International graduates’ experiences of reflection in postgraduate training : a cross-sectional survey

Background: Reflection is a key component of postgraduate training in general practice (GP). International medical graduates (IMG) are thought to be less familiar with reflection, with international medical schools favouring more didactic methods of education.

Aim: To explore IMGs’ experiences of reflection prior to and during GP training, and the support available for developing skills in reflection.

Design and setting: A cross sectional survey was sent to IMGs undertaking GP training in 12 of the 14 UK regions from March to April 2021.

Method: A pre-tested self-administered on-line questionnaire was used to collect data on experiences of reflection both prior to and during GP training, and support available for developing skills in reflection.

Results: 485 of 3413 IMG trainees completed the questionnaire (14.2% response rate, representative of national demographics). 79.8% of participants reported no experience of reflection as an undergraduate and 36.9% reported no formal training in reflection during GP training. 69.7% of participants agreed that reflection was beneficial for their training and 58.3% reported that the best support in reflection came from their supervisors. Experience of reflection, opinions on the benefits, and best sources of support all varied by where respondents' primary medical qualification was obtained (all p-values <.01).

Conclusion: Most IMGs have not experienced reflection prior to commencing UK GP training. There is diversity in experience and culture within this group which must be considered when tailoring educational interventions to support IMGs in their transition to UK GP training.