Exploring cultural and linguistic influences on clinical communication skills: a qualitative study of International Medical Graduates

BMC Medical Education

Research Article

Andrew Elder¹  Anju Verma²  Ann Griffin³  Jane Dacre⁴ 

[1] Edinburgh Medical School, 47 Little France Crescent, EH16 4TJ, Edinburgh, UK;MRCP(UK) Federation of the UK Royal Colleges of Physicians, MRCP(UK) Central Office, 11, St. Andrew’s Place, NW1 4LE, London, UK;Honorary Clinical Research Fellow, University College London Medical School, Royal Free Campus, Rowland Hill Street, NW3 2PF, Hampstead, UK;UCL Medical School, University College London Medical School, 74 Huntley Street, WC1E 6AU, London, UK;UCL Medical School, University College London Medical School, 74 Huntley Street, WC1E 6AU, London, UK;Royal College of Physicians, 11, St. Andrew’s Place, NW1 4LE, London, UK;

关键词: IMG;    Cultural dimensions;    MRCP(UK) PACES;    Hofstede;    Communication skills;    Differential attainment;   

DOI  :  10.1186/s12909-016-0680-7

 received in 2016-03-31, accepted in 2016-05-31,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundInternational Medical Graduates (IMGs) are known to perform less well in many postgraduate medical examinations when compared to their UK trained counterparts. This “differential attainment” is observed in both knowledge-based and clinical skills assessments. This study explored the influence of culture and language on IMGs clinical communication skills, in particular, their ability to seek, detect and acknowledge patients’ concerns in a high stakes postgraduate clinical skills examination. Hofstede’s cultural dimensions framework was used to look at the impact of culture on examination performance.MethodsThis was a qualitative, interpretative study using thematic content analysis of video-recorded doctor-simulated patient consultations of candidates sitting the MRCP(UK) PACES examination, at a single examination centre in November 2012. The research utilised Hofstede’s cultural dimension theory, a framework for comparing cultural factors amongst different nations, to help understand the reasons for failure.ResultsFive key themes accounted for the majority of communication failures in station 2, “history taking” and station 4, “communication skills and ethics” of the MRCP(UK) PACES examination. Two themes, the ability to detect clues and the ability to address concerns, related directly to the overall construct managing patients’ concerns. Three other themes were found to impact the whole consultation. These were building relationships, providing structure and explanation and planning.ConclusionHofstede’s cultural dimensions may help to contextualise some of these observations. In some cultures doctor and patient roles are relatively inflexible: the doctor may convey less information to the patient (higher power distance societies) and give less attention to building rapport (high uncertainty avoidance societies.) This may explain why cues and concerns presented by patients were overlooked in this setting. Understanding cultural differences through Hofstede’s cultural dimensions theory can inform the preparation of candidates for high stakes bedside clinical skills examinations and for professional practice.

【 授权许可】

CC BY   
© The Author(s). 2016