Clinical attachments: fond farewell or new beginning? A survey of the attitudes and practice of medical consultants and international medical graduates.

OBJECTIVES: To analyse the experience of clinical attachment (CA) of international medical graduates (IMGs) and consultants. DESIGN: Analysis of questionnaires and CVs. SETTING AND PARTICIPANTS: 573 IMGs applying for a house officer post and 102 consultant physicians working in North East England. RESULTS: IMGs had spent a mean of 16 months unemployed, of which 3.8 months was spent on CAs. The median number of CAs was two and the average number of applications sent before obtaining a CA was 73. 90% of IMGs found their CA helpful and 57% would not take up a post without a CA first. Criticisms related to lack of responsibility, isolation and poor job prospects. 90% would apply for honorary posts if advertised. 73% had received induction at the onset of placement, but only 32% had been assessed at the end. 50% of consultants took CAs and only 4% were thinking of stopping doing so. Those without CAs blamed work pressure (43%) and pressure from their employer (23%). CONCLUSIONS: There are deficiencies in pastoral care, the application process and assessment, but CAs are valued by IMGs and offered by half the consultants surveyed. New immigration rules will mean fewer IMGs will come to the UK, but CAs will be needed by those that do, as well by refugees and European Economic Area (EEA) graduates. The tradition of CAs for international graduates could be used to accommodate those coming to the UK on exchanges and scholarships and form part of the recently announced Medical Training Initiative for IMGs.

Measuring neighbourhood social and material context: generation and interpretation of ecological data from routine and non-routine sources.

Investigating the role of the social and material environment in determining mortality, morbidity and health behaviour has become increasingly popular in epidemiological research. However, despite calls to use more innovative data about areas, there is still a tendency to use 'off the shelf' data derived from pre-existing routine surveys and censuses. Many researchers argue that innovative ecological data about areas is difficult to collect and use effectively, difficult to compare and hard to interpret and analyse. This paper considers an approach to obtaining and interpreting innovative ecological data, and is based on a case study of empirical data collection in the UK. The paper focuses on issues of scale, quality, generation, use and interpretation of data. While it is important to start with a priori theories about the way specific domains of the local environment might influence health, we report that finding robust measures of these domains at the correct spatial scale is difficult and time consuming. However we argue that the attempt to measure specific chains of causation is important enough for public health for this approach to followed and improved upon.