‘IMG: A personal perspective’: Poole, 9 J an 2014

1. ‘IMG: A personal perspective’: Poole, 9 Jan 2014 Dilsher Singh First 5 GP Birmingham

2. Personal Journey

9. Common phrases • Spend a penny • Water works • Sample of water • Feeling under the weather • Suffering from pins and needles • Problems with back passage • X ray and blood test are ‘requested’ not ‘ordered’

12. CSA failure rates : Country of Graduation

13. UK Graduates – Fail rates AKT CSA British White: 4.6% British Asian: 16.3% • British White : 5.2 % • British Asian: 17.7%

14. Communicative Tolerance

15. Communicative Flexibility • All clinicians have to be Communicatively flexible • Local clinicians have to adapt their talk to a diverse patient population • IMG’s have to adapt their language skills and cultural understanding to a range of British consultations. • Mixed study groups maybe the way forward …

16. The way of Talk: • Conversalisation: eg metaphor : imagining and articulating the patient's thoughts back to them • Metacommunicating: sharing own thoughts with patients • Relativisation: relating/ connecting different parts of explanation • Thematisation: The way ideas are put forward and certain items selected for emphasis • Temporal logical sequencing

17. Why are the best clinical minds from abroad struggling • Is it: • Cultural ? • Language ? • Knowledge ? • Lack of Self- Esteem ? • Or • Something else?

18. Difference in approach: • Different educational training: Doctors are taught to treat symptoms without emphasis on patient's social life • Difference in technique to approach the patient • Difference in patient expectations: patient allow doctors to lead management plans. • The above issues need to be tackled: • By the Trainee themselves • By the Trainers: who can help provide resources to bridge the GAP

19. The start of my CSA Journey • Started with First IMG conference in Midlands • Gained insight into my consultation model • My consultation model: Long sentences – extended explanations • Identified common problem patterns in failing candidates • Learnt about strength of equal mix of study partners • Identified importance of work based assessments towards exam success

20. The preparation • Identified common recommended books • Accumulated study material from colleagues • Started CSA practice from second week in GPST3 • Developed regular Practice study schedule • Identified and attended CSA courses • Started Joint surgeries with trainer • Organised Video consultations • Practiced changing my consultations: one step at a time

21. CSA Journey - Barriers • Cultural • Knowledge • Experience • Technique / Approach • Language

22. CSA Exam • First experience : Feb 2013

25. Analysis • 13: Poor active listening skills, use of verbal/ nonverbal cues • 2: Does not recognise the priorities in the consultation • 4: Does not recognise abnormal findings and implications • 12:Does not explore patient's agenda , health beliefs

26. Reflections & Analysis • Had high number of ethnic patient consultations • Had very few video consultations • Had been practicing in only one group • Feedback from colleagues was very supportive • Concentrated more on my stronger areas of curriculum • Fear Factor: performance on the day suboptimal • Due to fear factor reverted back to my old consultation style

27. Solutions: • Increased the number of English speaking patients in clinics • For 6 weeks videoed every possible patient encounter • Reviewed my videos with trainer • Then reviewed with peers and myself • Watched each video 3 times • Learnt the use of succinct sentences to manage consultations • Aimed to explain the diagnosis in 2 lines only: using lay members of my family • Practiced with various other CSA groups • Developed a plan to manage uncertainty

28. Solutions: Continued.. • Feedback was constructive and brutal • Every new feedback was experimented immediately • Created style of statements that I could relate to • Developed sense of inquisitiveness about the patient: the impact of illness on their social life • Learnt to acknowledge cues • History: Red flags, ICE, Psychosocial(work/home/social/alcohol/ drugs), Why today • Learnt to critic the information presented: as has to have a reason • Use of play cards: to emphasise on one aspect of consultation at a time

29. CSA Exam • Second attempt: May 2013

32. Summary • The International graduates need to understand their strengths • They need to identify their area of weaknesses • Active Listening skills need to be developed using echoeing and reflection • Trainees need Constructive & Honest feedback from trainers. • Trainees need to have mixed study Groups • Trainers/ colleagues could help international graduates to integrate into the local society

33. Suggestion • Trainers to identify and signpost resources to trainees to bridge the GAP • Trainees need to spend time on analysis of their Video consultations- at least 3 times per video • Trainees need to avoid rapid topic shifts rather than topic gliding • Trainees should aim to have joint surgeries with their trainers • Improve their consultations one step at a time- by use of cards method • Trainees/ Trainers need to actively analyse MSF feedback • Trainees need to avoid ‘Over-modeling’: Avoid phrases that don’t sound convincing.