Can a novel blended learning resource improve the simulation experience for international medical graduates working in the UK? A survey of kent surrey sussex trainees in anaesthesia
Authors: Gheith Mohamed , Torrilla Christopher , Hall Alexander 
Published: November 2022

With the increasing number of International Medical Graduates (IMGs) hired by the UK National Healthcare Service (NHS), a unification of training becomes essential. One of the main obstacles facing IMGs is insufficient simulation-based training [1]. In 2021, 19,977 doctors were registered to the General Medical Council (GMC). 10,009 of them studied medicine outside the United Kingdom (UK) [2]. Blended learning offers the opportunity for engagement and interaction to facilitate learning experiences [3].

We created and distributed a survey to Anaesthetic trainees in the ‘Kent Surrey Sussex (KSS)’ Deanery. We received a total of 76 responses, 49 (64.5%) UK graduates (UKGs) and 27 (35.5%) international graduates. The survey was designed to ascertain their medical training, simulation experience, and their perception of that simulation experience. We also included additional questions aimed specifically at IMGs to demonstrate the best way they could be supported to acquaint themselves with the simulation process further.

IMGs were less likely to have simulation training as an undergraduate (24% IMGs vs 96% UKGs), and 37% of IMGs had no simulation exposure before coming to the UK. IMGs were also exposed to fewer simulation sessions during their career when compared with UKGs. When asked how simulation can improve human factor variables, including teamworking, leadership, and managing stressful situations, both groups responded similarly. An exception was that IMGs were much more likely to ‘strongly agree’ that simulation improved their communication skills (41% vs 29%). IMGs were less likely to find the overall simulation experience ‘excellent’ (24% vs 51% in UKGs), suggesting more can be done to improve their perception of simulation (

Comparison of UKGs versus IMGs simulation experience. As well as asking about how simulation improved communication skills, responders were asked the impact simulation had in improving other core skills including teamwork, leadership, and managing stressful situations with both groups responding similarly.

There is a clear discrepancy in simulation exposure and perception of simulation between IMGs and UKGs. We believe blended learning may be the solution to help bridge this gap. Our survey highlighted potential resources we can introduce, including introductory videos, additional learning materials, and attending simulation as an observer. We hope to incorporate some of these in the future within our Trust Simulation Department and, if successfully received, expand throughout the KSS deanery.

1. Martinerie L, Rasoaherinomenjanahary F, Ronot M, Fournier P, Dousset B, Tesnière A, Mariette C, Gaujoux S, Gronnier C. Health care simulation in developing countries and low-resource situations. J Contin Educ Health Prof. 2018;38(3):205–212

2. Campbell D. NHS hiring more doctors from outside UK and EEA than inside for first time. The Guardian. 8 June 2022.

3. Singh H. Building effective blended learning programs. Educational Technology. 2003; 43:51–54