friendships. The participants work on the OSCEs in small groups, taking turns to role play as the examination candidate, the patient or the examiner. The use of colloquialisms and discussions of cultural differences in medical practice are encouraged. Tutors circulate to ensure that groups run smoothly and to identify learning points to be fed back to the class. Evaluation of results and impact To evaluate the programme, semi-structured interviews were conducted with 19 participants. Students reported educational and social benefits, including: • greater understanding of different cultures, especially in terms of how culture affects the practice of medicine; • greater understanding of the issues faced by refugees and increased respect for migrant health workers, and • greater awareness of the value of opportunities to practise clinical and communication skills and the value of exchanges of skills and knowledge. Student comments included: • Ô…itÕs quite inspiring to meet people who, you know, at that stage in their life are willing to face more examinations, more tests and persevere some more so that they can have a career in medicine’, and • Ô…it is a 2-way thing so that you learn something from someone and they learn something from you, and it goes both ways... I think that is really important.Õ Refugee doctors described a number of benefits, including: • improved English language skills, particularly in terms of understanding idiom and slang terms, and enhanced ability to conduct a professional consultation in English; • improved understanding of the doctor)patient relationship in the UK, and • increased confidence in mixing with native British people and increased social support. Comments included: • Ô…when I attend this session, I feel like, like IÕm in, you know, like I’m with my family, so that is the social part which is so crucial … to feel that you are among your friends or your brothers.’ We conclude that links between refugee doctors and local medical students are seen as valuable by both groups. The programme could be usefully reproduced wherever there is a medical school and substantial numbers of international medical graduates entering the health care system. Correspondence: Dr Pip Fisher, REACHE North-west, Salford Royal Hospitals NHS Foundation Trust, Stott Lane, Salford, Manchester M6 8HD, UK. Tel: 00 44 161 206 4201; Fax: 00 44 161 206 0902; E-mail: pipfisher@hotmail.com doi: 10.1111/j.1365-2923.2007.02886.x Facilitating learning in low performers Vijaya V Mysorekar & Medha A Joshi Context and setting About 15% of students perform poorly in examinations. Various causes of low per- formance have been identified in medical students. These include academic and non-academic problems. Why the idea was necessary If low performers do not receive timely help and support, their performance falls further. It is necessary to identify methods to modify the curriculum in order to help weaker students complete their medical training and start to serve the community. This study was conducted to establish the various causes of low performance in medical students and to analyse the effectiveness of counselling and advice regarding study skills to improve their performance in pathology. What was done Of 115 students who sat a first internal assessment examination in pathology, 22 scored less than 30%. These students formed the sample for the project. A detailed questionnaire including items on demographic and personal information, stress-inducing factors and academic problems was prepared. The low performers were told the possible benefits of the intervention and assured that participation in the project was voluntary and that confidentiality would be maintained. Of the 22 low performers, 21 filled in the question- naire, but only 16 attended a preliminary session on study skills. These 16 students took part in regular 1 : 1 counselling regarding their personal problems. The counselling aimed to focus on the problematic issues made evident by the analysis of questionnaire responses. The students were instructed in various stress management strategies and techniques for developing improved skills in study methods, concentration, memory, writing examinations, etc. A second internal assessment examination was conducted 6 months later. The students’ really good stuff Ó Blackwell Publishing Ltd 2007. MEDICAL EDUCATION 2007; 41: 1083–1111 1106