Knowledge Bank
Practising difficult conversations with an AI patient
Back to Menu ↩ Good doctors do not simply tell patients what to do. They explain the options, listen to the patient’s values and concerns,
September 28, 2026
In many countries, a large part of the healthcare workforce has trained overseas. In the UK for example, international medical graduates (IMGs) now make up about half of all trainee GPs. Two new reviews, which bring together the results of many earlier studies, help us understand their working lives and the pressures they face. This is of particular interest to those who provide language tuition, both pre- and post-departure.
The first review, in Medical Care Research and Review, combined 34 studies published between 2004 and 2025. Internationally educated nurses generally reported moderate to high job satisfaction, but also moderate to high burnout (long-term exhaustion caused by work stress). Outcomes were most closely linked to conditions at work: workload, discrimination, leadership support and orientation. Levels of fluency in the host country’s language was also clearly linked to higher satisfaction and lower stress. The authors call for a two-way approach. International nurses need orientation, support and ongoing professional development – including in language – while local teams also need greater cultural humility, also an area where training and support can be provided.
The second review, from Newcastle University, was published in Education for Primary Care. It included 40 studies, mostly from the UK, Australia, the USA and Canada.
Its findings on language will be familiar to many of our readers. Many doctors were fluent in formal English but struggled with informal, everyday language: dialects, colloquialisms (informal words and phrases) and regional accents. Some patients found the doctors’ accents hard to understand, and some booked another appointment with a different GP to check the plan.
Communication style unsurprisingly was highlighted. Some doctors were seen as too direct or emotionally distant, because the expected ways of showing empathy and building rapport were unfamiliar to them. Colleagues noticed differences in tone, voice volume, gestures and humour that all impacted on relationship building with patients. Building rapport was even harder in remote consultations. Doctors also described the mental effort of translating in their heads, which slowed them down. Doctors who studied medicine in a language other than English had lower scores on GP licensing exams, and this extra mental effort may be one reason.
Other challenges were not about language and reflected those faced by the nurses. Doctors described bias from some patients and colleagues, isolation, visa restrictions, and unfamiliar training methods such as reflective portfolios and recorded consultations.
However, despite this, studies found similar levels of patient satisfaction for international and locally trained GPs. A range of approaches helped, including communication training with simulated patients or language experts, mentoring, peer networks, culturally sensitive feedback and structured induction. Doctors also helped themselves by practising with native speakers and actively asking for feedback. The authors recommend two-way support for trainers as well as trainees, again similar to the recommendations made for overseas nurses.
Both reviews point in the same direction. Passing an English test is not the end of language learning. Clinicians also need everyday and regional English, and the cultural side of communication, such as how to show empathy in a new setting. Language is clearly important, but there are other factors that make a difference. Training works best alongside good induction, mentoring and a welcoming team.
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