Beyond Medical Practice: Cultural and Linguistic Training of Refugee Doctors for Integration and Employment in the UK Khetam Al Sharou khetam.sharou.14@ucl.ac.uk Ceri Butler ceri.butler@ucl.ac.uk Centre for Translation Studies (CenTraS) Research Department of Primary Care & Population Health

Overview Who is a ‘Refugee’ Doctor? The Context Pathway to Employment Barriers to Employment Beyond Medical Practice Looking Forward

Who is a Refugee Doctor? An individual who has been recognised by the UK Home Office as entitled to leave to remain as a refugee or other individual fleeing persecution Has their original medical qualification in a country outside the UK who seeks to return to medicine How many refugee doctors are there? BMA: c.2000 c.900 in London of which 300 working (Butler & Eversley, 2007)

The Context…

…is highly politicised

Immigration & Asylum UK has long history as country of refuge Prevailing discourses that define who is ‘deserving’ or ‘undeserving’ Reinforced by bureaucratic labelling as ‘refugee’ or ‘migrant’ (Zetter, 1997, 2001) Studies and the media frame migrants as: Victims of inequality/discrimination; in need of support Villians of threats to jobs and security Benefit of (real of potential) contribution to society (Crawley et al, 2016) The UK has long been a country of refuge for individuals fleeing persecution and conflict. Some of these have been medically qualified doctors who have needed assistance to return to clinical practice. These doctors often have extensive clinical experiences but face linguistic and cultural challenges when seeking to work in the UK.

NHS Workforce UK NHS has history of reliance on internationally trained health professionals to fill (severe) shortages 69% of UK trusts are actively recruiting abroad 24k (9%) nursing vacancies 6k (7%) doctor vacancies International medical workforce: In 2016, 26% of all doctors qualified outside UK/EEA; 11% from the EEA (22% of nurses)

International Workforce

Pathway to Employment Acceptable primary medical qualification Knowledge of English (IELTS/OET) Professional and Linguistic Assessment Board (PLAB) set to reflect knowledge/skills end FY1 Clinical Observership

Difficulties in employment GMC’s State of Medical Education and Practice (2011) summarised the general ‘difficulties’ faced by non-UK qualified doctors when they start as: Unfamiliarity with UK systems (Slowther et al, 2009/2012) Communication and cultural issues (Illing et al 2009) Proficiency in English language Recurring themes: how can we plug these gap? English language (via IELTS) is a huge barrier BUT…it is a necessary but not sufficient requirement for health professionals ‘Medicine is medicine’ but gap exists in understanding of key terms and concepts, the system & cultural adaptation required How can we plug that gap?

Beyond Medical Practice UCL Grand Challenges cross-disciplinary doctoral project Project aims to improve the linguistic and cultural communication skills of refugee doctors through training in: key terms and cultural communication skills required in medical training and consultations the culture of UK medical practice and NHS

Methods 10 refugees with non-UK primary medical qualification September 2017 – June 2018 6 training sessions in small groups using discussions and role play and covers: UK medico-legal framework, medical ethics, professionalism, patient centred care & medical English. Drawing on UCL MBBS & PGME teaching

Outcomes Preliminary results indicate that participants have: increased confidence increased use and familiarity of a range of key terms of phrases used in UK medical training and practice a greater understanding of the prevailing medical culture in the NHS Benefit from ability to voice concerns and feel a part of a group. But… they need and want more dedicated support.

Conclusions & Looking Forward Refugee doctors have skills to benefit the UK NHS but their ability to return to practice is affected by the lack of familiarity with medical English, verbal cues and knowledge of the NHS Beyond Medical Practice has the potential to plug gaps in existing provision for refugee doctors The topics covered in this project form part of the undergraduate medical/nursing/dental curricula UK Universities can draw on their undergraduate curricula and offer training to refugee doctors.

References Butler C and Eversley J (2007) Guiding their way: assisting refugee health professionals The Clinical Teacher: 4 pp 146-152. Blackwell Publishing. Crawley H, McMahon S, Jones, K (2016) Victims & Villains. Migrant Voices in the British Media. Coventry: Centre for Trust, Peace and Social Relations, Coventry University. General Medical Council (2011) The State of Medical Education and Practice. GMC Illing, J et al (2009). The experiences of UK, EU and non-EU medical graduates making the transition to the UK workplace. Final report to the Economic and Social Research Council

Slowther A et al (2009) Non UK qualified doctors and Good Medical Practice: the experience of working within a different professional framework. Report for the General Medical Council. University of Warwick Zetter R (1991) Labelling Refugees: Forming and Transforming a Bureaucratic Identity. Journal of Refugee Studies. Vol 4. No 1