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Al-Jawad M, Chawla G, Singh N. Creating comics, songs and poems to make sense of decolonising the curriculum: a collaborative autoethnography patchwork. MEDICAL HUMANITIES 2024; 50:1-11. [PMID: 37863646 DOI: 10.1136/medhum-2023-012660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/22/2023]
Abstract
Decolonising the curriculum is a complex endeavour, with the potential to cause harm as well as benefit. People doing the work might find themselves questioning their personal and political identities and motives, it is common for people to get disillusioned. While surveys and toolkits are important to help us start the work, we are interested in finding out how decolonising practices can be sustained. We believe to practise meaningfully in this area we need to understand ourselves as practitioners, make sense of the work and have deep connections with colleagues and possibly our institutions.This research uses collaborative autoethnography; our personal experiences, reflected through the lenses of each other's point of view; to help us know ourselves and make sense of our practice. We also show how art, in the form of comics, poems and a song, can be used to deepen our research by adding meaning, connection and joy. We present this research as a patchwork text of writing, art and conversations. Our work is underpinned by theory, particularly drawing on Sara Ahmed and bell hooks. It is produced by the three of us to illuminate the process of decolonising a curriculum. We see this paper as part of our collective resistance: resistance to colonialism, to scientism and to inhumanity. We hope you will find resonances with your practice, and perhaps discover new ways to find meaning and connections.
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Affiliation(s)
- Muna Al-Jawad
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Gaurish Chawla
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Neil Singh
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
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Mannes MM, Thornley DJ, Wilkinson TJ. Cross-cultural code-switching - the impact on international medical graduates in New Zealand. BMC MEDICAL EDUCATION 2023; 23:920. [PMID: 38053141 DOI: 10.1186/s12909-023-04900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND New Zealand relies on International Medical Graduates (IMGs); however, the retention of IMGs is not optimal. This research uses a lens of cross-cultural code-switching to explore how professional and cultural differences impact on International Medical Graduates' (IMGs') journeys to practise effectively and remain in New Zealand. METHODS Utilising theory-informing inductive analysis within a constructivist approach, framework analysis was conducted following 14 face-to-face interviews with IMGs. The analysis then explored the degree to which their experiences could be explained by cross-cultural code-switching's psychological challenges (authenticity, competence, and resentment). RESULTS Analysis showed there was an expectation for IMGs to code-switch. The greater the cultural and professional difference of IMGs (compared to New Zealand), the greater the intensity of psychological challenges experienced when switching. Moreover, IMGs received minimal support, making it difficult to overcome psychological challenges, especially the competence challenge. This led to feelings of frustration and vulnerability. Code-switching could also explain why complaints about IMGs were more likely when IMGs were stressed or tired. CONCLUSION Cross-cultural code-switching can be used to explain and identify how cultural differences cause psychological challenges. These findings inform how programmes can better support IMGs in orientation and ongoing training. Additionally, establishing, and allocating IMG cultural mentors would assist in addressing IMGs' vulnerability and isolation. With this support, the journey may prove more manageable and encourage IMGs to continue practising in their adopted country.
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Affiliation(s)
- Mariska M Mannes
- School of Social Sciences, University of Otago Dunedin, PO Box 56, Dunedin, 9054, New Zealand.
| | - Davinia J Thornley
- School of Social Sciences - Media, Film and Communication, University of Otago Dunedin, Dunedin, New Zealand
| | - Tim J Wilkinson
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Adhiyaman V, Hobson P, Sundaram R, Williams L. What are the precise reasons for the disparity in referrals to fitness to practise between international and UK medical graduates? Med Leg J 2023; 91:198-203. [PMID: 37793643 DOI: 10.1177/00258172231184551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
PURPOSE OF THE STUDY To discover the precise reasons for referring a doctor to the Medical Practitioners Tribunal Service, and whether there are any disparities between referrals of international medical graduates and UK graduates. Further to consider whether understanding the precise reasons would provide insight into the nature of referrals. STUDY DESIGN We collected and analysed the data from the Medical Practitioners Tribunal Service website over a period of 12 months. RESULTS There were 228 cases of which 142 (62%) were international medical graduates and 86 (38%) were UK graduates. More international medical graduates were referred for professional misconduct, poor performance and lack of adequate English language. The common reasons for professional misconduct were providing sub-optimal care, sexual misconduct and dishonest behaviour. More UK graduates were referred following convictions due to offences related to alcohol intake and financial dishonesty. There is paucity of good quality information to identify the exact reasons for the disparity. CONCLUSION More international medical graduates were referred to the Medical Practitioners Tribunal Service than UK graduates. There was disparity in the nature of the referrals and we hope our findings will inform employers and the regulatory bodies to understand that comprehensive induction, inclusion, mentoring and adjustments are needed to support international medical graduates to mitigate the risks of failure and help them to meet the required professional standards.
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Brennan N, Langdon N, Gale T, Humphries N, Knapton A, Bryce M. Exploring recent patterns of migration of doctors to the United Kingdom: a mixed-methods study. BMC Health Serv Res 2023; 23:1204. [PMID: 37924092 PMCID: PMC10625180 DOI: 10.1186/s12913-023-10199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
INTRODUCTION A shortage of doctors is currently one of the biggest challenges faced by the healthcare workforce in the United Kingdom (UK). While plans are in place to increase the number of medical school places, in the short-term this gap will need to continue to be filled by the international recruitment of doctors. The aim of this study is to identify key factors that explain the patterns of migration of doctors to the UK, in order to aid the development of policies to recruit and retain a sustainable workforce. METHODS We analysed General Medical Council (GMC) secondary data on the patterns of migration of internationally trained doctors (2009-2019). Qualitative interviews were conducted with 17 stakeholders by videoconferencing which were audio-recorded, transcribed and thematically analysed using NVivo. RESULTS In 2019, 34.5% of UK doctors were trained internationally mainly in India, Pakistan, Italy, Nigeria, Greece, Romania and Egypt. Most new registrations by internationally trained doctors from 2009-2019 did not have a specialty at the time of initial registration (96.2% in 2019). Only a relatively small number of these doctors go on to gain specialist or GP registration (11.6% within 5 years and 27.2% within 10 years of registration). The stakeholder interviews highlighted training opportunities and career progression as the main drivers of migration. The barriers internationally trained doctors face regarding specialty training included differences between UK and destination health systems, systematic bias, bureaucracy and selection processes not being accessible. CONCLUSION This study makes a contribution to the literature by identifying recent patterns in the migration of doctors to the UK. The UK's dependence on internationally trained doctors has important global implications as source countries are losing skilled health workers which is undermining their health systems. In keeping with the WHO Global Code on the International Recruitment of Healthcare Personnel, policymakers need to consider how to reduce the UK's reliance on internationally trained doctors, particularly from countries on the safeguard list whilst continuing the drive to increase medical school places. Additional support is required for internationally trained doctors, to ensure that they get on the training programmes they seek, enabling their career progression.
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Affiliation(s)
- N Brennan
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK.
| | - N Langdon
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - T Gale
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - N Humphries
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Knapton
- Strategic Modelling Analysis and Planning Limited (SMAP), Winchester, UK
| | - M Bryce
- CAMERa, Peninsula Medical School, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
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Jager A, Harris M, Terry R. The challenges faced by early career international medical graduates in general practice and opportunities for supporting them: a rapid review. BJGP Open 2023; 7:BJGPO.2023.0012. [PMID: 37315989 PMCID: PMC10646205 DOI: 10.3399/bjgpo.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/04/2023] [Accepted: 06/12/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND British general practice is facing a workforce crisis against a backdrop of an ageing population experiencing increasingly complex health challenges. The NHS must increase the supply of GPs, including international medical graduate (IMG) GPs, by increasing recruitment and retention. IMG GPs face distinct challenges during training and their early careers. Understanding these challenges, as well as the help and support offered to early career IMG GPs, is crucial to building and sustaining the general practice workforce. AIM To understand the challenges facing early career IMG GPs and the help and support they can access. DESIGN & SETTING Rapid review of studies and grey literature on UK-based IMG GPs. METHOD Six databases were searched. Four websites were searched to find grey literature. Titles and abstracts were screened according to inclusion and exclusion criteria, followed by the full study where applicable. The included studies were analysed using a thematic synthesis approach to identify the challenges faced by early career IMG GPs, as well as the help and support available. RESULTS The database search yielded 234 studies, with 38 additional studies identified via other methods. Twenty-one studies were included in the synthesis. Seven challenges were identified, as well as a range of help and support available. Early career IMG GPs face a range of psychological, social, and practical challenges, which may not be adequately addressed by the help and support currently offered by the NHS. CONCLUSION Further research is required to understand the extent to which early career IMG GPs access the help and support offered, and if it adequately addresses the unique challenges they face.
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Affiliation(s)
- Alexandra Jager
- University of Exeter Medical School, Exeter, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Michael Harris
- University of Exeter Medical School, Exeter, UK
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
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Brennan N, Langdon N, Bryce M, Burns L, Humphries N, Knapton A, Gale T. Drivers and barriers of international migration of doctors to and from the United Kingdom: a scoping review. HUMAN RESOURCES FOR HEALTH 2023; 21:11. [PMID: 36788569 PMCID: PMC9927032 DOI: 10.1186/s12960-022-00789-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/21/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Many high-income countries are heavily dependent on internationally trained doctors to staff their healthcare workforce. Over one-third of doctors practising in the UK received their primary medical qualification abroad. Simultaneously, an average of around 2.1% of doctors leave the UK medical workforce annually to go overseas. The aim of this study was to identify the drivers and barriers of international migration of doctors to and from the UK. METHODS A scoping review was conducted. We searched EMBASE, MEDLINE, CINAHL, ERIC and BEI in January 2020 (updated October 2021). Grey literature and citation searching were also carried out. Empirical studies reporting on the drivers and barriers to the international migration of doctors to and from the UK published in the English language from 2009 to present were included. The drivers and barriers were coded in NVivo 12 building on an existing framework. RESULTS 40 studies were included. 62% were quantitative, 18% were qualitative, 15% were mixed-methods and 5% were literature reviews. Migration into and out of the UK is determined by a variety of macro- (global and national factors), meso- (profession led factors) and micro-level (personal factors). Interestingly, many of the key drivers of migration to the UK were also factors driving migration from the UK, including: poor working conditions, employment opportunities, better training and development opportunities, better quality of life, desire for a life change and financial reasons. The barriers included stricter immigration policies, the registration process and short-term job contracts. CONCLUSIONS Our research contributes to the literature by providing a comprehensive up-to-date review of the drivers and barriers of migration to and from the UK. The decision for a doctor to migrate is multi-layered and is a complex balance between push/pull at macro-/meso-/micro-levels. To sustain the UK's supply of overseas doctors, it is vital that migration policies take account of the drivers of migration particularly working conditions and active recruitment while addressing any potential barriers. Immigration policies to address the impact of Brexit and the COVID-19 pandemic on the migration of doctors to and from the UK will be particularly important in the immediate future. Trial registration PROSPERO CRD42020165748.
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Affiliation(s)
- N Brennan
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK.
| | - N Langdon
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - M Bryce
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - L Burns
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - N Humphries
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Knapton
- Strategic Modelling Analysis and Planning Limited (SMAP), Winchester, UK
| | - T Gale
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
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Tilsed F, Cattermole H, Mills C. Linguistic coaching: a pilot study of one-to-one near-peer coaching for international GP trainees in Yorkshire. EDUCATION FOR PRIMARY CARE 2023; 34:31-39. [PMID: 36522855 DOI: 10.1080/14739879.2022.2153750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION International medical graduates (IMGs) have a higher rate of examination failure and are more likely to be referred to the regulator for professional performance issues than their UK-trained counterparts. Support for IMGs to reduce differential attainment takes many forms. A pilot study to assess the feasibility and utility of early intervention to increase the support available for IMGs entering general practice (GP) training was undertaken. METHOD IMGs entering GP training in one UK region were offered one-to-one, near-peer linguistic coaching during their first two weeks of training. A session focusing on cultural acclimatisation, local accent and dialect using mock patient consultations was delivered and evaluated. RESULTS The coaching was valued by the trainees and the intervention allowed very early identification of a trainee who needed further support. It was possible to identify such trainees using a non-medical volunteer student coach. DISCUSSION Use of a non-medical, near-peer coach for one-to-one linguistic support has not previously been described for IMGs. This pilot study confirms the acceptability and utility of this approach. Early identification of trainees requiring enhanced support allows targeted interventions in a time-pressured speciality training programme. Further study with a larger-scale and longer-term coaching programme, assessing trainee feedback and uptake of early supportive intervention is recommended.
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Affiliation(s)
- Fiona Tilsed
- Student Volunteer Coach, Health Education England Yorkshire and the Humber, UK
| | - Helen Cattermole
- GP School, Health Education England Yorkshire and the Humber, UK
| | - Caroline Mills
- GP School, Health Education England Yorkshire and the Humber, UK
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Darboe A, Hawthorne L, Scott A, McGrail M. Exploring life satisfaction difference between domestic and international medical graduates: Evidence from a national longitudinal study. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2130641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Amadou Darboe
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Lesleyanne Hawthorne
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Anthony Scott
- Melbourne Institute, Applied Economic and Social Research, The University of Melbourne, Melbourne, Australia
| | - Matthew McGrail
- Rural Clinical School, University of Queensland, Queensland, Australia
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Handagala R, Indrasena BSH, Subedi P, Nizam MS, Aylott J. Implementing the HEART score in an NHS emergency department: can identity leadership combined with quality improvement promote racial equality? Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print. [PMID: 35815917 DOI: 10.1108/lhs-04-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to report on the dynamics of "identity leadership" with a quality improvement project undertaken by an International Medical Graduate (IMG) from Sri Lanka, on a two year Medical Training Initiative (MTI) placement in the National Health Service (NHS) [Academy of Medical Royal Colleges (AoMRC), 2017]. A combined MTI rotation with an integrated Fellowship in Quality Improvement (Subedi et al., 2019) provided the driver to implement the HEART score (HS) in an NHS Emergency Department (ED) in the UK. The project was undertaken across ED, Acute Medicine and Cardiology at the hospital, with stakeholders emphasizing different and conflicting priorities to improve the pathway for chest pain patients. DESIGN/METHODOLOGY/APPROACH A social identity approach to leadership provided a framework to understand the insider/outsider approach to leadership which helped RH to negotiate and navigate the conflicting priorities from each departments' perspective. A staff survey tool was undertaken to identify reasons for the lack of implementation of a clinical protocol for chest pain patients, specifically with reference to the use of the HS. A consensus was reached to develop and implement the pathway for multi-disciplinary use of the HS and a quality improvement methodology (with the use of plan do study act (PDSA) cycles) was used over a period of nine months. FINDINGS The results demonstrated significant improvements in the reduction (60%) of waiting time by chronic chest pain patients in the ED. The use of the HS as a stratified risk assessment tool resulted in a more efficient and safe way to manage patients. There are specific leadership challenges faced by an MTI doctor when they arrive in the NHS, as the MTI doctor is considered an outsider to the NHS, with reduced influence. Drawing upon the Social Identity Theory of Leadership, NHS Trusts can introduce inclusion strategies to enable greater alignment in social identity with doctors from overseas. RESEARCH LIMITATIONS/IMPLICATIONS More than one third of doctors (40%) in the English NHS are IMGs and identify as black and minority ethnic (GMC, 2019a) a trend that sees no sign of abating as the NHS continues its international medical workforce recruitment strategy for its survival (NHS England, 2019; Beech et al., 2019). IMGs can provide significant value to improving the NHS using skills developed from their own health-care system. This paper recommends a need for reciprocal learning from low to medium income countries by UK doctors to encourage the development of an inclusive global medical social identity. ORIGINALITY/VALUE This quality improvement research combined with identity leadership provides new insights into how overseas doctors can successfully lead sustainable improvement across different departments within one hospital in the NHS.
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Affiliation(s)
- Rangani Handagala
- Emergency Department, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Buddhike Sri Harsha Indrasena
- Institute for Quality Improvement (IQI), World Academy of Medical Leadership, Sheffield, UK and Department of General Surgery, Provincial General Hospital, Badulla, Sri Lanka
| | - Prakash Subedi
- Emergency Department, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK and QiMET Medical Institute (QMI), QiMET International, Doncaster, UK
| | - Mohammed Shihaam Nizam
- Acute Medicine Department, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Jill Aylott
- Institute for Quality Improvement (IQI), World Academy of Medical Leadership, Sheffield, UK and QiMET Medical Institute (QMI), QiMET International, Doncaster, UK
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Weng TL, Chu FY, Li CL, Chen TJ. Choices of Specialties and Training Sites among Taiwanese Physicians Graduating from Polish Medical Schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063727. [PMID: 35329418 PMCID: PMC8950236 DOI: 10.3390/ijerph19063727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 02/05/2023]
Abstract
Taiwanese students who graduated from Polish medical schools (P-IMGs) accounted for the second-largest group of international medical graduates in Taiwan. In 2009, domestic medical students in Taiwan staged mass demonstrations against P-IMG’s exemption from the qualifying test before the licensing exam. Although medical circles in Taiwan might still hold prejudices against P-IMGs, little is known about their career development. This study will analyze P-IMGs’ choices of specialties and training sites from 2000 to 2020 using data from the membership section of the Taiwan Medical Journal, the monthly official publication of the Taiwan Medical Association. Of 372 P-IMGs, 34.2% chose internal medicine and 17.1% surgery. Although academic medical centers offered 76% of all available trainee positions in a year, only 49.3% of P-IMGs received training there. By contrast, 20.9% of P-IMGs were trained at nonmetropolitan hospitals that altogether accounted for only 5.8% of trainee positions. In conclusion, P-IMGs had their residency training at less favorable specialties and sites. Their long-term career development deserves further study.
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Affiliation(s)
- Tzu-Ling Weng
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Feng-Yuan Chu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Chiao-Lin Li
- Department of Family Medicine, Taipei City Hospital Yangming Branch, Taipei 111, Taiwan;
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Correspondence:
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International graduates' experiences of reflection in postgraduate training: a cross-sectional survey. BJGP Open 2022; 6:BJGPO.2021.0224. [PMID: 35045955 PMCID: PMC9447326 DOI: 10.3399/bjgpo.2021.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/04/2022] [Indexed: 11/03/2022] Open
Abstract
Background Reflection is a key component of postgraduate training in general practice. International medical graduates (IMG) are thought to be less familiar with reflection, with international medical schools favouring more didactic methods of education. Aim To explore IMGs’ experiences of reflection prior to and during GP training and the support available for developing skills in reflection. Design & setting A cross sectional survey was sent to IMGs undertaking GP training in 12 of the 14 UK regions, from March to April 2021. Method A pre-tested self-administered online questionnaire was used to collect data on experiences of reflection, both prior to and during GP training, and the support available for developing skills in reflection. Results In total, 485 of 3413 IMG trainees completed the questionnaire (14.2% response rate, representative of national demographics). Of these, 79.8% of participants reported no experience of reflection as an undergraduate and 36.9% reported no formal training in reflection during GP training. The majority (69.7%) of participants agreed that reflection was beneficial for their training and 58.3% reported that the best support in reflection came from their supervisors. Experience of reflection, opinions on the benefits, and best sources of support all varied by where the responders' primary medical qualification (PMQ) was obtained (all P values<0.01). Conclusion Most IMGs have not experienced reflection prior to commencing UK GP training. There is diversity in experience and culture within this group that must be considered when tailoring educational interventions to support IMGs in their transition to UK GP training.
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Gondhalekar AR, Thevapalan L, Rashid MA. Analysis of Preparatory Courses for the Practical Component of the PLAB Exam for International Medical Graduates in the UK. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1053-1058. [PMID: 34584481 PMCID: PMC8464341 DOI: 10.2147/amep.s328255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Medical workforce shortages are a major threat to the future of the UK National Health Service (NHS) and countless other healthcare systems globally. Reliance on international medical graduates is likely to continue and may increase, although these doctors face many educational and professional challenges. The Professional and Linguistic Assessment Board (PLAB) test, delivered by the General Medical Council (GMC), is the "gateway" exam that doctors must pass through in order to practice in the UK. Despite the central importance of this exam, no official or accredited training courses are provided or approved by the GMC. METHODS This study used online and social media searches to identify and categorise preparatory courses available for the practical (clinical) component of the PLAB assessment. RESULTS A total of 13 courses were identified, delivered predominantly in the cities of Manchester and London, ranging from 1 to 28 days in duration and from £24.99 to £649.99 in cost. Most courses were organised by previous PLAB candidates and websites focussed on testimonials from previous participants rather than educational credentials or professional clinical experience of teachers running the courses. Courses were all provided by private education companies, and none were delivered by universities or National Health Service organisations. DISCUSSION A variety of preparatory services and courses exist for the PLAB assessment, although the public information about them is variable and limited. Further research is required to examine the quality of these courses and the potential for alternative avenues of training for international medical graduates preparing to practice in the UK.
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Subedi P, Aylott J, Khan N, Shrestha N, Lamsal D, Goff P. “Hybrid” medical leadership emergency medicine training for international medical graduates. Leadersh Health Serv (Bradf Engl) 2021. [DOI: 10.1108/lhs-05-2020-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, “earn, learn and return” programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS.
Design/methodology/approach
A shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a “HIEM programme”. The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis.
Findings
The HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis.
Research limitations/implications
The HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties.
Practical implications
The HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal.
Originality/value
This is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this “hybrid” curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This “hybrid” model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare.
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Rashid MA, Farrukh A, Mayberry JF. International medical graduates from India and Pakistan: an analysis of specialty areas on the UK medical register. Postgrad Med J 2021; 98:e165-e166. [PMID: 33547139 DOI: 10.1136/postgradmedj-2020-139597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/03/2022]
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Barat A, Goldacre MJ, Lambert TW. Career choices for nephrology and factors influencing them: surveys of UK medical graduates. JRSM Open 2018; 9:2054270418793024. [PMID: 30181891 PMCID: PMC6111404 DOI: 10.1177/2054270418793024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives To study early and eventual career choices for nephrology among UK medical
graduates and investigate factors which influenced career preferences. Design Self-completed survey questionnaires mailed to medical graduates 1, 3, 5 and
10 years after graduation. Setting United Kingdom. Participants UK medical graduates in 15 year-of-qualification cohorts between 1974 and
2015. Main outcome measures Early career specialty choices, career specialty destinations at 10 years and
ratings of factors affecting career choices. Results Around 0.4%–1.1% of these junior doctors expressed a career preference for
nephrology, varying by year of qualification and years after qualification.
Among all graduates of 1993–2002 combined, 0.4% expressed a career
preference for nephrology 1 year after qualification rising to 1.0% in year
5. Among graduates of 2005–2008, the corresponding figures were 1.0% in year
1 falling to 0.7% in year 5. Only 18% of doctors who chose nephrology in
year 1 eventually became nephrologists. Of doctors who were practising as
nephrologists for 10 years and more after qualification, 74% of the women
and 56% of the men had decided to pursue a career in nephrology by year 5
after qualification. ‘Enthusiasm/commitment’ had a great deal of influence
on those who chose nephrology, for all cohorts and all years studied. Conclusions The most recent data suggest that the proportion of young doctors who sustain
an interest in nephrology through the early postgraduate training years may
be lower than among their predecessors. Efforts are needed to reverse the
declining trend and increase interest in nephrology.
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Affiliation(s)
- Atena Barat
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Michael J Goldacre
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Trevor W Lambert
- UK Medical Careers Research Group, Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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Davda LS, Gallagher JE, Radford DR. Migration motives and integration of international human resources of health in the United Kingdom: systematic review and meta-synthesis of qualitative studies using framework analysis. HUMAN RESOURCES FOR HEALTH 2018; 16:27. [PMID: 29945616 PMCID: PMC6020357 DOI: 10.1186/s12960-018-0293-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 06/08/2018] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The aim of this review was to examine the migration motives, the barriers to and facilitators of integration of international dental graduates, compared with nurses and doctors in the United Kingdom. METHODS Electronic databases Ovid MEDLINE, EMBASE, PubMed, Web of Knowledge and OECD publications were systematically searched for English language publications from January 2000 to January 2017. A total of 31 qualitative studies were selected and quality appraised and meta-synthesis of the qualitative data was carried out using framework synthesis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to present the findings. RESULTS There were no studies on migration motives and one study on integration experiences of international dentists in the UK. The nursing literature had the highest volume and quality of evidence on nursing workforce, whilst there was limited literature on international doctors in the UK. Migration of health professionals to the UK is determined by personal and professional factors, together with source country-specific and UK drivers. Active recruitment, post graduate training and financial gain act as strong common macro, meso and micro drivers that perpetuate migration into the UK, but the extent to which each of these drivers influence nurses' and doctors' migration is different. Integration experiences for international nurses and doctors differed based on their source country experiences and the work environment they entered. Nurses reported a wider knowledge and skills gap, more multi-level discrimination and less career progression compared to the doctors. The migrants' integration experiences depend on their cultural awareness, discrimination exposure, English language and communication skills, social and professional support networks, social integration and personal attributes. CONCLUSION Migration of international health professionals is motivated by macro, meso and micro drivers at the international, national, professional and personal levels. The UK has strong common macro pull factors which attract nurses, doctors and dentists and may impact on the effectiveness of policies to restrict their migration. The integration experiences of nurses and doctors differ and further research is required to understand the integration experiences of dentists, in order to retain these professionals by tailoring policies to each of these professions.
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Affiliation(s)
- Latha S. Davda
- King’s College London Dental Institute, University of Portsmouth Dental Academy, The William Beatty Building, 1 Hampshire Terrace, Portsmouth, PO1 2QG UK
| | - Jennifer E. Gallagher
- Dean for International Affairs, Newland Pedley Professor of Oral Health Strategy, King’s College London Dental Institute, Denmark Hill Campus, Bessemer Road, London, SE5 9RS UK
| | - David R. Radford
- King’s College London Dental Institute, University of Portsmouth Dental Academy, The William Beatty Building, 1 Hampshire Terrace, Portsmouth, PO1 2QG UK
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Triscott JA, Szafran O, Waugh EH, Torti JM, Barton M. Cultural transition of international medical graduate residents into family practice in Canada. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2016; 7:132-41. [PMID: 27149322 PMCID: PMC4860287 DOI: 10.5116/ijme.570d.6f2c] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/12/2016] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice. METHODS This was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. RESULTS Participants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada's health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. CONCLUSIONS Residency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.
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Affiliation(s)
| | - Olga Szafran
- Department of Family Medicine, University of Alberta, Canada
| | - Earle H. Waugh
- Department of Family Medicine, University of Alberta, Canada
| | | | - Martina Barton
- Department of Family Medicine, University of Calgary, Canada
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Kamimura A, Samhouri MS, Myers K, Huynh T, Prudencio L, Eckhardt J, Al-Obaydi S. Physician Migration: Experience of International Medical Graduates in the USA. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2016. [DOI: 10.1007/s12134-016-0486-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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