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A faulty production line

International graduate GP trainees ‘need earlier work placements’

International medical graduates feel they would benefit from starting GP placements earlier in their training to help them build up a better understanding of the culture of UK general practice, according to a new study.

The research – published in Education for Primary Care journal – found international medical graduate (IMG) trainees also felt they would benefit from a more individual approach to identifying their learning needs at the start of their training.

The findings come as IMGs continue to experience higher fail rates in the MRCGP exam than UK graduates, specifically the clinical skills assessment part, with the BMA arguing the whole process of training needs to be overhauled to address the disparity.

Dr Christopher Warwick, associate dean for East Surrey and Crawley, conducted focus groups with international medical graduate trainees to explore their views of the challenges they face in GP specialty training.

Dr Warwick wrote: ‘The findings confirmed the central importance, and considerable challenges involved, in making an effective transition into the culture of the NHS and UK general practice.’

He said IMG’s lack of knowledge about the NHS should not be seen as a deficiency, ‘but a clue to what they needed to learn’.

‘IMGs also felt the earlier in their training they undertook a GP placement, the quicker they would start to understand the culture of general practice,’ Dr Warwick concluded.

Education for Primary Care 2014; available online 1 March

Readers' comments (14)

  • THE challenge is an unfair exam at the end of doing a hard year of visits, on calls, ooh and mindless portfolio entries. Then being told that despite doing all that you cannot be a GP because you could not pass an exam with fake patients - actors. honestly why do people want to investigate every possibility except the csa to explain the injustice of this?

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  • I agree with the comment @8.53pm. IMGs female pass rate is higher than male eventhough they have similar exposure to NHS in the UK and general practice. How do you explain the disparity here??

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  • The pass rate is different as communication skills vary among the groups - with females usually better than males.

    However a good doctor whether IMG, blue, green, white or orange will have communication skills and will pass the CSA, while a doctor centred candidate will struggle.

    It is very sad some people spend years trying to pass and end up out of General practice, but what is the point of having an exam that everyone passes by default. It is designed to uphold the minimum standard - and it does exactly that.

    The GP registrar year is hard, but protected from reality in many cases as they build up their skills, however real life day to day GP work is far harder and longer. If you don't have the skills required to communicate and work effectively then perhaps a different career path is more appropriate.

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  • 8.32 The idea that females usually communicate better than males is just expressing pure prejudice, nothing more. Men and women communicate differently but both have a place in our society and medicine, Unfortunately the RCGP have developed an exam based on dogma and their own entrenched beliefs that doctor centred care is always a bad thing. In reality modern medicine is now so technical that being so-called 'doctor centred' is often the only way to stay out of court. The RCGP have produced a model that is in fact very dangerous if used inappropriately at the coalface. It is high time they were challenged on setting an exam that tests little more than a set of political beliefs about how doctors should behave. Their is of course no excuse for lack of courtesy and it goes without saying GPs have to be nice to people but the present exam is clearly racist, unfit for purpose and hopefully soon to be exposed for the sham it is.

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  • With reference to comment @ 8.32, all medical trainees have gone through various exams in their career and no one expects to pass a exam by default as mentioned !! we all know that. but what is grossly apparent is very high fail rate for IMGs. No other Royal college would let their trainees leave the speciality after going through the whole couple of years training. They are stopped very early in their training at the SHO level if they do not show the competencies, exams etc. And also if trainees from other specialities who cannot pass their royal college exams can still practice as Staff grade, in other grades and contribute to NHS. Its only RCGP which has structured its training in such a way that if one cannot pass the exams right at the end of training, they you have to leave the speciality with no chance of practicing as a GP again. This is the reason why such a high pass rate for IMG's is so distressing. We all know as we have experienced in various other specialities that they are clinically competent and only because of slight accent and not a perfect grammar, I feel they have such a high fail rate. But does this really matter to the pts ?, I feel not.

    RCGP should have known this much earlier that IMGs are usually clinically competent and they need early and more extensive exposure to GP land.

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  • 'They are stopped very early in their training at the SHO level if they do not show the competencies, exams etc.'

    ST1-3 is early in training, you are usually just out of Foundation training. It is not like reaching ST7 in surgery after CT posts, then being turned away.

    Yes the IMG pass rate is not as high as other groups. However most IMG trainees who work hard will pass - stop blaming others for failing. If you are good enough you will pass, as most VTS trainees eventually do. Our local pass rate is in the high 90% range.

    If you don't pass, use the experienced gained to make you a better doctor in another field where you willing hopefully prosper with your enhanced skills.

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  • GP training is 3 years, so essentially ST1 - ST3 GP training is equivalent to ST1 - ST7 training in other specialities. So ST1 - 3 is not early in training, its the whole GP training after which trainees are turned away if they do not get their exams at the end of training. In my experience other Royal college for example RCoA has MRCA, FRCA early in training around ST3-4.And even if trainees cannot pass this exams, they lose their National training number but still they can practice as anesthetist, be it staff grade, clinical fellow, associalist specialist etc. So essentially all the public money spent in training is not lost. While with GP training, once you leave GP training by not passing exams etc, then essentially you cannot practice as a GP anymore. So all the efforts put in, all the public money spent is wasted. And if you look at figures ' IMG pass rate is not as high as other groups ' - it is actually IMG fail rate is very high as compared to other groups. And please all IMG trainees work hard like any other trainee. No one is blaming others, these are just the facts. I am sure IMGs trainees will prosper elsewhere but at the loss of a GP career.

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  • regarding @1.13 am comment, response @ 9.39 sumps up.

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  • Most of the locally trained medical graduates are exposed to OSCEs, dealing with actors as pts etc, so getting through the CSA is straight forward. But with IMGs all through their medical training they have dealt with real pts with real medical symptoms / signs. So dealing with actors as pts is a bit tricky. Was RCGP not aware of this big difference in undergraduate medical training beforehand ?? and if they were why wasn't more effort put in to help IMGs dealing with actors as pts. Did the RCGP check beforehand that trainers for IMGs have MRCGP qualification, have they seen a live CSA as a guest and help their IMG trainess what to expect of the CSA ? Most of the trainers base their training on old style video MRCGP and IMG trainees have no clue what to expect in a real CSA.

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  • with reference to @6.43, because IMGs trainees usually have no problems passing their workplace assessment with real pts supervised by trainers and falter in CSA clearly indicates the problem with dealing with actors at pts. I have heard stories that actors giggling, losing track etc. Is CSA fit for purpose ? either get real pts like other royal colleges do or get 2 examiners for each CSA station like other Royal colleges do.

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