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

Radicalized young people feel like ‘a speck of dust in an uncaring universe’ before joining extremists like ISIS | National Post

More good reporting on motivations for radicalization by Tom Blackwell in the Post:

What little evidence exists now indicates terrorists generally are no more likely to suffer from psychological problems than the general population, he [Lorne Dawson] said. As for the homegrown variety, some are second-generation immigrants struggling to find a place between their parents’ culture and Canadian society. Adhering to a dogmatic ideology might give them the direction they seek, said Prof. Dawson, noting that not all young people are craving freedom.

In fact, “there is a whole group to whom that is totally perplexing and frustrating,” he said. “They don’t want that. They want structure and order. They want a clear vision.”

Research that Prof. Bélanger and colleagues have done with Tamil Tigers and extremists in Jordan and the Philippines point to a single, overarching motivation, what the academics call the “quest for personal significance,” leading them to join a community they believe gives their lives meaning, and adopting its ideology in an effort to be accepted.

“When, for instance, [they feel they are] not important, they don’t matter, they are a speck of dust in some kind of uncaring universe, it increases psychological pain,” he said. “One way of assuaging this negative feeling is connecting through a group.”

That connection might occur in person or, in the case of “lone-wolf” radicals, through online correspondence with an extremist overseas, like ISIS members who have posted propaganda videos on the Internet, said Prof. Belanger. Once hooked, the home-grown radical may be willing to sacrifice his own life – as well as take others’ – thinking “they will have more in death than they had in life.”

Radicalized young people feel like ‘a speck of dust in an uncaring universe’ before joining extremists like ISIS | National Post.

Radicalization, the Loss of Canadian Innocence and the Need for Perspective

With the two killings this week of Canadian soldiers, one by Martin Couture-Rouleau’s running over soldiers in St-Jean-sur-Richelieu, the other by Michael Zehaf-Bibeau and his the attack on the War Memorial and Parliament Hill.

Surreal morning for me as I was downtown for meetings, about 8 blocks away from the Hill, learning about the shootings from TV monitors, along with others glued to TV monitors following developments. Felt very much, albeit on a much smaller scale, when I was in LA during the 911 attacks.

Some common points in recent commentary.

A note of caution on over-reacting and the need to maintain balance between freedom, access, and security. John Ivison: In response to Quebec terror attack we must remember a healthy balance between security and freedom, a point echoed by Andrew Coyne in Andrew Coyne: We can’t stop every little terror attack, so let’s brace ourselves and adapt where he recommends, not “a panicky search for false assurances, nor even defiance, but a collective insouciance.” Martin Regg Cohn praises the Ontario political leaders for keeping to the normal Parliamentary schedule in The democratic show must go on: Cohn.

While there was universal praise, and deservedly so, for Parliament’s Sergeant-at-Arms, Kevin Vickers, both for his quick and efficient handling of the attack as well as his philosophy of keeping Parliament a public space, Michael Den Tandt savages the overall handling of the attack in Michael Den Tandt: Ottawa shooting shows Canadian capital’s utter lack of readiness, and how information was not communicated. Haroon Siddiqui makes similar, but less well argued points, in Killings of two soldiers raise troubling questions: Siddiqui.

Margaret Wente takes the opposite tack, in an almost boosterish tone, contrary to much of the reporting, argues that Canadians will not change and that the attack was handled calmly and without hysteria in  Terrorists don’t have a chance in this country. Joe Warmington of The Toronto Sun takes the opposite tack in Canada will never be the same, as does Ian MacLeod in The Ottawa Citizen, in Analysis: Effects on Ottawa will be lasting and far-reaching (with video).

Also in the Post, which generally has some of the strongest reporting in this area, Tom Blackwell, their health reporter, reports on the “lone wolf” phenomenon and some of the factors that may result in some being open to radicalization in ‘Rhetoric and bluster’: Was attack on soldiers really terrorism, or just the violent act of a disturbed man? The Globe has a good profile on Michael Zehaf-Bibeau, the War Memorial and Parliament Hill in Suspected killer in Ottawa shootings had a disturbing side, that reinforces some of these points.

From La Presse, a report on the local mosque in St-Jean-sur-Richelieu and what appears to be a very conservative Imam in terms of social teachings but no indication that he preached violence, or whether Couture-Rouleau went to the mosque regularly (seems he was most active on social media) in Un imam controversé à Saint-Jean-sur-Richelieu.

Listening to the RCMP outline what they did and what they could do, particularly in the case of Couture-Rouleau (as of writing not as fulsome an account for Zehaf-Bibeau) hard to see that any of the Government’s recent or planned initiatives would have made a difference. The RCMP monitored him, spoke to friends and families who shared their well-founded worries, confiscated his passport but as the RCMP officer at the press conference said, “We couldn’t arrest someone for having radical thoughts, it’s not a crime in Canada.”

Couture-Rouleau, like Michael Zehaf-Bibeau, were both born in Canada. Couture-Rouleau was not a dual-national and would not be subject, had he lived, for citizenship revocation. It is unclear whether Michael Zehaf-Bibeau, given his father was Libyan in origin, would be entitled to Libyan citizenship and thus theoretically subject to revocation.

And while tragedies for the families and friends of the soldiers killed, and (another) reminder that we have extremists among us, both reassuring and worrying that both of these appear to be “lone wolf” attacks rather than groups and more “sophisticated” plans and conspiracies that could result in significantly more casualities.

I tend to be between Wente and Warmington: no, not everything has changed but neither has everything remained the same. Our political leaders, of all stripes, as well as the media and others, will play a role in ensuring, or not, that we retain perspective and balance.