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Steele S, Andrade G, Shantakumari N, Panigrahi D. Medical school origins of award-winning physicians; analysis of a complete national dataset. BMC Med Educ 2024; 24:268. [PMID: 38459549 PMCID: PMC10924332 DOI: 10.1186/s12909-024-05200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/19/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Educators and medical students share the same objective of achieving success in medical practice. Both groups consider doctors' successes to include optimum patient care outcomes and positive career progressions. Accordingly, identifying common educational features of such high-achieving doctors facilitates the generation of excellence amongst future medical trainees. In this study we use data from the British clinical merit award schemes as outcome measures in order to identify medical school origins of doctors who have achieved national or international prominence. METHODS Britain has Clinical Excellence Awards/Distinction Awards schemes that financially reward all National Health Service doctors in England, Scotland and Wales who are classified as high achievers. We used these outcome measures in a quantitative observational analysis of the 2019-20 dataset of all 901 national award-winning doctors. Where appropriate, Pearson's Chi-Square test was applied. RESULTS The top five medical schools (London university medical schools, Glasgow, Edinburgh, Oxford and Cambridge) were responsible for 51.2% of the physician merit award-winners in the 2019-20 round, despite the dataset representing 85 medical schools. 91.4% of the physician merit award-winners were from European medical schools. The lowest national award-winners (tier 3) originated from 61 medical schools representing six continents. International medical graduates comprised 11.4% of all award-winners. CONCLUSIONS The majority of physicians who were national merit award-winners originated from only five, apparently overrepresented, UK university medical schools. In contrast, there was a greater diversity in medical school origin among the lower grade national merit awards; the largest number of international medical graduates were in these tier 3 awards (13.3%). As well as ranking educationally successful university medical schools, this study assists UK and international students, by providing a roadmap for rational decision making when selecting physician and non-physician medical education pathways that are more likely to fulfil their career ambitions.
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Affiliation(s)
- Sinclair Steele
- College of Medicine, Ajman University, University Street, Al Jerf 1, Ajman, UAE.
| | - Gabriel Andrade
- College of Medicine, Ajman University, University Street, Al Jerf 1, Ajman, UAE
| | - Nisha Shantakumari
- College of Medicine, Ajman University, University Street, Al Jerf 1, Ajman, UAE
| | - Debadatta Panigrahi
- College of Medicine, Ajman University, University Street, Al Jerf 1, Ajman, UAE
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Hunter DD, Campbell RL, Mullan AF, Anderson JR, Homme JL. Relationship between individual and country-level socio-economic background, USMLE step scores, and demographics of international medical graduates and residency match results. BMC Med Educ 2024; 24:108. [PMID: 38303066 PMCID: PMC10835816 DOI: 10.1186/s12909-024-05052-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Twenty five percent of practicing physicians in the US are International Medical Graduates (IMGs) - physicians who completed their medical school training outside of the United States and Canada. There are multiple studies demonstrating higher socio-economic background is associated with medical school matriculation in the US. However, despite a substantial prevalence of IMGs in the American healthcare system, studies of the association between demographics, socio-economic background, and securing a residency position in the match are lacking. METHODS We created a survey with questions on residency match-related data and information on personal socio-economic background. An invitation to participate in the study was sent to all IMGs that applied to the included residency programs after the conclusion of the 2022 residency match. We used multivariable logistic regression to compare survey responses to the odds of securing a residency match. RESULTS The total number of survey respondents was 744 (response rate 15.1%). We found that younger age, higher United States Medical License Examination (USMLE) scores, higher-income country of origin (including the United States), fewer match attempts, applying to fewer specialties, having parents with college degree or higher, and coming from higher-than-average or lower-than-average family income were independently associated with increased odds of matching. Gender, personal income, and visa status did not demonstrate significant associations with residency match. CONCLUSIONS Residency match is a significant expense for IMGs, especially for those from lower-income countries. International applicants from higher socio-economic backgrounds might have advantages in securing medical residency positions in the United States when controlling for other variables.
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Affiliation(s)
- Daria D Hunter
- Department of Emergency Medicine, Mayo Clinic, Generose G-410, 200 2nd Stree, t, Rochester, MN, 55905, USA.
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Generose G-410, 200 2nd Stree, t, Rochester, MN, 55905, USA
| | - Aidan F Mullan
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Joel R Anderson
- Department of Emergency Medicine, Mayo Clinic, Generose G-410, 200 2nd Stree, t, Rochester, MN, 55905, USA
| | - James L Homme
- Department of Emergency Medicine, Mayo Clinic, Generose G-410, 200 2nd Stree, t, Rochester, MN, 55905, USA
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Chakma S, Wang H, English M, Namedre M, Hill E, Nagraj S. The role of medical support workers during the COVID-19 pandemic in the NHS in the UK: A qualitative service evaluation at the Oxford University Hospitals NHS Foundation Trust. Clin Med (Lond) 2024; 24:100006. [PMID: 38354621 PMCID: PMC11024825 DOI: 10.1016/j.clinme.2023.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
We conducted a service evaluation of the medical support worker (MSW) role at Oxford University Hospitals NHS Foundation Trust following the Coronavirus 2019 (COVID-19) pandemic. The aim was to explore the roles of MSWs, their contributions to the NHS, factors influencing their career choices, and the goals of the MSW position, to inform quality improvement in relation to their integration into the Trust. The perspectives of MSWs, their supervisors and recruiters were analysed through nine semi-structured interviews and two focus group discussions involving 18 participants. Results were categorised into micro-, meso-, and macro-levels of the health system. At the micro-level, MSWs were recognised as a diverse group of highly qualified international medical graduates (IMGs) who had a crucial role during the pandemic. At the meso-level, participants emphasised the importance of a comprehensive induction by the hospital, to clarify responsibilities and familiarise MSWs with the health system. At the macro-level, the role facilitated MSW integration within the NHS, with the aim of practising as doctors. The importance of comprehensive hospital induction, with role clarity for both MSWs and their teams, supportive supervision and assistance with applying for registration with the General Medical Council, were highlighted as key quality improvement areas.
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Affiliation(s)
- Samprita Chakma
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Hanyu Wang
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Mike English
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK; KEMRI-Wellcome Trust Research Programme, KEMRI-Wellcome Trust, Nairobi, Kenya
| | | | - Elaine Hill
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shobhana Nagraj
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Mannes MM, Thornley DJ, Wilkinson TJ. Cross-cultural code-switching - the impact on international medical graduates in New Zealand. BMC Med Educ 2023; 23:920. [PMID: 38053141 DOI: 10.1186/s12909-023-04900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND New Zealand relies on International Medical Graduates (IMGs); however, the retention of IMGs is not optimal. This research uses a lens of cross-cultural code-switching to explore how professional and cultural differences impact on International Medical Graduates' (IMGs') journeys to practise effectively and remain in New Zealand. METHODS Utilising theory-informing inductive analysis within a constructivist approach, framework analysis was conducted following 14 face-to-face interviews with IMGs. The analysis then explored the degree to which their experiences could be explained by cross-cultural code-switching's psychological challenges (authenticity, competence, and resentment). RESULTS Analysis showed there was an expectation for IMGs to code-switch. The greater the cultural and professional difference of IMGs (compared to New Zealand), the greater the intensity of psychological challenges experienced when switching. Moreover, IMGs received minimal support, making it difficult to overcome psychological challenges, especially the competence challenge. This led to feelings of frustration and vulnerability. Code-switching could also explain why complaints about IMGs were more likely when IMGs were stressed or tired. CONCLUSION Cross-cultural code-switching can be used to explain and identify how cultural differences cause psychological challenges. These findings inform how programmes can better support IMGs in orientation and ongoing training. Additionally, establishing, and allocating IMG cultural mentors would assist in addressing IMGs' vulnerability and isolation. With this support, the journey may prove more manageable and encourage IMGs to continue practising in their adopted country.
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Affiliation(s)
- Mariska M Mannes
- School of Social Sciences, University of Otago Dunedin, PO Box 56, Dunedin, 9054, New Zealand.
| | - Davinia J Thornley
- School of Social Sciences - Media, Film and Communication, University of Otago Dunedin, Dunedin, New Zealand
| | - Tim J Wilkinson
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Adhiyaman V, Hobson P, Sundaram R, Williams L. What are the precise reasons for the disparity in referrals to fitness to practise between international and UK medical graduates? Med Leg J 2023; 91:198-203. [PMID: 37793643 DOI: 10.1177/00258172231184551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
PURPOSE OF THE STUDY To discover the precise reasons for referring a doctor to the Medical Practitioners Tribunal Service, and whether there are any disparities between referrals of international medical graduates and UK graduates. Further to consider whether understanding the precise reasons would provide insight into the nature of referrals. STUDY DESIGN We collected and analysed the data from the Medical Practitioners Tribunal Service website over a period of 12 months. RESULTS There were 228 cases of which 142 (62%) were international medical graduates and 86 (38%) were UK graduates. More international medical graduates were referred for professional misconduct, poor performance and lack of adequate English language. The common reasons for professional misconduct were providing sub-optimal care, sexual misconduct and dishonest behaviour. More UK graduates were referred following convictions due to offences related to alcohol intake and financial dishonesty. There is paucity of good quality information to identify the exact reasons for the disparity. CONCLUSION More international medical graduates were referred to the Medical Practitioners Tribunal Service than UK graduates. There was disparity in the nature of the referrals and we hope our findings will inform employers and the regulatory bodies to understand that comprehensive induction, inclusion, mentoring and adjustments are needed to support international medical graduates to mitigate the risks of failure and help them to meet the required professional standards.
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Khoshpouri P, Mohseni A, Dabiri M, Ansari G, Zadeh FS, Ataeinia B, Saadat N, Sherbaf FG, Yousem DM. International Medical Graduates in Radiology Residencies: Demographics, Performance, and Visa Issues. Acad Radiol 2023; 30:3124-3134. [PMID: 37183141 DOI: 10.1016/j.acra.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023]
Abstract
RATIONALE AND OBJECTIVES The number of international medical graduates (IMG) in radiology residencies has varied from year to year even as the number of candidates continues to grow. It is unclear from which countries the IMGs are arriving and what visas are being used to accommodate them. MATERIALS AND METHODS We sent a survey to 195 program directors (PD) in diagnostic radiology (DR) inquiring about the number and nationality of IMG residents in their program, their attitudes about IMG candidates, the performance of their IMG trainees, and the visas that are offered. RESULTS We received responses from 121 of 195 (62.1%) DR programs (121/149 =81.2% of actionable emails). 80/121 (66.1%) had at least one IMG in their DR residency program and the countries of origin included India (36), Iran (30), Saudi Arabia (24), Egypt (16), Canada (14), Brazil (14), and Pakistan (9), as the most common. While most programs (76/104, 73.1%) offered J1 visas, 23/99 (23.2%) provided H-1B visas to trainees. IMG DR residents overall performed as well as American graduates, with an equal number of PDs saying IMGs performed better and worse than American graduates. PDs' issues with IMGs centered on visas: (1) expense, (2) lack of familiarity, (3) Educational Commission for Foreign Medical Graduates regulations, and (4) time commitment in submitting paperwork. CONCLUSION Most radiology IMG residents originate from India and Middle Eastern countries. Once enrolled, IMG residents perform similarly to US graduates. However, adding IMG candidates to the training program requires overcoming bureaucratic and monetary hurdles around visas. SUMMARY SENTENCE Most DR international medical graduate residents are from India or the Middle East. Although their performance is the same as American graduates in general, PDs note the monetary and bureaucratic hassles accompanying their recruitment.
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Affiliation(s)
- Parisa Khoshpouri
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada (P.K.)
| | - Alireza Mohseni
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland (A.M., G.A., D.M.Y.)
| | - Mona Dabiri
- Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran (M.D.)
| | - Golnoosh Ansari
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland (A.M., G.A., D.M.Y.)
| | | | - Bahar Ataeinia
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (B.A.)
| | - Niloufar Saadat
- Department of Radiology, University of Texas Southwestern, Dallas, Texas (N.S.)
| | - Farzaneh Ghazi Sherbaf
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, California (F.G.S.)
| | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland (A.M., G.A., D.M.Y.).
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Olatunde OA. Differences between international medical graduates and Canadian medical graduates in a medical learning environment: From matching to residency and beyond. J Family Med Prim Care 2023; 12:3055-3063. [PMID: 38361893 PMCID: PMC10866215 DOI: 10.4103/jfmpc.jfmpc_1714_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/13/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2024] Open
Abstract
Objective To determine the differences between international medical graduates (IMG) and canadian medical graduates (CMG) in the medical learning environment (MLE) as there is progression from matching to residency and beyond. Method A narrative literature review was done using the search engines pubmed, medline and embase on publications from 2000 to 2021 comparing IMG to CMG and those that compared IMG to non IMG in international publications were also considered. Results The IMGs are offered less residency program positions compared to CMGs during the CaRMS selection process and specifically less in specialty programs. Amongst the article, 66% of IMGs compared to 90% of CMG were successful in the certification examination of the college of family physicians of Canada. A US article on the other hand found similarities in performance of USMGs and IMGs in a surgical residency program. Conclusion A lot of IMG face several challenges including perceived systemic and individual discrimination, lack of mentorship and poor ability to navigate after immigration even after they are matched into a Canadian residency program. These are significant issues that should be dealt with to enable increase success and survival of IMGs in the MLE.
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Affiliation(s)
- Oluwasayo A. Olatunde
- Department of Family Medicine, Dalhousie University, NS, Canada
- Department of Family Medicine, UBC, BC, Canada
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Smith SM, Parkash V. Normalized "medical inferiority bias" and cultural racism against international medical graduate physicians in academic medicine. Acad Pathol 2023; 10:100095. [PMID: 37767366 PMCID: PMC10520300 DOI: 10.1016/j.acpath.2023.100095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/28/2023] [Accepted: 08/05/2023] [Indexed: 09/29/2023] Open
Abstract
Socio-historical barriers remain a concern in Academic Medicine. Regrettably, despite the modern cultural era defined by increased recognition and response to such issues, widespread covert barriers and misperceptions continue to limit the advancement of many, in particular, international medical graduate physicians (IMGs) who represent a significant proportion of the US physician workforce. Adversity is experienced in the form of cultural racism, affinity bias, and underrepresentation in distinct specialties as well as in leadership roles. Often, these unnecessary hardships exacerbate pre-existing discrimination in Academic Medicine, further marginalizing IMGs. In this article, we discuss the prevalence of "medical inferiority bias" and the resulting impact on US healthcare, specifying considerations to be made from a policy perspective.
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Affiliation(s)
- Stephen M. Smith
- Department of Laboratory Medicine & Pathobiology at Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology at the University of Toronto, Toronto, Ontario, Canada
| | - Vinita Parkash
- Yale University School of Medicine, New Haven, CT, USA
- Yale New Haven Hospital, New Haven, CT, USA
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Jansen E, Marquardt M. Retention and turnover intention of foreign-trained physicians (FTPs): A scoping review. Z Evid Fortbild Qual Gesundhwes 2023; 181:19-25. [PMID: 37567814 DOI: 10.1016/j.zefq.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/26/2023] [Accepted: 05/30/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND In many high-income countries, there is a regional or indication-specific shortage of physicians. One way to alleviate these shortages is to recruit physicians from abroad. However, the high turnover rate of foreign-trained physicians (FTPs) makes it difficult to maintain stable medical care. The purpose of this scoping review was to analyze recent studies on turnover intentions and retention in order to, first, understand how they are assessed and, second, to identify the parameters that contribute to reducing turnover and improving the retention of FTPs. METHOD A total of six articles were included, and a thematic analysis was conducted. The literature search was limited to English-language articles from bibliographic databases related to public health and health services research (MEDLINE, CINAHL, Web of Science, PsycINFO) between 2010 and 2022. RESULTS The topis identified were: (1) the quality of working relationships, (2) the quality of the work environment, (3) personal life and migration issues, (4) employment-related issues, and (5) career and training opportunities. Three approaches were considered in examining the retention and turnover intentions of FTPs: satisfaction, motivation for migration, and professional integration. Underrepresented fields are discrimination and social integration. CONCLUSIONS The processes of turnover intention and retention are still poorly understood. Standardizing definitions and certain parts of the methodology would help researchers navigate the process with more accuracy. Further studies should look at the causal relationships that can be collected in the form of qualitative data, as these are currently lacking.
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Affiliation(s)
- Eva Jansen
- Charité - University Hospital Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany.
| | - Manuela Marquardt
- Charité - University Hospital Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
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Mathews M, Ryan D, Bourgeault I. "I wish I had known what I was getting into": a qualitative study exploring the experiences of Canadians who study medicine abroad. BMC Med Educ 2023; 23:376. [PMID: 37226232 DOI: 10.1186/s12909-023-04367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND An increasing number of Canadians are choosing to study medicine abroad (CSA); however, many CSA are not fully informed of the challenges that exist in returning to Canada to practice and relatively little information is known on the topic. This study explores CSA experiences in choosing to study abroad and their attempts to navigate a return to Canada to practice medicine. METHODS We conducted semi-structured qualitative interviews with CSA who were attending medical school abroad, waiting to obtain or in a post-graduate residency program, or practicing in Canada. We asked participants about their decision to study medicine abroad and choice of school, medical school experiences, activities they engaged in to increase their likelihood of returning to Canada, perceived barriers and facilitators, and alternative plans if they were unable to return to Canada to practice. Interviews were transcribed and analyzed using a thematic analysis approach. RESULTS Fourteen CSA participated in an interview. Expedited timelines (i.e., direct entry from high school) and a lack of competitiveness for medical school in Canada were the main justifications for CSAs' decision to study abroad and a number of key factors (e.g., location, reputation) influenced their choice of school. Participants reported not fully anticipating the challenges associated with obtaining residency in Canada. CSA relied upon a variety of informal and formal supports and employed numerous methods to increase their likelihood of returning to Canada. CONCLUSIONS Studying medicine abroad remains a popular choice for Canadians; however, many trainees are unaware of the challenges associated with returning to Canada to practice. More information on this process as well as the quality of these medical schools is needed for Canadians considering this option.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada
| | - Ivy Bourgeault
- School of Sociological and Anthropological Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
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Postmes JJ, Rolim Medeiros RL. Respected physician in Syria, unemployed refugee in the Netherlands: An analysis of the integration of Syrian refugees with a medical degree in the Dutch medical field. Soc Sci Med 2023; 323:115836. [PMID: 36965202 DOI: 10.1016/j.socscimed.2023.115836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023]
Abstract
Refugees in the Netherlands are expected to integrate in society and find employment. Despite years of education, Syrian refugees who graduated in medicine (SRGMs') struggle to enter the Dutch medical field. To ensure patient safety, physicians with a medical degree obtained outside Europe are obliged to finish an 'assessment procedure' (AP) and might be forced to redo clinical internships, before being allowed to practice medicine. In this research, SRGMs' experiences were analysed using Bourdieu's capital theory. Semi-structured interviews were conducted with 17 SRGMs. In Syria, they acquired much capital as physicians, in the shape of financial means (economic capital), connections (social capital), medical degrees and skills (cultural capital), and status (symbolic capital). Their medical skills often provide the only capital that remains when arriving in the Netherlands, but it loses value as they have to prove their competence first in the AP. This is a long and arduous process. The mean duration, for those who had yet finished the AP, from arrival to employment was 4.5 years (n = 5, range 2.7-5.8 years). SRGMs experience difficulties in these AP years because they are forced to study from home and feel excluded from medical practice. They are unable to regain their economic, social and symbolic capital, whilst struggling to get their cultural capital acknowledged. Mentally this is challenging and when they do finish, this capital gap leaves them at a disadvantage when applying for competitive job applications. Once employed, SRGMs need time to adjust but are finally rebuilding their capital and integrating in Dutch society. Both SRGMs and Dutch society benefit when SRGMs' integration in the Dutch medical field improves. Although certain challenges for SRGMs seem inevitable, by offering a clinical internship before the assessment of SRGMs' skills, their capital acquisition might improve which would facilitate their integration.
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Affiliation(s)
- J J Postmes
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062, PA, Rotterdam, the Netherlands.
| | - R L Rolim Medeiros
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062, PA, Rotterdam, the Netherlands.
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Qazi U, Bhandari L. The International Medical Graduate Perspective in Hand Surgery: Legacy and Future Challenges. Hand Clin 2023; 39:87-93. [PMID: 36402530 DOI: 10.1016/j.hcl.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
International medical graduates (IMGs) have made significant contributions in the field of hand surgery in terms of bringing in skill, innovation, research, and leadership and have gone onto mentor the next generations of hand surgeons. In this article, we have highlights some such contributions. We also highlight various pathways that IMGs take to establish their practice in the United States and the various challenges and hurdles they face.
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Affiliation(s)
- Uzair Qazi
- Division of Plastic/Reconstructive and Hand Surgery/Burn Surgery, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way Suite MSB 2360A, Cincinnati, OH 45267, USA
| | - Laxminarayan Bhandari
- Kleinert Kutz Associates, 225 Abraham Flexner Way, Suite 700, Louisville, KY 40202, USA.
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Eley DS, Cortes C, Arja S, Villafuerte FRB, Khan YH, Grannum J, Jia Z. Perspectives on Medical Education in an Increasingly Globalized Society: Recognizing and Embracing Our Diversity. Med Sci Educ 2023; 33:247-254. [PMID: 37008439 PMCID: PMC10060606 DOI: 10.1007/s40670-022-01705-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 06/19/2023]
Abstract
Medical curricula around the globe are diverse, accommodating the social, political, cultural, and health needs in each country. Every medical school has the responsibility to educate graduates capable of providing quality medical care to their communities. Yet true globalization of medical education is a challenge. Little is known about the intrinsic variations which impact curricula in countries around the world. There are unique, often historical reasons that explain the challenges in attaining a genuine globalization of the medical curricula. This perspective provides a glance and general comparison of traditions, economic, and socio-political influences on medical education across seven countries.
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Affiliation(s)
- Diann S. Eley
- Academy for Medical Education, Medical School, The University of Queensland, Brisbane, QLD Australia
| | - Claudio Cortes
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI USA
| | - Sateesh Arja
- Sateesh Arja, Clinical Skills and Medical Education, Avalon University School of Medicine, Curacao Caribbean, Netherlands
| | | | - Yawar Hayat Khan
- Faculty of Dentistry, Riphah International University, Islamabad, Pakistan
| | - Joseph Grannum
- Centre for Educational Technology, University of Tartu, Tartu, Estonia
| | - Zhimin Jia
- Shenzhen Hospital of Southern Medical University, Shenzhen, China
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Byrd KM, Jain S, Choudhuri I, Çoruh B, McSparron JI, Viglianti EM. Differences in international medical graduates' letters of recommendation by gender in pulmonary and critical care medicine: a cohort analysis. BMC Med Educ 2023; 23:58. [PMID: 36694194 PMCID: PMC9875522 DOI: 10.1186/s12909-023-04042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/18/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND International Medical Graduates (IMGs) encounter barriers as they seek to match into fellowship programs in the United States (US). This study's objective is to determine if there are differences in letters of recommendation written for IMGs compared to U.S. Medical Graduates (USMGs) applying to pulmonary and critical care medicine (PCCM) fellowship programs. METHODS All applications submitted to a PCCM fellowship program in 2021 were included in this study. The applicant demographics and accomplishments were mined from applications. The gender of letter writers was identified by the author's pronouns on professional websites. Word count and language differences in the letters were analyzed for each applicant using the Linguistic Inquiry and Word Count (LWIC2015) program. Multivariable linear regressions were performed controlling for applicant characteristics to identify if IMG status was associated with total word count and degree of support, measured by a composite outcome encompassing several categories of adjectives, compared to USMG status. RESULTS Of the 573 applications, most of the applicants were USMGs (72%, N = 334/573). When adjusting for applicant characteristics, IMG applicants had shorter letters of recommendation (87.81 total words shorter 95% CI: - 118.61, - 57.00, p-value < 0.01) and less supportive letters (4.79 composite words shorter 95% CI: - 6.61, - 2.97, p-value < 0.01), as compared to USMG applicants. Notably, female IMG applicants had the biggest difference in their word counts compared to USMG applicants when the letter writer was a man. CONCLUSIONS IMG applicants to a PCCM fellowship received shorter and less supportive letters of recommendation compared to USMG applicants.
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Affiliation(s)
- Kaitland M Byrd
- Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, 2800 Plymouth Road, NCRC building 16, Ann Arbor, MI, 48109, USA.
| | - Snigdha Jain
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Irada Choudhuri
- Internal Medicine Resident in the Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Jakob I McSparron
- Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, 2800 Plymouth Road, NCRC building 16, Ann Arbor, MI, 48109, USA
| | - Elizabeth M Viglianti
- Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, 2800 Plymouth Road, NCRC building 16, Ann Arbor, MI, 48109, USA
- Veterans Affairs Center for Clinical Management Research, HSR&D Center for Innovation, Ann Arbor, MI, USA
- Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Sikdar S, Chowdhury N, Lake D, Turin TC. Alternative career pathway decision-support job database for international medical graduates in Canada. BMC Res Notes 2022; 15:336. [PMID: 36309723 PMCID: PMC9617379 DOI: 10.1186/s13104-022-06232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/14/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Canadian regulations have made it challenging for the international medical graduates (IMGs) to get jobs in their original profession as physicians. Consequently, alternative careers are gaining interest among IMGs to avoid underemployment or unemployment. We conducted research to identify the factors that IMGs consider for taking up an alternative career in Canada. Based on those understandings, we aimed to create a database where information about health-related alternative jobs is presented in a searchable way, which can aid IMGs’ strategic job search. Data description We first determined job searching preferences and constraints for IMGs regarding alternative career through focus groups. We used their preferred and constraining factors for collecting job-specific information through systematically reviewing job advertisements. Using this information, we created a database that contains available alternative career pathways for IMGs living in Canada. In total, we have identified 1374 job titles under 192 unique job categories comprising 47 National Occupational Classification (NOC) codes that could be suitable for IMGs seeking an alternative career based on their own short, intermediate, and long-term career goals. We expect that this database will help IMGs in deciding on alternative careers.
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Affiliation(s)
- Saif Sikdar
- Department of Microbiology, Immunology and Infectious Disease, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta International Medical Graduates Association, Calgary, AB, Canada
| | - Nashit Chowdhury
- Alberta International Medical Graduates Association, Calgary, AB, Canada.,Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deidre Lake
- Alberta International Medical Graduates Association, Calgary, AB, Canada
| | - Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Duvivier RJ, Buckley PF, Martin A, Boulet JR. International Medical Graduates in the United States Psychiatry Workforce. Acad Psychiatry 2022; 46:428-434. [PMID: 35486365 PMCID: PMC9053123 DOI: 10.1007/s40596-022-01635-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study describes the supply, distribution, and characteristics of international medical graduate (IMG) psychiatrists who provide services in the USA. METHODS Cross-sectional study design, using descriptive statistics based on combined data from the American Medical Association (2020 Physician Masterfile) and the Educational Commission for Foreign Medical Graduates. RESULTS International medical graduates continue to make significant contributions to the US physician workforce. As a group, they represent 29% of active psychiatrists in the USA, compared to 23% in all other medical specialties. Many IMG psychiatrists were US citizens who obtained their medical degrees outside the USA or Canada, often in the Caribbean. In some states (i.e., Florida, New Jersey), over 40% of active psychiatrists are IMGs. Over 30% of IMG psychiatrists graduated from medical schools in India and Pakistan. CONCLUSIONS This study provides an overview of the psychiatric workforce in the USA, quantifying the specific contribution of IMGs. Several factors, including immigration policies, continued expansion of US medical schools, and the number of available residency positions, could impact the flow of IMGs to the US. Longitudinal studies are needed to better understand the implications for workforce composition and distribution, and their potential impact on the care of psychiatric patients.
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Affiliation(s)
| | | | | | - John R Boulet
- Educational Commission for Foreign Medical Graduates, Philadelphia, PA, USA
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17
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Narayanan A, Greco M, Janamian T, Fraser T, Archer J. Are there differences between SIMG surgeons and locally trained surgeons in Australia and New Zealand, as rated by colleagues and themselves? BMC Med Educ 2022; 22:516. [PMID: 35778704 PMCID: PMC9250230 DOI: 10.1186/s12909-022-03560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Representation of specialist international medical graduates (SIMGs) in specific specialties such as surgery can be expected to grow as doctor shortages are predicted in the context of additional care provision for aging populations and limited local supply. Many national medical boards and colleges provide pathways for medical registration and fellowship of SIMGs that may include examinations and short-term training. There is currently very little understanding of how SIMGs are perceived by colleagues and whether their performance is perceived to be comparable to locally trained medical specialists. It is also not known how SIMGs perceive their own capabilities in comparison to local specialists. The aim of this study is to explore the relationships between colleague feedback and self-evaluation in the specialist area of surgery to identify possible methods for enhancing registration and follow-up training within the jurisdiction of Australia and New Zealand. METHODS Feedback from 1728 colleagues to 96 SIMG surgeons and 406 colleagues to 25 locally trained Fellow surgeons was collected, resulting in 2134 responses to 121 surgeons in total. Additionally, 98 SIMGs and 25 Fellows provided self-evaluation scores (123 in total). Questionnaire and data reliability were calculated before analysis of variance, principal component analysis and network analysis were performed to identify differences between colleague evaluations and self-evaluations by surgeon type. RESULTS Colleagues rated SIMGs and Fellows in the 'very good' to 'excellent' range. Fellows received a small but statistically significant higher average score than SIMGs, especially in areas dealing with medical skills and expertise. However, SIMGs received higher scores where there was motivation to demonstrate working well with colleagues. Colleagues rated SIMGs using one dimension and Fellows using three, which can be identified as clinical management skills, inter-personal communication skills and self-management skills. On self-evaluation, both SIMGs and Fellows gave themselves a significant lower average score than their colleagues, with SIMGs giving themselves a statistically significant higher score than Fellows. CONCLUSIONS Colleagues rate SIMGs and Fellows highly. The results of this study indicate that SIMGs tend to self-assess more highly, but according to colleagues do not display the same level of differentiation between clinical management, inter-personal and self-management skills. Further research is required to confirm these provisional findings and possible reasons for lack of differentiation if this exists. Depending on the outcome, possible support mechanisms can be explored that may lead to increased comparable performance with locally trained graduates of Australia and New Zealand in these three dimensions.
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Affiliation(s)
- Ajit Narayanan
- Auckland University of Technology, Auckland, New Zealand
| | - Michael Greco
- School of Medicine, Griffith University, Brisbane, QLD Australia
- CFEP Surveys, Everton Park, QLD Australia
| | - Tina Janamian
- CFEP Surveys, Everton Park, QLD Australia
- School of Business, University of Queensland, St Lucia, QLD Australia
- Education and Innovation, Australian General Practice Accreditation Limited (AGPAL), Brisbane, QLD Australia
| | - Tamieka Fraser
- Australian General Practice Accreditation Limited (AGPAL), Brisbane, QLD Australia
| | - Julian Archer
- School of Medicine and Dentistry, Griffith University, Brisbane, Australia
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Rasquinha M. Difficulties and educational challenges faced by international medical graduates in trust grade roles in the UK. Br J Hosp Med (Lond) 2022; 83:1-7. [PMID: 35506719 DOI: 10.12968/hmed.2021.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/AIMS Most international medical graduates obtain a non-training job, such as a trust grade role, when they first start work in the UK. This transition into a new healthcare system comes with many sociocultural and educational challenges. The aim of this study was to learn more about the different types of challenges and propose solutions where possible. METHOD Qualitative data from a cohort of current or previous trust grade international medical graduates were collected at a UK teaching hospital. This was achieved through the use of questionnaires, interviews and obtaining views through a monthly forum meeting. RESULTS Findings showed that participants lacked insight into the system and lacked clarity in relation to the role of a supervisor, career pathways, and medicolegal and ethical issues. Discrepancies in study budgets and study leave days, compared to those available to doctors in trainee posts was another issue that was raised. Communication in complex clinical scenarios was also reported to be an issue for many participants. Suggested solutions included a tailored online induction for international medical graduates in trust grade roles and a setting up a buddy system with existing or previous trust grade doctors. CONCLUSIONS This study highlighted the challenges faced by international medical graduates in trust grade roles and proposed solutions where possible. Although responses varied, educational barriers were the most widely highlighted concern. To understand the full extent of these hurdles, perceptions of other healthcare professionals should be explored.
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Affiliation(s)
- Melroy Rasquinha
- Department of Cardiac Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
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19
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van Zanten M, Boulet JR, Shiffer CD. Making the grade: licensing examination performance by medical school accreditation status. BMC Med Educ 2022; 22:36. [PMID: 35031043 PMCID: PMC8758986 DOI: 10.1186/s12909-022-03101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Accreditation systems strive to ensure the quality of undergraduate (basic) medical education and encourage ongoing improvements. Despite increasing global emphasis on quality assurance activities, there is limited research linking accreditation of medical education to improved student and graduate outcomes. The purpose of this study is to compare the United States Medical Licensing Examination® (USMLE®) performance of students and graduates who attended international medical schools accredited by an agency recognized by the World Federation of Medical Education (WFME) to individuals who attended schools that did not meet this criterion. METHODS During the 2018-2020 study period, 39,650 individuals seeking Educational Commission for Foreign Medical Graduates® (ECFMG®) certification took one or more USMLE examinations. We cross-tabulated USMLE performance (first-attempt pass/fail result) and medical school accreditation status. RESULTS Individuals seeking ECFMG certification who attended international medical schools accredited by an agency recognized by WFME had higher or comparable USMLE first-attempt pass rates compared to individuals who attended medical schools that did not meet this criterion. CONCLUSIONS Implementing and maintaining meaningful accreditation systems requires substantial resources. These results provide important positive evidence that external evaluation of educational programs is associated, on average, with better educational outcomes, including in the domains of basic science, clinical knowledge, and clinical skills performance.
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Affiliation(s)
- Marta van Zanten
- Foundation for Advancement of International Medical Education and Research (FAIMER), 3624 Market Street, 19104, Philadelphia, PA, USA.
| | - John R Boulet
- Foundation for Advancement of International Medical Education and Research (FAIMER), 3624 Market Street, 19104, Philadelphia, PA, USA
| | - Christine D Shiffer
- Educational Commission for Foreign Medical Graduates (ECFMG), Philadelphia, PA, USA
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Romero-Velez G, Rodriguez-Quintero JH, Moran-Atkin E, Lima DL, Malcher F, Camacho DR. Exploring the Challenges for International Medical Graduates Pursuing Minimally Invasive Surgery Training in the United States and Canada: A Cross-Sectional Analysis. JSLS 2022; 26:JSLS.2021.00084. [PMID: 35444402 PMCID: PMC8993460 DOI: 10.4293/jsls.2021.00084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: International Medical Graduates (IMGs) are an important component of the US healthcare workforce. Prior studies have investigated bias against IMGs during the general surgery residency application in the United States. Minimally invasive surgery (MIS) is a growing field; The MIS fellowship match was established in 2004 and is a competitive process with a match rate of 47%. Opportunities for applicants who are non-US citizens are limited by a series of factors that are not related to their professional qualifications. Objectives: The aim of the study was to explore the challenges faced by IMG in the MIS fellowship match. Methods: This is a cross-sectional study analyzing the minimally invasive surgery application requirements of all the programs listed in the Fellowship Council. Individual program requirements were collected into a database and a descriptive analysis was performed comparing programs who accept IMGs versus those that do not. Further statistical analysis was performed to explore those differences and associated factors. Results: There were 148 MIS fellowship programs and 187 positions offered during the 2021 match year in the US. Ninety-seven programs (65.5%) were found to accept graduates of foreign medical schools if they were US-citizens, whereas only 49 programs (33.1%) were found to accept IMG and sponsor a visa for their training. University affiliated programs (88.9% vs 75.0%, p = 0.04), programs with a general surgery residency (94.4% vs 75.0%, p = 0.003), and older programs (63.0% vs 45.5%, p = 0.04) were more likely to accept IMGs requiring visa sponsorship. Conclusions: There is a significant bias against IMGs in the MIS fellowship match, with a reduced number of positions available based on factors not related to their professional performance or qualifications. Well established programs, university, and residency affiliated programs are more likely to consider these physicians for training.
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Affiliation(s)
| | | | | | - Diego L Lima
- Department of Surgery, Montefiore Medical Center, Bronx, NY
| | - Flavio Malcher
- Center for Abdominal Core Health. Division of General Surgery, NYU Langone Health, New York, NY
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21
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Mathews M, Koudieh D, Yi Y, Hedden L, Marshall EG, Samarasena A, Barnum G, Bourgeault I. Retention of visa-trainee post-graduate residents in Canada: a retrospective cohort study. Hum Resour Health 2021; 19:98. [PMID: 34404430 PMCID: PMC8369610 DOI: 10.1186/s12960-021-00638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Visa trainees (international medical graduates [IMG] who train in Canada under a student or employment visa) are expected to return home after completing their training. We examine the retention patterns of visa trainee residents funded by Canadian (regular ministry and other), foreign, or mixed sources. METHODS We linked data from the Canadian Post-MD Medical Education Registry with Scott's Medical Database for a retrospective cohort study. Eligible trainees were IMG visa trainees as of their first year of training, started their residency program no earlier than 2000, and exited training between 2006 and 2016. We used Cox regression to compare the retention of visa trainees by funding source. RESULTS Of 1,913 visa trainees, 431(22.5%), 1353 (70.7%) and 129 (6.8%) had Canadian, foreign, or mixed funding, respectively. The proportion of trainees remaining in Canada decreased over time, with 35.5% (679/1913); 17.7% (186/1052); 10.8% (11/102) in Canada one, five, and ten years, respectively after their exit from PGME training. Trainees who remained on visas (HR: 1.91; [95% CI 1.59, 2.30]), were funded exclusively by foreign sources (HR: 1.46; [95% CI 1.25, 1.69]), and who had graduated from 'Western' countries (HR: 1.39; [95% CI 1.06, 1.84]) were more likely to leave Canada compared to trainees who became citizens/permanent residents, were funded by Canadian sources, or were visa graduates of Canadian medical schools, respectively. CONCLUSIONS Most visa trainees leave Canada following their training. Trainees with Canadian connections (funding and/or change in legal status) were more likely to remain in Canada.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, University of Western Ontario, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, N6G 2M1, Canada.
| | - Dania Koudieh
- Canadian Post-M.D. Education Registry, Association of Faculties of Medicine of Canada, 2733 Lancaster Road, Suite 100, Ottawa, ON, K1B 0A9, Canada
| | - Yanqing Yi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, A1B 3V6NL, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3H 4R2, Canada
| | - Asoka Samarasena
- Department of Anesthesia, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Geoff Barnum
- Canadian Post-M.D. Education Registry, Association of Faculties of Medicine of Canada, 2733 Lancaster Road, Suite 100, Ottawa, ON, K1B 0A9, Canada
| | - Ivy Bourgeault
- School of Sociological and Anthropological Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada
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Sturesson L, Palmgren PJ, Öhlander M, Nilsson GH, Stenfors T. Migrant physicians' choice of employment and the medical specialty general practice: a mixed-methods study. Hum Resour Health 2021; 19:63. [PMID: 33980236 PMCID: PMC8114484 DOI: 10.1186/s12960-021-00607-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 05/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE In many countries, migrant physicians (MP) tend to fill staff shortages in medical specialties perceived as low status. The aim of this study was to explore aspects that influence MPs', with a medical degree from outside EU/EEA, choice of employment and medical specialty in Sweden, and to explore and understand a potential over-representation in general practice (family medicine), a specialty suffering from staff shortages in Sweden. METHODS A mixed-methods approach was applied. This included questionnaire data from 101 MPs training and working as medical specialists in Sweden and semi-structured interview data from four MPs specializing in general practice. RESULTS Regardless of specialty, the most influential aspects when choosing employment were the ability to combine work with family, to develop one´s competence, and to have highly competent colleagues. Women scored higher on some aspects related to private life and the surroundings. More than half (55%) of the respondents specialized in general practice, and more women than men. The MPs in general practice scored higher on the aspect 'ability to have the same patients for a longer period' than MPs specializing in other specialties. No significant difference between MP general practitioner respondents and MPs in other medical specialties was found in relation to the item 'Was the specialty your first choice?'. Aspects identified in the interviews that influenced the choice to specialize in general practice related to job opportunities, positive experiences of primary health care, working conditions, and family conditions. CONCLUSION Labour market conditions such as high competition, and the time-consuming recertification process, can influence the choice to specialize in general practice as this reduces the time to become a medical specialist. We however did not find any results indicating that MPs' decision to specialize in general practice and to work as general practitioners was any less voluntary than that of MPs who chose other specialties.
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Affiliation(s)
- Linda Sturesson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Per J. Palmgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magnus Öhlander
- Department of Ethnology, History of Religions and Gender Studies, Stockholm University, 106 91 Stockholm, Sweden
| | - Gunnar H. Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
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Nair B, Moonen – van Loon JMW, Parvathy M, van der Vleuten CPM. Composite Reliability of Workplace Based Assessment of International Medical Graduates. MedEdPublish (2016) 2021; 10:104. [PMID: 38486602 PMCID: PMC10939524 DOI: 10.15694/mep.2021.000104.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Introduction All developed countries depend on International Medical Graduates (IMGs) to complement their workforce. However, the assessment of their fitness to practice and acculturation into the new system can be challenging. To improve this, we introduced Workplace Based Assessment (WBA), using a programmatic philosophy. This paper reports the reliability of this new approach. Method Over the past 10 years, we have assessed over 250 IMGs, each cohort assessed over a 6-month period. We used Mini-Cex, Case Based Discussions (CBD) and Multi-Source Feedback (MSF) to assess them. We analysed the reliability of each tool and the composite reliability of 12 Mini-Cex, 5 CBDs and 12 MSF assessments in the tool kit. Results A reliability coefficient of 0.78 with a SEM of 0.19 was obtained for the sample of 236 IMGs. We found the MSF to be the most reliable tool. By adding one more MSF to the assessment on two occasions, we can reach a reliability of 0.8 and SEM of 0.18. Conclusions The current assessment methodology has acceptable reliability. By increasing the MSF, we can improve the reliability. The lessons from this study are generalisable to IMG assessment and other medical education programs.
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Turin TC, Chowdhury N, Ekpekurede M, Lake D, Lasker MAA, O'Brien M, Goopy S. Professional integration of immigrant medical professionals through alternative career pathways: an Internet scan to synthesize the current landscape. Hum Resour Health 2021; 19:51. [PMID: 33865402 PMCID: PMC8052743 DOI: 10.1186/s12960-021-00599-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is a growing recognition that underutilization and underemployment of skilled immigrants, especially internationally trained health professionals, creates a financial burden on individuals and economic losses for the host country. Albeit a missed opportunity for both the immigrants and the receiving country, no public policy and systemic measures are in place to address this issue. Nevertheless, certain individuals and organizations have made some isolated efforts, but no synthesized knowledge is available for understanding what initiatives exist altogether and how they function. We have conducted a methodological Internet scan to identify the existing individual, private, and systemic initiatives and resources that support these health professionals. This will provide health and workforce policymakers, settlement service providers, and relevant academics with the knowledge base for potential different strategies to address this issue and guide them towards developing solution-oriented initiatives. METHODS To identify those we have systematically searched the three most popular search engines (Google, Bing, and Yahoo!) adapting the Canadian Institute for Health Information's grey literature review protocol. We identified relevant websites per our predefined inclusion criteria, charted the data from those sources, collated, summarized, and reported the results. RESULTS From 280 webpages initially identified through keyword search, we included 26 in our full-page screen and extracted data from 16 finally selected webpages. We have found webpages with information on different alternative careers namely, regulated and non-regulated, available resources to pursue those careers, and what skills they have that can be transferred to the alternative careers. CONCLUSION More systemic policies and IMG specific and ACP-focused employment support programmes are required. Research and development of programmes for facilitating IMGs' alternative career support need to be increased and strengthened.
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Affiliation(s)
- Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, G012F, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Nashit Chowdhury
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, G012F, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Mark Ekpekurede
- Alberta International Medical Graduates Association, Calgary, AB, Canada
| | - Deidre Lake
- Alberta International Medical Graduates Association, Calgary, AB, Canada
| | | | - Mary O'Brien
- School of Languages, Linguistics, Literatures and Culture, University of Calgary, Calgary, AB, Canada
| | - Suzanne Goopy
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
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Rajesh A, Asaad M, Sridhar M. Binary Reporting of USMLE Step 1 Scores: Resident Perspectives. J Surg Educ 2021; 78:304-307. [PMID: 32600888 DOI: 10.1016/j.jsurg.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/23/2020] [Accepted: 06/13/2020] [Indexed: 06/11/2023]
Abstract
The recent consensus from the Invitational Conference on USMLE Scoring has recommended a transition to a binary pass/fail reporting on the USMLE Step 1 exam to be implemented from January 22, 2022. While this change was instituted in an effort to decrease medical student stress and re-iterate the importance of the Step 1 as merely a licensing or qualifying exam, this decision has profound implications for medical graduates of both United States and foreign medical schools. In addition to compounding the difficulties of resident selection by residency programs, the new system could exert significant mental and financial burden on medical students, and potentially affect the diversity of graduate medical education in the United States. This article draws attention to the downstream effects of a pass/fail system on the future of medical and surgical education.
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Affiliation(s)
- Aashish Rajesh
- Department of Surgery, University of Texas Health Science Center, San Antonio, Texas.
| | - Malke Asaad
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Monica Sridhar
- Department of Surgery, University of Texas Health Science Center, San Antonio, Texas
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Jajosky RP, Jajosky AN, Jajosky PG. Pathology's historic 2019 incoming residents: Why "the internationalization of pathology" may markedly advance transfusion medicine and cellular therapeutics. Transfus Apher Sci 2019; 59:102591. [PMID: 31326290 DOI: 10.1016/j.transci.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study had two objectives: (1) to determine if, in the United States of America (US), the proportion of non-US citizen international medical graduates (non-US IMGs) entering pathology residencies had increased (again) in 2019 and (2) to assess how this multi-year trend might impact transfusion medicine in the US. METHODS The most recent (2019) "National Resident Matching Program" (NRMP) data were analyzed. To assess potential future impact, using controversies related to Plasmodium falciparum (Pf) malaria, conflicting US and non-US perspectives were reviewed. Differences between published US and non-US views were identified regarding, for example, the value of Pf-resistant ("variant") red blood cells (RBCs) and exchange transfusions. RESULTS Year 2019 is the first year non-US IMGs were the largest group to fill residency-training positions for a major US specialty via the "Main Residency Match." Also notable, US and non-US views were found to differ markedly regarding (1) the value and safety of Pf-resistant RBC variants and exchange transfusions, and (2) the threat of drug-resistant Pf-malaria parasites. Non-US clinicians and researchers seem more concerned about Pf-malaria, and their interest in cellular therapies seems greater and more optimistic. CONCLUSIONS In 2019, the historically high proportion of non-US IMGs among incoming pathology residents dramatically highlights the steady demographic shift that began years ago: "the internationalization of pathology" in the US. Fortunately, a review of publications related to exchange transfusion, Pf-malaria, and variant RBCs suggests non-US IMGs may markedly promote and advance cell therapies such as therapeutically-rational exchange (T-REX) of disease-resistant RBCs.
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Affiliation(s)
- Ryan Philip Jajosky
- Emory University, Whitehead Biomedical Research Building, 615 Michael St., 301 Atlanta, GA 30322; Biconcavity Inc., 1106 Spring Mill Dr. SW, Lilburn, GA, USA, 30047.
| | - Audrey N Jajosky
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Department of Pathology, 11100 Euclid Avenue, Cleveland, OH, USA, 44106.
| | - Philip G Jajosky
- Biconcavity Inc., 1106 Spring Mill Dr. SW, Lilburn, GA, USA, 30047.
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Duvivier RJ, Wiley E, Boulet JR. Supply, distribution and characteristics of international medical graduates in family medicine in the United States: a cross-sectional study. BMC Fam Pract 2019; 20:47. [PMID: 30927914 PMCID: PMC6441164 DOI: 10.1186/s12875-019-0933-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 03/10/2019] [Indexed: 11/23/2022]
Abstract
Background To describe the supply, distribution, and characteristics of international medical graduates (IMGs) in family medicine who provide patient care in the U.S. Methods A cross-sectional study design, using descriptive statistics on combined data from the Educational Commission for Foreign Medical Graduates and the American Medical Association, including medical school attended, country of medical school, and citizenship when entering medical school. Results In total, 118,817 physicians in family medicine were identified, with IMGs representing 23.8% (n = 28,227) of the U.S. patient care workforce. Of all 9579 residents in family medicine, 36.0% (n = 3452) are IMGS. In total, 35.9% of IMGs attended medical school in the Caribbean (n = 10,136); 19.9% in South-Central Asia (n = 5607) and 9.1% in South-Eastern Asia (n = 2565). The most common countries of medical school training were Dominica, Mexico, and Sint Maarten. Of all IMGs in family medicine who attended medical school in the Caribbean, 74.5% were U.S. citizens. In total, 40.5% of all IMGs in family medicine held U.S. citizenship at entry to medical school. IMGs comprise almost 40% of the family medicine workforce in Florida, New Jersey and New York. Conclusions IMGs play an important role in the U.S. family medicine workforce. Many IMGs are U.S. citizens who studied abroad and then returned to the U.S. for graduate training. Given the shortage of family physicians, and the large number of IMGs in graduate training programs, IMGs will continue to play a role in the U.S. physician workforce for some time to come. Many factors, including the supply of residency training positions, could eventually restrict the number of IMGs entering the U.S., including those contributing to family practice.
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Affiliation(s)
- Robbert J Duvivier
- Foundation for Advancement of International Medical Education and Research, 3624 Market Street, Philadelphia, PA, 19104-2685, USA. .,School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, Maastricht, MD, 6200, the Netherlands. .,Parnassia Psychiatric Institute, Kiwistraat 43, The Hague, DH, 2552, The Netherlands.
| | - Elizabeth Wiley
- Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - John R Boulet
- Educational Commission for Foreign Medical Graduates, 3624 Market Street, Philadelphia, PA, 19104-2685, USA
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Jimenez-Gomez A, FitzGerald MR, Leon-Astudillo C, Gonzalez-delRey J, Schubert CJ. Performance of International Medical Graduates in Pediatric Residency: A Study of Peer and Faculty Perceptions. Acad Pediatr 2018; 18:728-732. [PMID: 30056222 DOI: 10.1016/j.acap.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND International medical graduates (IMGs) constitute approximately 25% of the US pediatric workforce. Their recruitment into US residency training raises concerns regarding their competence, although this has not been formally studied. Cincinnati Children's Hospital has systematically recruited IMGs over the past 16 years. This study evaluates perceptions of IMG performance by faculty and US graduate (USG) peers. METHODS We surveyed IMG, USG, and faculty groups, including current and former trainees, assessing perceived IMG performance compared with that of USGs in terms of clinical knowledge/skills, resource utilization, communication, public health knowledge and efficiency, and overall impact on the program. RESULTS Overall perceived performance was within 1 standard deviation of expected USG performance. IMGs outperformed USGs in clinical knowledge/skills and resource utilization but underperformed in communication, public health knowledge, and efficiency. Significant differences were noted in communication with patients and public health knowledge; IMGs ranked their performance significantly lower than USGs/faculty ranked their performance. Overall impact was perceived positively, including an increased interest in global health in among USGs. CONCLUSIONS Carefully recruited IMGs are perceived to perform nearly equal to their USG peers, and their presence is perceived as positive to a major pediatric residency program. Specific domains for educational interventions are identified for programs wishing to expand IMG recruitment.
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Affiliation(s)
- Andres Jimenez-Gomez
- Department of Child Neurology and Developmental Neuroscience, Texas Children's Hospital (Dr Jimenez-Gomez), Houston, Tex; Division of Emergency Medicine (Dr FitzGerald) and Department of Pediatrics, University of Cincinnati (Drs Gonzalez-del Rey and Schubert), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Division of Respiratory Diseases, Boston Children's Hospital (Dr Leon-Astudillo), Boston, Mass.
| | - Michael R FitzGerald
- Department of Child Neurology and Developmental Neuroscience, Texas Children's Hospital (Dr Jimenez-Gomez), Houston, Tex; Division of Emergency Medicine (Dr FitzGerald) and Department of Pediatrics, University of Cincinnati (Drs Gonzalez-del Rey and Schubert), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Division of Respiratory Diseases, Boston Children's Hospital (Dr Leon-Astudillo), Boston, Mass
| | - Carmen Leon-Astudillo
- Department of Child Neurology and Developmental Neuroscience, Texas Children's Hospital (Dr Jimenez-Gomez), Houston, Tex; Division of Emergency Medicine (Dr FitzGerald) and Department of Pediatrics, University of Cincinnati (Drs Gonzalez-del Rey and Schubert), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Division of Respiratory Diseases, Boston Children's Hospital (Dr Leon-Astudillo), Boston, Mass
| | - Javier Gonzalez-delRey
- Department of Child Neurology and Developmental Neuroscience, Texas Children's Hospital (Dr Jimenez-Gomez), Houston, Tex; Division of Emergency Medicine (Dr FitzGerald) and Department of Pediatrics, University of Cincinnati (Drs Gonzalez-del Rey and Schubert), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Division of Respiratory Diseases, Boston Children's Hospital (Dr Leon-Astudillo), Boston, Mass
| | - Charles J Schubert
- Department of Child Neurology and Developmental Neuroscience, Texas Children's Hospital (Dr Jimenez-Gomez), Houston, Tex; Division of Emergency Medicine (Dr FitzGerald) and Department of Pediatrics, University of Cincinnati (Drs Gonzalez-del Rey and Schubert), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Division of Respiratory Diseases, Boston Children's Hospital (Dr Leon-Astudillo), Boston, Mass
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Davda LS, Gallagher JE, Radford DR. Migration motives and integration of international human resources of health in the United Kingdom: systematic review and meta-synthesis of qualitative studies using framework analysis. Hum Resour Health 2018; 16:27. [PMID: 29945616 PMCID: PMC6020357 DOI: 10.1186/s12960-018-0293-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 06/08/2018] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The aim of this review was to examine the migration motives, the barriers to and facilitators of integration of international dental graduates, compared with nurses and doctors in the United Kingdom. METHODS Electronic databases Ovid MEDLINE, EMBASE, PubMed, Web of Knowledge and OECD publications were systematically searched for English language publications from January 2000 to January 2017. A total of 31 qualitative studies were selected and quality appraised and meta-synthesis of the qualitative data was carried out using framework synthesis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to present the findings. RESULTS There were no studies on migration motives and one study on integration experiences of international dentists in the UK. The nursing literature had the highest volume and quality of evidence on nursing workforce, whilst there was limited literature on international doctors in the UK. Migration of health professionals to the UK is determined by personal and professional factors, together with source country-specific and UK drivers. Active recruitment, post graduate training and financial gain act as strong common macro, meso and micro drivers that perpetuate migration into the UK, but the extent to which each of these drivers influence nurses' and doctors' migration is different. Integration experiences for international nurses and doctors differed based on their source country experiences and the work environment they entered. Nurses reported a wider knowledge and skills gap, more multi-level discrimination and less career progression compared to the doctors. The migrants' integration experiences depend on their cultural awareness, discrimination exposure, English language and communication skills, social and professional support networks, social integration and personal attributes. CONCLUSION Migration of international health professionals is motivated by macro, meso and micro drivers at the international, national, professional and personal levels. The UK has strong common macro pull factors which attract nurses, doctors and dentists and may impact on the effectiveness of policies to restrict their migration. The integration experiences of nurses and doctors differ and further research is required to understand the integration experiences of dentists, in order to retain these professionals by tailoring policies to each of these professions.
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Affiliation(s)
- Latha S. Davda
- King’s College London Dental Institute, University of Portsmouth Dental Academy, The William Beatty Building, 1 Hampshire Terrace, Portsmouth, PO1 2QG UK
| | - Jennifer E. Gallagher
- Dean for International Affairs, Newland Pedley Professor of Oral Health Strategy, King’s College London Dental Institute, Denmark Hill Campus, Bessemer Road, London, SE5 9RS UK
| | - David R. Radford
- King’s College London Dental Institute, University of Portsmouth Dental Academy, The William Beatty Building, 1 Hampshire Terrace, Portsmouth, PO1 2QG UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Unwin E, Potts HWW, Dacre J, Elder A, Woolf K. Passing MRCP (UK) PACES: a cross-sectional study examining the performance of doctors by sex and country. BMC Med Educ 2018; 18:70. [PMID: 29625566 PMCID: PMC5889582 DOI: 10.1186/s12909-018-1178-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/22/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND There is much discussion about the sex differences that exist in medical education. Research from the United Kingdom (UK) and United States has found female doctors earn less, and are less likely to be senior authors on academic papers, but female doctors are also less likely to be sanctioned, and have been found to perform better academically and clinically. It is also known that international medical graduates tend to perform more poorly academically compared to home-trained graduates in the UK, US, and Canada. It is uncertain whether the magnitude and direction of sex differences in doctors' performance is variable by country. We explored the association between doctors' sex and their performance at a large international high-stakes clinical examination: the Membership of the Royal Colleges of Physicians (UK) Practical Assessment of Clinical Examination Skills (PACES). We examined how sex differences varied by the country in which the doctor received their primary medical qualification, the country in which they took the PACES examination, and by the country in which they are registered to practise. METHODS Seven thousand six hundred seventy-one doctors attempted PACES between October 2010 and May 2013. We analysed sex differences in first time pass rates, controlling for ethnicity, in three groups: (i) UK medical graduates (N = 3574); (ii) non-UK medical graduates registered with the UK medical regulator, the General Medical Council (GMC), and thus likely to be working in the UK (N = 1067); and (iii) non-UK medical graduates without GMC registration and so legally unable to work or train in the UK (N = 2179). RESULTS Female doctors were statistically significantly more likely to pass at their first attempt in all three groups, with the greatest sex effect seen in non-UK medical graduates without GMC registration (OR = 1.99; 95% CI = 1.65-2.39; P < 0.0001) and the smallest in the UK graduates (OR = 1.18; 95% CI = 1.03-1.35; P = 0.02). CONCLUSIONS As found in a previous format of this examination and in other clinical examinations, female doctors outperformed male doctors. Further work is required to explore why sex differences were greater in non-UK graduates, especially those without GMC registration, and to consider how examination performance may relate to performance in practice.
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Affiliation(s)
- Emily Unwin
- Research Department of Medical Education, University College London Medical School, Royal Free Hospital, GF 664, Rowland Hill Street, London, NW3 2PF UK
| | - Henry W. W. Potts
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Jane Dacre
- Research Department of Medical Education, University College London Medical School, Royal Free Hospital, GF 664, Rowland Hill Street, London, NW3 2PF UK
- Royal College of Physicians, 11 St Andrews Place, London, NW1 4LE UK
| | - Andrew Elder
- Royal College of Physicians, 11 St Andrews Place, London, NW1 4LE UK
| | - Katherine Woolf
- Research Department of Medical Education, University College London Medical School, Royal Free Hospital, GF 664, Rowland Hill Street, London, NW3 2PF UK
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Touchet B, Walker A, Flanders S, McIntosh H. A Pilot Study Examining Factors Influencing Readiness to Progress to Indirect Supervision Among First Year Residents in a General Psychiatry Training Program. Acad Psychiatry 2018; 42:207-211. [PMID: 28983854 DOI: 10.1007/s40596-017-0801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE In the first year of training, psychiatry residents progress from direct supervision to indirect supervision but factors predicting time to transition between these levels of supervision are unknown. This study aimed to examine times for transition to indirect levels of supervision and to identify resident factors associated with slower progression. METHODS The authors compiled data from training files from years 2011-2015, including licensing exam scores, age, gender, medical school, month of first inpatient psychiatry rotation, and transition times between levels of supervision. Correlational analysis examined the relationship between these factors. Univariate analysis further examined the relationship between medical school training and transition times between supervision levels. RESULTS Among the factors studied, only international medical school training was positively correlated with time to transition to indirect supervision and between levels of indirect supervision. CONCLUSIONS International medical graduate (IMG) interns in psychiatry training may benefit from additional training and support to reach competencies required for the transition to indirect supervision.
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Affiliation(s)
- Bryan Touchet
- The University of Oklahoma School of Community Medicine, Tulsa, OK, USA.
| | - Ashley Walker
- The University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Sarah Flanders
- The University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Heather McIntosh
- The University of Oklahoma School of Community Medicine, Tulsa, OK, USA
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Abstract
BACKGROUND Globally, the majority of visually impaired persons live in low- and middle-income countries. One of the reasons is a lack of ophthalmologists in the respective countries. Migration of qualified personnel would be an additional strain on ophthalmological patient care. OBJECTIVE This analysis aimed at evaluating the attitude of African residents in ophthalmology towards working in their home country or migrating abroad and comparing these findings with existing data also with respect to possible interventions. MATERIAL AND METHODS In 2016 and 2017, participants of ophthalmological training courses for residents in Dar es Salaam (Tanzania) and Addis Ababa (Ethiopia) as well as residents from Moshi (Tanzania) were interviewed on possible migration with the help of a questionnaire. RESULTS In total 60 questionnaires were analyzed. The main reasons for staying in the home country were: "want to support/serve community", "family" as well as "high demand of specialists". Prime motives for possible migration were: "better income", "better working structure/equipment" and "better education". CONCLUSION Links between German and African eye hospitals as they are supported, for example by the working group International Ophthalmology of the German Ophthalmological Society (DOG) and the German Committee for the Prevention of Blindness (DKVB), can contribute to improve some of the main reasons of migration, such as insufficient education, working structures and equipment and thus help to prevent a brain drain.
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Affiliation(s)
- K M Knoll
- Augenklinik und Poliklinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland.
- Augenabteilung, Kilimanjaro Christian Medical Centre, Moshi, Tansania.
| | - H Philippin
- Augenabteilung, Kilimanjaro Christian Medical Centre, Moshi, Tansania
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, Großbritannien
| | - W Makupa
- Augenabteilung, Kilimanjaro Christian Medical Centre, Moshi, Tansania
| | - M M Nentwich
- Augenklinik und Poliklinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland
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Morgan J, Crooks VA, Snyder J. "We have been forced to move away from home": print news coverage of Canadians studying abroad at Caribbean offshore medical schools. BMC Med Educ 2017; 17:228. [PMID: 29169351 PMCID: PMC5701339 DOI: 10.1186/s12909-017-1071-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/16/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND Canadian international medical graduates are Canadian-citizens who have graduated from a medical school outside of Canada or the United States. A growing number of Canadians enroll in medical school abroad, including at Caribbean offshore medical schools. Often, Canadians studying medicine abroad attempt to return to Canada for postgraduate residency training and ultimately to practice. METHODS The authors conducted a qualitative media analysis to discern the dominant themes and ideologies that frame discussion of offshore medical schools, and the Canadian medical students they graduate, in the Canadian print news. We carried out structured searches on Canadian Newsstand Database for print media related to offshore medical schools. RESULTS Canadian news articles used two frames to characterize offshore medical schools and the Canadian international medical graduates they train: (1) increased opportunity for medical education for Canadians; and (2) frustration returning to Canada to practice despite domestic physician shortages. CONCLUSION Frames deployed by the Canadian print media to discuss Caribbean offshore medical schools and Canadians studying abroad define two problems: (1) highly qualified Canadians are unable to access medical school in Canada; and (2) some Canadian international medical graduates are unable to return to Canada to practice medicine. Caribbean offshore medical schools are identified as a solution to the first problem while playing a central role in creating the second problem. These frames do not acknowledge that medical school admissions are a primary means to control the make-up of the Canadian physician workforce and they do not address the nature of Canadian physician shortages.
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Affiliation(s)
- Jeffrey Morgan
- Department of Geography, Simon Fraser University, Burnaby, Canada
| | | | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Duvivier RJ, Burch VC, Boulet JR. A comparison of physician emigration from Africa to the United States of America between 2005 and 2015. Hum Resour Health 2017; 15:41. [PMID: 28651539 PMCID: PMC5485566 DOI: 10.1186/s12960-017-0217-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/15/2017] [Indexed: 05/26/2023]
Abstract
BACKGROUND Migration of health professionals has been a cause for global concern, in particular migration from African countries with a high disease burden and already fragile health systems. An estimated one fifth of African-born physicians are working in high-income countries. Lack of good data makes it difficult to determine what constitutes "African" physicians, as most studies do not distinguish between their country of citizenship and country of training. Thus, the real extent of migration from African countries to the United States (US) remains unclear. This paper quantifies where African migrant physicians come from, where they were educated, and how these trends have changed over time. METHODS We combined data from the Educational Commission for Foreign Medical Graduates with the 2005 and 2015 American Medical Association Physician Masterfiles. Using a repeated cross-sectional study design, we reviewed the available data, including medical school attended, country of medical school, and citizenship when entering medical school. RESULTS The outflow of African-educated physicians to the US has increased over the past 10 years, from 10 684 in 2005 to 13 584 in 2015 (27.1% increase). This represents 5.9% of all international medical graduates in the US workforce in 2015. The number of African-educated physicians who graduated from medical schools in sub-Saharan countries was 2014 in 2005 and 8150 in 2015 (304.6% increase). We found four distinct categorizations of African-trained physicians migrating to the US: (1) citizens from an African country who attended medical school in their own country (86.2%, n = 11,697); (2) citizens from an African country who attended medical school in another African country (2.3%, n = 317); (3) US citizens who attended medical school in an African country (4.0%, n = 537); (4) citizens from a country outside Africa, and other than the United States, who attended medical school in an African country (7.5%, n = 1013). Overall, six schools in Africa provided half of all African-educated physicians. CONCLUSIONS The number of African-educated physicians in the US has increased over the past 10 years. We have distinguished four migration patterns, based on citizenship and country of medical school. The majority of African graduates come to the US from relatively few countries, and from a limited number of medical schools. A proportion are not citizens of the country where they attended medical school, highlighting the internationalization of medical education.
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Affiliation(s)
- Robbert J Duvivier
- Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, United States of America.
- Medical Education Unit, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Vanessa C Burch
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - John R Boulet
- Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, United States of America
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Majeed MH, Ali AA. Strengthening American psychiatry - Diversity, leadership and Asian applicants for residency. Asian J Psychiatr 2017; 27:145-146. [PMID: 28558889 DOI: 10.1016/j.ajp.2017.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
Affiliation(s)
| | - Ali Ahsan Ali
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (Elmhurst), Queens, NY, USA.
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Patterson F, Cousans F, Coyne I, Jones J, Macleod S, Zibarras L. A preliminary investigation to explore the cognitive resources of physicians experiencing difficulty in training. BMC Med Educ 2017; 17:87. [PMID: 28506289 PMCID: PMC5433187 DOI: 10.1186/s12909-017-0918-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/26/2017] [Indexed: 05/20/2023]
Abstract
BACKGROUND Treating patients is complex, and research shows that there are differences in cognitive resources between physicians who experience difficulties, and those who do not. It is possible that differences in some cognitive resources could explain the difficulties faced by some physicians. In this study, we explore differences in cognitive resources between different groups of physicians (that is, between native (UK) physicians and International Medical Graduates (IMG); those who continue with training versus those who were subsequently removed from the training programme); and also between physicians experiencing difficulties compared with the general population. METHODS A secondary evaluation was conducted on an anonymised dataset provided by the East Midlands Professional Support Unit (PSU). One hundred and twenty one postgraduate trainee physicians took part in an Educational Psychology assessment through PSU. Referrals to the PSU were mainly on the basis of problems with exam progression and difficulties in communication skills, organisation and confidence. Cognitive resources were assessed using the Wechsler Adult Intelligence Scale (WAIS-IV). Physicians were categorised into three PSU outcomes: 'Continued in training', 'Removed from training' and 'Active' (currently accessing the PSU). RESULTS Using a one-sample Z test, we compared the referred physician sample to a UK general population sample on the WAIS-IV and found the referred sample significantly higher in Verbal Comprehension (VCI; z = 8.78) and significantly lower in Working Memory (WMI; z = -4.59). In addition, the native sample were significantly higher in Verbal Comprehension than the UK general population sample (VCI; native physicians: z = 9.95, p < .001, d = 1.25), whilst there was a lesser effect for the difference between the IMG sample and the UK general population (z = 2.13, p = .03, d = 0.29). Findings also showed a significant difference in VCI scores between those physicians who were 'Removed from training' and those who 'Continued in training'. CONCLUSIONS Our results suggest it is important to understand the cognitive resources of physicians to provide a more focussed explanation of those who experience difficulties in training. This will help to implement more targeted interventions to help physicians develop compensatory strategies.
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Affiliation(s)
| | - Fran Cousans
- Work Psychology Group, Derby, UK
- Department of Neuroscience, Psychology and Behavoiur, University of Leicester, Leicester, UK
| | - Iain Coyne
- School of Business and Economics, Loughborough University, Loughborough, UK
| | - Jo Jones
- Health Education East Midlands, Nottingham, UK
| | | | - Lara Zibarras
- Work Psychology Group, Derby, UK
- City, University of London, London, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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. Teach Learn Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tiffin PA, Paton LW, Mwandigha LM, McLachlan JC, Illing J. Predicting fitness to practise events in international medical graduates who registered as UK doctors via the Professional and Linguistic Assessments Board (PLAB) system: a national cohort study. BMC Med 2017; 15:66. [PMID: 28316280 PMCID: PMC5357806 DOI: 10.1186/s12916-017-0829-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/27/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND International medical graduates working in the UK are more likely to be censured in relation to fitness to practise compared to home graduates. Performance on the General Medical Council's (GMC's) Professional and Linguistic Assessments Board (PLAB) tests and English fluency have previously been shown to predict later educational performance in this group of doctors. It is unknown whether the PLAB system is also a valid predictor of unprofessional behaviour and malpractice. The findings would have implications for regulatory policy. METHODS This was an observational study linking data relating to fitness to practise events (referral or censure), PLAB performance, demographic variables and English language competence, as evaluated via the International English Language Test System (IELTS). Data from 27,330 international medical graduates registered with the GMC were analysed, including 210 doctors who had been sanctioned in relation to at least one fitness to practise issue. The main outcome was risk of eventual censure (including a warning). RESULTS The significant univariable educational predictors of eventual censure (versus no censures or referrals) were lower PLAB part 1 (hazard ratio [HR], 0.99; 95% confidence interval, 0.98 to 1.00) and part 2 scores (HR, 0.94; 0.91 to 0.97) at first sitting, multiple attempts at both parts of the PLAB, lower IELTS reading (HR, 0.79; 0.65 to 0.94) and listening scores (HR, 0.76; 0.62 to 0.93) and higher IELTS speaking scores (HR, 1.28; 1.04 to 1.57). Multiple resits at either part of the PLAB and higher IELTS speaking score (HR, 1.49; 1.20 to 1.84) were also independent predictors of censure. We estimated that the proposed limit of four attempts at both parts of the PLAB would reduce the risk in this entire group by only approximately two censures per 5 years in this group of doctors. CONCLUSIONS Making the PLAB, or any replacement assessment, more stringent and raising the required standards of English reading and listening may result in fewer fitness to practice events in international medical graduates. However, the number of PLAB resits permitted would have to be further capped to meaningfully impact the risk of sanctions in this group of doctors.
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Affiliation(s)
- Paul A Tiffin
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Lewis W Paton
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Lazaro M Mwandigha
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - John C McLachlan
- School for Medicine, Pharmacy and Health, Durham University Queen's Campus, Thornaby, TS17 6BH, UK
| | - Jan Illing
- School of Medical Education, The Medical School, Newcastle University
- , Newcastle-upon-Tyne, NE1 7RU, UK
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Khalid U, Thomas E, Ilham MA. Correspondence to: International medical graduates among top US transplant surgeons. Int J Surg 2016; 37:85-86. [PMID: 27998734 DOI: 10.1016/j.ijsu.2016.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Usman Khalid
- Cardiff Transplant Unit, Department of Nephrology & Transplant Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK.
| | | | - Mohamed Adel Ilham
- Cardiff Transplant Unit, Department of Nephrology & Transplant Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
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Rosati CM, Ekser B, Kaafarani HMA, Gaudino M, Koniaris LG. International medical graduates among top US transplant surgeons. Int J Surg 2016; 35:19-20. [PMID: 27619016 DOI: 10.1016/j.ijsu.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Carlo Maria Rosati
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Burcin Ekser
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Leonidas G Koniaris
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Klingler C, Marckmann G. Difficulties experienced by migrant physicians working in German hospitals: a qualitative interview study. Hum Resour 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mpofu C, Gupta TS, Hays R. The Ethics of Medical Practitioner Migration From Low-Resourced Countries to the Developed World: A Call for Action by Health Systems and Individual Doctors. J Bioeth Inq 2016; 13:395-406. [PMID: 27312212 DOI: 10.1007/s11673-016-9726-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 12/22/2015] [Indexed: 06/06/2023]
Abstract
Medical migration appears to be an increasing global phenomenon, with complex contributing factors. Although it is acknowledged that such movements are inevitable, given the current globalized economy, the movement of health professionals from their country of training raises questions about equity of access and quality of care. Concerns arise if migration occurs from low- and middle-income countries (LMICs) to high-income countries (HICs). The actions of HICs receiving medical practitioners from LMICs are examined through the global justice theories of John Rawls and Immanuel Kant. These theories were initially proposed by Pogge (1988) and Tan (1997) and, in this work, are extended to the issue of medical migration. Global justice theories propose that instead of looking at health needs and workforce issues within their national boundaries, HICs should be guided by principles of justice relevant to the needs of health systems on a global scale. Issues of individual justice are also considered within the framework of rights and social responsibilities of individual medical practitioners. Local and international policy changes are suggested based on both global justice theories and the ideals of individual justice.
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Affiliation(s)
- Charles Mpofu
- Faculty of Health Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Tarun Sen Gupta
- School of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Richard Hays
- School of Medicine, University of Tasmania, Tasmania, Australia
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Tyrrell E, Keegan C, Humphries N, McAleese S, Thomas S, Normand C, Brugha R. Predictors of career progression and obstacles and opportunities for non-EU hospital doctors to undertake postgraduate training in Ireland. Hum Resour Health 2016; 14:23. [PMID: 27381321 PMCID: PMC4943483 DOI: 10.1186/s12960-016-0120-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The World Health Organization's Global Code on the International Recruitment of Health Personnel urges Member States to observe fair recruitment practices and ensure equality of treatment of migrant and domestically-trained health personnel. However, international medical graduates (IMGs) have experienced difficulties in accessing postgraduate training and in progressing their careers in several destination countries. Ireland is highly dependent on IMGs, but also employs non-European Union (EU) doctors who qualified as doctors in Ireland. However, little is known regarding the career progression of these doctors. In this context, the present study assesses the determinants of career progression of non-EU doctors with particular focus on whether barriers to progression exist for those graduating outside Ireland compared to those who have graduated within. METHODS The study utilises quantitative data from an online survey of non-EU doctors registered with the Medical Council of Ireland undertaken as part of the Doctor Migration Project (2011-2013). Non-EU doctors registered with the Medical Council of Ireland were asked to complete an online survey about their recruitment, training and career experiences in Ireland. Analysis was conducted on the responses of 231 non-EU hospital doctors whose first post in Ireland was not permanent. Career progression was analysed by means of binary logistic regression analysis. RESULTS While some of the IMGs had succeeded in accessing specialist training, many experienced slow or stagnant career progression when compared with Irish-trained non-EU doctors. Key predictors of career progression for non-EU doctors working in Ireland showed that doctors who qualified outside of Ireland were less likely than Irish-trained non-EU doctors to experience career progression. Length of stay as a qualified doctor in Ireland was strongly associated with career progression. Those working in anaesthesia were significantly more likely to experience career progression than those in other specialities. CONCLUSIONS The present study highlights differences in terms of achieving career progression and training for Irish-trained non-EU doctors, compared to those trained elsewhere. However, the findings herein warrant further attention from a workforce planning and policy development perspective regarding Ireland's obligations under the Global Code of hiring, promoting and remunerating migrant health personnel on the basis of equality of treatment with the domestically-trained health workforce.
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Affiliation(s)
- Ella Tyrrell
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland.
| | - Conor Keegan
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland
| | - Niamh Humphries
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons, Dublin, Ireland
| | - Sara McAleese
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons, Dublin, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland
| | - Ruairí Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons, Dublin, Ireland
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Abstract
International Medical Graduates (IMGs) form a coherent part of the National Health Service (NHS). Nearly 25% of the doctors working in the NHS are IMGs who obtained their primary medical degree from outside the EU. Moving to a different country that holds a different set of values and belief systems can be very challenging for IMGs, which in turn could have a significant effect on the service provided to NHS patients. This article will address the issue of effective communication skills within the IMG population and will explore the underlying issues behind this problem.
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Affiliation(s)
- Ashraf Hamarneh
- a The Hatter Cardiovascular Institute, University College London , 67 Chenies Mews, London, UK
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Neiterman E, Bourgeault IL. Professional integration as a process of professional resocialization: internationally educated health professionals in Canada. Soc Sci Med 2015; 131:74-81. [PMID: 25766266 DOI: 10.1016/j.socscimed.2015.02.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This paper examines the process of professional resocialization among internationally educated health care professionals (IEHPs) in Canada. Analyzing data from qualitative interviews with 179 internationally educated physicians, nurses, and midwives and 70 federal, provincial and regional stakeholders involved in integration of IEHPs, we examine (1) which aspects of professional work are modified in transition to a new health care system; (2) which aspects of professional practice are learned by IEHPs in the new health environment, and (3) how IEHPs maintain their professional identity in transition to a new health care system. In doing so, we compare the accounts of IEHPs with the policy stakeholders' positions and analyze the similarities and the differences across three health care professions (medicine, nursing, and midwifery). This enables us to explore the issue of professional resocialization from the analytical intersection of gender, professional dominance, and institutional/organizational lenses.
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Affiliation(s)
- Elena Neiterman
- Department of Sociology, McMaster University, KTH-633, 1280 Main St. W., Hamilton, Ontario L8S 4M4, Canada.
| | - Ivy Lynn Bourgeault
- Telfer School of Management, University of Ottawa, 1 Stewart St. Room 227, Ottawa, Ontario K1N 6N5, Canada(1); Health Human Resource Policy, University of Ottawa, 1 Stewart St. Room 227, Ottawa, Ontario K1N 6N5, Canada(2)(3); Ontario Health Human Resource Research Network & Population Health Improvement Research Network (PHIRN), University of Ottawa, 1 Stewart St. Room 227, Ottawa, Ontario K1N 6N5, Canada(4).
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