It takes two to tango: The ‘inter’ in intercultural competence
Abstract: Al‐Haddad and Lu highlight the importance of developing intercultural competence for healthcare students and professionals, whether migrating, visiting, or hosting people from other cultures.
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Cited by 4 publications
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International medical graduates' social connections: A qualitative study
IntroductionSocial connections in the host country improve International Medical Graduates' (IMGs') well‐being, intercultural competence and performance at work but is an issue that has been largely overlooked in the academic literature and policy discussions. The aim of this study was to better understand the social connections that IMGs form by exploring this phenomenon in a UK context.MethodsIMGs and UK Medical Graduates (UKMGs) practising in Scotland were invited to participate. This was a qualitative study using online semi‐structured interviews for data collection and reflexive thematic analysis.ResultsForty‐one participants were recruited (24 IMGs and 17 UKMGs), selected with maximum variation in terms of gender, ethnicity, speciality, grade and country of primary medical qualification. Twenty‐one (58%) of the participants had experience working in other parts of the UK.Five themes were identified: (i) overcoming early isolation, IMGs strove to overcome their initial social isolation which harmed their mental well‐being; (ii) where connections are made, IMGs form social connections mainly at work and within their religious communities; (iii) seeds of segregation, some IMGs found themselves outside tight UK native friendship groups. Alcohol was a socially exclusive activity for some IMGs, as were other host country cultural norms. Exclusion led IMGs to form social connections with other IMGs or other ‘outsider’ groups; (iv) degrees of Discrimination, discrimination and racism were experienced by some IMGs. Discrimination was individual, structural and institutional, and (v) “Open (ing) the door”, participants described interventions at organisational, departmental, and individual levels to improve IMGs' ability to form social connections.DiscussionThis study highlighted the challenges that IMGs face when trying to form social connections. More emphasis needs to be placed on promoting an environment where social connections, in particular between IMGs and host country natives, can flourish.
International medical graduates' social connections: A qualitative study
IntroductionSocial connections in the host country improve International Medical Graduates' (IMGs') well‐being, intercultural competence and performance at work but is an issue that has been largely overlooked in the academic literature and policy discussions. The aim of this study was to better understand the social connections that IMGs form by exploring this phenomenon in a UK context.MethodsIMGs and UK Medical Graduates (UKMGs) practising in Scotland were invited to participate. This was a qualitative study using online semi‐structured interviews for data collection and reflexive thematic analysis.ResultsForty‐one participants were recruited (24 IMGs and 17 UKMGs), selected with maximum variation in terms of gender, ethnicity, speciality, grade and country of primary medical qualification. Twenty‐one (58%) of the participants had experience working in other parts of the UK.Five themes were identified: (i) overcoming early isolation, IMGs strove to overcome their initial social isolation which harmed their mental well‐being; (ii) where connections are made, IMGs form social connections mainly at work and within their religious communities; (iii) seeds of segregation, some IMGs found themselves outside tight UK native friendship groups. Alcohol was a socially exclusive activity for some IMGs, as were other host country cultural norms. Exclusion led IMGs to form social connections with other IMGs or other ‘outsider’ groups; (iv) degrees of Discrimination, discrimination and racism were experienced by some IMGs. Discrimination was individual, structural and institutional, and (v) “Open (ing) the door”, participants described interventions at organisational, departmental, and individual levels to improve IMGs' ability to form social connections.DiscussionThis study highlighted the challenges that IMGs face when trying to form social connections. More emphasis needs to be placed on promoting an environment where social connections, in particular between IMGs and host country natives, can flourish.
Reclaiming identities: exploring the influence of simulation on refugee doctors’ workforce integration
BackgroundHealthcare professionals are a precious resource, however, if they fail to integrate into the workforce, they are likely to relocate. Refugee doctors face workforce integration challenges including differences in language and culture, educational background, reduced confidence, and sense of identity. It has been proposed that simulation programmes may have the power to influence workforce integration. This study aimed to explore how an immersive simulation programme influenced workforce integration for refugee doctors joining a new healthcare system.MethodsDoctors were referred to a six-day immersive simulation programme by a refugee doctor charity. Following the simulation programme, they were invited to participate in the study. Semi-structured interviews, based on the ‘pillars’ conceptual model of workforce integration, were undertaken. Data were analysed using template analysis, with the workforce integration conceptual model forming the initial coding template. Themes and sub-themes were modified according to the data, and new codes were constructed. Data were presented as an elaborated pillars model, exploring the relationship between simulation and workforce integration.ResultsFourteen doctors participated. The ‘learning pillar’ comprised communication, culture, clinical skills and knowledge, healthcare systems and assessment, with a new sub-theme of role expectations. The ‘connecting pillar’ comprised bonds and bridges, which were strengthened by the simulation programme. The ‘being pillar’ encompassed the reclaiming of the doctor’s identity and the formation of a new social identity as an international medical graduate. Simulation opportunities sometimes provided ‘building blocks’ for the pillars, but at other times opportunities were missed. There was also an example of the simulation programme threatening one of the integration pillars.ConclusionsOpportunities provided within simulation programmes may help refugee doctors form social connections and aid learning in a variety of domains. Learning, social connections, and skills application in simulation may help doctors to reclaim their professional identities, and forge new identities as international medical graduates. Fundamentally, simulation experiences allow newcomers to understand what is expected of them. These processes are key to successful workforce integration. The simulation community should be curious about the potential of simulation experiences to influence integration, whilst also considering the possibility of unintentional ‘othering’ between faculty and participants.
“It is exhausting … to keep up an interested and pleasant eager face throughout”: Impression management in the clinical learning environment
Background: Existing literature suggests that learning during clinical placements is predominantly informal and unstructured, requiring medical students to be proactive and agentic to maximise learning opportunities. Exploring ways in which students navigate social structures of the clinical learning environment (CLE) through Goffman’s theory of impression management should illuminate our perspective on agentic efforts related to work-based learning. This in-turn should aid in better preparation of medical students for learning in the clinical environment and support enhanced student experience and well-being. Method: An ethnographic approach included 120 hours of observations conducted in two wards hosting clinical placements for medical students, in a Scottish urban hospital. Additionally, individual interviews with 36 staff and students who populated these clinical sites, aimed to capture the lived experiences and perspectives around self-presentation, and impact of these performances in the workplace. Sensitising concepts from Goffman’s theory related to impression management served as priori guides in data analysis to identify prominent patterns. Results: We identified five key themes: students display a veneer of interest and engagement aligned to their understanding of the social norms in the CLE, creating a positive first impression on healthcare staff is a preventive practice adopted by students to avoid interprofessional conflicts, atypical personal front of overseas doctors and students impacts their social status, participatory learning with near peers involves less impression management burden and consequent stress, and understanding social rules of the CLE takes time and slows learning. Conclusion: The study findings reveal diverse ways in which medical students perform their role in the CLE through presentation of themselves and their activities to others. Engineering convincing and desired impressions is an affective and cognitive task for students, in their dual position of actor-performers and learners. Our findings indicate that certain personal fronts punctuate student learning, and we advocate for clinical workplaces to incorporate participatory learning opportunities, given their empowering benefits. Robust induction programmes and allowing learners to be authentically contributory in the CLE should ensure that diverse learners thrive in unfamiliar cultural spaces.
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