Chuka Nwokolo came to the UK from Nigeria and has become a prominent consultant. He tells Tim Tonkin greater support for overseas-trained doctors will help others share in his success

‘In a sense, I am the one that got away.’ Chuka Nwokolo, a consultant gastroenterologist and leading figure in the Royal College of Physicians, gives a wry reflection of the career outcomes of other doctors who, like him, are black and trained overseas.

‘I can’t claim to be typical of black doctors [in this country]. I was helped by a huge infusion of luck mostly by way of supportive idealistic NHS trainers that I encountered,’ he says.

When Professor Nwokolo came to the UK on an RCP training programme in 1985, he at least did not have the stark sense of unfamiliarity felt by many overseas doctors.

His father Chukwuedu was an internationally recognised physician and had taken his family on visits to the UK from their home in Nigeria. The young Chuka had chosen to come to Cambridge for a medical elective – a neat reversal of the traditional practice of British students going to Africa.

He had not only got to know the UK’s hospitals, but a different section of society too. He recalls a holiday job in the East End of London, in a factory making cigarette vending machines. He may be the only luminary of a medical royal college famous for publishing the link between smoking and lung cancer to have seen the opposition quite so up close.

Overseas doctors perhaps do not have the time to pursue some of the other goals UK-born doctors are able to.

Chuka Nwokolo, consultant gastroenterologist

Under-representation

Working first in Epsom, he later took a research post at the Royal Free Hospital in London and decided to stay in the UK because of the growing political instability back in Nigeria. He is now a consultant gastroenterologist at the University Hospitals Coventry and Warwickshire NHS Trust, an honorary professor of gastroenterology at Warwick Medical School, the UK’s representative on the European Board of Gastroenterology and, since 2016, the treasurer of the RCP.

Asked what he felt might be contributing to under-representation of black doctors in senior and leadership roles, he says that the differing priorities of overseas medical graduates could sometimes play a role.

‘Discrimination in its many forms is present in every facet of life but in fairness it is probably less in the NHS because of its long period of interaction with an overseas workforce.

‘I think that when [BAME (black, Asian and minority ethnic)] doctors come from abroad they are busy trying to settle, trying to understand the way the system works trying to look after their family – some of them may have family still at home to support financially. They put their heads down and concentrate on their day jobs.

‘They [therefore] perhaps do not have the time to pursue some of the other goals that UK-born doctors are able to, [such as] research, medical education and management and medical politics.’

Cultural differences

Professor Nwokolo adds that overseas-trained doctors who come to the UK sometimes also have to deal with adapting to different workplace cultures and medical traditions, a transition which is not always easy.

‘I try to explain this to my NHS colleagues using the example of a UK-trained doctor arriving to work in a village in Nigeria prescribing Chloroquine tablets for non-falciparum malaria. His patients would rapidly lose trust since they believe that any treatment not delivered by injection is ineffective. The doctor of course would also lose a powerful placebo tool.’

He says it would potentially be useful to provide brief adaptation training for doctors newly arrived from abroad. The curriculum would be difficult but not impossible to design to include the unwritten, cultural nuances in UK medical practice.

There are also initiatives to help newly arriving international medical graduates. The February issue of The Doctor profiled the Royal College of Psychiatrists’ mentoring scheme, offered to doctors coming to the UK through the medical training initiative. One recipient said she particularly valued the impartial advice available from a doctor who was not her clinical or educational supervisor.

We have to support newly arrived overseas doctors if we genuinely want them to be able to overcome impediments to aspiration.

Call for support

Professor Nwokolo says: ‘A number of foreign-trained doctors run into trouble because of difficulties making this transition, and I think more can be done.

‘It is fine for the GMC to test these skills in the context of the PLAB [Professional and Linguistic Assessments Board], and similar exams, but I hope that it should be possible for such transition courses underpinned by a well-designed curriculum to be available in future.

‘We have to support newly arrived overseas doctors if we genuinely want them to be able to overcome impediments to aspiration to higher roles in medicine.’

Professor Nwokolo is no doubt an exceptional doctor – but there is no reason why overseas doctors, who are also successful, have to be ‘exceptions’. He hopes he can be an example.

‘Most doctors wherever they come from are ambitious and it helps if they can see that someone like them has reached a higher level.’