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| Journal of the New Zealand Medical Association,
23-June-2006, Vol 119 No 1236
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International medical graduates’ training needs:
perceptions of New Zealand hospital staff
Seshasayee Narasimhan, Anil Ranchord, Mark Weatherall
A large proportion of medical practitioners who work in New
Zealand are graduates of an overseas medical school. Indeed, the most recent
figures from the Medical Council of New Zealand (MCNZ) estimate that 34% of the
medical workforce has an overseas qualification.1
Within the hospital system, 17% of house officers, 33% of
registrars, and 50% of medical officers have an overseas qualification.1 The
MCNZ website does not specify the proportion of overseas medical graduates
working in New Zealand from countries that do not have reciprocal registration
arrangements with New Zealand.1
All medical practitioners must meet standards set by the
MCNZ. International Medical Graduates (IMGS) from Australia, the United Kingdom,
and North America obtain the right to practice medicine readily in New Zealand.
This could reflect similar standards of training and practice for these
countries or reciprocal agreements between both countries.1
Doctors from Australia, the United Kingdom, and North
America are exempt from sitting the English examination (as the medium of
instruction in the medical schools they have trained at is English.)1 IMGS from
all other parts of the world have to sit both written and oral examinations.
Additionally, they have to pass an English examination to practice medicine,
although there are some exceptions.1 For the purposes of this study, IMGS refers
to doctors trained in countries that do not have reciprocal registration
arrangements with New Zealand.
In recent years, a specific training programme called
The Bridging Programme has been
introduced to help prepare some IMGS for the New Zealand registration
examination (NZREX).2 However even after passing the NZREX or achieving entry
into the New Zealand health system through other means, IMGS may experience
other difficulties such as differences in practice, lack of familiarity with the
New Zealand hospital system, cultural differences, and language barriers.
Fortunately, most IMGS overcome these difficulties and
adapt. Unfortunately, for some doctors, the road to this is a long and difficult
one. Often an important phase of entry into more independent practice within the
New Zealand health system is a period of time spent in public hospitals under
supervision of intern supervisors, in conjunction with reports from colleagues
within the health system.
In this study we were interested in identifying the training
needs for IMGS based on the reports of colleagues within the health system as
well as determining if there were any differences between doctors’ and
nurses’ ratings.
The aims of the study were to:
MethodsThis is a pilot study, conducted in acute care
hospitals in greater Wellington region. With the agreement of the service and/or
clinical leaders and the team leaders, anonymous self-addressed envelopes
containing a questionnaire were posted to the consultants, registrars, and house
surgeons as well as the charge nurse/team leader, clinical nurse specialist, and
three senior registered nurses (as identified by the charge nurse/team leader)
in general medical and general surgical areas.
Senior registered nurses, for the purposes of this
study, were those with more than 4 years of post-registration experience. All
doctors, regardless of whether they had a New Zealand or overseas qualification,
received the questionnaire.
The questionnaire was based on the Resident Medical
Officer (RMO) run review form from Capital and Coast District Health Board
(CCDHB) and the Northern Clinical Training Network (NCTN) questionnaire.4 The
questions that cover a number of dimensions of hospital practice were each rated
with a response indicating a RMO performs at a poor level (rating=1) to an
excellent level (rating=5). A level of ‘3’ is considered
satisfactory.
New Zealand doctors (NZD) were considered to be either
New Zealand-qualified doctors or IMGS who had worked in New Zealand for 5 years.
The latter were considered likely to have integrated successfully into the New
Zealand health system. A copy of the questionnaire is available from the authors
on request. Potential areas of improvement were identified by median scores of
less than ‘3’.
Ratings by doctors and nurses to the same questions
were compared using the Mann-Whitney test, using a p value of 0.10 to identify
potential differences.
ResultsThe response rate for the doctor’s questionnaire was
68/174 (39.1%) and for the nurses questionnaire it was 58/60 (96.7%); 51 of the
doctor’s questionnaires were from NZDs, and one of these doctors had not
worked with an IMG in the last year. The doctors scored four questions and
nurses scored two questions with a median score of less than ‘3’.
The remaining questions had a median score of ‘3’.
No question had a median score of more than ‘3’.
Doctors and nurses median scores were not different at a type 1 error rate of
less than 0.1. Five questions had median scores of less than ‘3’ for
either doctors or nurses. They were documentation (clinical clerking, adequacy
of records, legibility, accurate drug charts); communication ability with
patients and their families; communication with other healthcare professionals;
professional knowledge (hospital policies and procedures, medicolegal
matters); and patient management (management decisions, response to calls,
emergency care).
DiscussionThis small study found the perceptions of the hospital
nurses of IMGS were satisfactory. The low response rate from doctors could
reflect the reluctance of doctors to comment on fellow colleagues and tackle the
sensitive issue of medical performance questions. However, the study identified
potential areas for improvement including communication (both with patients,
their families, and health professionals), documentation, knowledge of the
health system, and some aspects of patient management.
Less than satisfactory communication skills were not due to
poor English skills. The strength of our study is that it directly involved
colleagues of IMGS who work with them daily. Our study reflects only doctors and
nurses in the greater Wellington area who may have a different experience from
those in other parts of New Zealand.
Although the questionnaire appears to have face validity,
its reliability and responsiveness to both poor and excellent practice is not
known. Additionally, in an effort to maintain confidentiality, the respondents
were not asked to specify their own background or the IMG they were assessing.
This could have included doctors from countries with reciprocal registration
arrangements with New Zealand being inadvertently assessed as IMGS. However we
think that the comments made addressed our target group.
Improvement in the aspects of practice identified in this
study might partly be achieved by establishing a 6-week pre-employment training
program similar to that of trainee interns. A pre-employment program for IMGS
has been successfully trialled in Australia.3 This may address the
‘professional knowledge’, ‘patient management’, and
communication issues identified in our study. Another way of addressing the
communication issues might be to establish regular performance reviews with the
assigned supervisor.
As this is a pilot study, we believe a follow-up study
specifically for IMGS would be useful as it may get a better understanding of
the experiences of IMGS in New Zealand and it may identify their perceived
needs.
We recommend that the MCNZ publish statistics on those IMGS
working in New Zealand who are from countries that do not have reciprocal
registration arrangements with New Zealand—as it may benefit any future
studies on this topic.
Author information:
Seshasayee Narasimhan, Medical Registrar, Department of Internal Medicine,
Wellington Hospital; Anil Ranchord, Medical Registrar, Department of Internal
Medicine, Wellington Hospital; Mark Weatherall, Associate Professor,
Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington
School of Medicine and Health Sciences, Otago University; Wellington
Correspondence: Dr
Seshasayee Narasimhan, 24 Virginia Grove, Brooklyn, Wellington 6002. Email: docsesh@gmail.com
References:
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