Cultural dimensions in the transition of overseas medical graduates to the UK workplace

Abstract

Background: Historically, overseas-qualified doctors have been essential for meeting service needs in the UK National Health Service (NHS). However, these doctors encounter many cultural differences, in relation to training, the healthcare system and the doctor-patient relationship and training. Aim: To examine whether Hofstede's cultural model may help us understand the changes doctors from other countries experience on coming to work in the UK, and to identify implications for supervisors and clinical teams. Method: Telephone interviews were conducted with overseas medical graduates before starting work as a Foundation Year One (F1) doctor, followed up after four months and 12 months; and with educational supervisors. Data were analysed using a confirmatory thematic approach. Results: Sixty-four initial interviews were conducted with overseas doctors, 56 after four months, and 32 after 12 months. Twelve interviews were conducted with educational supervisors. The changes doctors experienced related particularly to Hofstede's dimensions of power distance (e.g. in relation to workplace hierarchies and inter-professional relationships), uncertainty avoidance (e.g. regarding ways of interacting) and individualism-collectivism (e.g., regarding doctor-patient/family relationship; assertiveness of individuals). Conclusion: Hofstede's cultural dimensions may help us understand the adaptations some doctors have to make in adjusting to working in the UK NHS. This may promote awareness and understanding and greater 'cultural competence' amongst those working with them or supervising them in their training.

Power distance and migrant nurses: The liminality of acculturation

“…Loss of familiarity and comfort with power distance expectations have also been highlighted in Morrow’s, Rothwell, Burford, and Illing () qualitative study of 66 UK new migrant doctors from high power distance countries. Participants in their study noted significant adjustments.…”

“…In a comparative study investigating clinical reasoning skills in an Australian and an Indonesian medical school, the findings illustrated that power distance differences were evident between participants at the two sites, thus playing a significant part in the students’ different attitudes to authority, which impacted on uncertainty avoidance (Findyartini, Hawthorne, McColl, & Chiavaroli, ). A UK study by Morrow, Rothwell, Burford and Illing () used the concept of power distance to portray that status and hierarchy were the most challenging area to navigate for new migrant doctors from high power distance countries across all professional relationships. In another UK study, researchers identified high power distance was evident in the ways international medical graduates engaged with simulated patients, compared to their UK educated counterparts (Verma, Griffin, Dacre, & Elder, ).…”

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How does culture affect experiential training feedback in exported Canadian health professional curricula?

“…Hofstede has put forth a theoretical framework to describe a country’s cultural predisposition according to its population’s proclivity across six main domains (power distance, collectivism, uncertainty avoidance, long term orientation, indulgence and masculinity) 16 . This cultural dimensions’ concept has been previously employed in health research, notably as it pertains to understanding communication between health professional and patients among international medical graduates joining practice in the UK 17 , 18 . According to Hofstede, relative distinctions between Canadian and Middle East regions exist in cultural dimensions of power distance, individualism and uncertainty avoidance.…”