International medical graduates: a qualitative exploration of factors associated with success in the clinical skills assessment

Abstract

Background: International medical graduates (IMGs) are known to have significantly lower first attempt pass rates at the clinical skills assessment examination (CSA) than UK graduates. Whilst much has been published concerning higher fail rates in this group, there has been very little exploration of factors associated with success. Aims: This research aims to identify and explore factors associated with success in the CSA. Method: Telephone interviews with 10 IMGs who had passed the CSA on their first attempt were undertaken. Participants were current or recent (previous academic year) GP trainees in Scotland. Transcripts of the interviews were analysed by a thematic analysis approach. Results: Six main themes emerged from the data analysis. These were insights into the challenges, a proactive approach, refining consultation skills, learning with UK graduates, valuing feedback and supportive relationships. Conclucions: This research adds the much-needed voice and experience of IMGs to a current area of uncertainty and challenge in medical education. It provides some insights into potential solutions to the issues and will be of interest to both trainees and those involved in their education.

Keywords:

• Clinical skills assessment
• international medical graduates
• differential attainment
• licensing examinations

Acknowledgements

Many thanks to the doctors who kindly agreed to take part in this research. Thanks for the opportunity to undertake this research afforded by a medical education fellowship, funded by NHS Education for Scotland.

Funding

This work was supported by the NHS Education for Scotland.

Disclosure statement

I am a UK graduate, and passed the CSA in 2010. I have been involved in formal and informal support of trainees sitting the CSA in recent years, both UK and international medical graduates, in a number of roles: as a peer, colleague, Medical Education Fellow and Associate Advisor in General Practice. I have been involved in the planning and delivery of the Scottish Trainees Enhanced Programme from 2015, which includes educational support for international medical graduates.