THE NEW ZEALAND MEDICAL JOURNAL

examiners to provide valid assessment of OTDs English proficiency. This idea was
successfully implemented in the Auckland programme. The actors (as simulated
patients) were comfortable with indicating (on a scale) how easy it was to understand
the OTD’s English within the consultation.
Doctors need a high degree of proficiency in the language being used by their
patients, as local colloquial terms and cultural nuances are used frequently in
conveying meaning in the consultation. 7 It is important, therefore, to assess OTDs’
proficiency and to provide language training where necessary. Indeed, proficiency in
the language is essential to maximising the effectiveness of clinical communication
and preventing poor outcomes and complaints.
Minimising failure
To maximise the potential gain from retraining courses, there should be careful
selection of participants. Combining an intensive bridging course with the challenge
of learning a whole new way of consulting with patients can mean that OTDs are
overwhelmed by the demands of the course, especially considering the other possible
stressors in their lives such as health concerns, financial strain, family commitments,
and adaptation to a new culture.
There have been few reported studies on the issue of adjusting curricula to facilitate
OTDs’ adaptation to new situations. 8 Yet, since studies (in other settings) have shown
that stress, depression and financial strain can affect motivation, it is not surprising
that one study found that OTDs showed a deterioration in mental health as evidenced
by their scores on the General Health Questionnaire. 9 Attention also needs to be paid
to personal loss and life-cycle considerations for the OTD. 8
Researchers in Australia have reported that long-term unemployment and culture
shock have adverse effects on OTDs’ mental and physical health, leading to poor
general well-being and psychosomatic symptoms; and that OTDs also experienced
alienation and anger when attempting to enter the Australian workforce. 10
An OTD’s potential to learn and adapt to a changing clinical environment may be
influenced by previous learning, and the length and depth of experience in practice in
their country of origin. As the overseas-trained doctor is relearning a different style of
medicine (e.g. being more patient-centred), a significant identity change may be
required. Changes in those who have been in clinical practice for some time, it is
postulated, are rare since little ‘learning-to-learn’ takes place after formal medical
training is complete. 11 It follows that for the older overseas-trained doctor it will be
hard to change what he/she has learnt, especially since formal medical training was
more likely to have been traditional didactic teaching, with less emphasis on selfdirected
learning, problem-solving, or self-reflection. This can be a barrier to the
older, more experienced OTDs learning and changing their professional behaviour.
When the profession investigates a report of poor practice, it is not uncommon to find
that the doctor is professionally isolated and appears to be unaware of his or her poor
performance. 12,13 Reflectiveness is therefore seen as a key skill for health
professionals working in clinical practice. It is critical that doctors have the skills to
recognise their own strengths and weaknesses; they also need to be committed to selfdirected
learning in order to maintain competence. A range of factors may trigger or
contribute to insight, including observing others consulting, undertaking case review,
NZMJ 29 July 2005, Vol 118 No 1219 Page 2 of 5
URL: http://www.nzma.org.nz/journal/118-1219/1584/
© NZMA