What you are about to read in this thesis has already changed how medical educational support for the International Medical Graduate Specialist (IMGS) in Anaesthesia is provided in Australia. The Queensland State government has funded for six training positions that support IMGSs in Anaesthesia using the educational methods described in this thesis. The federal government is also reviewing its approach to IMGSs in all specialties within the medical profession and outcomes from this investigation have contributed to their current appraisal. Specialist colleges have the role of ensuring that IMGSs’ practise is comparable with a locally trained specialist. The Australian and New Zealand College of Anaesthetists’ (ANZCA) final examination reports show that the pass rate of the IMGSs in Anaesthesia is considerably lower than local candidates. An IMGS in Anaesthesia does not enter an alternative training program. Instead, bound by visa requirements, they work in rural areas and are often professionally isolated from their peers. Reports in the published literature have examined related problems in training the overseas trained generalist doctor and suggest a variety of factors are causing difficulties. These include geographical isolation, lack of a single point source of information, communication difficulties, variability in knowledge, insufficient orientation and supervision and additional workloads for hospital staff.1-3 However, these conditions do not fully match the experiences of the overseas trained specialist in Anaesthesia or their perception of these problems—an analysis of which is not yet published in Australia.
Investigations focused on current educational support for IMGSs in Anaesthesia and a distance education system was developed to complement this. The scope of the thesis crosses over three main disciplines to produce an applied scientific approach to distance educational support of overseas trained specialists. Aspects of telecommunications techniques applied within the field of Telemedicine were drawn upon to engage with this clinically focused group. A medical educational method was developed from the Education Psychology literature and underpinned by a philosophical framework that supported the chosen medical distance education. A third approach from the applied scientific field of Information Technology was employed to measure the medical educational outcomes. The thesis combined aspects of these disciplines to inform a plausible model that can be used to effectively support International Medical Graduates in Anaesthesia at a distance.
A survey tool to understand the educational issues of IMGSs in Anaesthesia and a known questionnaire to illustrate motivation and study strategies of both IMGSs and local trainee candidates that take the final exams of the Australian and New Zealand College of Anaesthetists were used. Videoconferencing equipment was installed, with permission, in 20 anaesthetic departments across the state of Queensland. Remotely located IMGSs in Anaesthesia who were preparing for specialist examinations were invited to take part in weekly discussions, at a distance, with local trainee registrars. An existing medical educational program formed the basis of distance education support for IMGSs in Anaesthesia. Video recordings were obtained from participants attending the program that included discussion-based tutorials. Computer-assisted content analysis was applied to transcriptions of the recordings resulting in the production of a generated graphical output in a short space of time. A novel measurement tool was produced from statistical correlation with exam outcomes to provide an interpretation of the generated graphs obtained from the outcomes of this medical distance educational system.
The survey tool and questionnaire provided information to help understand reasons for the low pass rate of IMGSs at the ANZCA structured examinations. The investigation also revealed the IMGSs’ view of this perceived problem and highlighted their difficulties, such as obtaining adequate supervision and education. The IMGSs are different from the local advanced trainee registrar. They have more varied backgrounds, reduced access to study and they are not familiar with the exam requirements. The low pass rate cannot be explained by their approaches to study and motivational behaviours as they either match or are better than the higher achieving group of local trainees. IMGSs in Anaesthesia achieved a pass rate at the specialist recognition exams that match that of local trainees when a program specifically addressing their learning needs was generated. Videoconferencing was found to be a feasible method to assist IMGSs to become aware of the requirements of the exam and to better prepare. The pass rate at the ANZCA final examinations of IMGSs who joined the tutorials was increased. It was demonstrated that it is possible to achieve success although the mechanisms for this were not clearly shown nor was the optimum form of technology and teaching method evident. The novel measurement tool produced from this study is an early predictor of exam performance. A continuing and sustained level of just 3% meaningful participation relevant to discussed tutorial topics is needed to markedly increase the chance of success at the final ANZCA examinations. The percentage level is independent of candidate background and the mode of participation being either face-to-face or at a distance via videoconference.
The IMGSs are fundamentally different from the local trainee. They have suitable achievement strategies and the motivation required for successful study that may be a distinguishing feature of this group. They are prepared to confront additional challenges that are known to be associated with emigrating home and family. IMGSs in Anaesthesia may not know what is pertinent for examinations in a foreign system. A medical educational system was tested using videoconferencing. IMGSs located at remote health facilities have achieved improved examination results by interacting in discussion groups with local trainees. A practical measure provided a progressive picture of candidate level of preparation for the ANZCA exams as well as an early predictor of individual exam outcome. During progressive analysis, it became evident that there may need to be a different kind of college assessment for IMGSs in Anaesthesia. It is possible that performance at college final exams may be measuring the examination process rather than the IMGS’s clinical ability. Future research may show that IMGSs in Anaesthesia are able to perform rather than verbalise their level of clinical skill. The following is quoted from an IMGS in Anaesthesia who assisted with sponsorship of this thesis:
“It is easier and more productive to provide help to ensure a standard rather than criticise the basic training and leave the IMGS to struggle. However this help will remain a challenge.”