International Medical Graduate

trainees

Bradford Trainers’ Workshop12 5 2010Maggie Eisner

Session plan

Sharing experiences of IMGs – Amanda Nix

IMGs and the CSA – Louise Riley

The IMGs’ point of view

How can trainers and the training scheme best support IMGs?

Sheffield IMG survey

Sent to Sheffield IMGs in 2009

Headings under nMRCGP competencies

Also sent to educators

42 full responses

Report includes comments by many others to whom initial responses were sent

Full report on Deanery website

Communication

The biggest issue by miles!

Underlies many of the other problem areas

Language and culture interlinked but useful to consider separately

Communication - language

Colloquialisms

Pronunciation and accents – both the doctor’s and the patients

Difficulty with humour

Learning stock phrases is of limited use - may sound formulaic and insincere doesn’t help doc adapt language to patient

Non verbal and para verbal (e g intonation) skills also important

Communication - culture

IMGs (like all hospital doctors) may have difficulty explaining their thoughts and plans to patients

NB – not confined to IMGs – like many of the difficulties, applies to any doctor and patient communicating across language and cultural barriers

Working with colleagues

Cultural differences important (medical and social culture)

Most IMGs come from more hierarchical medical culture – adapting to ours may be uncomfortable, with disorientating sense of loss of role

Forms of address may cause discomfort (on both sides)

Cultural learning should be 2 way – it is as important for team to understand IMG’s culture as vice versa.

We are all ambassadors for our culture – colleagues’ behaviour has great influence on how we perceive and interact with others from the cultures they represent.

Holistic approach

Not true that IMGs don’t understand a holistic approach – but theirs is in different social context (extended family system)

Psych illness stigmatised in some cultures, may make doctors reluctant to explore

Fee paying health service in home country may make Dr reluctant to waste patient’s time discussing psychosocial stuff

Biomedical -> holistic shift also experienced by UK trained docs moving from hosp to GP

Clinical management

Different approaches determined by patient expectations the doctor is used to, or range of management options available

Incidence of different conditions in different countries, implications of same sympts and signs (e g fever in tropics and in UK)

Cultural communication factors may create clinical management problems if sensitive issues need to be discussed (esp male Dr and female pt)

Medical complexity

Hard for all trainees (? and trainers) to grasp at first

IMGs may find it especially hard because of lack of experience earlier in career of

managing elderly patients with many co morbidities

NHS type primary care system Idea of health promotion as integral to GP’s work

Professionalism

Values vary between cultures, including ethical values underlying professional codes like ‘Duties of a doctor’

Apparently ‘unprofessional’ behaviour can reflect lack of familiarity with current UK professional codes and the values underlying them

Teaching methods

Student-teacher relationship differs between cultures. Most IMGs used to expectation that teachers should be respected unconditionally and not challenged

Concept of self directed learning AND skills needed for it may be unfamiliar

NB – all learners have individual learning styles; educational culture IMGs have come from is only one factor you need to know to design an appropriate teaching programme

IMGs on Bradford STS

Currently 12 (11 Indian subcontinent, 1 EU)

3 meetings in 2010, ½ day at HDR and 2 full days at Broughton Hall

Found out about their point of view – all felt that communication is most important issue

Discussed areas of concern

Discussion and role play about difficult communication areas – sex and death

Watched London Deanery video

Helping IMGs - principles

Start early

Be aware of challenges faced by IMGs

Respect them – don’t see them as a problem

IMGs in difficulty may need multifaceted support (trainer, ES, TPD)

Helping IMGs – encourage to

Recognise and practise pt centred consultation skills (ICE, looking for cues, sharing options) early

Be curious about patients’ lives, ask about them in consultation

Self assess on competencies early, and understand what they mean

Observe experienced colleagues’ consultations

Get involved in informal aspects of practice life

Watch TV soaps with local accent (Emmerdale), read newspapers

Get involved with English social groups

Try to speak English at home

Helping IMGs – trainers – at the beginning

Get to know them as a person as early as poss, show interest in their background, ? Invite them home

Team social activity early in their attachment

Go out/sit in with different team members

Early tutorial on practice patients’ help seeking behaviour, perceptions of GP, role of GP in NHS

Assess their English (speaking, listening, reading, writing); plan to address language needs

Explore their learning style and educational background in order to plan your approach to their training

Helping IMGs – trainers

Tutorials about cultural/linguistic aspects of Care of the elderly Death, bereavement, care of the dying Sexuality, sexual behaviour, sexual health

Tutorials on ethics and professionalism, sharing dilemmas and areas which might be dealt with differently in different cultures

Lots of video and role play

Lots of feedback (more than UK graduates) To give confidence and encouragement To identify learning needs