Title: Simulated assessments of General Practitioners' consultations in a multicultural society: a linguistic analysis
Funder: Economic and Social Research Council

Abstract: The multicultural society we live in necessitates a similarly diverse healthcare provision. Nowhere is this more the case than in the frontline of the NHS healthcare system, General Practice, our first port of call for nearly all health enquiries as a population. But achieving this diversity is difficult. Medical graduates and in particular GP trainees for whom English is a second language are faced with a system of medical education and exams in which they are continually aware of the lower pass rates for non-white and non-British candidates. But this is not an issue that has gone unrecognised. The Royal College of General Practitioners who administer the membership and licensing exam to work as GP in the UK would like to look at the disparity in pass rates between candidates in greater detail, addressing how the exam and the training leading up to it might be improved. The most important focus of attention is on their 'Clinical Skills Assessment', an appraisal of GP candidates' abilities to conduct consultations through observing them in simulated, pre-designed cases with actors. In order to look at this, they are working closely with researchers in the academic field of linguistics to look at issues of social communication that might affect performance in the exam, and the study proposed here would enable the expertise of academics at the University of Nottingham to be centrally involved in this. The purpose of the study is to look at linguistic and communicative aspects of the exam, including the integration of nonverbal elements of communication such as body language, that contribute to candidates' successful or poorer performance. It is clear that failure to do well in the exam is not simply a case of second language fluency, but much subtler aspects of communication that may or may not convey a patient centred and empathetic manner. These elements have been identified by examiners to be significant in their assessments of potential GPs but are often overlooked or misunderstood in the actual training of GP registrars. Given current controversies over biases in the pass rates for particular candidates in this exam, a better understanding of these communicative, interpersonal requirements is of great importance. A more detailed understanding of how to achieve the sometimes under recognised and complex requirements in the exam will enable better training for GPs and also a more insightful discussion of the exam's setup more generally. The academic field of Applied Linguistics, in which this study falls, particularly the directions that have been pioneered at the University of Nottingham for looking at videos and gestural communication using up to the minute developments in technology, means that this is an evidence based analytical discipline that is ideally placed to address these issues. A dataset of videoed consultations from some 200 candidates for the exam will be carefully analysed using specialised software tools that enable a carefully substantiated understanding of the exam that can then be used further in informative material for GP candidates, trainers and examiners. The outputs from the research will therefore fall into many areas. There will be direct impacts for the Royal College of General Practitioners, who wish to provide greater training resources and information on the Clinical Skills Assessment so as to better prepare candidates for their role as GPs. The academic developments in analysing these types of complex video datasets will be of great importance to the field of Applied Linguistics, where these methods are still in their early stages. The work will also have an impact on those who study healthcare communication more broadly and wish to learn more about under researched aspects of communication, such as gesture and body-language in patient-centred consultation styles, as well as addressing issues surrounding simulations in medical education with greater evidence.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE