Download - IMGs Workshop 2012. Definition Non-UK/EU Medical School Graduates Non-UK/EU Medical School Graduates
IMGsIMGs
Workshop 2012Workshop 2012
DefinitionDefinition
Non-UK/EU Medical School GraduatesNon-UK/EU Medical School Graduates
Why discuss IMGs?Why discuss IMGs?
Frequently ‘Trainees in Difficulty’Frequently ‘Trainees in Difficulty’
Increasing numbersIncreasing numbers
TodayToday
What are the issues?What are the issues?
How can we help?How can we help?
Questioning our assumptions?Questioning our assumptions? Understanding the challenges?Understanding the challenges?
CSACSA
Failure rates (2010)Failure rates (2010)
UK Graduate: 8.4%UK Graduate: 8.4% EU Graduate: 28%EU Graduate: 28% Non-EU Graduate: 46% Non-EU Graduate: 46%
IMGs @ first attempt: 50%IMGs @ first attempt: 50%
CSACSA
Dichotomous predictors of variation Dichotomous predictors of variation in outcome scores:in outcome scores:
UK/Non-UK grads 30%UK/Non-UK grads 30% White/non 3%White/non 3% Gender 2%Gender 2% Age 1%Age 1%
CSACSA
Similar results in all other College Similar results in all other College examsexams
Even more striking in…Even more striking in…
……..Psychiatry..Psychiatry
What are the issues?What are the issues?
Think about an IMG Think about an IMG
RM, 32 year old manRM, 32 year old man Graduated Med School in India 2006Graduated Med School in India 2006
Now arrives as your ST2, first GP Now arrives as your ST2, first GP placementplacement
What are the issues?What are the issues?
In groups of fourIn groups of four
Brainstorm what are the challenges Brainstorm what are the challenges for him for him that a UK graduate may not that a UK graduate may not faceface??
We will look at solutions later…We will look at solutions later…
What are the issues?What are the issues?
LanguageLanguage
Educational experienceEducational experience
CultureCulture
Life stage/personal stressLife stage/personal stress
Life stage/personal stressLife stage/personal stress
Evidence: IMGs experience more Evidence: IMGs experience more emotional stressemotional stress
Displacement, separation, financialDisplacement, separation, financial
CultureCulture
Trainees need to:Trainees need to:
Understand the Understand the contextcontext in which in which patients present & what motivates patients present & what motivates them. them.
Respond to behaviour based on Respond to behaviour based on societal norms.societal norms.
May never have been inside a UK home.May never have been inside a UK home.
““Double consciousness”Double consciousness”
W.E.B du Bois (African American W.E.B du Bois (African American Harvard Graduate)Harvard Graduate)
Compartmentalisation of mental life: Compartmentalisation of mental life: distinct spheres separating public distinct spheres separating public and private selfand private self
Fear of being found out = STRESSFear of being found out = STRESS
Educational cultureEducational culture
SDL/reflective model may be SDL/reflective model may be unfamiliarunfamiliar
Deference to teacher? Fear of Deference to teacher? Fear of admitting ‘shortcomings’?admitting ‘shortcomings’?
May value doctor centred approach May value doctor centred approach and medical knowledgeand medical knowledge
LanguageLanguage
Self reporting of English as second Self reporting of English as second language surprisingly LOWlanguage surprisingly LOW
Many (eg India) med schools taught Many (eg India) med schools taught in Englishin English
All non EU doctors will have PLABAll non EU doctors will have PLAB
LanguageLanguage
accent, colloquialismaccent, colloquialism style of English eg old fashioned in style of English eg old fashioned in
IndiaIndia humour, ironyhumour, irony features of conversational structure eg features of conversational structure eg
turn-taking & use of silenceturn-taking & use of silence manners: greeting, politeness, saying manners: greeting, politeness, saying
no, expressing angerno, expressing anger
LanguageLanguage
paralinguistic features of speech: paralinguistic features of speech: emphasis, pace, intonation, volume emphasis, pace, intonation, volume (Spanish/Italian may seem over (Spanish/Italian may seem over emotional) emotional)
non verbal communication: eg space, non verbal communication: eg space, touch (more likely in S America), eye touch (more likely in S America), eye contact (avoided in Nigeria), contact (avoided in Nigeria), gestures, facial expressiongestures, facial expression
Linguistic CapitalLinguistic Capital
Cultural capitalCultural capital: forms of knowledge, skills, : forms of knowledge, skills, education, and advantages that a person education, and advantages that a person has, which give them a higher status in has, which give them a higher status in society.society.
Linguistic capital:Linguistic capital: The mastery of The mastery of language = a form of embodied cultural language = a form of embodied cultural capital in that it represents a means of capital in that it represents a means of communication and self-presentation communication and self-presentation acquired from one's surrounding culture. acquired from one's surrounding culture. (Bourdieu)(Bourdieu)
So what does that mean?So what does that mean?
‘‘Double consciousness’Double consciousness’ Fear of being found outFear of being found out StressStress Increased inability to use linguistic Increased inability to use linguistic
capitalcapital
So what does that mean?So what does that mean?
Trainees mayTrainees may over modelover model: stick to linear consultation : stick to linear consultation
model or use platitudesmodel or use platitudes notnot pick up on patient frustration/anxiety pick up on patient frustration/anxiety notnot seem patient-centred, or empathic seem patient-centred, or empathic Seem Seem disorganised and chaoticdisorganised and chaotic when when
attempting spiral (not linear) attempting spiral (not linear) consultationsconsultations
Examples from Prof Celia RobertsExamples from Prof Celia Roberts http://www.bradfordvts.co.uk/wp-http://www.bradfordvts.co.uk/wp-
content/onlineresources/content/onlineresources/0307teachinglearning/0307teachinglearning/internationalmedicalgraduates/theinternationalmedicalgraduates/the%20csa%20and%20IMGs%20by%20csa%20and%20IMGs%20by%20celia%20celia%20roberts.ppt#266,11,Slide 11%20roberts.ppt#266,11,Slide 11
So how can we help?So how can we help?
Back in our fours…Back in our fours…
How can we help RM? Think of How can we help RM? Think of practical steps that may be useful.practical steps that may be useful.
Remember the 4 issues…Remember the 4 issues…
Remember the four issues…Remember the four issues…
LanguageLanguage
Educational experienceEducational experience
CultureCulture
Life stage/personal stressLife stage/personal stress
Early evaluationEarly evaluation
Create SAFE environment : stress and Create SAFE environment : stress and alienation impact on ability to learnalienation impact on ability to learn
Kiddy RingKiddy Ring http://www.dundee.ac.uk/gptraining/http://www.dundee.ac.uk/gptraining/
SPTC%20Files/CD%20Rom/Unit%201/SPTC%20Files/CD%20Rom/Unit%201/The%20Kiddie%20Ring.rtfThe%20Kiddie%20Ring.rtf
Get to know them / Invite them homeGet to know them / Invite them home
Observation & feedback is Observation & feedback is key:key:
VideosVideos Joint surgeriesJoint surgeries Sitting inSitting in
Address issues directlyAddress issues directly Emphasise no need to prove medical Emphasise no need to prove medical
knowledgeknowledge
Key tutorialsKey tutorials
Early: Role of GP, patient Early: Role of GP, patient expectations, health seeking expectations, health seeking behaviourbehaviour
EthicsEthics Sexuality, death etcSexuality, death etc Non medical consultationsNon medical consultations Explaining common conditions to Explaining common conditions to
patientspatients
Encourage trainee toEncourage trainee to
Recognise and value patient centred Recognise and value patient centred consulting earlyconsulting early
Be curious about patient livesBe curious about patient lives Study group with non IMGs (to avoid Study group with non IMGs (to avoid
collusion)collusion) Culture eg magazines, soapsCulture eg magazines, soaps Embed in team: social events, learn Embed in team: social events, learn
from all stafffrom all staff
ResourcesResources
http://www.londondeanery.ac.uk/var/http://www.londondeanery.ac.uk/var/language-and-communication-language-and-communication-resource-unitresource-unit
http://www.londondeanery.ac.uk/var/http://www.londondeanery.ac.uk/var/international-medical-graduates/international-medical-graduates/international-medical-graduates/?international-medical-graduates/?searchterm=imgsearchterm=img
http://www.londondeanery.ac.uk/var/http://www.londondeanery.ac.uk/var/language-and-communication-language-and-communication-resource-unitresource-unit
http://www.londondeanery.ac.uk/var/http://www.londondeanery.ac.uk/var/international-medical-graduates/international-medical-graduates/international-medical-graduates/?international-medical-graduates/?searchterm=imgsearchterm=img
SummarySummary
Be Be awareaware of challenge of challenge Commit the Commit the timetime Create the Create the safestsafest of environments of environments Don’t shy away from addressing the Don’t shy away from addressing the
issuesissues