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IMGs

IMGs. Workshop 2012. Definition. Non-UK/EU Medical School Graduates. Why discuss IMGs?. Frequently ‘Trainees in Difficulty’ Increasing numbers. Today. What are the issues? How can we help? Questioning our assumptions? Understanding the challenges?. CSA. Failure rates (2010)

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IMGs

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  1. IMGs Workshop 2012

  2. Definition • Non-UK/EU Medical School Graduates

  3. Why discuss IMGs? • Frequently ‘Trainees in Difficulty’ • Increasing numbers

  4. Today • What are the issues? • How can we help? • Questioning our assumptions? • Understanding the challenges?

  5. CSA • Failure rates (2010) • UK Graduate: 8.4% • EU Graduate: 28% • Non-EU Graduate: 46% • IMGs @ first attempt: 50%

  6. CSA • Dichotomous predictors of variation in outcome scores: • UK/Non-UK grads 30% • White/non 3% • Gender 2% • Age 1%

  7. CSA • Similar results in all other College exams • Even more striking in… • …..Psychiatry

  8. What are the issues? • Think about an IMG • RM, 32 year old man • Graduated Med School in India 2006 • Now arrives as your ST2, first GP placement

  9. What are the issues? • In groups of four • Brainstorm what are the challenges for him that a UK graduate may not face? • We will look at solutions later…

  10. What are the issues? • Language • Educational experience • Culture • Life stage/personal stress

  11. Life stage/personal stress • Evidence: IMGs experience more emotional stress • Displacement, separation, financial

  12. Culture • Trainees need to: • Understand the context in which patients present & what motivates them. • Respond to behaviour based on societal norms. • May never have been inside a UK home.

  13. “Double consciousness” • W.E.B du Bois (African American Harvard Graduate) • Compartmentalisation of mental life: distinct spheres separating public and private self • Fear of being found out = STRESS

  14. Educational culture • SDL/reflective model may be unfamiliar • Deference to teacher? Fear of admitting ‘shortcomings’? • May value doctor centred approach and medical knowledge

  15. Language • Self reporting of English as second language surprisingly LOW • Many (eg India) med schools taught in English • All non EU doctors will have PLAB

  16. Language • accent, colloquialism • style of English eg old fashioned in India • humour, irony • features of conversational structure eg turn-taking & use of silence • manners: greeting, politeness, saying no, expressing anger

  17. Language • paralinguistic features of speech: emphasis, pace, intonation, volume (Spanish/Italian may seem over emotional) • non verbal communication: eg space, touch (more likely in S America), eye contact (avoided in Nigeria), gestures, facial expression

  18. Linguistic Capital • Cultural capital: forms of knowledge, skills, education, and advantages that a person has, which give them a higher status in society. • Linguistic capital: The mastery of language = a form of embodied cultural capital in that it represents a means of communication and self-presentation acquired from one's surrounding culture. (Bourdieu)

  19. So what does that mean? • ‘Double consciousness’ • Fear of being found out • Stress • Increased inability to use linguistic capital

  20. So what does that mean? • Trainees may • over model: stick to linear consultation model or use platitudes • not pick up on patient frustration/anxiety • not seem patient-centred, or empathic • Seem disorganised and chaotic when attempting spiral (not linear) consultations

  21. Examples from Prof Celia Roberts • http://www.bradfordvts.co.uk/wp-content/onlineresources/0307teachinglearning/internationalmedicalgraduates/the%20csa%20and%20IMGs%20by%20celia%20roberts.ppt#266,11,Slide 11

  22. So how can we help? • Back in our fours… • How can we help RM? Think of practical steps that may be useful. • Remember the 4 issues…

  23. Remember the four issues… • Language • Educational experience • Culture • Life stage/personal stress

  24. Early evaluation • Create SAFE environment : stress and alienation impact on ability to learn • Kiddy Ring • http://www.dundee.ac.uk/gptraining/SPTC%20Files/CD%20Rom/Unit%201/The%20Kiddie%20Ring.rtf • Get to know them / Invite them home

  25. Observation & feedback is key: • Videos • Joint surgeries • Sitting in • Address issues directly • Emphasise no need to prove medical knowledge

  26. Key tutorials • Early: Role of GP, patient expectations, health seeking behaviour • Ethics • Sexuality, death etc • Non medical consultations • Explaining common conditions to patients

  27. Encourage trainee to • Recognise and value patient centred consulting early • Be curious about patient lives • Study group with non IMGs (to avoid collusion) • Culture eg magazines, soaps • Embed in team: social events, learn from all staff

  28. Resources • http://www.londondeanery.ac.uk/var/language-and-communication-resource-unit • http://www.londondeanery.ac.uk/var/international-medical-graduates/international-medical-graduates/?searchterm=img • http://www.londondeanery.ac.uk/var/language-and-communication-resource-unit • http://www.londondeanery.ac.uk/var/international-medical-graduates/international-medical-graduates/?searchterm=img

  29. Summary • Be aware of challenge • Commit the time • Create the safest of environments • Don’t shy away from addressing the issues

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