Communication skills of overseas doctors and training implications for psychiatry

The ability to communicate effectively is fundamental for a doctor practising in any medical specialty, and it assumes crucial importance in psychiatry. Good communication between doctor and patient is necessary for history-taking, eliciting symptoms of mental illness, exploring sensitive issues and establishing rapport with patients. Proficiency in the English language may not be sufficient in understanding its subtleties and nuances.

The General Medical Council (GMC) guidelines state that doctors should have adequate language and communication skills to practise in the UK, involving submission of an original International English Language Testing System (IELTS) certificate, showing attainment of minimum scores in speaking, listening, reading and writing English (www.gmc-uk.org/doctors/registration_applications/join_the_register/language_proficiency.asp). In 2008, just 6% of candidates sitting Paper 1 of the Membership of the Royal College of Psychiatrists examination were UK graduates (www.rcpsych.ac.uk/member/rcpsychnews/august2008.aspx). A majority of psychiatry trainees for whom English is not their first language have received training overseas.

A qualitative survey was conducted to gauge the opinions of trainers, trainees and service users regarding communication skills of overseas doctors. Self-report questionnaires addressing communication and language were completed by a sample of consultant trainers, psychiatry trainees and service users of Greater Manchester West Mental Health NHS Foundation Trust. Questions addressed issues regarding effective communication, language ability, impact on patient care and training implications for psychiatrists.

There were 99 respondents (11 trainers, 15 trainees and 73 service users). Trainers perceived the need for additional training for trainees if their language skills were deficient. They suggested that a system for assessing language competency should be provided by the Royal College of Psychiatrists. Trainees reported a high level of English language competency, but regarded IELTS as not meeting the requirements for training in psychiatry. They also suggested additional training components and language testing to be introduced by the College and the GMC. Service users who had been seen by overseas doctors perceived them to be good communicators with minimal language difficulties. They also felt that doctors who had problems speaking English should receive additional training.

Although overseas doctors’ language competencies are regarded as being adequate by trainers, service users and trainees, additional formalised language training is felt to be necessary. This should be recognised by the GMC and the Royal College of Psychiatrists. Localised language training should be facilitated and encouraged as part of skills development and should be assessed through regular workplace-based assessments.