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More support needed to give overseas doctors confidence in interpersonal skills

Posted on 3 September 2018

More emphasis should be put on improving the interpersonal skills of overseas doctors wanting to work in the NHS as GPs, a new study has suggested.

The authors of the report say interpersonal skills may be just as important as clinical knowledge for those on GP training programmes.

The research, from the University of York and Work Psychology Group (WPG) suggests that many overseas medical graduates don’t do as well as UK medical graduates in examinations that simulate interactions with patients.

Consideration should therefore be given to providing more support to overseas candidates to improve their confidence in social and communication interactions within the context and culture of the NHS.

The authors suggest that additional support could help to narrow the gap in exam performance between international and UK graduates.

Senior author, Dr Paul Tiffin, from the Department of Health Sciences at the University of York and the Hull York Medical School, said:

“Since its inception the NHS has relied heavily on the hard work and dedication of overseas doctors and further efforts should be made to enhance their confidence in terms of communication and interpersonal skills, within the specific context of the UK health service.

“This is likely to further reduce differences in pass rates between UK and overseas graduates at medical exams.”

As a follow-up from an initial project commissioned by the General Medical Council (GMC), the research team analysed data from 1874 international medical graduates who applied for GP training between 2008 and 2012.

The study builds on previous research which showed that when compared to UK graduates, overseas doctors tend to perform more poorly on the Clinical Skills Assessment, an element of the Membership of the Royal College of General Practitioners (MRCGP) licensing examination; an assessment that doctors are required to pass to practice as a GP.

The Clinical Skills Assessment involves a simulation of actual medical practice and candidates are observed and rated according to their interactions with patients.
To compare the importance of interpersonal competence and clinical knowledge in performance on the MRCGP licencing examination, the study examined the relationship between exam performance, and performance in the GP training selection process.

The GP selection process includes a situational judgement test (SJT) and clinical problem solving test (CPST). The SJT is a written test, designed to assess interpersonal competence. Candidates are presented with a series of scenarios and response options, and are required to rank the response options in order of appropriateness. The CPST is designed to assess clinical knowledge and a candidates’ ability to apply this in making clinical decisions.

The study found that performance on the SJT is as predictive of subsequent performance in the Clinical Skills Assessment at the end of training, as scores achieved on the Clinical Problem Solving Test. Dr Tiffin added:

“Our findings provide evidence that interpersonal skills may be at least as important as medical knowledge when it comes to clinical exam performance in qualified doctors.

“However, we have to exercise some caution as, at present, we don’t know whether there are any differences in academic performance that translate into actual practice in relation to patient care. This is something we are hoping to study in the very near future.”

By demonstrating the importance of interpersonal competence to licencing examination results, the research team have provided new insights into how to support future GP trainees who are likely to struggle with exams that involve social and communication interactions.

Lead author, Professor Fiona Patterson from Work Psychology Group (WPG), said:

“The reasons behind differential attainment for overseas doctors entering training in the UK are more complex than previous research has acknowledged. Our study provides new insights and practical implications on how best to design educational interventions and support trainees in future; specifically targeting the confidence of overseas doctors with regard to their interpersonal competence.”

“Through our work we can now use information collected at point of selection to help identify those most at risk of falling in to difficulty during training, before it happens. Early pick up of those more at risk is critical so that identified trainees can navigate the challenges of training to be a competent independent General Practitioner.

“This means better support can be provided to trainees to pass their licensing exams on time, and using our research findings in this way will significantly reduce the costs (both human and financial) associated with extended training, which is welcome news for a resource constrained NHS”.

Unpacking the dark variance of differential attainment on examinations in overseas graduates, is published in Medical Education.