If you’re new to North Devon, the UK or trained overseas then we would all like to take the opportunity to say welcome and we hope you have a great time living and working here. We recognise that those trainees who come from overseas generally possess a huge reserve of resilience.  Deciding to continue your medical education in a different country potentially in a different language is a massive and daunting challenge that should be recognised and appreciated. We’re glad you chose our little part of the country to come and enjoy!

Due primarily, but not entirely, to the differences in experiences as an undergraduate or when growing up outside the UK we’re aware that trainees from overseas (often referred to as International Medical Graduates or IMGs) or from Black, Asian and Minority Ethnic (BAME) backgrounds often have more difficulty with postgraduate training than UK graduates. This has been examined in depth by many Royal Colleges including the Royal College of General Practitioners and the BMA and advice has been given to help both trainees and trainers. What is clear from all the research undertaken is that the reasons behind lower pass marks in this cohort is not down to capability but more a reflection on the level of “Britishness” deemed to be the starting point in training. UK graduates who are used to the NHS as a system, speak English as a first language and understand the local dialect and traditions for example have a huge advantage over a trainee who may have recently moved to the UK and is learning to practice in their second or third language with a system that they haven’t experienced before.

Although it is important to try not to label people, as it risks developing stereotypes, and rather embrace individuality and diversity it is also important to recognise that those trainees who have recently come to the UK will face some difficulties that their UK trained colleagues may not. This page is designed to offer some resources that may be helpful to understand the difficulties and develop a greater understanding of British culture, language and linguistics which is often the crux of the issues seen within the consultation and the CSA.

Your trainer will want to understand where they can best help you get used to the local dialect, customs and practices to help develop communication skills that will make assessments like COTs and the CSA feel more natural. Hopefully, the resources and ideas below here can be used as an adjunct to your trainer/trainee relationship.

Locally you may find yourself quite isolated in some of the more rural areas. It can be quite tempting to go home straight after surgery and relax into your first language after a hard day. Feedback from previous trainees suggests that trying to embrace the local culture will help with not only feeling less isolated but also developing a more natural understanding of English language, linguistics and customs. Join practice staff for social occasions, enrol in a local sports team or social group, watch British soap operas on TV (apologies; they are almost always depressing but will help!) or listen to British radio.

Jill Choudhury, from the Dorset VTS, has kindly created a glossary of colloquial UK medical terms which you can find here. I think it’s great to flick through and will help when the patient might say they want to “spend a penny” for example!

With regards to the consultation and the system as a whole, starting right from the beginning, this link is a short video outlining British General Practice and how it fits into the NHS. There are a number of books that can help with consultation skills as they are taught on the GP Vocational Training Scheme (VTS) (the hyperlinks are there solely to show you the book not to advise you on where to buy them!):

The Inner Consultation by Roger Neighbour

Skills for Communicating with Patients by Silverman, Kurtz and Draper

The Naked Consultation by Liz Moulton

Practicing communication skills requires repetition and regular review with your trainer. Embrace the video camera early as an effective tool to review cases and discuss the language that you used and the patient communicates with. Don’t be afraid to ask questions of colleagues, educators and the patients if you are unsure of the language that was used. British people can often not mean exactly what they say so it can take some time to get used to what they are actually telling you. Don’t fall into the trap of thinking a CSA course will give you all the answers to passing the CSA. Yes, they can be useful to prepare for the exam but must be a small part of a greater plan whose back bone is practice, practice, practice!

Finally, if you find that you are struggling to come to terms with a new culture, feel isolated or just want to chat to someone please let any of the team know nice and early. Don’t let yourself get behind or feel overwhelmed, we’re very much here to help.