1. Easing Transition into Working in the NHS: Piloting an Enhanced Shadowing Programme for Overseas Doctors J Metcalf #, H Woodun*, N Pierce #, J Golla #, D Basu #, D Cross ~, A Smalldridge ~, M Sykes ~, M Keaney ~, J Illing ^ *3 rd Year Medical Student, Newcastle University # North Tees and Hartlepool NHS Foundation Trust ~ REACHE North West (Refugee and Asylum Seekers Centre for Healthcare Professionals Education) ^ Durham University

2. Aim and Background Aim to facilitate transition to working in the NHS 37% of NHS Doctors qualified overseas 1 GMC/DoH commissioned reports identified issues: Professionalism 2,3 Ethics 4,5 Communication/cultural differences 4,5 Team working 4,5 Practicalities 4,5 Trust funded pilot programme for overseas junior doctors

3. Methods 5 day programme pre FY shadowing July 2013 Informed by literature and discussions with overseas doctors and supervisors within trust Included NHS and Trust specific sessions Engaged with REACHE to deliver sessions

4. Week before Foundation Shadowing July 2013

5. Methods: Evaluation Ethical approval not required (by NRES) Anonymised pre and post Likert scale questionnaires including Knowledge of the structure of NHS Awareness of communication issues/cultural diversity Patient centred approach/team working Ethical framework eg consent and confidentiality Analysed using paired T-tests Semi structured individual interviews and participant observation Participants’ expectations FAQs during sessions Concerns/suggestions Evaluation questionnaires for each session looking for themes

6. Results 7 participants 3 foundation doctors 2 international medical students 1 refugee doctor 1 clinical attaché Response rates Pre and post Questionnaires: 100% Session Evaluations: 93.8% Overall programme rated ‘very good’ (highest rating) by 100% of respondents

7. Significant results *P=0.011 *P=0.042

8. Verbal feedback

9. Changes to practice

10. Comments/Improvements

11. Discussion: Strengths and Limitations Strengths: Valued by participants and Trust Targeted, flexible and responsive training REACHE highly skilled Full evaluation underway Limitations: Small numbers/mixed group Observer bias as evaluation by participant Stigma Time to release trainees Measuring outcomes difficult as looking at whole career

12. Discussion Programme addressed issues identified by studies Responsiveness to individuals was crucial Participants identify on-going benefits: One participant passed PLAB and now employed by Trust Key identified improvements: Patient centredness Communication skills Professionalism Seeking help Future programmes influenced by feedback How to generalise locally, regionally, nationally?

13. Future plans Trust funded PhD student undertaking realistic evaluation Follow up on 2 nd /3 rd July 2014 informed by feedback More role plays for communication skills Clinical simulation including human factors 2 nd programme May 2014 (2 days only) for juniors in Trust including clinical attachés and refugee docs 3 rd programme (full week) Autumn 2014 for new cohort

14. Conclusion Targeted programme to overseas doctors Perceived Benefits for participants and Trust Addressed issues around NHS cultural values Professionalism Patient Safety Ethics and communication skills Practicalities Now embedded (and funded) within Trust

15. References 1. http://www.gmc-uk.org/Primary_Medical_Qualification_2010.pdf_45103170.pdf 2. NCAS 2011: UK National Patient Safety Agency. National Clinical Assessment Service: Concerns about professional practice and associations with age, gender, place of qualification and ethnicity - 2009/10 data (February 2011). http://www.ncas.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=95145 http://www.ncas.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=95145 3. UK House of Commons Health Committee. Fourth report. Revalidation of Doctors. London: House of Commons, 2011. http://http//www.publications.parliament.uk/pa/cm201011/cmselect/cmhealth/557/55702.htm http://http//www.publications.parliament.uk/pa/cm201011/cmselect/cmhealth/557/55702.htm 4. Illing, J et al. The experiences of UK,EU and non-EU medical graduates making the transition to the UK workplace: Full Research Report, ESRC End of Award Report. RES-153-25-0097. Swindon: ESRC 2009 5. Slowther A, Lewando Hundt GA, Purkis J, Taylor R. Experiences of non-K-qualified doctors working within the UK regulatory framework: a qualitative study. J R Soc Med 2012; 105:157-165.