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Wongprom I, Ruangsomboon O, Huang J, Ghavam-Rassoul A. International medical learners and their adjustment after returning to their countries of origin: a qualitative study. BMC MEDICAL EDUCATION 2024; 24:731. [PMID: 38970082 PMCID: PMC11227183 DOI: 10.1186/s12909-024-05702-w] [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: 01/24/2024] [Accepted: 06/24/2024] [Indexed: 07/07/2024]
Abstract
INTRODUCTION International medical trainees, including residents and fellows, must cope with many challenges, such as differences in cultural hierarchical systems, languages, and acceptance. Nonetheless, the need for adjustment perpetuates even after training is completed abroad. When some international trainees return to their countries of origin, they continue to face adjustment challenges due to reverse culture shock. Others must make many further readjustments. This study presents an exploration of the adjustment and coping strategies of international medical learners after returning to their countries of origin upon completion of their programs. METHOD This study employed a qualitative approach grounded in interpretivism and utilised inductive thematic analysis following Braun and Clarke's method. Semi-structured, in-depth individual interviews were employed to explore the participants' coping strategies. Participants included international medical learners who were (1) international medical graduates who had already returned to their countries of origin, (2) non-Canadian citizens or nonpermanent residents by the start of the programs, and (3) previously enrolled in a residency or fellowship training programme at the University of Toronto, Ontario, Canada. RESULTS Seventeen participants were included. Three main themes and seven subthemes were created from the analysis and are represented by the Ice Skater Landing Model. According to this model, there are three main forces in coping processes upon returning home: driving, stabilising, and situational forces. The sum and interaction of these forces impact the readjustment process. CONCLUSION International medical learners who have trained abroad and returned to their countries of origin often struggle with readjustment. An equilibrium between the driving and stabilising forces is crucial for a smooth transition. The findings of this study can help stakeholders better understand coping processes. As healthy coping processes are related to job satisfaction and retention, efforts to support and shorten repatriation adjustment are worthwhile.
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Affiliation(s)
- Itthipon Wongprom
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Street, Ratchtevi District, Bangkok, 10400, Thailand.
| | - Onlak Ruangsomboon
- Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Jikai Huang
- Department of Nursing, Toronto General Hospital, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Abbas Ghavam-Rassoul
- St. Michael's Hospital, Unity Health,Toronto, Canada and Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Ave, 5th Floor, Toronto, ON, M5G 1V7, Canada
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Bhugra D, Smith AJ, Ventriglio A, Rao N, Ng R, Javed A, Chisolm MS, Malhi G, Kar A, Chumakov E, Liebrenz M. World Psychiatric Association-Asian Journal of Psychiatry Commission on the Mental Health and Wellbeing of International Medical Graduates. Asian J Psychiatr 2024; 93:103943. [PMID: 38342035 DOI: 10.1016/j.ajp.2024.103943] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
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.
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Affiliation(s)
- Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, De Crespigny Park, London SE5 8AF, UK.
| | - Alexander J Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | | | - Nyapati Rao
- Stony Brook University Health Sciences Center School of Medicine, New York, USA
| | - Roger Ng
- World Psychiatric Association, Geneva, Switzerland
| | - Afzal Javed
- World Psychiatric Association, Geneva, Switzerland
| | | | - Gin Malhi
- School of Psychiatry, University of Sydney, Sydney, Australia
| | - Anindya Kar
- Advanced Neuropsychiatry Institute, Kolkata, India
| | - Egor Chumakov
- Department of Psychiatry & Addiction, St Petersburg State University, St Petersburg, Russia
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
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Al-Haddad M. Facilitating international medical graduates' acculturation: From theory to practice. MEDICAL EDUCATION 2024; 58:136-148. [PMID: 37524527 DOI: 10.1111/medu.15175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/19/2023] [Accepted: 07/05/2023] [Indexed: 08/02/2023]
Abstract
CONTEXT International medical graduates (IMGs) are forming an ever-increasing proportion of the medical workforce. Much of the discourse around IMGs is about their performance at work and interventions to improve it. This discourse, however, is rarely situated in the wider context of the experiences of IMGs as migrants despite the wider context of migration and acculturation being likely to have a significant impact on IMGs' well-being and, ultimately, performance at work. OBJECTIVES The objectives of this article were to (1) raise awareness of the inextricable broader context within which IMGs are situated as migrants; (2) outline the impact this context might have on IMGs' performance; (3) discuss literature from the social sciences related to acculturation that could better inform the way we view IMG transition and performance; (4) highlight how acculturation theory can help inform the design, implementation and evaluation of interventions to facilitate the transition of IMGs into the host country and the workplace; (5) list some interventions that can provide support; and (6) suggest theory driven lines of enquiry to study acculturation in IMGs and the impact related issues might have on performance. METHODS This is a cross-cutting edge review drawing on selected theory and literature from the social sciences to explore its relevance to IMGs. CONCLUSION The broader context of migration and acculturation should not be ignored when discussing IMG performance in the workplace or when instigating interventions to improve it. There is an urgent need to further evaluate the impact this broader context has on IMGs' well-being and performance.
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Affiliation(s)
- Mo Al-Haddad
- University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK
- NHS Education, Scotland, UK
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Gelaidan A, Jagpal S. To the United States and Back: Perspective from an International Medical Graduate Trainee. ATS Sch 2023; 4:118-121. [PMID: 37538075 PMCID: PMC10394612 DOI: 10.34197/ats-scholar.2022-0082vl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/16/2022] [Indexed: 08/05/2023] Open
Affiliation(s)
| | - Sugeet Jagpal
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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Murillo Zepeda C, Alcalá Aguirre FO, Luna Landa EM, Reyes Güereque EN, Rodríguez García GP, Diaz Montoya LS. Challenges for International Medical Graduates in the US Graduate Medical Education and Health Care System Environment: A Narrative Review. Cureus 2022; 14:e27351. [PMID: 35910699 PMCID: PMC9334519 DOI: 10.7759/cureus.27351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Zaidi Z, Dewan M, Norcini J. International Medical Graduates: Promoting Equity and Belonging. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S82-S87. [PMID: 32889932 DOI: 10.1097/acm.0000000000003694] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
International medical school graduates (IMGs) play a vital role in the health care system of the United States. They constitute roughly one-quarter of the physician workforce, comprising a significant proportion of the primary care providers in high-need rural and urban areas, where they provide equal and, in some instances, better care than U.S. graduates. Nonetheless, they face a series of hurdles in entering U.S. residency programs and throughout their training experiences.IMGs must expend significant resources to obtain Education Commission for Foreign Medical Graduates certification, which includes Steps 1, 2 Clinical Knowledge and 2 Clinical Skills of the United States Medical Licensing Examination. They encounter the uncertainty of matching and, if successful, obtaining a visa to enter the United States. Once here, they need to adapt to the complexities of the health care system and familiarize themselves with the cultural nuances, professional behaviors, and communication skills of another country. They encounter biases and microaggressions and lack support groups and mentors. Those who choose an academic career are less likely to obtain leadership positions.This Perspective provides an overview of these challenges and highlights opportunities for change at local and national levels. Specifically, it identifies strategies that would assist IMGs before entry, at entry, during training, at the transition to practice, and in practice. The current COVID-19 pandemic highlights the shortage of physicians in the United States and illustrates the importance of ensuring that IMGs, who are essential health care workers, feel welcome, valued, and recognized for their contributions.
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Affiliation(s)
- Zareen Zaidi
- Z. Zaidi is professor, Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Mantosh Dewan
- M. Dewan is interim president and distinguished service professor of psychiatry and behavioral sciences, Upstate Medical University, Syracuse, New York
| | - John Norcini
- J. Norcini is president emeritus, Foundation for Advancement of International Medical Education and Research (FAIMER), and research professor, Department of Psychiatry, Upstate Medical University, Syracuse, New York
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Khan-Gökkaya S, Higgen S, Mösko M. Qualification programmes for immigrant health professionals: A systematic review. PLoS One 2019; 14:e0224933. [PMID: 31730626 PMCID: PMC6857917 DOI: 10.1371/journal.pone.0224933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/24/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Immigrant health professionals are a particularly vulnerable group in a host country's labour market, as they face several barriers when re-entering their occupations. International studies indicate that early interventions can increase the employability of immigrants. Qualification programmes are one of these early interventions that can support the re-integration of these health professionals into the labour market. The purpose of this review is to identify international qualification programmes for immigrant health professionals, analyse their content and evaluate their effectiveness. METHODS Six international databases (PubMed, Web of Science, CINAHL, PsychInfo, EBSCO and ProQuest Social Sciences) were systematically searched. The search terms were identified using the PICOS-framework. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were screened independently by two authors and discussed. Studies included in the final synthesis were assessed with the Mixed Methods Appraisal Tool (MMAT) and Kirkpatrick's Training Evaluation Model. RESULTS Out of 10,371 findings, 31 articles were included in the final synthesis. The majority of them were addressed to international health care professionals and doctors. Two of them were addressed to refugee doctors. Three types of programme elements were identified: teaching, clinical practise and social support. The programmes' length ranged from 2 days to up to 2.5 years. Despite recommendations in its favour, pre- and post-programme support was scarce. Results also indicate a lack of transparency and quality in terms of evaluation. Effectiveness was mostly observed in the area of language improvement and an increase in self-confidence. CONCLUSION This review points out the lack of systematically evaluated qualification programmes for immigrant health professionals. Programme providers should focus on implementing programmes for all health professionals as well as for underrepresented groups, such as refugees. In order to generate best practises it is necessary to evaluate these programmes. This requires the development of appropriate instruments when working with immigrant population in the context of educational programmes.
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Affiliation(s)
- Sidra Khan-Gökkaya
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Research Group on Migration and Psychosocial Health, Hamburg, Germany
| | - Sanna Higgen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Research Group on Migration and Psychosocial Health, Hamburg, Germany
| | - Mike Mösko
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Research Group on Migration and Psychosocial Health, Hamburg, Germany
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Najeeb U, Wong B, Hollenberg E, Stroud L, Edwards S, Kuper A. Moving beyond orientations: a multiple case study of the residency experiences of Canadian-born and immigrant international medical graduates. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:103-123. [PMID: 30259266 DOI: 10.1007/s10459-018-9852-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/19/2018] [Indexed: 05/16/2023]
Abstract
Many international medical graduates (IMGs) enter North American residency programs every year. The Canadian IMG physician pool increasingly includes Canadian-born IMGs (C-IMGs) along with Immigrant-IMGs (I-IMGs). Similar trends exist in the United States. Our objective was to understand the similarities and differences in the challenges faced by both I-IMGs and C-IMGs during residency to identify actionable recommendations to support them during this critical time. We performed a multiple case study of IMGs' experiences at a large Canadian university. Within our two descriptive cases (I-IMGs, C-IMGs) we iteratively conducted twenty-two semi-structured interviews; we thematically analyzed our data within, between, and across both cases to understand challenges to IMGs' integration and opportunities for curricular innovations to facilitate their adaptation process. Research team members with different perspectives contributed reflexively to the thematic analysis. Participants identified key differences between medical culture and knowledge expected in Canada and the health systems and curricula in which they originally trained. I-IMG and C-IMG participants perceived two major challenges: discrimination because of negative labelling as IMGs and difficulties navigating their initial residency months. C-IMGs described a third challenge: frustration around the focus on the needs of I-IMGs. Participants from both groups identified two major opportunities: their desire to help other IMGs and a need for mentorship. I-IMGs and C-IMGs face diverse challenges during their training, including disorientation and discrimination. We identified specific objectives to inform the design of curriculum and support services that residency programs can offer trainees as well as important targets for resident education and faculty development.
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Affiliation(s)
- Umberin Najeeb
- Wilson Centre for Research in Education, Toronto, ON, Canada.
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada.
- Faculty Lead R4 Internal Medicine Program, University of Toronto, Toronto, ON, Canada.
- Faculty Lead IMG/IFT Mentorship Program, University of Toronto, Toronto, ON, Canada.
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Brian Wong
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre of Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
| | | | - Lynfa Stroud
- Wilson Centre for Research in Education, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Core Internal Medicine Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Susan Edwards
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Urban Family Health Team, St. Joseph Health Centre, Toronto, ON, Canada
- Resident Wellness, Postgraduate Medical Education Office, University of Toronto, Toronto, ON, Canada
| | - Ayelet Kuper
- Wilson Centre for Research in Education, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Massey College, Toronto, ON, Canada
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Kehoe A, McLachlan J, Metcalf J, Forrest S, Carter M, Illing J. Supporting international medical graduates' transition to their host-country: realist synthesis. MEDICAL EDUCATION 2016; 50:1015-32. [PMID: 27628719 PMCID: PMC5113661 DOI: 10.1111/medu.13071] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/14/2016] [Accepted: 03/07/2016] [Indexed: 05/28/2023]
Abstract
CONTEXT Many health services and systems rely on the contribution of international medical graduates (IMGs) to the workforce. However, concern has grown around their regulation and professional practice. There is a need, in the absence of strong evidence and a robust theoretical base, for a deeper understanding of the efficacy of interventions used to support IMGs' transition to their host countries. This study seeks to explore and synthesise evidence relating to interventions developed for IMGs. It aims to provide educators and policy makers with an understanding of how interventions should be developed to support IMGs in their transition to the workplace, particularly looking to identify how and why they are effective. METHODS The realist synthesis involved an initial systematic search of the literature for the period January 1990 to April 2015. Secondary searches were conducted throughout the review in order to inform and test the developing programme theory. The context, mechanism and outcome data were extracted from all sources meeting the inclusion criteria. Fourteen case studies were included to further aid theory refinement. RESULTS Sixty-two articles were identified, describing diverse interventions of varying intensity. A further 26 articles were identified through a secondary search. The findings illustrate that, alongside a developed programme, ongoing support and cultural awareness at organisational and training levels are crucial. Individual differences must also be taken into consideration. This will ensure that IMGs engage in transformative learning, increase their levels of self-efficacy and cultural health capital, and reduce feelings of stress and anxiety. These factors will have an impact on work, interactions and cultural adjustment. CONCLUSIONS Organisational, training and individual contexts all play a role in IMGs' adjustment during the transition process. Establishing ongoing support is critical. A list of recommendations for implementation is given.
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Affiliation(s)
- Amelia Kehoe
- Durham University, School of Medicine, Pharmacy and Health, Stockton-on-Tees, UK.
| | - John McLachlan
- Durham University, School of Medicine, Pharmacy and Health, Stockton-on-Tees, UK
| | - Jane Metcalf
- University Hospital North Tees, Education and Organisational Development, Stockton-on-Tees, UK
| | - Simon Forrest
- Durham University, School of Medicine, Pharmacy and Health, Stockton-on-Tees, UK
| | - Madeline Carter
- Durham University, School of Medicine, Pharmacy and Health, Stockton-on-Tees, UK
| | - Jan Illing
- Newcastle University, School of Medical Education, Newcastle, UK
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Lineberry M, Osta A, Barnes M, Tas V, Atchon K, Schwartz A. Educational interventions for international medical graduates: a review and agenda. MEDICAL EDUCATION 2015; 49:863-879. [PMID: 26296403 DOI: 10.1111/medu.12766] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/08/2014] [Accepted: 04/07/2015] [Indexed: 06/04/2023]
Abstract
CONTEXT International medical graduates (IMGs) play key roles in the health systems of their host countries, but face unique challenges, which makes the provision of effective, tailored support for IMGs essential. OBJECTIVES Research on the effectiveness of educational interventions for IMGs was reviewed to characterise current knowledge and guide future research and education. METHODS PubMed, Web of Science and EMBASE were searched for relevant articles published to October 2014, describing a systematic evaluation of educational interventions designed for IMGs that included at least one post-intervention outcome. Articles were coded independently by two or more researchers for content and methodology, and discussed to reach consensus. RESULTS Twenty-two articles were identified, describing a wide variety of interventions, content and durations of intervention. Clinical topics and general principles of cross-cultural competency were the most common content areas included in curricula (13 and 12 articles, respectively). All studies deemed the interventions evaluated to be successful. However, only one study drew from theory on cross-cultural differences to guide either the curriculum or evaluation. Additionally, study designs were generally weak; no studies featured random assignment to treatment versus control groups, most studies did not use control groups at all, and no studies compared the effectiveness of different interventions. CONCLUSIONS Research into education for IMGs is critically important but currently underdeveloped. An abundance of justification studies and lack of clarification studies parallel other areas of medical education. Academic fields outside medical education, such as those of cross-cultural psychology and expatriate management, are highly relevant; researchers from these areas should be sought for collaboration. Future research should employ conceptual frameworks in order to facilitate a broader, more nuanced consideration of the diversity of individual IMGs, educational and medical contexts, interventions and outcomes. Rigorous comparative effectiveness research is lacking, but represents a promising avenue for future scholarship.
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Affiliation(s)
- Matthew Lineberry
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Amanda Osta
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Michelle Barnes
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Vildan Tas
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Koffitse Atchon
- Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Alan Schwartz
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Chen PG, Auerbach DI, Muench U, Curry LA, Bradley EH. Policy solutions to address the foreign-educated and foreign-born health care workforce in the United States. Health Aff (Millwood) 2014; 32:1906-13. [PMID: 24191079 DOI: 10.1377/hlthaff.2013.0576] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Foreign-educated and foreign-born health workers constitute a sizable and important portion of the US health care workforce. We review the distribution of these workers and their countries of origin, and we summarize the literature concerning their contributions to US health care. We also report on these workers' experiences in the United States and the impact their migration has on their home countries. Finally, we present policy strategies to increase the benefits of health care worker migration to the United States while mitigating its negative effects on the workers' home countries. These strategies include attracting more people with legal permanent residency status into the health workforce, reimbursing home countries for the cost of educating health workers who subsequently migrate to the United States, improving policies to facilitate the entry of direct care workers into the country, advancing efforts to promote and monitor ethical migration and recruitment practices, and encouraging the implementation of programs by US employers to improve the experience of immigrating health workers.
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Cryer J, Anpananthar A, Stoneham S. The international paediatric trainee experience in the UK. Arch Dis Child 2014; 99:487. [PMID: 24554054 DOI: 10.1136/archdischild-2013-305646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jo Cryer
- Barnet & Chase Farm NHS Hospital Trust, London Specialty School of Paediatrics Trainee Committee, , London, UK
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Rao A, Freed CR, Trimm RF. International and American medical graduates in a U.S. pediatric residency program: a qualitative study about challenges during post-graduate year 1. MEDICAL TEACHER 2013; 35:815-819. [PMID: 23758181 DOI: 10.3109/0142159x.2013.802297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND In the United States (U.S.), international medical graduates (IMGs) and American medical graduates (AMGs) confront work-related and adjustment challenges during post-graduate year one (PGY-1) of residency. AIM To understand the challenges that IMGs and AMGs confronted during PGY-1 of a U.S. pediatric residency program from the perspective of the residents themselves. METHODS A purposive sample of PGY-1, PGY-2, and PGY-3 residents participated in three semi-structured focus groups (N = 18). The data were analyzed inductively using a grounded theory approach to identify and verify emergent themes. RESULTS IMGs confronted work-related and adjustment challenges during PGY-1 that included practicing medicine in the U.S., communicating with medical supervisors and nursing staff, communicating with patients, and relocating to the U.S. AMGs confronted work-related challenges that included medical decision-making and medical licensing. CONCLUSION The work-related and adjustment challenges that IMGs and AMGs confronted during PGY-1 suggest that the culture of residency socializes IMGs and AMGs regarding professional expectations and responsibilities. Increased awareness of this socialization process among residency program directors, and interventions based on concrete recommendations, can help enhance PGY-1 for IMGs and AMGs across the medical specialties.
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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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Affiliation(s)
- Parul Jain
- School of Communication, The Ohio State University, USA.
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Chen PGC, Nunez-Smith M, Bernheim SM, Berg D, Gozu A, Curry LA. Professional experiences of international medical graduates practicing primary care in the United States. J Gen Intern Med 2010; 25:947-53. [PMID: 20502974 PMCID: PMC2917670 DOI: 10.1007/s11606-010-1401-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 05/03/2010] [Accepted: 05/05/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited. OBJECTIVE To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US. DESIGN Qualitative study based on in-depth in-person interviews. PARTICIPANTS Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut. APPROACH A standardized interview guide was used to explore professional experiences of IMGs. KEY RESULTS Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of "the deal"; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace. CONCLUSIONS Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs' experiences may also improve the experiences of an increasingly diverse healthcare workforce.
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Affiliation(s)
- Peggy Guey-Chi Chen
- Robert Wood Johnson Foundation Clinical Scholars, Yale University School of Medicine, 333 Cedar Street; IE-61 SHM, PO Box 208088, New Haven, CT 06520-8088, USA.
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Chintakuntlawar A. Disorientation: finding the north. Health Aff (Millwood) 2008; 27:1749. [PMID: 18997243 DOI: 10.1377/hlthaff.27.6.1749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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