Consternation and complexity: learning from people who seek asylum

People seeking asylum experience health inequalities, and it is challenging to meet their needs in primary care. Consultations can feel overwhelming; however, there are excellent opportunities for Transformational Learning, transferable to other vulnerable people. A critical approach to evidence-based medicine, emphasising values, can be used to mitigate the consternation generated by these encounters and expand learners’ perceptions about their roles and responsibilities. Global health, diversity, discrimination, intersectionality and power differentials can be explored. Realisation of the part practitioners play in leadership and advocacy is key. Helping the most marginalised is crucial to understanding patient-safety and quality improvement. Community-orientated approaches are performed well by Voluntary and Community Organisations. There is much to learn about co-production and their ‘No Wrong Door’ philosophy. Recognition of health literacy and promoting cultural sensibility for a growing population with Limited English Proficiency, also requires learning advanced communication skills. Developing therapeutic trust with forced migrants subjected to ill-treatment brings skills and behaviour relevant to other challenging encounters in primary care. Vicarious traumatisation is well-recognised when dealing with the sequelae of violence and, aided by their educators, primary care learners must understand ways to protect themselves and reflect on vicarious resilience, through recognising meaning in their work.