English language problems in GP Trainees

The following is a summary of the conclusions of the East Cumbria Trainers group, following discussion regarding English language problems in GP Registrars.

Problems experienced/shared by trainers who have had GP Registrars with English language problems

  • Patients sometimes experience difficulties understanding the GPR, leading to confusion, and need for further patient contact to clarify matters.
  • Sometimes patients refusing to go back to see the GPR because they haven’t understood.
  • Poor development of rapport with patient due to poor understanding, or cultural differences
  • GPR sometimes can’t understand patients, especially those with heavy accents and local dialects
  • Cultural differences in expression/behaviour lead to patient or staff conflict e.g. abrupt manner, inappropriate laughter or smiling.
  • Excessive speed of language, or low volume can sometimes be very difficult to understand.
  • GPR having poor understanding of NHS system, having just arrived from overseas
  • Some GPR’s come from a culture of ‘doctor-centred’ consultations – which can be difficult to change
  • Difficulty with written English leading to problems with spelling and accurate written clinical note keeping
  • Concern from trainers about the GPR making the grade to pass the summative assessment video, MRCP oral and video due to English language problems
  • Problems with social isolation in peer group and community.
  • Problems with seminars and teaching due to cultural differences and poor understanding
  • Prejudice from patients and staff due to English language problems and poor understanding of GPR

How can trainers help? – Possible solutions.

  • If necessary encourage GPR to enrol in additional local English language course
  • Plan an early seminar or informal chat about their English language skills early in the first GPR attachment – to identify the GPR’s learning needs and discuss early ways in which the trainer can help the GPR.
  • Encourage increased social mixing to help with possible social isolation e.g. Joining sports group, local community group etc.
  • Plan a video session/seminar specifically to look at language skills/cultural behaviour and rapport building.
  • With agreement of GPR correct spoken English and written English mistakes early on – obviously impossible to do all the time, but every little bit helps
  • Encourage GPR to introduce themselves early to the practice staff with details of their background and culture – helps to improve communication with staff and route out any prejudice as a result of poor understanding due to English language problems
  • Have a clear in house equal opportunities policy, with clear statement about zero tolerance to racism/prejudice for staff and patients – helps protect the GPR with English language skills having prejudice problems with staff and patients.
  • Allow longer consultation lengths especially at the beginning of the attachment, and possibly for longer than allowed for other GPR’s
  • If necessary refer for speech therapy classes – one trainer found this very useful for a GPR who had difficulty with pronunciation of English words.
  • Encourage GPR to challenge or question trainer if they don’t understand.
  • Encourage GPR to develop consultation skills early that will specifically help patient understanding e.g. Checking patient understanding
  • Joint telephone consultations to assess language skills on the telephone can be helpful.
  • Joint out of hour’s sessions can be useful in assessing language skills especially when the GPR is under stress/pressure.
  • Use a local dialect dictionary if available to help GPR’s who have problems with understanding accents/dialects
  • Encourage GPR to use patient leaflets to improve patient understanding.
  • Encourage GPR to use internet learning sites – can be a useful medical English language tool, and GPR can paraphrase or copy phrases from internet to help with written English
  • Encourage use of spell check before writing clinical notes
  • One GPR used an A- Z logbook/dictionary to record new words that she had learnt, in order to remember more easily and provide an easy way to look them up again when required.
  • Include a specific question in appraisal or feedback in order to encourage discussion about English language skills.
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