International Journal of Healthcare Simulation

Background:

International Medical Graduates (IMGs) are making up an increasing proportion of the medical workforce in secondary care [1,2]. One of the most popular routes to enter clinical practice in the United Kingdom is through Trust-based Clinical Fellow posts, particularly for those not yet working at Consultant level [2]. At the Royal Wolverhampton NHS Trust (RWT), Clinical Fellows now make up almost half of non-Consultant doctor positions, working alongside, and equivalent to, colleagues that are in traditional training positions. Doctors employed by Health Education England, have specific training pathways that are funded centrally [2]. Conversely, doctors in non-training positions, including Clinical Fellows, do not have access to the same level of structure and funding. This also applies to educational opportunities, including Simulation-Based Education. IMGs often join the National Health Service with a wealth of clinical knowledge, skills, and experience. However, a local learning needs analysis revealed that their biggest challenges lie around differences in healthcare systems and culture. These skills are essential components of non-technical skills, which, we would argue, are ideal to be addressed using a simulation-based approach.

Methods:

The results of the learning needs analysis informed the development of a bespoke simulation-based course for Clinical Fellows at RWT. We discuss the challenges of developing and organising such a course, as well as the successes and learning points gained from a pilot course.

Results:

A pilot course was delivered to three cohorts of Clinical Fellows. All 23 of the participating Clinical Fellows had undergone medical training outside of the United Kingdom. The course comprised a variety of workshops and simulation-based scenarios covering a range of non-technical skills. Pre- and post-course surveys demonstrated significant positive outcomes in all areas, including communication, respectful challenge, breaking bad news, and medical handover.

Conclusion:

Simulation-based education provides a beneficial learning environment for Clinical Fellows. For a group whose biggest learning gap lies with non-technical skills, it can be argued that this cohort of doctors is likely to have a greater benefit from simulation-based education than colleagues that have worked and trained within the United Kingdom. It is envisaged that this data can enable the Clinical Fellow Programme Team to obtain funding for further simulation-based courses aimed at Clinical Fellows in all medical specialties, hence having a positive impact on patient care and safety across the Trust.

References

1. Baker C. NHS staff from overseas: statistics. House of Commons Library; 2021

2. Jalal M, Bardhan KD, Sanders D, Illing J. Overseas doctors of the NHS: migration, transition, challenges and towards resolution. Future healthcare journal. 2019;6(1):76–81.