1. Peter Morley, ICU RMH International Medical Graduates Peter Morley

2. Peter Morley, ICU RMH Variability in medical training Entry Duration Curriculum –Educational style –Clinical involvement before graduate Timing of specialisation Nature of postgraduate experience

3. Peter Morley, ICU RMH Variability in medical practice Public vs private How funded, how doctors paid Reciprocal healthcare agreements Prescribing –How to do it (legally) –Tricks and traps Mandatory reporting –Coroner’s court, suspected abuse, diseases

4. Peter Morley, ICU RMH Working in a hospital in Australia Your role within the hierarchy Interactions with nursing staff (and others) Informed consent to treatment Confidentiality Not for resuscitation orders Emergency procedures Communication with staff/patient/relatives Quality assurance Patient rights (and expectations): incl. right to know Patient complaints, medical defense insurance

5. Peter Morley, ICU RMH Medicine in Australia Common diagnoses Uncommon diagnoses! Available investigations (vs unavailable) Appropriate investigations (vs inapprop.) Available treatment (vs unavailable) Appropriate treatment (vs inapprop) Resources available (vs limited)

6. Peter Morley, ICU RMH

13. Pathways General registration –“General Practice” Specialist Vocational Training –Assessed by specialist colleges –Variable approach to recognition of prior training

14. Peter Morley, ICU RMH

15. What is culture?

16. Peter Morley, ICU RMH

19. In your opinion how does your culture influence the way people do the following? Greet each other React to a compliment Apologise Watch TV Regard sexual behaviour Dismiss employees Interview applicants Assess their status in society Standing position when talking to the boss Define friendship Make small talk O’Sullivan, K (1994) Understanding Ways Communicating Between Cultures

20. Peter Morley, ICU RMH Key factors to consider

21. Peter Morley, ICU RMH

22. Ethnocentrism and stereotyping

23. Peter Morley, ICU RMH Culture specific assumptions- Ethnocentrism

24. Peter Morley, ICU RMH Culture specific assumptions- Ethnocentrism

25. Peter Morley, ICU RMH Culture specific assumptions- Ethnocentrism

26. Peter Morley, ICU RMH Ways to acknowledge the validity of other cultures (1) Understand that culture is pervasive. It influences the way you act, see, feel, do, interact, and behave. Accept that quite a lot of your own behaviour is rule-governed and ritualised. You are a member of a culture which regulates your behaviour. Don’t make assumptions about other people’s culture based on their ethnicity or nationality. Don’t draw conclusions about a person’s culture based on some aspect of their lifestyle.

27. Peter Morley, ICU RMH Ways to acknowledge the validity of other cultures (2) Don’t assume that when you see something familiar in another culture that it has the same meaning and significance as in your culture. Don’t make the mistake of thinking that your culture is more complex than others. Allow yourself to like and dislike aspects of other cultures, but don’t condemn entire cultures. Don’t make the mistake of thinking that the people in your culture are diverse individuals, whereas the people in other cultures are indistinguishable.

28. Peter Morley, ICU RMH Ways to acknowledge the validity of other cultures (3) Don’t feel that you have to change your culture. Remember that your aim is to become a more skilled communicator, not a ‘better’ person. If you meet someone from another culture whom you don’t like, don’t generalise. Remember this happens in your own culture (and you don’t generalise and dismiss all of the people in your own culture.)

29. Peter Morley, ICU RMH Ways to avoid ethnocentric behaviour (1) Remember, cultures manage their bodies differently, requiring different behaviours and imposing different constraints on physical actions. Acknowledge that your language is not “better” (more precise, more complex, more beautiful) than other languages. Understand that other cultures are not necessarily trying to achieve the same things as you. They may have different values. Understand that other cultures may be trying to achieve the same things as you, but may do so in very different ways. Accept that your own behaviour stems from a set of cultural values.

30. Peter Morley, ICU RMH Ways to avoid ethnocentric behaviour (2) Accept that your perceptions stem from a set of concepts and attitudes developed by your tribe. Your perceptions are biased and subjective. Remember that other cultures may have a different perspective on power distance (between bosses and workers, for example). Remember that other cultures may have a different predisposition to uncertainty avoidance. Above all, don’t assume your way is the way. Be ready for different approaches.

31. Peter Morley, ICU RMH I get uncomfortable or irritated when someone (1): Speaks a language other than English in the workplace. Speaks English with a strong “foreign” accent. Does not take initiative. Agrees with everything I say, even when she or he does not agree with me or understand. Frequently challenges me in front of colleagues. Stands too close to me. Stands too far away from me. Fails to show understanding or acknowledge what I am communicating. Does not make eye contact.

32. Peter Morley, ICU RMH I get uncomfortable or irritated when someone (2): Agrees with everything I say but does not act in ways that suggest agreement. Speaks very softly. Speaks very loudly. Shies away from conflict. Is often silent. Does not answer questions directly. Gets emotional when provided with feedback. Is argumentative. Giggles and smiles at “inappropriate times”. Always answers questions. Never answers questions.

33. Peter Morley, ICU RMH How do you interpret these behaviors? What might these behaviors mean to the other person?

34. Peter Morley, ICU RMH What is your general style of communication when at work?

35. Peter Morley, ICU RMH What about the communication style of a colleague with whom you do not communicate well.?

36. Peter Morley, ICU RMH Barriers to communication Assuming similarity –Assuming words or gestures have universal meaning Non-verbal clues Verbal language

37. Peter Morley, ICU RMH Barriers to communication

38. Peter Morley, ICU RMH Barriers to communication

39. Peter Morley, ICU RMH Tactics for removing cross- cultural communication barriers

40. Peter Morley, ICU RMH Removing communication barriers

41. Peter Morley, ICU RMH Removing communication barriers

42. Peter Morley, ICU RMH Generational change Baby boomers, Gen X, Gen Y, & ???

43. Peter Morley, ICU RMH Summary Diverse background of IMGs Complex new environment –Medical –Cultural –Social Lots of resources available