Psychodynamic Psychotherapy Training as Acculturative Experience for International Medical Graduates: A Commentary

Abstract

“Preparing International Medical Graduates (IMGs) for Psychiatry Residency: AMulti-Site NeedsAssessment” (1) addresses the needs of IMGs entering psychiatry residency training in Canada. On the basis of a survey of five psychiatric residency training programs, the authors report that respondents ranked (in order of importance) understanding the Canadian healthcare system, learning medical documentation, practicing evidence-based medicine, and providing mental health care among the greatest challenges they face in successfully adapting to postgraduate medical training. Language barriers and social isolation were particularly difficult for those residents who did not speak English as their first language. Furthermore, residents who had lived in Canada for 12 months or less reported greater perceived knowledge gaps in psychotherapy. This commentary will focus on acculturation issues that underlie the survey’s findings, including language difficulties causing social isolation that may affect the psychotherapeutic competence of IMGs. Among the cultural challenges, we will examine how differences between the collectivistic cultures of origin (for the majority of IMGs originating in non-Western countries) and the host country’s individualistic culture (2) can affect an IMG’s performance in psychiatry. After assessing various approaches to acculturation of IMGs, we will explore how training in psychodynamic psychotherapy can serve as an acculturation tool, offering IMGs unique opportunities for letting go of their old cultures and adapting to the new culture in a phase-appropriate manner. In this commentary, we use the term psychotherapy to refer to psychodynamic psychotherapy.