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‘IMG: A personal perspective’: Poole, 9 J an 2014 . Dilsher Singh First 5 GP Birmingham. Personal Journey. Common phrases. Spend a penny Water works Sample of water Feeling under the weather Suffering from pins and needles Problems with back passage

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common phrases
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’
uk graduates fail rates
UK Graduates – Fail rates



British White: 4.6%

British Asian: 16.3%

  • British White : 5.2 %
  • British Asian: 17.7%
communicative flexibility
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 …
the way of talk
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
why are the best clinical minds from abroad struggling
Why are the best clinical minds from abroad struggling
  • Is it:
    • Cultural ?
    • Language ?
    • Knowledge ?
    • Lack of Self- Esteem ?
    • Or
    • Something else?
difference in approach
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
the start of my csa journey
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
the preparation
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
csa journey barriers
CSA Journey - Barriers
  • Cultural
  • Knowledge
  • Experience
  • Technique / Approach
  • Language
csa exam
CSA Exam
  • First experience : Feb 2013
  • 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
reflections analysis
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
  • 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
solutions continued
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
csa exam1
CSA Exam
  • Second attempt: May 2013
  • 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
  • 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.