1. Implementing a programme for overseas doctors
Amelia Kehoe

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

3. 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

4. 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

5. 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?

6. Overview of research

7. 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 papers
From this 62 papers were included
A further 26 papers were added from secondary searches (total 88 papers)

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

9. 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
Steven Yull - Community perspective
Anne Lamb - Collieries, language and the Trust
Evaluation
Meal at Da Vinci’s, Yarm
Tour of the area
Personal Development Plans – Preston Park

10. 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)

11. Findings
INTERVENTION

13. “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)

15. “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)

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

18. “…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)

19. 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

20. 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

21. Thank you for listening!