The universal GP Training website for everyone, not just Bradford.   Created in 2002 by Dr Ramesh Mehay

Helping Trainers Help IMGs

making truly transformative changes...

A Workshop for GP Trainers
by Dr Ramesh Mehay

If you want to succeed at anything, surely you need to know the end goal – the destination.  Right?  Even Stephen Covey (7 Habits of Highly Effective People) said it  – it’s habit number 2 –“begin with the end in mind”.     You’re on the road to nowhere if you don’t have a destination. The ancient philosopher Seneca (49-62AD) said: “Let all your efforts be directed to something, let it keep that end in view“.    

Perhaps you’re thinking: “yeah, that nothing new, and it’s not exactly rocket science”, but let me ask you this.  Is it always true?  If your answer is yes, then I have another question for you.   If it’s so obvious, then why is it that many of us struggle to get to the destination even when we have previously defined it? 

Now, I am not saying that “beginning with the end in mind” is bad.   A fixed finishing point helps us define a pathway to try and get there.  Having a fixed point also helps us stop and reflect and see how we are progressing towards it.  We can see if we are doing good or veering off at a tangent.      This in itself can help fine-tune and orientate our actions and efforts in the present moment.  

But one of the problems with the “end in mind” approach is that this end can persistently hijack our attention.  It results in us constantly having a  future focus.   And when problems arise (as they inevitably do), we continue to be future-directed rather than the more meaningful act of stopping and staying in the ‘here and now’.    Fixing an endpoint and working along a concrete path towards it is restricting.   It puts pressure on the project-people to only move that way, and it does not allow for the flexibility needed in the complex process of making sense of a people’s thoughts, experiences, and learning.  

But those who embrace the natural pauses to reflect will often receive new enlightenment, such as the realisation that an alternative path is more optimal than the one you are on.  And often, there are several routes – some more colourful than others.  BUT, if you continue to put the blinkers on and fast-forward through these natural learning moments, you continue on the suboptimal path, which requires a lot of time and effort and sucks the enthusiasm out of you. On the other hand, allowing more freedom is less pressurising, more enjoyable, more flexible as blind spots are uncovered, and you step into that beautifully enriching transformation territory. 

So how does this apply to training IMGs? 

We are often consumed by the end goal, which hijacks us and prevents us from truly hitting our trainees’ natural transformative points of influence.  Yes, you have to have an end goal – (like helping them get through all the MRCGP requirements, e.g. AKT, RCA/CSA, ePortolfio, WPBA etc.), but what I am saying is not to forget the journey!  When there are natural moments of “new enlightenment” – remember to stop, pause, explore, and understand before carrying on.  You still get to the end – but you also get to make transformative educational changes along the way.   And you both learn during the process.

In this session, we will explore some of the things you can do to become a transformative teacher as well as helping IMGs to “jump through the hoops”.  We will also explore culture and diversity, compare it with your current worldview and see how it differs   Come and join me and let’s simply explore.

SECTION 1: Where are you at?

Exercise 1 - Poll of IMG experience

Let’s see how many of you have had IMG experience and what it was like.

Exercise 2 - Poll (Barack Obama)

What does this quiz demonstrate?
What was the purpose of me asking you to do it?

Exercise 3 - Flashcards

Many of the descriptions on the cards could be applicants for GP training, GP trainees or even trainers themselves.


  • Turn the cards over one at a time, do not look at them in advance
  • Respond with the FIRST thing that comes into your head – share with  group.
  • Group to discuss and perhaps challenge each other; not get into cosy agreement
  • You don’t have to get through all the cards 
  • 20 minutes, then we re-group and form another group.

Woman with short hair wearing Doc Martens

Asian man with a bushy black beard

Well groomed softly spoken young man 

Woman carrying the Guardian

Asian man, fashionably dressed, with gold rings and state-of-the-art mobile phone

Young woman with tattoo visible creeping up her neck and also on forearms

Black man with a very strong Nigerian accent,  speaks loudly on the bus into his mobile phone.

Person whose mobile phone rings and he answers it during your consultation with them.

Woman with strong accent and a lot of make up

60y old woman dressed elegantly with a small gold cross on a very fine gold chain.

SECTION 2: How is it for them? (IMGs)

Exercise 4 - Read this account

SECTION 3: Getting the start write

Exercise 5: It starts with names

Split these names up…



  • Genuine interest
  • Genuine desire to want to help
  • And you can’t go wrong. 
  • Great relationship = lots of cotton balls of forgiveness.
  • Opportunity to make mistakes and GROW.
  • Cultural Competence
Exercise 6: Change your name
  • Getting a trainee’s name wrong can be a pervasive irritant.  So, get things rigth from the start.   It shouldn’t be that hard – just ask the trainee.  Slow down, until you get it right.
  • Grab a partner.   Each of you creates a name badge for the other.  Change one of the vowels OR order of words.   So, Brian might become Biaran.   
  • For rest of the morning, in breaks and things, we refer to each other by these new names.   
  • Funny?  Annoying?  We shall see….  (PS This is not permission to physically hurt each other)
  • Quick noteL Forms of address may cause discomfort (on both sides).  Boss (Nigerians).   Dr Mehay vs Ram.
Exercise 5: The Learning Environment - Honesty, Openness & Trust

How can you do this in your practice?
Think from before the trainee joins your practice to after they leave.
So think in terms of pre-beginning, beginning, middle, end, post-end

Quick Note:

  • IMGs come from more hierarchical medical culture.  How to reset?
  • Cultural learning should be 2 way (all staff are ambassadors of our culture)
  • Self assess on competencies early, and understand what they mean
Exercise 6 - Getting to know each other through Timelines (PAIRS)
Exercise 7 - Getting to know each other through Personal Shields (PAIRS)

Social skills, blending in with Ireland
Meal, Tour, Cafes

SECTION 3: The Meatier Stuff

Exercise 8 - Revisiting Basics

What sorts of things might you go back with basics for?


Communication Skills is biggest issue by miles!

Underlies many of the other problem areas


Linguisitics – move away from King’s English

Linguistic Capital


Non verbal & para verbal (e g intonation) skills also important



Learning stock phrases

Useful initially

But need to move away

Tutorials on

  • Sex
  • LGBTQIA+ (including attitudes)
  • Dying
  • Mental Health – psych stigmatised in some cultures, relucance to explore
  • Humour
  • Attitudes to Abortion

Language and culture interlinked but useful to consider separately

ICE is not cultural

PSO – fee paying health service in home country may make Dr reluctant to waste patient’s time discussing psychosocial stuff

Not true that IMGs don’t understand a holistic approach – but theirs is in different social context (extended family system)

Biomedical -> holistic shift also experienced by UK trained docs moving from hosp to GP

Teach the to be curious about patients’ lives, ask about them in consultation


– medical conditions

-their thoughts

– their plansBlack and white feedback



  • Get involved in informal aspects of practice life
  • Watch TV soaps with local accent (Emmerdale, The Dry), read newspapers
  • Get involved with English social groups
  • Try to speak English at home


Incidence of different conditions in different countries, eg fever in tropics and in UK)

Cultural communication factors may create clinical management problems if sensitive issues need to be discussed (esp male Dr and female pt)

Medical Complexity – not used to comorbidities in elderly

Health Prevention/Promotion done by others in their home country.  But here, part of being a GP.


‘unprofessional’ behaviour can reflect lack of familiarity with current UK professional codes and the values underlying them

Differering codes between countries like “Duties of the doctor”

Lots of tutorials/mini discussions of ethical/professional probs encountered daily working life.


Teachable moments – natural occurence of descrepancy


Student-teacher relationship differs between cultures.  Teachers should be respected unconditionally and not challenged differs between cultures.  

Concept of self directed learning AND skills needed for it may be unfamiliar.  Spoonfed medical school.

Remind they are GPs,

…not hospital doctors.
…not medical students.
…not just about the medicine (there is an art too).
…common things are common.
…live with uncertainty.

Exercise 9 - Consultation Skills: CSA cases for DG, CM and IP

Practising CSA cases, even though the CSA fails to exist, should not be forgotten.   Don’t throw out the baby with the bathwater.  Use the cases to help your trainee.   Work on all domains. 

  • You the patient.  Them the doctor. 
  • Sometimes switch roles to demonstrate what that it is doable.
  • Replay segments.
  • Work on pronunciation
Exercise 10 - Resources to help you

Communication Skills Books

  1. How many of you use one to teach?  
  2. How many trainees read one?
  3. Which one?  Favourites?

Ram’s shortest communication skills handbook ever with a new SIMPLE easy to remember 4 tasks model.  (Coming within next 2 weeks)

MAD – Medical Analogies Database  (EXPLANATIONS)

The MAD is the Medical Analogies Database that I developed a couple of years ago.  Patients understand medical things so much better when referenced to an everyday analogy they are familiar with.   For example, comparing Hypertension to the plumbing in a central heating system.  Too high and the boiler (in your case, your heart) gets damaged.     You can help your IMG trainee to explain things better if they start using analogies than direct medical explanations.  

  • Have a read through some of the explanations. 
  • What do you think of them?  They are not all perfect.   But they provide a starting point.
  • Remember the KISS principle – Keep It Simple.
  • If you have just had a thought for another or one that you like to use often, please post it in the comments section on that page. 

 Don’t forget COTs and CBDs

  • Yes… CBDs too 
  • Get them to talk about what they are doing communication skills wise.
  • This helps them to understand the intelligence behind their communication skills.  The theory.   The META-communication

Colloquial English

Exercise 11 - Sit and Swap Surgeries (TRIOs)

Sit and Swaps are powerful.  How often do you do them?  
Not only do you observe them and give real-time feedback while the hot potato is hot, but for the next patient you can role model behaviour and demonstrate.
Let the patient know it is a teaching session so they don’t think you’re being a poo to your trainee. 
Work on pronunciation


KEYNOTE: Other consultation methods…

  • Get them to self assess on competencies early, and understand what they mean
  • Demonstrative vids on youtube
  • Observe experienced colleagues’ consultations, FREQUENTLY
Exercise 11 - My top tops

PPT slide


10 Key Points

1. Helping IMGs starts with us, not them
2. Respect them – don’t see them as a problem.
Understand and embrace diversity POSITIVELY.
3. Engage in natural conversation, which results in dual disclosure
4. Stop and Explore natural moments of discrepancy
5. Make feedback black or white. Also more than UK for confidence boosting and encouragement
6. Practise, practise and practice some more
7. Encourage, Motivate & Inspire
8. Some Don'ts… jokes, slang, long-windedness, stereotype
09. It's all about relationships
10. IMGs in difficulty may need multifaceted support (trainer, ES, TPD).
Final note...

Remember at all times the trainee has talents. 

A more diverse workforce will have access to the broadest range of talent in the workplace and thus often opening up new markets.

I honestly believe that.  I hope I have convinced you of that too (even just a little…).

Use natural moments to transform ideas and visions.


Geert Hofstede's work on cultural dimensions. (click on this grey box)

Kate Fox Book called "Watching the English."

Bradford VTS Pages on IMGs (click on this grey box)

Bradford VTS Pages on Ethinicity, Race & Culture (click on this grey box)

Bradford VTS Pages on Equality & Diversity (click on this grey box)

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Bradford VTS was created by Dr. Ramesh Mehay, a Programme Director for Bradford GP Training Scheme back in 2001. Over the years, it has seen many permutations.  At the time, there were very few resources for GP trainees and their trainers so Bradford decided to create one FOR EVERYONE. 

So, we see Bradford VTS as  the INDEPENDENT vocational training scheme website providing a wealth of free medical resources for GP trainees, their trainers and TPDs everywhere and anywhere.  We also welcome other health professionals – as we know the site is used by both those qualified and in training – such as Associate Physicians, ANPs, Medical & Nursing Students. 

Our fundamental belief is to openly and freely share knowledge to help learn and develop with each other.  Feel free to use the information – as long as it is not for a commercial purpose.   

We have a wealth of downloadable resources and we also welcome copyright-free educational material from all our users to help build our rich resource (send to

Our sections on (medical) COMMUNICATION SKILLS and (medical) TEACHING & LEARNING are perhaps the best and most comprehensive on the world wide web (see white-on-black menu header section on the homepage).