How to handle medical interns

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OPINION

By Prof. Medi Kauma

I would like to comment on an article that appeared on page 3 of The Weekend Vision of February 28-March 1, 2026. The article is titled: “Medical students to graduate after six years”. The first paragraph states that “...no medical student will graduate before completing an internship”. The English is wrong, and so is the medical implication. No university medical school in the world can allow anyone to do an internship before graduating. Every person who has spoken or speaks about such a system should get this clear.

A student must first pass and become a doctor; he or she then goes for internship for a year or two, as is the case elsewhere. The intern is not a student, but a very junior doctor who is newly qualified. There is no such thing as “You are going to graduate after you have finished your internship”. This reflects a great deal of ignorance about the training of medical doctors.

An intern must first be registered by the Uganda Medical and Dental Practitioners Council (UMDPC). He or she is then issued a one-year temporary practising licence, which authorises him or her to handle patients, speak with them, examine them and prescribe drugs or perform simple operations. No person is allowed or permitted to do this without such a licence. It is very surprising to me that some senior officers in the Ministry of Health do not know this. The UMDPC, or any senior doctor who supervises interns, does not allow anyone who is not licensed to touch, examine, or treat patients.

There are many medical procedures that a graduate intern will be allowed to learn and to which someone who has not graduated cannot be permitted. So how will a non-graduate learn how to carry out such procedures?

It is true that internships have traditionally been managed and assessed by independent regulatory bodies such as the UMDPC. However, the assessment is conducted periodically. The daily, weekly and monthly supervision and teaching are carried out by the senior clinical doctors who supervise the interns in their respective hospitals. One of the major functions of the UMDPC is to physically inspect the medical schools. They examine the number of students in each class, the number of teachers for each discipline in each school, the number of cadavers each school has and the hospitals where junior doctors undertake their internship.

It was very disturbing to me to read statements by Ministry of Health administrators that “...supervision will entirely remain under the health ministry”! I was a member of the UMDPC for four years and its chairperson for six years, a total of 10 years. Not once did I ever see anyone from the Ministry of Health going anywhere to carry out supervision of interns. Interns are supervised by clinical doctors, not ministry administrators.

Let me point out some of the reasons why Uganda produces inadequately trained doctors, and which the UMDPC and the Government need to attend to urgently. One, the number of universities with medical students is too high for a country with fewer than 60 million people.

Two, the number of senior medical doctors in those schools is low, much lower than what the UMDPC recommends. What some such schools do is engage part-time teachers who travel long distances and teach on Saturdays, Sundays, or in the evenings.

Three, the number of students in each class is too high. Some universities have 140 students in each class.

Four, the cadavers used to teach first-year students are few. One may find four cadavers in a class of 150 students.

Five, universities are at liberty to select their own external examiners for final-year students. These external examiners are given a great deal of money. As such, they wish to be invited again and again. The result is that they are reluctant to fail many students, for fear of not being invited again. Consequently, they pass students who do not have adequate knowledge to become doctors.

Six, Uganda has not accepted the recommendations made by the medical councils of many African countries when I was chairperson of the UMDPC. The recommendation was that an internship should take two years, that is, six months in each of the four subjects, namely medicine, paediatrics, obstetrics and gynaecology and surgery. Kenya, Tanzania, Zambia, South Africa and others adopted the recommendation, while Uganda did not, and that is one of the reasons why we are producing inadequately trained doctors and sending them upcountry to work unsupervised.

The article I am responding to quoted a medical student as saying each university has its own entry criteria. This is very true. There are university medical schools that admit candidates with one principal pass at A’level. Others admit students who have completed Senior Four, but have not studied Senior Five and Six. Does every university medical school have a hospital with an adequate number of patients for the students?

I worked as a member of the Health Service Commission (HSC) for 12 years. During some of the interviews, I would speak with young people who had completed internships, applied for government jobs and had been shortlisted. My experience leaves me very concerned. Some of these young doctors could not answer questions that a third-year medical student in a good school should be able to answer. Some of this information is available in certain HSC reports.

Let me pray that all those concerned will attend to these serious issues.

The writer is a medical ethicist.