Barriers to education of overseas doctors in paediatrics: a qualitative study in South Yorkshire

Abstract

Objective: To explore the factors that may influence the progress of doctors who come from the Indian subcontinent to train in paediatrics in the UK. Methods: Overseas doctors training in paediatrics in Rotherham, Sheffield and Doncaster participated in the study. Focus groups were used to collect data; two focus groups, each with 4-5 participants, were conducted at 6-week intervals. Semistructured, one-to-one interviews were conducted to add more understanding and depth to issues highlighted in the focus groups. The focus groups and interviews were audiotaped; the tapes were transcribed and data were analysed using the Grounded Theory; open codes were formed and concepts identified using microanalysis, and initial theories were built. Results: Lack of information about the National Health Service (NHS)/Royal Colleges, inappropriate communication skills, difficulties in team working, difficulties in preparing for Royal College examinations, visa and job hunting, and social and cultural isolation were identified as major barriers. Problems arose not only from difficulties with language but also from use of local and colloquial words, different accents and difficulty in communicating sensitive issues. Lack of understanding of role in teams and difficulties in working in multiprofessional setting all contributed to the problems. Cultural differences inside and outside the workplace, and social isolation were also highlighted. Induction programmes, mentoring, awareness of the issues within the teams, and courses in communication specifically directed at overseas doctors were identified as means to overcome these barriers. Conclusions: Several intercultural factors were identified that could act as barriers to the progress of overseas doctors training in paediatrics in the UK. Increased awareness of these factors within the teams would be the first step in resolving some of the issues.

Ways in which healthcare organisations can support overseas-qualified doctors in the UK

“…22 Differences in training cultures may lead to difficulties adapting to hierarchies and different relationships with teachers and seniors. 16,20,23 Difficulties may arise around the colloquial expressions used by patients 14,24,25 and jargon and abbreviations used in the clinical setting, 24,26 leading to confusion, misunderstandings and potential risks to patient safety. A relative lack of language skills may be interpreted as indicating a lack of medical knowledge and skills.…”

Cultural dimensions in the transition of overseas medical graduates to the UK workplace

“…The UK healthcare system is less hierarchical than many others, and overseas doctors can feel uncomfortable with challenging their supervisors (Hall et al 2004). Working within a multi-disciplinary team, an important feature in the NHS, is also a new way of working for many overseas doctors and can be a challenge to those from more hierarchical cultures (Kramer 2005;Mahajan & Stark 2007).…”

A Model for a Novel Communication Training Program Focused on Accent Modification for International Medical Professionals

“…The pronunciation and intonation patterns of these non-native speakers of English often interfere with their ability to make themselves completely understood (Hall, Keely, Dojeiji, Byszewski, & Marks, 2004;Mahajan & Stark, 2007). Furthermore, IMGs often lack an understanding of regional dialects, colloquialisms and cultural nuances of communication (Fiscella & Frankel, 2000;Kramer, 2006).…”

“…Mahajan et al (Mahajan & Stark, 2007) highlighted inappropriate communication skills as one of the barriers that influence the professional advancement of IMGs. Problems arise not only from difficulties with language but also from a difference in accents and lack of understanding of colloquial words (Fiscella & Frankel, 2000).…”

“…Some researchers (Hall et al, 2004;Mahajan & Stark, 2007) have pointed to the need for induction programs and communication training courses specifically directed at IMGs as means to overcome these barriers. Jain et al (Jain & Krieger, 2011) studied the communication strategies used by international medical graduates in intercultural medical encounters.…”