Experience of clinical supervisors of international medical graduates in an Australian district hospital
David Henderson A D , Pam D. McGrath B and Mary Anne Patton CA Griffith University, School of Human Services and Social Work, Meadowbrook, PO Box 180, Clayfield, Qld 4011, Australia.
B Centre for Community Science, Population & Social Health Program, Griffith Health Institute, Griffith University, Level 1, LO5 Logan Campus, Meadowbrook, Qld 4131, Australia. Email: pmcgrathgu@gmail.com
C School of Medicine, The University of Queensland, Brisbane, Qld 4072, Australia. Email: patton@onlinestrategy.com.au
D Corresponding author. Email: drfh12@gmail.com
Australian Health Review 41(4) 365-371 https://doi.org/10.1071/AH15094
Submitted: 27 May 2015 Accepted: 28 June 2016 Published: 2 September 2016
Abstract
Objective Herein we record the experience of clinical supervisors of international medical graduates (IMGs) working as junior staff in a district hospital by examining supervisor perspectives on IMG performance, the factors affecting their performance and the requirements of supervision under these circumstances.
Methods The present study had an open-ended exploratory qualitative design. Thirteen 13 open-ended, in-depth interviews were undertaken with supervisors of IMGs employed in a public district hospital in Queensland, Australia.
Results The supervisors reported that, although performance was an individual and variable characteristic, IMGs tended to perform less well than Australian graduates and required more intensive supervision. Factors that affected performance were motivation and experience, and specifically lack of familiarity with the Australian healthcare system, lack of recent of practice, education, language, communication and cultural factors. English language proficiency was regarded as crucial to performance.
Conclusions The additional work required to supervise IMGs in order to enable them to perform at a satisfactory level and successfully integrate into the Australian healthcare system needs to be recognised and resourced. Assistance with attaining proficiency in English and with communication skills over and above the standard required to pass the International English Language Testing System examination should be seriously considered as a means of improving performance.
What is known about the topic? To date, there is little research available about the experience of supervisors of IMGs in Australia.
What does this paper add? The findings of the present study make an important contribution to the literature by examining the critical role clinical supervisors of IMGs have in helping IMGs adapt to the Australian healthcare system and ensuring that they are able to provide quality health care. It identifies current challenges and highlights areas in need of attention to ensure a strong healthcare system for Australia.
What are the implications for practitioners? Supervisors of IMGs need recognition of the extra time and expertise required in their role if they are to be effectively supported in their endeavours to integrate IMGs into the Australian health workforce. More attention needs to be given to the development of English language proficiency of IMGs, including colloquial usage, and communication in medical practice.
References
[1] AIHW. Medical workforce 2012. National health workforce series no. 8. Catalogue no. HWL 54. Canberra: Australian Institute of Health and Welfare; 2014.[2] McGrath P, Henderson D. The observer program: insights from international medical graduates. Educ Health 2009; 22 344
[3] McGrath P, Henderson D, Phillips E. Integration into the Australian health care system: insights from international medical graduates. Aust Fam Physician 2009; 38 844–8.
| 19893827PubMed |
[4] McGrath PD, Henderson D, Tamargo J, Holewa HA. ‘All these allied health professionals and you’re not really sure when you use them’: insights from Australian international medical graduates on working with allied health. Aust Health Rev 2011; 35 418–23.
| 22126943PubMed |
[5] McGrath P, Henderson D, Tamargo J, Holewa HA. Doctor–patient communication issues for international medical graduates: research findings from Australia. Educ Health 2012; 25 48–54.
| Doctor–patient communication issues for international medical graduates: research findings from Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3sjkt1KksQ%3D%3D&md5=938ed8f84eefc4913a9594486e6ac08cCAS |
[6] McGrath P, Henderson S, Holewa HA, Henderson D, Tamargo J. International medical graduates’ reflections on facilitators and barriers to undertaking the Australian medical council examination. Aust Health Rev 2012; 36 296–300.
| International medical graduates’ reflections on facilitators and barriers to undertaking the Australian medical council examination.Crossref | GoogleScholarGoogle Scholar | 22935121PubMed |
[7] McGrath P, Henderson D, Holewa H. Language issues: an important professional practice dimension for Australian international medical graduates. Commun Med 2013; 10 191–200.
| 25233557PubMed |
[8] Pilotto LS, Duncan GF, Anderson-Wurf J. Issues for clinicians training international medical graduates: a systematic review. Med J Aust 2007; 187 225–8.
| 17708725PubMed |
[9] Terry DR, Lê Q, Hoang H. Satisfaction amid professional challenges: international medical graduates in rural Tasmania. Australas Med J 2014; 7 500–17.
| Satisfaction amid professional challenges: international medical graduates in rural Tasmania.Crossref | GoogleScholarGoogle Scholar | 25646126PubMed |
[10] Terry DR, Lê Q. Social capital among migrating doctors: the ‘bridge’ over troubled water. J Health Organ Manag 2014; 28 315–26.
| Social capital among migrating doctors: the ‘bridge’ over troubled water.Crossref | GoogleScholarGoogle Scholar | 25080647PubMed |
[11] Terry DR, Lê Q. Challenges of working and living in a new cultural environment: a snapshot of international medical graduates in rural Tasmania. Aust J Rural Health 2016;
| Challenges of working and living in a new cultural environment: a snapshot of international medical graduates in rural Tasmania.Crossref | GoogleScholarGoogle Scholar |
[12] Spike NA. International medical graduates: the Australian perspective. Acad Med 2006; 81 842–6.
| International medical graduates: the Australian perspective.Crossref | GoogleScholarGoogle Scholar | 16936498PubMed |
[13] Zubaran C, Douglas S. Peers or pariahs? The quest for fairer conditions for international medical graduates in Australia. Med J Aust 2014; 201 509–10.
| Peers or pariahs? The quest for fairer conditions for international medical graduates in Australia.Crossref | GoogleScholarGoogle Scholar | 25358566PubMed |
[14] McDonnell L, Usherwood T. International medical graduates: challenges faced in the Australian training program. Aust Fam Physician 2008; 37 481–4.
| 18523706PubMed |
[15] Chen PG, Curry LA, Bernheim SM, Berg D, Gozu A, Nunez-Smith M. Professional challenges of non-US-born international medical graduates and recommendations for support during residency training. Acad Med 2011; 86 1383–8.
| Professional challenges of non-US-born international medical graduates and recommendations for support during residency training.Crossref | GoogleScholarGoogle Scholar | 21952056PubMed |
[16] Huijskens EG, Hooshiaran A, Scherpbier A, van der Horst F. Barriers and facilitating factors in the professional careers of international medical graduates. Med Educ 2010; 44 795–804.
| Barriers and facilitating factors in the professional careers of international medical graduates.Crossref | GoogleScholarGoogle Scholar | 20633219PubMed |
[17] Sockalingam S, Khan A, Tan A, Hawa R, Abbey S, Jackson T, Zaretsky A, Okrainec A. A framework for understanding international medical graduate challenges during transition into fellowship programs. Teach Learn Med 2014; 26 401–8.
| A framework for understanding international medical graduate challenges during transition into fellowship programs.Crossref | GoogleScholarGoogle Scholar | 25318037PubMed |
[18] Streubert-Speziale HJ, Carpenter DR. Qualitative research in nursing: advancing the humanistic imperative. 3rd edn. Philadelphia: Lippincott Williams & Wilkins; 2003.
[19] Holloway I. A–Z of qualitative research in healthcare. 2nd edn. Oxford: Blackwell Publishing; 2008.
[20] Patton M. Qualitative research and evaluation methods. 3rd edn. Thousand Oaks: Sage; 2002.
[21] Krathwohl D. Methods of educational and social science research: an integrated approach. New York: Longman; 1993.
[22] Polit D, Hungler B. Nursing research: principles and methods. 5th edn. Philadelphia: Lippincott; 1995.
[23] Field PA, Morse JM. Nursing research: the application of qualitative approaches. London: Chapman & Hall; 1992.
[24] Menzies L, Minson S, Brightwell A, Davies-Muir A, Long A, Fertleman C. An evaluation of demographic factors affecting performance in a paediatric membership multiple-choice examination. Postgrad Med J 2015; 91 72–6.
| An evaluation of demographic factors affecting performance in a paediatric membership multiple-choice examination.Crossref | GoogleScholarGoogle Scholar | 25617382PubMed |
[25] Tiffin PA, Illing J, Kasim AS, McLachlan JC. Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study. BMJ 2014; 348 g2622
| Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study.Crossref | GoogleScholarGoogle Scholar | 24742539PubMed |
[26] Rushd S, Landau AB, Lindow SW. An evaluation of the first time performance of international medical graduates in the MRCOG Part 1 and Part 2 written examinations. Eur J Obstet Gynecol Reprod Biol 2013; 166 124–6.
| An evaluation of the first time performance of international medical graduates in the MRCOG Part 1 and Part 2 written examinations.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3s7jtFWmsA%3D%3D&md5=d24352d4582e46b3a80ab7692726a4a2CAS | 23149096PubMed |
[27] Takahashi SG, Rothman A, Nayer M, Urowitz MB, Crescenzi AM. Validation of a large-scale clinical examination for international medical graduates. Can Fam Physician 2012; 58 e408–17.
| 22859643PubMed |
[28] Holtzman KZ, Swanson DB, Ouyang W, Dillon GF, Boulet JR. International variation in performance by clinical discipline and task on the United States medical licensing examination step 2 clinical knowledge component. Acad Med 2014; 89 1558–62.
| International variation in performance by clinical discipline and task on the United States medical licensing examination step 2 clinical knowledge component.Crossref | GoogleScholarGoogle Scholar | 25250743PubMed |
[29] Esmail A, Roberts C. Academic performance of ethnic minority candidates and discrimination in the MRCGP examinations between 2010 and 2012: analysis of data. BMJ 2013; 347 f5662
| Academic performance of ethnic minority candidates and discrimination in the MRCGP examinations between 2010 and 2012: analysis of data.Crossref | GoogleScholarGoogle Scholar | 24072882PubMed |
[30] Hawthorne L, Hawthorne G, Crotty B. The registration and training of overseas trained doctors in Australia: final report. Melbourne: Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne; 2007.
[31] Tyrer SP, Smalls J, Leung WC, Katona C. The relationship between medical school of training, age, gender and success in the MRCPsych examinations. Psychiatr Bull 2002; 26 257–63.
| The relationship between medical school of training, age, gender and success in the MRCPsych examinations.Crossref | GoogleScholarGoogle Scholar |
[32] Boulet JR, Swanson DB, Cooper RA, Norcini JJ, McKinley DW. A comparison of the characteristics and examination performances of US and non-US citizen international medical graduates who sought Educational Commission for Foreign Medical Graduates certification: 1995–2004. Acad Med 2006; 81 s116–9.
| A comparison of the characteristics and examination performances of US and non-US citizen international medical graduates who sought Educational Commission for Foreign Medical Graduates certification: 1995–2004.Crossref | GoogleScholarGoogle Scholar | 17001120PubMed |
[33] Gogineni RR, Fallon AE, Rao NR. International medical graduates in child and adolescent psychiatry: adaptation, training, and contributions. Child Adolesc Psychiatr Clin N Am 2010; 19 833–53.
| International medical graduates in child and adolescent psychiatry: adaptation, training, and contributions.Crossref | GoogleScholarGoogle Scholar | 21056349PubMed |
[34] Hamoda HM, Sacks D, Sciolla A, Dewan M, Fernandez A, Gogineni RR, Goldberg J, Kramer M, Saunders R, Sperber J, Rao NR. A roadmap for observership programs in psychiatry for international medical graduates. Acad Psychiatry 2012; 36 300–6.
| A roadmap for observership programs in psychiatry for international medical graduates.Crossref | GoogleScholarGoogle Scholar | 22851028PubMed |
[35] Kalra G, Bhugra DK, Shah N. Identifying and addressing stresses in international medical graduates. Acad Psychiatry 2012; 36 323–9.
| Identifying and addressing stresses in international medical graduates.Crossref | GoogleScholarGoogle Scholar | 22851031PubMed |
[36] Wallis W. Communication as fundamental to doctor–patient relationship. Acta Biomed 2008; 79 52–6.
| 18551823PubMed |
[37] Neo LF. Working toward the best doctor–patient communication. Singapore Med J 2011; 52 720–5.
| 1:STN:280:DC%2BC3Mbit12rsQ%3D%3D&md5=0e4ff2a3221940a80ec0e0bed198b7ceCAS | 22009390PubMed |
[38] Matusitz J, Spear J. Effective doctor–patient communication: an updated examination. Soc Work Public Health 2014; 29 252–66.
| Effective doctor–patient communication: an updated examination.Crossref | GoogleScholarGoogle Scholar | 24802220PubMed |
[39] Commonwealth of Australia. Lost in the labyrinth. Report on the inquiry into registration processes and support for overseas trained doctors. Canberra: Commonwealth of Australia, House of Representatives Standing Committee on Health and Ageing; 2012.
