Easing Transition into Working in the NHS: Piloting an Enhanced Shadowing Programme for Overseas Doctors J Metcalf#, H Woodun*, N Pierce#, J Golla#, D Basu#, D Cross~, A Smalldridge~, M Sykes~, M Keaney~, J Illing^

*3rd Year Medical Student, Newcastle University# North Tees and Hartlepool NHS Foundation Trust~REACHE North West (Refugee and Asylum Seekers Centre for Healthcare

Professionals Education)^Durham University

Aim and Background Aim to facilitate transition to working in the NHS

37% of NHS Doctors qualified overseas1

GMC/DoH commissioned reports identified issues: Professionalism2,3

Ethics4,5

Communication/cultural differences4,5 Team working4,5

Practicalities4,5

Trust funded pilot programme for overseas junior doctors

Methods• 5 day programme pre FY shadowing July 2013

• Informed by literature and discussions with overseas doctors and supervisors within trust

• Included NHS and Trust specific sessions• Engaged with REACHE to deliver sessions

Week before Foundation ShadowingJuly 2013

Methods: Evaluation Ethical approval not required (by NRES) Anonymised pre and post Likert scale questionnaires including

Knowledge of the structure of NHS Awareness of communication issues/cultural diversity Patient centred approach/team working Ethical framework eg consent and confidentiality Analysed using paired T-tests

Semi structured individual interviews and participant observation Participants’ expectations FAQs during sessions Concerns/suggestions

Evaluation questionnaires for each session looking for themes

Results7 participants

3 foundation doctors2 international medical students1 refugee doctor1 clinical attaché

Response rates Pre and post Questionnaires: 100%Session Evaluations: 93.8%

Overall programme rated ‘very good’ (highest rating) by 100% of respondents

Significant results

*P=0.011*P=0.042

Verbal feedback

Changes to practice

Comments/Improvements

Discussion: Strengths and Limitations

Strengths: Valued by participants and Trust Targeted, flexible and responsive training REACHE highly skilled Full evaluation underway

Limitations: Small numbers/mixed group Observer bias as evaluation by participant Stigma Time to release trainees Measuring outcomes difficult as looking at whole career

Discussion• Programme addressed issues identified by studies• Responsiveness to individuals was crucial• Participants identify on-going benefits:

• One participant passed PLAB and now employed by Trust

• Key identified improvements: • Patient centredness• Communication skills• Professionalism• Seeking help

• Future programmes influenced by feedback• How to generalise locally, regionally, nationally?

Future plansTrust funded PhD student undertaking realistic evaluation

Follow up on 2nd/3rd July 2014 informed by feedback More role plays for communication skillsClinical simulation including human factors

2nd programme May 2014 (2 days only) for juniors in Trust including clinical attachés and refugee docs

3rd programme (full week) Autumn 2014 for new cohort

Conclusion Targeted programme to overseas doctors Perceived Benefits for participants and Trust Addressed issues around

NHS cultural valuesProfessionalismPatient SafetyEthics and communication skillsPracticalities

Now embedded (and funded) within Trust

References• 1. http://www.gmc-uk.org/Primary_Medical_Qualification_2010.pdf_45103170.pdf • 2. NCAS 2011: UK National Patient Safety Agency. National Clinical

Assessment Service: Concerns about professional practice and associations with age, gender, place of qualification and ethnicity - 2009/10 data (February 2011). http://www.ncas.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=95145

• 3. UK House of Commons Health Committee. Fourth report. Revalidation of Doctors. London: House of Commons, 2011. http://http//www.publications.parliament.uk/pa/cm201011/cmselect/cmhealth/557/55702.htm

• 4. Illing, J et al. The experiences of UK,EU and non-EU medical graduates making the transition to the UK workplace: Full Research Report, ESRC End of Award Report. RES-153-25-0097. Swindon: ESRC 2009

• 5. Slowther A, Lewando Hundt GA, Purkis J, Taylor R. Experiences of non-K-qualified doctors working within the UK regulatory framework: a qualitative study. J R Soc Med 2012; 105:157-165.