International Medical Graduate GP trainees' understanding of the 'Relating to Others' domain in the Simulated Consultation Assessment: a phenomenographic study.

Abstract

<i>Relating to Others</i> (RTO) is a central competency in UK general practice, reflecting the Royal College of General Practitioners' (RCGPs') emphasis on relationship-based care. As one of three key domains in the Simulated Consultation Assessment (SCA), RTO is crucial for GP trainees to qualify. However, International Medical Graduates (IMGs) experience persistent differential attainment (DA) in RCGP exit exams and are twice as likely to fail compared with UK graduates, highlighting the need to explore how they understand RTO in the SCA. To explore how IMG GP trainees understand and experience the RTO domain in the SCA. Semi-structured interviews were conducted with IMG GP trainees who had undertaken the SCA and GP trainers of IMG GP trainees. Interviews were audio-recorded, auto-transcribed, and analysed using the seven steps of phenomenographic analysis. NVivo (version 12) software supported data organisation and theme development. IMG GP trainees described difficulties understanding UK cultural norms and communication styles required for success in RTO. Three themes captured their conceptualisations: 1) relationship with patients - empathy, tone, cues, and shared management; 2) professional curiosity - use of ideas, concerns, and expectations, relevant questioning, and curiosity throughout; and 3) the 'glue' of the consultation - advanced communication linking empathy and decision making. Findings reveal that some IMG GP trainees engage in 'code switching', adapting their persona to meet perceived UK expectations. This aligns with the concept of communicative flexibility and highlights the cultural adaptation needed for success in RTO. Targeted support and training may help IMG GP trainees develop culturally congruent yet authentic consultation skills.