Graduates Of Foreign Medical Schools Research Articles

Knowledge and practice towards status epilepticus among emergency room physicians in the Gaza Strip: a cross-sectional study (P9-1.006)

<h3>Objective:</h3> To determine the level of knowledge and practice of Palestinian ER physicians towards status epilepticus (SE). <h3>Background:</h3> SE is a medical and neurologic emergency with many serious complications. Management is both time and knowledge-dependent. <h3>Design/Methods:</h3> This cross-sectional study recruited all ER physicians working in the six main governmental hospitals in Gaza Strip during June 2022. A questionnaire was used to assess the knowledge and practice toward SE. <h3>Results:</h3> Overall, 137 physicians participated (response rate 81%), including 100 males and 37 females. Mean age was 28.36 years (SD 3.4). Most participants were fresh graduates (107 had graduated in 2018 or later). The mean number of status epilepticus cases per participant during the past 12 months was 4.42 (SD 6.33). Out of 22 knowledge questions, the mean score was 13.24 (SD 3.13). A weak negative correlation (−0.20) existed between age and knowledge. Also, graduates of local medical schools scored significantly higher compared to graduates of foreign medical schools (mean score 14.3 vs. 12.17, p=0.000). Only 63.5% of participants recognized the correct, updated definition of status epilepticus. On the other hand, 85.4 and 83.9% recognized that it might cause permanent brain damage or death, respectively. In terms of practice, only 51 (37.2%) participants correctly answered whether an EEG monitoring device was available at their facility or not, while 17 (12.4%) did not correctly answer if their hospital had a neurologist among the staff. Self-revision of Status epilepticus guidelines was associated significantly with higher knowledge scores. <h3>Conclusions:</h3> Palestinian ER physicians in this survey demonstrated low levels of knowledge and practice towards SE. This should be addressed by the local health authorities to avoid potentially preventable SE-related mortality and morbidity. <b>Disclosure:</b> Dr. Aldabbour has nothing to disclose. Dr. AbuNemer has nothing to disclose. Mr. Alfarra has nothing to disclose. Dr. Aldabbour has nothing to disclose. Dr. Abu Zaydah has nothing to disclose. Dr. Abuzaid has nothing to disclose.

When policy meets reality: the new 18-hour on-call shift policy and the Israeli anesthesia workforce crisis

BackgroundThe Israeli physician workforce faces multiple challenges. These include planned policies reducing physician on-call from 26 to 18 h and, from 2026, allowing only graduates of Ministry of Health approved foreign medical schools to take the Israeli licensing examination and an ongoing physician shortage (2019: Israel had 3.19 physicians/1000 persons vs. OECD average of 3.49 physicians/1000 persons). This study examines the potential impact of these planned policies on the Israeli anesthesiology workforce.MethodsSurveys conducted among 34 public and private Israeli hospital anesthesiology department chairs collected data on their department's number of weekday on-call anesthesiologists and current shortage of anesthesiologists. A subsequent survey collected data on each anesthesiologist in the workforce, including the country where they studied medicine.ResultsEach weekday night there were 114 on-call anesthesiologists; 72 residents and 42 attendings. Using productive work coefficients, this translates to 104 resident and 51 attending anesthesiologists. Furthermore, 21 departments had existing anesthesia workforce shortages totaling 110 anesthesiologists. There were 873 anesthesiologists from non-OECD countries whose medical schools are not accredited by the World Federation for Medical Education, of whom 332 were residents (61.9% of residents). Only 20.1% of anesthesiology residents were Israeli medical school graduates.ConclusionsDescriptive survey data assessed the immediate and long-term consequences for the healthcare system and anesthesiology workforce of two new Health Ministry policies. Implementing the 18-h policy will immediately remove from the daytime workforce 155 anesthesiologists and who will be unavailable to staff elective surgery operating rooms. This will compound the current national shortage of 110 anesthesiologists. It is unclear how to replace this shortfall since there are no surplus Israeli physicians and very few Israeli graduates choose anesthesiology as a specialty. This situation will be exacerbated after 2026 when graduates of certain foreign medical schools will be unable to enter the medical workforce, further reducing the pool of potential anesthesiology residents. Both policies were promulgated without adequate operational and budgetary planning or fiscal or workforce resources; implementation of the 18-h on-call policy has already been postponed. Therefore, new or updated policies must be accompanied by specific operational plans, budgetary allocations and funds for additional workforce.

Pathology Job Search and Interview: Perspectives on the United States Experience.

Pathology training is focused on the attainment of clinical, diagnostic, and administrative skills. Preparation for employment search and the interview process are often neglected. Given that a near majority of pathology trainees in the United States are graduates of foreign medical schools, training in the job search and interview process according to local customs, norms, and expectations has greater salience for individuals new to the United States. To offer perspectives on 2 components of the job search process: (1) finding a suitable job opening in academic and private practice settings and (2) preparing for an interview. We have provided a set of common interview questions and suggested preparatory methodology. The differences in the process and expectations in academic settings and private practice operations are highlighted. Engaging in the job search process early and networking are emphasized. We have also suggested approaches for pathology teachers and mentors in guiding trainees in a job search and preparation for an interview. The information and opinions expressed in this communication are based on the personal experiences of 4 senior pathologists in academic and private practice settings. Start networking early. Leverage contacts with teachers, attending pathologists, senior residents, and people at national meetings to locate appropriate job opportunities. Seek assistance from attending pathologists in preparing a curriculum vitae and cover letter. Prepare for the questions that may come up in an interview. A dress rehearsal for an interview is strongly recommended.

Exploring the Challenges for International Medical Graduates Pursuing Minimally Invasive Surgery Training in the United States and Canada: A Cross-Sectional Analysis.

Background:International Medical Graduates (IMGs) are an important component of the US healthcare workforce. Prior studies have investigated bias against IMGs during the general surgery residency application in the United States. Minimally invasive surgery (MIS) is a growing field; The MIS fellowship match was established in 2004 and is a competitive process with a match rate of 47%. Opportunities for applicants who are non-US citizens are limited by a series of factors that are not related to their professional qualifications.Objectives:The aim of the study was to explore the challenges faced by IMG in the MIS fellowship match.Methods:This is a cross-sectional study analyzing the minimally invasive surgery application requirements of all the programs listed in the Fellowship Council. Individual program requirements were collected into a database and a descriptive analysis was performed comparing programs who accept IMGs versus those that do not. Further statistical analysis was performed to explore those differences and associated factors.Results:There were 148 MIS fellowship programs and 187 positions offered during the 2021 match year in the US. Ninety-seven programs (65.5%) were found to accept graduates of foreign medical schools if they were US-citizens, whereas only 49 programs (33.1%) were found to accept IMG and sponsor a visa for their training. University affiliated programs (88.9% vs 75.0%, p = 0.04), programs with a general surgery residency (94.4% vs 75.0%, p = 0.003), and older programs (63.0% vs 45.5%, p = 0.04) were more likely to accept IMGs requiring visa sponsorship.Conclusions:There is a significant bias against IMGs in the MIS fellowship match, with a reduced number of positions available based on factors not related to their professional performance or qualifications. Well established programs, university, and residency affiliated programs are more likely to consider these physicians for training.

Binary Reporting of USMLE Step 1 Scores: Resident Perspectives

The recent consensus from the Invitational Conference on USMLE Scoring has recommended a transition to a binary pass/fail reporting on the USMLE Step 1 exam to be implemented from January 22, 2022. While this change was instituted in an effort to decrease medical student stress and re-iterate the importance of the Step 1 as merely a licensing or qualifying exam, this decision has profound implications for medical graduates of both United States and foreign medical schools. In addition to compounding the difficulties of resident selection by residency programs, the new system could exert significant mental and financial burden on medical students, and potentially affect the diversity of graduate medical education in the United States. This article draws attention to the downstream effects of a pass/fail system on the future of medical and surgical education.

Doctors Who Perform Abortions: Their Characteristics and Patterns of Holding and Using Hospital Privileges.

Controversy exists regarding whether doctors who perform abortions should be required to hold hospital admitting privileges, but no research exists as to the extent to which they actually hold and use such privileges. Extensive Internet and government data sources were used to identify and verify abortionists in Florida. All medical and osteopathic abortion doctors who were licensed to practice at any time during the period 2011 to 2016 were included in the study (n = 85). Every abortionist hospital admission of a female patient aged 15 to 44 occurring during the 6-year study period was identified (n = 21 502). Abortionist physicians are 74.1% male, 62% have been in practice for 30 years or longer, 27.1% are graduates of foreign medical schools, and 55.3% are board certified. Nearly half (48.2%) of the abortionists had at least 1 malpractice claim, public complaint, disciplinary action, or criminal charge. Half (50.6%) of the abortionists reported hospital privileges, but only 32 (37.6%) admitted at least 1 patient to a hospital. Seven physicians accounted for 68.2% of all the admissions, and 79.6% of all admissions were related to a live birth. Black was the modal race (47.6%) and Medicaid the most frequent (64.9%) pay source. Nearly one-fifth (19.4%) of admissions came through the emergency department. Physicians who hold hospital privileges are significantly (P < .05) more likely to be board certified and to be approved for Medicaid payment than their colleagues without privileges. Of those doctors who hold and use hospital privileges, the lowest admission volume physicians are significantly less likely to be involved in live births, more likely to admit commercially insured and white inpatients, and much more likely to use the emergency room as the route to hospital admissions for their Medicaid-eligible and black patients. Further study of abortionist physicians is indicated regarding their heterogeneous personal and professional characteristics; their career pathways and practice concentrations; their relative integration with or isolation from peers and the professional network; the importance of black and poor induced abortion patients in their total caseload; and, especially for abortionists without hospital privileges, the means by which their patients requiring emergency care and hospitalization are accommodated.

New recommendation and coverage of low-dose computed tomography for lung cancer screening: uptake has increased but is still low

BackgroundIn 2013, the US Preventive Services Task Force (USPSTF) issued recommendations for low-dose computed tomography for lung cancer screening (LDCT-LCS), but there continues to be a dearth of information on the adoption of LDCT-LCS in healthcare systems. Using a multilevel perspective, our study aims to assess referrals for LDCT-LCS and identify facilitators and barriers to adoption following recent policy changes.MethodsA retrospective analysis of electronic medical record data from patients aged 55–80 years with no history of lung cancer who visited a primary care provider in a large healthcare system in California during 2010–2016 (1,572,538 patient years). Trends in documentation of smoking history, number of eligible patients, and lung cancer screening orders were assessed. Using Hierarchical Generalized Linear Models, we also evaluated provider-level and patient-level factors associated with lung cancer screening orders among 970 primary care providers and 12,801 eligible patients according to USPSTF guidelines between January 1st, 2014 and December 31st, 2016.ResultsDocumentation of smoking history to determine eligibility (59.2% in 2010 to 77.8% in 2016) and LDCT-LCS orders (0% in 2010 to 7.3% in 2016) have increased since USPSTF guidelines. Patient factors associated with increased likelihood of lung cancer screening orders include: younger patient age (78–80 vs. 55–64 years old: OR, 0.4; 95% CI, 0.3–0.7), Asian race (vs. Non-Hispanic White: OR, 1.6; 95% CI, 1.1–2.4), reported current smoking (vs. former smoker: OR, 1.7; 95% CI, 1.4–2.0), no severe comorbidity (severe vs. no major comorbidity: OR = 0.2, 95% CI = 0.1–0.3; moderate vs. no major comorbidity: OR = 0.5; 95% CI = 0.4–0.7), and making a visit to own primary care provider (vs. other primary care providers: OR, 2.4; 95% CI, 1.7–3.4). Appropriate referral for lung cancer screening varies considerably across primary care providers. Provider factors include being a female physician (vs. male: OR, 1.6; 95% CI, 1.1–2.3) and receiving medical training in the US (foreign vs. US medical school graduates: OR = 0.4, 95% CI = 0.3–0.7).ConclusionsFuture interventions to improve lung cancer screening may be more effective if they focus on accurate documentation of smoking history and target former smokers who do not regularly see their own primary care providers.

A standardized practical examination for title revalidation of graduates of foreign medical schools

The University of Chile, backed by its extensive experience in Objective Structured Clinical Examinations (OSCEs), performs the practical exam to graduates of foreign medical school in this format. This test format would give more guarantees of validity and fairness as compared with the previous oral examination that was required for title revalidation. To compare the performance of graduates of foreign medical schools and last year medical students of the University of Chile in the same internal medicine OSCE. Seventy-seven last year medical students and thirty-three graduates of foreign medical schools participated in the same Internal Medicine OSCE, but in different moments. At the end of the examination, graduates of foreign medical schools answered a questionnaire about their prior experience with OSCEs and about their perception about this type of examination. The performance of graduates of foreign medical schools was lower than those of our last year medical students in four of the eight stations of the examination. Graduates of foreign medical schools considered the examination objective, fair, and that it assessed skills adequately and that the degree difficulty was homogeneous for all examinees. The possibility of obtaining comparable results in a transparent process makes the OSCE the assessment tool of choice for title revalidation of physicians migrating from foreign countries.

Is Canadian surgical residency training stressful?

Surgical residency has the reputation of being arduous and stressful. We sought to determine the stress levels of surgical residents, the major causes of stress and the coping mechanisms used. We developed and distributed a survey among surgical residents across Canada. A total of 169 participants responded: 97 (57%) male and 72 (43%) female graduates of Canadian (83%) or foreign (17%) medical schools. In all, 87% reported most of the past year of residency as somewhat stressful to extremely stressful, with time pressure (90%) being the most important stressor, followed by number of working hours (83%), residency program (73%), working conditions (70%), caring for patients (63%) and financial situation (55%). Insufficient sleep and frequent call was the component of residency programs that was most commonly rated as highly stressful (31%). Common coping mechanisms included staying optimistic (86%), engaging in enjoyable activities (83%), consulting others (75%) and exercising (69%). Mental or emotional problems during residency were reported more often by women (p = 0.006), who were also more likely than men to seek help (p = 0.026), but men reported greater financial stress (p = 0.036). Foreign graduates reported greater stress related to working conditions (p < 0.001), residency program (p = 0.002), caring for family members (p = 0.006), discrimination (p < 0.001) and personal and family safety (p < 0.001) than Canadian graduates. Time pressure and working hours were the most common stressors overall, and lack of sleep and call frequency were the most stressful components of the residency program. Female sex and graduating from a non-Canadian medical school increased the likelihood of reporting stress in certain areas of residency.

Lymphatic Vessel Distribution in the Mucosa and Submucosa and Potential Implications for T1 Colorectal Tumors

Previous studies have reported that as many as one third of applicants misrepresent their publication record on residency or fellowship applications.To determine the incidence of potentially fraudulent (or "phantom") research publications among applicants to a colorectal surgery residency program.Electronic Residency Application Services applications were reviewed. All listed publications were tabulated and checked whether they were published using various search engines.Cedars-Sinai Medical Center.Applicants from 2006 to 2008.We searched for phantom publications, defined as peer review journal citations that could not be verified. Demographics and other academic factors were compared between applicants with phantom publications and applicants with verifiable publications.Of the 133 study group applicants, there were 91 (68%) males and 58 (44%) whites. Median age of the study cohort was 32 years (range, 27-48 y). Eight-seven of 130 applicants (65%) listed a total of 392 publications. Thirty-six (9%) of these 392 citations could not be verified and were considered to be phantom publications. The 36 phantom publications were identified in 21 applicants, representing 16% (21/133) of all applicants and 24% (21/87) of all applicants who cited publications. We found no significant difference in any demographic or other studied variable between applicants with phantom publications and those with verifiable publications. When comparing applicants with 3 or more phantom publications with applicants with verifiable publications, the former group had a significantly higher rate of individuals over age 35 (50% vs 24%; P = .02), foreign medical school graduates (75% vs 20%; P = .03), and individuals with 5 or more publications (100% vs 30%; P = .01).Publications may simply have been missed in our search. We specifically may have failed to find publications in foreign journals.The significance of professionalism and ethical behavior must be emphasized in surgery training programs.

Physician Attitudes Toward Personal Relationships With Patients

Maintenance of appropriate boundaries in the doctor-patient relationship is central to medical professionalism. Little is known about physician attitudes toward personal relationships with patients. To explore physician attitudes toward a range of personal relationships with patients and the connection between them and other facets of professional behavior. National survey by mail using a stratified random sample. Active physicians specializing in internal medicine, family medicine, pediatrics, cardiology, surgery, and anesthesiology. Respondents rated the appropriateness of social, business, and sexual contacts with patients and expressed level of agreement with statements regarding other aspects of medical professionalism relating to patient welfare and professional self-regulation. Endorsement of relationships was dichotomized as never versus rarely, sometimes, often, or always appropriate. A total of 1662 eligible physicians responded of 3504 sampled (adjusted response rate: 58%). Support was high for social relations (91%), somewhat less for business relations (65%), and low for sexual contact (9%). Women, nonwhites, and foreign medical school graduates were less likely to support all 3 relationships. Support for sensitive relationships was associated with rejection of the primacy of patient welfare over physician financial interests (P = 0.015), providing care to indigent patients (P = 0.010), reporting medical errors (P = 0.002), and participating in peer evaluations (P = 0.002). Physicians may perceive different types of relations with patients to fall on a continuum of potential for conflict with their professional role. Support for personal relationships was associated with physician demographic characteristics. More permissive interpersonal boundaries may be associated with weaker support for other professional standards.

Analysis of Residents Knowledge Base: A Pilot Project to Establish a New Teaching Paradigm

Purpose: Subspecialty lectures to Internal Medicine (IM) residents have been based on the traditional topic based core curriculum lectures. Will analysis of resident's knowledge base special emphasis on filling knowledge gaps be a better approach? A majority of IM residents graduate to become primary care physician and are the first to encounter and diagnose patients with hepatitis C virus (HCV) infection. Our aim was to query the knowledge base of practice guidelines regarding HCV infection of IM residents. Methods: A one-page questionnaire was administered to 216 IM residents at four community New York City residency training programs. Results: IM residents were distributed equally across postgraduate years, 93% were foreign medical school graduates, and 100% had taken care of >10 (HCV) patients in the past year. 48% of respondents tested patients for HCV if they had elevated transaminases; 46% routinely screened patients for HCV with a history of blood transfusion; 40% routinely screened patients with a history of intravenous drug use; 20% routinely screened patients with AIDS; 3% routinely screened patients with a history of cocaine snorting or tattoos; 2% of respondents tested all admitted in-hospital patients. Genotype 1 was reported by 47% as the most common in the U.S., while genotype 2 and 3 were reported by 39% and 7% respectively. 85% reported interferon plus ribavirin as the appropriate therapy for HCV. 55% considered alpha-fetoprotein as the screening test of choice for hepatocellular carcinoma. Any form of depression was considered a contraindication to treatment by 36% of respondents, while 31% considered cirrhosis, 3% considered AIDS and 8% considered pregnancy a contraindication. Conclusion: The results of this survey make us conclude that a large majority of IM residents are not fully familiar with recommended guidelines in the assessment and management of HCV. Core curriculum lectures should be specifically designed to fill in gaps of knowledge. A focused lecture, dictated by the results and deficiencies found in the answers to the questionnaire on hepatitis C, was delivered to IM residents at a single institution consisting of 20% of the original respondents. After the lecture, residents were re-surveyed. One hundred percent of the respondents correctly identified risk factors in transmission, whom to test, contraindications to treatment and screening for hepatocellular carcinoma in patients with hepatitis C. 90% of the residents correctly identified genotype 1 as the predominant amongst patients with hepatitis C. These results make it possible to suggest a new paradigm in teaching. Core curriculum lectures should be dictated by an analysis of the institution's resident knowledge base to have maximal impact on outcome.

Medical Malpractice in Gastroenterology

Gastroenterologists commonly perceive themselves to be at increased legal risk because they perform invasive procedures. However, there is little published information about gastroenterology (GI) malpractice claims. The goal of this study was to evaluate available malpractice claim data within GI. This study was a database analysis of GI claims submitted by insurance companies to the Physician Insurers Association of America Data Sharing Project from January 1, 1985, to December 31, 2005. Another analysis from 2005 compared GI claims with other subspecialties. Sixty-six percent of physicians involved in claims had previous claims experience. The most common reasons for claims were errors in diagnosis (28%) and improper performance of a procedure (25%). Seventy-two percent of reported closed claims were settled out of court. Of 12,367 total claims in 2005, only 233 (1.8%) were within GI. GI ranked below other procedurally based subspecialties in numbers of claims per physician. GI does not rank highly among subspecialties in malpractice claims and only a minority of claims are procedure-related. Physicians with claims experience are likely to have further claims against them and should consider evaluating their practices.

When the Third Degree Is Necessary: Do Pediatricians Obtain Enough Information to Detect Patients at Risk for HCM?

This study was designed to see if pediatricians are collecting sufficient data in family histories to be able to ascertain whether children are at risk for hypertrophic cardiomyopathy (HCM). Surveys were returned by 326 general pediatricians who were members of the Second Chapter of the American Academy of Pediatrics. The majority of pediatricians (98.2%) reported taking family histories; however, only 51.2% reported that this information was updated on a regular basis. Only 29.8% of the pediatricians reported including all five risk factors for HCM in a medical family history. Although almost all of the pediatricians reported including first-degree relatives in medical family histories, only 40.5% reported including all second-degree relatives. Female physicians were found to take more thorough medical family histories than male physicians, and foreign medical school graduates were found to take more thorough medical family histories than US medical school graduates. Additionally, graduates of foreign medical schools reported updating medical family histories more often than graduates of US medical schools. This study suggests that pediatricians might not be identifying risks pertinent to the identification of HCM.

The Primary Care Physician Workforce: Ethical and Policy Implications

We undertook a study to examine the characteristics of countries exporting physicians to the United States according to their relative contribution to the primary care supply in the United States. We used data from the World Health Organization and from the American Medical Association Physician Masterfile to gather sociodemographic, health system, and health characteristics of countries and the number of international medical graduates (IMGs) for the countries, according to the specialty of their practice in the United States. Countries whose medical school graduates added a relatively greater percentage of the primary care physicians than the overall percentage of primary care physicians in the United States (31%) were poor countries with relatively extreme physician shortages, high infant mortality rates, lower life expectancies, and lower immunization rates than countries contributing relatively more specialists to the US physician workforce. The United States disproportionately uses graduates of foreign medical schools from the poorest and most deprived countries to maintain its primary care physician supply. The ethical aspects of depending on foreign medical graduates is an important issue, especially when it deprives disadvantaged countries of their graduates to buttress a declining US primary care physician supply.

One MATCH fits all?

It's the uncertainty principle, writ large, on the medical residency stage. Angered by a proposal to put graduates of Canadian and foreign medical schools into 1 competition hopper and buffeted by conflicting reports about the future process for determining residency positions in Canada's

Linkage between the Israeli Defense Forces Primary Care Physician Demographics and Usage of Secondary Medical Services and Laboratory Tests

The primary care physicians in the Israeli Defense Forces, as in the Israeli civilian health system, have two major subpopulations. Graduates of Israeli schools of medicine, and graduates of foreign medical schools, most of them in Eastern Europe. To evaluate differences in the referral patterns of primary care physicians according to their graduation institution and demographic characteristics. The study took place in one primary care practice in central Israel. The referrals to consultations and laboratory tests over a period of 1 year were evaluated. Physicians that had less than 37 encounters were excluded from the study. Data were extracted from the central computerized databases of the Medical Corps and Israeli Defense Forces. Sixty-eight physicians had a total of 18,402 encounters that resulted in 23,845 outcomes. There were no associations between demographic and training backgrounds of the physicians and their actual referral rates to consultations and laboratory tests. The background data of the primary care physicians does not predict their referral patterns and their role as "gate keepers".

US Graduate Medical Education, 2004-2005

Over the last decade, the primary care specialties have experienced an ebb and flow in popularity. A description of the future primary care workforce may inform planning for the health care needs of our population. To describe characteristics of physicians training in primary care specialties over the past 9 years and to monitor trends in the characteristics of the entire residency population. Descriptive survey study of the National GME Census, conducted by the American Medical Association and Association of American Medical Colleges, which jointly surveyed 8246 allopathic graduate medical education (GME) programs during the academic year 2004-2005 about active, transferred, and graduated residents, as well as about program characteristics. Program directors confirmed the status of 97.3% of active residents. The accompanying program survey was completed by 7163 (87%) of the program directors. General trends in the numbers and characteristics of all residents, fellows, and training programs, with specific trends for residents and fellows training in the primary care specialties and subspecialties over the past 9 years. The census counted 101 291 physicians-in-training during the 2004-2005 academic year, the largest number ever recorded by this survey. The number of osteopathic medical school graduates (DOs) in allopathic GME decreased from 5838 in 2003-2004 to 5675, following many years of annual increases. The number of residents in primary care specialties reached a peak in the mid 1990s. The number of family medicine residents who are graduates of US allopathic medical schools (USMDs) has fallen from 8232 (77.6%) in 1998-1999 to 4848 (51.7%) in 2004-2005. The number of primary care residents who are graduates of foreign medical schools and US citizens (USIMGs) nearly doubled between 1995-1996 (n = 1768) and 2004-2005 (n = 3304). The number of USIMGs training in internal medicine or pediatrics subspecialties increased by 45.7% between 1995-1996 (n = 622) and 2004-2005 (n = 906). The number of pediatric subspecialty fellows grew 55.7%, mostly because of the near doubling of USMDs, from 813 to 1617. More than half of primary care residents are women (52.5%). All primary care specialties and subspecialties experienced gains in the proportion of female residents, with the greatest in obstetrics/gynecology, which increased by 28.7% (57.9% in 1995-1996 vs 74.5% in 2004-2005). An increasing proportion of physicians are pursuing subspecialty training, while the number in primary care specialties has leveled off. Trends in GME suggest that the primary care medical workforce of the future will include more women, more IMGs, and more DOs.

(Not) "Born in the USA": foreign medical school graduates in the American healthcare system

(Not) "Born in the USA": foreign medical school graduates in the American healthcare system

A (bittersweet?) taste of “American pie”: foreign medical school graduates in the US postgraduate medical work force

A (bittersweet?) taste of “American pie”: foreign medical school graduates in the US postgraduate medical work force