Implementing a programme for overseas doctors Amelia Kehoe Email: amelia.kehoe@durham.ac.uk Twitter: @mildredkehoe

Overview What is the problem? Aim of research Literature review Realist evaluation Findings Programme for Overseas Doctors Conclusion and recommendations

What is the problem? NHS relies on overseas qualified doctors (41.5%) Concern has grown around regulation and practice e.g. high rates of failure, over-represented in General Medical Council (GMC) fitness to practice (5 x more likely to be ‘struck off’) The area is underdeveloped. Interventions implemented without sufficient consideration of what is likely to work or how much training is appropriate (e.g. GMC regional induction) Outcomes of not having sufficient interventions in place? PATIENT SAFETY! spoke to someone who said they had wanted to send omg home as no good. Asked if inducted? No just put straight in. So not their ability, but not enough inf and support to enablee them to work properly

spoke to someone who said they had wanted to send omg home as no good spoke to someone who said they had wanted to send omg home as no good. Asked if inducted? No just put straight in. So not their ability, but not enough inf and support to enablee them to work properly

Aim of research To understand how interventions, set up to support overseas medical graduates, support them in making a successful transition to the UK workplace What interventions and services are provided to support the transition of overseas medical graduates to the workplace? How and why are these interventions effective? What factors are vital to the success of interventions? What barriers may hinder transition? How can interventions be developed and improved for future implementation?

Overview of research

Literature review: realist synthesis A realist approach has greater explanatory power Explains why interventions work and what would make them work in another context Realist approach asks about the context that influences the intervention success (or not) Literature search identified 4124 papers From this 62 papers were included A further 26 papers were added from secondary searches (total 88 papers)

Model explaining how interventions work Kehoe et al., (2016). Supporting international medical graduates’ transition to their host-country: realist synthesis. Medical Education.

Programme for Overseas Doctors (POD) July 2014 Monday 22 July Tuesday 23 July Wednesday 24 July Thursday 25 July Friday 26 July 9am   Introduction 10am Research Team 11am Tour of the Hospital / Quiz REACHE Communication skills History Taking, etc Clinical Governance Cultural Diversity Session Hard Day’s Night L U N C H 1pm – 2pm F1 teaching session 2pm Structure of the NHS / Hierarchy / team working (P4P) A patients journey / Social Services 1pm Summarisation Handover SBAR 7pm Bowling at Hollywood Bowl, Teesside Park Trust Cultural Diversity Session - 1-2 Edwin Thorman - Jehovah’s Witness 2-3 Lynn Purvis - Chaplain 3-4 Ian Snaith - Prison Service 4-4.30 Steven Yull - Community perspective 4.30-5 Anne Lamb - Collieries, language and the Trust Evaluation Meal at Da Vinci’s, Yarm Tour of the area Personal Development Plans – Preston Park

Realist evaluation Primary data collection (across 2 years): Comparative case studies (intervention Vs non-intervention) Discussions with key stakeholders (Directors of Medical Education, Postgraduate Dean, Intervention Leads, policy makers) Researcher observation Interviews (n=123) - overseas medical graduates, supervisors, ‘buddies’, intervention ‘experts’ Pre and post intervention questionnaires Educational Governance data e.g. Serious Untoward Incidents/complaints, retention and career outcomes Analysis: Realist approach (using framework analysis)

Findings INTERVENTION

“I had no UK experience, none of the consultants knew, and none of the other colleagues knew. So, I was given the on-call bleep on the first day. I had no clue whatsoever, and there were like eight patients to clerk.” (non-intervention, overseas medical graduate)

“So, after four months, someone told me oh I'm your clinical supervisor, do you know that? I'm not sure what clinical supervisor means. So I wasn’t aware of that, what the clinical supervisor actually does.” (non-intervention, overseas medical graduate)

“Such a huge support to me personally, always has an encouraging word (intervention, overseas medical graduate)

“…they were all angry with me because I didn’t know how to, because I was asking questions from everyone, even the nursing staff, and they were laughing at me.” (intervention, overseas medical graduate)

Developed intervention - POD Increased cultural awareness within organisation Better recruitment process – improved links with HR/supervisors 4 day programme, spread across 4 weeks (GMC sessions included) Each session repeated Use of internal staff & resources Individual needs assessment (OSCE style assessment) A buddying system (using previous programme attendees) Trust doctor tutor to support trust doctors Trust doctor database Enhanced supervision training Increased awareness of intervention both inside and outside of organisation

Conclusions & recommendations Contextual factors must be considered when implementing interventions for overseas medical graduates The developed programme theory highlights the need to address organisational, training and individual factors to ensure intervention success Establishing ongoing support is critical to adjustment – impacting on both performance and retention Regulators need to assess their current guidance in ensuring necessary support is in place for overseas doctors – regionally/locally The developed Programme for Overseas Doctors at North Tees should be used as an example to guide the implementation of interventions at a local level to improve the development and transition of overseas medical graduates

Thank you for listening! amelia.kehoe@durham.ac.uk