‘IMG: A personal perspective’: Poole, 9 Jan 2014

Dilsher SinghFirst 5 GP

Birmingham

Personal Journey

Common phrases Spend a penny Water works Sample of water Feeling under the weather Suffering from pins and needles Problems with back passage X ray and blood test are ‘requested’ not ‘ordered’

CSA failure rates : Country of Graduation

AKT examCountry of Origin

Fail rates (%)

n Female : Male % in failed candidates

UK 9.1 2187 F:M = 6.7% :12.8%EEA 34.8 184 F:M = 27.1% :43.2%IMG 29.7 948 F:M = 28.2% :31%

CSA examCountry of Origin

Fail rates (%)

n Female : Male % in failed candidates

UK 8.2 1464 F:M = 4.7% :13.9%EEA 24.8 125 F:M = 16.2% :19%IMG 43.1 831 F:M = 36.2% :47.1%

UK Graduates – Fail rates

AKT British White : 5.2 % British Asian: 17.7%

CSA British White: 4.6% British Asian: 16.3%

Communicative ToleranceWho Purpose/

contextDegree of knowledge of listeners

Communicative Tolerance

Italian football player/ Manager

Stance: defensive. Self confident

High High

Ghanian Urologist

Scientific/ medical knowledge

Low High

Indian GP Relationship / Credibility

Variable Low

Communicative Flexibility All clinicians have to be Communicatively flexible Local clinicians have to adapt their talk to a

diverse patient population IMG’s have to adapt their language skills and

cultural understanding to a range of British consultations.

Mixed study groups maybe the way forward …

The way of Talk: Conversalisation: eg metaphor : imagining and

articulating the patient's thoughts back to them Metacommunicating: sharing own thoughts with

patients Relativisation: relating/ connecting different parts of

explanation Thematisation: The way ideas are put forward and

certain items selected for emphasis Temporal logical sequencing

Why are the best clinical minds from abroad struggling

Is it: Cultural ? Language ? Knowledge ? Lack of Self- Esteem ? Or Something else?

Difference in approach: Different educational training: Doctors are taught

to treat symptoms without emphasis on patient's social life

Difference in technique to approach the patient Difference in patient expectations: patient allow

doctors to lead management plans. The above issues need to be tackled:

By the Trainee themselves By the Trainers: who can help provide resources to

bridge the GAP

The start of my CSA Journey Started with First IMG conference in Midlands Gained insight into my consultation model My consultation model: Long sentences – extended

explanations Identified common problem patterns in failing

candidates Learnt about strength of equal mix of study partners Identified importance of work based assessments

towards exam success

The preparation Identified common recommended books Accumulated study material from colleagues Started CSA practice from second week in GPST3 Developed regular Practice study schedule Identified and attended CSA courses Started Joint surgeries with trainer Organised Video consultations Practiced changing my consultations: one step at a time

CSA Journey - Barriers Cultural Knowledge Experience Technique / Approach Language

CSA Exam First experience : Feb 2013

Analysis 13: Poor active listening skills, use of verbal/

nonverbal cues 2: Does not recognise the priorities in the

consultation 4: Does not recognise abnormal findings and

implications 12:Does not explore patient's agenda , health

beliefs

Reflections & Analysis Had high number of ethnic patient consultations Had very few video consultations Had been practicing in only one group Feedback from colleagues was very supportive Concentrated more on my stronger areas of

curriculum Fear Factor: performance on the day suboptimal Due to fear factor reverted back to my old

consultation style

Solutions: Increased the number of English speaking patients in clinics For 6 weeks videoed every possible patient encounter Reviewed my videos with trainer Then reviewed with peers and myself Watched each video 3 times Learnt the use of succinct sentences to manage consultations Aimed to explain the diagnosis in 2 lines only: using lay members of

my family Practiced with various other CSA groups Developed a plan to manage uncertainty

Solutions: Continued.. Feedback was constructive and brutal Every new feedback was experimented immediately Created style of statements that I could relate to Developed sense of inquisitiveness about the patient: the impact of

illness on their social life Learnt to acknowledge cues History: Red flags, ICE, Psychosocial(work/home/social/alcohol/ drugs),

Why today Learnt to critic the information presented: as has to have a reason Use of play cards: to emphasise on one aspect of consultation at a

time

CSA Exam Second attempt: May 2013

Summary The International graduates need to understand their

strengths They need to identify their area of weaknesses Active Listening skills need to be developed using echoeing

and reflection Trainees need Constructive & Honest feedback from

trainers. Trainees need to have mixed study Groups Trainers/ colleagues could help international graduates to

integrate into the local society

Suggestion Trainers to identify and signpost resources to trainees to bridge

the GAP Trainees need to spend time on analysis of their Video

consultations- at least 3 times per video Trainees need to avoid rapid topic shifts rather than topic

gliding Trainees should aim to have joint surgeries with their trainers Improve their consultations one step at a time- by use of cards

method Trainees/ Trainers need to actively analyse MSF feedback Trainees need to avoid ‘Over-modeling’: Avoid phrases that

don’t sound convincing.