International Medical Graduates Research Articles

478 Career Transition Experience of International Medical Graduates (IMGs) Within the NHS Post-COVID19: Evaluation of Challenges and Support

Abstract Aim The main purpose of this research is to identify the challenges facing international medical graduates (IMGs) during their career transition into the National Health Service (NHS), particularly post-pandemic, and evaluate the organisational support offered to them, its significance, and its effectiveness in easing their transition, based on the practice of inclusion. Method A cross-sectional retrospective study was conducted with a mixed-methods design, quantitative data were collected firstly by online questionnaires (n = 72), followed by semi-structured interviews with part of the first-stage participants (n = 4). Quantitative data were analysed in SPSS whereas thematic analysis was used for qualitative data. Results The findings show positive insights regarding the support offered to IMGs throughout the pandemic, particularly from seniors and colleagues. It points out the crucial role of the support, organisational support as well as seniors' and colleagues' support, in facilitating the career transition of the IMGs into the NHS in order to fulfil their capabilities and benefit the service as well as move up the career ladder. The equality of support was a point of concern when it comes to the nature of IMGs’ starting position (training/non-training). Conclusions The study reveals that it is beneficial to have a higher level of support for the IMGs right from the early stages. Organisational support interventions should be sustained by ongoing seniors’ and peers’ support to get the functional adjustment level of the newcomer IMGs and assist them in their progression.

1050 Application of Bloom’s Taxonomy and Kolb’s Experiential Learning Theory While Designing Low-Cost Surgical Skills Courses for Junior Doctors & International Medical Graduates (IMGs) in the NHS

Abstract Aim To design a surgical skills course underpinned by Bloom’s & Kolb’s learning theory for junior doctors in the NHS. To develop an affordable skills course for the acquisition of the necessary skills & confidence among junior doctors. Method RCSEd CPD approved 1-Day Surgical Skills Course with course fees of £95 was designed based on the learning theory and was attended by 12 foundation-level doctors (>60% IMGs). The course contents were Knot Tying, Suturing Technique, Skin-Lesions excision, Bowel Anastomosis & Tendon Repair. All six levels of Bloom’s Taxonomy were adopted for the Knot Tying session and Kolb’s for designing the remaining skills sessions. Results There was the flexibility of learning for the delegates as someone with good clinical knowledge and skills was able to reach level 6 Taxonomy (e.g one-finger knot-tying techniques) rather than limiting to Level 3(Apply) as seen in the conventional courses. Kolb’s learning theory helped the delegates to enter the learning cycle through any stage adopting any learning cycle complementing IMGs with their wide concrete experience. 100% n = 11 delegates responded their course expectations were met. Avg.54.5%n = 6 strongly agreed & 45.5%n = 5 agreed on improvement in their post-course surgical skills. Conclusions The low cost of the surgical skills course was found to be one of the confounding factors for the wide participation by junior doctors & IMGs (54.5% n = 5 scored 5/5 & 45.5% n = 6 scored 4/5 for appropriateness on course fees). Adapting these learning theories helped enhance the course outcomes by widening the horizons of skills acquisition.

The Impact of International Medical Graduates on Rural Healthcare in the USA: Challenges and Opportunities

The Impact of International Medical Graduates (IMGs)on Rural Healthcare in the United States depicts alandscape in which challenges collide with opportunities,affecting the course of healthcare delivery. IMGs haveimmense promise as the foundations of the healthcareprofession, but the rural terrain presents uniquechallenges. Scarce resources and inadequate facilitiesimpede seamless practice, particularly in specialty fieldssuch as cardiology and cancer. For effective patientengagement, the fabric of rural communities, which islinked to many cultures, requires enhanced culturalcompetence. Language barriers highlight the challengeof providing care. Despite these challenges, IMGs holdthe seeds of opportunity. Their resource-constrainedingenuity gives them novel solutions to rural healthcaredisparities. Furthermore, IMGs have the potential toovercome the healthcare professional gap, givingvitality to poor places. Fostering the synergy betweenIMGs and rural healthcare requires infrastructuralimprovements, cultural awareness, and equitableintegration. Strategic investments in technology andeducation have the potential to improve patient care.Recognizing and treating IMGs fairly shows their criticalrole in redefining rural healthcare accessibility andquality.

Applicant Experience in Communication With Residency Programs After the Introduction of Program Signaling

Examine the applicant experience after introduction of program signaling for the 2023 obstetrics and gynecology (OBGYN) residency application cycle. Responses to an online survey of OBGYN applicants participating in the 2023 match who participated in residency program signaling were compared to responses from a similar survey conducted in 2022. Demographic information included personal and academic background and how applicants and advisors communicated with programs. Numbers of applications and interviews, second look visits, away rotations, manner of contact, and timing of communication was compared. Statistical analysis included ANOVA for interval data, and χ2 and Kruskal-Wallis tests for categorical data. A total of 711 of 2631 (27%) applicants responded in 2022 and 606 of 2492 (24.3%) responded in 2023. Approximately 2/3 of gold signals and 1/3 of silver signals led to an interview. There was no change in number of applications or interviews per applicant, but there was a broader distribution of interviews per applicant in 2023. Applicants in 2023 were less likely to engage in preinterview communication or do an away rotation to indicate interest in a program. There was decreased communication between applicants and programs after signaling was introduced. Informal communication continued to differ by racial and medical school background. Applicants from DO programs and international medical graduates (IMG) had more communication with programs than MD applicants but received fewer interview invitations. Fewer Black and Latin(x)/Hispanic applicants had faculty reach out to residency programs on their behalf compared to White and Asian applicants. There were differences in the number of interviews received based on racial and ethnic identity. In the first year after implementation of program signaling, there was a decrease in preinterview communication and a broader distribution of interviews among applicants. Further efforts to create standard means of program communication may help to begin leveling the uneven playing field for applicants.

Role of clinical attachments in psychiatry for international medical graduates to enhance recruitment and retention in the NHS.

There are numerous challenges in the recruitment and retention of the medical workforce in psychiatry. This mixed-methods study examined the role of psychiatry clinical attachments for international medical graduates (IMGs) to enhance recruitment and retention. An online survey was launched to capture views and perceptions of IMGs about clinical attachments. The quantitative and qualitative responses were analysed to elicit findings. In total, 92 responses were received, with respondents commonly from India, Pakistan and Egypt. Respondents were mostly aged 25-34, with ≥3 years of psychiatry experience. Over 80% expressed strong interest in completing a psychiatry clinical attachment and believed it would support career progression. Qualitative data indicated that IMGs hoped to gain clinical experience and understanding of the National Health Service (NHS). They wished for a clearer, simpler process for clinical attachments. Clinical attachment can be mutually beneficial, providing IMGs with opportunity to confidently start their psychiatry career in the UK and enhance medical recruitment in mental health services across the NHS.

International medical graduates' experiences with caring for cross-cultural patient populations: Qualitative study in Alberta.

To explore experiences of international medical graduate (IMG) FPs in providing cross-cultural patient care and to identify rewards and challenges they experienced when caring for patients of cultural backgrounds different from their own. Descriptive qualitative study. Family medicine primary care practices in Alberta. Eighteen IMG FPs practising in the metropolitan areas of Edmonton or Calgary in Alberta as of May 2013. Individual face-to-face or telephone interviews were conducted using a semistructured interview guide. Seventeen interviews occurred between July and August 2013 and 1 took place in August 2014. All interviews were audiorecorded and transcribed verbatim. Transcribed data were subject to thematic analysis. International medical graduates identified several rewarding aspects of caring for patients with cultural backgrounds different from their own, including learning about different cultures, perceiving that appointments are more succinct, and advocating for patients whom they perceive to be at a disadvantage. Family physicians also identified several challenges associated with caring for patients of different cultural backgrounds, including encountering language barriers, perceiving that visits take longer, and experiencing patients' lack of acceptance of FPs with cultural backgrounds different from their own. Cultural differences between FPs and patients can enhance or undermine doctor-patient relationships. The results of this study speak to the need for cultural competency training for FPs practising in culturally diverse settings.

Prevalence of International Medical Graduates in Integrated Plastic Surgery Programs.

The annual match reports from 2010 to 2020 were retrieved and summarized. Electronic surveys for program directors and program coordinators were distributed to US integrated plastic surgery programs. Each program's website was appraised for information regarding the eligibility of IMGs. Websites were also used to identify the number of IMG residents. The number of applicants who matched into integrated programs ranged from 69 to 180 per year, of which US applicants comprised 61-165. US IMGs filled one to three positions per year, whereas non-US IMGs filled two to seven. Although 48% of programs have matched non-citizen IMGs and 79% have not encountered difficulties during the visa process, 67% of coordinators reported that the onboarding process is more challenging for IMGs. There are no IMGs in 52% of programs, and most institutions offer information on their website regarding visa sponsorship. IMGs make up less than 10% of filled positions per cycle. Although most programs accept IMGs, a small number matriculate. This may be explained by the competitiveness of integrated programs and the volume of IMG applications. Further research is needed to identify contributing factors of low IMG representation in plastic surgery programs.

Facilitating international medical graduates' acculturation: From theory to practice.

International medical graduates (IMGs) are forming an ever-increasing proportion of the medical workforce. Much of the discourse around IMGs is about their performance at work and interventions to improve it. This discourse, however, is rarely situated in the wider context of the experiences of IMGs as migrants despite the wider context of migration and acculturation being likely to have a significant impact on IMGs' well-being and, ultimately, performance at work. The objectives of this article were to (1) raise awareness of the inextricable broader context within which IMGs are situated as migrants; (2) outline the impact this context might have on IMGs' performance; (3) discuss literature from the social sciences related to acculturation that could better inform the way we view IMG transition and performance; (4) highlight how acculturation theory can help inform the design, implementation and evaluation of interventions to facilitate the transition of IMGs into the host country and the workplace; (5) list some interventions that can provide support; and (6) suggest theory driven lines of enquiry to study acculturation in IMGs and the impact related issues might have on performance. This is a cross-cutting edge review drawing on selected theory and literature from the social sciences to explore its relevance to IMGs. The broader context of migration and acculturation should not be ignored when discussing IMG performance in the workplace or when instigating interventions to improve it. There is an urgent need to further evaluate the impact this broader context has on IMGs' well-being and performance.

Evaluation of the Conrad 30 Waiver Program’s Success in Attracting International Medical Graduates to Underserved Areas

This cross-sectional study evaluated the growth and distribution of physicians in the Conrad 30 Waiver program during the past 2 decades.

Bibliometric Analysis of International Medical Graduates and Professorship Promotion in Neurosurgery

International medical graduates (IMGs) comprise ∼25% of physicians in the United States. Differences in promotion rates from assistant to associate to full professorship based on medical school location have been understudied. We aim to stratify odds of professional advancement by 3 categories: IMG with U.S. residency, IMG with international residency, and U.S. medical with U.S. residency training. We created and queried a database after exclusions of 1334 neurosurgeons including multiple demographic factors: academic productivity and promotion rates. Stratified logistic regression modeled odds of promotion including the variables: decades out of training, Scopus h-index, gender, and training location. Odds ratios (ORs) and 95% confidence intervals (CIs) for each variable were calculated. Significant predictors of increased associate versus assistant professorship included decades out of training (OR= 2.519 [95% CI: 2.07-3.093], P < 0.0001) and Scopus h-index (OR= 1.085 [95% CI: 1.064-1.108], P < 0.0001) while international medical school with U.S. residency (OR= 0.471 [95% CI: 0.231-0.914], P= 0.0352) was associated with decreased promotion. Significant predictors of associate versus full professorship were decades out of training (OR= 2.781 [95% CI: 2.268-3.444], P < 0.0001) and Scopus h-index (OR= 1.064 [95% CI: 1.049-1.080], P < 0.0001). Attending medical school or residency internationally was not associated with odds of full professorship. Time out of residency and Scopus h-index were associated with higher academic rank regardless of career level. Attending medical school internationally with U.S. residency was associated with lower odds of associate professorship promotion over 10 years. There was no relationship between IMG and full professorship promotion. IMGs who attended residency internationally did not have lower promotion rates. These findings suggest it may be harder for IMGs to earn promotion from assistant to associate professor in neurosurgery.

International Medical Graduates in Otolaryngology Education: The Overlooked Path to Diversity and Inclusivity.

"International Medical Graduates" (IMGs) make up a large percentage of "underrepresented in medicine" physicians and comprise 25% of the US physician workforce. The American Academy of Otolaryngology-Head and Neck Surgery, in its "Statement on Diversity," has expressed its enduring commitment to inclusion and diversity in all its forms. However, unlike various other specialties, a discussion about integration of IMGs in Otolaryngology has not been raised in our community. This commentary reviews the data on the recruitment of IMGs in Otolaryngology residency programs and highlights the need for a strategic effort to increase their participation in the US residency programs. Strong benefits may be derived from this effort such as promoting inclusivity and diversity of the workforce and increasing the support of the nation's underserved communities.

Tackling differential attainment in specialist GP training in England and Scotland

ABSTRACT In this article NHS England and NHS Education for Scotland describe practical ways we are tackling differences in the attainment of people training as general practitioners (GPs). Trainees from minority ethnic groups and international medical graduates are less likely than others to qualify as GPs. It is difficult to change systemic inequalities, but over the past five years we have made practical changes to GP speciality training. Educators recognise there is an issue and are trying to tackle it. For example, people who had not successfully qualified had an opportunity to return to GP training. When we provided individualised targeted support, the proportion who completed training significantly increased (76%). This was a catalyst for reviewing unconscious bias in GP training. We implemented a national programme to tackle differential attainment and system-level bias. Educators now work with all GP trainees to identify their individual needs. Supervisors are trained to recognise bias and provide targeted support. There is mental health support and regular reviews to see whether trainees are ready to sit exams. Trainee representatives are championing the learner voice in national committees. Exams are being altered to reduce unconscious bias. We are monitoring attainment over time. The key message is that differential attainment should not be in the ‘too hard basket’. The narrative is changing from ‘can’t do’ to ‘must do’, supported by appropriate leadership, promotion and resourcing. There is much more to do, but we are making changes, evaluating and applying our learning. We have moved from talking to taking action.

Comparison Between Surgical Trainee Self-Assessment With Supervisor Scores in Technical and Nontechnical Skills to Identify Underperforming Trainees

This study aims to compare trainee self-assessment with supervisor assessment to identify differences in correlations of the demographic data and evaluate whether the instrument can be utilized to identify underperforming trainees. A novel instrument was designed based off the Royal Australasian College of Surgeons original 9 competencies utilizing the JDocs framework and covers 48-items across all surgical competencies. A multiple regression model using age, gender, postgraduate year, IMG status, and level of training as the variables was performed with backwards elimination, and pairwise comparisons made to identify the degree and direction of influence each variable contributed to trainee and supervisor ratings. Surgical trainees employed in tertiary centers within the Australian Capital Territory and South-East New South Wales health network in Australia. A total of 36 of 59 (61%) trainees responded. Two grossly incomplete responses were excluded from further analysis resulting in 34 completed self-assessments for analysis. There was a total of 68 supervisor assessments provided by 25 different nominated supervisors. Of these assessments, 67 were fully completed and one was partially complete. We identified that for both self-ratings and supervisor ratings, the most significant correlation is with the postgraduate year of the trainee, with correlation identified in 7 out of 9 competencies, although in different competency domains. International Medical Graduate status is associated in 2 of 9 self-ratings, and in 3 of 9 supervisor ratings. Underperforming trainees were able to be identified through supervisor assessment but not self-assessment. The supervisor assessment form was able to identify underperforming trainees. Our findings resonate with existing literature in other specialty fields, and surgical units that employ assessment forms should feel more confident in the interpretation of the data and provision of feedback to trainees.

Inequitable treatment as perceived by international medical graduates (IMGs): a scoping review

ObjectivesThis scoping review seeks to detail experiences of inequitable treatment, as self-reported by international medical graduates (IMGs), across time and location.DesignScoping review.Search strategyThree academic medical databases (MEDLINE, SCOPUS and PSYCINFO)...

COVID-19 Pandemic Impact on Pediatricians Entering the Pediatric Workforce.

Determine extent of impact of coronavirus disease 2019 (COVID-19) pandemic on career choice and employment of pediatricians entering pediatric workforce. A national, cross-sectional electronic survey of pediatricians registering for the 2021 American Board of Pediatrics initial general certifying examination on the impact of the COVID-19 pandemic on 3 aspects of career (career choice, employment search, employment offers) was performed. Data were analyzed using descriptive statistics and multivariate logistic regression to determine factors associated with the pandemic's impact on career. Thematic analysis was used to generate themes for open-ended survey questions. Over half (52.3%, 1767 of 3380) of pediatricians responded. Overall, 29.1% reported that the pandemic impacted their career (career choice [10.4%], employment search [15.6%], or employment offers [19.0%]); applicants to general pediatrics (GP) (52.9%) or pediatric hospitalist (PH) positions (49.3%) were most affected. Multivariate logistic regression modeling found those applying to GP (odds ratio [OR]: 3.83, 95% confidence interval [CI]: 2.22-6.60), PH (OR: 9.02, 95% CI: 5.60-14.52), and International Medical Graduates (IMGs) (OR: 1.90; 95% CI: 1.39-2.59) most likely to experience any career impact. Almost one third of pediatricians registering for the initial general pediatrics certifying examination reported their careers were impacted by the COVID-19 pandemic, with 10% of respondents reporting the pandemic impacted their career choice. Half of new pediatricians seeking employment reported being impacted by the pandemic, particularly IMGs. As the pandemic evolves, career advising will continue to be critical to support trainees in their career choices and employment.

Recruitment of medical graduates from Prague to foundation programme jobs in a UK hospital: results of a 6-year project

International medical graduates (IMGs) are required to fill foundation-level posts in the NHS. Recruiting for these posts is difficult and time consuming. In 2016, we created a link between the Great Western Hospital, Swindon and Charles University, Prague to recruit to these posts. Here, we describe in detail the recruitment process, level of support and outcomes after 6 years, including the success rate of completion of foundation training and their career progression. Formal structured interviews occurred in Prague or online. Support included tailored educational/clinical supervision and additional simulation sessions. Data collected included exception reports and sick leave records. In 2022, a survey established satisfaction levels with the project and subsequent career progression. All 51 doctors (100%) recruited as IMGs completed foundation training. Exception reporting and sick leave were below the Trust average. Of those doctors, 39 (76%) replied to the survey. All reported that the appointments helped them progress in their careers and 23 (45%) have subsequently been appointed successfully to a national Specialty Training Scheme. This project improved recruitment of non-deanery foundation doctors, prevented rota gaps and provided adequate staffing of junior doctors in our hospital. Concerns around employment of IMGs can be offset by providing a supportive and developmental environment.

Provision of Food Allergy Care in the United Kingdom and United States: Current Issues and Future Directions.

Food allergy (FA) is a growing issue worldwide. The United Kingdom (UK) and United States (US) are high-income, industrialized countries with reported increases in FA prevalence over the past few decades. This review compares delivery of FA care in the UK and US and each country's response to the heightened demand and disparities for FA services. In the UK, allergy specialists are scarce and general practitioners (GPs) provide most allergy care. While the US has more allergists per capita than the UK, there is still a shortage of allergy services owing to the greater reliance on specialist care for FA in America and wide geographic variation in access to allergist services. At this time, generalists in these countries lack the specialty training and equipment to optimally diagnose and manage FA. Moving forward, the UK aims to enhance training for GPs so they may provide better quality frontline allergy care. In addition, the UK is implementing a new tier of semi-specialized GPs and increasing cross-center collaboration through clinical networks. The UK and US aim to increase the number of FA specialists, which is critical at a time of rapidly expanding management options for allergic and immunologic diseases requiring clinical expertise and shared decision-making to select appropriate therapies. While these countries aim to actively grow their supply of quality FA services, further efforts to build clinical networks, and perhaps, recruit international medical graduates and expand telehealth services, are necessary to reduce disparities in access to care. For the UK in particular, this will require additional support from the leadership of the centralized National Health Service, which remains challenging.

An evaluation of The Social Prescribing Scheme Pilot for International Medical Graduate GP Trainees in Yorkshire and the Humber.

IMG's experience disproportionally worse outcomes in GP Specialty Training when compared to their peers.1 This disparity in outcomes is not explained by any single identifiable trainee factor such as the academic ability, or trainee motivation and is called Differential Attainment.2Woolfe et al (2016) found factors such as lack of autonomy about the geographical location of work, combined with poor work-life balance can leave trainees unsupported, isolated, and vulnerable to anxiety, depression and other mental health conditions 3 coupled with potential stigma of supplementary help, anxiety about the increased probability of exam failure, visa difficulties and costs, all impact on the trainees' chances of progressing through training. 3 AIM: An evaluation of The Social Prescribing Scheme Pilot for International Medical Graduate GP Trainees in Yorkshire and the Humber. The data collected was readily available from the social prescribing team. They held data on how many trainees used the scheme, for what reasons and outcomes from their meetings. The IMG GP Trainees are engaging with the service, and asking for help with complex issues, including mental health, and visa queries. Of the 33 referrals, 21% of requests have been for accommodation issues, 18% for childcare issues and 11% for mental health issues. The Pilot scheme has met all short-term outcomes and all available trainee feedback (limited) has been excellent. Human factors such as accommodation and financial worries can have a huge impact on trainees' wellbeing and progression and should not be underestimated.

Differential Impact of COVID-19 on Junior Doctors

The COVID-19 pandemic had a significant impact on the working circumstances for doctors. To cope with increased workload, hospitals had to increase working hours, reallocate vacation and study leaves and rotations. This impacted the physical and mental well-being of all doctors, particularly international medical graduates (IMG). We explored the differential impact on junior doctors working in a district general hospital. In a mixed methods study, we evaluated the experience and perception of junior doctors in a United Kingdom district hospital in the south of England during the first wave of COVID-19 between March 2020 and September 2020. The study was conducted in two phases: creating a questionnaire followed by an evaluation of qualitative and quantitative content. About 83% doctors in non-consultant grades responded and 37.8% were IMG. The study found that IMG were significantly more likely to experience stress when compared to UK medical graduates (p = 0.008). They were also more worried about contracting the virus when compared to UK medical graduates (p = 0.004). Both groups felt that their training and career progression had been adversely affected. Various factors could play a role in increased stress in IMG when compared to UK medical graduates. These factors included: adjusting to a new system, being away from family, exams and interviews being cancelled, and reports suggesting that members of the the Black, Asian and Minority Ethnic (BAME) community were more likely to be affected by serious illness if contracted COVID-19. This highlights the need for additional support for IMG.

Easing the Entry of Qualified International Medical Graduates to U.S. Medical Practice.

Almost one quarter of physicians and physicians-in-training in the United States are international medical graduates (IMGs), meaning they have graduated from a medical school not accredited in the United States. Some IMGs are U.S. citizens and others are foreign nationals. IMGs, many of whom have years of training and experience gained in their countries of origin, have long contributed to the U.S. health care system, especially by providing care to populations that have been historically underserved. Additionally, many IMGs contribute to the diversity of the health care workforce, which can enhance the health of the population. The diversity of the United States is increasing, and racial and ethnic concordance between a physician and a patient has been linked to improved health outcomes.IMGs must meet national- and state-level licensing and credentialing standards like any other U.S. physician. This assures the ongoing quality of the care provided by the medical workforce and protects the public. However, at the state level, variation in standards and standards that may be more challenging to meet than those for U.S. medical school graduates may hamper IMGs' contributions. IMGs who are not U.S. citizens also face visa and immigration barriers.In this article, the authors present insights gleaned from Minnesota's model IMG integration program as well as changes made in 2 states in response to the COVID-19 pandemic. Improving and streamlining processes for IMGs to be licensed and credentialed as well as the policies governing visas and immigration, where appropriate, can ensure that IMGs will be willing and able to continue to practice when and where they are needed. This, in turn, could increase the contribution of IMGs to addressing health care inequities, improving health care access through service in federally designated Health Professional Shortage Areas, and reducing the impact of potential physician shortages.