How do international medical graduates and colleagues perceive and deal with difficulties in everyday collaboration? A qualitative study

Abstract

Aim: Many medical doctors work outside their countries of origin. Consequently, language barriers and cultural differences may result in miscommunication and tension in the workplace, leading to poor performance and quality of treatment, affecting patient safety. However, there is little information about how foreign doctors and their colleagues perceive their collaboration and handle situations that can affect the quality of health services.Methods: Individual, semi-structured in-depth interviews were conducted with two groups of informants 16 doctors who had recently started working in Norway, and 12 unrelated Norwegianborn healthcare providers who had extensive experience working with doctors from foreign countries. Interviews were analysed according to the systematic text condensation method.Results: The foreign doctors described themselves as newcomers and found it difficult to speak with colleagues about their shortcomings, as they wanted to be viewed as competent. The Norwegian colleagues reported that many new foreign doctors had demanding work schedules; therefore, they were reluctant to give them negative feedback. They also feared that foreign doctors would react negatively to criticism. All participants, both the new foreign doctors and colleagues, reported that they took responsibility for the prevention of misunderstandings and errors; nevertheless, they struggled to discuss such issues with each other. Conclusions:Silence was the coping strategy adopted by foreign doctors and native healthcare professionals when facing difficulties in their working relationships. In such situations, many foreign doctors are socialised into a new workplace in which uncertainty and shortcomings are not openly discussed. Effective leadership and procedures to facilitate communication may alleviate this area of concern.

Internationally educated nurses’ and medical graduates’ experiences of getting a license and practicing in Sweden – a qualitative interview study

“…An integrated review [ 23 ] found that, because of language difficulties, IENs experienced feelings of deprecation and low self-esteem. In the present study, both IENs and IMGs described how lack of language skills hindered interaction with colleagues and patients, which has also been reported by others [ 23 , 43 ]. This may be an even greater problem when learning a completely new language like Swedish as compared to English, which many people learn during school.…”

“…A Norwegian study [ 43 ] found that IMGs were reluctant to ask colleagues for support because they wanted to be seen as competent. The problem of lacking knowledge while needing to maintain one’s image at work may be problematic.…”

The possible impact of vulnerability on clinical communication: Some reflections and a call for empirical studies

“…Medical culture in the scientific era may have developed an unhealthy aim of eliminating uncertainty (28). If staying in control is the overarching paradigm of the working climate you are part of, loss of control means loss of confidence from peers and represents a major threat to your position and sometimes identity (17,27,29). It probably takes repeated unpleasant emotional experiences before many physicians are able to recognize and acknowledge their own vulnerability.…”

“…As clinicians consider themselves helpers, with good intentions, patient reactions in this vein might not be understood: "why would people withdraw or become angry when I am here to help?" Of note, such reactions may also occur in collaboration between physicians, if their competency seems to be questioned (17).…”

Migrant physicians’ entrance and advancement in the Swedish medical labour market: a cross-sectional study

“…Empirical investigations on MPs often focus on their arrival and the early stages of recertification processes [1, 9], on educational interventions [1, 10] or on challenges, barriers and facilitating factors for workplace integration, i.e. when MPs have found employment [1, 9–14].…”