International Medical Graduates Face Research Articles

IMG Track Offers Advice, Counsel, and Guidance for International Graduates

IMG Track Offers Advice, Counsel, and Guidance for International Graduates

Understanding Meta-Ethnography in Health Professions Education Research.

Understanding Meta-Ethnography in Health Professions Education Research.

International medical graduates' experiences before and after migration: A meta-ethnography of qualitative studies.

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.

Match Day: The Roadblocks International Medical Graduates Face

Match Day: The Roadblocks International Medical Graduates Face

The International Medical Graduate

International medical graduates (IMGs) are graduates of medical schools located outside the United States (U.S.) and Canada. IMGs face various challenges on the road to U.S. residency training. These challenges include sitting for the United States Medical Licensing Examinations (USMLEs) to obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG). After that, IMGs are faced with a foreign application process whereby they must apply for and secure a position in a residency program through the Electronic Residency Application System (ERAS) and the National Resident Matching Program (NRMP). Once accepted into a residency program, IMGs who are not US citizens or legal permanent residents are challenged with securing a visa to be able to practice in the U.S. In this article, we elaborate on these processes and highlight the challenges IMGs may face along the way.

Developing rapport in inter-professional communication: Insights for international medical graduates

Many Western countries including Australia have become reliant on international medical graduates (IMGs) to strengthen their medical workforce. In Australia, the majority of IMGs are now from non-English speaking backgrounds and work in medical and communicative environments in which they were not raised or trained themselves. They therefore face the challenge of understanding unfamiliar hospital systems and guidelines, and a new set of cultural and communicative parameters. In this paper, we report findings from a pilot study investigating the communicative challenges that IMGs face in simulated medical handovers in an Australian hospital context. Using a case study approach and tools from applied linguistics and intercultural pragmatics, we analyse the discourse of two doctors to identify some of the discourse features that native English-speaking and expert medical practitioners use to establish and maintain rapport with colleagues. We draw on the distinction between the pragmalinguistic and sociopragmatic aspects of the inter-professional context to illuminate the different areas of communication that might be tackled explicitly and systematically as part of IMG preparation for practice in Australia. In this way we illustrate how discourse data can contribute to an evidence base from which principled approaches to communication training for IMGs may be developed.

International Medical Graduates (IMGs) in the UK—a Systematic Review of Their Acculturation and Adaptation

International medical graduates (IMGs) constitute about 23–28 % of the medical workforce providing support and contribution to the UK, Canada, USA and Australia. This review will inform the need for trainers, deaneries and colleges to plan and develop strategies to enhance the potential of IMGs. The authors aim to review and inform the relevant authorities about the barriers faced by IMGs in training and career progression in the UK health service. Two hundred forty-eight studies were reviewed at step 1; 54 were excluded on the basis of selection criteria, and further 115 studies were excluded which did not focus on issues discussed in the selection criteria; and after reviewing 79 studies, a further 20 were excluded for methodological qualities, and finally, 59 were included. The results have been discussed under various themes which emerged as significant issues related to IMGs. Seeking better life and higher education and training are the main reasons for migration. The training process of IMGs in their own countries impacts on the transition process results in struggling career progression. The most crucial impediment in the path of career progression is the process of passing examinations which IMGs face during their career struggle. The psychological aspects of migration and legal and ethical issues are found to be significant for IMGs. They also struggle with the adaptations needed with reference to learning and teaching styles resulting in the change of multiple specialties. IMGs contributed significantly to not only filling the space of under-recruitment but also serving comprehensively in a variety of specialties. There has been a consistent decline in preferring some specialties as career option among UK medical graduates and medical students. IMGs migrate to foreign countries in pursuit of better medical education, desire for better income, general security and improved prospects for the family, but in doing so, they are confronted with psychosocial problems, cultural differences, hurdles in career progression and passing exams.

Which Educational Programs Promote the Success of International Medical Graduates in Psychiatry Training?

The exceptional importance of international medical graduates (IMGs) in academic psychiatry (1, 2) is underscored in this special theme issue of our journal. As noted by Boulet et al. in this collection, about 31% of the psychiatry workforce in the United States are IMGs, and about 32% are psychiatry residents (3). In clinical psychiatric practice, IMGs disproportionately serve poor patients and the most severely ill patient populations (4). IMGs also contribute substantially to the U.S. health system in research, leadership, and education (5). International medical graduates face the considerable challenges of emigrating to a dissimilar culture and healthcare and educational system. These challenges include navigating dual learning curves as immigrants and residents (6). In the workplace, some report having been treated insensitively (6), and wider discrimination very possibly exists (7, 8). Educational challenges include communicating in specialized ways (9), as well as rectifying any knowledge deficiencies related to the management of sexual health problems (10), and the management of illnesses and healthcare problems more commonly encountered in the U.S., as compared with other countries. This issue, consisting of nine special articles (3, 11–18), serves to contribute to our understanding of these challenges by presenting an array of ideas and formal recommendations for ameliorating them. Sockalingamet al., in a surveyof IMGs training in Canada, reported that more training preparatory to residency and targeted to need would be helpful (11), and Sacks et al. developed guidelines for observerships preparatory to residency (12). Jain et al. provide information on how training is conducted in various international settings, so as to help educators assist IMGs adapt to training in the United States (13). Two articles (14, 15), concern the practice of psychotherapy. Weerasekera recommended guidelines for teaching psychotherapy to IMGs (14), and Rao emphasizes the potential role of individual psychotherapy in facilitating a successful acculturation experience (15). Rao et al. also surveyed IMGs taking the Clinical Skills Verification Examination to learn how a better experience and better performance could be achieved (16). Broquet and Punwani provide recommendations for helping foreign-born IMGs utilize behavioral-based feedback as a cornerstone of their educational experiences (17). One additional report describes anobservership for international child mental health professionals, whowere required to take what they had learned home (18). Participants were screened carefully in order to minimize the possibility that they would stay or return to practice in the United States. This model is especially valuable in the context of an international migration of doctors and other healthcare professionals from lowand middle-income, resource-poor countries to rich countries, when this migration may severely compromise healthcare in the resource-poor countries (19–23). Training specialists for the role of strengthening themental health services in resource-poor countries represents a creative policy approach to this problem. Such creative policy approaches warrant development and further evaluation. Our primary goal for this editorial, however, is to describe published programs that support and promote IMGs, including those programs that assist in the acculturation process to clinical practice and training in North American settings. There are several reasons for adopting this focus. Received and accepted May 17, 2012. From the Dept of Psychiatry– Behavioral Sciences, Baylor College of Medicine, Houston TX; the University Psychiatric Center, Detroit, MI; and the Dept of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Send correspondence to acadpsych@gmail.com Copyright © 2012 Academic Psychiatry

Practising medicine in two countries: South African physicians in Canada

This qualitative study examines the pre- and post-migration practice experiences of 73 physicians trained in South Africa who have relocated to Canada. The aims are to explore the workings of two different healthcare systems from an insider standpoint and to address the medical autonomy debate as it relates to international medical graduates (IMGs). While study respondents reported practice frustrations in both countries, they generally preferred working in a socialised health insurance environment that grants wider accessibility than a two-tiered system that favours a privileged few. Concerns such as family safety and opportunities for children also contributed to more satisfaction with Canada. We discuss our findings in relation to a broader international context and the sociological literature on medical autonomy. We argue that IMGs face different autonomy issues from other physicians and stress the need to broaden sociological inquiry of medical work by investigating how autonomy interfaces with other neglected aspects of physicians' work and non-work lives.

Commentary: Coming to America: The Integration of International Medical Graduates into the American Medical Culture

This Commentary is a companion piece to two Research Reports appearing in this issue: "Behavioral Science Education and the International Medical Graduate," by Searight and Gafford, and "International Medical Graduates and the Diagnosis and Treatment of Late-Life Depression," by Kales et al. International medical graduates (IMGs) come to America from diverse cultures around the world to complete their graduate medical education (GME). These residents are and will continue to be a fundamental part of the American health care delivery system. IMGs' acculturation into the norms and standards of medicine as practiced in the U.S. is crucial to their education as well as to quality patient care. The time has come for GME to begin to systematically and effectively address the cultural challenges that IMGs face not only within the context of American medicine and GME, but in the larger context of American culture. Specific programs and strategies need to be developed and put in place early in the GME experience-or even before entry into GME-to assist IMGs in understanding the context for, and issues associated with, providing optimum health care in the United States. The author reflects on the findings of the two Research Reports, and calls for increased attention in the medical education community to acculturating and educating IMGs for optimal patient care.

Assisting international medical graduates applying for their first post in the UK: what should be done?

The number of international medical graduates (IMGs) passing the Professional and Linguistic Assessment Board (PLAB) examination was six times greater in 2004 than in 2000. This has resulted in unprecedented numbers of applicants for junior posts, with some attracting over 1,000 overseas graduates. The Royal College of Physicians working group on IMGs was established in 2004 to address the problems that face newly qualified IMGs. The group has ascertained and now publishes current levels of competition for junior posts in order to inform overseas graduates of the levels of competition they are likely to encounter. The group is seeking ways of selecting applicants when such large numbers apply for posts and is looking at ways of improving clinical attachments. The paper considers these and other difficulties that IMGs face when they first seek employment in the UK and discusses possible solutions.