{"id":88,"date":"2019-07-31T11:25:40","date_gmt":"2019-07-31T10:25:40","guid":{"rendered":"http:\/\/gp.51.143.169.215.xip.io\/?page_id=88"},"modified":"2021-07-14T15:29:45","modified_gmt":"2021-07-14T14:29:45","slug":"imgs","status":"publish","type":"page","link":"https:\/\/gp-training.hee.nhs.uk\/cornwall\/your-training\/imgs\/","title":{"rendered":"International Medical Graduates"},"content":{"rendered":"\n

Page authored by Ramesh Mehay – Bradford VTS scheme <\/i><\/span><\/p>\n\n\n\n

Who is this page for and what is an IMG?<\/h3>
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This page is dedicated to those GP trainees who are training in the UK but who have graduated in medicine at a university elsewhere (like Africa, India, Spain, Romania and so on) and their GP Trainers. International Medical Graduates are often referred to as IMGs.  Personally, I feel a little uncomfortable with labelling a group of people in this way because it encourages stereotypes rather than embracing individuality and diversity.  This is made worse when the word is often used in association with negative circumstances.    However, if you are a trainee reading this, what I can safely say is that medical educators who use this word are usually using it to help identify a group of people who they genuinely want to help. <\/p>\n\n\n\n

If you graduated outside the UK, I hope this web page will help bridge some of the gaps \u2013 there are quite a number of tips on this page to help you with the MRCGP and GP training in general. If you have any further comments or recommendations, please drop me a line at rameshmehay@googlemail.com<\/a><\/p>\n<\/div><\/div>\n\n\n\n

The problem with GP training schemes in the UK<\/h3>
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The problem with most GP training schemes in the UK (and the accompanying formal assessment procedures) is that most are based on a \u2018formula\u2019 which is really only suited to those who graduated in the UK. For instance, CSA\/ RCA courses tend to assume that you have good enough knowledge of \u2018British culture, language and linguistics\u2019. We know that IMGs struggle with specific components of the MRCGP exams because of this.  <\/p>\n\n\n\n

Although many IMGs underperform, the fact remains \u2013 they are highly intelligent people.  Please remember that less than 1% of the world\u2019s population have a medical degree!   Compared to British born-and-bred graduates, IMGs have a very difficult intellectual task to do. In addition to dealing with medical issues, they have to do  a number of things simultaneously that the rest of us take for granted \u2013 like translating between two languages, trying to understand non-verbal and verbal nuances, grasping colloquial remarks, and doing that extra thing to make patients feel that they\u2019re being understood and respected.   How would we fair with these other tasks if we were in another country?<\/p>\n\n\n\n

In terms of MRCGP, the main difficulty IMGs face is with CSA\/ RCA and the COT part of Work Place Based Assessment. Unfortunately, there is a much higher failure rate amongst IMGs doing the CSA than those who graduated from the UK.   We think the problem is that IMGs are<\/em> being taught consultation skills but are not<\/em> being taught how to apply them.     The other problem is that most IMGs are relatively socially and physically isolated compared to those born in this country.  This is made worse if they belong to a scheme on the coast like Scarborough or Cornwall.   We need to somehow tackle this too if we are to improve their social, linguistic and cultural capital.  Interestingly, female IMGs find it easier to adapt to the professional culture in the UK than men. This may be because women in other cultures may not have the same status and expectations as their male counterparts and are therefore more adaptable to the \u2018 partnership\u2019 approach that is expected UK doctors.<\/p>\n<\/div><\/div>\n\n\n\n

Britishness and Linguistic Capital<\/h3>
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Some trainees attend CSA courses and get told (in their feedback) that they need to be \u2018more British\u2019. Personally, I think it\u2019s an awful phrase because<\/p>\n\n\n\n

  1. It is vague and therefore can mean different things to different people.  For example, is spending two weeks in a European mass tourist holiday destination, getting sunburnt, drinking too much, slurring unintelligible football chants and taking all sorts of risks with one\u2019s sexual health the essence of being British? Or is it tut tutting at such behaviour through the pages of a popular newspaper? (Hopefully, you\u2019ll say neither).<\/li>
  2. It doesn\u2019t celebrate the cultural diversity and individuality inherent within our IMGs \u2013 which we all can use and learn from.  Actually, Damian Green (former UK\u2019s immigration officer) recently said that \u2018to be British is to be part of a \u2018tolerant and mutually respectful society\u2019.<\/em><\/li>
  3. It might give the impression to others that being \u2018British\u2019 implies a sense of a more superior culture, which is clearly not the intention (nor the reality) when trainees are being advised to be more \u2018British\u2019.<\/li><\/ol>\n\n\n\n

    I think what people mean when they advise their trainees that they need to be \u2018more British\u2019 is that they need to develop their linguistic capital in their internal linguistic bank. So let\u2019s go onto define what that exactly means.  Linguistic capital<\/strong> (Bourdieu, 1990) is defined as the mastery of and relation to language. And that doesn\u2019t just mean having a good vocabulary. Other than fluency, we are talking about the expertise and comfort with a language \u2013 idioms, turns of phrase and so on.  Trainees can expand their linguistic capital if they submerge themselves in British culture through watching soap operas, widening their social circle of friends and going out with English groups. The idea is that by being immersed in UK idioms, turns of phrase, meta-communication, tone of voice etc., one understands them better and might even start to use them. If IMGs make no attempt to get a grasp of these things, they then remain culturally alien to them. This in turn will affect their learning, growth and thus other people\u2019s (e.g. patients\u2019) faith in them. Investing in linguistic capital is a long term endeavour and that the returns are seldom immediate.<\/p>\n\n\n\n

    By having good linguistic capital of a culture that is not part of your embodied* cultural capital (i.e. from the country you were brought up in) can give you three good advantages in your host country:<\/p>\n\n\n\n

    1. It gives you a means of being able to communicate effectively with others (like patients)<\/li>
    2. It gives others some sort of faith, respect and reliance in you.  It\u2019s like presenting yourself and showing that you\u2019ve submerged yourself in your surrounding culture and have acquired a lot from it \u2013 and people respect you for that no matter what country you\u2019re in.<\/li>
    3. Linguistic capital thesis states that trainees who possess, or develop linguistic capital, thereby have access to better life chances.
      Remember, linguistic capital can be acquired even by those who do not have ancestral precedents. For example, it is completely possible for a Tamil trainee who still lives with his Tamil speaking parents to acquire linguistic capital that is grounded in English<\/li><\/ol>\n\n\n\n

      * Embodied cultural capital = consists of both the consciously acquired and the passively \u201cinherited\u201d properties of one\u2019s self (with \u201cinherit[ance]\u201d here used not in the genetic sense but in the sense of receipt over time, usually from the family through socialisation, of culture and traditions). Cultural capital is not transmissible instantaneously like a gift or bequest; rather, it is acquired over time as it impresses itself upon one\u2019s habitus (character and way of thinking), which in turn becomes more attentive to or primed to receive similar influences. <\/em><\/p>\n<\/div><\/div>\n\n\n\n

      How does the NHS in England work?<\/h3>
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