It is generally accepted that the level of healthcare delivery in a society is directly related to the amount of research and dissemination of research information. Journals are a veritable tool in driving research and in continuing medical education..Fundamental tenet of academia is an obligation to disseminate acquired knowledge Journal publications rank very high in the hierarchy of sources for decisions on healthcare funding, research endeavours and patient care, Previous studies have alluded to the underdeveloped CME and poor reading culture among Nigerian doctors. A review of the role of Nigerian medical publications in world literature shows a level probably similar to our Health status indices with poor per capita contribution to world knowledge. Only 9 journals published within Nigeria are in PUBMED with 8 having 2010 articles. Of the 45 Medical journals listed in AJOL from Nigeria only 12 have any articles in 2010. A review of causes implicated the following poor funding, poor infrastructure, poor distribution systems, poor institutional support and sharp author and editorial practices. Remedial factors highlighted included institutional commitment to philosophy of research and publications, institutional review boards and measures to eliminate common author-associated fraudulent practices like plagiarism, duplicate publication, salami slicing and others. Editor / reviewer/ author training programs should be instituted. The use of current technology like etBLAST, Cross-Ref, Plagiarism checker, Google scholar and others to check widespread author sharp practices are recommended.

Background: The ultimate goal of medical education is to improve the health of the community. To ensure that medical training achieves this objective, its quality must be assured. Objective: The aim of this presentation is to attempt a definition of quality assurance in the context of medical education, explore its linkage to improved services and outline a framework for its application in Nigeria. Methods: A review of published articles and policy documents on quality assurance in higher education and medical training from different parts of the world, identified through an internet search, was done to distil the current ideas on the subject. Findings: There is a consensus that graduates from training institutions must attain an agreed minimum standard in the quantum of skills and knowledge, as well as the attitudinal disposition that they are expected to acquire in the course of their medical education. This applies to both undergraduate and postgraduate professional training. There is no guarantee that the quality assurance that is implied in enforcing such minimum standards necessarily leads to an improvement in the quality of care that the community receives. Nonetheless, quality assurance should be seen as a first step towards quality improvement. Sustained improvement requires that stakeholders demand quality in service delivery and a credible process of clinical audit, with widespread dissemination of evaluation results, to ensure accountability and maintenance of quality. However, this can only happen if the medical professionals are properly trained in all accredited institutions, a situation that can best be attained by agreement on a common core curriculum and the systematic use of improvement tools, especially the continuing professional development (CPD) of trainers. The National Universities Commission (NUC) and the Medical and Dental Council of Nigeria (MDCN) are the two bodies that have the legal mandate for the accreditation of medical and dental schools in Nigeria. Both have published separate policy documents on minimum standards of training. There is however no system of audit or formalized CPD in place yet. Conclusions: For proper quality assurance and service improvement in Nigeria, the NUC and the MDCN need to achieve a consensus on the implementation of minimum standards for trainees and trainers, with the former leading the way on curricular issues while the latter sets the pace on quality of training facilities, the credentialing of trainers and their continuing medical education and self development.

'Medical Education' is the study, research and application of educational processes employed in the training of physicians for continuous quality and standard in the production of competent physicians for improvement of healthcare delivery. It has evolved into a discipline with its own specializations such as Curriculum Development, Educational Foundations and Theory, Assessment Techniques, and Educational Methodology among others. Worldwide, high quality training and education of physicians is increasingly being recognised as critical to global health and emphasis is being made that the training of these physicians be done by professionally competent medical teachers. Medical school teachers should therefore be trained in educational foundations and theory as well as in modern educational instructional methodologies. Expertise does not automatically translate to effective teaching. In Nigeria, nearly all medical school teachers have no professional or formal training in teaching though they are experts in their fields (i.e. content experts). Evidences from research show improved learning of medical trainees when instructed by teachers trained in pedagogy and other educational processes. Teacher evaluation though alien to the Nigerian medical schools system, is an integral aspect of pedagogy and should be undertaken to ensure that teaching quality and facilitation of learning are enhanced. However such evaluation makes sense only when the teachers have been trained. There is a real necessity that medical school teachers be trained through short term courses, workshops and seminars so that the quality of teaching and imparting knowledge can be improved and sustained. Invariably, this is a call also for the establishment of departments of Medical Education in our Medical Schools across the country.

Formal attempts at Medical Education in Nigeria began in 1927 with the establishment of an institution in Lagos for training medical manpower to diploma level. They were trained to practice only in Nigeria. The program was not popular and was discontinued. Following the report of the Elliot Commissions on higher education in West Africa it was decided to establish the University of London College at Ibadan, with a Faculty of Medicine as one of the initial faculties. This was realized in 1948. The debate on what type of doctor to produce for Nigeria ended with the decision to produce high caliber doctors of the same standing as British trained doctors. In 1960 the Ashby Commission on Higher Education in Nigeria recommended the establishment of more training institutions, including those for medicine. This led to the establishment of the University of Lagos with the College of Medicine. The three initial regional governments all established their universities with medical faculties. Medical education has expanded rapidly with the expansion of universities, and we now have Federal and State governments as well as other organizations or private individuals owning universities with medical schools. Regulation of undergraduate medical education has continued to be under the dual oversight of the National Universities Commission and the Medical and Dental Council of Nigeria. The main problems of the medical schools have been the shortage of properly trained staff and poor facilities, curriculum stagnation and lack of modern teaching and assessment instruments. To tackle these problems training in educational methods should be mandatory for academic staff; there should be greater synergy between the NUC and MDCN, and curriculums should be reviewed to reflect modern trends.

In 1960 the first 13 medical students fully trained in Nigeria to internationally accepted standard graduated from the then University College Ibadan, earning the Bachelor of Medicine, Bachelor of Surgery (MBBS) London degree. Since then thousands of doctors trained to international standard have been produced from different medical schools in Nigeria. The Medical & Dental Council of Nigeria has now registered about 50, 000 doctors most of whom trained locally in Nigerian universities. The doctors were admitted into the universities with SSCE or its equivalent as the minimum entry requirement. These doctors have acquitted themselves by admirably working hard to in various capacities, including research, teaching and clinical services, to address and solve the health needs of Nigerians and beyond. Recently the National Universities Commission (NUC) proposed and may soon implement a policy that would make the university first degree the minimum qualification for entry into medical schools in Nigeria. The new policy advocates a 4 year medical undergraduate curriculum. However this would in effect translate to a minimum of 9 years post-secondary school to produce a medical doctor. Given the perennial instability in the health and educational sectors in Nigeria as well as the difficulties in obtaining placement for internship, it may practically take up to 15 years post-secondary school to fully register a doctor. Therefore the new NUC policy will have the effect of producing aging young doctors which will in turn put the lives of Nigerians at increased risk. Whatever be the flaw with the current 5 or 6 year straight MBBS programme is not due to the fact that SSCE or its equivalent is the minimum entry qualification. A minimum medical school entry qualification that has served Nigeria well for more than 50 years should not be jettisoned without convincing scientific evidence that it is detrimental to Nigeria's health policy and medical education process.

The objective of this report is to provide a summary of the outcome of Nigerian Medical Graduates globally. Since the establishment of the first medical school at the University College Hospital, Ibadan, at least four generations of medical schools have been created. With approximately 306 health training institutions and ~ 26 medical schools, www.who.int/hrh/wdms/ media/Nigeria.pdf, Nigeria graduates approximately 2300 medical doctors each year. Nigeria has one of the largest stocks of human resources for health in Africa comparable only to Egypt and South Africa. In 2005, there were about 39, 210 doctors and 124, 629 nurses registered in the country, which translates into about 39 doctors and 124 nurses per 100, 000 populations as compared to the Sub-Sahara African average of 15 doctors and 72 nurses per 100, 000 populations^[2]. Between 2005 and 2007 requests for certificate of good standing (a surrogate for migration), were 2, 341, 2, 989 and 3, 567 respectively. While many graduates remain in-country, migration occurs in a significant percentage. Based on one study, the most common country of migration is the U.S.A ( 20%), United Kingdom ( 9%) and Ireland ( 5%). In the U.S. most Nigerian physicians in clinical practice, are in a private practice, whereas a small minority is engaged in academic medicine. Curriculum reform in medical schools will be important to adequately prepare medical graduates for practice within and outside Nigeria.