Hey loves!
This weekend just gone saw me present my medical education research project at the MANSAG educational symposium, it was really full circle for me because this time last year I was 7 months pregnant with my boy – and this year I got to be cheered on by my 8 month old and doting husband. Truly felt so blessed. Loved that the women that came pregnant last year returned with their expanded families and still had amazing research to publish even though we were on maternity leave in between – truly you can do whatever you set your mind to do once you commit it to God; having amazing support systems makes it all the more rewarding.
So what was my research about? As you know I am now a General Practice (GP) trainee – so my research was about how International Medical Graduate (IMG) GP trainees understand the “relating to others” domain of the SCA – that is the Simulated Consultation Assessment which is the final exam required to pass to become a GP at the end of training.
The reason why I decided to research this is because there is a longstanding disparity in the results between GP trainees that schooled in the UK (UKG) and the rest (IMGs). In the most recent report of the results, whilst UKG pass rate for the exam was 94.27%, IMGs was only 51.52% – and this huge gap in pass rates has been the case for decades. In fact, the examination body RCGP has actually been taken to court for it by BAPIO (British Association of Physicians of Indian Origin), and even though the court ruled against BAPIO, RCGP vowed to make changes to the exam – which they did: the SCA is a new and improved version of the exit exam which was introduced in November 2023 after a lot of stakeholder involvement, including BAPIO.
The exam has three domains: one for how well the doctor interviews the patient to find out their issues, another is how well they treat their clinical problems – these two have remained constant over the various versions of the exam. The relating to others domain however, is the brand new domain which replaced interpersonal skills.
I was drawn to studying the last domain because for the doctors to be eligible to sit the exam, they must have been competent in treating patients throughout their training, so their clinical knowledge is unlikely to be the source of exam failure – but this nuanced area called relating to others could be the source because it tests a phenomenon called “communicative flexibility”. This basically is the skill of being able to modify your language and its delivery to suit the conversation you’re in – but it is dependent on the prevailing culture that the conversation is taking place in. The way a doctor from Nigeria shows empathy to a patient would likely differ from that of a UK trained doctor, simply because of their cultural backgrounds – but as this exam takes place in the UK, the UK doctor’s mannerisms will be readily understood by the British simulated patient and examiner – but the International doctor may not. This led to identifying a previously coined phenomenon called “code-switching” in which the IMG GP trainees felt they had to be a different person to themselves in order to pass the exam; they understood that they risk being misunderstood and poorly marked if they don’t make changes to their persona during the exam.
I am glad that I did this piece of work and that I was able to present it and get my abstract published; I hope that my drop in the ocean of Medical Education will lead to better support for IMGs working in the UK health system so we can all succeed in our individual lives while also improving the health system at large.
Till next time,
Dr ETK xo
