Support for doctors in training who have language or cultural communications challenges

Adopting another language for daily workplace use is often not a matter of simply learning it, but also a challenge of adjusting in other ways too. Even those who satisfy regulatory language requirements may experience challenges in their professional communication, often as a result of a complex interplay of linguistic and cultural factors, along with challenges they may be unaware of.

This case study looks at the work of the Pan London Professional Support Unit (PSU) to help doctors overcome these barriers.

What is the challenge?

A significant and growing number of doctors applying for support from the Pan London Professional Support Unit (PSU) are international or EU medical graduates.

These learners are often unaware they may be transferring patterns of interaction from their first language or culture into their professional communication in English, and may find it difficult to understand why they are misunderstood, and how they should adapt. This may in turn have an impact on well-being, team dynamics, career progression, and potentially on patient safety. Similar issues are also being observed amongst health professionals from other disciplines, such as internationally educated nurses, who are now able to access the Pan London PSU.

There are also challenges for educators. Many may not have the specialist knowledge and skills to help identify the language and cultural learning needs of this group. They may also need to reflect on the implicit cultural values and expectations they bring to the teacher/learner relationship, how these may differ from others', and how they interpret learner behaviour.

What support is provided?

The Pan London PSU aims to support healthcare professionals in London to communicate effectively across all clinical contexts; in interaction with patients and their families, in relationships with colleagues, face to face, on the telephone and in writing. A key aspect of this work is the specialist communication skills support offered to international medical graduates, EU doctors, and UK graduates who have a first language other than English.

The PSU team includes linguists who are able to offer feedback initially through a one to one learning needs review, and will signpost non-native speakers of English to additional language and intercultural support according to their needs. This covers topics such as culture and communication, English pronunciation, and written English. A further advantage of having linguists working alongside clinical communication skills specialists is that educators are able to share best practice and develop the analytical language to identify and describe, in greater detail, the linguistic learning needs of non-native speakers.


Supporting the Safe Transition of Internationally Educated Health Professionals

In November 2014 the PSU, together with Health Education North Central and East London (HENCEL) launched a framework for educators entitled Supporting the Safe Transition of Internationally Educated Health Professionals. The framework provides an overview of the potential challenges educators need to be aware of when supporting international graduates, together with guidance relating to strategies they can use to address key issues.

The framework is structured around the following five main domains:

  • communicative and cultural capability
  • clinical capability
  • professional culture
  • developing resilience
  • teaching and learning.

Positive impact

Feedback from individual international and UK graduates who have accessed language support from the Pan London PSU has been overwhelmingly positive, with many providing examples of improved relationships with patients and colleagues, and greater job satisfaction. A system for post-support follow up has recently been set up, following Kirkpatrick's learning evaluation model.

The Pan London PSU/HENCEL framework and resources for supporting internationally educated health professionals was very positively received and has been accessed over 8000 times since the launch in November 2014. Feedback has been invited from educators and a follow-up event to evaluate the resource further is planned for November 2015.

Learning points

Involvement of linguistic specialists

The experience of the Pan London PSU suggests that, given the proportion of healthcare professionals who practise in English as a second language, it would be helpful for educational teams to consider involving language and intercultural specialists in order to offer more refined and targeted support to internationally educated colleagues.

Categorisation of learners

Broad categorisation of learners by place of primary qualification may mean that assumptions are made about language and cultural background. The PSU has supported a significant number of UK graduates who have a first language other than English, were born and have attended school overseas, as well as bilingual UK nationals, who rarely use English outside the workplace.

Challenges for educators

It is important for educators to be aware of the impact of culture on their own as well as others' communication. The interpretation of behaviour is often based on implicit, culturally determined expectations, which may need to be made explicit before they can be reconciled.

I want to learn more

For further information, contact Lynne Rustecki at or visit the Pan London PSU's website for the Pan London PSU/HENCEL framework and resources.

Who is this page for?
This case study may be helpful for doctors in training whose first language is not English, or those who know such doctors in training.
Why might this page help you?
Being able to communicate effectively is a key skill which all doctors must possess.