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Abstract
Supervision in medicine traditionally relied on the apprenticeship model where the experienced supervisor mentored the new doctor into the culture of the profession and no specific training was required for supervisors. The relatively recent change to a more competence based approach to postgraduate medical training has meant that medicine as a profession is now more exposed to outside scrutiny and a recognition that supervisors require specific training in teaching skills has begun to emerge. In addition, the number of International Medical Graduate (IMG) registrars filling general practice (GP) training positions in Australia has been steadily increasing. The diversity in the medical, social and cultural backgrounds of registrars presents challenges to the traditional apprenticeship model of training for GP supervisors as they seek to support registrars who have been trained outside the Australian medical system.
This thesis examines the training issues for the supervisors as they identify the needs of culturally diverse IMG registrars and modify their traditional supervision approaches to provide additional support for this group of doctors. Supervisors need to develop cultural competence skills and be provided with training opportunities where they can reflect upon their own culture and attitudes before engaging in cross-cultural supervision. A cultural competence training workshop was devised, implemented and evaluated in this study. Results showed statistically significant changes in supervisor attitudes which were maintained over time.
Analysis of in-depth interviews with GP supervisors who discussed their experiences supervising overseas trained registrars revealed changes in the field of supervision where registrars are not so committed to communities, are often older and have different attitudes to and expectations of, teaching and learning. Addressing communication issues and differences in cultural values were also areas where supervisors identified challenges but felt unsure as to how to address those challenges.
While some attempts have been made to identify the training issues relating to International Medical Graduate doctors little has been offered to supervisors in the way of solutions. This thesis presents a comprehensive model of cross-cultural supervision that supports supervisors in developing cultural competence skills, organising structured teaching and learning sessions, creating spaces for cultural discussions, engaging in direct observation and providing feedback on clinical and communication issues.