November 2011


Patient centred care

Are international medical graduates ‘expert novices’?

Volume 40, No.11, November 2011 Pages 895-900

Maria R Dahm


Depending on their previous training, international medical graduates (IMGs) may be unfamiliar with patient centred care (PCC). This study explores the PCC skills that IMGs demonstrated during observed role play.


Qualitative observational data were collected during an IMG communication skills course and IMGs' perceptions of PCC were explored in semistructured interviews. Analysis followed principles of grounded theory and focused specifically on the elements of Candlin's (2002) quality of discourse.


Many of the IMGs observed in this study used discourse features that identify them as novices in PCC: they framed consultations as interviews as opposed to conversations, maintained topic control instead of allowing digressions, and focused on achieving simple coherence rather than seeing the consultation as a whole.


This study suggests that some IMGs may be novices in PCC while being experts in medical knowledge. A view of IMGs as 'expert novices' may be useful to inform the development of bridging courses.

The Australian Medical Council (AMC) asserts that ‘good medical practice is patient centred’.1 Qualitative studies conducted in Canada,2 the United States of America3 and Australia,4 where international medical graduates (IMGs) represent a crucial part of the healthcare workforce, have shown that some IMGs are unfamiliar with the patient centred model of care. Unfortunately, little is known about how IMGs develop the communication skills required for patient centred care (PCC), a medical model that is new to many of them.3 Assuming that the success of IMGs in gaining access to the workforce is dependent on their master of the communicative norms of the healthcare sector, it is important to explore any issues IMGs have with adapting to the principles of PCC.

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