Use of high-fidelity simulation to ensure inclusivity and equality of international medical graduates
Authors: Mahmood Maria , Kasfiki Eirini , Blackmore Andrew , Wright Dave , Ganesh Soma , Bestley John 
Published: November 2022

The UK medical profession is becoming increasingly diverse as the number of international medical graduates (IMGs) joining the UK medical workforce increases every year. However, IMGs face a number of significant sociocultural and educational challenges. Recent studies show that IMGs lack insight into the system and lack clarity in relation to the role of a supervisor, career pathways, and medico-legal and ethical issues [1,2]. They exhibit differences in clinical practices and team dynamics. Recent studies suggest the introduction of dedicated induction programs in the form of formal teaching sessions, or tailored online induction for IMGs prior to their first job [1–3]. Most IMGs have minimal exposure to simulation and human factors training with international medical schools favouring more didactic methods of education. We have designed a high-fidelity simulation course with frequently encountered clinical scenarios to improve inclusion and a harmonious transition for the IMGs. This provides an opportunity to familiarise themselves with the healthcare system and team dynamics within the NHS and instils confidence to perform to the best of their ability in their respective roles.
The course has been designed specifically tailored to the needs of IMGs who may find it daunting at first to make their place in a completely new system. We employ high-fidelity simulation encompassing multiple frequently encountered clinical scenarios. The scenarios are followed by a debriefing, with a special focus on human factors, interpersonal and communication skills, and understanding of authority gradients. The attendees are also encouraged to reflect on their performance and to participate in the discussion, share their professional opinions, experiences, and cultural influences. The attendees are asked to fill a pre-course and post-course questionnaire.
Two pilot courses were conducted with a total of 22 attendees. Pre- and post-course feedback with reflective questions about various aspects of the course was obtained. The scenarios assessed 5 categories, which the IMGs graded on a Likert scale. Pairwise comparison was performed between pre- and post-course feedback, showing a statistically significant increase in confidence levels related to all assessed categories; basic management skills (p <0.001), clinical skills (p=0.006), communication skills (p<0.001), teamwork (p<0.001), and leadership (p<0.001).
Based on the positive feedback from attendees we believe that this induction simulation course can greatly help IMGs have a smooth transition into the NHS, and ensure inclusivity by equipping them with confidence, a knowledge of the system, and human factors.
1. Rasquinha M. Difficulties and educational challenges faced by international medical graduates in trust grade roles in the UK. British Journal of Hospital Medicine. 2022;83(4):1–7.
2. Hashim A. Educational challenges faced by international medical graduates in the UK. Advances in Medical Education and Practice. 2017;8:441–445.
3. Emery L, Jackson B, Oliver P, Mitchell C. International graduates’ experiences of reflection in postgraduate training: a cross-sectional survey. BJGP open. 2022.