FAMILY MEDICINE

The clinic served as a crucial hub for providing medical care to a significant number of individuals, offering valuable opportunities for medical officers to hone their skills in diagnosing and treating various conditions that didn’t necessitate specialized or inpatient care. Moreover, it provided early exposure to managing critically ill patients.

Recognizing the exceptional teaching potential within the department, medical officers were eventually replaced with registrars from the Department of Medicine. In 1968, a teaching unit with an accompanying laboratory was introduced to facilitate the training of medical students. The clinic also extended its services to non-traumatic emergency cases, operating around the clock.

However, during periods of civil unrest in the country, which disrupted health services, the clinic experienced a surge in patient numbers, leading to the discontinuation of after-hours emergency services due to staff overload. Consequently, the after 4.00pm service was relocated to the Casualty Department, prompting a renaming of the clinic to the General Outpatients Department (GOPD). GOPD offered care to the general public, regardless of referral letters, as well as to staff and their families.

Over time, the services provided to the public and staff/staff families were separated into two distinct departments, each with its own staff structure, to enhance organizational efficiency. GOPD initiated postgraduate training in Family Medicine in 1980, following hospital accreditation for training Postgraduate Resident Doctors in General Medical Practice/Family Medicine.

Concurrently, the Staff Medical Services focused on delivering occupational health services and care for staff and their families.

In 2013, the General Outpatients Department underwent a name change to the Department of Family Medicine, signaling a shift towards a more patient-centered approach to care aimed at improving patient satisfaction. Presently, the Department of Family Medicine continues to serve approximately 60,000 patients annually.

Dr. K.M. Cobban served as the first Head of the Department from 1957 to 1965, while Dr. Alaba Kalejaiye became the first indigenous Head of the Department, leading from 1983 to 1996. Below is a comprehensive list of the heads of the Department from its inception to the present day.

The vision of the department is to provide standard quality family medical care to all patients and increase the critical mass of Family Physicians by attracting doctors into the specialty of Family Medicine to improve the health care system in the nation. The Department also ensures that doctors and nurses work as a team to provide comprehensive health care services, arrive at a working diagnosis, refer appropriately and give longitudinal care if necessary. It also trains postgraduate residents in the principles of Family Medicine and coordinates their clinical skills training. The department continues to build a library of research in Family Medicine through the senior residency program with Consultant Family Physicians in the department to support the specialty.

The GOP clinic is the entry port for most patients presenting to UCH. It provides care for an estimated average of 300 patients daily between the hours of 8am to 8pm on Weekdays and 8am to 4pm on Saturdays and public holidays. Family physicians and postgraduate resident doctors provide care, and refer to other specialties as required. New comers or patients with non-emergency problems are attended to in the triaging (sorting) hall, where they are treated, transferred and registered in the GOP clinic, or referred to other specialities as the need may be. They are grouped into male, female and children categories. The services offered by the department, are presented thus:

• Patients with acute emergencies are triaged, treated and transferred to the ward under the various hospital sub-specialties. The registered patients, as well as follow-ups are given comprehensive and continuous care at the GOP clinic.
• The GOP clinic provides “managed care” for the health insured patients under the National Health Insurance Scheme (NHIS) in designated consulting rooms called the NHIS Clinic.
• The Family Medicine Residents also attend to trauma and emergency matters during the out of hours’ duty from 4pm through to 8am on rotational basis in the Emergency department.
• The Public Health Nursing Division provides clinical nursing duties and work closely with the department on Public health issues which include Immunization, Health Education, Nutritional Advice and monitoring, Oral Re-hydration and notification for home-based care of HIV/AIDS patients.
• HIV Counselling and Testing (HCT) is offered in GOP clinic, in conjunction with a Public Health Nurse (Mrs. S. O. Mosobalaje-CNO).
• Family Physicians from the department are involved in the President Emergency Plan for AIDS Relief (PEPFAR) project in UCH in the management of People Living with HIV/AIDS (PLWHA). Now called APIN Clinic.
• Healthy Women’s Clinic (LIFE Clinic) offering cervical cancer screening (Visual Inspection with Acetic Acid) and Pap smear test are also done for sexually active women in the Department of Family Medicine, Breast Self-Examination and Lifestyle modification to prevent non-communicable diseases.
• Coordination of Family Nutrition clinics managed by Consultant Family Physicians twice a week
• Once every week, the department runs a Comprehensive Healthy Men’s Clinic (LIFE Clinic) offering life style modification, preventive health checkups and management of Erectile Dysfunction.
• The department runs a Couples Clinic which offers Psychological and medical management to couples with sexual dysfunction.
• It also runs the Cope Clinic – which adopts an integrated approach to the clinical management of family–related crises by using biopsychosocial models of care.
• Adolescent Health Comprehensive Services are offered on demand and specifically once a week for coordinated preventive adolescent health.
• The department offers comprehensive, Pre-employment and pre-admission medical examination for adults, youths and children on request and by arrangement with institutions, as well as Travel Clinics.
• Clinical Psychologists Service: Clinical Psychologists and their trainees from the University of Ibadan work in close collaboration with Family Physicians in the Department of Family Medicine in Psychological evaluation and short psychotherapy sessions.
• Regular Consultant Teaching for medical students rotating through Paediatrics, Medicine, Surgery and during their Primary Care Posting covering all the clinical sets of students i.e I, II, and III.
• The GOP-Ophthalmology Outreach Program: Family Physicians in GOPD, in association with Ophthalmologists in UCH run a community outreach program for patients with cataracts and a walk in clinic for patients with other eye complaints.
• Clinical Services at the Igbo-Ora out-station: Junior and Senior Family Medicine residents go on posting at the General Hospital, Igbo-Ora where an average of 1,000 patients are seen per month on out-patient basis. There are 8 beds each on the male and pediatrics ward, 12 beds on the female ward and 6 beds on the maternity ward with a total of 34 beds. The Center records an average of 65 admissions and 37 deliveries per month.  Also, the training is in conjunction with Dr. A. C. Sagua, Consultant Rural Surgeon. Late Dr. A.O. Awojobi, Consultant rural surgeon was also involved in the training.
• Agbeke Mercy Medical Center– AMMC (Urban posting): AMMC is a 6-bed clinic situated at the Oluyole Chesire Home (OCH) for the handicapped along polytechnic road, Ijokodo, Ibadan. The department posts senior resident doctors to provide outpatient care and primary surgical services for the community, as well as the residents at the Chesire home for a 3 month period. The resident doctor is exposed to a variety of common acute and chronic illnesses, as well as the functional limitation/challenges of OCH residents.
• Private Suites: The Private Suites provide a fast track specialized in-patient and out-patient services for the higher socio-economic class who want to avoid the delay in hospital care at UCH, Ibadan. The senior resident spends 2 months under the supervision of 2 consultant family Physicians, and several other specialists. The resident doctor acquires interpersonal skills with different social class and coordination of care in a highly specialized unit.
• Geriatric Center: The senior residents spend 3 months (optional posting) at the foremost geriatric center in Nigeria – Chief Tony Anenih Geriatric Care Center (CTAGC). The resident doctor is exposed to a one stop-shop that provides comprehensive care to the growing geriatric population in Nigeria. It is a 9-bed center with two operating theatres, a laboratory, a physiotherapy unit, a pharmacy, kitchen, and recreational day unit. The senior resident doctors train under 3 consultant Family Physicians and other visiting specialists running general, Ophthalmology, Dental, Neuropsychiatry, Surgical and Gynaecology services.
• Tutelage – Molly Specialist Hospital (MSH), Idi-Ape Ibadan: Senior residents serve 3 months tutelage at MSH, a 54-bed private hospital at Idi-ape, Ibadan. MSH is a multispecialty hospital that provides most of the specialty care available in Ibadan. It has a resident Consultant Family Physician who coordinates care with several visiting consultants from all specialties. It provides laboratory and renal dialysis services amongst other services. The senior resident doctor acquires hospital management skills, and the skill/experience of providing comprehensive clinical care in a private setting. Other Tutelage centers where senior residents in the department have rotated through include:
  • Ace Medicare Clinics, Idiroko Road, Sango-Ota Ogun State
  • Shalom Medical center, Ogbomoso
• The NHIS Annex of the Department, at Ikolaba Federal Secretariat:The NHIS annex is located at the Ikolaba Federal Secretariat, where an average of 650 patients are seen on a quarterly basis. Some of the other services rendered at the annex, include health talks, immunization, HIV counselling & testing as well as pharmaceutical services.
• The large and varied patient load at the G.O.P. clinic affords Corps doctors a unique exposure to a variety of patient presentations during their mandatory one-year National Youth Service Posting.
• Clinical Services at the UCH Rural Comprehensive Health Centre, Sepeteri. The department coordinates the clinical services aspect at the Center.

Modifications in the delivery of care within the department have been instituted resulting in improved patient satisfaction.

These include:-

• Increase in health education programs by the Public Health nurses
• More comprehensive medical reviews and longitudinal care
• Better coordination of hospital health services in respect to the patients
• Screening for cervical Dysplasia and associated risk factors among women seen at GOPD
• Better seating arrangement for consultations
• Improved ventilation with provision of fans
• Improved records services, fee collection and toilet facilities
• Phlebotomy and laboratory services within the clinic
• Fee collection point within the clinic

Regular academic activities in the department include:

• Daily morning reviews of patients
• Consultation skills review on Mondays
• Dermatology sessions on Tuesdays
• Residents clinical presentations alternating with morbidity/mortality and Journal review sessions on Wednesdays
• Radiology/Evidence Based Medicine session on Thursday
• Consultation skills review on Fridays

Consultants are regularly invited from other departments to deliver lecturers on recent advances in their disciplines.

• Research Activities

These include:

• Intra departmental research
• Interdepartmental research
• Postgraduate medical research & social sciences research
• Medical records research
• Training Activities

These include:

• Postgraduate Medical Training in Family Medicine: A 6-year program leading to the award of Fellowship.
• BSc Nursing Clinical Attachment from the University of Ibadan.
• Undergraduate Medical Students Posting in Primary Care/Family Medicine/elective posting
• Regular Consultant teaching for medical students’ rotating through Paediatrics, Medicine, Surgery, and during their Primary Care Posting, covering all the clinical sets of students i.e I, II and III.
• Clinical attachment training for Clinical Psychologists from the University of Ibadan
• Integration of Family Medicine into undergraduate evaluation medical curriculum at the University of Ibadan.

Every resident doctor must have a broad based training and must be able to fulfil the objectives of the training at the end of the program which are:

• The ability to provide continuous and comprehensive care in the context of the home, workplace and the community.
• The ability to build up a trusting doctor-patient relationship by using a patient-centered approach.
• A broad-based knowledge in various disciplines of medicine in addition to Sports medicine, Public health, Health policy, Medical Ethics, Spirituality, Reproductive and Adolescent Health, and Geriatrics.
• A consistent focus on participatory care, prevention and health promotion at personal, family and community levels.
• Ability to carry out quality research.
• Ability to provide cost effective and efficient health care in a community and arrange referrals whenever needed.

Resident doctors are admitted into the training program after an interview conducted by the Hospital Board of Management and the Head of the Department. Candidates must have passed their primary examination in Family Medicine prior to the interview.

There is a compulsory Family Medicine posting in the department for registrars.  Thereafter, the resident doctor proceeds on a 23^1/2 months rotation through outer departments within and outside the hospital to acquire the broad knowledge and skills required and to prepare for the part I examination.  In this centre, Part I training covers 27^1/2months.

A sample rotation is as follows:

Table showing a sample of the rotation of Registrars within the Family Medicine Department

The resident doctor is only eligible to sit for the part I examination after duly completing these postings, and having attended the required number of workshops/seminars and revision courses organized by the Postgraduate Colleges.  Log books must be duly signed during each posting. On the successful completion of the Part I examination conducted by the Colleges, there is a compulsory 24 months senior residency period within the department of Family Medicine.  Two senior postings in Family Medicine are carried out at the Igbo-Ora outstation, and any accredited Family Medicine hospital for tutelage.

The commencement of rotations is staggered so that there is always adequate coverage of the GOP clinic.  Presently, there are 40 resident doctors at different stages of their training in the clinic and on the rotational postings to various departments. In addition to this, there are 11 consultant Family physicians in the department.

In addition to the achievements derived from treating patients, saving and improving lives, the Department of Family Medicine and its versatile/brilliant staff have been recognized and awarded on a couple of occasions. The Department has also participated in various programmes of significant capacities. Some of these achievements are indicated below:

Awards

• Two doctors have been recognized by the National Postgraduate Medical College for outstanding performance and have obtained scholarship awards for a year abroad. These are Dr. I.O. Ajayi and Dr. A.E. Irabor. Ajayi spent her time in Canada obtaining a Masters in Clinical Sciences, while Dr. Irabor went to France and was attached to an HIV/AIDS Centre.
• A. Adetunji was recognized by the West Africa College of Physicians (Family Medicine) for an outstanding Part II dissertation in the year 2005.
• M. Obimakinde was recognized by the West Africa College of Physicians (Family Medicine) for Best Part II dissertation in the year 2010.
• A. Silva and Dr. T. Ilori were recognized by the West African College of Physicians (Family Medicine) for Best Graduating Fellow in 2011 and 2012 respectively.

Training Achievements:

• The department hosted the 25^thanniversary of Family Medicine in 2005
• The department held a Joint Training conference in 2007 between National Postgraduate Medical College Faculty of Family Medicine and the department.
• The department is a Host to West African College of Physicians examinations biannually.
• The department organized a Seminar on retraining of GOP Clinic nurses on general care of patients with diabetes mellitus in 2016
• The department provided high level personnel for the development of Clinical services in:
  • APIN supported HIV clinic, UCH since 2004
  • Chief Tony Anenih Geriatric Centre since 2013
• HCT Unit – G.O.P Clinic
  • GOP Research & Training Laboratory
  • Initiated the Viral Haemorrhargic Fever triage protocol

The Department has been involved in the publication of several research papers covering vast areas within the discipline. Members of staff of the department have also collaborated with members of other departments on various occasions to carry out fruitful research activities towards the progression of quality health care delivery.