addressing the training needs of international medical graduates anjla sharman pd equality in...
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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