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A description of some of the features of general practice consultations in a clinic in India with reference to the Clinical Skills Assessment (CSA) of the United Kingdom Royal College of General Practitioners

Mohanna, K; (2017) A description of some of the features of general practice consultations in a clinic in India with reference to the Clinical Skills Assessment (CSA) of the United Kingdom Royal College of General Practitioners. Doctoral thesis , UCL (University College London). Green open access

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Abstract

This thesis describes some of the features of general practice consultations in a clinic in India with reference to the Clinical Skills Assessment (CSA) of the United Kingdom Royal College of General Practitioners. There is a significant difference in the success rate in this postgraduate licensing assessment between those doctors trained in India and those trained in the UK, the reasons for which are not known. Some doctors from India feel that this is in part due to family medicine being performed differently in India. The results presented here first explore the reported experience of doctors working in family medicine in India through focus group and interviews looking at contextual aspects of practice; and then through conversation analysis explore the work done by talk-in-interaction in video recordings of actual family medicine consultations in India; a unique study. The CSA heavily emphasises the assessment of talk as used in three domains - data gathering, clinical management and interpersonal skills. I will propose a definition of ‘interactional fluidity’, based on the expectations of RCGP examiners about markers of competence, and consider its implications in this high stakes assessment process. Using a model that differentiates between ‘core business work talk’ , ‘work-related talk’ , ‘social talk’ and ‘phatic communion’, which last two are grouped as ‘small talk’, the talk in these consultations will be analysed. The impact of Indian societal norms and the risk of examiners mistaking unfamiliar patterns of talk for lack of medical competence are discussed. Reflecting on the journey from clinician-educator to practitioner-researcher the thesis describes the impact the study has had on the personal practice of the author and also the implications for maintaining fairness in training and assessing international medical graduates within the UK.

Type: Thesis (Doctoral)
Title: A description of some of the features of general practice consultations in a clinic in India with reference to the Clinical Skills Assessment (CSA) of the United Kingdom Royal College of General Practitioners
Event: UCl
Open access status: An open access version is available from UCL Discovery
Language: English
Keywords: General Practice, Clinical Skills Assessment, conversation analysis, India, video recorded consultations
URI: http://discovery.ucl.ac.uk/id/eprint/1538682
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