Abstract:

Background:
The decision to work in a foreign healthcare system and the lengthy process can be daunting for International Medical Graduates (IMGs), despite their qualifications and skills acquired in their home countries. It is not straightforward to take on the mammoth task of adapting to a new country and, quite often, a very different healthcare system. Recognizing this challenge, an online course has been developed to specifically address and alleviate the fears that prospective IMGs may have when considering joining the National Health Services (NHS) in the UK. Our department hosted an impactful online webinar for IMGs last year receiving great feedback. Drawing insights from this experience, we strategically organised another course this year, achieving even greater success.

Aim:
To identify the biggest fears of IMGs regarding the NHS, and address those fears via a locally designed online course

Method:
The course was created after consultation with IMGs currently working in the NHS, and the content was based on the three Higher Level Outcomes (HLOs) of the Foundation Programme and it was designed to tackle common fears of new IMGs in the first month of working in the NHS and to fulfil the expectations for doctors in the UK. The course was held on a free online streaming platform divided into 4 sessions, delivered weekly. Each session had an initial presentation followed by an interactive question answer segment, had 3 faculty personnel, and lasted 2 hours. Interactive teaching methods such as case-based discussion, documentation simulation and live quizzes were deployed. A good laptop with internet connection was all the equipment needed for the course. Pre and post course questionnaires were used to analyse course content and change in participants’ confidence, motivation and fear regarding working in the NHS.

Results:
In total, 699 participants registered for the course. About 92% of them had never attended similar courses before, and about 73% has never worked in the NHS. Primary motivation for working in the NHS were better training (56%), better lifestyle in a developed country (17%), better work-life balance (17%), being with family (5%) and better salary (4%). The biggest fear of prospective IMGs regarding working in the NHS were lack of knowledge of the NHS system (32%), medico-legal issues (25%), workload (11%), clinical knowledge/ skills (9%), on-calls (6%), short staffing (5%), communication skills in challenging situations (4%), dealing with difficult colleagues (4%), unwell patients (2%) and others (1%).

406 unique attendees were recorded and 281 participants completed post-course feedback questionnaire. Post course feedback revealed that their confidence about working in the NHS increased by 30% after this course. Their confidence in working on-calls and building portfolio has also increased after the course by 26%. 88% of participants agreed or strongly agreed this course helped them understand fundamental concepts of surviving in NHS as an IMG. 78% of participants said their biggest fear was addressed by this course. The question answer segment was rated helpful by 92% of participants.

Conclusion:
This study illustrated the biggest fear of IMGs is not knowing the NHS system properly. This apprehension can be eliminated by organising similar courses to address specific needs of IMGs with minimal resources via free online platforms. More importantly, these courses are scalable and reproducible.

Keywords:

International Medical Graduates, IMGs.