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If you find anything you feel would be helpful to others, please email me here.

 

GENERAL

 

 

RESOURCES

A fabulous teaching resource set by Marie McCullagh and Ross Wright:

A particularly good book to learn about communication skills is:

 

 

..more resources on the CSA and why people fail, here

 

..more online resources on ethnicity, culture, diversity and IMGs here

 

 

 

Helping International Medical Graduates

What is an IMG?

This page is for those GP trainees who are training in the UK but who graduated in Medicine at a University elsewhere (like Africa, India and so on). International Medical Graduates are often referred to as IMGs. I don't particularly like referring to a group of humans in this way - somehow (to me) it feels like they're being labelled as an outcast group. However, what I can safely say is that people who use the word IMGs to identify this group of people are usually doing it to help them rather than denegrate or undermine them.

 

What's the problem in general?

The problem with GP training schemes in the UK (and formal assessment procedures) is that most are based on a 'formula' which is really suited to those who graduated in the UK. For instance, most CSA courses already assume that you have good enough knowledge of 'British culture, language and linguistics'. We know IMGs struggle with specific components of the MRCGP exam (notably CSA).

 

To try and bridge this gap, this page is solely devoted to the IMG community and their educators. You will find quite a number of tips on this page to help you with the MRCGP and GP training in general. If you have any further comments or recommendations, please drop me a line at rameshmehay@googlemail.com

 

What are the specific problems IMGs face?

  • Although many IMGs underperform, they are usually highly intelligent (less than 1% of the world's population have a medical degree). Compared to British born and bred graduates, IMGs have an intellectually very difficult task to do. They have to deal with medical issues whilst simultaneously having to mentally translating between at least two languages.

  • The main difficulty IMGs face is with CSA and the COT part of Work Place Based Assessment. IMGs are being taught consultation skills but are not being taught how to apply them. Unfortunately, there is a much higher failure rate amongst IMGs doing the CSA than those who graduated from the UK.
  • The other big problem is that most IMG's compared to those born in this country, are relatively socially AND physically isolated. This is made worse if they are on a scheme which is in a coastal town in the UK like Scarborough, Whitby and so on.

 

Some interesting points

  1. Female IMGs find it easier to adapt to the professional culture in the UK than men. This may be because women in other cultures may not have the same status and expectations as their male counterparts and are therefore more adaptable to the ‘ partnership’ approach that is expected UK doctors.
  2. IMG doctors may find it hard to admit their weaknesses, for example with language. An example was quoted where a doctor was unable to admit to the patient that his language was not always good enough and that he occasionally misunderstood things.
  3. IMGs learn a great deal from role-play. A technique that is widely thought to work well is one in which the trainee role-plays a scenario in which they believe that communication was difficult either based on personal experience or one that they know well enough to act out.
  4. Peer learning in half-day release, particularly where doctors at different stages of specialist training interact with each other, is another valuable approach.

 

 

A website you must look at

Yorkshire & Humber IMG Website (click to go there)

Don't forget to look at some of the other resources available specifically for IMGs as listed in the blue 'Downloads' box above.

 

'Britishness' and Linguistic Capital

Some trainees attend CSA courses and get told (in their feedback) that they need to be 'more British'. Personally, I think it's an awful phrase because

a) it is vague and therefore can mean different things to different people (e.g is spending two weeks in a European mass tourist holiday destination, getting suburnt, drinking too much, slurring unitelligable football chants and taking all sorts of risks with one's sexual health the essence of being British?.....or is it tut tutting at such behavior through the pages of a popular newspaper? - hopefully neither!)

b) It doesn't celebrate the cultural diversity inherent within our IMGs which we should be using and learning from. Actually, Damian Green (the UK's immigration officer) recently said that to be British is to be part of a ‘tolerant and mutually respectful society’.

c) It might give the impression to others that being 'British' implies a sense of a more superior culture, which is clearly not the intention (nor the reality) when trainees are being advised to be more 'British'.

 

 

I think what people mean when they advise their trainees that they need to be 'more British' is that they need to develop their linguistic capital. So let's go onto define what that exactly means.

 

Linguistic capital (Bourdieu, 1990) is defined as the mastery of and relation to language. And that doesn't just mean having a good vocabulary. Other than fluency, we are talking about the expertise and comfort with a language - idioms, turns of phrase and so on.

 

Trainees can expand their linguistic capital if they submerge themselves in British culture through watching soap operas, widening their social circle of friends and going out with English groups. The idea is that by being immersed in UK idioms, turns of phrase, meta-communication, tone of voice etc, one understands them better and might even start to use them. If you make no attempt to get a grasp of these things, they then remain culturally alien to you. This in turn will affect your learning, growth and thus other people's faith in you. Investing in linguistic capital is a long term endeavour and that the returns are seldom immediate.

 

By having good linguistic capital of a culture that is not part of your embodied* cultural capitol (i.e. from the country you were brough up in) can give you two good advantages in your host country:

a) it gives you a means of being able to communicate effectively with others (like patients)

b) it gives others some sort of faith, respect and reliance in you (it's like presenting yourself and showing that you've submerged yourself in your surrounding culture and have acquired a lot from it - and people respect you for that no matter what country you're in)

c) Linguistic capital thesis states that trainees who possess, or develop linguistic capital, thereby have access to better life chances.

 

Remember, linguistic capital can be acquired even in those who do not have ancestral precedents. For example, it is completely possible for a Tamil trainee who still lives with his Tamil speaking parents to acquire linguistic capital that is grounded in English.

 

* Embodied cultural capital = consists of both the consciously acquired and the passively "inherited" properties of one's self (with "inherit[ance]" here used not in the genetic sense but in the sense of receipt over time, usually from the family through socialisation, of culture and traditions). Cultural capital is not transmissible instantaneously like a gift or bequest; rather, it is acquired over time as it impresses itself upon one's habitus (character and way of thinking), which in turn becomes more attentive to or primed to receive similar influences.

 

Top Tips for improving your Linguistic Capital

* Start watch English TV Soaps

* Start making new friends - don't just stick with other people who are also IMGs (otherwise you may learn some grossly wrong habits). Try and make some English friends too. Go out for a coffee, beer, meal.... anything - just socialise!

* Try to start talking at home in English

 

Top tips for the CSA/COT

  • The problems with consulting skills seem to follow a similar pattern, with lack of listening particularly in the early part of the consultation and as a result, jumping to premature conclusions about the nature of the problem.
  • Nick Whelan has a useful analogy that ‘ you can’t cross the road from halfway across; to do it well or to survive the crossing, you have to get it right at the start’.

 

  • Going on a one off course is not necessarily going to make it all better for you - get out of this bad way of thinking. Targeted support for IMGs often deals with substantial issues like communication skills, which require at least a full day’s work. Half days are often not thought to allow sufficient time for deep learning to be supported. Even with full days, you must continue to PRACTISE those skills in your everyday working life. Try and view the courses you attend as platforms that allow you to move off to a higher level. Stop seeing them as quick fixes.

 

Tips for Trainers

  • Use the RDM-p framework to help 'diagnose' what the current difficulties are for your IMG trainee. RDM-p framework available here: RDM-p framework

 

Start any remediation work EARLY. If your trainee is at the ST1 stage - start and do it there! The earlier, the better. Don't just think someone else later on will pick it all up and fix it. You need to start that fixing process early, right now! (Likewise for Educational Supervisors who may notice 'things' whilst the trainee is in a hospital post). We have to act before trainees begin to fail and resources are wasted. Besides, we need to give the trainee the best opportunity for success and development.

 

  • It can be difficult to judge the extent to which to educate IMG’s separately from their UK trained peers.  There are potential risks of stigmatisation and emphasising differences that must be avoided.  The experience is that IMG’s appreciate the insight of educators into their difficulties and their support in overcoming specific challenges.  Peer education is a powerful, and finding opportunities for additional educational activities for doctors with a heavy service commitment can be challenging.