Multicultural Meanderings

From language troubles to the female body, foreign doctors training in Canada can face challenges: study

Good overview of some of the challenges and discussion of whether better to be handled individually or through an orientation course (or both).

My experience during my various cancer treatments, dealing with a variety of  new Canadian doctors, was that language was sometimes an issue, manner generally less so:

It was one striking example of a culture clash the Alberta study suggests is common for graduates of foreign medical schools who do two-year family-medicine residencies here.

Some balk at being taught by female doctors, struggle with the nuances of English, use inappropriate body language, are uncomfortable with the mentally ill — or unfamiliar even with the concept of patient confidentiality, the researchers found.

Many of the “international medical graduates” (IMGs) also are highly educated, have rich cultural perspectives and strong characters, reported colleagues who were surveyed for the study.

But the authors say residency programs — whose on-the-job training is required to become a licensed doctor — should recognize the transition difficulties and incorporate “medico-cultural” education into their curriculums.

“In some countries, males look after males and females look after females,” said Olga Szafran, associate research director in the University of Alberta’s family-medicine department and the study’s lead author.

“(But) we can’t be selective in the kind of patients that our physicians end up treating. If you’re not familiar with the anatomy of the opposite sex, it’s very difficult to end up in the delivery room and deliver a baby.”

Canada relies heavily on IMGs, with graduates from medical schools outside North America making up about a quarter of practising physicians.

Universities here typically reserve a set number of residency spots for those foreign doctors, with the Edmonton faculty training about a dozen in family medicine a year, said Szafran.

Her study does not specify countries of origin, but the top five sources of IMGs countrywide in 2012 were South Africa, India, Libya, the U.S. and Pakistan, according to a Canadian Medical Association report.

The Alberta team admit their research was “qualitative,” not an empirical study with statistically significant results. They conducted interviews or held focus groups with the doctors who supervise family medicine trainees, with nurses and other health professionals who work alongside them and with both Canadian and international residents.

IMGs are an important part of the system, not least because they help serve an increasingly multicultural patient population, said Szafran. But she said the study subjects were consistent in outlining an array of challenges they face.

The combination of thick accents and difficulties with the subtleties of English can undermine communication with patients, which “makes life difficult and diagnosis difficult and affects everything,” one physician-trainer told the researchers.

The linguistic barrier can be exacerbated by different types of body language — like refusing to make eye contact with patients, or invading their personal space.

Some have a more direct style of talking to patients. A Canadian resident recalled a foreign colleague telling someone: “ ‘You’re fat, that’s why your joints suck,’ and the patient started to cry because nobody says that stuff here.”

Participants in the study reported IMGs unfamiliar with common mental-health conditions like depression, addiction, anxiety and panic attacks — problems that patients never sought medical help for in their home countries.

The mix of genders is also an issue, with some foreign graduates refusing to shake hands with patients of the opposite sex, or recognizing that a female doctor could have authority over them, the paper noted. “They tend to walk over you a bit, and you have to stand your ground and push back and just remind them about gender equality,” one female physician told the researchers.

Foreign graduates often make “stellar” doctors, but some of the Alberta study’s findings do sound familiar, said the head of Canada’s biggest family-medicine program.

Dr. David White, interim chair of the University of Toronto’s department, recalled a highly motivated, hard-working and likeable male medical graduate from southwest Asia — who had never treated women or children.

It left him with “knowledge gaps you could drive a truck through,” but White said such shortcomings can be relatively easily fixed by, for instance, teaching how to conduct a pelvic exam.

More difficult, he said, is to unlearn the mindset of a different medical culture. White cited a resident from a central Asian republic who had the doctor-knows-best attitude long since discouraged in Canada, and “a very reserved approach that did not come across as very empathic or warm.”

But White questioned whether formal cross-cultural training is necessary. So long as teachers understand the challenges faced by IMGs, such issues can be addressed on an individual basis, he argued.

Source: From language troubles to the female body, foreign doctors training in Canada can face challenges: study | National Post