The IMG Supervisor’s Toolbox

It is well recognised that IMGs face multiple challenges to successful passage through, and completion of, GP training.GPSA recognises the important role that GP supervisors play in supporting IMG registrars and other GPs in training.For consultation skill teaching, please also refer to the Consultation Skills Toolbox and the Consultation Skills Teaching plans here.

Key Resources

Supervising the International Medical Graduate (IMG) GP Registrar Webinar and FAQ.
This video highlights range of practical tips for the supervisor to support the IMG GP registrar in the practice. A written summary of the webinar has been developed as a FAQ.

 

There are a number of broad principles that should guide the supervision of IMG GP registrars.
While these are appropriate to all registrars, they have particular importance for IMGs.
International Medical Graduates are not a homogenous group, and have a wide range of knowledge, skills, attitudes, experience, and backgrounds, even within the same cultural group. This may sound obvious, but it is critical to avoid generalisations or stereotyping, and for supervisors to regard every IMG as unique. Where issues arise, it is critical to specifically ‘diagnose’ the problem (educational, personal etc.), rather than generalising it as being ‘cultural’ or ‘language’.
While often associated with posing educational and training challenges, IMG GPRs can bring a wealth of positive skills, attributes and expertise to GP training and the general practices in which they train. Such positives include:
  • A broader world view
  • Experience of alternative health systems (often in disadvantaged communities)
  • Specific clinical skills
  • Second (or third) languages
  • Resilience to setbacks
Reflecting this, a recent paper on supporting IMG GPRs argued that the focus on supervision of IMG GPRs should be on ‘difference’, not ‘deficit’. Furthermore, the authors stated that labelling IMGs as having learning needs was unfair without also acknowledging their unique strengths.
The IMG GPR is may need increased support across all facets of training – educational, pastoral, personal and professional.
While the transition from the hospital to the general practice setting is potentially highly challenging for all registrars – characterised by a breath of clinical problems, relative independence of decision making, time pressures, management of uncertainty, new practice systems, financial and billing issues – this challenge is likely to be exacerbated for many IMGs.
It is essential that the supervisor of IMG GPRs is willing to take on this broad responsibility, and to be overt about their support role in all aspects of the registrar’s development.
It is vital to foster an open and honest culture of teaching, learning and feedback in the practice.
Supervisors should use a broad range of teaching methods and focus on skill development, rather than clinical knowledge. It may be necessary at times for the supervisor to have challenging conversations with the IMG GPR on sensitive areas like cultural norms and communication issues. Thus, it is critical for both supervisor and registrar to agree on a process for frank feedback, while also maintaining a culture of mutual support.
One of the key planks in effective supervision of the IMG GP registrar is provision of a comprehensive orientation at the commencement of the training term.
In addition to the usual clinical and administrative benefits, there is evidence that effective orientation of IMGs can increase their sense of professional identity, morale and belonging. IMG registrars are likely to benefit from discussion of Aboriginal and Torres Strait Islander culture, as well as Australian culture more broadly, and community support. This may also include an orientation to the IMG registrar’s partner and family.
Supervisors need to engage appropriate support from their regional training organisation, or elsewhere, when performance issues arise.
Performance issues for IMG GPRs are often complex and may require specialist input. Supervisors should therefore have a low threshold for seeking guidance from the registrar’s medical educator.
IMG Principles
There are multiple issues related to cultural differences that are challenges for IMGs.  

Resource

VIDEO: How do cultural values and perceptions impact on clinical care?
It is well known that some IMG registrars have significant language issues that may impact on satisfactory communication, both with patients and peers. IMG GPRs may struggle with fluency and structure, and comprehension of colloquial English. Specific scenarios that require the use of specific communication skills can also be challenging, for example managing the angry patient, and saying no.

Resources

Consultation skills toolbox
VIDEO: Australian slang
Australian slang dictionary
Slang terms in the consulting room
Website: Doctors Speak Up
VIDEO: Doctors Speak Up website
There are many aspects of teaching and learning that may be challenging for IMGs. These include cultural approaches to learning, approach to feedback and help seeking behaviour.

Resources

Self-assessment tool for IMG registrars
Supervisor assessment tool for IMG GP registrars
Teaching and learning toolbox
VIDEO: Socratic versus Confucian conceptions of teaching and learning
Webinar: Communication and Feedback in GP Training – A Cultural Lens

Date reviewed: 19 July 2024

Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.
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