title: How do international medical graduates and colleagues perceive and deal with difficulties in everyday collaboration? A qualitative study.
abstract: OBJECTIVE
  Many medical doctors work outside their countries of origin. Consequently, language barriers and cultural differences may result in miscommunication and tension in the workplace, leading to poor performance and quality of treatment and affecting patient safety. However, there is little information about how foreign doctors and their colleagues perceive their collaboration and handle situations that can affect the quality of health services.
  
  
  METHODS
  Individual, semi-structured in-depth interviews were conducted with two groups of informants: 16 doctors who had recently started working in Norway and 12 unrelated Norwegian-born healthcare providers who had extensive experience of working with doctors from foreign countries. The interviews were analysed according to the systematic text condensation method.
  
  
  RESULTS
  The foreign doctors described themselves as newcomers and found it difficult to speak with their colleagues about their shortcomings because they wanted to be seen as competent. Their Norwegian colleagues reported that many new foreign doctors had demanding work schedules and therefore they were reluctant to give them negative feedback. They also feared that foreign doctors would react negatively to criticism. All participants, both the new foreign doctors and their colleagues, reported that they took responsibility for the prevention of misunderstandings and errors; nevertheless, they struggled to discuss such issues with each other.
  
  
  CONCLUSIONS
  Silence was the coping strategy adopted by both the foreign doctors and native healthcare professionals when facing difficulties in their working relationships. In such situations, many foreign doctors are socialized into a new workplace in which uncertainty and shortcomings are not discussed openly. Effective leadership and procedures to facilitate communication may alleviate this area of concern.
authors.affiliation: 1 Helse Øst Health Services Research Unit, Akershus University Hospital, Norway.|2 Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Skjeggestad
authors.affiliation: 3 Work Research Institute, Oslo and Akershus University College, Norway.
authors.forename: Reidun
authors.initials: R
authors.lastname: Norvoll
authors.affiliation: 4 Department of Psychosocial Science, University of Bergen, Norway.
authors.forename: Gro M
authors.initials: GM
authors.lastname: Sandal
authors.affiliation: 1 Helse Øst Health Services Research Unit, Akershus University Hospital, Norway.|2 Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: Pål
authors.initials: P
authors.lastname: Gulbrandsen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D003144:Communication Barriers; D003466:Cultural Characteristics; D005260:Female; D005550:Foreign Medical Graduates / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D009664:Norway; D061214:Patient Safety; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D055815:Young Adult
keywords: International medical graduates; cross-cultural teamwork; qualitative study; safety culture