1. Supporting Doctors from Different Backgrounds
Dr Julia Whiteman
Dean of Postgraduate Medicine
North West London

2. Supporting safe transition for internationally educated health professionals (IEHP) working in the NHS in London

3. Challenges:
Enabling the rich diversity of backgrounds of doctors and other health professionals to deliver high quality health care……
…..in a rich diversity of settings
Cultural awareness including professional culture
Colleagues appreciating cultural differences
Clinical experience and capability
Understanding of the complexity of the NHS
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4. Challenges: Communication
Appreciation of communication complexities
Linguistic and language
Non-verbal communication
Norms may be both explicit (stated rules) or implicit
(‘that’s just what we do’)
NB GMP include both
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5. Process of Communication
Sender and receiver each have their own norms.
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6. Intent and effect may differ
Intent may be misread – notably when non-native speakers
transfer patterns of interaction from first language
Source of ‘interference’ may not be recognised
Causes of breakdown may be complex:
Language
Non-verbal behaviour
Cultural values
Concepts of professionalism
Ethnocentric position – reasons may be generalised –attributed
to ‘language barrier’, attitude, lack of competence
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7. Sociolinguistic aspects
Informed by culture – deviation from norm may be more harshly judged than language errors (Wolfson 2002)
Para-linguistic: pace, volume of speech, ‘noises’
Extra-linguistic: body language, personal space, gesture, touch
Interactional style: formality, directness, content (extent and perceived relevance) structure or lack of
Conversational norms: turn-taking, interruption, use of silence
Wolfson N. Rules of speaking. In: Richards JC and Schmidt RW, eds. Language and
Communication. Harlow, Essex: Addison Wesley Longman 1983:61–87
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8. Influence of Culture Cultural values
Usually acquired through early socialisation
Deeply held and often out of awareness
Resistant to change (Hall 1997)
Inform behaviour and expectations of others
Determine what is considered polite, friendly, humorous, taboo, empathetic etc in communication
Hall, Edward T. Beyond Culture, Anchor Books 1997
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9. Approaches to support
 Develop a repertoire of approaches:
Recognise differences in learning needs in UK graduates
Teach communication in context
Not just ‘how’ and ‘what’ – emphasise / explore the ‘why’
Involve professionals from a variety of backgrounds
Soaps
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10. The challenge for educators
Recognise that this is difficult
Seek supervision support and development – including E&D
Reflect on own assumptions
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11. Encourage trainees from different backgrounds to:
Become familiar with professional expectations of performance
Recognise the implicit cultural values underpinning this – and
how they may differ from own
Understand the form and style of communication expected in a
given situation  
Consciously decode and reflect on a ranges of written and verbal interactions: the good and the less good
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12. Other enablers Flexing induction programmes to meet need
Managing expectations on both sides
Social integration
Allow time - acquiring new skills may require ‘unlearning’ of old patterns

13. Further support London Professional Support Unit
Internationally Educated Health Professionals
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