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Contexts Mechanisms Outcomes Shortage of junior doctors resulting in increased recruitment of temporary staff at premium rates and inconsistent clinical care Employing new entrant international medical graduates at standard NHS salary A stable workforce leading to improved clinical care and financial position of the trust Poor performance and low level of wellbeing in the initial stages at the workplace among new entrant international medical graduates Structured intervention during the orientation period including a good learning environment, adequate mentoring and pastoral support Improvement in the participation, self-efficacy and learning of these doctors Risks to patient safety due to poor knowledge of contextual factors including policies and procedures by the new entrant international medical graduates Providing clear communication of curriculum competencies along with peer support to these doctors Improvement in the awareness among these doctors of the contextual factors contributing to the provision of high-quality patient care Managers uncertainty about recruitment and orientation of new entrant international medical graduates Holding meetings with managers to discuss the design and implementation of the intervention Increased participation and support of managers for the intervention Lack of standardised communication channels between junior doctors, their supervisors and the trust management Developing a standardised communication strategy will facilitate effective communication of critical success factors The stakeholders perceive that their voice is being heard and they are valued resulting in their increased satisfaction Availability of on-site staff accommodation in the trust Providing free accommodation to doctors doing honorary clinical attachment Improved cost efficiency of the trust by attracting overseas junior doctors into honorary posts, increasing their recruitment Lack of criteria for assessment and unrealistic expectations from new entrant international medical graduates during their orientation Tailoring the intervention based on requirements of junior doctors, their supervisors, and managers of the trust Clarity of roles and requirements and better participation of the stakeholders
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