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Moynihan R. Overseas trained doctors in Australia call for inquiry into registration system. BMJ 2012; 344:c6686. [PMID: 22258105 DOI: 10.1136/bmj.c6686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chen PGC, Curry LA, Bernheim SM, Berg D, Gozu A, Nunez-Smith M. Professional challenges of non-U.S.-born international medical graduates and recommendations for support during residency training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:1383-8. [PMID: 21952056 PMCID: PMC3257160 DOI: 10.1097/acm.0b013e31823035e1] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE Despite a long history of international medical graduates (IMGs) coming to the United States for residencies, little research has been done to find systematic ways in which residency programs can support IMGs during this vulnerable transition. The authors interviewed a diverse group of IMGs to identify challenges that might be eased by targeted interventions provided within the structure of residency training. METHOD In a qualitative study conducted between March 2008 and April 2009, the authors contacted 27 non-U.S.-born IMGs with the goal of conducting qualitative interviews with a purposeful sample. The authors conducted in-person, in-depth interviews using a standardized interview guide with potential probes. All participants were primary care practitioners in New York, New Jersey, or Connecticut. RESULTS A total of 25 IMGs (93%) participated. Interviews and subsequent analysis produced four themes that highlight challenges faced by IMGs: (1) Respondents must simultaneously navigate dual learning curves as immigrants and as residents, (2) IMGs face insensitivity and isolation in the workplace, (3) IMGs' migration has personal and global costs, and (4) IMGs face specific needs as they prepare to complete their residency training. The authors used these themes to inform recommendations to residency directors who train IMGs. CONCLUSIONS Residency is a period in which key elements of professional identity and behavior are established. IMGs are a significant and growing segment of the physician workforce. Understanding particular challenges faced by this group can inform efforts to strengthen support for them during postgraduate training.
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Jain P, Krieger JL. Moving beyond the language barrier: the communication strategies used by international medical graduates in intercultural medical encounters. PATIENT EDUCATION AND COUNSELING 2011; 84:98-104. [PMID: 20638218 DOI: 10.1016/j.pec.2010.06.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 06/11/2010] [Accepted: 06/16/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To understand the communication strategies international medical graduates use in medical interactions to overcome language and cultural barriers. METHODS In-depth interviews were conducted with 12 international physicians completing their residency training in internal medicine in a large hospital in Midwestern Ohio. The interview explored (a) barriers participants encountered while communicating with their patients regarding language, affect, and culture, and (b) communication convergence strategies used to make the interaction meaningful. RESULTS International physicians use multiple convergence strategies when interacting with their patients to account for the intercultural and intergroup differences, including repeating information, changing speaking styles, and using non-verbal communication. PRACTICE IMPLICATIONS Understanding barriers to communication faced by international physicians and recognizing accommodation strategies they employ in the interaction could help in training of future international doctors who come to the U.S. to practice medicine. Early intervention could reduce the time international physicians spend navigating through the system and trying to learn by experimenting with different strategies which will allow these physicians to devote more time to patient care. We recommend developing a training manual that is instructive of the socio-cultural practices of the region where international physician will start practicing medicine.
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Lyfar-Cissé V, Kumar V. “Fitness to practise” process. Racial justice is long overdue. BMJ 2011; 342:d3041. [PMID: 21586469 DOI: 10.1136/bmj.d3041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nunez-Smith M. Migration of doctors and the "fitness to practise" process. BMJ 2011; 342:d1641. [PMID: 21467100 DOI: 10.1136/bmj.d1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Humphrey C, Hickman S, Gulliford MC. Place of medical qualification and outcomes of UK General Medical Council "fitness to practise" process: cohort study. BMJ 2011; 342:d1817. [PMID: 21467101 PMCID: PMC3071377 DOI: 10.1136/bmj.d1817] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate whether country of medical qualification is associated with "higher impact" decisions at different stages of the UK General Medical Council's (GMC's) "fitness to practise" process after allowing for other characteristics of doctors and inquiries. DESIGN Retrospective cohort study. SETTING Medical practice in the United Kingdom. PARTICIPANTS 7526 inquiries to the GMC concerning 6954 doctors. MAIN OUTCOME MEASURES Proportion of inquiries referred for further investigation at initial triage by the GMC, proportion of inquiries investigated that were subsequently referred for adjudication, and proportion of inquiries resulting in doctors being erased or suspended from the medical register; relative odds of higher impact decisions, by country of qualification, adjusted for doctors' sex, years since primary medical qualification, medical specialty, source and type of inquiry, and nature of allegations. RESULTS Of 7526 inquiries, 4702 concerned doctors who qualified in the UK, 624 concerned doctors who qualified elsewhere in the European Union (EU), and 2190 concerned doctors who qualified outside the EU. At the initial triage, 30% (n = 1398) of inquiries concerning doctors who qualified in the UK had a high impact decision, compared with 43% (267) for doctors who qualified elsewhere in the EU and 46% (998) for those who qualified outside the EU. The adjusted relative odds of an inquiry being referred for further investigation were 1.67 (95% confidence interval 1.28 to 2.17) for doctors who qualified elsewhere in the EU and 1.61 (1.38 to 1.88) for those who qualified outside the EU, compared with doctors who qualified in the UK. At the investigation stage, 5% (228) of inquiries received concerning UK qualified doctors were referred for adjudication, compared with 10% for EU (63) or non-EU (221) qualified doctors. The adjusted relative odds of referral for adjudication were 2.14 (1.46 to 3.16) for doctors who qualified elsewhere in the EU and 1.68 (1.31 to 2.16) for those who qualified outside the EU. At the adjudication stage, 1% (69) of inquiries received concerning UK qualified doctors led to erasure or suspension, compared with 4% (24) for doctors who qualified elsewhere in the EU and 3% (71) for non-EU qualified doctors. The adjusted relative odds of erasure or suspension were 2.16 (1.22 to 3.80) for doctors who qualified elsewhere in the EU and 1.48 (1.00 to 2.19) for those who qualified outside the EU. CONCLUSIONS Inquiries to the GMC concerning doctors qualified outside the UK are more likely to be associated with higher impact decisions at each stage of the fitness to practice process. These associations were not explained by measured inquiry related and doctor related characteristics, but residual confounding cannot be excluded.
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McGrath P, Wong A, Holewa H. Canadian and Australian licensing policies for international medical graduates: a web-based comparison. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2011; 24:452. [PMID: 21710414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT The increasing global mobility of physicians and severe physician shortages of many countries has led to an increasing reliance on International Medical Graduates (IMGs) by countries including Australia and Canada. OBJECTIVES A web-based comparison of licensing policies for IMGs in Australia and Canada to inform and improve policies in each country. METHODS The research involved identification of relevant government and medical regulatory bodies' official websites documenting information on the licensing process for IMGs from each respective country; in-depth examination and comparison of the licensing processes outlined on these sites; and compilation of a comprehensive list of similarities and differences. FINDINGS While difficult entry requirements are imposed in Canada, once full registration is achieved IMGs have the same membership rights as Canadian medical graduates and their separate status (nominally) ends. In Australia, IMGs are allowed relatively easy access to temporary or conditional licenses, especially in designated underserviced areas or areas of need in order to fulfil resource demands. However IMGs are predominantly restricted to practise in limited and less prestigious positions within the medical hierarchy. DISCUSSION The Canadian process for recertifying IMGs can be characterized as being based on the integration/assimilation of IMGs with domestically trained doctors. In contrast, Australia has pursued a different strategy of parallelism of its IMGs. CONCLUSIONS The findings provide insights into how each country balances national licensing requirements with physician shortages in a globalized environment in order to provide healthcare for its citizens.
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Castel OC, Ezra V, Alperin M, Nave R, Porat T, Golan AC, Vinker S, Karkabi K. Can outcome-based continuing medical education improve performance of immigrant physicians? THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2011; 31:34-42. [PMID: 21425358 DOI: 10.1002/chp.20099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care. METHODS Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program. RESULTS Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p <.01) and improved their OSCE scores (p <.001). Most program graduates (90%) rated overall satisfaction as very good or excellent. In comparison with nonparticipants, program graduates performed better on work-based assessments (Cohen's d =.63). DISCUSSION Our intensive, outcome-based, longitudinal CME program has yielded encouraging results. Other medical educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach.
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Rojas C, Samson SN, Ullilen JF, Amoateng-Adjepong Y, Manthous CA. Are international and American graduates equally ACGME competent? Results of a pilot study. CONNECTICUT MEDICINE 2011; 75:31-36. [PMID: 21329290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Despite a substantial proportion of international medical graduates (IMG) matching to U.S. programs in Internal Medicine, little is known about their readiness in the six medical competencies compared to graduates of U.S. schools (USMG). METHODS A brief questionnaire with two questions designed to assess basic understanding of each of the six medical competencies (knowledge, patient care, communication, professionalism, systems based- and practice-based learning) was sent by electronic mail to all 1,737 applicants to a community teaching hospital Categorical Internal Medicine Residency Program. Correct responses of IMG were compared to USMG. RESULTS Two hundred and eight IMGs were similar except for older age (29 vs 27 years; P = 0.02) compared to 39 USMGs who responded. USMG and IMG had similar percent correct answers (67% vs 62%; P = 0.22). USMG and IMG scored similarly across all but two of the six medical competencies. USMGs more often answered correctly questions on U.S. healthcare economics (39.5% vs 20.4% correct, P = 0.01) and the elements of practice-based learning (69.2% vs 47.5%; P = 0.01). CONCLUSIONS While this study is limited by its small sample size, it supports a hypothesis that USMG and IMG may differ in their preparedness for systems-based and practice-based learning. This hypothesis deserves exploration in future studies.
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Louis WR, Lalonde RN, Esses VM. Bias against foreign-born or foreign-trained doctors: experimental evidence. MEDICAL EDUCATION 2010; 44:1241-1247. [PMID: 21070342 DOI: 10.1111/j.1365-2923.2010.03769.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Bias against foreign-born or -trained medical students and doctors is not well understood, despite its documented impact on recruitment, integration and retention. This research experimentally examines the interaction of location of medical education and nationality in evaluations of doctors' competence and trustworthiness. METHODS A convenience sample of prospective patients evaluated fictitious candidates for a position as a doctor in community practice at a new local health clinic. All applicants were described as having the same personality profile, legal qualifications to practise, a multi-degree education and relevant work experience. The location of medical education (the candidate's home country or the UK) and national background (Australia or Pakistan) of the applicants were independently experimentally manipulated. RESULTS Consistent with previous research on skills discounting and bias, foreign-born candidates were evaluated less favourably than native-born candidates, despite their comparable education level, work experience and personality. However, overseas medical education obtained in the First World both boosted evaluations (of competence and trustworthiness) and attenuated bias based on nationality. CONCLUSIONS The present findings demonstrate the selective discounting of foreign-born doctors' credentials. The data show an interaction of location of medical education and birth nationality in bias against foreign doctors. On an applied level, the data document that the benefits of medical education obtained in the First World can extend beyond its direct outcomes (high-quality training and institutional recognition) to the indirect benefit of the attenuation of patient bias based on nationality.
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MacLellan AM, Brailovsky C, Rainsberry P, Bowmer I, Desrochers M. Examination outcomes for international medical graduates pursuing or completing family medicine residency training in Quebec. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2010; 56:912-918. [PMID: 20841596 PMCID: PMC2939121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To review the success of international medical graduates (IMGs) who are pursuing or have completed a Quebec residency training program and examinations. DESIGN We retrospectively reviewed IMGs' success rates on the pre-residency Collège des médecins du Québec medical clinical sciences written examination and objective structured clinical examination, as well as on the post-residency Certification Examination in Family Medicine. SETTING Quebec. PARTICIPANTS All IMGs taking their examinations between 2001 and 2008, inclusive, and Canadian and American graduates taking their examinations during this same period. MAIN OUTCOME MEASURES Success rates for IMGs on the pre-residency and post-residency examinations, compared with success rates for Canadian and American graduates. RESULTS Success rates on the pre-residency clinical examinations remained below 50% from 2001 to 2008 for IMGs. Similarly, during the same period, the average success rate on the Certification examination was 56.0% for IMGs, compared with 93.5% for Canadian and American medical graduates. CONCLUSION Despite pre-residency competency screening and in-program orientation and supports, a substantial number of IMGs in Quebec are not passing their Certification examinations. Another study is under way to analyze reasons for some IMGs' lack of success and to find ways to help IMGs complete residency training successfully and pass the Certification examination.
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Andrew RF. How do IMGs compare with Canadian medical school graduates in a family practice residency program? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2010; 56:e318-e322. [PMID: 20841570 PMCID: PMC2939132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To compare international medical graduates (IMGs) with Canadian medical school graduates in a family practice residency program. DESIGN Analysis of the results of the in-training evaluation reports (ITERs) and the Certification in Family Medicine (CCFP) examination results for 2 cohorts of IMGs and Canadian-trained graduates between the years 2006 and 2008. SETTING St Paul's Hospital (SPH) in Vancouver, BC, a training site of the University of British Columbia (UBC) Family Practice Residency Program. PARTICIPANTS In-training evaluation reports were examined for 12 first-year and 9 second-year Canadian-trained residents at the SPH site, and 12 first-year and 12 second-year IMG residents at the IMG site at SPH; CCFP examination results were reviewed for all UBC family practice residents who took the May 2008 examination and disclosed their results. MAIN OUTCOME MEASURES Pass or fail rates on the CCFP examination; proportions of evaluations in each group of residents given each of the following designations: exceeds expectations, meets expectations, or needs improvement. The May 2008 CCFP examination results were reviewed. RESULTS Compared with the second-year IMGs, the second-year SPH Canadian-trained residents had a greater proportion of exceeds expectations designations than the IMGs. For the first-year residents, both the SPH Canadian graduates and IMGs had similar results in all 3 categories. Combining the results of the 2 cohorts, the Canadian-trained residents had 310 (99%) ITERs that were designated as either exceeds expectations or meets expectations, and only 3 (1%) ITERs were in the needs improvement category. The IMG results were 362 (97.6%) ITERs in the exceeds expectations or meets expectations categories; 9 (2%) were in the needs improvement category. Statistically these are not significant differences. Seven of the 12 (58%) IMG candidates passed the CCFP examination compared with 59 of 62 (95%) of the UBC family practice residents. CONCLUSION The IMG residents compared favourably with their Canadian-trained colleagues when comparing ITERs but not in passing the CCFP examination. Further research is needed to elucidate these results.
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Sciolla A, Ziajko LA, Salguero ML. Sexual health competence of international medical graduate psychiatric residents in the United States. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2010; 34:361-368. [PMID: 20833907 DOI: 10.1176/appi.ap.34.5.361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Currently in the United States, more than one in three psychiatric residents are international medical graduates (IMGs). In light of forecasts of physician shortages, this proportion is likely to continue growing. Although central to psychiatric care, sexual health competence levels of IMGs may be lower than those of U.S. graduates. METHODS The authors conducted a nonsystematic review of the literature and online data to establish the learning needs of IMGs in this area. RESULTS Data on five areas are summarized: demographic and sociocultural data of IMGs in the United States; the need for sexual medicine competence for practicing psychiatrists; how sexual health is currently taught in foreign medical schools; attitudes toward sexuality and sexual problems among physicians and patients of different cultures; and the management of sexual issues, including sexual boundaries, by IMGs. CONCLUSION The authors found evidence suggesting that IMGs from areas most culturally dissimilar to the United States are likely to benefit from sexual medicine curricula in the context of cultural competence training. The diversity and resilience of IMGs are emphasized. Implications for immediate training and future research are outlined.
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Trewby PN. Locum issues. New scheme for staff shortages. BMJ 2010; 341:c3880. [PMID: 20659994 DOI: 10.1136/bmj.c3880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tsikoudas A. Locum issues. The price of saving money. BMJ 2010; 341:c3875. [PMID: 20659992 DOI: 10.1136/bmj.c3875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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van Zanten M, Boulet JR, Simon FA. Flexner's global influence: medical education accreditation in countries that train physicians who pursue residency in the United States. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:324-332. [PMID: 20107363 DOI: 10.1097/acm.0b013e3181c87638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Abraham Flexner's report on medical education, published 100 years ago, remains influential in the United States today, although its international impact is unclear. In addition to global variability in content and delivery of medical education programs, systems of quality assurance oversight are not universal, and there are variations in the scope of the reviews, protocols, and standards used. METHOD The authors used the process and elements of medical school evaluation that Flexner regarded as important for ensuring quality to create a framework for describing aspects of the accreditation systems used in the 10 countries that supply the greatest numbers of international medical graduates (IMGs) to the United States. RESULTS Of these 10 countries, most have an accreditation system, although the review in some is voluntary. Globally, there is variability in the use of Flexner's system. Prerequisite entrance requirements vary according to the degree offered. Faculty involvement in research is frequently encouraged but seldom required. Almost all standards mention the need for adequate facilities for experiential learning in the basic sciences. Three accrediting organizations require that clinical facilities be under the direct control of the medical school, and seven indicate that affiliation agreements are acceptable. All accreditation plans use predetermined standards and external evaluation. CONCLUSIONS Data describing accreditation of the medical education programs of IMGs currently seeking to enter graduate training in the United States contribute to a better understanding of medical education practices around the world and can supplement other information available to graduate medical education program directors who select IMGs for their training programs.
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Dorgan KA, Lang F, Floyd M, Kemp E. International medical graduate-patient communication: a qualitative analysis of perceived barriers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:1567-1575. [PMID: 19858820 DOI: 10.1097/acm.0b013e3181baf5b1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE International medical graduates (IMGs) represent a substantial portion of all medical residents in the United States. Yet, IMGs may be disadvantaged in their communications with U.S. patients for a variety of reasons. The authors conducted a qualitative study to examine IMGs' perceptions of the barriers to their communication with patients. METHOD A convenience sample of 12 IMGs participated in interviews that lasted 1 to 1.5 hours. Residents from the Caribbean, Colombia, Denmark, India, Iran, Pakistan, and Peru participated in individual interviews conducted on-site at one of three clinics. Interviews were transcribed and then coded independently and jointly. The authors used a qualitative analysis of interview transcripts to identify primary and secondary themes. RESULTS IMGs' perceptions of the barriers to communication with their Appalachian patients fit into two broad themes: educational barriers and interpersonal barriers. Within each of these themes, the authors identified secondary themes: education-related barriers were science immersion and lack of communication training, and interpersonally related barriers were unfamiliar dialects, new power dynamics, and different rapport-building expectations. CONCLUSIONS The analysis of the interview data yielded several important findings that residency programs should consider when designing orientations, training curricula, and communication interventions. Programs may need to address challenges related to regional dialect and "informal" English use, as well as communication barriers associated with cross-cultural differences in norms, values, and beliefs. Programs also need to draw on multilayered interventions to address the multidimensional challenges of cross-cultural physician-patient communication.
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Steier KJ. Do not exclude IMGs. THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION 2009; 109:554-556. [PMID: 19861597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Lewis F. Report of the American Board of Surgery. ARCHIVES OF SURGERY (CHICAGO, ILL. : 1960) 2009; 144:591-593. [PMID: 19528396 DOI: 10.1001/archsurg.2009.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Bajammal S, Zaini R, Abuznadah W, Al-Rukban M, Aly SM, Boker A, Al-Zalabani A, Al-Omran M, Al-Habib A, Al-Sheikh M, Al-Sultan M, Fida N, Alzahrani K, Hamad B, Al Shehri M, Abdulrahman KB, Al-Damegh S, Al-Nozha MM, Donnon T. The need for national medical licensing examination in Saudi Arabia. BMC MEDICAL EDUCATION 2008; 8:53. [PMID: 19032779 PMCID: PMC2631006 DOI: 10.1186/1472-6920-8-53] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 11/25/2008] [Indexed: 05/19/2023]
Abstract
BACKGROUND Medical education in Saudi Arabia is facing multiple challenges, including the rapid increase in the number of medical schools over a short period of time, the influx of foreign medical graduates to work in Saudi Arabia, the award of scholarships to hundreds of students to study medicine in various countries, and the absence of published national guidelines for minimal acceptable competencies of a medical graduate. DISCUSSION We are arguing for the need for a Saudi national medical licensing examination that consists of two parts: Part I (Written) which tests the basic science and clinical knowledge and Part II (Objective Structured Clinical Examination) which tests the clinical skills and attitudes. We propose this examination to be mandated as a licensure requirement for practicing medicine in Saudi Arabia. CONCLUSION The driving and hindering forces as well as the strengths and weaknesses of implementing the licensing examination are discussed in details in this debate.
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Copeland EM, Trunkey DD. Medicine in a vortex: quality versus quality. BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS 2008; 93:10-13. [PMID: 18672613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Lehrmann JA, Walaszek A. Assessing the quality of residency applicants in psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2008; 32:180-182. [PMID: 18467472 DOI: 10.1176/appi.ap.32.3.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Caplan JP, Borus JF, Chang G, Greenberg WE. Poor intentions or poor attention: misrepresentation by applicants to psychiatry residency. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2008; 32:225-229. [PMID: 18467480 DOI: 10.1176/appi.ap.32.3.225] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This study examines the veracity of self-reported data by applicants to psychiatry residency. METHODS The authors reviewed the reported publications of all applicants to a psychiatry residency training program over a 2-year span. RESULTS Nine percent of applicants reporting publications were found to have misrepresented them. International medical graduates were found to be more likely to have misrepresented their publications than U.S. medical graduates. CONCLUSION A small but significant number of applicants to psychiatry residency training misrepresent their publications. Identification of misrepresentation may provide valuable information about the applicant and their future performance in training and practice.
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Maudsley RF. Assessment of international medical graduates and their integration into family practice: the Clinician Assessment for Practice Program. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:309-315. [PMID: 18316885 DOI: 10.1097/acm.0b013e318163710f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The Clinician Assessment for Practice Program (CAPP), a program of the College of Physicians and Surgeons of Nova Scotia (CPSNS), assesses the readiness for family practice of international medical graduates (IMGs) who have trained and practiced abroad with no formal Canadian residency training.CAPP has three parts. Part A, a therapeutics exam and an objective structured clinical examination, assesses practice readiness. Part B is a 12-month mentorship in which the CAPP physician is in active practice under a defined license and is mentored by an established family physician. The mentor provides teaching, supervision, guidance, and regular performance assessment. Each CAPP physician negotiates an individualized continuing medical education plan. An on-site assessment of each CAPP physician's practice is conducted by an external assessor who provides feedback to the CAPP physician and his or her mentor. Multisource feedback is administered at 10 months, using questionnaires from patients and colleagues. After 12 months, all assessment data are reviewed by the CPSNS to determine whether to continue the defined license. Part C, run by the registration department (not CAPP), may last three additional years until full licensure is obtained. To date, 148 IMGs have been assessed, 35 have been deemed eligible for a defined license, and 27 have entered family practice, virtually all in small or medium-sized communities in Nova Scotia. The program has been well received by participants and their communities. The mentorship, particularly valuable in assisting IMGs to integrate into their communities, has proven to be the defining feature of CAPP.
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Johnson DA. Establishing a national clearinghouse on international medical education programs: an idea whose time has finally come. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:305-308. [PMID: 18316883 DOI: 10.1097/acm.0b013e3181636f10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In 2006, a special committee appointed by the Federation of State Medical Boards (FSMB) issued a report that evaluated undergraduate medical education in the United States and abroad. With accreditation systems that can provide reasonable and adequate assurance for the quality of medical education in this country, the committee focused its attention on international medical school programs. Because international medical graduates (IMG) comprise a quarter of the physician workforce, U.S. medical licensing boards continue to seek useful and appropriate information on the medical schools of their licensees. Among the report's recommendations is one calling for the establishment of a national clearinghouse of information and data on international medical schools. A workgroup with representation from the FSMB, the Educational Commission for Foreign Medical Graduates, and state medical boards has been formed to establish this clearinghouse. The clearinghouse workgroup is considering various quality indicators suggested by the special committee report such as admission requirements, policies relative to advanced standing, and aggregate performance data on the United States Medical Licensing Examination. The challenges facing the clearinghouse are significant (e.g., gaining cooperation from multiple parties in the United States and abroad, prioritizing data collection efforts). One likely means for facilitating success may be to concentrate data-collection efforts primarily on the 8 to 10 schools currently supplying the largest number of IMGs seeking medical licensure in the United States. In this way, the clearinghouse will provide licensing boards with a resource for standardized information on those medical schools commonly presented by their IMG licensees.
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Wong A, Lohfeld L. Recertifying as a doctor in Canada: international medical graduates and the journey from entry to adaptation. MEDICAL EDUCATION 2008; 42:53-60. [PMID: 18086199 DOI: 10.1111/j.1365-2923.2007.02903.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Globalisation and severe doctor shortages in many countries have resulted in increased numbers of international medical graduates (IMGs) in medical training programmes in major recipient countries such as Canada. Much of the literature on IMGs is written from the perspective of the doctor workforce. Less is known about the recertification training experiences of IMGs in recipient countries. This study aims to describe the recertification training experiences of IMGs in Canada in order to help medical training programmes understand how to facilitate the integration of IMGs into recipient medical communities. METHODS A phenomenological (qualitative) research approach was undertaken for this study. International medical graduates undergoing recertification training in order to practise in Canada were individually interviewed about their experiences. Data collection and analysis followed the procedures of interpretive phenomenology. RESULTS Twelve IMGs participated. Analysis of the interviews revealed 4 themes that typified IMG recertification training experiences: training entry barriers; and a 3-phase process of loss, disorientation and adaptation. International medical graduates must complete this 3-phase process in order to feel fully integrated into their professional environments. CONCLUSIONS This study provided a description of IMGs' training experiences during certification for practice in Canada and revealed that these experiences were characterised by a 3-phase process of adjustment. Using this framework, a series of recommendations were proposed for medical training programmes to help IMGs with this process.
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Kaushik M, Jaiswal A, Shah N, Mahal A. High-end physician migration from India. Bull World Health Organ 2008; 86:40-5. [PMID: 18235888 PMCID: PMC2647348 DOI: 10.2471/blt.07.041681] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 06/11/2007] [Accepted: 06/25/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the relation between the quality of physicians and migration among alumni of All India Institute of Medical Sciences (AIIMS), New Delhi, India over the period 1989-2000. METHODS In a retrospective cohort study, data on graduates of AIIMS were collected from entrance exam qualifier lists, the AIIMS alumni directory, convocation records, the American Medical Association and informal alumni networks. The data were analysed by use of 2x2 contingency tables and logistic regression models. FINDINGS Nearly 54% of AIIMS graduates during 1989-2000 now reside outside India. Students admitted under the general category are twice as likely to reside abroad (95% confidence interval: 1.53-2.99) as students admitted under the affirmative-action category. Recipients of multiple academic awards were 35% more likely to emigrate than non-recipients of awards (95% confidence interval: 1.04-1.76). Multivariate analyses do not change these basic conclusions. CONCLUSION Graduates from higher quality institutions account for a disproportionately large share of emigrating physicians. Even within high-end institutions, such as AIIMS, better physicians are more likely to emigrate. Interventions should focus on the highly trained individuals in the top institutions that contribute disproportionately to the loss of human resources for health. Our findings suggest that affirmative-action programmes may have an unintended benefit in that they may help retain a subset of such personnel.
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García-Pérez MA, Amaya C, Otero Á. Physicians' migration in Europe: an overview of the current situation. BMC Health Serv Res 2007; 7:201. [PMID: 18070353 PMCID: PMC2248190 DOI: 10.1186/1472-6963-7-201] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 12/10/2007] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The migration of medical professionals as a result of the expansion of the European Union is cause for concern. But there is a significant lack of information available about this phenomenon. METHODS Search of secondary databases about the presence of european doctors working abroad, through two search engines in the Internet (Google and Pubmed) and a survey of professional organisations and regulators in countries of the European Union. RESULTS The United Kingdom has more foreign doctors than all other European countries for which figures are available (Ireland, France, Germany, Norway, Portugal, Italy, Austria and Poland). Some 74,031 foreign doctors are registered in the UK, 30.94% of the total. European countries with the highest percentage of doctors working abroad are Ireland (47.5%, or 10,065 doctors) and Malta (23.1%, 376 doctors). The data obtained from Norway, France and Germany do not indicate an increase in the migration of professionals from countries recently incorporated into the EU. CONCLUSION There is significant mobility and heterogeneous distribution of doctors within the EEA and it should be cause for concern among health care authorities. However, there is no evidence about a possible increase in this phenomenon after the recent expansion of the EU.
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Svefors J. [Why does the Medical Association approve of increased education if the result is lower quality?]. LAKARTIDNINGEN 2007; 104:3127; author reply 3127. [PMID: 17985718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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van Zanten M, Boulet JR, McKinley DW, DeChamplain A, Jobe AC. Assessing the communication and interpersonal skills of graduates of international medical schools as part of the United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills (CS) Exam. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2007; 82:S65-8. [PMID: 17895694 DOI: 10.1097/acm.0b013e318141f40a] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND The ability to communicate effectively with patients is an essential element of a physician's clinical expertise. METHOD As part of the USMLE Step 2 Clinical Skills exam, standardized patients (SPs) provided ratings of communication and interpersonal skills (CIS) along three dimensions. Assessment data from a one-year (2006) cohort of graduates of international medical schools (IMGs) were analyzed and psychometric characteristics of the CIS measures are described. RESULTS Female and native English-speaking physicians received slightly higher CIS ratings than did males and examinees of other language backgrounds across all dimensions. However, no significant examinee by SP gender interaction effect was detected. Correlations with other measures support the construct validity of the CIS scale. CONCLUSIONS Results of this preliminary study indicate that properly trained SPs can provide accurate and defensible ratings of IMGs' communication and interpersonal skills.
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Karle H. [Quality assessment of medical education]. LAKARTIDNINGEN 2007; 104:2682-2685. [PMID: 17969758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Hallock JA, Seeling SS. Foreign-Trained Physicians and US Residencies. J Am Coll Surg 2007; 205:519; author reply 519-20. [PMID: 17765176 DOI: 10.1016/j.jamcollsurg.2007.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 05/02/2007] [Indexed: 11/24/2022]
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Bayram C, Knox S, Miller G, Ng A, Britt H. Clinical activity of overseas-trained doctors practising in general practice in Australia. AUST HEALTH REV 2007; 31:440-8. [PMID: 17669067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 04/26/2006] [Accepted: 11/15/2006] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Medical workforce shortages in Australia have led to increasing reliance on overseas-trained doctors (OTDs) to work in general practice in areas of need, particularly in rural areas. These OTDs do not have Australian postgraduate training in general practice, and we know little about how they practise. OBJECTIVE To determine differences in practice style between a self-selected group of overseas-trained general practitioners undertaking the Alternative Pathways Program and GPs who are Fellows of the Royal Australian College of General Practitioners (FRACGP), and whether such differences can be explained by other practitioner, practice and patient characteristics. METHOD A self-selected sample of 89 OTDs from the Alternative Pathways Program were compared with FRACGPs in a continuous national study of GP activity (n=1032). Each GP provided details about themselves and their practice and recorded data about patients, morbidity and treatments for 100 encounters. RESULTS OTDs were younger, less experienced, worked more sessions per week, in smaller practices. OTDs saw fewer children and elderly patients, more new patients, health concession card holders and Indigenous people. OTDs managed less general, urological, social, skin and pregnancy problems, and more cardiovascular problems, urinary tract infections, tonsillitis and conjunctivitis. They provided more medications, other treatments and referrals, and ordered more pathology and imaging tests. CONCLUSION This study suggests that OTDs see a different patient mix and range of morbidity and provide different management to that of FRACGPs, generating higher costs of care. Regular study of the clinical activities of a representative sample of overseas-trained GPs is needed.
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Couser G. Twelve tips for developing training programs for international medical graduates. MEDICAL TEACHER 2007; 29:427-30. [PMID: 17885968 DOI: 10.1080/01421590701317843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND International Medical Graduates (IMGs) are a diverse group of doctors who provide essential health services in many western countries, and hospitals are increasingly relying upon IMGs to fill vacancies in all staff grades. Clinical skills and experience vary greatly between doctors, and orientation and clinical skills training is a way of addressing any identified deficiencies. WORK DONE This paper relates the experiences of establishing a training program and support services for IMGs working in the public hospital system in Tasmania, Australia, and offers advice for other agencies contemplating establishing similar programs. CONCLUSIONS A 'hub and spoke' model is a useful model to adopt: a central coordinating office designs and implements programs informed by best available evidence, and clinical educators on site at healthcare facilities implement programs and provide direct assistance and orientation. Broad-based programs attending to orientation, doctor's families' needs, communication skills and clinical skills training are required. Support from health administrators is essential.
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Akl EA, Maroun N, Major S, Chahoud B, Schünemann HJ. Graduates of Lebanese medical schools in the United States: an observational study of international migration of physicians. BMC Health Serv Res 2007; 7:49. [PMID: 17411430 PMCID: PMC1854889 DOI: 10.1186/1472-6963-7-49] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 04/05/2007] [Indexed: 11/26/2022] Open
Abstract
Background As healthcare systems around the world are facing increasing physician shortages, more physicians are migrating from low to high income countries. As an illustrative case of international migration of physicians, we evaluated the current number and historical trends of Lebanese medical graduates (LMG) in the US, and compared their characteristics to those of US medical graduates (USMG) and other international medical graduates (IMG). Methods We evaluated the number of LMG using the 2004 the American Medical Association Physicians' Professional Data (AMA-PPD) and then compared it to the number of graduates of other countries. We evaluated the historical trends using the 1978–2004 historical files of the AMA-PPD. We analyzed the characteristics of all LMG and compared them to a random sample of 1000 USMG and a random sample of 1000 IMG using the 2004 AMA-PPD. Results In 2004, there were 2,796 LMG in the US, constituting 1.3% of all IMG. Compared to other foreign countries contributing to the US physician workforce, Lebanon ranked 2nd after adjusting for country population size (about 4 million) and 21st overall. About 40% of those who graduated from Lebanese medical schools in the last 25 years are currently active physicians in the US. Since 1978, the number of LMG in the US showed a consistent upward trend at a rate of approximately 71 additional graduates per year. Compared with USMG and IMG, LMG were more likely to work in medical research (OR = 2.31; 95% Confidence Interval (CI) = 1.21; 4.43 and OR = 2.63; 95% CI = 1.34; 5.01, respectively) and to be board certified (OR = 1.43; 95% CI = 1.14; 1.78 and OR = 2.04; 95% CI = 1.65;2.53, respectively) and less likely to be in family practice (OR = 0.14; 95% CI = 0.10; 0.19 and OR = 0.18; 95% CI = 0.12; 0.26, respectively). Conclusion Given the magnitude and historical trends of migration of LMG to the US, further exploration of its causes and impact is warranted. High income countries should consider the consequences of their human resources policies on both low income countries' and their own healthcare systems.
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Leon LR, Villar H, Leon CR, Psalms SB, Aranha G. The Journey of a Foreign-Trained Physician to a United States Residency. J Am Coll Surg 2007; 204:486-94. [PMID: 17324786 DOI: 10.1016/j.jamcollsurg.2006.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 11/29/2006] [Accepted: 12/04/2006] [Indexed: 10/23/2022]
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Escobar GA. How to select better international graduates for surgical positions. Surgery 2007; 141:281. [PMID: 17263988 DOI: 10.1016/j.surg.2006.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Accepted: 09/30/2006] [Indexed: 11/29/2022]
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van Zanten M, Boulet JR, McKinley D. Using standardized patients to assess the interpersonal skills of physicians: six years' experience with a high-stakes certification examination. HEALTH COMMUNICATION 2007; 22:195-205. [PMID: 17967142 DOI: 10.1080/10410230701626562] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Communication and interpersonal skills are essential elements of a physician's clinical expertise. Since 1998, the interpersonal competencies of over 37,000 internationally-trained physicians have been assessed as part of the Educational Commission for Foreign Medical Graduates (ECFMG) Clinical Skills Assessment (CSA). Standardized patients (SPs) provided ratings of interpersonal skills along 4 dimensions: skills in interviewing and collecting information; skills in counseling and delivering information; rapport; and personal manner. The content of the rating scale, the development and implementation of training materials and procedures, and the psychometric characteristics of the measures are described. Data from over 400,000 simulated patient encounters were analyzed. Correlations with other measures supported the construct validity of the assessment. A generalizability study showed that the ratings were reproducible over encounters. Analysis of individual SP ratings indicated that they were consistent in their application of the scoring rubric. Overall, the findings indicate that SPs, with proper training and a benchmarked scoring rubric, can provide accurate and defensible ratings of physicians' interpersonal skills. These results may also generalize to other clinical skills assessments, or other evaluations that employ raters to judge communication abilities.
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Pandeya NK. Osteopathic degrees overseas. THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION 2007; 107:6-7; discussion 7. [PMID: 17299029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Chur-Hansen A, Elliott TE, Klein NC, Howell CA. Assessment of English-language proficiency for general practitioner registrars. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2007; 27:36-41. [PMID: 17385731 DOI: 10.1002/chp.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION English-language proficiency of medical practitioners is an issue attracting increasing attention in medical education. To best provide language education support, it is essential that learning needs are assessed and that useful feedback and advice are provided. We report the outcomes of a language assessment that was embedded within the context of a comprehensive general practice learning-needs analysis. METHODS A group of general practitioner registrars (N = 18) training in Adelaide, South Australia, participated in the learning-needs analysis. The analysis used reliable, validated rating scales that provided information on both verbal and written language skills. These scales were used in the context of an objective structured clinical interview. The interviews were videotaped to enable multiple ratings per candidate. Following the learning-needs analysis, ratings were collated and fed back individually to participants according to a feedback report and template. RESULTS Of this sample, 5 (28%) were found to have no need for any assistance with either spoken or written language, 5 had poor handwriting, 5 were considered to have minor difficulties, and 3 (17%) were identified as having substantial spoken and written English-language difficulties. These outcomes allowed medical educators to focus the language education support offered to the general practitioner registrars appropriately. CONCLUSIONS Language skills can be usefully assessed within a more comprehensive learning-needs analysis. In combination with this assessment, the provision of specific feedback and recommendations for appropriate language-learning opportunities is essential.
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Gastel B. Impact of International Medical Graduates on U.S. and Global Health Care: summary of the ECFMG 50th anniversary invitational conference. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S3-6. [PMID: 17086042 DOI: 10.1097/01.acm.0000243340.89496.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Karle H. Global standards and accreditation in medical education: a view from the WFME. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S43-8. [PMID: 17086046 DOI: 10.1097/01.acm.0000243383.71047.c4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Globalization of medicine is increasing, as manifested by the growing number of migrating doctors and cross-border education providers. In addition, new medical schools of dubious quality are proliferating. This situation accentuates the need to define standards and introduce effective and transparent accreditation systems. With this background, and reflecting the important interface between medical education and health care delivery, a World Health Organization (WHO)/World Federation for Medical Education (WFME) Strategic Partnership to improve medical education was formed in 2004. In addition to working on reform processes, capacity building, and evaluation of medical education at the regional and national levels, the partnership in 2005 published guidelines for accreditation of basic medical education. Only a minority of countries have quality assurance systems based on external evaluation, and most of these use only general criteria for higher education. The WHO/WFME Guidelines recommend establishing accreditation that is effective, independent, transparent, and based on criteria specific to medical education. An important prerequisite for this development was the WFME Global Standards program, initiated in 1997 and widely endorsed. The standards are now being used in all regions as a basis for improving medical education throughout its continuum and as a template for national and regional accreditation standards. Promotion of national accreditation systems will pivotally influence future international appraisal of medical education. Information about accreditation status--agencies involved and criteria and procedures used--will be essential to future databases of medical schools and will be a foundation for international "meta-recognition" of institutions and programs ("accrediting the accreditors").
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Dauphinee WD. The circle game: understanding physician migration patterns within Canada. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S49-54. [PMID: 17086047 DOI: 10.1097/01.acm.0000243341.55954.e0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This report explores the movement of physicians to, from, and within Canada and identifies recurring patterns of migration. The primary position of the report is that physician movement is part of reality both internationally and within Canada, and that movement of Canadian-trained physicians creates a need for international medical graduates (IMGs) in "physician-losing" locations. The report's argument is based on data retrieved from public sources on aggregate physician practice patterns in Canada and analyzed for migration patterns. In addition, literature was reviewed on factors affecting the migration patterns being described.Canadian-educated physicians have tended to move from less prosperous to more prosperous provinces and from rural to urban areas; because of the resulting need, the physician-losing locales generally have the highest proportions of IMGs. Physicians traditionally have tended to emigrate from Canada to the United States, thus increasing Canadian demand for IMGs, but recently this movement has slowed and even reversed. In Canada, liberalized immigration policies for physicians combined with a shortage of postgraduate training positions to create a serious bottleneck early in the current decade. However, this problem is now being resolved. In summary, physician migration within Canada shows specific long-term patterns, and IMGs will be needed in underserved areas for years to come. Well-informed policies for workforce management are essential in Canada to ensure an adequate physician supply consisting mainly of Canadian-educated physicians but also including IMGs. A role for nonadvocacy groups such as the Educational Commission for Foreign Medical Graduates may be to help ensure that recruitment of physicians from developing countries follows accepted ethical principles.
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Thompson JN. The future of medical licensure in the United States. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S36-9. [PMID: 17086044 DOI: 10.1097/01.acm.0000243351.57047.2e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Medical licensure in the United States is undergoing significant change. With calls for greater accountability and transparency, state medical boards and their membership association, the Federation of State Medical Boards (FSMB), are seeking ways to assure the public that physicians are maintaining their competence throughout the lifetime of their practice of medicine. At present, competence in cognitive, clinical, and communicative skills is regularly measured only at initial licensure. Yet, the public and policy-related organizations are demanding ongoing assessment of physicians' ability to safely and competently practice medicine. The author reports on activities that involve the FSMB and other national organizations, including the Educational Commission for Foreign Medical Graduates, in planning for a future of increased accountability and transparency of the licensing and regulatory communities that oversee the practice of medicine. He notes that topics of discussion include possible nationalization of what has been traditionally state-based licensure. He raises questions about a future that may include specialty-based licensure and greater national and even international license portability.
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Zerhouni EA. International medical graduates in the United States: a view from an ECFMG certificant. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S40-2. [PMID: 17086045 DOI: 10.1097/01.acm.0000243348.55441.3b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The author was instilled with a passion for mathematics and physics by his father, who taught those subjects in a small Algerian town. Another indelible influence came during a high school mathematics class when his teacher gave the class a problem to solve. Little did the students know that it was Fermat's Last Theorem, which stumped them, and before that, every mathematician since 1630. This experience taught the author that failing to get the final answer was part of learning. He became enchanted with imaging techniques and after earning his medical degree in Algeria, came to study at Johns Hopkins. There he received the training he desired in diagnostic radiology. The author believes science has no borders and would like to see the opportunities that were extended to him in 1975 given to immigrants today. Although the United States produces many graduates in the sciences and mathematics, the nation still has a shortfall and must, he argues, work harder to educate and inspire this country's youth in addition to welcoming the brightest and most able scientists from around the world. He also discusses the crucial role of the National Institutes of Health in furthering global health by funding international biomedical research and by transforming medicine in the 21st century.
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