Unconscious bias must be tackled to reduce worry about overseas trained doctors, says BAPIO

Abstract

Doctors trained overseas are more likely to be assessed by the GMC than UK trained doctors, but BAPIO says that unconscious bias could be key to explaining this difference. Abi Rimmer reports

Collaborative healthcare education programmes for continuing professional education in low and middle-income countries: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 65

“…Educational resources and care models developed in HICs may lack relevance in LMICs as they focus on HIC pathology and treatment approaches (Ndura 2004;Aarabi et al 2015;Carter et al 2016), which may explain why most interventions in the studies were developed specifically for the LMIC. Unconscious bias within individuals (Hall et al 2015;Fitzgerald and Hurst 2017;Rimmer 2017) and institutions (Pritlove et al 2019), combined with not understanding that LMIC learners may lack expected knowledge and skills due to an absence of facilities and opportunities (Ventres and Wilson 2015), may also limit LMIC learners to observerships in HIC clinical areas. Whilst several of the studies reviewed provided learning opportunities for LMIC staff in the HIC partner country, only three enabled them to participate more fully in clinical practice (Gunathilake et al 2009;Blignault et al 2010Blignault et al , 2012, with the first study involving a clinical placement for participating doctors in the UK National Health Service.…”

Country of qualification is linked to doctors’ General Medical Council performance assessment rate, but is it linked to their clinical competence?

“…Using qualitative research approaches, explanations should examine the frequently-repeated concerns that unconscious bias “prevalent through much of the NHS,” leading to “disparate treatment of international medical graduates,” may have contributed to differential PA referral rates [ 6 ].…”

“…The publication of Mehdizadeh et al’s data caused understandable dismay among graduates of countries with high IRRs. Within two weeks of the paper’s online publication, a news report appeared in the BMJ [ 6 ] in which the president of the British Association of Physicians of Indian Origin (BAPIO) was quoted as saying that the paper was “useless really, it doesn’t mean anything…it is retrospective.” The president also asserted, “it doesn’t say anything about the competence of these doctors.” In a sense, this is correct, as the outcome of the PA was not considered, only the PA referral; however, there must be serious concerns about a doctor’s competence for a referral to have been made.…”

A comparison of patient appraisal of professional skills for GPs in training participating in differing education programs

“…Internationally, there is increasing awareness that policies and strategies for increasing the number of international medical graduates (IMGs) and overseas trained doctors (OTDs, a term used to describe doctors who obtained their primary medical qualification in a country apart from Australia and New Zealand) in overburdened healthcare systems need to focus on enhancing pathways to allow such doctors to be registered and credentialed, so that they can practice effectively in their newly adopted country. Three policy issues under current debate include historical bias in the registration process, making it more difficult for IMGs and OTDs to qualify than locally trained doctors [4,5]; increased risk of complaints against IMGs and OTDs [6] should pathways be eased; and racism and bias against IMGs and OTDs at both systemic and individual levels [7]. There is also a perception that increased risk of complaints may be due not to lack of clinical skills but of professional or 'soft skills' , such as interpersonal communication skills and empathy, where different cultural backgrounds can lead to different use of language and interactions with patients [5].…”

“…Three policy issues under current debate include historical bias in the registration process, making it more difficult for IMGs and OTDs to qualify than locally trained doctors [4,5]; increased risk of complaints against IMGs and OTDs [6] should pathways be eased; and racism and bias against IMGs and OTDs at both systemic and individual levels [7]. There is also a perception that increased risk of complaints may be due not to lack of clinical skills but of professional or 'soft skills' , such as interpersonal communication skills and empathy, where different cultural backgrounds can lead to different use of language and interactions with patients [5].…”