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Guest eureka

psychiatry bulletin article

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in a recent issue of PB a study has been published by femi oyebode and elizabeth furlong that confirms that 56 %Irish and  68%UK graduates passed their PART II MRCPsych in first attempt while only 35% of indians,24.8% from indian borders,33.2% from other medical schools passed it in the first go between 1997-2002

and this difference is statistically significant.p< 0.001

i think this is a very significant finding which we all already knew ...but now its out in the open.

any suggestions as to why foreign graduates  fail this exam so easily...apart from the obvious

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It's easy.

The approach of a UK trained is not the same as an overseas candidate.

I have not taken the exam but thats my thought.

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Poor communication skills for sure. If the study is stratified by communication skills, the result would not be this significant.

Bias for sure..the glass is half full in one case and half empty in the other. Its natural..a local graduate is good until otherwise proved whilst an overseas is not until proven otherwise.

Local grads are more focussed and driven.

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The same article also sasy that girls r more likely to pass than boys! Any thoughts? is there gender bias as well?

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there has been an increasing trend for girls to do better academically at all levels from GCSE to A levels to university degrees. This is interesting and not sure why. Are girls branier, study harder, more driven or the current learning environment grossly favours girls than blokes? There was the positive discrimination thingy with UK medical schools for females a few years ago resulting in loads of women doctors.

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Things to ponder

1. If we all wore trousers to the clinical would girls do better. A bit of leg can go a long way!!!

2. As for foreign docs, their knowledge base is usually very good, often better than any of the UK grads. However their technique of learning is usually not based around understanding, but on a rote learning basis. It often seems they are regurgitating a text book. Their application of knowledge is not as good as UK grads. I've seen this first hand at courses and with fellow trainees.

There is an element of knowing how to get out of a tricky situation, and the Uk grads are always better at this. You cant teach this in a course. Its natural. Maybe its about knowing how to 'wing it' or bluff your way out of trouble. Maybe i am trying to say we are the more convincing blaggers.

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The findings in the psychiatric bullentin are interesting but come on what on earth is expected. You turn up at the borders of a country a full grown adult having all your life lived in a different culture and you want to seriously compete on the same basis with people who are local and know about their system without thinking. We foreign doctors should give ourselves credit but at times there are limits to what we can realistically do.

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Well said folder, imagine a british doctor taking his postgraduate exam in Hindi or urdu! And atleast the theory bit, in both Part 1 and 2 evaluates your english language skills more than anything else. So I am not surprised there is a difference in the pass rate between IMGs and UK grads.

There are also 'cultural' differences in the way exams are conducted between UK and asian countries. In India if you are bursting with confidence during an exam thats a definite fail, but I know many of my colleagues with relatively poor knowledge base managed to get thru just because of it. I was disappointed that this wasnt acknowldeged in the article. I have sent a mail to the editor.

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In India if you are bursting with confidence during an exam thats a definite fail

:lol: :lol: :lol: U r spot on psychedelic. In India some examiners can't tolerate if they think that u know more than them. They will strart asking questions from some corner of the text book, and not only will they not fail u, but also tell u how useless u r!

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During my final mbbs exams the examiner a very friendly gentleman for a change was asking me the management of MI and guess what happened??

The poor man had a massive MI and had to be rushed to the cardiology dept, lucky for him the dept was next to the building where the exams were being held.

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I am surprised to see

LACK OF OPPORTUNITY FOR CLINICAL EXPERIENCE

as one of the options. If anything, doctors from India have had

more and wider clinical experience. I am aware that Anatomy and dissection

here in the UK is only theoritical and on probably dummies which is different

to what doctors get to do in India.

When I came here to do Plab, I remember trying to learn phrases like

'There is nothing you could or couldn't have done to change the situation'

with the advice of Mahadev Bhide in Plabmaster. It was an effort, it didn't come

naturally to me and my friends. That is not because of language problems or lack

of empathy but just a different way of saying things. Things like meals on wheels,

bereavement counselling, child protection etc came naturally to UK graduates just because

they are grown up with these concepts and others have to remind themselves about

them.

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Well said folder, imagine a british doctor taking his postgraduate exam in Hindi or urdu!

doesnt quiet amount to the same thing as IMGs taking an exam here in english, becasue majorityof us  have all had our medical education in english ;)

and speaking only from personal circumstances, i have always been taught in english right from LKG... so cant really complaint about english not being my first language.. yet i managed to fail the clinicals...

I guess i have to agree with the explanation that local grads are 'better wingers' and probably apply the adult learning principles better than we do...

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If anything, doctors from India have had

more and wider clinical experience. I am aware that Anatomy and dissection

here in the UK is only theoritical and on probably dummies which is different

to what doctors get to do in India.

DK14- we use cadavers for dissection in the UK and its not theoretical only, practical part is a major part of the syllabus......as was playing catch with dissection spleens!!!!!

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hi dk 14

the options in poll were stated in the article as possible reasons...bias was ofcourse not mentioned...that bit is mine

i personally think the pass rate of UK people is high for the same reasons they are giving jobs to them -the govt feels their own candidates are the ones who should get a degree b4 a foreign grad...not becoz they are better or they have better communication skills...

a lot of indians are more empathetic than british, empathy depends upon your personality more than culture.I have worked with people who talk like jade goody...but they still pass...

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hi dk 14

;):D:lol:

a lot of indians are more empathetic than british, empathy depends upon your personality more than culture.I have worked with people who talk like jade goody...but they still pass...

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A medical student was telling me two days ago that it is rare for them to get

cadavers for dissection. Perhaps it depends on which medical school you train in.

hi dk 14

;):D:lol:

a lot of indians are more empathetic than british, empathy depends upon your personality more than culture.I have worked with people who talk like jade goody...but they still pass...

I am now confused. I thought even I was trying to say that empathy has nothing to do with languague or culture but more to do with individuals. Anyway, if it reads otherwise, then that was not what I was trying to say. :-?

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I just wonder if the trend is the same even in the last couple of years. Any thoughts?

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It is quite interesting to read the responses sent around.

Actually this article should go side by side versus a similar survey done on the PLAB exam.I cannot remember accurate figures but while over 75% IMGs passed the exam only 16 % of UK graduates did!!!!!!

Is that surprising ...certainly not.......The exam here is more about knowing the system and presentation style.

Conduct a simple test......ask a local graduate to name the wrist bones...........and you can see them struggling.......ask them the expansion of CTEV.........and they will stare at you........I am sure people overseas would readily remember 'she looks too pretty try to catch her' mnemonic from medical school days..........and also what a Club foot is all about........

We do tend to focus a lot on theory, but take much longer to understand the finer nuances of the English language and also the local practices and customs here..........

In my view that explains the results more than anything else.

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It would be intresting to see the outcome under the new exam system which by the looks of is more objectice and well structured.This will eliminate bias, hopefully :)

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I think the causes are multiple... Some of the statements I make may be controversial... But I am trying take an objective view...

1. Lack of clinical experience in psychiatry during UG... I think we have to admit that clinical experience in psychiatry in India is not as good as here. The amount of exposure and training the UK grads get is quite good. Most of them are quite good even at an undergrad level. I remember bunking most of my third year psychiatry posting.

2. A lot of people who come to UK, tend to take up psychiatry, because it was much more easy to get into psychiatry, and some of them because they could not get into other subjects... while most of the UK grads who are in training take psy as that was their main career choice. This would certainly bias the performance towards the population here.

3. A  sample of population from India get through entrance exams in India and stay back there. It is possible that those who get through the entrance exams in India, are academically quite good. There is also a possibility of a subpopulation who came in to UK, because they did not get thru an entrance exam in India... (PLAB which is a much easier exam compared to most entrance exams in India)

There is also a possibility that those people may be better candidates than those who come to the UK, atleast in taking multiple choice exams.  So, atleast the Indian sample may not be representative of the whole Indian population...

4. Factual knowledge is important... but how many of us, use the names of carpal bones on a daily basis??? but if you dont know how to establish rapport with your patient, thats not going to help isnt it??? so... I would say both are eqally important and we shud aim to attain a balance of the same... That is what the local graduates attain...

We dont need a lot of skills in India... because of the heirarchial and paternalistic attitude we have in India, we tend to take ourselves for granted...

From what I have seen, the local graduates are quite hard working and sincere to their work. To be very frank, atleast where I come from I have seen more of our people skiving (that includes me)...

About the sex difference, girls definitely will get more into jobs and pass more exams as long as men are interviewers and examiners.... that is a universal fact... ;)

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The same article also sasy that girls r more likely to pass than boys! Any thoughts? is there gender bias as well?

Although the article did quote this, I suspect that it was a confounder.

More IMGs are men, and they go onto fail the exam at a higher rate, thus making it appear that men per se are more likley to fail the exam.

Overall a fairly poorly written article with a weak statistical analysis, and little idea of how the results would inform the debate.

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Some of the statements I make may be controversial.

Yes some statements definitely r controversial! ;) : :), but u have a right to express ur opinion mate!

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freedman,

I agree with you on the weak statistical analysis.

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