Helping International Medical Graduates to Success in the MRCGP Louise Remedios, GP Educational Fellow. Ameet Deshpande, IMG tutor. Michael Harris, Associate Postgraduate Dean all at Severn SoPC

What are IMGs? IMGs are nationals of countries outside the UK, EEA or Switzerland who graduated from a medical school outside the UK.

What's the problem? Pass rates for the 2008 Clinical Skills Assessment (CSA) component of the MRCGP: – UK graduates92% – EEA graduates72% – IMGs54%

Implications of low IMG pass rates Distress for those that fail Financial cost to trainees – £1,481 for CSA component Cost to the NHS – failing CSA may lead to a 4-month extension of the GPST's training.

What about the knowledge test? The pass rate for the Applied Knowledge Test (AKT) was higher for IMGs (71%) than for EEA candidates (65%) This suggests that lack of knowledge of primary care medicine is not the main cause of the low CSA pass rate for IMGs The CSA is a complex amalgamation of knowledge, clinical acumen, negotiation skills and non verbal communication; requires – highly advanced language skills, – a working understanding of British social culture, – good patient rapport; – IMGs may find these particularly challenging.

What does the research show? USA study of medical graduates from India: – less likely to consider patients as equals – had not been trained to talk patients through an examination – or to explain illness, medical procedures or prognosis to patients – knew less about the psychosocial aspects of illnesses – were less used to self-directed learning – grasp of English could be sub-optimal. The authors felt that it might benefit IMGs to have additional time in training so that they could build on their interpersonal skills in the office and hospital settings.

What does the research show? Australian systematic review – focused on the issues for clinicians who train international IMGs IMGs from Asia and the Middle East were particularly likely to – encounter difficulties adjusting to life in a Western culture; – have reactions to separation from extended family and friends Some IMGs had difficulty – coping with practising medicine in an English-language environment – adjusting to the Anglophone “medical culture”.

What does the research show? IMGs had to cope with – changes in self-esteem, – differences in learning styles, – new patterns of disease, – communication issues, – learning about the health systems to which they were attached. The review suggested that: – clinicians responsible for supporting and training IMGs need a thorough understanding of the range of communication issues confronting IMGs; – medical teachers themselves needed specific skills training in this area.

What were our own findings? Key areas identified included: – language issues – lack of knowledge of the NHS and UK systems – different attitudes to learning – different relationship with patients – a possible wider variation in core cognitive ability.

What else did we find? Half-day release course sessions: – IMGs had a low attendance rate Residential courses: – important forums for discussion and building of social and study groups – but IMGs were less likely to view the residential courses as being useful – particularly so if they perceived that the main aims of the course were socializing and cultural activities.

What are the challenges in helping IMGs? We decided to run a monthly group for IMGs – however, attendance was very poor; – lack of interest in extra training on the part of some of those that need it most; – risk of perception of ghettoizing.

How can IMGs be incentivised to engage? Is there a place for compulsion? – or for linking attendance at special training sessions to the MRCGP portfolio? What are effective ways of deploying the skills of – GP educators with IMG backgrounds, or – recent IMG trainees – to help IMG candidates improve their success rates? Can focussed attention on the problem can result in a significant increase in MRCGP pass rates?

Discussion points What is your experience of the high points and challenges of helping IMGs? What can we do to help? –in hospital? –in General Practice? Remedios L, Deshpande A, Harris M. (2010) Helping international medical graduates (IMGs) to success in the nMRCGP. Education for Primary Care, 21(3),