International Medical Graduates Research Articles

Demystifying the MRCP exams for IMGs: the impact of five Nigerian Specialist Registrars through a virtual medical academy

‘There is a loftier ambition than to stand tall in theworld, it is to stoop down and raise mankind higher’ – Henry Van Dyke. The MRCP PACES exam is the last hurdle to climb for internal medicine registrars before they become a prestigious Member of the Royal College of Physicians United Kingdom. However, most International Medical Graduates (IMGs) do shy away from the medical specialty because of the failure rate of these exams. According to the Paces Spring Performance Report 2023, the failure rate of IMG in Paces was alarming compared with British Medical Graduates; Around 60% of IMGs failed the exam-700 IMGs in comparison to approximately 30–200% UK graduates [1, 2]. These disparities invigorated five Nigerian IMG registrars to bridge this gap through a free weekly virtual PACES exam for the last 40 weeks. We also started monthly MRCP Courses and PACES-centred MRCP Masterclasses to support International Medical Graduates to ace their PACE exams. Furthermore, through the power of representation, we are inspiring and attracting IMG doctors to the physician specialty [3]. Five Nigerian IMG registrars – ST4 to ST5, trainees of HEE in Acute Medicine, Neurology, Cardiology, and Stroke Medicine across diverse regions in England facilitated weekly tutorials up to three times weekly since June 2023 through the Zoom Platform. The success of the free tutorials led to the development of the Virtual PACES and created a need to start a Virtual MRCP PACES Course. We have facilitated more than 10 PACES courses, 15 Paces Mocks, 4 Neurology Masterclasses, and 4 Communication Master Classes. To the best of our knowledge, we are the first group to conduct a Successful Virtual PACES Mock exam. We have more than 500 International Medical Graduates on our social media platform who participate actively in all our educational courses. The majority of them live in the United Kingdom and completed their medical school in Asia, Africa, or Europe. To rate the impacts of our weekly IMG Paces tutorials, we decided to conduct an anonymous online survey. More than 50 doctors responded. More than 96% of the respondents were IMGs. A third of the respondents were Internal Medicine Trainees (IMTs) in the UK. About a third were trainee registrars and a third were in a non-training role. A third of our respondents have attempted paces before. More than about half of the respondents had attended more than five weekly sessions. When asked to ‘rate their strength in the paces content before attending Free PACES teaching’; more than half of respondents rated themselves as either poor or fair across all pace components, especially in Neurology, Communication, and Consultation [4]. When asked to rate their improvement in the PACES content after attending our free PACES teaching. More than 90% rated improvement across all the paces and approximately 60% of respondents said they ‘improved a lot’ in Communication, Consultation, and Neurology. When asked ‘how do you feel seeing fellow IMG Registrars taking you through the Sessions? More than 90% of respondents feel more confident, more supported, inspired, and more included to pass paces. Almost all respondents now have a more positive perception of IMG registrars following the tutorials [5]. Finally, for people who attend our courses and mocks, we have a success rate of more than 50% in the MRCP exams which is higher than the national average for IMGs. This bold and altruistic step taken by five Nigerian Specialist Registrars has bridged the gap to improve the success rates of IMGs in completing the MRCP PACES exam. We hope to extend this innovative platform to other specialties who are willing to collaborate with us in our quest to empower IMGs. Beyond that, we believe we are changing narratives and shaping the perception of Nigerian doctors, Nigeria, and Africa as a whole. That to us, becomes an ‘icing on the cake’.

Reverse mentoring – a useful tool for integrating into the system and making a change

Introduction: Reverse mentoring is useful for closing the generational gap,improving inclusion, and developing skills. Here, a junior team membermentors a senior team member. The scheme run by the Future LeadersProgram is open to International Medical Graduates (IMGs) in Yorkshireand Humber. The aim is to close the differential attainment gap byencouraging Equality, Diversity, and Inclusion (EDI) conversations.Method: Matching is done by MentorNet®. Mentor training consists ofhandbook, induction, and supervision meetings. We planned for threevirtual meetings within 6 months.• Session 1 – Aims and lived experience.• Session 2 – What does it take to feel safe, valued, and accepted?• Session 3: Setting up IMGs to succeed and the impact of the first placementon their careers.Discussion: Reverse mentoring is beyond sharing bad experiences as itcreates avenues for reflection and insights on how to better integrate intothe system.We do not need to have a bad experience before we advocate for EDIin our workplace. Sharing positive experiences is a powerful tool.Pairing Nigerian Junior doctors in the UK with senior doctors inNigeria would reduce the impact of ‘brain drain’ and be a positive toolfor exchanging knowledge and skills with the Nigerian workforce.’

Past Imperfect: Revisiting the History of the Federation of State Medical Boards

ABSTRACT: In 2020, FSMB commenced a closer look at its history to provide a more transparent accounting of past statements, actions and policies evincing bias, discrimination, or racism. There is much in FSMB history that is positive but it is clear that FSMB fell short at times in demonstrating a consistent commitment to values we recognize as integral to a just society. This failure proved especially impactful to international medical graduates (IMGs), osteopathic physicians, women, and persons of color. Vitriolic language, under-representation and bias factored into the FSMB experience of these groups to varying degrees. While some FSMB statements and policies reflected overt bias, more often, inaction or silence characterized FSMB response to discrimination unfolding within the medical profession and society. This can be attributed, in part, to the long period in which FSMB's modest resources created over-reliance upon the profession (eg, the American Medical Association). This dependence resulted in missed opportunities for FSMB to champion priorities committed to the responsibilities and interests of the regulatory community and the public it serves, as opposed to those of the profession. Unsurprisingly, FSMB governance reflected the same power dynamics and lack of diversity seen within leadership in the profession until recent decades. FSMB has taken multiple steps to address past failures: revisiting how it recognizes and honors individual contributors to medical regulation, adopting policy statements and guidelines codifying a commitment to inclusive governance and educational programming. Further actions are possible through naming conventions behind FSMB awards and potential policy addressing the appointive process to state medical boards.

Overcoming The Odds:"Making It" - Personally and Professionally - In Orthopaedic Surgery Residency As An International Medical Graduate.

Overcoming The Odds:"Making It" - Personally and Professionally - In Orthopaedic Surgery Residency As An International Medical Graduate.

Analysis of neurosurgery resident research activity in the United States.

Evaluation of the demographic and academic characteristics of current neurosurgery residents may provide prospective students with insight into factors that affect research output. Therefore, this study aimed to evaluate the research output among neurosurgery residents. US neurosurgery residency programs were abstracted from the American Association of Neurological Surgeons website. Demographic data on 1690 current residents across 119 programs were collected using publicly available institutional websites, Doximity, and LinkedIn. The h-index of each resident was recorded using Scopus and exported into the NIH iCite tool to determine the weighted relative citation ratio (w-RCR) and mean relative citation ratio (m-RCR). The total number of publications, h-index, and w-RCR were used as a proxy for research output, while m-RCR was used to measure research impact. One-way ANOVA and Kruskal-Wallis H-tests were used to assess the statistical significance of relationships between demographic data and measures of research activity. A total of 1690 residents (25.4% female), representing 119 programs, were evaluated. Neurosurgery residents had an average of 17 publications, h-index of 5.5, m-RCR of 1.4, and w-RCR of 16.9, with an upward trend of research activity by postgraduate year (PGY) class. Male residents on average had a greater total number of publications (p < 0.001), higher h-index (p < 0.001), and higher w-RCR (p = 0.002) compared with their female peers. Significant differences in research activity were also observed by degree (Doctor of Medicine [MD], Doctor of Osteopathy [DO], or other), where those with MD and other degrees had higher metrics than those with DO degrees. International medical graduates (IMGs) also had higher research output than American medical graduates (AMGs) (p < 0.001). Differences in all measures of research activity except impact were also observed in research activity when pre-residency medical school ranks were compared. The authors observed overall high research activity among neurosurgery residents. Factors such as gender, degree, PGY, IMG/AMG status, and medical school rank may therefore be related to the success of matching within neurological surgery. Although large disparities in gender representation have been identified in neurosurgery, newer classes are trending toward shrinking the gap. These data may be used by prospective residents to gauge changes and progress occurring in the neurosurgery match.

Inequities at the Transition to Obstetrics and Gynecology Residency

Although approximately one-fifth of obstetrics and gynecology (OBGYN) residents matriculate from osteopathic or international medical schools, most literature regarding the transition to residency focuses on allopathic medical school graduates. To create comprehensive interventions for this educational transition, we must understand the needs of all incoming residents. Our objective was to examine OBGYN residents' perceptions of their transition to residency, and to understand how residents' background and medical school environment influence their perceived sense of readiness. A 16-item survey asked questions about demographics, the transition to residency, resident well-being, burnout, and the transition to fellowship. Perception of preparedness was assessed with the question "I felt that I was well-prepared for the first year of residency" (1=strongly agree, 5=strongly disagree). Chi-squared and Fisher's exact tests and logistic regression explored association of perceived preparedness with residents' backgrounds. Survey administered at time of the in-training examination in 2022. All OBGYN residents. Of 5761 eligible participants, 3741 (64.9%) provided consent and completed the survey. Of the 3687 participants who answered the question, 2441 (66.2%) either agreed or strongly agreed that they felt well-prepared. Fewer osteopathic graduates reported feeling prepared compared to allopathic graduates (379/610, 62.1% vs 1,924/2,766, 69.6%) (OR 0.72, 95%CI 0.60-0.86, p < 0.01). International medical school graduates were seven times less likely to report feeling prepared compared to those from allopathic institutions (137/304, 45.1% vs 1924/2776, 69.6%) (OR 0.60, 95%CI 0.53-0.68, p < 0.01). Respondents from underrepresented racial and ethnic backgrounds were less likely to report feeling prepared compared to White respondents (276/535, 51.6% vs 1738/2387, 72.8%) (OR 0.39, 95%CI 0.33-0.48, p < 0.01). Differences in residents' perceptions of their transition to residency highlight the need to begin offsetting pervasive inequities with comprehensive and accessible resources.

Impact of the Proposed Closure of the NHS Practitioner Mental Health Programme for Doctors and Managers in Secondary Care

To reduce its financial deficit, NHS England decided to cull the funding of the Practitioner Health Programme (PHP), which has been providing confidential mental health services to 110,000 NHS doctors/ senior managers since 2011. This decision was announced when NHS doctors were in a dispute over pay and conditions, AND coincided with increasing prevalence of mental illness, stress and burnout. This decision raised concerns among doctors' unions, medical royal colleges, and doctors through social media. An open letter asked the Health Secretary to reconsider this decision. Access to primary care doctors was maintained. What appears not to have been considered is that around 50,000 junior doctors, including locally employed doctors and international medical graduates who are in short-term contracts or rotational attachments, are unlikely to meet the waiting time for such ‘secondary care OH services’. In addition, the elephant in the room of a massive challenge of the professional stigma that prevents doctors from accessing mental health support early seems to have been missed. This editorial briefly explores the causes of a high prevalence of stress and work-related mental illness amongst HCPs, the consequences on their overall health, employing organisations and their patients.

Migration and professional mobility: Rural attraction and retention of South African educated physicians

Rural communities in Alberta, Canada have faced physician shortages for decades. Attracting internationally educated physicians, including many South African physicians, is one way to address this problem. While much of the research on international medical graduates (IMGs) focuses on the push and pull of attraction and retention, I situate the decision to stay as a matter of geographic and professional mobility, all within a life course perspective. More specifically, I explore physicians' decisions to migrate from South Africa to rural Alberta and the impact of professional mobility on their migrations. To understand the processes, I collected data via semi-structured virtual interviews with 29 South African educated generalist/family physicians with experience in rural Alberta. Research was guided by abductive grounded theory and data was analysed using open thematic coding. I found that South African educated physicians made the decision to leave South Africa and to come to Canada to pursue prestige and opportunity they perceived to be inaccessible in South Africa. However, physicians were limited to perceived low prestige work as rural generalists, while they understood that more prestigious work was reserved for Canadian educated physicians. Physicians who remained in rural communities brought their aspirations to life, or achieved upward professional mobility in rural communities, through focused clinical and administrative opportunities. The decision to leave rural communities was often a matter of lifestyle and burnout over prestige.

The need to educate on effective reflective practice for international medical graduates

The need to educate on effective reflective practice for international medical graduates

Perception of Accent Modification Programs: Assimilation or Racism?

Background: International medical graduates (IMGs) represent approximately 25% of practicing physicians in the United States (US), including residents and fellows. Unfortunately, often non-American English accents often challenge professional credibility. In fact, many healthcare providers and scholars in the US face linguistic discrimination. This type of discrimination has not been examined in great depth, especially in academic medicine. Objective: The objective of this study is to examine IMG perspective as they relate to linguistic accent, explore accent modification programs, and analyze the message such programs may send to trainees. Methods: The authors utilized semi-structured interviews. The interviews took place virtually for 30 to 45 minutes. Interviews were transcribed and all response summaries were relayed back to the participant to assure correct meaning. Data was analyzed by 3 authors using the constant comparative method to extract recurrent themes. Secondary data specifically explores accent modification programs. Selection of institutions was purposeful and derived from web searches. We selected eight institutions, which allowed for a content analysis of each institutional website. A final thematic analysis was performed via discussing the themes as a group, inclusive of the publicly available institutional messages. Results: We identified three main themes: (1) perception of accent modification as racist and as forced assimilation, and (2) accent as linguistic discrimination and deficit-based thinking (3) hidden message in accent modification programs. Conclusions: Our research highlights an unsettling sentiment among IMGs: accent modification programs might harbor a racist undertone, potentially suggesting forced assimilation and covert biases. A significant number of participants expressed that perceived accents can be a source of discrimination.

DO seniors and IMGs have lower match probabilities than MD seniors after adjusting for specialty choice and USMLE Step 1 score.

It is unknown if US residency applicants of different educational backgrounds (US allopathic [MD], Doctor of Osteopathic Medicine [DO], and international medical graduates [IMG]) but comparable academic performance have similar match success. Our objective was to compare match probabilities between applicant types after adjusting for specialty choice and United States Medical Licensing Examination (USMLE) Step 1 scores. We performed a secondary analysis of published data in National Resident Matching Program (NRMP) reports from 2016, 2018, 2020, and 2022 for US MD seniors, DO seniors, and IMGs (US citizens and non-US citizens). We examined the 10 specialties with the most available spots in 2022. Average marginal effects from a multiple variable logistic regression model were utilized to estimate each non-MD senior applicant type's probability of matching into their preferred specialty compared to MD seniors adjusting for specialty choice, Step 1 score, and match year. Each non-MD applicant type had a lower adjusted percent difference in matching to their preferred specialty than MD seniors,-7.1 % (95 % confidence interval [CI],-11.3 to-2.9) for DO seniors,-45.6 % (-50.6 to-40.5) for US IMGs, and-56.6 % (-61.5 to-51.6) for non-US IMGs. Similarly, each non-MD applicant type had a lower adjusted percent difference in matching than MD seniors across almost all Step 1 score ranges, except for DO seniors with Step 1 scores <200 (-2.0 % [-9.5 to 5.5]). After adjusting for specialty choice, Step 1 score, and match year, non-US MD applicants had lower probabilities of matching into their preferred specialties than their US MD colleagues.

A 10-Year Analysis of Application and Match Rates for Pain Medicine Training in the United States.

We analyzed application and match rates for pain medicine training in the United States (US) and hypothesized that there would be 1.) greater growth in the number of training positions than applicants, 2.) higher match rates among US allopathic graduates relative to non-US allopathic graduates, and 3.) greater number of unfilled training positions over time. Retrospective, cross-sectional study of all applicants for pain medicine training in the US. National Resident Matching Program (NRMP) data were obtained over a ten-year period (2014-2023). Match rates and applicant-to-position ratios were calculated and compared over time with linear regression. Comparisons were made with chi square tests. Growth in the number of annual training positions (261 to 377, 44% increase) exceeded growth in the number of interested applicants (398 to 415, 4% increase) (P < 0.001). Annual applicant-to-training position ratios decreased (1.5 to 1.1, P < 0.001). The representation of US allopathic graduates among incoming pain medicine fellows decreased over the study period (73% to 58%, P < 0.001) while US osteopathic graduates increased (9% to 28%, P < 0.001).Match rates increased for both US allopathic graduates (71% to 91%, P < 0.001) and non-US allopathic graduates (51% to 81%, P < 0.001). From 2018 to 2023, US allopathic graduates (79%) had higher match rates than US osteopathic graduates (60%, P < 0.001) and international medical graduates (57%, P < 0.001). More available annual training positions went unfilled over the study period (2% to 5%, P = 0.006). Stagnant annual applicant volume and increasing number of available training positions have led to increasing match rates for pain medicine fellowship training. Fewer US allopathic graduates are pursuing pain medicine training. The increasing percentage of unfilled training positions warrants ongoing surveillance.

Brain drain in pediatric anesthesiology: The geographic and demographic distribution of national origin among pediatric anesthesiologists in the United States.

American pediatric anesthesiologists have a long history of international volunteerism. However, the US healthcare system also benefits from the contributions of a large number of physicians who come from other nations to work within its borders. Despite this fact, little is known about the contribution of international medical graduates (IMG) to the pediatric anesthesiology subspecialty. To characterize the contribution of IMG to the field of pediatric anesthesiology in the United States, and to elucidate the geographic and demographic distribution of their national origins so as to understand the movement of skilled personnel between countries. Online physician directories of American children's hospitals were searched, and anesthesiologists were recorded for their national origin of medical education. International graduates were reported as a percentage of the pediatric anesthesiology workforce. Those attending medical colleges catering to American students ("offshore" medical schools) were analyzed separately from other IMGs. The cohort of non-offshore IMGs were analyzed for national and continental origins, and by national level of economic development. Of 1979 anesthesiologists analyzed, 397 attended medical school outside the United States, with 58 being from offshore schools. The remaining 338 represented 17.1% of the total pediatric anesthesiology workforce. They came from 58 countries on six continents. Of those, 65.1% attended medical school in low- and middle-income countries. International medical graduates, disproportionately from low- and middle-income countries, compose a large proportion of the US Pediatric Anesthesiology workforce. While these clinicians play a vital role in providing care for American children, the potential impacts of skilled physician loss on their nations of origin must also be considered.

ChatGPT: bridging the gap on mentorship for International Medical Graduates in low enrolment specialties

ChatGPT: bridging the gap on mentorship for International Medical Graduates in low enrolment specialties

International Medical Graduates (IMGs) peer-led support group: an audit

International Medical Graduates (IMGs) peer-led support group: an audit

814 Results and Opinions on the Implementation of a Preference Signaling System in Neurosurgical Residency Applications

INTRODUCTION: The 2022-2023 neurosurgery residency application cycle employed an optional preference signaling system that indicated a focused interest in a particular program. During this first iteration, applicants could signal interest in up to eight participating programs. METHODS: A survey consisting of 28 questions pertaining to the signaling process was distributed via email to all neurosurgery applicants participating in the 2022-2023 cycle. Results were compiled, and descriptive statistics were used to generate results. RESULTS: Of the 361 total applicants, 82 (22.7%) completed the survey; 84.1% attend a US MD program, 1.2% a DO program, 12.2% are international medical graduates, and 2.4% are post-graduates. The mean number of programs applied to was 78 (range 21-116 (all). The median number of interviews received was 17 (range 0 to 57). Notably, 14.6% of individuals signaled their home programs, and 63.4% signaled at least one externship program. 90.2% of applicants utilized all eight signals. Applicants averaged 3.5 interviews from programs they signaled, and 15.6% of applicants matched at a program they signaled. Sixty-five percent of applicants were unsatisfied with the application process, but 53.1% indicated preference signaling should continue. Regarding the number of available signals, 43.75% felt eight was appropriate, 32.5% felt it was too few, 13.75% thought it was too many, and 10% were indifferent. CONCLUSIONS: Preference signaling was implemented in the 2022-2023 applicant cycle to improve interview efficiency and equity. Applicant opinions were mixed about this first iteration. Two consistently noted themes were the desire for improved home and away rotation signaling standardization and the perceived lack of impact on match outcome.

International Medical Graduates and a Career as a Geriatric Psychiatrist

International Medical Graduate (IMG) is a physician who received their basic medical degree or qualification from a medical school located outside the United States and Canada. The location of the medical school and not the citizenship of the physician determines whether the graduate is an IMG. Presently, IMGs represent 23.3% of the total active US physician workforce and 29.2% of the psychiatry workforce. IMGs constitute 52.2 % of the geriatric psychiatry workforce in the US, a number significantly greater than noted in other psychiatry subspecialities, emphasizing the reliance of geriatric psychiatry on IMGs for it's sustainability. Some of the reasons for this are coming from cultures of intergenerational families where older adults play an important role, easier access to geriatric psychiatry fellowships in prestigious universities and access to senior IMG faculty members as mentors in this field.Recently, the number of IMGs being accepted into psychiatry residency has declined, mostly due to increase in interest in psychiatry from American Medical Graduates (AMGs). While more AMGs are matching into psychiatry, their interest in Geriatric psychiatry has remained low, which is reflected in decrease in trainees choosing geriatric psychiatry fellowship. Of all psychiatry subspecialties, Geriatric psychiatry fellowship has seen the biggest drop by 27.59% between 2015-2019 in trainees entering these programs. The decrease in IMGs choosing geriatric psychiatry as a career path not only decreases the overall geriatric psychiatry work force, it also affects the culturally sensitive services that can be offered to increasingly racially diverse US older adult population. IMGs are more likely to work in the public sector and receive a larger proportion of their income from Medicare and Medicaid, often providing services to minorities and socio-economically challenged older adults, which will be compromised from shrinking IMG representation in geriatric psychiatry.Despite the role IMGs play in the field of geriatric psychiatry, they face a lot of challenges unique to them. IMGs in psychiatry are often seen working as full-time hospital staff compared to their US counterparts who are more likely to be working as administrators or medical teachers. They are also less likely to be seen at leadership level, both in institutions and professional organizations. This may be partly due to lack of understanding of the new culture, particularly academic and organizational culture, and hence lack of communication skills to be able to thrive in the new work culture. IMGs often face biases and lack of support and microaggressions, holding them back from their full potential. Additionally, visa issues can serve as barriers in accessing better opportunities. Fortunately, there are ways for IMGs to circumvent some of these hurdles and set themselves up for success.This session focuses on IMGs in geriatric psychiatry, the obstacles they face in choosing geriatric psychiatry as career path, and strategies for success.

A quality improvement project developing a specific induction programme for International medical graduates (IMG) starting Respiratory Higher specialty training in the Northern Deanery

A quality improvement project developing a specific induction programme for International medical graduates (IMG) starting Respiratory Higher specialty training in the Northern Deanery

The birth of an impactful PACES tutorials for international medical graduates after '39 pregnant weeks' of virtual PACES sessions

The birth of an impactful PACES tutorials for international medical graduates after '39 pregnant weeks' of virtual PACES sessions

Challenges for international medical graduates in the US and the UK graduate medical education and health care system environment: A comprehensive review

A comprehensive review of past research and statistical data is necessary to understand the significant obstacles encountered by International Medical Graduates (IMGs) in the healthcare systems of the USA and UK. A careful review of the literature shows that financial, cultural, and linguistic barriers are worsened by the intricate USA licensing processes overseen by the ECFMG. The BMJ and the AAMC's research statistics demonstrate the prevalence of these difficulties and their impact on the career trajectories and well-being of IMGs. The study assesses the impact of professional networks, mentoring programs, and support systems in addressing challenges faced by IMGs in the healthcare sectors of the US and UK, emphasizing the significance of evidence-based interventions in developing inclusion and equality. International Medical Graduates (IMGs) play an important role in graduate medical education and broad medical settings, but their integration present challenges that need thoughtful evaluation of many concerns they face.