Patient centred care - are international medical graduates 'expert novices'?

BACKGROUND: Depending on their previous training, international medical graduates (IMGs) may be unfamiliar with patient centred care (PCC). This study explores the PCC skills that IMGs demonstrated during observed role play.

METHODS: Qualitative observational data were collected during an IMG communication skills course and IMGs' perceptions of PCC were explored in semistructured interviews. Analysis followed principles of grounded theory and focused specifically on the elements of Candlin's (2002) quality of discourse.

RESULTS: Many of the IMGs observed in this study used discourse features that identify them as novices in PCC: they framed consultations as interviews as opposed to conversations, maintained topic control instead of allowing digressions, and focused on achieving simple coherence rather than seeing the consultation as a whole.

DISCUSSION: This study suggests that some IMGs may be novices in PCC while being experts in medical knowledge. A view of IMGs as 'expert novices' may be useful to inform the development of bridging courses.