The following is a summary of the conclusions of the East Cumbria Trainers
group, following discussion regarding English language problems in GP
Problems experienced/shared by trainers who have had GP
Registrars with English language problems
- Patients sometimes experience difficulties understanding the GPR,
leading to confusion, and need for further patient contact to clarify
- Sometimes patients refusing to go back to see the GPR because they
- Poor development of rapport with patient due to poor understanding, or
- GPR sometimes can’t understand patients, especially those with heavy
accents and local dialects
- Cultural differences in expression/behaviour lead to patient or staff
conflict e.g. abrupt manner, inappropriate laughter or smiling.
- Excessive speed of language, or low volume can sometimes be very
difficult to understand.
- GPR having poor understanding of NHS system, having just arrived from
- Some GPR’s come from a culture of ‘doctor-centred’ consultations – which
can be difficult to change
- Difficulty with written English leading to problems with spelling and
accurate written clinical note keeping
- Concern from trainers about the GPR making the grade to pass the
summative assessment video, MRCP oral and video due to English language
- Problems with social isolation in peer group and community.
- Problems with seminars and teaching due to cultural differences and poor
- Prejudice from patients and staff due to English language problems and
poor understanding of GPR
How can trainers help? – Possible solutions.
- If necessary encourage GPR to enrol in additional local English language
- Plan an early seminar or informal chat about their English language
skills early in the first GPR attachment – to identify the GPR’s learning
needs and discuss early ways in which the trainer can help the GPR.
- Encourage increased social mixing to help with possible social isolation
e.g. Joining sports group, local community group etc.
- Plan a video session/seminar specifically to look at language
skills/cultural behaviour and rapport building.
- With agreement of GPR correct spoken English and written English
mistakes early on – obviously impossible to do all the time, but every
little bit helps
- Encourage GPR to introduce themselves early to the practice staff with
details of their background and culture – helps to improve communication
with staff and route out any prejudice as a result of poor understanding due
to English language problems
- Have a clear in house equal opportunities policy, with clear statement
about zero tolerance to racism/prejudice for staff and patients – helps
protect the GPR with English language skills having prejudice problems with
staff and patients.
- Allow longer consultation lengths especially at the beginning of the
attachment, and possibly for longer than allowed for other GPR's
- If necessary refer for speech therapy classes – one trainer found this
very useful for a GPR who had difficulty with pronunciation of English
- Encourage GPR to challenge or question trainer if they don’t understand.
- Encourage GPR to develop consultation skills early that will
specifically help patient understanding e.g. Checking patient understanding
- Joint telephone consultations to assess language skills on the telephone
can be helpful.
- Joint out of hour’s sessions can be useful in assessing language skills
especially when the GPR is under stress/pressure.
- Use a local dialect dictionary if available to help GPR’s who have
problems with understanding accents/dialects
- Encourage GPR to use patient leaflets to improve patient understanding.
- Encourage GPR to use internet learning sites – can be a useful medical
English language tool, and GPR can paraphrase or copy phrases from internet
to help with written English
- Encourage use of spell check before writing clinical notes
- One GPR used an A- Z logbook/dictionary to record new words that she had
learnt, in order to remember more easily and provide an easy way to look
them up again when required.
- Include a specific question in appraisal or feedback in order to
encourage discussion about English language skills.