Medical students and refugee doctors: learning together

Abstract

assessing residents' interpersonal and communication skills in asthma cases. Why the idea was necessary Child or adolescent SPs have been used increasingly in the assessment of residents' clinical skills. However, no prior studies have evaluated the reliability of adolescent SPs in assessing the interpersonal and communication skills of residents in cases of asthma. Several prior studies have raised the question of whether SPs can assess interpersonal and communication skills as reliably and validly as faculty members. Resolving this question is extremely important in view of increasing clinical demands on faculty time. Thus, we decided to examine adolescent SPs' reliability in assessing residents' interpersonal and communication skills in asthma. What was done We conducted a prospective criterion standard study at a major academic medical centre. Twelve adolescent SPs were trained to rate residents' interpersonal and communication skills in a scenario involving a patient with asthma. A cohort of paediatric residents (n ¼ 18) interviewed the SPs. All interviews were directly observed by 2 trained faculty members. The SPs and faculty stuff completed identical checklists immediately following the encounter and were blinded to each others' ratings. The checklist items were adapted from the National Heart, Lung and Blood Institute Guidelines for the Diagnosis and Management of Asthma. Faculty ratings were used as the criterion standard. To validate SP ratings, we made comparisons between faculty and SP ratings. We assessed inter-rater reliability by determining the percentage of agreement, Kendall tau-b coefficient of concordance, and Cohen's kappa coefficient of correlation. Evaluation of results and impact Overall, 36 resident-SP interactions were analysed. There was a statistically significant high level of correlation between faculty and SP ratings in all areas of the interpersonal and communication skills assessed, including in terms of questions asked and information provided by the residents. Examples of statements from the checklists and their corresponding results for inter-rater reliability measures are as follows:• ÔThe doctor explained things clearlyÕ (percentage agreement 100%, Kendall tau-b coefficient ¼ 1.00, kappa ¼ 1.00; P < 0.0001); • ÔThe doctor asked about asthma medicationsÕ (percentage agreement 100%, Kendall tau-b coefficient ¼ 1.00, kappa ¼ 1.00; P < 0.0001); • ÔThe doctor asked about asthma triggersÕ (percentage agreement 94%, Kendall tau-b coefficient ¼ 0.89, kappa ¼ 0.89; P < 0.0001); • ÔThe doctor provided education about asthmaÕ (percentage agreement 94%, Kendall tau-b coefficient ¼ 0.86, kappa ¼ 0.85; P ¼ 0.002); • ÔThe doctor asked about night-time symptomsÕ (percentage agreement 89%, Kendall tau-b coefficient ¼ 0.66, kappa ¼ 0.64; P ¼ 0.005), and • ÔThe doctor asked about my feelings of having asthmaÕ (percentage agreement 83%, Kendall tau-b coefficient ¼ 0.71, kappa ¼ 0.68; P < 0.0001).The results of this study provide evidence that support the use of adolescent SPs in the assessment ...

Supporting international medical graduates’ transition to their host-country: realist synthesis

“…A safe environment, which is low risk and controlled, must be created when implementing interventions for IMGs (c)(CS1‐7, 10‐11, 13). IMGs must feel able to recognise and admit mistakes and share challenges without fear, reducing anxiety both during the intervention and in practice (m) .…”

“…Experiential learning with feedback and reflection (CS1‐3, 7, 11, 13), such as simulation and role play, creates active participation (c), enabling IMGs to learn through errors, problem solving and skill rehearsal and relate these to real life practice (m) . Professional self‐efficacy will increase (m), enabling IMGs to feel more able to apply new knowledge and skills in practice (o) (CS1‐3).…”

“…Learning is both an individual and social experience and small group discussion and peer feedback are essential (c) (CS1‐3, 6, 10, 14), as they promote self‐reflection and self‐awareness (transformative learning) (m). Engagement is much more likely to occur in small groups than in larger groups (m) once initial shyness is overcome .…”

“…The programme content must be relevant to IMGs and reflect issues of concern to them (CS1‐7, 9, 13, 14), being learner focused and meeting individual needs (c) (CS2, 3, 10). IMGs are more likely to engage with the content (m) if a rationale for learning is identified.…”

“…Peer support in practice is also essential to ensure the necessary support is available . It is noted that there is often a lack of support and cultural awareness amongst colleagues (CS6, 14), which may lead to a risk of stereotyping, prejudice and discrimination (c) (CS14).…”