International Medical Graduates (IMGs) are known to perform less well in many postgraduate medical examinations when compared to their UK trained counterparts. This “differential attainment” is observed in both knowledge-based and clinical skills assessments. This study explored the influence of culture and language on IMGs clinical communication skills, in particular, their ability to seek, detect and acknowledge patients’ concerns in a high stakes postgraduate clinical skills examination. Hofstede’s cultural dimensions framework was used to look at the impact of culture on examination performance.