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Silvestre J, Fernandez CA, Oni JK, Sabesan VJ, Nelson CL, Slone HS. International medical graduates in orthopaedic surgery: An opportunity to improve diversity and inclusion? J Clin Orthop Trauma 2024; 56:102522. [PMID: 39286006 PMCID: PMC11402300 DOI: 10.1016/j.jcot.2024.102522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 06/08/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024] Open
Abstract
Background/aims Racial and ethnic minorities are under-represented in orthopaedic surgery despite efforts to promote diversity and inclusion in the specialty. The purpose of this study was to determine the proportion of international medical graduates (IMGs) in the surgical workforce and future residency pipeline. We further analyze IMG applicant qualifications relative to their US-based counterparts to assess the viability of recruiting IMG candidates as one strategy to advance diversity and inclusion in orthopaedic surgery. Methods Physician workforce data from the American Medical Association and residency match data from the National Resident Match Program were analyzed for Orthopaedic Surgery. Trends in the proportion of IMG applicants were compared with those from other specialties. Qualifications of applicants were compared including board exam scores, number of abstracts/publications, and additional graduate degrees. Results In 2020, orthopaedic surgery had the lowest percentage of IMGs relative to otolaryngology (5.8 %, p < 0.001), neurosurgery (12.1 %, p < 0.001), obstetrics & gynecology (14.0 %, p < 0.001), and general surgery (19.1 %, p < 0.001). From 1986 to 2021, IMG Graduates who matched into orthopaedic surgery increased from 1 (0.3 %) to 8 (0.9 %). Compared to other surgical specialties, orthopaedic surgery had among the lowest annual rates of incoming IMG residents. In 2021, most respondents to the orthopaedic surgery residency program directors survey reported never selecting IMG applicants for interview (74 % for non-US IMG applicants and 53 % for US IMG applicants). From 2020 to 2021, non-US IMG applicants (17 %) and US IMG applicants (26 %) had lower match rates than DO Senior (74 %) and MD Senior (80 %) applicants (p < 0.001). In 2020, matched non-US IMGs had similar board scores as matched US MD Senior applicants, but more abstracts/publications. Conclusion The recruitment of IMGs into orthopaedic surgery residency remains limited and lower than other surgical specialties. IMGs have similar board scores and more abstracts/publications, thus representing a potential pipeline for workforce diversity. More research is needed to understand the special needs of IMGs in the orthopaedic surgery match.
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Affiliation(s)
| | | | - Julius K Oni
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Charles L Nelson
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Harris S Slone
- Medical University of South Carolina, Charleston, SC, USA
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2
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Li W, Gillies RM, Liu C, Wu C, Chen J, Zhang X, Cheng B, Dai J, Fu N, Li L, Liu S, Sun H. Specialty preferences of studying-abroad medical students from low- and middle-income countries. BMC MEDICAL EDUCATION 2023; 23:158. [PMID: 36922811 PMCID: PMC10015544 DOI: 10.1186/s12909-023-04123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND This study explored the specialty preferences of China-educated international medical students (IMSs), who are mainly from low- and middle-income countries (LMICs) and constitute a potential medical workforce both for their home countries and foreign countries, and the influence of migration intentions on their specialty preferences. METHODS A cross-sectional, questionnaire-based survey was conducted at 5 universities in China. The questionnaire link was distributed electronically among the IMSs at the 5 universities via emails. The questionnaire enquired IMSs' demographic information, migration intentions and their specialty preferences. The Chi-square test was applied to determine the influence of the respondent's gender, intention to practise in the home country and intention to practise in a high-income country on their specialty choices. The Chi-square test was also applied to determine the influence of the respondent's gender, year of study and country of origin on their preferences for generalist-orientated or non-generalist orientated specialties. RESULTS Altogether, 452 IMSs returned their responses, yielding a response rate of 64.1%. Approximately half of the IMSs planned to not return to their home country. The most selected specialty was general surgery and the least selected specialty was physical medicine and rehabilitation. No significant differences were evident in most specialty preferences between those who intended to return home and those who intended to stay abroad. Among the IMSs having intentions of returning to their home country, male students tended to choose a generalist-orientated specialty, while female students tended to choose a non-generalist-orientated specialty. CONCLUSION China-educated IMSs could play important roles in the primary care services as well as other shortage specialties both for their home countries or foreign countries. Therefore, it is recommended that governments in these countries plan migration and recruitment policies that cater for these studying-abroad medical students from LMICs, especially in this challenging time during the COVID-19 pandemic.
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Affiliation(s)
- Wen Li
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
- School of Education, The University of Queensland, 4072, Brisbane, Australia
| | - Robyn M Gillies
- School of Education, The University of Queensland, 4072, Brisbane, Australia
| | - Chang Liu
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
| | - Changhao Wu
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, GU2 7XH, Guildford, Surrey, UK
| | - Jiayi Chen
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
| | - Xiaoning Zhang
- School of Management, Xuzhou Medical University, 221004, Xuzhou, China
| | - Bin Cheng
- School of International Education, Weifang Medical University, 261053, Weifang, China
| | - Jing Dai
- College of International Education, Guilin Medical University, 541199, Guilin, China
| | - Ning Fu
- School of International Education, Shandong First Medical University & Shandong Academy of Medical Sciences, 271016, Tai'an, China
| | - Lin Li
- Language and Literature School, Hebei North University, 075000, Zhangjiakou, China
| | - Shenjun Liu
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China.
| | - Hong Sun
- School of Basic Medicine, Xuzhou Medical University, Xuzhou, China.
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Khoujah D, Ibrahim A. Exploring Teamwork Challenges Perceived by International Medical Graduates in Emergency Medicine Residency. West J Emerg Med 2023; 24:50-58. [PMID: 36735007 PMCID: PMC9897247 DOI: 10.5811/westjem.2022.11.58002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/20/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Non-US international medical graduates (IMG) represent a gradually increasing portion of emergency medicine (EM) residents in the United States. Yet there are no previous studies that explore the needs of this learner population. We conducted a qualitative study to examine non-US IMGs' perceptions of challenges they face specifically regarding team dynamics during their first year of an EM residency. METHOD Nine non-US IMGs in EM from all over the US participated in anonymous, semi-structured phone interviews lasting 45-60 minutes. We then coded and analyzed the interviews to identify axes and themes using an inductive approach informed by grounded theory. Focused coding and member checking were employed. RESULTS Non-US IMGs' perceptions of challenges regarding team dynamics during their first year of an EM residency coalesced into two themes: system-based challenges, such as a new power dynamic and understanding the local hospital system, and interpersonal challenges, such as establishing rapport and articulation of critical thinking. CONCLUSION Non-US IMGs perceived several unique challenges regarding team dynamics during their first year of an EM residency, whether system-based or interpersonal-based. We propose solutions such as a transitional curriculum (as suggested by the participants as well) and cultural-competence training for academic leadership.
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Affiliation(s)
- Danya Khoujah
- Tampa AdventHealth, Emergency Medicine, Tampa, Florida,University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Ahmed Ibrahim
- Johns Hopkins University, School of Education, Baltimore, Maryland
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Duvivier RJ, Buckley PF, Martin A, Boulet JR. International Medical Graduates in the United States Psychiatry Workforce. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:428-434. [PMID: 35486365 PMCID: PMC9053123 DOI: 10.1007/s40596-022-01635-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study describes the supply, distribution, and characteristics of international medical graduate (IMG) psychiatrists who provide services in the USA. METHODS Cross-sectional study design, using descriptive statistics based on combined data from the American Medical Association (2020 Physician Masterfile) and the Educational Commission for Foreign Medical Graduates. RESULTS International medical graduates continue to make significant contributions to the US physician workforce. As a group, they represent 29% of active psychiatrists in the USA, compared to 23% in all other medical specialties. Many IMG psychiatrists were US citizens who obtained their medical degrees outside the USA or Canada, often in the Caribbean. In some states (i.e., Florida, New Jersey), over 40% of active psychiatrists are IMGs. Over 30% of IMG psychiatrists graduated from medical schools in India and Pakistan. CONCLUSIONS This study provides an overview of the psychiatric workforce in the USA, quantifying the specific contribution of IMGs. Several factors, including immigration policies, continued expansion of US medical schools, and the number of available residency positions, could impact the flow of IMGs to the US. Longitudinal studies are needed to better understand the implications for workforce composition and distribution, and their potential impact on the care of psychiatric patients.
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Affiliation(s)
| | | | | | - John R Boulet
- Educational Commission for Foreign Medical Graduates, Philadelphia, PA, USA
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Supakul S, Ozaki A, Tanimoto T. A Call for Enhanced Healthcare Support for Increasingly Vulnerable Groups of Foreigners in Japan: Insights from a Former Thai-Native Medical Student in Japan. Malays J Med Sci 2022; 28:149-152. [PMID: 35115898 PMCID: PMC8793978 DOI: 10.21315/mjms2021.28.5.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sopak Supakul
- Medical Governance Research Institute, Minato City, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato City, Tokyo, Japan.,Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato City, Tokyo, Japan
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Pahalyants V, Murphy W, Harrris ST, Gunasekera N, Nambudiri VE. Internationally educated dermatologists in the active Medicare workforce. Int J Dermatol 2021; 61:e220-e223. [PMID: 34152610 DOI: 10.1111/ijd.15715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/08/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Vartan Pahalyants
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard Business School, Boston, MA, USA
| | - William Murphy
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard Business School, Boston, MA, USA
| | - Samantha T Harrris
- Harvard Medical School, Boston, MA, USA.,Harvard Business School, Boston, MA, USA
| | - Nicole Gunasekera
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Duvivier RJ, Gusic ME, Boulet JR. International Medical Graduates in the Pediatric Workforce in the United States. Pediatrics 2020; 146:peds.2020-003301. [PMID: 33154152 DOI: 10.1542/peds.2020-003301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To describe the supply, distribution, and characteristics of international medical graduates (IMGs) in pediatrics who provide patient care in the United States. METHODS Cross-sectional study, combining data from the 2019 Physician Masterfile of the American Medical Association and the Educational Commission for Foreign Medical Graduates database. RESULTS In total, 92 806 pediatric physicians were identified, comprising 9.4% of the entire US physician workforce. Over half are general pediatricians. IMGs account for 23.2% of all general pediatricians and pediatric subspecialists. Of all IMGs in pediatrics, 22.1% or 4775 are US citizens who obtained their medical degree outside the United States or Canada, and 15.4% (3246) attended medical school in the Caribbean. Fifteen non-US medical schools account for 29.9% of IMGs currently in active practice in pediatrics in the United States. IMGs are less likely to work in group practice or hospital-based practice and are more likely to be employed in solo practice (compared with US medical school graduates). CONCLUSIONS With this study, we provide an overview of the pediatric workforce, quantifying the contribution of IMGs. Many IMGs are US citizens who attend medical school abroad and return to the United States for postgraduate training. Several factors, including the number of residency training positions, could affect future numbers of IMGs entering the United States. Longitudinal studies are needed to better understand the implications that workforce composition and distribution may have for the care of pediatric patients.
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Affiliation(s)
- Robbert J Duvivier
- Foundation for Advancement of International Medical Education and Research, Philadelphia, Pennsylvania.,Center for Educational Development and Research in Health Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Maryellen E Gusic
- Office of Medical Education, Center for Medical Education Research and Scholarly Innovation, School of Medicine, University of Virginia, Charlottesville, Virginia; and
| | - John R Boulet
- Foundation for Advancement of International Medical Education and Research, Philadelphia, Pennsylvania; .,Educational Commission for Foreign Medical Graduates, Philadelphia, Pennsylvania
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Dagher GA, Lewandowski C, Ali SS, Barsky C, Kazzi B, Cheaito MA, Lotfipour S, Kazzi A, Kazzi Z. The International Medical Graduate and Emergency Medicine. J Emerg Med 2020; 58:e99-e104. [PMID: 31812453 DOI: 10.1016/j.jemermed.2019.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
International medical graduates (IMGs) are medical graduates who have received their degree from international medical schools. IMGs must undertake a 3-step process to apply to the National Residency Matching Program match. First, they must obtain a valid standard certificate from the Educational Commission for Foreign Medical Graduates. Following certification, they must apply for and secure a position in a residency training program. Third, they must obtain a visa that would enable them to commence their training. In this article, we delve thoroughly into these stepladders to provide IMGs with a clear roadmap of the process as well as contacts to key agencies that may provide more comprehensive assistance.
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Affiliation(s)
| | - Christopher Lewandowski
- Department of Emergency Medicine, Henry Ford Hospital and Wayne State University, Detroit, Michigan
| | - Syed S Ali
- Memorial Hermann Memorial City Hospital, Houston, Texas
| | - Carol Barsky
- Department of Emergency Medicine, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut
| | - Brigitte Kazzi
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | | | - Amin Kazzi
- American University of Beirut, Beirut, Lebanon; University of California, Irvine, Rivine, California
| | - Ziad Kazzi
- American University of Beirut, Beirut, Lebanon; Department of Emergency Medicine, Emory University, Atlanta, Georgia
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9
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Duvivier RJ, Wiley E, Boulet JR. Supply, distribution and characteristics of international medical graduates in family medicine in the United States: a cross-sectional study. BMC FAMILY PRACTICE 2019; 20:47. [PMID: 30927914 PMCID: PMC6441164 DOI: 10.1186/s12875-019-0933-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 03/10/2019] [Indexed: 11/23/2022]
Abstract
Background To describe the supply, distribution, and characteristics of international medical graduates (IMGs) in family medicine who provide patient care in the U.S. Methods A cross-sectional study design, using descriptive statistics on combined data from the Educational Commission for Foreign Medical Graduates and the American Medical Association, including medical school attended, country of medical school, and citizenship when entering medical school. Results In total, 118,817 physicians in family medicine were identified, with IMGs representing 23.8% (n = 28,227) of the U.S. patient care workforce. Of all 9579 residents in family medicine, 36.0% (n = 3452) are IMGS. In total, 35.9% of IMGs attended medical school in the Caribbean (n = 10,136); 19.9% in South-Central Asia (n = 5607) and 9.1% in South-Eastern Asia (n = 2565). The most common countries of medical school training were Dominica, Mexico, and Sint Maarten. Of all IMGs in family medicine who attended medical school in the Caribbean, 74.5% were U.S. citizens. In total, 40.5% of all IMGs in family medicine held U.S. citizenship at entry to medical school. IMGs comprise almost 40% of the family medicine workforce in Florida, New Jersey and New York. Conclusions IMGs play an important role in the U.S. family medicine workforce. Many IMGs are U.S. citizens who studied abroad and then returned to the U.S. for graduate training. Given the shortage of family physicians, and the large number of IMGs in graduate training programs, IMGs will continue to play a role in the U.S. physician workforce for some time to come. Many factors, including the supply of residency training positions, could eventually restrict the number of IMGs entering the U.S., including those contributing to family practice.
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Affiliation(s)
- Robbert J Duvivier
- Foundation for Advancement of International Medical Education and Research, 3624 Market Street, Philadelphia, PA, 19104-2685, USA. .,School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, Maastricht, MD, 6200, the Netherlands. .,Parnassia Psychiatric Institute, Kiwistraat 43, The Hague, DH, 2552, The Netherlands.
| | - Elizabeth Wiley
- Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - John R Boulet
- Educational Commission for Foreign Medical Graduates, 3624 Market Street, Philadelphia, PA, 19104-2685, USA
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Zavlin D, Jubbal KT, Noé JG, Gansbacher B. A comparison of medical education in Germany and the United States: from applying to medical school to the beginnings of residency. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2017; 15:Doc15. [PMID: 29051721 PMCID: PMC5617919 DOI: 10.3205/000256] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/04/2017] [Indexed: 11/30/2022]
Abstract
Both Germany and the United States of America have a long tradition of science and medical excellence reaching back as far as the nineteenth century. The same tribute must be paid to the medical educational system in both countries. Despite significant initial similarities and cross-inspiration, the paths from enrolling in a medical university to graduating as a medical doctor in Germany and the US seem to have become much different. To fill a void in literature, the authors’ objective therefore is to delineate both structures of medical education in an up-to-date review and examine their current differences and similarities. Recent medical publications, legal guidelines of governmental or official organizations, articles in media, as well as the authors’ personal experiences are used as sources of this report. Tuition loans of over $200,000 are not uncommon for students in the US after graduating from medical schools, which are often private institutions. In Germany, however, the vast majority of medical universities are tax-funded and, for this reason, free of tuition. Significant differences and surprisingly multiple similarities exist between these two systems, despite one depending on government and the other on private organizations. Germany currently employs an integrated medical curriculum that typically begins right after high school and consists of a 2-year long pre-clinical segment teaching basic sciences and a 4-year clinical segment leading medical students to the practical aspects of medicine. On the other hand, the US education is a two-stage process. After successful completion of a Bachelor’s degree in college, an American student goes through a 4-year medical program encompassing 2 years of basic science and 2 years of clinical training. In this review, we will address some of these similarities and major differences.
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Affiliation(s)
- Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, USA
| | - Kevin T Jubbal
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Jonas G Noé
- Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Bernd Gansbacher
- Institute of Molecular Immunology & Experimental Oncology, Technical University Munich, Munich, Germany
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11
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Duvivier RJ, Burch VC, Boulet JR. A comparison of physician emigration from Africa to the United States of America between 2005 and 2015. HUMAN RESOURCES FOR HEALTH 2017; 15:41. [PMID: 28651539 PMCID: PMC5485566 DOI: 10.1186/s12960-017-0217-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/15/2017] [Indexed: 05/26/2023]
Abstract
BACKGROUND Migration of health professionals has been a cause for global concern, in particular migration from African countries with a high disease burden and already fragile health systems. An estimated one fifth of African-born physicians are working in high-income countries. Lack of good data makes it difficult to determine what constitutes "African" physicians, as most studies do not distinguish between their country of citizenship and country of training. Thus, the real extent of migration from African countries to the United States (US) remains unclear. This paper quantifies where African migrant physicians come from, where they were educated, and how these trends have changed over time. METHODS We combined data from the Educational Commission for Foreign Medical Graduates with the 2005 and 2015 American Medical Association Physician Masterfiles. Using a repeated cross-sectional study design, we reviewed the available data, including medical school attended, country of medical school, and citizenship when entering medical school. RESULTS The outflow of African-educated physicians to the US has increased over the past 10 years, from 10 684 in 2005 to 13 584 in 2015 (27.1% increase). This represents 5.9% of all international medical graduates in the US workforce in 2015. The number of African-educated physicians who graduated from medical schools in sub-Saharan countries was 2014 in 2005 and 8150 in 2015 (304.6% increase). We found four distinct categorizations of African-trained physicians migrating to the US: (1) citizens from an African country who attended medical school in their own country (86.2%, n = 11,697); (2) citizens from an African country who attended medical school in another African country (2.3%, n = 317); (3) US citizens who attended medical school in an African country (4.0%, n = 537); (4) citizens from a country outside Africa, and other than the United States, who attended medical school in an African country (7.5%, n = 1013). Overall, six schools in Africa provided half of all African-educated physicians. CONCLUSIONS The number of African-educated physicians in the US has increased over the past 10 years. We have distinguished four migration patterns, based on citizenship and country of medical school. The majority of African graduates come to the US from relatively few countries, and from a limited number of medical schools. A proportion are not citizens of the country where they attended medical school, highlighting the internationalization of medical education.
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Affiliation(s)
- Robbert J Duvivier
- Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, United States of America.
- Medical Education Unit, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Vanessa C Burch
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - John R Boulet
- Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, United States of America
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Talamantes E, Aguilar-Gaxiola S. Perspective: POTUS Trump's Executive Orders - Implications for Immigrants and Health Care. Ethn Dis 2017; 27:121-124. [PMID: 28439182 DOI: 10.18865/ed.27.2.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The United States, under new executive orders proposed by its 45th president, may quickly lose its greatness in serving Emma Lazarus' untimely portrait of immigrants and refugees as "the tired, poor and huddled masses yearning to breathe free." After years of progress in improving health care access to underserved populations, new executive orders threaten our nation's advancements in health equity. Within this perspective, we offer examples on how these actions may result in damaging impacts on patients, families, communities and the health care workforce. We add our voices to a myriad of national leaders who are advocating for the preservation of the Affordable Care Act (ACA) and the protection of immigrants, including Deferred Action for Childhood Arrivals (DACA).
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Affiliation(s)
- Efrain Talamantes
- Center for Reducing Health Disparities, Division of General Internal Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, Division of General Internal Medicine, University of California, Davis School of Medicine, Sacramento, California
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Majeed MH, Ali AA, Saeed F. International medical graduates: from brain drain to potential gain. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8:37-38. [PMID: 28161694 PMCID: PMC5293484 DOI: 10.5116/ijme.5869.008a] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/01/2017] [Indexed: 05/28/2023]
Affiliation(s)
| | - Ali Ahsan Ali
- Department of Psychiatry, Brown University, Providence, RI, USA
| | - Fahad Saeed
- Department of Medicine, Divisions of Nephrology and Palliative Care, University of Rochester Medical Center, Rochester, NY, USA
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Kesselheim JC, Najita J, Morley D, Bair E, Joffe S. Ethics knowledge of recent paediatric residency graduates: the role of residency ethics curricula. JOURNAL OF MEDICAL ETHICS 2016; 42:809-814. [PMID: 27884969 DOI: 10.1136/medethics-2016-103625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/08/2016] [Accepted: 09/27/2016] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To evaluate the relationship between recently trained paediatricians' ethics knowledge and exposure to a formal ethics or professionalism curriculum during residency. METHODS We conducted a cross-sectional survey of recently trained paediatricians which included a validated 23-item instrument called the Test of Residents' Ethics Knowledge for Pediatrics. The sample included paediatricians who completed medical school in 2006-2008, whose primary specialty was paediatrics or a paediatric subspecialty, and who completed paediatric residency training in 2010-2011. This sample was stratified based on residency programme variables: presence of a formal curriculum in ethics or professionalism, programme size and American Board of Pediatrics certifying exam passage rate. Paediatricians were randomly selected from each stratum for survey participation. RESULTS Among the 370 responding paediatricians (55%), the mean knowledge score was 17.3 (SD 2.2) out of a possible 23. Presence of a formal curriculum in ethics and/or professionalism was not significantly associated with knowledge. Knowledge was lowest on items about parental requests for a child to undergo genetic testing (2 items, 44% and 85% incorrect), preserving patient confidentiality over email (55% incorrect), decision-making regarding life-sustaining technologies (61% incorrect), and decision-making principles such as assent and parental permission (2 items, 47% and 49% incorrect). CONCLUSIONS This study highlights several areas in which paediatricians' knowledge may be low and that are amenable to targeted educational interventions. These findings should prompt discussion and research among ethicists and educators about how ethics and professionalism curricula can more consistently influence paediatricians' knowledge.
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Affiliation(s)
- Jennifer C Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie Najita
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Department of Biostatistics Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Debra Morley
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elizabeth Bair
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Halpern JA, Al Hussein Al Awamlh B, Mittal S, Shoag JE, Hu JC, Lee RK. International Medical Graduate Training in Urology: Are We Missing an Opportunity? Urology 2016; 95:39-46. [DOI: 10.1016/j.urology.2016.03.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/06/2016] [Accepted: 03/18/2016] [Indexed: 10/21/2022]
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Verma V, Shah C, Lautenschlaeger T, Lin C, Beriwal S, Zhen W, Mehta MP, Zietman AL. International Medical Graduates in Radiation Oncology: Historical Trends and Comparison With Other Medical Specialties. Int J Radiat Oncol Biol Phys 2016; 95:1102-6. [DOI: 10.1016/j.ijrobp.2016.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/20/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
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Financing Graduate Medical Education to Meet the Needs of Children and the Future Pediatrician Workforce. Pediatrics 2016; 137:peds.2016-0211. [PMID: 27020794 DOI: 10.1542/peds.2016-0211] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics (AAP) believes that an appropriately financed graduate medical education (GME) system is critical to ensuring that sufficient numbers of trained pediatricians are available to provide optimal health care to all children. A shortage of pediatric medical subspecialists and pediatric surgical specialists currently exists in the United States, and this shortage is likely to intensify because of the growing numbers of children with chronic health problems and special health care needs. It is equally important to maintain the supply of primary care pediatricians. The AAP, therefore, recommends that children's hospital GME positions funded by the Health Resources and Services Administration be increased to address this escalating demand for pediatric health services. The AAP also recommends that GME funding for pediatric physician training provide full financial support for all years of training necessary to meet program requirements. In addition, all other entities that gain from GME training should participate in its funding in a manner that does not influence curriculum, requirements, or outcomes. Furthermore, the AAP supports funding for training innovations that improve the health of children. Finally, the AAP recommends that all institutional recipients of GME funding allocate these funds directly to the settings where training occurs in a transparent manner.
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Kamimura A, Samhouri MS, Myers K, Huynh T, Prudencio L, Eckhardt J, Al-Obaydi S. Physician Migration: Experience of International Medical Graduates in the USA. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2016. [DOI: 10.1007/s12134-016-0486-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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The Nation׳s Physician Workforce and Future Challenges. Am J Med Sci 2016; 351:11-9. [DOI: 10.1016/j.amjms.2015.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/14/2015] [Indexed: 11/22/2022]
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20
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LaPaglia D, Robiner WN, Yozwiak JA, Brosig C, Cubic B, Leventhal G. A Shortage of Medical Residency Positions: Parallels with Psychology. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:706-712. [PMID: 26022617 DOI: 10.1007/s40596-015-0324-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/05/2015] [Indexed: 06/04/2023]
Abstract
Physician shortages in the US are expected to intensify with the implementation of the Patient Protection and Affordable Care Act. These shortages may negatively impact access to care, quality of care, and confidence in the system's ability to adequately provide for health needs in the US. Concerns regarding physician demand underscore how critical Graduate Medical Education funding is to preparing the physician workforce. In 2014 5.6 % of US medical school seniors did not match into residency. Psychology has faced longstanding training imbalance issues with a misalignment between the number of internship positions and the number of applicants. The authors summon attention to the damaging effects a training imbalance poses to a health care profession, its trainees, and ultimately the public it serves.
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Affiliation(s)
| | | | - John A Yozwiak
- University of Kentucky College of Medicine, Lexington, KY, USA
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Ibrahim H, Stadler DJ, Archuleta S, Shah NG, Bertram A, Chandrasekhar Nair S, Alkhal A, Ali Al-Mohammed A, Cofrancesco J. Clinician-educators in emerging graduate medical education systems: description, roles and perceptions. Postgrad Med J 2015; 92:14-20. [DOI: 10.1136/postgradmedj-2015-133241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 10/05/2015] [Indexed: 11/03/2022]
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Gomez PP, Willis RE, Jaramillo LA. Evaluation of a dedicated, surgery-oriented visiting international medical student program. JOURNAL OF SURGICAL EDUCATION 2014; 71:325-328. [PMID: 24797847 DOI: 10.1016/j.jsurg.2013.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/22/2013] [Accepted: 09/05/2013] [Indexed: 06/03/2023]
Abstract
PURPOSE Programs dedicated to the successful integration of international medical graduates into the U.S. surgical residency training are scarce and foreign students are often unaware of their availability. In 2007, the Department of Surgery at the University of Texas Health Science Center at San Antonio developed the Visiting International Students in San Antonio (VISSA) program designed to bring international senior medical students to rotate at our institution. The program has enrolled 55 students who rotated through various general surgery services. The purpose of this study was to assess prior participants' professional statuses, career selections, and satisfaction with our program. METHODS A 21-item anonymous online survey was distributed via e-mail. Demographic information, current professional status, residency specialty selection, assessment of satisfaction, and personal experience with the VISSA program were collected. RESULTS We obtained an 84% (46/55) response rate among participants. Most respondents were men (75.6%) and younger than 25 years of age (82.6%). Students from 14 nations have visited our institution, mostly from Latin America (56.5%) and Asia (36.9%). Before visiting our program, 80.4% considered applying to a residency program in the United States, which increased to 88.9% after rotating at our institution. Of our respondents, 42.1% applied to a residency program in the United States and 17.4% were accepted to a general surgery position (50% categorical and 50% preliminary). Respondents agreed or strongly agreed that being part of the VISSA program helped them obtain a general surgery residency position (90.4%) and considered our program as their first option (77.8%). Independently of their current professional status or residency selection process, 100% of respondents would recommend participation in our program to colleagues at their medical schools. CONCLUSION A dedicated, surgery-oriented visiting foreign medical student program has a positive effect in residency selection, application, and professional development.
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Affiliation(s)
- Pedro Pablo Gomez
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Ross E Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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