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00:00:01
Interview with Dr Azmy Birdi
13 Plays2 months ago
In this episode, Dr. Birdi shares insights from her own training journey and offers heartfelt advice for IMG trainees. We’ll be talking about the common challenges faced during GP training and how to navigate them with resilience and confidence.
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Transcript
Introduction to the Podcast
00:00:03
Speaker
Hello and welcome to this episode of our podcast series dedicated to supporting international medical graduates in GP training across the Thames Valley region.
Meet Dr. Azmy Birdi
00:00:14
Speaker
Today I'm delighted to be joined by dr Azmy Birdi a GP partner at Cookham Medical Center, an author and a dedicated GP educator with over 22 years of experience as a GP trainer.
00:00:30
Speaker
Dr. Birdi has earned numerous accolades throughout her career and has a particular passion for women's health. She's not only a specialist in the field, but also a strong advocate and activist, making a real impact in her local community.
Journey and Advice for IMG Trainees
00:00:45
Speaker
In this episode, Dr. Birdi shares in insights from her own training journey and offers some heartfelt advice for the IMG trainees. We'll be talking a bit about the common challenges faced facing our GP training and how to navigate them with resilience and confidence.
00:01:06
Speaker
Thank you very much, Dr. Birdi for joining us today. ah Thank you for that very generous introduction. So can I start by asking about your own experiences as an IMG yourself, your your own training journey and and the challenges you faced at the time?
Challenges Upon Arriving in the UK
00:01:26
Speaker
Yes, so I came to the UK 31 years ago. So, you know, it seems like a lifetime ago in some ways, and it seems like just yesterday in another way.
00:01:39
Speaker
But um it was it was very different um ah from what I'd experienced. ah My own country, my home country, when I had first come was India, now British citizen.
00:01:52
Speaker
But I had done... ah my basic training in Ops and Guine in India and got a certain amount of experience. I was coming to do my Royal College exams and specialise, you know, in Ops and Guine, which I did.
00:02:06
Speaker
But it was it was um hard on
Cultural and Medical Adjustments
00:02:10
Speaker
two fronts. One was that obviously it's a different country and you're coming, you're adjusting to a different climate, different way of shopping, working, ah living um ah without friends and family.
00:02:27
Speaker
And the other thing is you're going into a different medical system, um ah which, you know, the approach to patients, the approach to management is totally different. And the third thing is that nobody cares, or at the time at least, nobody was interested in anything that was done back.
00:02:49
Speaker
back in India, you know, was considered, you know, well, you're here now and you start from scratch. And all those things have to be, ah you know, I needed to adjust to that.
00:03:00
Speaker
um ah So i think the the the real, the first realization that, you know, I am going to have to adjust to everything here, to life, to work, to, to you know, um just the country, the climate and the weather,
00:03:18
Speaker
everything.
Reflections on Youthful Challenges and Optimism
00:03:19
Speaker
So it's it's it's it's it it was a big adjustment. And I think um being younger at the time and being full of hope and optimism, um it wasn't so bad.
00:03:33
Speaker
but But I'm looking, you know, certain things seemed very big at the time, which you look back and you think, well, that would have been normal. And certain things you just took I took in my stride that actually today, I think that you know that might have been you know not acceptable. But here I am now.
00:03:52
Speaker
And I think some of those challenges of moving moving between two completely different nations, it's still universal for the GP trainees as well as any international medical graduates who come over.
00:04:09
Speaker
um However, in in in today's climate, um you know with all the ah unemployment and antagonism, there's some added to challenges.
Current Job Market Challenges for IMGs
00:04:21
Speaker
um How do you feel about that and and what would be your advice to the IMGs or IMG-GP trainees applying or in early training today? What do you have to say to them?
00:04:33
Speaker
So the first thing i I think I should have said at the beginning was when I first came, and as I said, 31 years ago, it was 1994, the jobs were freely available, ah not no necessarily training posts or you know career training that you know would have led you on a pathway to consultant or CCST as they now call it, but but ad hoc standalone jobs were always available provided that you know you had passed your PLAB, which is the licensing exam.
00:05:08
Speaker
So for example, I passed my PLAB and I needed to do um a year out of Hobbes and Gynae in order to to do my part two, I'd done my part one.
00:05:22
Speaker
And then I did my PLAB and literally within a week, um but there was a friend's husband who was working He was a GP, but he was working in A&E as a clinical assistant, as they they do sometimes, or and they did more commonly previously.
00:05:38
Speaker
And he said, come, and I'll introduce you to the local consultant, the the consultant of the department, the head of the department. so you know And i really went for a chat and some advice, and he just took me to HR. And before I knew it, I'd signed on.
00:05:52
Speaker
That does not happen now. First and foremost, there are no standalone jobs. oh um And ah so I appreciate that today when the IMGs come, they are they are um ah you know they are faced with junior doctors sort of you know agitating about pay.
00:06:12
Speaker
There's this issue about there were not enough jobs for for doctors. There's been issues that about certain you know sections of junior doctors saying that they should the british trainees should be given oh the British graduates should be given preference to international trainees.
00:06:28
Speaker
So I appreciate that today in terms of the job front, the availability is not as immediate and as easy as it used to be ah when I came.
00:06:40
Speaker
ah Despite that, there is a huge need. I think there's a huge, huge need for for doctors um um and particularly for those who want to come into general practice and specialties as well.
00:06:54
Speaker
you know ah There isn't enough. There aren't enough. and Therefore, um yeah there is a need for these, the IMGs. It can be discouraging when you come at first and you feel that, you know, you come, some of them have spent a lot of money coming.
00:07:13
Speaker
ah They might have saved up to come. Their families might have sponsored them. Some might even have taken loans, you know, to, to, to, to know to come. And so making all these sacrifices without a clear um a promise of some benefit at the end, or at least a job at the end, it ah is it can be disheartening.
00:07:36
Speaker
But I think that this is a temporary process. um And I think it will not last forever. Now, I can't predict, unfortunately, how long it will go on.
00:07:47
Speaker
um ah But i in in in my experience, any bottleneck shortages of posts, et cetera, tend to last on an average for about six to months to two years, depending on the... the And if ah you can wait it out, if you can persevere,
00:08:11
Speaker
it will open up again because there is need. it has to that We can't cope with the with the ah population needs um um and the demands of the communities.
00:08:29
Speaker
Just need to remain optimistic Yes, yes, that's a very important and persevere. and And, you know, you may have to take a circuitous route, so it may not be the job you want necessarily or the specialty within place that you want, but but things will get better. I mean, this too will pass. That's if there is anything that I've learned over the years. It's that, you know, no situation is completely permanent.
00:08:56
Speaker
Yes. And this reminds me, back in 2006, when I was applying for training jobs, there was a legislation, at least for a short period of time, and this was way before Brexit and everything, and that a training post could only be offered to an IMG, um only <unk> if a UK or a U-trained ah graduate had not been found. And I think it wasn't.
00:09:23
Speaker
requirement on the hospitals to demonstrate that. plant so So things will change. it's so It's always been in waves, I suppose. Correct. And and when I came, that was not that um ah there was no legislation. it was unsaid, but it was very much in practice that you would not be um recruited if there was ah but you know a UK graduate of the same of the same level. Sometimes even if it was you know somebody was a, say, Irish graduate or South African graduate, um things have very much changed. So in that respect, the IMGs should be um reassured or you know certainly may not discouraged that,
00:10:12
Speaker
At the moment, it's very much equal opportunities and equal, you know, they are considered on the on the same level as a UK graduate of that same experience was applying for the job.
00:10:27
Speaker
And that is unlikely to change despite what people say because there would there would be challenges now, you know, equality, diversity, you know, the employment law is is is very clear on that standpoint. So to that extent, yes, there are fewer jobs, so they're disadvantaged that way, but then they're considered on an equal footing to UK graduates um once they end this you know once they pass the exams and they're eligible to apply for jobs. so in While we were better off in certain respects, they're better off in certain other respects.
00:11:00
Speaker
um ah And the job situation will change. It has to open up. theres there is There is nothing else for it. But um ah ah you know that is the way forward.
00:11:12
Speaker
Yes, absolutely. And yes, in spite of the restrictions at different times, many IMGs have found opportunities and built meaningful and successful careers, I suppose. Yeah.
Cultural Differences and Support Systems
00:11:24
Speaker
um Moving on from this topic, one of the challenges that IMGs often face is navigating the cultural differences between the countries. And I wanted to ask you, what what what have you found among your trainees and what advice would you have for them?
00:11:42
Speaker
I think the first thing is to acknowledge the cultural differences that you, you you know, depending where you come from, some IMGs may have come from a big city.
00:11:53
Speaker
which is quite cosmopolitan. Some may have come from smaller places. So it is, it is But it it is a totally different way of life, of, you know, the family structure is different, etc. So I think the first thing to do is acknowledge that.
00:12:12
Speaker
um a I think I said to you when we first spoke that there will be some people who'd say, some people from the same region as yourself, in the same country, I never faced anything, I never had a problem.
00:12:25
Speaker
That is not helpful because everyone's experience is is different and it's like saying um there's nothing like, as I said, the example I gave was there's nothing like sexual harassment in the workplace.
00:12:38
Speaker
I have never experienced that personally, but do I acknowledge that it can happen? And if somebody came to me, would I acknowledge? Absolutely, because we know that it happens you know even today despite all the the training and despite all the legislation that is in place.
00:12:53
Speaker
um the The advice I would have is that there is try try and learn. Try and learn. my My son said something to me this weekend. He said that, you know, when you talk about bias and things like that, he said that humans have an in instinctive mistrust or caution about what they call the other, you know, somebody who's different from them.
00:13:19
Speaker
somebody who has, and we all tend to gravitate, that's what churches and synagogues and temples and, you know, communities do. They come together because you seek people similar to yourself in terms in terms of belief.
00:13:33
Speaker
So it is, you um ah and you know, it's so across the world. The thing is that try and get some support system. You know, it is sometimes hard, hard because you don't find, um even if you find other, i keep talking about Indians because I'm from an Indian background, it can be any, any, from any international background, any different country.
00:14:00
Speaker
But if you, if you find somebody from your own country, may not necessarily bond with them. And that's, that's because you are different people, even though you come from the same region. um it The integration will take place in the workplace. When you start working with people, you start getting to know them. Sometimes children in primary schools and they have friends and then you get to know them.
00:14:22
Speaker
And it it it is worth, if you really feel quite isolated or lonely, it might be worth trying to join a group or a class.
00:14:34
Speaker
um It could be it could be ah like I joined a bridge class many years ago, not with the attempt of finding friendship, but i always wanted to play bridge.
00:14:46
Speaker
And I went there my own. People had come with somebody that they hoped would be their partner in bridge playing because you need a partner. But I just turned up by myself. And um I made friends with,
00:14:59
Speaker
um um you know, three local English ladies that, and for about six months that friendship was very tight, and people have drifted away but it because was nearly 10 years ago, nine years ago, but one has remained a very close friend and we speak regularly. and And that that playing, that kind of support that we gave you because you have to practice, et cetera, and you have to meet,
00:15:22
Speaker
We used to meet in a cafe. That creates a bond and that transcends. and And then you have a common interest, a mutual interest that that transcends the the the umul you know cultural differences.
00:15:36
Speaker
um ah so It could be something like dancing. It could be going to the gym because we all make, at least I do, you know i think I have so much work you know at home. and they they you know Do we really want to to do something?
00:15:50
Speaker
And then this is important too, you know just as you would brush your teeth, you'd look after yourself in other ways, you know it is important that you have some sort of social fulfillment, because that that feeds into you into your um emotional wellbeing, your mental wellbeing. you know If nothing else, even if you don't make friends, just that that that activity will keep you going.
00:16:19
Speaker
And I completely agree. It can be very easy to be overlooked in the first few, even few years of moving countries because you're trying to find your foot at your workplace, trying to settle your family.
00:16:33
Speaker
But um it is really, really important to find something that you enjoy outside work. but it I think it plays a huge part in in that sort of integration um whether it's across cultures, you know, finding something in common, like you said, a walking group, a book club, anything like that. yeah It helps hugely um and in in that process of settling in and finding something that you enjoy.
00:16:58
Speaker
Thank you, Azmy, that. um Moving on from that, I was, one of the other things that I often hear from um speaking to IMG trainees is their experience of of of a subconscious bias and I know that a lot of the trainees before they come to the yeah UK are are well experienced in their own ah fields of medicine, might be in a different speciality or in their own countries where they've trained to have substantial experience and I think sometimes the unfamiliarity may may be defined as incompetence which doesn't help and
00:17:41
Speaker
again, it is something that can really affect confidence and information. Azmy, I'd love to hear your thoughts on this and from your experience, both as ah as ah as an IMG, GP o yourself, and as a GP trainer, what advice do you have for trainees who may be navigating this kind of a situation during their training?
Subconscious Bias and Confidence
00:18:05
Speaker
Again, the first thing is to acknowledge it because the worst thing that people feel is when they're gaslighted, you know, when somebody says, no, no, you're going you're overthinking this. you're youre I think the thing to do is to acknowledge it.
00:18:19
Speaker
And then um also to distinguish this between... overt racism, which should not be tolerated. um And then subconscious bias was, you know, I experienced where people would ask me, i mean, the thing that they need to, you know, they, a lot of people were curious about, did you have an arranged marriage? Because I had, I had, I had recently got married, ah you know, when I started working. And, and i was just thinking, is that the most
00:18:51
Speaker
important thing or is that the the the thing you know you want to know about me? is that and I don't think they meant it badly, but but it was it was you know I used to find that so ah peculiar um ah Sometimes it can be unconscious bias that is not necessarily negative, but it's like um ah some people think that because you are from an ethnic minority, particularly South Asian background, they're all educated. You know, everyone is, you know, your children are going to be educated. you know, ah children don't rebel.
00:19:32
Speaker
um ah you know, they they have closely, you know, this this stereotype that they have, that this is going to be, you know, this this perfect obedient to, and it doesn't work out like that.
00:19:45
Speaker
um ah I think the the thing about self-conscious biases, these are subtle things, and they sometimes are slipped in where it kind of, you think, ah it It almost goes because it happens so, so quickly. And so, so um it it blends in so much with with the daily sort of conversation that it may go unnoticed. And sometimes I've looked back and thought, should I have said something or could I have spoken up for myself? But I felt awkward and I didn't.
00:20:23
Speaker
ah So there was a, yeah, um a presentation once actually when in general when I had joined general practice and um i I was the only partner of colour in fact the only doctor of colour at that time in the practice now it's all changed um going back 24, 25 years so um and ah is somebody who did a presentation and said that oh you know um you have to be careful when patients are sent back from a e It was about sort of safety netting and that people who are discharged from hospital may not necessarily, it may not necessarily be that.
00:21:04
Speaker
He said he might have been seen by somebody from India or Africa where life is cheap. And I was, I got a, you know, I thought, why would you think that somebody from India or Africa won't look after you properly, the whole NHS is staffed by people from from from these countries.
00:21:23
Speaker
And if they weren't there, that's that's what would would affect your your you know the health care system adversely. But it was in a meeting and, you know, everyone was there, nobody said anything and it just kind of passed.
00:21:39
Speaker
ah Now I might have the confidence to say, excuse me, I'd like to ask a question. Say yes. And i would I would say, why would you think that? You know, can you explain to me why would, you know, you you would think that? And and and kind of call him out or call call them out. so So, but but those things those things go and you know they've they've happened, they will probably always happen. Sometimes it is just, as I keep saying, there's the impression on our stereotypic view of the of the other ah rather than an actual bias, deep seated bias, but it does come out.
00:22:18
Speaker
Yes, and and it's difficult because I suppose it is vital for the IMGs to understand the importance of accepting feedback and recognising their limitations and and knowing when to ask for help.
00:22:30
Speaker
Correct. So, yes, I did find some really useful resources actually on the Royal College of Nursing under a section of important concepts to understand.
00:22:42
Speaker
um It talked about subconscious bias, psychological safety, and I will be posting a link along with the transcript of of this interview for the listeners.
00:22:54
Speaker
um Thank you very much, Azmy. It's been great to have you here. um to hear about your experiences as an IMG yourself and and as a successful IMG who has built a very successful career.
00:23:11
Speaker
ah Just on that note, I'm concluding.
Final Encouragement to IMGs
00:23:14
Speaker
Do you have any final words of wisdom to add to our listeners before we sign off? Yes, I would say that the fact that you are here in this country applying for jobs demonstrates so much initiative and courage.
00:23:31
Speaker
That alone is something to be to be proud of, and that in itself is an achievement. so I will say that keep going. you It will take some time sometimes to evolve into the professional that you want to be oh it may you may evolve into somebody that you are eventually, and you will eventually be proud to be, different from what you might have envisaged.
00:23:54
Speaker
So ah you are incredible just for having undertaken this journey. That's beautiful. Thank you very much, Dr. Azmy Birdi. Thank you very much for joining us today.
00:24:07
Speaker
Yeah, thank you. Thank you, Nasheeda for having