Evaluating international graduates’ experiences of reflection in general practice training
Compared to their UK trained colleagues, international medical graduates (IMGs) have worse outcomes both during GP training(1), and when it comes to the RCGP membership exam(2). This differential attainment may in part be related to a lack of experience of reflection, which has been identified as key to the progression of IMGs in GP training(3,4). Reflection is a requirement for self-regulated and lifelong learning, and key in the development of therapeutic relationships and professional expertise(5). Many UK medical schools include elements of reflection in their undergraduate curricula, and UK graduates experience reflection during the UK Foundation Programme. By contrast, IMGs often have limited exposure to reflection because of the didactic methods favoured by many international medical schools(6,7).GP trainees have been shown to benefit from reflecting on difficult or challenging situations encountered in practice(8). For IMGs potential areas of difficulty in adapting to UK based practice include changing to a patient centred model of care(9) and engaging with ethical dilemmas in a different socio-cultural context(10). Awareness of socio-cultural differences encountered by IMGs through use of reflection may be key to understanding and therefore narrowing the gap in attainment.This research aims to explore IMG experiences of reflection within UK general practice training.
A stakeholder group of 3 IMG GP trainees and 3 GPs with experience of working and/or training abroad has been recruited and will be consulted through all stages of the research process. Workstream 1 is currently in progress; an online questionnaire has been developed and is currently being piloted in a small group of South Yorkshire based IMG trainees. In the week commencing the 8th March, this questionnaire will be circulated to all IMGs currently employed by UK GP training programmes through local postgraduate deaneries. Data collected will include previous experience of reflection, support available for development of reflection and benefits perceived from engaging with reflection. In Workstream 2, 15 IMG trainees will be invited to participate in a telephone interview to explore emerging themes. Participants will be purposively sampled from the pool of survey respondents and ‘snowballing’, to achieve a maximum variety sample. The questionnaire results, literature review and stakeholder feedback will be used to develop an interview topic guide.
Results from Workstream 1 are expected by April 2021.
This research will provide a greater understanding of IMGs’ experiences of reflection including what support and training, if any, they have found most useful for developing this important skill for professional development. The key to addressing differential attainment must first be to appreciate the experience of IMGs so that we can develop training which suits their needs.