Japanese International Medical Graduates and the United States clinical training experience: Challenges abroad and methods to overcome them

Distribution of internal medicine rotations among resident physicians in Japan: a nationwide, multicenter, cross-sectional study

BACKGROUND

In Japan, postgraduate clinical training encompasses a 2-year residency program, including at least 24 weeks of internal medicine (IM) rotations. However, the fragmented structure of these rotations can compromise the training's quality and depth. For example, a resident might spend only a few weeks in cardiology before moving to endocrinology, without sufficient time to deepen their understanding or have clinical experience. This study examined current patterns and lengths of IM rotations within the Japanese postgraduate medical system. It scrutinized the piecemeal approach-whereby residents may engage in multiple short-term stints across various subspecialties without an overarching, integrated experience-and explored potential consequences for their clinical education.

METHODS

This nationwide, multicenter, cross-sectional study used data from self-reported questionnaires completed by participants in the 2022 General Medicine In-Training Examination (GM-ITE). Data of 1,393 postgraduate year (PGY) one and two resident physicians who participated in the GM-ITE were included. We examined the IM rotation duration and number of IM subspecialties chosen by resident physicians during a 2-year rotation.

RESULTS

Approximately half of the participants chose IM rotation periods of 32-40 weeks. A significant proportion of participants rotated in 5-7 internal medicine departments throughout the observation period. Notable variations in the distribution of rotations were observed, characterized by a common pattern where resident physicians typically spend 4 weeks in each department before moving to the next. This 4-week rotation is incrementally repeated across different subspecialties without a longer, continuous period in any single area. Notably, 39.7% of participants did not undertake general internal medicine rotations. These results suggest a narrowed exposure to medical conditions and patient care practices.

CONCLUSIONS

Our study highlights the need to address the fragmented structure of IM rotations in Japan. We suggest that short, specialized learning periods may limit the opportunity to gain broad in-depth knowledge and practical experience. To improve the efficacy of postgraduate clinical education, we recommend fostering more sustained and comprehensive learning experiences.

World Psychiatric Association-Asian Journal of Psychiatry Commission on the Mental Health and Wellbeing of International Medical Graduates

Historically, doctors have migrated for a range of personal, educational, economic, and political reasons. Likewise, medical students from many countries have moved abroad to complete their training and education and may or may not return to their country of origin. Within this context, globalisation has had a major impact on medical education and healthcare workforces, contributing to recent migration trends. Globalisation is a complex phenomenon with positive and negative outcomes. For example, lower-income countries are regularly losing doctors to higher-income areas, thereby exacerbating strains on existing services. Across various national healthcare settings, migrating International Medical Graduates (IMGs) can face socioenvironmental and psychosocial pressures, which can lead to lower mental wellbeing and undermine their contributions to clinical care. Rates of stress and burnout are generally increasing for doctors and medical students. For IMGs, stressors related to migration, acculturation, and adjustment are not dissimilar to other migrants but may carry with them specific nuances. Accordingly, this Commission will explore the history of IMG trends and the challenges faced by IMGs, proposing recommendations and solutions to support their mental health and wellbeing.

Prevalence of International Medical Graduates in Integrated Plastic Surgery Programs

International medical graduates (IMGs) are physicians who did not attend medical school in the USA or Canada. IMGs comprise nearly one-quarter of the physician workforce and play a vital role in health care. Here, we aimed to identify the prevalence of IMGs in integrated programs and evaluate factors that influence their success in the residency match.

Methods

The annual match reports from 2010 to 2020 were retrieved and summarized. Electronic surveys for program directors and program coordinators were distributed to US integrated plastic surgery programs. Each program's website was appraised for information regarding the eligibility of IMGs. Websites were also used to identify the number of IMG residents.

Results

The number of applicants who matched into integrated programs ranged from 69 to 180 per year, of which US applicants comprised 61-165. US IMGs filled one to three positions per year, whereas non-US IMGs filled two to seven. Although 48% of programs have matched non-citizen IMGs and 79% have not encountered difficulties during the visa process, 67% of coordinators reported that the onboarding process is more challenging for IMGs. There are no IMGs in 52% of programs, and most institutions offer information on their website regarding visa sponsorship.

Conclusion

IMGs make up less than 10% of filled positions per cycle. Although most programs accept IMGs, a small number matriculate. This may be explained by the competitiveness of integrated programs and the volume of IMG applications. Further research is needed to identify contributing factors of low IMG representation in plastic surgery programs.

Challenges for International Medical Graduates in the US Graduate Medical Education and Health Care System Environment: A Narrative Review

International medical graduates (IMGs) have become a vital part of the US graduate medical education (GME) and health care system (HCS) workforce; they contribute to essential diversity that relieves cultural and linguistic barriers to health care. The number of IMGs looking for medical training in the United States. has constantly been increasing in the last decades. The challenges they meet begin long before residency application, continue during their transition to residency programs, through early medical training, and eventually subside in senior years. IMGs' hurdles permeate the themes of navigating the US GME and HCS, adaptation to the US culture, communication skills, racial discrimination, emotional distress, and finances. This article aims to comprehensively review available information concerning the challenges encountered by IMGs in their transition to the US GME and HCS environments.

Medical English Education in Japan : Developing a Curriculum to Motivate Students by Providing Visualization Opportunities Using Near-peer Teaching

Despite advancements in the pedagogy of medical education in various fields, Japan has no standardized medical English education. The U.S. Medical Licensing Examination (USMLE) Study Group of Tokushima is an extracurricular activity in which medical students and recent graduates meet every 1-2 months. The aim is to stimulate students' curiosity ; cultivate their initiative, self-efficacy, and English learning goals ; and motivate them to be self-regulated learners. Accordingly, we conducted near-peer teaching style lectures that focused on sharing medical English-related experiences, so students could have regular opportunities to visualize the benefits of learning medical English. Following the activities, we observed increased motivation and self-study among students, resulting in a high USMLE passing rate. Furthermore, five members started their training at American hospitals and pursued careers in English-speaking environments. Thus, near-peer teaching style leads to shared medical English-related experiences that help students to visualize English-related opportunities. This education style taught by similar generations aids in setting a specific goal by providing access to role models, cultivating their initiative and self-efficacy, motivating them to learn English, and producing positive outcomes.Modifying the curriculum to actively create opportunities for students to visualize themselves in an international environment can motivate them to continue learning English. J. Med. Invest. 69 : 332-334, August, 2022.

Critical values of learning to speak English for Japanese clinicians

We suggest three reasons why Japanese clinicians should learn to speak English: international academic interaction, gaining experience abroad, and having another skill in the rapidly changing world during the COVID-19 pandemic. Not only reading and writing English but also speaking the language is inevitable for Japanese clinicians. Although speaking English is not easy owing to the disparity between English and Japanese, verbal English fluency adds tremendous value to academic development.

Author reply to "Being a family medicine resident in the United States"

This is a reply to a Letter to the Editor regarding our recent publications. We feel that the letter's content largely aligns with the content of our work.