THE NEW ZEALAND MEDICAL JOURNAL

More documents

Recommendations

Info

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
the degree of internal or external motivation, and the visibility of professional practice norms. 14 Being a reflective practitioner also infers having the capacity to change. This requires not only accurate insight, but also motivation to improve. There is no doubt that OTDs are highly motivated as they have emigrated in the hope of a better life and have undertaken the Bridging Programme to prepare for NZREX. Yet when it came to supporting the usefulness of belonging to a peer group, some participants were unconvinced. 1 This could be because it was still a new concept and they could not yet see its value, or that it was uncomfortable and challenging for them, or that this component was inadequate for their needs. Some participants stated that they were more comfortable and confident working alone. In our experience, a small minority of participants lacked insight into their performance and hence were unable to take advantage of the intensive tuition in Professional Development provided by the Bridging Programme. As a result, they could not meet the standards required to pass. Training modules An important recommendation, arising from our experience in teaching OTDs, is that we design a system of re-training that takes into account the vastly different backgrounds and training requirements of immigrant doctors. Specifically, a system of modules could be developed that meets individual OTDs’ needs. For example, almost all OTDs would require a module on Maori and Pacific health, and another on the ethical and legal environment in New Zealand. Many would need modules on the patient-centred style of consultation; some may need updates in particular specialty areas (e.g. paediatrics or obstetrics & gynaecology); while some may need only an orientation programme informing them about the New Zealand health system. A module-based programme would need additional work in the planning stage, especially in designing the more specialised modules. It might also be a little more complex to administer; but it might be well worth it in the long run. The way ahead It is clear, both from our own experience and from current research, that there needs to be a fuller assessment of OTDs’ learning needs 15 before they enter a re-training programme. For example, there needs to be a measure of English proficiency, set at a standard higher than it is currently, and appropriate to the medical setting. There is also a need to recruit the most appropriate candidates. It might be advisable to develop special tools to screen for those doctors best able to make the changes in behaviour required to practice in New Zealand. To this end, the Medical Council of New Zealand might consider developing a diagnostic interview, covering all aspects of the requirements for registration and practice in New Zealand. This would be a challenge. In addition to the established measures of clinical competence, it would be advantageous to have specific tools for measuring motivation, mood, learning behaviours and awareness of what others think. 14 We should also try to include a measure of capacity to change. NZMJ 29 July 2005, Vol 118 No 1219 Page 3 of 5 URL: http://www.nzma.org.nz/journal/118-1219/1584/ © NZMA
Page 1: THE NEW ZEALAND MEDICAL JOURNAL Vol
Page 5: 13. Bahrami J, Evans A. Underperfor

THE NEW ZEALAND MEDICAL JOURNAL

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?