PACES is a difficult exam and the chances of passing it the first time is about 50%. We were both dedicated to our individual and collective visions of becoming specialists we carried on with our revision and encounters with patients and eventually gained the MRCP qualification within that year. My friend has now gone on to be an Assistant Professor in Diabetes and Endocrinology in Liverpool.
After you passed the exam, what did you do next?
I entered higher specialist training in clinical neurology for 5 years and then became a consultant neurologist. I then moved back to Kenya, my home country where I was born and brought up, as there is a significant deficit of neurologists: currently only 18 to serve a population of 45 million!
Given the attendant rigors, is it worthwhile?
Yes; the systematic way in which both IMT and MRCP inform how one should approach patients has definitely had a long lasting positive effect on my practice as a neurologist.
Why is this exam so important for doctors in East Africa and the continent as a whole?
The MRCP(UK) diploma is an internationally recognised qualification and is valued as a significant professional distinction. It is obtained after the successful completion of the entire three-part examination: 2 written exams, and finally a practical clinical exam known as the Practical Assessment of Clinical Examination Skills, or PACES, both of which are now offered at Aga Khan University’s Medical College, East Africa (MCEA). PACES is the largest international clinical examination for postgraduate physicians in the world, and involves senior physicians assessing doctors’ competency across a range of skills with real patients, such as communication, bedside examination, and maintaining patient welfare, all of which translate to a high standard of care.
The confirmation of all the examinations being made available at MCEA now allows candidates in the region to be assessed on all elements of the MRCP qualification locally, which makes it readily applicable to enhance the quality of national and regional healthcare delivery.
What makes doctors with MRCP (UK) qualifications stand out?
Doctors with the MRCP(UK) qualification are deemed to have attained a high standard of knowledge, clinical skill and competence to provide safe and high-quality care to patients with medical conditions. This makes them more competitive when applying for physician posts across the world. In the UK, it is an entrance criteria to higher specialist training, so doctors with MRCP(UK) are eligible for competing for higher specialist training posts in the UK. This can be under the RCP medical training initiative (MTI) where such doctors are contracted to return to their country of origin with their expertise obtained from the training post in the UK.
This is an important interim step because the infrastructure to train the physicians of tomorrow in Kenya and the region is quite limited at present. There are only three post-graduate Internal Medicine training programme centres in the country, the other two being University of Nairobi, and Moi Teaching and Referral Hospital in Eldoret. Further, specialist training programmes – called fellowships – are also few in the country and for some specialties e.g. endocrinology they do not yet exist. This may well change in the future do the launch the East, Central and Southern Africa College of Physicians (ECSACoP, another RCP-led initiative) in the region that occurred in 2018. I presented the MRCP at AKU during the ECSACoP conference in September 2018 and there is interest in how to join forces to continue to improve the physician training in the region.
How will this help Kenya’s healthcare system in terms of improving healthcare delivery?
Having international standards for examining postgraduate doctors in the region such as MRCP(UK) will improve the breadth and quality care to patients, which align with the Social Pillar of Kenya’s Vision 2030. Indeed, the achievement of AKU bringing MRCP to the region has been positively supported and recognised by ECSACoP which aims to double the number of physicians being trained in the region by 2030.