International medical graduates provide a valuable service to the healthcare of their adopted countries. However, there remain a significant number of challenges in their adjustment and acculturation in the post-migration phase. We believe that the cultural capital these doctors bring with them can act as a support as well as a challenge. They are likely to face subtle and not-so-subtle, covert and overt discrimination at a number of levels. In this brief report, we highlight some of the issues faced by them and some potential solutions.

International medical graduates: challenges and solutions in psychiatry

Ryan Essex , Mala Rao, Fraz Mir, Surash Surash and Mark Exworthy Institute for Lifecourse Development, The University of Greenwich, London, SE10 9LS, UK Director, Ethnicity and Health Unit, Department of Primary Care and Public Health, Imperial College London, London, W6 6RP, UK Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Newcastle Hospitals NHS Foundation Trust, Newcastle, UK Health Services Management Centre, University of Birmingham, Birmingham, B15 2RT, UK Corresponding author: Ryan Essex. Email: Essexr.w.essex@gre.ac.uk

https://doi.org/10.1177/01410768221108499

The National Clinical Impact Awards: cosmetic change or fundamental reform?

The main goal of Total Quality Management (TQM) and Perceived Service Quality (PSQ) in the healthcare sector is to provide high-quality care to patients to meet their needs and expectation. Even in very unique circumstances like the COVID-19 outbreak, there is a need to evaluate how much the prementioned approaches affect patient satisfaction. However, patient satisfaction requires a proper synchronization between what the patient value and what the management perceives. In addition, there should be a focus on what impact the dimensions of TQM and PCQ have on patient satisfaction. As a result, studies have been conducted to identify what the patients value the most related to PSQ and TQM by designing and distributing questionnaires to a sample of patients and analyzing their responses. In this study, a review is conducted of empirical studies from various databases covering the period between 2008 and 2021. The objective is to analyze the influence of TQM and PSQ dimensions on patient satisfaction in healthcare organizations. 

The Impact of Total Quality Management and Perceived Service Quality on Patient Satisfaction in Healthcare: A Systematic Review

Abstract Populations with a migration background have a higher prevalence of mental health problems than their native counterparts. They are also more likely to have unmet medical needs and are less frequently referred to mental health services. One potential explanation for this is that physicians, such as general practitioners (GPs), may unintentionally discriminate against migrant patients, particularly when they lack humanization. To date, no experimental study has investigated this hypothesis. This paper assesses the influence of humanization on GPs’ discriminatory decisions regarding migrant patients with depression. A balanced 2 × 2 factorial experiment was carried out with Belgian GPs (N = 797) who received video-vignettes depicting either a native patient or a migrant patient with depression. Half of the respondents were exposed to a text that humanized the patient by providing more details about the patient’s life story. Decisions related to diagnosis, treatment and referral were collected, as well as the time spent on each video and text, and were analysed using ANOVA. Migrant patients’ symptoms were judged to be less severe than those of native patients (F = 7.71, p &lt; 0.05). For almost all treatments, the decision was less favourable for the migrant patient. Humanization had little effect on medical decisions. We observed that GPs spent significantly more time on the vignette with the humanization intervention, especially for the migrant patients. The results indicate that ethnic differences in the management of depression persist in primary care. Humanization, however, does not mitigate those differences in medical decisions. 

/pdf/unintentional-discrimination-against-patients-with-a-26c9hvrh.pdf

Unintentional Discrimination Against Patients with a Migration Background by General Practitioners in Mental Health Management: An Experimental Study

To inform the discussion regarding the origins of Laboratory Medical Consultant clinical merit award holders (LMC) whether the awards came from the Clinical Excellence Awards (CEA) or Distinction Awards (DA) schemes.Setting - CEA is a scheme to financially reward senior doctors in England and Wales who are assessed to be working over and above the standard expected of their role. The DA scheme is the parallel and equivalent scheme in Scotland. Participants - All of the merit award holders in the 2019 round. Design - This involved a secondary analysis of the complete 2019 published dataset of award winners. Statistical analyses were performed with Chi-square tests set at p < 0.05 level for statistical significance.The top five medical schools (London University, Glasgow, Edinburgh, Aberdeen and Oxford) were responsible for 68.4% of the LMC merit award holders in the 2019 round. 97.9% of the LMC merit award holders were from European medical schools, whereas 90.9% of the non-LMC award holders were from European medical schools. The LMCs with A plus or platinum awards came from only six medical schools: Aberdeen, Edinburgh, London University, Oxford, Sheffield and Southampton. In contrast, the B or silver/bronze LMC award holders came from a more diverse background of 13 medical schools.The majority of LMC merit award holders originated from only five university medical schools. All the LMCs with A plus or platinum awards came from only six university medical schools. There is an apparent overrepresentation of a small number of medical schools of origin amongst those LMCs that hold national merit awards. 

/pdf/a-national-analysis-of-the-medical-schools-of-training-for-3hq251za.pdf

A national analysis of the medical schools of training for merit award-winning laboratory medical doctors working in Britain

Ryan Essex and colleagues call for abolition of the Clinical Excellence Awards owing to their inherent divisiveness and persistent structural inequalities

https://www.bmj.com/content/bmj/373/bmj.n876.full.pdf

Clinical Excellence Awards-time for a fairer NHS rewards scheme.

After the murder of George Floyd and the Black Lives Matter protests, there has been a renewed appetite to tackle racism in all aspects of life. Within medicine and especially primary care, many people seem unclear about the racial disparities in health contexts, society, and beyond. This editorial highlights how racism and racial disparities can interweave and influence a day in the life of a GP.

### Practising

It can be easy to miss the health disparities between White people and non-White people in the four walls of our consulting rooms and busy appointment lists. It is well known that people from Black, Asian, and minority ethnic (BAME) communities experience poorer health outcomes than their White counterparts. This phenomenon occurs across many different diseases1. In some cases its role is well-known, as in diabetes; it is lesser known in other cases such as asthma and cancer care. It’s particularly striking to note a fivefold higher maternal mortality2 among Black women compared to White women in the UK. Socioeconomic factors are more likely than genetic factors3 to explain why some groups experience more illness than others.

A significant proportion of patients from ethnic minorities struggle to get the healthcare they need,4 are afraid to complain about their local health services, and feel they have little influence on improving them. This raises questions about how we perceive non-White people. Systematic review data identified that negative implicit bias5 in healthcare providers towards people from ethnic minorities is linked to poor interactions, such as less respect and worse patient outcomes. Furthermore, racism (treating other people differently based on their ethnic origin) is associated with poorer physical and mental health.6

> ‘If you don't like something, change it. If you can't change it, change your attitude .’ Maya Angelou

### Teaching

Many GPs …

https://bjgpopen.org/content/bjgpoa/early/2020/11/23/BJGPO.2020.0143.full.pdf

Race and racism: are we too comfortable with comfort?

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Clinical Excellence Awards-time for a fairer NHS rewards scheme.

Race and racism: are we too comfortable with comfort?