Addressing the Training Needs of International Medical Graduates Anjla Sharman PD Equality in Training.

Addressing the Training Needs of International Medical Graduates

Anjla Sharman

PD Equality in Training

Objectives

• Consider data relating to IMG exam pass rates.

• Examine the research looking at why IMGs struggle in training.

• Discuss strategies that may be helpful in supporting IMG trainees.

National pass rates in AKT and CSA in 2010-11

Attempt Pass Rates (%) AKT Pass Rates (%) CSA

UK Grad Non-UK Grad

UK Grad Non-UK Grad

1 86.6 54.4 91.8 40.8

2 70 50.3 82.8 37.6

3 66.7 57.4 50 28.7

4 45.5 48.6 37.5 24.3

Demographics of EMHWD Trainees Sitting AKT & CSA

UKGrad

Non-UKGrad

AKT 121 96

55.8% 44.2%

CSA 99 61

61.9% 38.1%

Research evidence (US)

• Less likely to consider patients as equals, • Not been trained to talk patients through an

examination • Not trained to explain illness, medical

procedures or prognosis to patients. • Less knowledge re the psychosocial aspects of

illnesses• Less used to self-directed learning. • Linguistic issues (including accents)

Research evidence (Australia)

• Difficulties adjusting to Western culture• Reactions to separation from extended family

and friends. • Difficulties adjusting to Anglophone ‘medical

culture’. • New patterns of disease.• IMGs have to cope with changes in self-esteem

and differences in learning styles.• Language and communication issues.

Research evidence (York and Humber)

• Communication – both linguistic and cultural contexts

• Working with colleagues• Differing views re holistic approach

(psychosocial aspects of healthcare)• Patient centred care• Differences in ethical approach to practice

Research evidence: GMC 2009

• Many IMGs find there are major differences in the ethical frameworks of their country of training and in the UK.

• In particular the greater emphasis on autonomy, duty of confidentiality and informed consent may come as a surprise.

• The GMC has recommended increased training and support around ethics alongside clinical practice.

Main Areas of Challenge

• Cultural competence• Linguistic competence• NHS and new systems• Status as doctors• Self directed learning• Knowledge gaps as

new patterns of disease

• Differences in medical ethics

• Reflection• Psychosocial aspects

of care• Patient centred care

– ICE

– Shared management

– Explanations

• Teamwork

Small Group Activity

• Split into groups of 4-5.

• Consider the main areas of difficulty that IMGs encounter in training. Discuss each area and formulate three strategies that could be used to support IMGs.

Understanding the Consultation

• Teaching on reflection can improve AKT outcomes:• Control group - 32.5% pass rate• Intervention group – 60.6% pass rate

Final thoughts...

• It’s not just IMGs who struggle...

• In 2011 a meta-analysis published in the BMJ showed that there were differences in academic performance in both UG and PG assessments in UK trained doctors from ethnic minorities.

• Potentially a significant issue for the East Midlands:

Ethnicity of EM Trainees Sitting the AKT and CSA

Exam Ethnic Group

White South Asian

Black Chinese/SE Asian

MixedRace/Other

Not Known

AKT 73 118 17 2 7 0

33.6% 54.4% 7.8% 0.9% 3.2% 0

CSA 55 86 10 3 5 1

34.4% 53.8% 6.3% 1.9% 3.1% 0.6%

Bibliography

• MRCGP: Statistics 2010-11.Annual report(Aug 2010 to July 2011) on the results of the MRCGP AKT and CSA Assessments. Richard Wakeford.

Available at: http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam-overview/~/media/Files/GP-training-and-exams/Annual%20reports/MRCGP%20Statistics%20201011%20draft%20at%20071111.ashx

• General comments about features/behaviours observed in passing and failing candidates in the CSA. RCGP. Available at: http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam-overview/~/media/Files/GP-training-and-exams/General-comments-about-features-behaviours.ashx

• Singhal K and Ramakrishnan K (2004) Training needs of international medical graduates seeking residency training: evaluation of medical training in India and the United States. The Internet Journal of Family Practice

• Pilotto LS, Duncan GF and Anderson-Wurf J (2007) Issues for clinicians training international medical graduates: a systematicreview. Medical Journal of Australia 187: 225–8.

• Rughani, A. and Davangere, A. (2010) Curriculum evaluation focused on the experience of IMG trainees in Yorkshire and the Humber Deanery.

Available at: http://www.yorksandhumberdeanery.nhs.uk/general_practice/IMGs/

• Slowther, A., Lewano Hundt, G., Taylor, R. And Purkis, J. (2009) Non UK qualified doctors and Good Medical Practice: The experience of working within a different professional Framework. Report for the General Medical Council

Available at: http://www.gmc-uk.org/FINAL_GMC_Warwick_Report.pdf_25392230.pdf

• Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis. K Woolfe, HWW Potts, IC McManus.

Available at: http://www.bmj.com/content/342/bmj.d901.pdf%2Bhtml