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Bhugra D, Smith AJ, Ventriglio A, Rao N, Ng R, Javed A, Chisolm MS, Malhi G, Kar A, Chumakov E, Liebrenz M. World Psychiatric Association-Asian Journal of Psychiatry Commission on the Mental Health and Wellbeing of International Medical Graduates. Asian J Psychiatr 2024; 93:103943. [PMID: 38342035 DOI: 10.1016/j.ajp.2024.103943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
Historically, doctors have migrated for a range of personal, educational, economic, and political reasons. Likewise, medical students from many countries have moved abroad to complete their training and education and may or may not return to their country of origin. Within this context, globalisation has had a major impact on medical education and healthcare workforces, contributing to recent migration trends. Globalisation is a complex phenomenon with positive and negative outcomes. For example, lower-income countries are regularly losing doctors to higher-income areas, thereby exacerbating strains on existing services. Across various national healthcare settings, migrating International Medical Graduates (IMGs) can face socioenvironmental and psychosocial pressures, which can lead to lower mental wellbeing and undermine their contributions to clinical care. Rates of stress and burnout are generally increasing for doctors and medical students. For IMGs, stressors related to migration, acculturation, and adjustment are not dissimilar to other migrants but may carry with them specific nuances. Accordingly, this Commission will explore the history of IMG trends and the challenges faced by IMGs, proposing recommendations and solutions to support their mental health and wellbeing.
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Affiliation(s)
- Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, De Crespigny Park, London SE5 8AF, UK.
| | - Alexander J Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | | | - Nyapati Rao
- Stony Brook University Health Sciences Center School of Medicine, New York, USA
| | - Roger Ng
- World Psychiatric Association, Geneva, Switzerland
| | - Afzal Javed
- World Psychiatric Association, Geneva, Switzerland
| | | | - Gin Malhi
- School of Psychiatry, University of Sydney, Sydney, Australia
| | - Anindya Kar
- Advanced Neuropsychiatry Institute, Kolkata, India
| | - Egor Chumakov
- Department of Psychiatry & Addiction, St Petersburg State University, St Petersburg, Russia
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
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Marthyman A, Nimmon L. Exploring how immigrant international medical graduates successfully manage complex sociocultural challenges. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:40-50. [PMID: 38226312 PMCID: PMC10787855 DOI: 10.36834/cmej.76244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Background While immigrant international medical graduates (I-IMGs) contribute significantly to the physician workforce in North America, researchers have highlighted the myriad of ways sociocultural challenges can negatively impact their success. Conceptual understanding that unpacks the complex processes of how I-IMGs effectively manage sociocultural challenges is relatively sparse. In addressing this critical knowledge gap, this study explored how I-IMGs successfully manage sociocultural differences as postgraduate residents. Methods We interviewed eleven I-IMGs from diverse backgrounds who are in training or recently trained in a distributed multi-site postgraduate medical training program in Canada. We used the lens of sociocultural learning theory to gain insights into the processes of how I-IMGs describe successful management of sociocultural challenges. Results The overarching storyline of participants emphasized that their experiences were humbling as they grappled with inner struggles, emotions, and vulnerabilities while embracing the ambiguity of not knowing what was expected of them. The following dominant themes from their narratives encapsulate the salient processes for how I-IMGs conceptualize and successfully manage sociocultural challenges: 1) successfully navigating transitions; 2) resisting or altering elements of prior sociocultural norms while embracing the new; 3) living and being in community and having supportive social networks; 4) risk taking to self-advocate and actively seek help. Conclusion Understanding the strengths and positive strategies for how I-IMGs interface with complex sociocultural challenges has application for medical training institutions. Our insights suggest the need for practical, effective, and continuous assistance within I-IMG training programs to better support future trainees dealing with sociocultural challenges.
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Affiliation(s)
- Azaria Marthyman
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, British Columbia, Canada
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Camargo A. Developing strategies to improve the sense of belonging and mitigate tokenism. Clin Imaging 2023; 103:109987. [PMID: 37742412 DOI: 10.1016/j.clinimag.2023.109987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/30/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
Despite the increase in DEI initiatives and the rising social awareness, diversity, equity, and inclusiveness are still scarce in many work environments. In the process of implementing a diverse group in the workplace and training programs, retention efforts should always follow recruitment strategies; it is crucial to establish an environment that offers recruited women and minorities a sense of belonging and inclusiveness. Literature shows that diversity and belonging benefit not only the individual, but also the organization, society, and health care system. Many strategies to foster a sense of belonging in the workplace have been suggested, including, but not limited to, mentorship, sponsorship, affinity groups, dashboards, and surveys. Leaderships should acknowledge DEI initiatives, promoting efforts to enhance inclusiveness and mitigate tokenism. Amid DEI criticism and backlash, it is important to continue to promote education and positive discussions and aim for cultural changes targeting rooted systemic racism and discrimination, which continue to impose an obstacle to DEIB achievements.
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Affiliation(s)
- Aline Camargo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA.
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Healey SJR, Fakes K, Nair BR. Inequitable treatment as perceived by international medical graduates (IMGs): a scoping review. BMJ Open 2023; 13:e071992. [PMID: 37438072 DOI: 10.1136/bmjopen-2023-071992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES This scoping review seeks to detail experiences of inequitable treatment, as self-reported by international medical graduates (IMGs), across time and location. DESIGN Scoping review. SEARCH STRATEGY Three academic medical databases (MEDLINE, SCOPUS and PSYCINFO) and grey literature (GOOGLE SCHOLAR) were systematically searched for studies reporting first-hand IMG experiences of perceived inequitable treatment in the workplace: discrimination, prejudice or bias. Original (in English) qualitative, quantitative, mixed studies or inquiry-based reports from inception until 31 December 2022, which documented direct involvement of IMGs in the data were eligible for inclusion in the review. Systematic reviews, scoping reviews, letters, editorials, news items and commentaries were excluded. Study characteristics and common themes were identified and analysed through an iterative process. RESULTS We found 33 publications representing 31 studies from USA, Australia, UK, Canada, Germany, Finland, South Africa, Austria, Ireland and Saudi Arabia, published between 1982 and 2022. Common themes identified by extraction were: (1) inadequate professional recognition, including unmatched assigned work or pay; (2) perceived lack of choice and opportunities such as limited freedoms and perceived control over own future; (3) marginalisation-subtle interpersonal exclusions, stereotypes and stigma; (4) favouring of local graduates; (5) verbal insults, culturally or racially insensitive or offensive comments; and (6) harsher sanctions. Other themes identified were effects on well-being and proposed solutions to inequity. CONCLUSIONS This study found evidence that IMGs believe they are subject to numerous common inequitable workplace experiences and that these experiences have self-reported repercussions on well-being and career trajectory. Further research is needed to substantiate correlations and causality in relation to outcomes of well-being and differential career attainment. Furthermore, research into support for IMGs and the creation of more equitable workforce environments is also recommended.
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Affiliation(s)
- Sunita Joann Rebecca Healey
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Health, New Lambton Heights, New South Wales, Australia
| | - Kristy Fakes
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Balakrishnan R Nair
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Health, New Lambton Heights, New South Wales, Australia
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Khoujah D, Ibrahim A. Exploring Teamwork Challenges Perceived by International Medical Graduates in Emergency Medicine Residency. West J Emerg Med 2023; 24:50-58. [PMID: 36735007 PMCID: PMC9897247 DOI: 10.5811/westjem.2022.11.58002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/20/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Non-US international medical graduates (IMG) represent a gradually increasing portion of emergency medicine (EM) residents in the United States. Yet there are no previous studies that explore the needs of this learner population. We conducted a qualitative study to examine non-US IMGs' perceptions of challenges they face specifically regarding team dynamics during their first year of an EM residency. METHOD Nine non-US IMGs in EM from all over the US participated in anonymous, semi-structured phone interviews lasting 45-60 minutes. We then coded and analyzed the interviews to identify axes and themes using an inductive approach informed by grounded theory. Focused coding and member checking were employed. RESULTS Non-US IMGs' perceptions of challenges regarding team dynamics during their first year of an EM residency coalesced into two themes: system-based challenges, such as a new power dynamic and understanding the local hospital system, and interpersonal challenges, such as establishing rapport and articulation of critical thinking. CONCLUSION Non-US IMGs perceived several unique challenges regarding team dynamics during their first year of an EM residency, whether system-based or interpersonal-based. We propose solutions such as a transitional curriculum (as suggested by the participants as well) and cultural-competence training for academic leadership.
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Affiliation(s)
- Danya Khoujah
- Tampa AdventHealth, Emergency Medicine, Tampa, Florida,University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Ahmed Ibrahim
- Johns Hopkins University, School of Education, Baltimore, Maryland
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Murillo Zepeda C, Alcalá Aguirre FO, Luna Landa EM, Reyes Güereque EN, Rodríguez García GP, Diaz Montoya LS. Challenges for International Medical Graduates in the US Graduate Medical Education and Health Care System Environment: A Narrative Review. Cureus 2022; 14:e27351. [PMID: 35910699 PMCID: PMC9334519 DOI: 10.7759/cureus.27351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
International medical graduates (IMGs) have become a vital part of the US graduate medical education (GME) and health care system (HCS) workforce; they contribute to essential diversity that relieves cultural and linguistic barriers to health care. The number of IMGs looking for medical training in the United States. has constantly been increasing in the last decades. The challenges they meet begin long before residency application, continue during their transition to residency programs, through early medical training, and eventually subside in senior years. IMGs' hurdles permeate the themes of navigating the US GME and HCS, adaptation to the US culture, communication skills, racial discrimination, emotional distress, and finances. This article aims to comprehensively review available information concerning the challenges encountered by IMGs in their transition to the US GME and HCS environments.
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Al-Haddad M, Jamieson S, Germeni E. International medical graduates' experiences before and after migration: A meta-ethnography of qualitative studies. MEDICAL EDUCATION 2022; 56:504-515. [PMID: 34859484 DOI: 10.1111/medu.14708] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION International medical graduates (IMGs) represent a large portion of practising doctors in many countries. Many experience difficulties, including higher rates of complaints against them and lower exam pass rates. The UK's General Medical Council (GMC) recently set targets to 'eliminate disproportionate complaints' and 'eradicate disadvantage and discrimination in medical education'. Our timely meta-ethnography aimed to synthesise existing qualitative literature on the wider personal and professional experiences of IMGs to identify factors affecting IMGs' professional practice (either directly or indirectly). METHODS In September 2019, we systematically searched Medline, Embase, Cochrane, PsycINFO, ERIC and EdResearch for peer-reviewed qualitative and mixed-methods articles that described experiences of IMGs. We extracted participant quotes and authors' themes from included articles and used the technique of meta-ethnography to synthesise the data and develop new overarching concepts. RESULTS Of the 1613 articles identified, 57 met our inclusion criteria. In total, the articles corresponded to 46 studies that described the experiences of 1142 IMGs practising in all six continents in a range of settings, including primary and secondary care. We developed five key concepts: migration dimensions (issues considered by IMGs when migrating), a challenging start (the stressful early period), degree of dissonance (between the IMG and host country in relation to the four main barriers of language, culture, medical education and belonging), levelling the playing field (interventions to reduce the impact of the barriers) and survive then thrive (adjustments IMGs made). A conceptual model that brings these constructs together in a line of argument is presented. CONCLUSIONS This meta-ethnography, based on a large amount of diverse qualitative studies, is the first to provide a comprehensive picture of the experiences and challenges that IMGs face before and after migration. Our results should be used to guide the development of interventions aiming to support IMGs and meet the GMC targets.
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Affiliation(s)
- Mo Al-Haddad
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Susan Jamieson
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Evi Germeni
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Heponiemi T, Hietapakka L, Lehtoaro S, Aalto AM. Foreign-born physicians' perceptions of discrimination and stress in Finland: a cross-sectional questionnaire study. BMC Health Serv Res 2018; 18:418. [PMID: 29879955 PMCID: PMC5992868 DOI: 10.1186/s12913-018-3256-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/30/2018] [Indexed: 11/30/2022] Open
Abstract
Background Foreign-born physicians fill in the shortage of physicians in many developed countries. Labour market theory and previous studies suggest that foreign-born physicians may be a disadvantaged group with a higher likelihood of discrimination and less prestigious jobs. The present study examines foreign-born physicians’ experiences of discrimination (coming from management, colleagues and patients separately) and patient-related stress and integration-related stress, and it examines how gender, age, employment sector, country of birth, years from getting a practicing license in Finland, language problems, cross-cultural training, cross-cultural empathy, team climate and skill discretion were associated with these factors. Methods The present study was a cross-sectional questionnaire study among 371 foreign-born physicians in Finland, aged between 26 and 65 (65% women). Analyses of covariance and logistic regression analyses were conducted to examine the associations. Results A good team climate and high cross-cultural empathy were associated with lower likelihoods of discrimination from all sources, patient-related stress and integration-related stress. Skill discretion was associated with lower levels of integration-related stress and discrimination from management and colleagues. Language problems were associated with higher levels of integration-related stress. The biggest sources of discrimination were patients and their relatives. Conclusions The present study showed the importance of a good team climate, cross-cultural empathy and patience, skill discretion and language skills in regard to the proper integration of foreign-born health care employees into the workplace. Good job resources, such as a good team climate and the possibility to use one’s skills, may help foreign-born employees, for instance by giving them support when needed and offering flexibility. Health care organizations should invest in continuous language training for foreign-born employees and also offer support when there are language problems. Moreover, it seems that training increasing cross-cultural empathy and patience might be beneficial.
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Affiliation(s)
- Tarja Heponiemi
- National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
| | - Laura Hietapakka
- National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Salla Lehtoaro
- National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Anna-Mari Aalto
- National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
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Jansen E, Hänel P, Klingler C. Rehabilitation-specific challenges and advantages in the integration of migrant physicians in Germany: a multiperspective qualitative interview study in rehabilitative settings. Public Health 2018; 160:1-9. [PMID: 29702272 DOI: 10.1016/j.puhe.2018.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 02/17/2018] [Accepted: 03/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In Germany, rehabilitative healthcare institutions increasingly rely on migrant physicians to meet their staffing needs. Yet until now, research on the integration of migrant physicians has focussed entirely on the acute care setting. This study is the first to address the specific advantages and challenges to integration in the field of rehabilitative medicine where a high number of migrant physicians work. From the experiences of migrant physicians and their colleagues, we provide actionable suggestions to counteract potential sources of conflict and thereby improve the integration of migrant physicians in the German workforce. STUDY DESIGN We conducted a qualitative interview study. METHODS We conducted 23 interviews with a total of 26 participants occupying a variety of roles in two different rehabilitation centres (maximum variation sampling). Interviews were recorded, transcribed verbatim and parsed through thematic analysis. RESULTS Our research revealed advantages and challenges to integration in three distinct areas: rehabilitative care institutions, competencies of migrant professionals and interpersonal relations. The first set of issues hinges on the work processes within rehabilitative hospitals, professional prospects there and the location of the institutions themselves. Second, migrant physicians may encounter difficulties because of limited linguistic skills and country-specific knowledge. And finally, aspects of their interactions with care teams and patients may constitute barriers to integration. CONCLUSIONS Some of the factors influencing the integration of migrant physicians are the same in both rehabilitative and acute medicine, but the rehabilitative setting presents distinct advantages and challenges that are worthy of study in their own right. We outline several measures which could help overcome challenges to the integration of migrant physicians, including those associated with professional relationships. Further research is needed to develop concrete support programmes.
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Affiliation(s)
- E Jansen
- Institute for Social Anthropology, Eberhard Karls University, Tübingen, Germany.
| | - P Hänel
- Alice Salomon University of Applied Science, Berlin, Germany.
| | - C Klingler
- Institute of Ethics, History & Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany.
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Kirmayer LJ, Sockalingam S, Fung KPL, Fleisher WP, Adeponle A, Bhat V, Munshi A, Ganesan S. International Medical Graduates in Psychiatry: Cultural Issues in Training and Continuing Professional Development. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:258-280. [PMID: 29630854 PMCID: PMC5894917 DOI: 10.1177/0706743717752913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A position paper developed by the Canadian Psychiatric Association's Education Committee and approved by the CPA's Board of Directors on August 15, 2016.
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Affiliation(s)
- Laurence J Kirmayer
- 1 Professor and Director, Division of Social and Transcultural Psychiatry, McGill University, Montréal, Québec; Editor-in-Chief, Transcultural Psychiatry; Director, Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montréal, Québec
| | - Sanjeev Sockalingam
- 2 Psychiatrist, Centre for Mental Health, University Health Network; Associate Professor, Department of Psychiatry, University of Toronto; Centre Researcher, Wilson Centre, University of Toronto, Faculty of Medicine and University Health Network, Toronto, Ontario
| | - Kenneth Po-Lun Fung
- 3 Associate Professor, Department of Psychiatry, University of Toronto; Clinical Director, Asian Initiative in Mental Health, Toronto Western Hospital, University Health Network, Toronto, Ontario
| | - William P Fleisher
- 4 Director, Academic Affairs, Professor, Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | | | - Venkat Bhat
- 6 Fellow, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Alpna Munshi
- 7 Assistant Professor and Director of International Medical Graduate Training, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Soma Ganesan
- 8 Clinical Professor, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Director, Crosscultural Program, University of British Columbia, Vancouver, British Columbia
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Klingler C, Ismail F, Marckmann G, Kuehlmeyer K. Medical professionalism of foreign-born and foreign-trained physicians under close scrutiny: A qualitative study with stakeholders in Germany. PLoS One 2018; 13:e0193010. [PMID: 29447259 PMCID: PMC5814013 DOI: 10.1371/journal.pone.0193010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/19/2018] [Indexed: 11/22/2022] Open
Abstract
Hospitals in Germany employ increasing numbers of foreign-born and foreign-trained (FB&FT) physicians. Studies have investigated how FB&FT physicians experience their professional integration into the German healthcare system, however, the perspectives of stakeholders working with and shaping the work experiences of FB&FT physicians in German hospitals have so far been neglected. This study explores relevant stakeholders’ opinions and attitudes towards FB&FT physicians—which likely influence how these physicians settle in—and how these opinions were formed. We conducted a qualitative interview study with 25 stakeholders working in hospitals or in health policy development. The interviews were analyzed within a constructivist research paradigm using methods derived from Grounded Theory (situational analysis as well as open, axial and selective coding). We found that stakeholders tended to focus on problems in FB&FT physicians’ work performance. Participants criticized FB&FT physicians’ work for deviating from presumably shared professional standards (skill or knowledge and behavioral standards). The professional standards invoked to justify problem-focused statements comprised the definition of an ideal behavior, attitude or ability and a tolerance range that was adapted in a dynamic process. Behavior falling outside the tolerance range was criticized as unacceptable, requiring action to prevent similar deviations in the future. Furthermore, we derived three strategies (minimization, homogenization and quality management) proposed by participants to manage deviations from assumed professional standards by FB&FT physicians. We critically reflect on the social processes of evaluation and problematization and question the legitimacy of professional standards invoked. We also discuss discriminatory tendencies visible in evaluative statements of some participants as well as in some of the strategies proposed. We suggest it will be key to develop and implement better support strategies for FB&FT physicians while also addressing problematic attitudes within the receiving system to further professional integration.
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Affiliation(s)
- Corinna Klingler
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- * E-mail:
| | - Fatiha Ismail
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Georg Marckmann
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Katja Kuehlmeyer
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
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12
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Skjeggestad E, Gerwing J, Gulbrandsen P. Language barriers and professional identity: A qualitative interview study of newly employed international medical doctors and Norwegian colleagues. PATIENT EDUCATION AND COUNSELING 2017; 100:1466-1472. [PMID: 28283216 DOI: 10.1016/j.pec.2017.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore how language barriers influence communication and collaboration between newly-employed international medical doctors and Norwegian health personnel. METHODS Interviews were conducted with 16 doctors who had recently started working in Norway and 12 Norwegian born health personnel who had extensive experience working with international medical doctors. Analyses were consistent with principles of systematic text condensation. RESULTS All participants experienced that language barriers caused difficulties in their everyday collaboration. Furthermore, the participants' descriptions of "language barriers" encompassed a wide range of topics, including semantics (e.g., specialized professional vocabulary, system knowledge), pragmatics (e.g., using language in doctor-patient and interprofessional interactions), and specific culturally sensitive topics. All participants described that language barriers provoked uncertainty about a doctor's competence. CONCLUSION Newly employed international medical doctors and their colleagues are concerned by ineffective communication due to language barriers. Experiences of language barriers threaten professional identity as a competent and effective doctor. PRACTICE IMPLICATIONS Newly employed doctors who are non-native speakers could benefit from support in understanding and handling the array of barriers related to language.
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Affiliation(s)
- Erik Skjeggestad
- HØKH, Health Services Research Unit, Akershus University Hospital, Pb.1000, 1478 Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.
| | - Jennifer Gerwing
- HØKH, Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway; HØKH, Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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Michalski K, Farhan N, Motschall E, Vach W, Boeker M. Dealing with foreign cultural paradigms: A systematic review on intercultural challenges of international medical graduates. PLoS One 2017; 12:e0181330. [PMID: 28715467 PMCID: PMC5513557 DOI: 10.1371/journal.pone.0181330] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/29/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES An increasing number of International Medical Graduates (IMG), who are defined to be physicians working in a country other than their country of origin and training, immigrate to Western countries. In order to ensure safe and high-quality patient care, they have to take medical and language tests. This systematic review aims to (1) collect all empiric research on intercultural communication of IMGs in medical settings, (2) identify and categorize all text passages mentioning intercultural issues in the included studies, and (3) describe the most commonly reported intercultural areas of communication of IMGs. METHODS This review was based on the PRISMA-Guidelines for systematic reviews. We conducted a broad and systematic electronic literature search for empiric research in the following databases: MEDLINE, BIOSIS Citation Index, BIOSIS Previews, KCI-Korean Journal Database and SciELO Citation Index. The search results were synthesized and analyzed with the aid of coding systems. These coding systems were based on textual analysis and derived from the themes and topics of the results and discussion sections from the included studies. A quality assessment was performed, comparing the studies with their corresponding checklist (COREQ or STROBE). Textual results of the studies were extracted and categorized. RESULTS Among 10,630 search results, 47 studies were identified for analysis. 31 studies were qualitative, 12 quantitative and 4 studies used mixed methods. The quality assessment revealed a low level of quality of the studies in general. The following intercultural problems were identified: IMGs were not familiar with shared decision-making and lower hierarchies in the health care system in general. They had difficulties with patient-centered care, the subtleties of the foreign language and with the organizational structures of the new health care system. In addition, they described the medical education in their home countries as science-oriented, without focusing on psychosocial aspects. CONCLUSION There is a need for a better training of IMGs on culture-related and not culture-related topics in the new workplace country. The topics that emerged in this review constitute a basis for developing these courses. Further empiric research is needed to describe the findings of this review more precisely and should be in accordance with the existing reporting guidelines.
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Affiliation(s)
- Kerstin Michalski
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Nabeel Farhan
- Freiburg International Academy – University of Freiburg, Freiburg, Germany
| | - Edith Motschall
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Werner Vach
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
| | - Martin Boeker
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
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Skjeggestad E, Norvoll R, Sandal GM, Gulbrandsen P. How do international medical graduates and colleagues perceive and deal with difficulties in everyday collaboration? A qualitative study. Scand J Public Health 2017; 45:428-435. [PMID: 28381112 DOI: 10.1177/1403494817698286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Many medical doctors work outside their countries of origin. Consequently, language barriers and cultural differences may result in miscommunication and tension in the workplace, leading to poor performance and quality of treatment and affecting patient safety. However, there is little information about how foreign doctors and their colleagues perceive their collaboration and handle situations that can affect the quality of health services. METHODS Individual, semi-structured in-depth interviews were conducted with two groups of informants: 16 doctors who had recently started working in Norway and 12 unrelated Norwegian-born healthcare providers who had extensive experience of working with doctors from foreign countries. The interviews were analysed according to the systematic text condensation method. RESULTS The foreign doctors described themselves as newcomers and found it difficult to speak with their colleagues about their shortcomings because they wanted to be seen as competent. Their Norwegian colleagues reported that many new foreign doctors had demanding work schedules and therefore they were reluctant to give them negative feedback. They also feared that foreign doctors would react negatively to criticism. All participants, both the new foreign doctors and their colleagues, reported that they took responsibility for the prevention of misunderstandings and errors; nevertheless, they struggled to discuss such issues with each other. CONCLUSIONS Silence was the coping strategy adopted by both the foreign doctors and native healthcare professionals when facing difficulties in their working relationships. In such situations, many foreign doctors are socialized into a new workplace in which uncertainty and shortcomings are not discussed openly. Effective leadership and procedures to facilitate communication may alleviate this area of concern.
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Affiliation(s)
- Erik Skjeggestad
- 1 Helse Øst Health Services Research Unit, Akershus University Hospital, Norway.,2 Institute of Clinical Medicine, University of Oslo, Norway
| | - Reidun Norvoll
- 3 Work Research Institute, Oslo and Akershus University College, Norway
| | - Gro M Sandal
- 4 Department of Psychosocial Science, University of Bergen, Norway
| | - Pål Gulbrandsen
- 1 Helse Øst Health Services Research Unit, Akershus University Hospital, Norway.,2 Institute of Clinical Medicine, University of Oslo, Norway
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Osta AD, Barnes MM, Pessagno R, Schwartz A, Hirshfield LE. Acculturation Needs of Pediatric International Medical Graduates: A Qualitative Study. TEACHING AND LEARNING IN MEDICINE 2017; 29:143-152. [PMID: 28033485 DOI: 10.1080/10401334.2016.1251321] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Phenomenon: 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.
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Affiliation(s)
- Amanda D Osta
- a Department of Pediatrics , University of Illinois-Chicago , Chicago , Illinois , USA
- b Department of Internal Medicine , University of Illinois-Chicago , Chicago , Illinois , USA
| | - Michelle M Barnes
- a Department of Pediatrics , University of Illinois-Chicago , Chicago , Illinois , USA
- b Department of Internal Medicine , University of Illinois-Chicago , Chicago , Illinois , USA
| | - Regina Pessagno
- c Department of Sociology , University of Illinois-Chicago , Chicago , Illinois , USA
| | - Alan Schwartz
- d Department of Medical Education , University of Illinois-Chicago , Chicago , Illinois , USA
| | - Laura E Hirshfield
- d Department of Medical Education , University of Illinois-Chicago , Chicago , Illinois , USA
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Klingler C, Marckmann G. Difficulties experienced by migrant physicians working in German hospitals: a qualitative interview study. HUMAN RESOURCES FOR HEALTH 2016; 14:57. [PMID: 27662831 PMCID: PMC5034673 DOI: 10.1186/s12960-016-0153-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/08/2016] [Indexed: 05/29/2023]
Abstract
BACKGROUND With Germany facing a shortage of doctors, hospitals have been increasingly recruiting physicians from abroad. Studies in other countries have shown that migrant physicians experience various difficulties in their work, which might impact the quality of patient care, physician job satisfaction, and, accordingly, retention. The experiences of migrant doctors in Germany have not been systematically studied so far and will likely differ from experiences migrant physicians make in other contexts. A thorough understanding of challenges faced by this group, however, is needed to develop adequate support structures-as required by the WHO Global Code of Practice on the International Recruitment of Health Personnel. METHODS A qualitative study was conducted to give an overview of the multifaceted difficulties migrant physicians might face in German hospitals. Twenty semi-structured interviews with foreign-born and foreign-trained physicians were conducted in German. Participants were recruited via the State Chambers of Physicians and snowballing based on a maximum variation sampling strategy varying purposefully by source country and medical specialty. The interviews were recorded, transcribed verbatim, and analysed using qualitative content analysis. RESULTS Participants described difficulties relating to healthcare institutions, own competencies, and interpersonal interactions. Participants experienced certain legal norms, the regulation of licensure and application for work, and the organization of the hospital environment as inadequate. Most struggled with their lack of setting-specific (language, cultural, clinical, and system) knowledge. Furthermore, behaviour of patients and co-workers was perceived as discriminating or inadequate for other reasons. CONCLUSIONS This is the first study to describe the broad range of issues migrant physicians experience in Germany. Based on this information, institutional actors should devise support structures to ensure quality of care, physician wellbeing, and retention. For example, training opportunities should be offered where needed to support acquisition of setting-specific knowledge. Discrimination experienced by participants calls for better diversity management as a leadership task in healthcare institutions. Misinformation practices in recruitment could be managed by a voluntary code of ethical conduct. Further research is necessary to identify strategies that adequately address diverging normative positions between migrant health personnel and their patients and colleagues.
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Affiliation(s)
- Corinna Klingler
- Institute of Ethics, History & Theory of Medicine at LMU Munich, Lessingstr. 2, 80336 Munich, Germany
| | - Georg Marckmann
- Institute of Ethics, History & Theory of Medicine at LMU Munich, Lessingstr. 2, 80336 Munich, Germany
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Verma A, Griffin A, Dacre J, Elder A. Exploring cultural and linguistic influences on clinical communication skills: a qualitative study of International Medical Graduates. BMC MEDICAL EDUCATION 2016; 16:162. [PMID: 27287316 PMCID: PMC4902940 DOI: 10.1186/s12909-016-0680-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/31/2016] [Indexed: 05/28/2023]
Abstract
BACKGROUND International Medical Graduates (IMGs) are known to perform less well in many postgraduate medical examinations when compared to their UK trained counterparts. This "differential attainment" is observed in both knowledge-based and clinical skills assessments. This study explored the influence of culture and language on IMGs clinical communication skills, in particular, their ability to seek, detect and acknowledge patients' concerns in a high stakes postgraduate clinical skills examination. Hofstede's cultural dimensions framework was used to look at the impact of culture on examination performance. METHODS This was a qualitative, interpretative study using thematic content analysis of video-recorded doctor-simulated patient consultations of candidates sitting the MRCP(UK) PACES examination, at a single examination centre in November 2012. The research utilised Hofstede's cultural dimension theory, a framework for comparing cultural factors amongst different nations, to help understand the reasons for failure. RESULTS Five key themes accounted for the majority of communication failures in station 2, "history taking" and station 4, "communication skills and ethics" of the MRCP(UK) PACES examination. Two themes, the ability to detect clues and the ability to address concerns, related directly to the overall construct managing patients' concerns. Three other themes were found to impact the whole consultation. These were building relationships, providing structure and explanation and planning. CONCLUSION Hofstede's cultural dimensions may help to contextualise some of these observations. In some cultures doctor and patient roles are relatively inflexible: the doctor may convey less information to the patient (higher power distance societies) and give less attention to building rapport (high uncertainty avoidance societies.) This may explain why cues and concerns presented by patients were overlooked in this setting. Understanding cultural differences through Hofstede's cultural dimensions theory can inform the preparation of candidates for high stakes bedside clinical skills examinations and for professional practice.
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Affiliation(s)
- Anju Verma
- Honorary Clinical Research Fellow, University College London Medical School, Royal Free Campus, Rowland Hill Street, Hampstead, NW3 2PF, UK
| | - Ann Griffin
- UCL Medical School, University College London Medical School, 74 Huntley Street, London, WC1E 6AU, UK.
| | - Jane Dacre
- UCL Medical School, University College London Medical School, 74 Huntley Street, London, WC1E 6AU, UK
- Royal College of Physicians, 11, St. Andrew's Place, London, NW1 4LE, UK
| | - Andrew Elder
- Edinburgh Medical School, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
- MRCP(UK) Federation of the UK Royal Colleges of Physicians, MRCP(UK) Central Office, 11, St. Andrew's Place, London, NW1 4LE, UK
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Lineberry M, Osta A, Barnes M, Tas V, Atchon K, Schwartz A. Educational interventions for international medical graduates: a review and agenda. MEDICAL EDUCATION 2015; 49:863-879. [PMID: 26296403 DOI: 10.1111/medu.12766] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/08/2014] [Accepted: 04/07/2015] [Indexed: 06/04/2023]
Abstract
CONTEXT International medical graduates (IMGs) play key roles in the health systems of their host countries, but face unique challenges, which makes the provision of effective, tailored support for IMGs essential. OBJECTIVES Research on the effectiveness of educational interventions for IMGs was reviewed to characterise current knowledge and guide future research and education. METHODS PubMed, Web of Science and EMBASE were searched for relevant articles published to October 2014, describing a systematic evaluation of educational interventions designed for IMGs that included at least one post-intervention outcome. Articles were coded independently by two or more researchers for content and methodology, and discussed to reach consensus. RESULTS Twenty-two articles were identified, describing a wide variety of interventions, content and durations of intervention. Clinical topics and general principles of cross-cultural competency were the most common content areas included in curricula (13 and 12 articles, respectively). All studies deemed the interventions evaluated to be successful. However, only one study drew from theory on cross-cultural differences to guide either the curriculum or evaluation. Additionally, study designs were generally weak; no studies featured random assignment to treatment versus control groups, most studies did not use control groups at all, and no studies compared the effectiveness of different interventions. CONCLUSIONS Research into education for IMGs is critically important but currently underdeveloped. An abundance of justification studies and lack of clarification studies parallel other areas of medical education. Academic fields outside medical education, such as those of cross-cultural psychology and expatriate management, are highly relevant; researchers from these areas should be sought for collaboration. Future research should employ conceptual frameworks in order to facilitate a broader, more nuanced consideration of the diversity of individual IMGs, educational and medical contexts, interventions and outcomes. Rigorous comparative effectiveness research is lacking, but represents a promising avenue for future scholarship.
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Affiliation(s)
- Matthew Lineberry
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Amanda Osta
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Michelle Barnes
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Vildan Tas
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Koffitse Atchon
- Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Alan Schwartz
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Skjeggestad E, Sandal GM, Gulbrandsen P. International medical graduates' perceptions of entering the profession in Norway. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:1129-32. [PMID: 26130545 DOI: 10.4045/tidsskr.14.0332] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND There is little knowledge available about how it feels for an international medical graduate arriving in Norway. We have investigated how the initial period as an employee of the Norwegian health services is perceived. MATERIAL AND METHOD We conducted semi-structured interviews with 16 international medical graduates who had foreign training and citizenship. They had worked as doctors in Norway for less than two years. Transcriptions of the interviews were analysed using the Systematic Text Condensation method. RESULTS Their background for working in Norway varied. Some had an affiliation to the country and a social network, which appeared to be a support during the initial period. Many perceived the authorisation process as bureaucratic and as throwing suspicion on them. The doctors felt that they could cope with most of their work assignments, but reported having faced challenges in terms of language, a lack of insight into systems and uncertainty regarding what was expected of the doctor's role in a Norwegian context. There was also uncertainty associated with a perceived absence of collegial support. Because of the availability of jobs, some had adjusted their career plans towards psychiatry, geriatrics or general practice. INTERPRETATION It appears that preparatory measures such as training courses, tests and the authorisation process fail to provide the practice-related experience and local knowledge that many doctors feel that they need in their new job situation. Measures such as language training and introduction to systems would be likely to improve their general well-being as well as integration.
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Affiliation(s)
- Erik Skjeggestad
- Avdeling for helsetjenesteforskning (HØKH) Akershus universitetssykehus
| | | | - Pål Gulbrandsen
- Institutt for klinisk medisin Campus Ahus Universitetet i Oslo og Avdeling for helsetjenesteforskning (HØKH) Akershus universitetssykehus
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Neumark T, Brudin L, Mölstad S. Antibiotic prescribing in primary care by international medical graduates and graduates from Swedish medical schools. Fam Pract 2015; 32:343-7. [PMID: 25715961 DOI: 10.1093/fampra/cmv001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies of antibiotic prescribing related to diagnosis comparing prescribers trained abroad with those trained in Sweden are lacking. OBJECTIVES To determine whether general practices (GPs) and GP residents trained abroad had different prescribing patterns for antibiotics for common infections than those trained in Sweden using retrospective data from electronic patient records from primary health care in Kalmar County, Sweden. METHODS Consultations with an infection diagnosis, both with and without the prescription of antibiotics to 67 GPs and residents trained in Western Europe outside Sweden and other countries, were compared with a matched control group trained in Sweden. RESULTS For 1 year, 44101 consultations of patients with an infection diagnosis and 16276 prescriptions of antibiotics were registered. Foreign-trained physicians had 20% more visits compared with physicians trained in Sweden. The prescription of antibiotics per visit and physician in the respective groups, and independent of diagnosis, did not significantly differ between groups, when scaled down from number of consultations to number of prescribing physicians. CONCLUSIONS There were minor and non-significant differences in antibiotic prescribing comparing GPs and residents trained abroad and in Sweden, most likely the result of an adaptation to Swedish conditions. Nevertheless, no group prescribed antibiotics in accordance to national guidelines. The results suggest that interventions are needed to reduce irrational antibiotic prescribing patterns, targeting all physicians working in Swedish primary health care.
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Affiliation(s)
- Thomas Neumark
- Primary Health Centre, Lindsdal, Kalmar, Department of Planning, Division of Pharmacotherapy, Kalmar County Council, Kalmar,
| | - Lars Brudin
- Department of Clinical Physiology, Kalmar County Hospital, Kalmar and
| | - Sigvard Mölstad
- Department of Clinical Sciences, General Practice, Lund University, Malmö, Sweden
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Internationally trained pharmacists' perception of their communication proficiency and their views on the impact on patient safety. Res Social Adm Pharm 2015; 11:428-41. [DOI: 10.1016/j.sapharm.2014.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 11/19/2022]
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Morrow G, Rothwell C, Burford B, Illing J. Cultural dimensions in the transition of overseas medical graduates to the UK workplace. MEDICAL TEACHER 2013; 35:e1537-e1545. [PMID: 23782047 DOI: 10.3109/0142159x.2013.802298] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Historically, overseas-qualified doctors have been essential for meeting service needs in the UK National Health Service (NHS). However, these doctors encounter many cultural differences, in relation to training, the healthcare system and the doctor-patient relationship and training. AIM To examine whether Hofstede's cultural model may help us understand the changes doctors from other countries experience on coming to work in the UK, and to identify implications for supervisors and clinical teams. METHOD Telephone interviews were conducted with overseas medical graduates before starting work as a Foundation Year One (F1) doctor, followed up after four months and 12 months; and with educational supervisors. Data were analysed using a confirmatory thematic approach. RESULTS Sixty-four initial interviews were conducted with overseas doctors, 56 after four months, and 32 after 12 months. Twelve interviews were conducted with educational supervisors. The changes doctors experienced related particularly to Hofstede's dimensions of power distance (e.g. in relation to workplace hierarchies and inter-professional relationships), uncertainty avoidance (e.g. regarding ways of interacting) and individualism-collectivism (e.g., regarding doctor-patient/family relationship; assertiveness of individuals). CONCLUSION Hofstede's cultural dimensions may help us understand the adaptations some doctors have to make in adjusting to working in the UK NHS. This may promote awareness and understanding and greater 'cultural competence' amongst those working with them or supervising them in their training.
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Sommer J, Macdonald W, Bulsara C, Lim D. Grunt language versus accent: the perceived communication barriers between international medical graduates and patients in Central Wheatbelt catchments. Aust J Prim Health 2012; 18:197-203. [PMID: 23069362 DOI: 10.1071/py11030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 08/04/2011] [Indexed: 11/23/2022]
Abstract
Due to the chronic shortages of GPs in Australian rural and remote regions, considerable numbers of international medical graduates (IMG) have been recruited. IMG experience many difficulties when relocating to Australia with one of the most significant being effective GP-patient communication. Given that this is essential for effective consultation it can have a substantial impact on health care. A purposive sample of seven practising GPs (five IMG, two Australian-trained doctors (ATD)) was interviewed using a semistructured face-to-face interviewing technique. GPs from Nigeria, Egypt, United Kingdom, India, Singapore and Australia participated. Interviews were transcribed and then coded. The authors used qualitative thematic analysis of interview transcripts to identify common themes. IMG-patient communication barriers were considered significant in the Wheatbelt region as identified by both IMG and ATD. ATD indicated they were aware of IMG-patient communication issues resulting in subsequent consults with patients to explain results and diagnoses. Significantly, a lack of communication between ATD and IMG also emerged, creating a further barrier to effective communication. Analysis of the data generated several important findings that rural GP networks should consider when integrating new IMG into the community. Addressing the challenges related to cross-cultural differences should be a priority, in order to enable effective communication. More open communication between ATD and IMG about GP-patient communication barriers and education programs around GP-patient communication would help both GP and patient satisfaction.
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Affiliation(s)
- Jessica Sommer
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, WA 6009, Australia
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Sandvik H, Hunskaar S, Diaz E. Clinical practice patterns among native and immigrant doctors doing out-of-hours work in Norway: a registry-based observational study. BMJ Open 2012; 2:e001153. [PMID: 22798255 PMCID: PMC3400071 DOI: 10.1136/bmjopen-2012-001153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 06/25/2012] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To evaluate whether immigrant and native Norwegian doctors differ in their practice patterns. DESIGN Observational study. SETTING Out-of-hours (OOH) emergency primary healthcare in Norway, 2008. PARTICIPANTS All primary care physicians doing OOH work, altogether 4165 physicians. MAIN OUTCOME MEASURES Number of patient contacts per doctor. Use of laboratory tests, minor surgery, sickness certification and length of consultations. Use of diagnoses related to psychiatric and sexual health. Choice of management strategy with psychiatric patients (psychotherapy or hospitalisation). RESULTS 21.4% of the physicians were immigrants, and they had 30.6% of the patient contacts. Immigrant doctors from Asia, Africa and Latin America had most patient contacts, 633 (95% CI 549 to 716), while native Norwegian doctors had 306 (95% CI 288 to 325). In multivariate analyses, immigrant physicians did not differ significantly from native Norwegians regarding use of laboratory tests, minor surgery or length of consultations, but immigrant doctors wrote more sickness certificates, OR 1.75 (95% CI 1.24 to 2.47) for immigrant doctors from Europe, North America and Oceania versus native Norwegian doctors and OR 1.56 (95% CI 1.15 to 2.11) for immigrant doctors from Asia, Africa and Latin America versus native Norwegians. Immigrant physicians from Europe, North America and Oceania used more diagnoses related to pregnancy, family planning and female genitals, OR 1.55 (95% CI 1.11 to 2.16), versus native Norwegian physicians. Immigrant doctors from Asia, Africa and Latin America used less psychiatric diagnoses, OR 0.71 (95% CI 0.53 to 0.95), versus native Norwegian doctors but did not differ significantly in their management of recognised psychiatric illness. CONCLUSIONS Immigrant doctors make an important contribution to OOH emergency primary healthcare in Norway. The authors found only modest evidence that their clinical practice patterns are different from that of native Norwegian doctors.
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Affiliation(s)
- Hogne Sandvik
- National Centre for Emergency Primary Health Care, Uni Health, Uni Research, Bergen, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, Uni Health, Uni Research and Research Group for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Esperanza Diaz
- Research Group for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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Slowther A, Lewando Hundt GA, Purkis J, Taylor R. Experiences of non-UK-qualified doctors working within the UK regulatory framework: a qualitative study. J R Soc Med 2012; 105:157-65. [PMID: 22408082 DOI: 10.1258/jrsm.2011.110256] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore the experience of non-UK-qualified doctors in working within the regulatory framework of the General Medical Council (GMC) document Good Medical Practice. DESIGN Individual interviews and focus groups. SETTING United Kingdom. PARTICIPANTS Non-UK-qualified doctors who had registered with the GMC between 1 April 2006 and 31 March 2008, doctors attending training/induction programmes for non-UK-qualified doctors, and key informants involved in training and support for non-UK-qualified doctors. MAIN OUTCOME MEASURES Themes identified from analysis of interview and focus group transcripts. RESULTS Information and support for non-UK qualified doctors who apply to register to work in the UK has little reference to the ethical and professional standards required of doctors working in the UK. Recognition of the ethical, legal and cultural context of UK healthcare occurs once doctors are working in practice. Non-UK qualified doctors reported clear differences in the ethical and legal framework for practising medicine between the UK and their country of qualification, particularly in the model of the doctor-patient relationship. The degree of support for non-UK-qualified doctors in dealing with ethical concerns is related to the type of post they work in. European doctors describe similar difficulties with working in an unfamiliar regulatory framework to their non-European colleagues. CONCLUSIONS Non-UK-qualified doctors experience a number of difficulties related to practising within a different ethical and professional regulatory framework. Provision of information and educational resources before registration, together with in-practice support would help to develop a more effective understanding of GMP and its implications for practice in the UK.
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Affiliation(s)
- A Slowther
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
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Chen PG, Curry LA, Nunez-Smith M, Bradley EH, Desai MM. Career satisfaction in primary care: a comparison of international and US medical graduates. J Gen Intern Med 2012; 27:147-52. [PMID: 21866306 PMCID: PMC3270248 DOI: 10.1007/s11606-011-1832-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 06/20/2011] [Accepted: 08/05/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND International medical graduates (IMGs) have substantial representation among primary care physicians in the USA and consistently report lower career satisfaction compared with US medical graduates (USMGs). Low career satisfaction has adverse consequences on physician recruitment and retention. OBJECTIVE This study aims to identify factors that may account for or explain lower rates of career satisfaction in IMGs compared with USMGs. DESIGN Using data from the 2008 Health Tracking Physician Survey, a nationally representative survey, we examined the association between IMG status and career satisfaction among primary care physicians. We used multivariable logistic regression modeling to adjust for a broad range of potential explanatory factors and physician characteristics. PARTICIPANTS The study participants comprise primary care physicians who reported at least 20 h a week of direct patient care activities (N = 1,890). MAIN MEASURES The main measures include respondents' overall satisfaction with their careers in medicine. KEY RESULTS IMGs were statistically significantly less likely than USMGs to report career satisfaction (75.7% vs. 82.3%; p = 0.005). This difference persisted after adjusting for physician characteristics and variables describing the practice environment (adjusted odds ratio = 0.62; 95% confidence interval, 0.43-0.90). Pediatricians (vs. internists) and those who earned $200,001-250,000 (vs. <$100,000) or >$250,000 were more likely to report career satisfaction, while solo practitioners and those who reported being unable to provide high-quality patient care were less likely to report career satisfaction. CONCLUSIONS After adjusting for a number of variables previously shown to have an impact on career satisfaction, we were unable to identify additional factors that could account for or explain differences in career satisfaction between IMGs and USMGs. In light of the central role of IMGs in primary care, the potential impact of poorer satisfaction among IMGs may be substantial. Improved understanding of the causes of this differential satisfaction is important to appropriately support the primary care physician workforce.
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Affiliation(s)
- Peggy G Chen
- Division of Health Policy and Administration, Yale School of Public Health, 47 College Street, New Haven, CT 06520-8088, USA.
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Chen PGC, Curry LA, Bernheim SM, Berg D, Gozu A, Nunez-Smith M. Professional challenges of non-U.S.-born international medical graduates and recommendations for support during residency training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:1383-8. [PMID: 21952056 PMCID: PMC3257160 DOI: 10.1097/acm.0b013e31823035e1] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE Despite a long history of international medical graduates (IMGs) coming to the United States for residencies, little research has been done to find systematic ways in which residency programs can support IMGs during this vulnerable transition. The authors interviewed a diverse group of IMGs to identify challenges that might be eased by targeted interventions provided within the structure of residency training. METHOD In a qualitative study conducted between March 2008 and April 2009, the authors contacted 27 non-U.S.-born IMGs with the goal of conducting qualitative interviews with a purposeful sample. The authors conducted in-person, in-depth interviews using a standardized interview guide with potential probes. All participants were primary care practitioners in New York, New Jersey, or Connecticut. RESULTS A total of 25 IMGs (93%) participated. Interviews and subsequent analysis produced four themes that highlight challenges faced by IMGs: (1) Respondents must simultaneously navigate dual learning curves as immigrants and as residents, (2) IMGs face insensitivity and isolation in the workplace, (3) IMGs' migration has personal and global costs, and (4) IMGs face specific needs as they prepare to complete their residency training. The authors used these themes to inform recommendations to residency directors who train IMGs. CONCLUSIONS Residency is a period in which key elements of professional identity and behavior are established. IMGs are a significant and growing segment of the physician workforce. Understanding particular challenges faced by this group can inform efforts to strengthen support for them during postgraduate training.
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Affiliation(s)
- Peggy Guey-Chi Chen
- Division of Health Policy and Administration, Yale University School of Public Health, New Haven, Connecticut 06520-8088, USA.
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Hausmann-Stabile C, Zayas LH, Hauser D, Carvajal C, Mejia C, Nieves D. Challenges and Solutions for Latin American-Trained International Medical Graduates in Psychiatry Residency. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2011; 40:29-40. [DOI: 10.2753/imh0020-7411400302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Luis H. Zayas
- b Center for Latino Family Research, Washington University in St Louis
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Jain P, Krieger JL. Moving beyond the language barrier: the communication strategies used by international medical graduates in intercultural medical encounters. PATIENT EDUCATION AND COUNSELING 2011; 84:98-104. [PMID: 20638218 DOI: 10.1016/j.pec.2010.06.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 06/11/2010] [Accepted: 06/16/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To understand the communication strategies international medical graduates use in medical interactions to overcome language and cultural barriers. METHODS In-depth interviews were conducted with 12 international physicians completing their residency training in internal medicine in a large hospital in Midwestern Ohio. The interview explored (a) barriers participants encountered while communicating with their patients regarding language, affect, and culture, and (b) communication convergence strategies used to make the interaction meaningful. RESULTS International physicians use multiple convergence strategies when interacting with their patients to account for the intercultural and intergroup differences, including repeating information, changing speaking styles, and using non-verbal communication. PRACTICE IMPLICATIONS Understanding barriers to communication faced by international physicians and recognizing accommodation strategies they employ in the interaction could help in training of future international doctors who come to the U.S. to practice medicine. Early intervention could reduce the time international physicians spend navigating through the system and trying to learn by experimenting with different strategies which will allow these physicians to devote more time to patient care. We recommend developing a training manual that is instructive of the socio-cultural practices of the region where international physician will start practicing medicine.
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Affiliation(s)
- Parul Jain
- School of Communication, The Ohio State University, USA.
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Chen PGC, Nunez-Smith M, Bernheim SM, Berg D, Gozu A, Curry LA. Professional experiences of international medical graduates practicing primary care in the United States. J Gen Intern Med 2010; 25:947-53. [PMID: 20502974 PMCID: PMC2917670 DOI: 10.1007/s11606-010-1401-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 05/03/2010] [Accepted: 05/05/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited. OBJECTIVE To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US. DESIGN Qualitative study based on in-depth in-person interviews. PARTICIPANTS Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut. APPROACH A standardized interview guide was used to explore professional experiences of IMGs. KEY RESULTS Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of "the deal"; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace. CONCLUSIONS Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs' experiences may also improve the experiences of an increasingly diverse healthcare workforce.
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Affiliation(s)
- Peggy Guey-Chi Chen
- Robert Wood Johnson Foundation Clinical Scholars, Yale University School of Medicine, 333 Cedar Street; IE-61 SHM, PO Box 208088, New Haven, CT 06520-8088, USA.
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Hill TE. How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research. Philos Ethics Humanit Med 2010; 5:11. [PMID: 20618947 PMCID: PMC2914676 DOI: 10.1186/1747-5341-5-11] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 07/09/2010] [Indexed: 05/09/2023] Open
Abstract
Physicians, nurses, and other clinicians readily acknowledge being troubled by encounters with patients who trigger moral judgments. For decades social scientists have noted that moral judgment of patients is pervasive, occurring not only in egregious and criminal cases but also in everyday situations in which appraisals of patients' social worth and culpability are routine. There is scant literature, however, on the actual prevalence and dynamics of moral judgment in healthcare. The indirect evidence available suggests that moral appraisals function via a complex calculus that reflects variation in patient characteristics, clinician characteristics, task, and organizational factors. The full impact of moral judgment on healthcare relationships, patient outcomes, and clinicians' own well-being is yet unknown. The paucity of attention to moral judgment, despite its significance for patient-centered care, communication, empathy, professionalism, healthcare education, stereotyping, and outcome disparities, represents a blind spot that merits explanation and repair. New methodologies in social psychology and neuroscience have yielded models for how moral judgment operates in healthcare and how research in this area should proceed. Clinicians, educators, and researchers would do well to recognize both the legitimate and illegitimate moral appraisals that are apt to occur in healthcare settings.
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Affiliation(s)
- Terry E Hill
- Department of Medicine, University of California, San Francisco, USA.
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Gozu A, Kern DE, Wright SM. Similarities and differences between international medical graduates and U.S. medical graduates at six Maryland community-based internal medicine residency training programs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:385-390. [PMID: 19240453 DOI: 10.1097/acm.0b013e318197321b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE Approximately 25% of practicing physicians in the United States are graduates of medical schools in other countries; they are called international medical graduates (IMGs). Their transition into the U.S. health care system may be difficult and challenging. This study sought to identify the similarities and differences between IMGs and U.S. medical graduates (USMGs) working together in residency training programs. METHOD In 2006, the authors conducted a cross-sectional survey study of house officers (interns and residents) at six internal medicine (IM) community-based residency programs in Baltimore, Maryland. The survey asked about demographics, relocation for residency training, practice experience, and career plans and included four previously validated instruments: the Iowa Fatigue Scale, Cohen's Perceived Stress Scale, Rosenberg's Self-Esteem Scale, and the Personal Growth Scale. RESULTS Of 225 potential house officers, 176 (78%) responded. In multivariable modeling, independent characteristics that differentiated IMGs from USMGs were that IMGs had (1) a native language other than English (odds ratio [OR] 18.3, 95% CI: 5.8-57.3), (2) less debt (<$50K) upon graduation from medical school (OR 7.3, 2.5-21.2), and (3) experiences practicing medicine before residency training (OR 41.02, 1.6-1017). With modeling to control for these three differences, the authors found IMGs to have lower fatigue (OR 2.7; 1.2-6.0), higher self-esteem (OR 3.0; 1.2-7.5), and greater personal growth scores (OR 3.6; 1.6-8.2). CONCLUSIONS Differences exist between the IMGs and USMGs who are working together in community-based IM residency training programs. Considering such differences may help educators and program directors trying to support and train this diverse cadre of trainees.
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Affiliation(s)
- Aysegul Gozu
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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McGrail KA, Morse DS, Glessner T, Gardner K. "What is found there": qualitative analysis of physician-nurse collaboration stories. J Gen Intern Med 2009; 24:198-204. [PMID: 19089507 PMCID: PMC2628997 DOI: 10.1007/s11606-008-0869-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2007] [Revised: 08/06/2008] [Accepted: 11/11/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effective physician-nurse collaboration is an important, but incompletely understood determinant of patient and nurse satisfaction, and patient safety. Its impact on physicians has not been described. This study was undertaken to develop a fuller understanding of the collaboration experience and its outcomes. METHODS Twenty-five medical residents, 32 staff nurses, 5 physician and 5 nurse faculty wrote narratives about successful collaboration; the narratives were then qualitatively analyzed. Narrative analysis was the initial qualitative method iteratively employed to identify themes. A phenomenological approach was subsequently used to develop a framework for collaborative competence. RESULTS Collaboration triggers, facilitative behaviors, outcomes and collaborative competence were the themes identified. Affect was identified in the triggers leading to collaboration and in its outcomes. Practioners typically entered a care episode feeling worried, uncertain or inadequate and finished the interaction feeling satisfied, understood and grateful to their colleagues. The frequency of affective experience was not altered by gender, profession, or ethnicity. These experiences were particularly powerful for novice practioners of both disciplines and appear to have both formative and transformative potential. Collaborative competence was characterized by a series of graduated skills in clinical and relational domains. Many stories took place in the ICU and afterhours settings. CONCLUSIONS Despite the prevailing wisdom that nursing and medicine are qualitatively different, the stories from this study illuminate surprising commonalities in the collaboration experience, regardless of gender, age, experience, or profession. Collaborative competence can be defined and its component skills identified. Contexts of care can be identified that offer particularly rich opportunities to foster interprofessional collaboration.
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Affiliation(s)
- Kathleen A McGrail
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Kaafarani HMA. International medical graduates in surgery: facing challenges and breaking stereotypes. Am J Surg 2008; 198:153-4. [PMID: 19095214 DOI: 10.1016/j.amjsurg.2008.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 08/07/2008] [Accepted: 08/08/2008] [Indexed: 11/18/2022]
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Lopez L, Vranceanu AM, Cohen AP, Betancourt J, Weissman JS. Personal characteristics associated with resident physicians' self perceptions of preparedness to deliver cross-cultural care. J Gen Intern Med 2008; 23:1953-8. [PMID: 18807099 PMCID: PMC2596517 DOI: 10.1007/s11606-008-0782-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 01/09/2008] [Accepted: 08/22/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent reports from the Institute of Medicine emphasize patient-centered care and cross-cultural training as a means of improving the quality of medical care and eliminating racial and ethnic disparities. OBJECTIVE To determine whether, controlling for training received in medical school or during residency, resident physician socio-cultural characteristics influence self-perceived preparedness and skill in delivering cross-cultural care. DESIGN National survey of resident physicians. PARTICIPANTS A probability sample of residents in seven specialties in their final year of training at US academic health centers. MEASUREMENT Nine resident characteristics were analyzed. Differences in preparedness and skill were assessed using the chi(2) statistic and multivariate logistic regression. RESULTS Fifty-eight percent (2047/3500) of residents responded. The most important factor associated with improved perceived skill level in performing selected tasks or services believed to be useful in treating culturally diverse patients was having received cross-cultural skills training during residency (OR range 1.71-4.22). Compared with white residents, African American physicians felt more prepared to deal with patients with distrust in the US healthcare system (OR 1.63) and with racial or ethnic minorities (OR 1.61), Latinos reported feeling more prepared to deal with new immigrants (OR 1.88) and Asians reported feeling more prepared to deal with patients with health beliefs at odds with Western medicine (1.43). CONCLUSIONS Cross-cultural care skills training is associated with increased self-perceived preparedness to care for diverse patient populations providing support for the importance of such training in graduate medical education. In addition, selected resident characteristics are associated with being more or less prepared for different aspects of cross-cultural care. This underscores the need to both include medical residents from diverse backgrounds in all training programs and tailor such programs to individual resident needs in order to maximize the chances that such training is likely to have an impact on the quality of care.
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Affiliation(s)
- Lenny Lopez
- Department of Medicine, Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Legassie J, Zibrowski EM, Goldszmidt MA. Measuring resident well-being: impostorism and burnout syndrome in residency. J Gen Intern Med 2008; 23:1090-4. [PMID: 18612750 PMCID: PMC2517942 DOI: 10.1007/s11606-008-0536-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Assessing resident well-being is becoming increasingly important from a programmatic standpoint. Two measures that have been used to assess this are the Clance Impostor Scale (CIS) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). However, little is known about the relationship between the two phenomena. OBJECTIVES To explore the prevalence and association between impostorism and burnout syndrome in a sample of internal medicine residents. DESIGN Anonymous, cross-sectional postal survey. PARTICIPANTS Forty-eight internal medicine residents (postgraduate year [PGY] 1-3) at the Schulich School of Medicine & Dentistry (62.3% response rate). MEASUREMENTS AND MAIN RESULTS Short demographic questionnaire, CIS and MBI-HSS. Impostorism and burnout syndrome were identified in 43.8% and 12.5% of residents, respectively. With the exception of a negative correlation between CIS scores and the MBI's personal accomplishment subscale (r = -.30; 95% CI -.54 to -.02), no other significant relations were identified. Foreign-trained residents were more likely to score as impostors (odds ratio [OR] 10.7; 95% CI 1.2 to 98.2) while senior residents were more likely to experience burnout syndrome (OR 16.5 95% CI 1.6 to 168.5). CONCLUSIONS Both impostorism and burnout syndrome appear to be threats to resident well-being in our program. The lack of relationship between the two would suggest that programs and researchers wishing to address the issue of resident distress should consider using both measures. The finding that foreign-trained residents appear to be more susceptible to impostorism warrants further study.
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Affiliation(s)
- Jenny Legassie
- Division of Internal Medicine, Department of Medicine, London Health Sciences Centre, London, ON, Canada
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Pilotto LS, Duncan GF, Anderson-Wurf J. Issues for clinicians training international medical graduates: a systematic review. Med J Aust 2007; 187:225-8. [PMID: 17708725 DOI: 10.5694/j.1326-5377.2007.tb01204.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 05/31/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To ascertain the specialised communication issues clinicians need to understand when preparing international medical graduates (IMGs) for clinical practice in Australia. STUDY DESIGN Systematic review. DATA SOURCES A series of searches using MEDLINE (1990-2006) was conducted with relevant keywords. Literature from countries with experience in the integration of IMGs into their medical workforces was included. All except four articles were published between 1997 and 2006. STUDY SELECTION The initial search identified 748 articles, which reduced to 234 evidence-based English language articles for review. Of these, only articles relating to postgraduate medical training and overseas trained doctors were selected for inclusion. DATA EXTRACTION Titles and abstracts were independently reviewed by two reviewers, with a concordance rate of 0.9. Articles were included if they addressed communication needs of IMGs in training. Any disparities between reviewers about which articles to include were discussed and resolved by consensus. DATA SYNTHESIS Key issues that emerged were the need for IMGs to adjust to a change in status; the need for clinicians to understand the high level of English language proficiency required by IMGs; the need for clinicians to develop IMGs' skills in communicating with patients; the need for clinicians to understand IMGs' expectations about teaching and learning; and the need for IMGs to be able to interact effectively with a range of people. CONCLUSION Training organisations need to ensure that clinicians are aware of the communication issues facing IMGs and equip them with the skills and tools to deal with the problems that may arise.
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Affiliation(s)
- Louis S Pilotto
- Rural Clinical School, University of New South Wales, Wagga Wagga, NSW, Australia.
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Woods SE, Harju A, Rao S, Koo J, Kini D. Perceived Biases and Prejudices Experienced by International Medical Graduates in the US Post-Graduate Medical Education System. MEDICAL EDUCATION ONLINE 2006; 11:4595. [PMID: 28253800 DOI: 10.3402/meo.v11i.4595] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose - The purpose of this project was to collect qualitative data on the types of bias and prejudices experienced by international medical graduates (IMGs) in the US graduate medical education system. Methods - We conducted thirty-six qualitative interviews from a single internal medicine residency program in a large mid-western city over a four-year time period. The study population consisted of 33 IMGs and 3 USMGs. Results - The data aggregated into four major themes; the externship requirements of residency programs for IMGs, difficult interview experiences, US medical students are critical of residency programs with IMGs, and greater difficulties for IMGs finding employment after residency. Conclusion - The IMGs from one Internal Medicine residency program in the US post-graduate medical system self-reported considerable bias and prejudice.
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Affiliation(s)
- Scott E Woods
- a Bethesda Family Medicine Residency Program Cincinnati, Ohio USA
| | - Aaron Harju
- a Bethesda Family Medicine Residency Program Cincinnati, Ohio USA
| | - Shoba Rao
- a Bethesda Family Medicine Residency Program Cincinnati, Ohio USA
| | - Julie Koo
- a Bethesda Family Medicine Residency Program Cincinnati, Ohio USA
| | - Divya Kini
- a Bethesda Family Medicine Residency Program Cincinnati, Ohio USA
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Rao NR, Rao UK, Cooper RA. Indian medical students' views on immigration for training and practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:185-8. [PMID: 16436584 DOI: 10.1097/00001888-200602000-00015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE To assess the attitudes of medical students in India about participating in graduate medical education in the United States and other countries and in subsequent clinical practice in those countries. METHOD A total of 240 students who were attending their final year at two medical schools in Bangalore, India, were surveyed during 2004. Surveys were completed by 166 (69%) of the students. RESULTS Among the responding students, 98 (59%) thought of leaving India for further training abroad. Of those who wished to leave, 41 (42%) preferred the United States, 42 (43%) preferred the United Kingdom, and 9 (9%) preferred Canada, Australia or New Zealand. Only two students preferred the Middle East. Most who favored training in the United States indicated that they intended to remain after training, whereas fewer than 20% of those who favored training in the United Kingdom had such intentions. While more than 60% perceived greater professional opportunities in the United States than in India, approximately 75% were concerned that the United States had become less welcoming after the terrorist attacks of 9/11, and similar numbers were concerned about the examination administered by the Educational Commission on Foreign Medical Graduates. Conversely, the majority of respondents felt that opportunities for physicians in India were improving. CONCLUSIONS While optimism about future medical careers in India is increasing, the interest of Indian medical students in training and subsequently practicing in the United States remains high.
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Affiliation(s)
- Nyapati R Rao
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Suite 314, Philadelphia, PA 19104-6218, USA
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Kuczkowski KM. A (bittersweet?) taste of “American pie”: foreign medical school graduates in the US postgraduate medical work force. Arch Gynecol Obstet 2005; 273:131-2. [PMID: 15650836 DOI: 10.1007/s00404-004-0704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2004] [Accepted: 10/12/2004] [Indexed: 11/27/2022]
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Kuczkowski KM. International medical school graduates in American medicine: is there the “dark side of the moon”? Acta Obstet Gynecol Scand 2004; 83:1228-9. [PMID: 15548165 DOI: 10.1111/j.0001-6349.2004.0452a.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kinchen KS, Cooper LA, Wang NY, Levine D, Powe NR. The impact of international medical graduate status on primary care physicians' choice of specialist. Med Care 2004; 42:747-55. [PMID: 15258476 DOI: 10.1097/01.mlr.0000132352.06741.d4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately one fourth of practicing physicians in the United States graduated from medical schools in other countries. It is unknown how the role of international medical graduate status affects physician decision-making. OBJECTIVE The objective of this study was to determine whether a primary care physicians' knowledge of a specialist's international medical graduate status affects his or her decision to refer patients to that specialist. RESEARCH DESIGN AND SUBJECTS We studied a national, cross-sectional study of primary care physicians who see adult patients. The sample was drawn from the American Medical Association Physician's Professional Data. Each physician received 2 clinical case vignettes describing a patient for whom referral to a specialist was considered necessary. Each vignette was followed by 5 vignette specialist descriptions with medical school graduate status varied randomly alongside other physician characteristics. MEASURE We measured the decision to refer to an international versus U.S. medical graduate specialist. RESULTS Of 1054 eligible physicians, 623 (59.1%) responded. Respondents were significantly more likely to refer to a U.S. medical graduate (USMG) compared with an international medical graduate (IMG) (63% vs. 54%, P <0.05). After adjustment for age, race, sex, and referral characteristics of the vignette specialists, a positive referral decision was noted in a higher proportion of vignettes in which the vignette specialist was described as a USMG versus an IMG (63% vs. 51%, P <0.05). CONCLUSION With other factors being equal, vignette specialists described as IMGs versus USMGs were significantly less likely to be associated with a positive referral decision. Although specialist IMG status, relative to other factors, might not have a major effect on referral decisions, it is possible that negative views of international medical graduates could lead to suboptimal choices in referral decisions. Potentially, a patient could be referred to an USMG who happens to have inferior clinical skills than an IMG with superior clinical skills.
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Affiliation(s)
- Kraig S Kinchen
- Robert Wood Johnson Clinical Scholars Program, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Kuczkowski KM. “A taste of honey?” (or not?): international medical graduates in North American medicine. Can J Anaesth 2004; 51:514. [PMID: 15128641 DOI: 10.1007/bf03018317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kuczkowski KM. Pursuing your American (medical) dream: a "stairway to heaven?" or not? Acta Anaesthesiol Scand 2004; 48:257. [PMID: 14995953 DOI: 10.1111/j.0001-5172.2004.00295c.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
There has been sentiment against international medical graduates (IMGs) that could lead to a reduction in their future supply within the US. In this study, an analytical framework is proposed to illustrate the many issues that need to be considered in replacing IMGs in rural, needy areas. To learn about possible approaches to IMG replacement, interviews with 15 recruiters and planners at the local, regional and state levels in four states with strong IMG concentrations were conducted. Through analysis of participants' comments, this study shows that every posited solution to replacing IMGs has serious flaws.
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Affiliation(s)
- Leonard D Baer
- Department of Geography, Lancaster University, Lancaster LA1 4YB, UK.
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Bates J, Andrew R. Untangling the roots of some IMG's poor academic performance. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2001; 76:43-6. [PMID: 11154193 DOI: 10.1097/00001888-200101000-00012] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- J Bates
- Faculty of Medicine, University of British Columbia, Canada
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