Abstract
International medical graduates (IMGs) represent a large portion of practising doctors in many countries. Many experience difficulties, including higher rates of complaints against them and lower exam pass rates. The UK's General Medical Council (GMC) recently set targets to 'eliminate disproportionate complaints' and 'eradicate disadvantage and discrimination in medical education'. Our timely meta-ethnography aimed to synthesise existing qualitative literature on the wider personal and professional experiences of IMGs to identify factors affecting IMGs' professional practice (either directly or indirectly). In September 2019, we systematically searched Medline, Embase, Cochrane, PsycINFO, ERIC and EdResearch for peer-reviewed qualitative and mixed-methods articles that described experiences of IMGs. We extracted participant quotes and authors' themes from included articles and used the technique of meta-ethnography to synthesise the data and develop new overarching concepts. Of the 1613 articles identified, 57 met our inclusion criteria. In total, the articles corresponded to 46 studies that described the experiences of 1142 IMGs practising in all six continents in a range of settings, including primary and secondary care. We developed five key concepts: migration dimensions (issues considered by IMGs when migrating), a challenging start (the stressful early period), degree of dissonance (between the IMG and host country in relation to the four main barriers of language, culture, medical education and belonging), levelling the playing field (interventions to reduce the impact of the barriers) and survive then thrive (adjustments IMGs made). A conceptual model that brings these constructs together in a line of argument is presented. This meta-ethnography, based on a large amount of diverse qualitative studies, is the first to provide a comprehensive picture of the experiences and challenges that IMGs face before and after migration. Our results should be used to guide the development of interventions aiming to support IMGs and meet the GMC targets.
Highlights
International medical graduates (IMGs) represent a large portion of practising doctors in many countries
Characteristics of all 57 articles included in the meta-ethnography are presented in the order they were synthesised in Online Supplement 4
This meta-ethnography is a comprehensive synthesis of the published qualitative literature, spanning from 1997 to 2019 and reporting the experiences of more than 1000 IMGs
Summary
International medical graduates (IMGs) represent a large portion of practising doctors in many countries. An international medical graduate (IMG) is a doctor who practises medicine in a country different to the country where they received their primary medical qualification (PMQ).[1] Around 40% of practising doctors in the United Kingdom are IMGs.[1] This figure is over 25% in the United States and Canada and over 40% in Australia, Ireland, Israel, New Zealand and Norway.[2,3,4] Compared to domestic medical graduates (DMGs), IMGs are more likely to receive patient complaints,[5,6] have lower pass rates at postgraduate exams[7,8,9,10] and are less likely to achieve board certification.[11] There is a similar pattern of higher complaints rates and differential attainment for doctors from ethnic minorities (some of whom are IMGs).[5,12] In recognition of the urgency in addressing these issues, the General Medical Council (GMC) recently set a target to ‘eliminate disproportionate complaints from employers about ethnic minority doctors’ by 2026 and ‘eradicate disadvantage and discrimination in medical education and training’ by 2031.8
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