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 havent understood.
- Poor development of rapport with patient due to poor understanding, or cultural differences
- GPR sometimes cant 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 GPRs 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 GPRs 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 dont 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 hours 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 GPRs 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.