BMJ 2013;347:f7176 doi: 10.1136/bmj.f7176 (Published 2 December 2013)
Page 1 of 2
Views & Reviews
VIEWS & REVIEWS FROM THE FRONTLINE
Indebted to international medical graduates Des Spence general practitioner, Glasgow of medicine and broader society, and the NHS is privileged by their presence.
Yet the NHS reflects little on these facts, nor on the ethics of mining rare resources from developing countries. And if IMGs are competent to practise as junior doctors then logically they are also competent to practise as senior doctors. So why do they have less chance of career progression?5 Perhaps it’s weaknesses in initial selection and poor training, but the strongest theme is that there’s a cultural bias in postgraduate exams. But British culture is in flux. Do these exams reflect the cultural reality of the 13% of the population who are born abroad,6 in some areas rising to more than half of residents?7 Exams are a mere snapshot in time, and continuous oversight through reaccreditation makes exams far less important.
In 1979 I moved from Oxford to Orkney. I landed at a small rural Presbyterian school in an Afghan jacket, flared embroidered jeans, and a necklace, sporting shoulder length hair. I smelt of goat. Framed by the doorway, my future classmates looked at me, and I looked at them. This was more a Roswell than a Ring of Bright Water moment. Looking and sounding different, even when you speak the same language, breeds feelings of isolation, resentment, frustration, judgment, discrimination, and anger. All you can do is wait and hope for change.
Much has been written about the exam performance of international medical graduates (IMGs), with explanations, rationalisations, and reasons—but little exploration of how they feel.1-3 Medical immigrants make great sacrifices, of family, culture, friends, and country. They often leave senior positions in their own countries, and some spend their life savings to do so. These doctors are recruited as NHS junior doctors under the pretext of education but are cast off to work in unpopular areas. And let’s not pretend that they receive much education or supervision. IMGs currently make up a staggering 30% of the medical workforce: the NHS would cease to function without them.4 You cannot overstate the contribution they have made to British medicine over the decades. And British medicine enjoys a disproportionate position in the medical world partly through these international links. IMGs have enriched the culture
If the General Medical Council and the NHS allow IMGs to practise in the UK, they should have a duty to ensure that they can progress in their careers just as British graduates can. Few IMGs have spoken out about how they feel, but it seems to me that we are not treating them fairly. Irrespective of the findings of the judicial review into the Royal College of General Practitioners exams,8 we should do much more to support and value IMGs. Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare. Provenance and peer review: Commissioned; not externally peer reviewed. 1 2 3 4 5 6 7 8
Bhopal RS. We need to investigate whether racial discrimination explains differences in MRCGP exam results. BMJ 2013;347:f6479. Knight RA. Reasons why doctors who perform well as doctors may fail the MRCGP clinical skills assessment exam. BMJ 2013;347:f6438. Shaw Q. High failure rate of ethnic minority groups in MRCGP exam comes from changes to exam and candidate selection. BMJ 2013;347:f6442. BMA. NHS watch: How many doctors work in the UK. http://bma.org.uk/working-forchange/nhs-watch-how-many-doctors-work-in-the-uk. Esmail A. Academic performance of ethnic minority candidates and discrimination in the MRCGP examinations between 2010 and 2012: analysis of data. BMJ 2013;347:f5662. Office of National Stastics. 2011 census shows non-UK born population of England and Wales continues to rise. 2012. www.ons.gov.uk/ons/rel/census/2011-census/key-statisticsfor-local-authorities-in-england-and-wales/sty-non-uk-born-population.html. The UK’s foreign-born population: see where people live and where they’re from. Guardian 2011 May 26. www.theguardian.com/news/datablog/2011/may/26/foreign-born-ukpopulation GMC named as defendant in judicial review over MRCGP exam. Pulse 2013 Oct 18. www.pulsetoday.co.uk/your-practice/practice-topics/education/gmc-named-as-defendantin-judicial-review-over-mrcgp-exam/20004786.article.
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Subscribe: http://www.bmj.com/subscribe
BMJ 2013;347:f7176 doi: 10.1136/bmj.f7176 (Published 2 December 2013)
Page 2 of 2
VIEWS & REVIEWS
Cite this as: BMJ 2013;347:f7176
For personal use only: See rights and reprints http://www.bmj.com/permissions
© BMJ Publishing Group Ltd 2013
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
Views & Reviews
VIEWS & REVIEWS FROM THE FRONTLINE
Indebted to international medical graduates Des Spence general practitioner, Glasgow of medicine and broader society, and the NHS is privileged by their presence.
Yet the NHS reflects little on these facts, nor on the ethics of mining rare resources from developing countries. And if IMGs are competent to practise as junior doctors then logically they are also competent to practise as senior doctors. So why do they have less chance of career progression?5 Perhaps it’s weaknesses in initial selection and poor training, but the strongest theme is that there’s a cultural bias in postgraduate exams. But British culture is in flux. Do these exams reflect the cultural reality of the 13% of the population who are born abroad,6 in some areas rising to more than half of residents?7 Exams are a mere snapshot in time, and continuous oversight through reaccreditation makes exams far less important.
In 1979 I moved from Oxford to Orkney. I landed at a small rural Presbyterian school in an Afghan jacket, flared embroidered jeans, and a necklace, sporting shoulder length hair. I smelt of goat. Framed by the doorway, my future classmates looked at me, and I looked at them. This was more a Roswell than a Ring of Bright Water moment. Looking and sounding different, even when you speak the same language, breeds feelings of isolation, resentment, frustration, judgment, discrimination, and anger. All you can do is wait and hope for change.
Much has been written about the exam performance of international medical graduates (IMGs), with explanations, rationalisations, and reasons—but little exploration of how they feel.1-3 Medical immigrants make great sacrifices, of family, culture, friends, and country. They often leave senior positions in their own countries, and some spend their life savings to do so. These doctors are recruited as NHS junior doctors under the pretext of education but are cast off to work in unpopular areas. And let’s not pretend that they receive much education or supervision. IMGs currently make up a staggering 30% of the medical workforce: the NHS would cease to function without them.4 You cannot overstate the contribution they have made to British medicine over the decades. And British medicine enjoys a disproportionate position in the medical world partly through these international links. IMGs have enriched the culture
If the General Medical Council and the NHS allow IMGs to practise in the UK, they should have a duty to ensure that they can progress in their careers just as British graduates can. Few IMGs have spoken out about how they feel, but it seems to me that we are not treating them fairly. Irrespective of the findings of the judicial review into the Royal College of General Practitioners exams,8 we should do much more to support and value IMGs. Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare. Provenance and peer review: Commissioned; not externally peer reviewed. 1 2 3 4 5 6 7 8
Bhopal RS. We need to investigate whether racial discrimination explains differences in MRCGP exam results. BMJ 2013;347:f6479. Knight RA. Reasons why doctors who perform well as doctors may fail the MRCGP clinical skills assessment exam. BMJ 2013;347:f6438. Shaw Q. High failure rate of ethnic minority groups in MRCGP exam comes from changes to exam and candidate selection. BMJ 2013;347:f6442. BMA. NHS watch: How many doctors work in the UK. http://bma.org.uk/working-forchange/nhs-watch-how-many-doctors-work-in-the-uk. Esmail A. Academic performance of ethnic minority candidates and discrimination in the MRCGP examinations between 2010 and 2012: analysis of data. BMJ 2013;347:f5662. Office of National Stastics. 2011 census shows non-UK born population of England and Wales continues to rise. 2012. www.ons.gov.uk/ons/rel/census/2011-census/key-statisticsfor-local-authorities-in-england-and-wales/sty-non-uk-born-population.html. The UK’s foreign-born population: see where people live and where they’re from. Guardian 2011 May 26. www.theguardian.com/news/datablog/2011/may/26/foreign-born-ukpopulation GMC named as defendant in judicial review over MRCGP exam. Pulse 2013 Oct 18. www.pulsetoday.co.uk/your-practice/practice-topics/education/gmc-named-as-defendantin-judicial-review-over-mrcgp-exam/20004786.article.
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
BMJ 2013;347:f7176 doi: 10.1136/bmj.f7176 (Published 2 December 2013)
Page 2 of 2
VIEWS & REVIEWS
Cite this as: BMJ 2013;347:f7176
For personal use only: See rights and reprints http://www.bmj.com/permissions
© BMJ Publishing Group Ltd 2013
Subscribe: http://www.bmj.com/subscribe
