Japanese International Medical Graduates and entrance into US clinical training: Challenges and methods to overcome them

Impact of COVID-19 on international medical education and the future plans of medical students in Japan

Background: The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on the current study methods and future plans of medical students compared to those in the pre-pandemic period. Methods: Second-grade medical students reported their academic experiences, study methods, and future career plans before (between 2016 and 2019) and during the pandemic (2020) using a questionnaire-based survey at Hokkaido University, Japan (n = 534). Results: From 2016 to 2019, we found an increasing trend for participation in short-term international exchange programs, taking the United States Medical Licensing Examination (USMLE), clinical training, and undertaking research abroad among the students. However, these percentages significantly declined (to 35.5%) during the COVID-19 pandemic in 2020 for all the assessed future plans, including short-term exchange programs (-27.9%), taking USMLE (-19.8%), clinical training (-24.5%), and undertaking research abroad (-13.2%) compared to 2019, wherein 67.9% of the students wished to have at least one of these four above-mentioned academic activities. Conclusions: The COVID-19 pandemic adversely and significantly influenced our medical students' plans to go abroad for clinical and research training. Future studies are warranted to assess the long-term influence of this pandemic on the career planning of medical students.

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.

Japanese International Medical Graduates and entrance into US clinical training: Challenges and methods to overcome them

INTRODUCTION

Entering US clinical training requires completing requirements and navigating an application process differing from the Japanese system. Additionally, increases to the number of US medical school graduates have increased competition for US residency positions. We examined profiles of Japanese International Medical Graduates (IMGs) who completed US clinical training, the timelines to securing US clinical positions, and the greatest challenges during this process and methods to overcome them.

METHODS

Individual semistructured interviews were conducted with 35 purposively sampled Japanese IMGs. We performed exploratory thematic analysis using iterative data collection and constant comparison.

RESULTS

Twenty percent of participants lived in a native English-speaking country during childhood. The United States Medical Licensing Examinations were completed at ages 25-40 years. Challenges were categorized as: (1) English communication, (2) understanding the application process, (3) motivation to persevere through the process, (4) time management to complete Educational Commission for Foreign Medical Graduates requirements, (5) receiving letters of recommendation and overcoming competition for US residency positions, (6) financial cost of the process. Pragmatic generally self-dependent methods helped overcome challenges 1-4 and 6. Participants detailed personal or, more commonly, institutional connections to US training programs required to overcome challenge 5.

CONCLUSIONS

Japanese IMGs pursue US clinical training from diverse backgrounds commonly without the advantage of prior English fluency. Amidst increased competition internationally to enter US residency coupled with cultural and linguistic differences making this challenge often greater for Japanese IMGs, the competition to participate in institutionalized connections to US training programs is anticipated to increase.