Acculturation, Education, Training, and Workforce Issues of IMGs: Current Status and Future Directions

Abstract

In assembling the International Medical Graduate (IMG)focused articles for this special issue of Academic Psychiatry, our goal has been to “reexamine the role of IMGs in American psychiatry so that we can advocate for rational public policies and develop training models that successfully address IMGs’ sociocultural and educational needs” (1). We invited papers on themes that “include but are not limited to psychiatric workforce dilemmas in the context of healthcare reform, educational and training strategies, acculturation and linguistic challenges, issues in evaluation and feedback, and effective psychotherapy and clinical research training models pertinent to IMGs” (1). We believe this special issue takes an important step in meeting our goal. IMGs constitute 33% of all U.S. psychiatry residents (2); they are composed of two groups: USIMGs and foreign IMGs. USIMGs, who comprise 20% of all IMGs, are U.S. citizens who obtained their medical education abroad (i.e., in foreign countries outside of the U.S. or Canada), whereas foreign IMGs (FIMGs), are citizens of foreign nations whose medical education also took place in their native countries or elsewhere abroad. FIMGs are an extremely diverse group. In 2010, 9,399 ECFMG-certified FIMGs graduated from 1,074 medical schools located in 138 countries or territories (3). They spoke more than 130 native languages, with English being the most common (34.1%), followed by Arabic (9.7%), Spanish (7.1%), Urdu (5.3%), and Hindi (5.1%) (3). USIMGs, U.S.or Canadian-born or naturalized citizen physicians, tend to be younger than FIMGs. Most members of this group receive their medical education at one of four foreign medical schools: Ross, St. Georges, and American University of the Caribbean (all located in the Caribbean), and Guadalajara University School of Medicine, located in Mexico. Although USIMGs have cultural and linguistic advantages over FIMGs, their overall performance on the qualifying examinations and board examinations is not as robust as that of FIMGs. The considerable heterogeneity that exists in cultural, ethnic, language, and medical-educational backgrounds has resulted in lack of a cohesive identity among IMGs regarding just what is implied by being an IMG. Some IMGs, both USIMGs and FIMGs, see the continued use of the initials “IMG” as insulting, gratuitous, and discriminatory, and ask that this practice be abandoned (4). However, others experience no such degradation in being referred to as IMGs, but recognize that some IMGs have specific additional educational requirements and want their needs to be appropriately addressed. In ourview, the latter perspective hasmerit because the educational, cultural, and linguistic challenges that confront IMGs are quite real (5), and psychiatric educators owe it to the American public, the field at large, and the IMGs themselves to address them appropriately during their training. As compared with psychiatric scholars, educators in general medicine have done a better job at systematically examining the needs of their IMG residents and fellows. Lacking a formal, published “evidence base” pertaining to IMGs’ training in psychiatry, we must first turn to the generalmedical literature for perspectives on IMG education.