are advantages to the colleges taking responsibility for parts of this as microcultures exist within ... Take Home Messages. 1) Culture and communication issues ...
Whose Culture is it Anyway? Lessons for #brexit Why are IMGs involved in more complaints? Is it cultural? C. Turner, C. Trivedy, UHCW NHS Trust, Coventry R. Broom, D. Harmer, Coventry and Warwickshire Partnership Trust, Coventry
Questions to be answered 1) What are the Royal Colleges doing within their curricula to address the disparity between complaints made against international medical graduates and UK based graduates? 2) Cultural differences could be responsible for this disparity, are the Royal Colleges addressing these in their curricula? 3) Communication difficulties could also have an impact, are these being addressed?
In terms of "communication" references, the range was from 3 (paediatrics) to 140 (O&G), with the RCEM curriculum having 94 references (the second highest).
Introduction The NHS is a culturally diverse organisation: international medical graduates (IMGs) from outside the European Union represent 25.9% of the medical workforce. This could increase following the (likely) future exit of the UK from the EU. IMGs, however, are disproportionately represented in GMC hearings and sanctions. IMGs having a GMC hearing also have a 29% rate of being erased, whilst UK graduates have a 10% rate. This outcome is mirrored in other countries such as Australia. Cultural and communication issues appear to be at the core of many of these complaints. We wished to know the extent to which the various Royal Colleges recognise cultural differences within their curricula and, additionally, the extent to which they discuss communication skills.
Methods Within each of the Royal Colleges' curricula we searched for the terms "culture" and "communication", as well as relevant synonyms. We then manually assessed those mentions for relevance; excluding uses such as "culture" within "blood culture" where the searches did not relate to our aims. This process was repeated for each Royal College in turn. Area of practice
% of trainees reporting being underprepared (n=102)
% of supervisors reporting problems (n=59)
GMC’s Good Medical Practice
24
29
UK ethical standards
36
27
Legal framework for practising medicine
52
24
Quality of doctor-patient relationship in the UK
36
53
Communication skills
33
76
Cultural understanding of multicultural London
50
66
Confidence in use of English
15
66
How many mentions? Relevant references to culture and communication in Royal College Syllabi
Discussion There are differences between the approaches of the different colleges to acknowledging culture and communication within their curricula. This may contribute to the level of preparedness of IMGs for life within the NHS, and the subsequent level of complaints received. Additionally, upon review it is clear that almost all references to culture within the Colleges' curricula often only refer to understanding non-UK culture. We feel that there would also be a benefit in helping IMGs to understand British and NHS culture for those unfamiliar with it. Whilst it may seem that this area would more naturally belong with the GMC there are advantages to the colleges taking responsibility for parts of this as microcultures exist within specialties. These microcultures contain subtleties of interactions and expectations that generic courses find impossible to address. Emergency Medicine fares relatively well in its emphasis on these factors and crucially they are tested at examination. We, in Emergency Medicine, thus have the potential to build upon this and be at the vanguard of communication improvements.
Conclusion In this post Brexit NHS, we feel there is an urgent and unmet need to develop pan-speciality and speciality specific resources related to this issue. This would include both teaching and quality assurance with the aim of improving patient safety and experience. Could this be driven by RCEM?
IMGs underprepared? Figure from Difficulties for international medical graduates working in the NHS Bhat M et al. 12/05/14, BMJ Careers article
Results Within the Royal Colleges' curricula, the number of relevant references to "culture" varied between 0 (anaesthetics) and 15 (O&G). Within the Emergency Medicine curriculum culture is mentioned 13 times.
References 1. General Medical Council. The state of medical education and practice in the UK report: 2013. GMC, 2013 2. University of Warwick. Report for the General Medical Council. Non UK qualified doctors and Good Medical Practice : the experience of working within a different professional framework. February 2009 3. Difficulties for international medical graduates working in the NHS, Mohan Bhat, Ali Ajaz, Nuruz Zaman, 12 May 2014, BMJ Careers 4. Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia. Elkin k., et al. Med J Aust. 2012; 197 (8): 448-452. 5. International Medical Graduates (IMGs) in the UK—a Systematic Review of Their Acculturation and Adaptation. Khan, F.A., Chikkatagaiah, S., Shafiullah, M. et al. Int. Migration & Integration (2015) 16
Take Home Messages 1) Culture and communication issues appear to often be at the heart of GMC complaints about IMGs 2) The number of references to ‘culture’ and ‘communication’ vary greatly between Royal Colleges’ curricula 3) Cultural references in the Colleges’ curricula appear to be more concerned with “looking out” to explain other cultures rather than “looking in” to explain NHS and UK culture. IMGs may need the latter.
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