A study to explore how interventions support the successful transition of Overseas Medical Graduates to the NHS: Developing and refining theory using realist approaches

Abstract

Background:
The UK’s National Health Service (NHS) currently relies on overseas doctors to ensure effective healthcare delivery. However, concern has grown around their regulation and practice and there is a recognition of the need to support overseas qualified doctors to make a successful transition to the NHS. Interventions have been implemented to address transitional issues without sufficient exploration of what is likely to work or how much training and support are appropriate. The absence of a supportive framework, targeting social, cultural and work related issues, has led to overseas graduates feeling stressed, being isolated and experiencing mental health issues. Difficulties in career progression, retention and performance are also evident. This thesis explores and evaluates interventions that have been developed to support the transition of overseas medical graduates to the UK.

Method:
A realist approach was adopted. A realist synthesis (exploration of literature and development of initial theory) was conducted. A realist evaluation was then completed to test and refine theory. The main intervention subject was the Programme for Overseas Doctors (POD) developed within one North East Trust. A comparative case study design, using mixed methods, was used (including interviews, questionnaires, researcher observation and analysis of performance data).

Findings:
A synthesis of the findings, including 123 interviews, illustrated that three key contextual levels; organisational, training and individual, will likely impact on the adjustment of overseas doctors (including performance, retention, career progression and wellbeing). One of the main outcomes of this thesis is a transferable, theoretical explanation of how interventions can successfully support the transition of overseas medical graduates to the NHS.

Conclusions:
In order to successfully support the transition of overseas doctors, interventions need to be more comprehensive and broad ranging than a simple induction or one-off training programme. Interventions must focus on building an open and supportive culture, address individual needs, and include ongoing support from all staff beyond the initial intervention. This work has reviewed factors that contribute to a successful intervention and has put forward recommendations for future policy, interventions and future research.