International Medical Graduate Residents Research Articles

Challenges faced by international medical graduate (IMG) residents interested in hematology-oncology.

29 Background: International Medical Graduates (IMGs) comprise over one-third of internal medicine (IM) trainees and practicing oncologists in the United States. We aimed to examine challenges faced by IM IMG residents in pursuing hematology-oncology (HO) fellowship positions. Methods: We conducted a pilot survey using SurveyPluto to assess demographics and evaluate visa related challenges amongst ACGME residents interested in HO. The survey was disseminated through the ASCO IMG Community of Practice (CoP), the Heme-Onc Fellows Mentorship Empowerment (H.O.M.E) group and the IMG Oncologists social media homepage (@IMG_Oncologists). Results: A total of 59 IMG residents completed the survey (20% PGY-1, 36% PGY-2 and 44% PGY-3). The majority of trainees (88%) were from community or university-affiliated community programs. J-1 visa was the most common visa type (67.8%). The visa process was rated as difficult or very difficult by 36% of trainees. Annual visa renewal was required by 51% trainees and 55.9% reported visa related impact on plans for research grant applications (Table). The greatest challenges associated with visa status were disruption of travel plans and inability to unite with family (35.6%); obtaining documentation from home country (33.9%); visa renewal (28.8%) and lack of clarity in visa instructions (27.1%). Among resources that respondents wanted better access to, IMG networking groups (81.4%), legal/financial aids (47.5%), institutional visa seminars (45.8%) and flexibility from their program to visit family overseas (45.8%) were identified as priorities. Conclusions: Visa related barriers pose significant challenges to IMGs interested in HO. Policy changes, advocacy work and additional resources could be beneficial for future IMG oncologists. Challenges associated with visa status for hematology/oncology aspirants. Greatest visa related barriers during training % of respondents (n=59) Documentation from home country 33.9% Disruption in travel plans/ inability to unite with family 35.6% Lack of clarity in renewal instructions/ renewal process post document procurement 55.9% Ability to secure grant affected by visa 22% Non-monetary grant aspects affected by visa 13.6% Did not pursue grants due to visa 20.3% Desired resources during residency Institutional visa seminars 45.8% IMG network groups 81.4% Program flexibility to visit family overseas/ legal and financial aids 45.8%/47.5%

International medical graduates in orthopaedic surgery: An opportunity to improve diversity and inclusion?

Background/aimsRacial and ethnic minorities are under-represented in orthopaedic surgery despite efforts to promote diversity and inclusion in the specialty. The purpose of this study was to determine the proportion of international medical graduates (IMGs) in the surgical workforce and future residency pipeline. We further analyze IMG applicant qualifications relative to their US-based counterparts to assess the viability of recruiting IMG candidates as one strategy to advance diversity and inclusion in orthopaedic surgery. MethodsPhysician workforce data from the American Medical Association and residency match data from the National Resident Match Program were analyzed for Orthopaedic Surgery. Trends in the proportion of IMG applicants were compared with those from other specialties. Qualifications of applicants were compared including board exam scores, number of abstracts/publications, and additional graduate degrees. ResultsIn 2020, orthopaedic surgery had the lowest percentage of IMGs relative to otolaryngology (5.8 %, p < 0.001), neurosurgery (12.1 %, p < 0.001), obstetrics & gynecology (14.0 %, p < 0.001), and general surgery (19.1 %, p < 0.001). From 1986 to 2021, IMG Graduates who matched into orthopaedic surgery increased from 1 (0.3 %) to 8 (0.9 %). Compared to other surgical specialties, orthopaedic surgery had among the lowest annual rates of incoming IMG residents. In 2021, most respondents to the orthopaedic surgery residency program directors survey reported never selecting IMG applicants for interview (74 % for non-US IMG applicants and 53 % for US IMG applicants). From 2020 to 2021, non-US IMG applicants (17 %) and US IMG applicants (26 %) had lower match rates than DO Senior (74 %) and MD Senior (80 %) applicants (p < 0.001). In 2020, matched non-US IMGs had similar board scores as matched US MD Senior applicants, but more abstracts/publications. ConclusionThe recruitment of IMGs into orthopaedic surgery residency remains limited and lower than other surgical specialties. IMGs have similar board scores and more abstracts/publications, thus representing a potential pipeline for workforce diversity. More research is needed to understand the special needs of IMGs in the orthopaedic surgery match.

The Relationship Between Program and Applicant Characteristics With Applicant Program Signals in the 2022 Residency Recruitment Cycle: Findings From 3 Specialties.

Continuing increases in application volume have driven a national dialogue to reform the residency recruitment process. Program signaling allows applicants to express interest in a program at the preinterview stage with the goal of helping programs identify applicants with more genuine interest in their programs. This study explored the relationship between program signals and program and applicant characteristics. Participating dermatology, general surgery, and categorical internal medicine (IM) programs and applicants of the 2022 supplemental ERAS application (SuppApp) were included. Data from the SuppApp, the MyERAS Application for Residency Applicants (MyERAS), and the 2020 GME Track Survey were used. Cohen's h was used to determine effect size, and chi-squared was used to determine statistical significance. There was an uneven distribution of signals to programs, with 25% of programs receiving about half of the signals across all 3 specialties. Programs with larger numbers of both residents and applicants received greater numbers of program signals relative to their program density, although this effect was small ( h < 0.50, P < .001). No meaningful differences were seen across genders for any specialty. Only Hispanic applicants in IM sent a higher proportion of signals to programs with more underrepresented in medicine residents than White only applicants (40% vs 26%, h = 0.30, P < .001). Across all specialties, there was a small-to-moderate effect for international medical graduate (IMG) applicants sending a larger proportion of signals to programs with more IMG residents ( h < 0.80, P < .001). This first-year pilot study (i.e., SuppApp) provided initial evidence that supports the feasibility and fairness of program signals in residency selection. As program signals become more common across specialties, future research should continue to evaluate trends in where applicants send signals, and possible relationships between program and application characteristics.

International Medical Graduates in Radiology Residencies: Demographics, Performance, and Visa Issues

The number of international medical graduates (IMG) in radiology residencies has varied from year to year even as the number of candidates continues to grow. It is unclear from which countries the IMGs are arriving and what visas are being used to accommodate them. We sent a survey to 195 program directors (PD) in diagnostic radiology (DR) inquiring about the number and nationality of IMG residents in their program, their attitudes about IMG candidates, the performance of their IMG trainees, and the visas that are offered. We received responses from 121 of 195 (62.1%) DR programs (121/149=81.2% of actionable emails). 80/121 (66.1%) had at least one IMG in their DR residency program and the countries of origin included India (36), Iran (30), Saudi Arabia (24), Egypt (16), Canada (14), Brazil (14), and Pakistan (9), as the most common. While most programs (76/104, 73.1%) offered J1 visas, 23/99 (23.2%) provided H-1B visas to trainees. IMG DR residents overall performed as well as American graduates, with an equal number of PDs saying IMGs performed better and worse than American graduates. PDs' issues with IMGs centered on visas: (1) expense, (2) lack of familiarity, (3) Educational Commission for Foreign Medical Graduates regulations, and (4) time commitment in submitting paperwork. Most radiology IMG residents originate from India and Middle Eastern countries. Once enrolled, IMG residents perform similarly to US graduates. However, adding IMG candidates to the training program requires overcoming bureaucratic and monetary hurdles around visas. Most DR international medical graduate residents are from India or the Middle East. Although their performance is the same as American graduates in general, PDs note the monetary and bureaucratic hassles accompanying their recruitment.

The Value of Qualitative Methods in Cross Cultural Education: A Case Study from a First Person Perspective

This paper presents a first-person account of using qualitative research methods to address medical residency education. The results of this project have been published. However, the study's process and its educational impact on the participants have not been well-described. The purpose of this article is to describe the background and conduct of the study itself. A family medicine residency program, the setting for this project, had recently begun accepting international medical graduates (IMGs) who had lived and received medical school education outside of the United States. The author, a faculty member in the residency and a clinical psychologist, and the physician faculty observed residents as they saw patients in the family medicine residency clinic. Concern was expressed about some of the IMG resident physicians’ knowledge base and their ability to develop rapport with patients. In providing instruction in behavioral science, the author and a psychologist colleague noted that some of the IMG residents were confused by aspects of U.S. family life and the educational system. The relationship with clinical instructors and expectations of faculty also differed from the pedagogical norms in U.S. medical education. As a result, a qualitative interview project was undertaken to understand better how these IMG residents were experiencing and interpreting faculty-learner and resident physician-patient interactions. The results were beneficial in multiple ways. First, recognizing that faculty members were interested in their experiences helped develop rapport and trust between the faculty and residents. Providing the project results to the residents helped open discussion about cultural differences in medical education and patient care. For educators who may have difficulty understanding the perspective that learners bring to their education, the process described could be of potential benefit.

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

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

International Medical Graduates' perceptions about residency training experience: a qualitative study.

To explore International Medical Graduates residents' experiences and perspectives of their residency training program. This qualitative study was conducted at a large research-intensive University. Purposeful sampling was used to recruit 14 International medical graduates. The residents recruited for this study were at different levels in their training ranging from Postgraduate year one to five. Residents interviewed represented seven unique specialties. Each trainee was interviewed, and the data were recorded and transcribed verbatim. A thematic analysis framework was used to conduct the data analysis, resulting in the development of study themes. Our analysis generated six main themes. These themes were related to costly decisions, unspoken expectations, the stigma associated with being an IMG, fears of being an IMG, the strength and resilience of IMGs, and recommen-dations proposed by IMGs for program improvement. In this study, we wanted to explore international residents' experiences with their programs. The experience of each individual international resident is unique. However, in this study, we were able to provide firsthand perceptions of IMGs from a research-intensive university and identified common themes experienced and perceived by our resi-dents. This study's findings may help educate, reduce stigma, and guide the implementation of effective individu-al and systemic support for these trainees. Which in turn will enhance the overall educational experiences for IMGs trainees. Our study found that themes seem to be recur-ring, hence, an urgency to bring about appropriate chang-es, equitable opportunities, and support for IMGs.

Geographic Trends of International Medical Graduate Residents and Faculty in US Plastic Surgery Training Programs.

Of the academic plastic surgeons in the United States, 13.6% are international medical graduates (IMGs). The objective of this study was to identify the countries from which IMGs obtained their medical degrees and the states they matched in. We sought to establish a correlation between IMG faculty and residents in plastic surgery programs. Plastic surgery program Web sites were reviewed. The primary outcome of interest was the country IMG residents had obtained their medical degrees from. Secondary outcomes of interest were program state location, IMG resident postgraduate year, and programs' number of IMG faculty. One hundred one programs were screened. A total of 39 states were represented; there were 1262 current residents, of which 92 (7.3%) were IMGs. International medical graduate residents received their medical degrees from 46 different countries. The most common countries were England (n = 6 [6.5%]) for IMG residents and Canada (24.5%) for IMG faculty. The most common region represented for residents was South America (n = 44 [47.8%]). The highest proportions of IMGs per total state plastic surgery residents were found in West Virginia (33.3%) and Minnesota (25%); 13.5% and 15.6% of program directors and program chairs were IMGs, respectively. There was a statistically significant difference between the proportion of IMG residents in programs that had an IMG program director versus programs with no IMG program director (P = 0.016). No such statistically significant difference was found between the proportion of IMG residents in given programs with IMG chairs (P = 0.55). There were significantly more IMG faculty in programs with IMG chairs (P = 0.001). The number of IMG faculty was positively correlated to the number of IMG residents in a given program (P = 0.0001, r = 0.39). International medical graduate residents constitute a small but appreciable portion of current plastic surgery residents; the majority have earned their degrees from the South America region. International medical graduate plastic surgery residents are more likely to be recruited to programs that have an IMG program director and a higher number of IMG faculty. International medical graduate faculty have a strong representation in academic plastic surgery, as evidenced by the percentage of IMG program directors and chairs. Programs with IMG chairs had a greater number of IMG faculty.

Effect of Faculty Diversity on Minority Student Populations Matching into Orthopaedic Surgery Residency Programs.

The American Orthopaedic Association's Orthopaedic Residency Information Network database was used to collect demographic data on 172 US residency programs. Linear regression analyses were performed to determine the relationship between the proportion of female or URiM attendings at a program and the proportion of female, URiM, or IMG residents or top-ranked applicants (≥25 rank). URiM was defined as "racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population." A mean of 13.55% of attendings were female and 14.14% were URiM. A larger fraction of female attendings was a positive predictor of female residents (p < 0.001). Similarly, a larger percentage of URiM attendings was a positive predictor of URiM residents (p < 0.001), as well as of URiM (p < 0.001) and IMG (p < 0.01) students being ranked highly. There was no significant association between URiM attendings and female residents/overall top-ranked applicants, or vice versa. Residency programs with more female attendings were more likely to match female residents, and programs with more URiM attendings were more likely to highly rank URiM and IMG applicants as well as match URiM residents. Our findings indicate that orthopaedic surgery residencies may be more likely to rank and match female or URiM students at similar proportions to that of their faculty. This may reflect minority students preferentially applying to programs with more diverse faculty because they feel a better sense of fit and are likely to benefit from a stronger support system. III.

Challenges with international medical graduate selection: finding positive attributes predictive of success in family medicine residency

BackgroundCriteria to select residents most likely to succeed, other than proficiency of their medical knowledge, is a challenge facing preceptors. International Medical Graduates (IMGs) play an integral role in mitigating the high demand for family medicine physicians across Canada. Thus, selecting IMG candidates that have a high probability of succeeding in Canadian educational settings is important. The purpose of this study is to elucidate qualitative attributes that positively correspond to success in residency, to ultimately assist in the selection of IMG residents most likely to achieve family medicine residency.MethodsInterviews of 13 family medicine preceptors from some of the largest IMG training sites in Canada were performed to collect original data. The data was coded in tandem sequences using standardized coding techniques to increase robustness of results.ResultsThe identified positive predictors of an IMG residents’ success are: presence of a positive attitude, proficient communication skills, high level of clinical knowledge, trainability.ConclusionsThe results provide adequate guidelines to assist in selection of IMG residents. Canada is a unique sociocultural setting where standardized selection methods of IMGs have not been employed. By selecting IMG residents who possess these attributes upon inception of residency, benefits of instruction will be maximized and result in residents developing increased aptitudes for patient care.

PD30-05 INTERNATIONAL MEDICAL GRADUATES IN UROLOGY: TRACKING SUCCESS THROUGH RESEARCH EXPERIENCE

You have accessJournal of UrologyCME1 May 2022PD30-05 INTERNATIONAL MEDICAL GRADUATES IN UROLOGY: TRACKING SUCCESS THROUGH RESEARCH EXPERIENCE David E. Hinojosa-Gonzalez, Anton Wintner, Dimitar V. Zlatev, Wesley A. Mayer, Ruslan Korets, and Brian H. Eisner David E. Hinojosa-GonzalezDavid E. Hinojosa-Gonzalez More articles by this author , Anton WintnerAnton Wintner More articles by this author , Dimitar V. ZlatevDimitar V. Zlatev More articles by this author , Wesley A. MayerWesley A. Mayer More articles by this author , Ruslan KoretsRuslan Korets More articles by this author , and Brian H. EisnerBrian H. Eisner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002578.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: International Medical Graduates (IMGs) constitute nearly 25% of the current physician workforce in the United States. However, IMGs account for only ∼ 2.2% of all urology matched residency positions per cycle. This study aims to identify the countries of origin, research pathways and residency destinations of successfully matched IMGs in urology. METHODS: The rosters of 145 urology residency programs were screened for IMG residents. PubMed searches were conducted for each identified IMG and the affiliations of research predating their start of residency were recorded. Total research activity as well as geographical mapping based on research affiliations were compared to IMG resident matching sites. RESULTS: Fifty-seven matched IMGs were identified from 2016-2021 Urology Residency Match Program cycles, making up 3.2% of the identified resident pool. The most common international medical schools represented by matched IMGs were as follows: 11 from the Caribbean (18%), 8 from Iran (13%), 8 from Columbia (13%) and 5 from India (8%) (Table 1). Thirty-nine (68%) IMGs had dedicated research years in the US before applying. Of these, 37/39 (94%) participated in urology-specific research. Mayo Clinic, Johns Hopkins, Massachusetts General Hospital, Mount Sinai and MD Anderson were the most common sites for research years. Florida residency programs have the most IMGs, with a total of 10 (17.5% of total IMGs) IMGs, followed by Texas with 6 (10.5%) and California, Massachusetts, and New York each with 4 (7%). Forty out of 145 total programs have at least one IMG resident (27.5%). CONCLUSIONS: IMGs represent a minority of the current urology resident workforce. Most devote one to two years to research at prestigious institutions before matching. Florida and Texas are the most frequent destinations for IMGs. Source of Funding: No funding was received © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e511 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David E. Hinojosa-Gonzalez More articles by this author Anton Wintner More articles by this author Dimitar V. Zlatev More articles by this author Wesley A. Mayer More articles by this author Ruslan Korets More articles by this author Brian H. Eisner More articles by this author Expand All Advertisement PDF DownloadLoading ...

Distribution of international medical graduates across USA surgical training programs: a descriptive cross-sectional study.

International medical graduates (IMGs) have been a critical part of the USA healthcare in the past 30 years, especially in small rural and poor counties. However, little to no publications are present on the distribution of these IMGs across general surgery residency programs. All freely accessible information on current residents in accredited general surgery residency programs within the USA with at least a 5-year history was explored for IMGs in the current roster using the AMA residency and fellowship database in 2020. Demographic and geographic data were summarized. A total of 230 general surgery residency program were included. Programs were distributed among 46 (92%) states. Of a total 6304 categorical general surgery residents, 573 (9%) were IMGs. Florida (USA) had the highest total number of current IMG general surgery residents with 64. The highest percentage of current IMG residents was found in Maryland (USA) with 31%. IMGs obtained their medical degrees from 76 different countries worldwide. Grenada was the country with the highest origin of IMGs with 77 residents. Central/North America had the highest origin of IMGs with 217 (38%). IMGs make up a small portion of current general surgery residents in USA programs. Some states host more IMGs than others. Particular countries have contributed more IMGs than others. More research is needed to the challenges facing IMGs and come up with novel solutions for them.

In Reply to the Letter to the Editor Regarding “Geographic Distribution of International Medical Graduate Residents in U.S. Neurosurgery Training Programs”

In Reply to the Letter to the Editor Regarding “Geographic Distribution of International Medical Graduate Residents in U.S. Neurosurgery Training Programs”

Letter to the Editor Regarding “Geographic Distribution of International Medical Graduate Residents in U.S. Neurosurgery Training Programs”

Letter to the Editor Regarding “Geographic Distribution of International Medical Graduate Residents in U.S. Neurosurgery Training Programs”

Geographic Distribution of International Medical Graduate Residents in U.S. Neurosurgery Training Programs

Neurosurgery residency in the United States is highly sought after by many international medical graduates (IMGs), and the geographic distribution of IMG candidates who have successfully matched has not been quantitatively explored to date. The aim of this study was to highlight the countries in which successfully matched IMG residents obtained their medical degrees and the states of their respective residency destinations. All available resident lists of approved neurosurgical residency programs within the United States with at least 7 years of history were reviewed for IMGs in the most currently updated rosters. Demographic and geographic characteristics were summarized. A total of 1393 current neurosurgical residents in U.S. residency programs were identified from 99 programs across 39 states. Of 1393 residents, 87 were IMGs (6%). The IMG contingent originated from 39 countries, the most common of which was Lebanon (n= 14/87 [16%]). The Middle East was the most represented geographic region (n= 23/87 [26%]). The states with the highest number of IMGs were Kentucky, New York, and Texas (all n= 7/87 [8%]). IMGs constitute a small but appreciable portion of current neurosurgical residents in U.S. training programs. Particular countries have contributed more IMGs to neurosurgical programs than others, and particular states have higher counts and proportions of IMG residents than others. These outcomes are not geographically homogeneous, and the mechanisms by which IMG applicants successfully match to U.S. neurosurgery programs require more biographic granularity to elucidate.

Admission factors associated with international medical graduate certification success: a collaborative retrospective review of postgraduate medical education programs in Ontario.

The failure rate on certification examinations of The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) is significantly higher for international medical graduates than for Canadian medical school graduates. The purpose of the current study was to generate evidence that supports or refutes the validity of hypotheses proposed to explain the lower success rates. We conducted retrospective analyses of admissions and certification data to determine the factors associated with success of international medical graduate residents on the certification examinations. International medical graduates who entered an Ontario residency program between 2005 and 2012 and had written a certification examination by the time of the analysis (2015) were included in the study. Data available at the time of admission for each resident, including demographic characteristics, previous experiences and previous professional experiences, were collected from each of the 6 Ontario medical schools and matched with certification examination results provided by The CFPC and the RCPSC. We developed logistic regression models to determine the association of each factor with success on the examinations. Data for 900 residents were analyzed. The models revealed resident age to be strongly associated with performance across all examinations. Fluency in English, female sex and the Human Development Index value associated with the country of medical school training had differential associations across the examinations. The findings should contribute to an improved understanding of certification success by international medical graduates, help residency programs identify at-risk residents and underpin the development of specific educational and remedial interventions. In considering the results, it should be kept in mind that some variables are not amenable to changes in selection criteria.

No. of Seniors Matching Into Psychiatry Takes Large Leap

No. of Seniors Matching Into Psychiatry Takes Large Leap

Acculturation Needs of Pediatric International Medical Graduates: A Qualitative Study

ABSTRACTPhenomenon: International medical graduates (IMGs) play a key role in host countries' health systems but face unique challenges, which makes effective, tailored support for IMGs essential. Prior literature describing the acculturation needs of IMGs focused primarily on communication content and style. We conducted a qualitative study to explore acculturation that might be specific to IMG residents who care for children. Approach: In a study conducted from November 2011 to April 2012, we performed four 90-minute semistructured focus groups with 26 pediatric IMG residents from 12 countries. The focus group transcripts were analyzed using open and focused coding methodology. Findings: The focus groups and subsequent analysis demonstrated that pediatric IMG residents' socialization to their home culture impacts their transition to practice in the United States; they must adjust not only to a U.S. culture, different from their own, but also to the culture of medicine in the United States. We identified the following new acculturation themes: understanding the education system and family structure, social determinants of health, communication with African American parents, contraception, physician handoffs, physicians' role in prevention, adolescent health, and physicians' role in child advocacy. We further highlight the acculturation challenges faced by pediatric IMG residents and offer brief recommendations for the creation of a deliberate acculturation curriculum for pediatric IMG residents. Insight: Residency training is a unique period in physicians' personal and professional development and can be particularly challenging for IMGs. There is a significant gap in the identified acculturation needs and the current curricula available to IMG residents who care for children.

International Medical Graduate Training in Urology: Are We Missing an Opportunity?

To examine trends in international medical graduate (IMG) representation within urology and compare these trends to those of other specialties. Urology match data were obtained from the American Urological Association from 1987 to 2015. IMG representation among residencies was extracted from reports on Graduate Medical Education published in Journal of the American Medical Association from 1978 to 2013. We analyzed trends in the number of IMG urology applicants, match rates in urology for IMGs vs US medical graduates, and the annual percentage of IMGs among all urology residents vs residents of other specialties. Between 1987 and 2015, 6790 applicants matched into urology. The number of positions offered increased by 24% (224 to 295) between 1987 and 2015. However, the number of IMG urology applicants did not increase accordingly (r = -0.55, P = .78). Match rates for US students and IMGs ranged from 68% to 91% and 6% to 33%, respectively. From 1978 to 2013, the proportion of IMGs across all specialties remained relatively stable (25% to 27%), whereas the proportion of IMGs in urology decreased substantially (27% to 5%). The proportion of IMGs in urology training has dramatically decreased over time and remains lower than most other specialties. IMGs are critical to urology as they can assist in meeting workforce demands, contribute diversity to the workplace, and help to propel the field forward through urologic research. Further efforts should be directed toward understanding the unique needs of IMG residents and helping them to navigate the challenges of practicing in a foreign country.

Cultural transition of international medical graduate residents into family practice in Canada.

ObjectivesTo identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice.MethodsThis was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. ResultsParticipants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada’s health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. ConclusionsResidency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.