Introduction
International medical graduates (IMGs) are non-UK trained doctors, and they make up to 26% of the UK medical workforce.1 As IMGs enter postgraduate medical programmes, some with little to no NHS clinical experience, there are foreseeable challenges that might affect their professional and personal lives.2 These include communication, adapting to local systems and work culture, dealing with discrimination and bullying, and educational barriers, among other professional and personal setbacks.3–5
Aim
The aim of this project was to assess the impact of a peer-led induction and ongoing support on the professional and personal lives of IMGs in the internal medicine training (IMT) programme.
Methods
This study was a quality improvement project (Fig 1). IMGs in the IMT programme, for both 2020 (pilot group) and 2021 cohorts, in Yorkshire and Humber region were surveyed.
A questionnaire assessing professional and personal experiences was administered to the 2020 cohort as a pilot group to assess the burden of challenges. The 2021 cohort (intervention group – who benefited from support activities) was then surveyed before commencing their training, as well as shortly after their first 4-month rotation. The project ran from December 2020 to December 2021. Peer-led support included: induction session, ongoing support through an instant messaging platform, a webinar on the training portfolio and follow up induction Q&A session.
Quality improvement cycle for peer-led support for international medical graduates in the internal medicine training programme.
Results
Trainees expressed anxiety about starting the programme (26.7% in 2020; 58.3% in 2021 group). This improved as a third of trainees felt more settled into the programme after 4 months. Respondents in both groups expressed some concerns about their communication skills (13% in 2020; 8% in 2021), however, none in the 2021 cohort expressed such concerns after the intervention period. With regard to the training online portfolio, 20% of respondents in the 2020 cohort were not confident they would be able to utilise it properly by the end of their first placement, whereas half of the respondents in the 2021 cohort felt the same. After the interventions, none of the trainees expressed difficulty using the portfolio, with half of them feeling very confident about their ability to navigate the portfolio. Respondents in both groups also expressed concerns about having difficulty reaching or approaching their educational supervisor with training concerns (27% in the 2020 cohort; 24% in the 2021 cohort), after the interventions, two-thirds did not express concerns with this, but a third still had challenges. Regarding personal challenges, 6% of 2020 respondents and 25% of 2021 respondents admitted to struggling with adapting to life in the UK. This improved among the 2021 cohort as none expressed such challenges.
Conclusion
IMGs have peculiar challenges during their training period. The project has thus far identified the extent and magnitude of challenges faced by IMGs in the IMT programme. Interventions need to be sustainable and expanded to other specialty programmes. The input of the deanery and local trusts is invaluable in ensuring that IMGs receive much needed support to improve their welfare and enhance training outcomes.
- © Royal College of Physicians 2022. All rights reserved.
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